bluuebunny/crossref_metadata_2025 huggingface dataset:
Suture Lifting: A Review of the Literature and Our Experiences
Authors: McClean Megan E. , Boen Monica , Alhaddad Marwan , Hoss Elika , Kollipara Ramya , Butterwick Kimberly
Published: December 2019

BACKGROUND

In the past 5 years, several absorbable sutures for use in minimally invasive suture lifts have appeared on the market. These newer sutures were preceded by several iterations of nonabsorbable counterparts, all of which were eventually removed from the market because of complications.

OBJECTIVE

This review will provide a history of suture lift experience, review the published evidence on the safety and efficacy of currently available absorbable suture lift materials, and detail the clinical experience of the authors using these products.

MATERIALS AND METHODS

A review of relevant clinical terms was performed on PUBMED and MEDLINE databases. All articles were reviewed, and further studies examined from citations of selected articles. Articles that focused on suture lifting using extensive dissection were excluded.

RESULTS

Twelve studies detailed the results of absorbable suture lifting largely through patient satisfaction surveys or retrospective chart review of cases. No randomized controlled studies were available.

CONCLUSION

Data on suture lifting are limited, with largely descriptive and retrospective case reports available in the literature entailed Oxford Centre evidence-based medicine Levels 2a to 5. Based on the available data, suture lifting appears to be safe and well tolerated, with patient satisfaction similar to or above that reported for other noninvasive lifting and tightening procedures. However, due to the lack of randomized controlled trials, the authors give the suture lifting Strength of Recommendation Level C. Further controlled studies are necessary to determine efficacy, longevity, and safety of this technology.
Differential Analgesia From Vibratory Stimulation During Local Injection of Anesthetic: A Randomized Clinical Trial
Authors: Kazi Rashek , Govas Panayiota , Slaugenhaupt Rachel M. , Carroll Bryan T.
Published: December 2019

BACKGROUND

Inadequate pain reduction during anesthetic injection is a significant medical and surgical problem. Vibratory distraction reduces this pain; however, there are minimal data identifying those who respond best.

OBJECTIVE

To quantify analgesia from vibration before anesthetic injection.

MATERIALS AND METHODS

In this partially blinded, single-institution trial, adult participants were randomized to intervention (vibratory anesthetic device, VAD ON) or placebo (VAD OFF). Pain was assessed using the 11-point numeric rating scale (NRS). Relative reduction in NRS between VAD OFF and ON was used to identify minimum clinically important and substantially clinically important difference in pain.

RESULTS

One hundred one tested sites from 87 subjects were assessed. Sixty-three percent were men with a median age of 66 years. From univariate analysis, males, subjects aged <60, and head and neck (HN) treated subjects had a significant reduction in NRS (p < .05). Multivariate analysis identified NRS reductions in females <60 (p = .012), males ≥70 (p = .002), females and males treated on HN (p = .048 and p = .035, respectively), and males ≥70 treated on HN (p = .012). Substantially clinically important difference (≥57% NRS reduction) included subjects <60, females <70, HN treatment aged 60 to 69, males ≥70, and females treated on HN.

CONCLUSION

Vibratory anesthetic device reduces pain during anesthetic injection, primarily for HN treatments and older male subjects.
Evaluation of the antidepressive property of β-hydroxybutyrate in mice
Authors: Pan Shengying , Hu Peili , You Qingsheng , Chen Jinliang , Wu Jingjing , Zhang Yaru , Cai Zixuan , Ye Ting , Xu Xing , Chen Zhuo , Tong Lijuan , Huang Chao , He Haiyan
Published: December 2019

β-hydroxybutyrate, a ketone body metabolite, has been shown to suppress depression-like behavior in rodents. In this study, we examined its antidepressive property in acute and chronic administration modes in mice by using forced swim test and tail suspension test. Results showed that the decrease effect of β-hydroxybutyrate (300 mg/kg) on immobility time in the tail suspension test and forced swim test in stress-naive mice began to be significant at day 11. In a dose-dependent experiment, β-hydroxybutyrate treatment (11 days) showed significant antidepressant activities at the dose of 200 and 300 mg/kg. Unlike fluoxetine, β-hydroxybutyrate treatment (300 mg/kg) showed no antidepressant activities in the acute (1 hour before the test) and three times administration mode within 24 hours (1, 5, and 24 hours before the test). But in a co-administration mode, β-hydroxybutyrate (100 mg/kg) -fluoxetine (2.5 mg/kg) co-administration exhibited an obvious antidepressant activity in the tail suspension test and forced swim test. Further analysis showed that the antidepressant effects of β-hydroxybutyrate and fluoxetine were not associated with the change in mouse locomotor activity. Furthermore, both chronic β-hydroxybutyrate treatment and β-hydroxybutyrate-fluoxetine co-treatment suppressed chronic unpredictable stress-induced increase in immobility time in the tail suspension test and forced swim test as well as chronic unpredictable stress-induced decrease in mouse body weight. Taken together, these results indicate that β-hydroxybutyrate (1) needs a relatively long time to show comparable behavioral activity to that of fluoxetine in assays that are sensitive to the behavioral effects of established antidepressant compounds and (2) can augment the antidepressant action of a sub-therapeutic dose of fluoxetine.
Naturalistic operant responses in deer mice (Peromyscus maniculatus bairdii) and its response to outcome manipulation and serotonergic intervention
Authors: de Brouwer Geoffrey , Harvey Brian H. , Wolmarans De Wet
Published: December 2019

Investigating the motivational triggers underlying naturalistic compulsive-like behavior is generally regarded as challenging. To this extent, the current study aimed to establish a proof-of-concept for future investigation by probing unconditioned and naturalistic operant responses aimed at obtaining nesting material by normal (NNB) and large (LNB) nest building deer mice (Peromyscus maniculatus bairdii). LNB mice and NNB controls were individually placed in cages equipped with a lever-operated nesting material (cotton rope) dispenser and allowed to become accustomed to the response (lever press)-outcome (obtaining cotton rope) contingency over seven nights. Subsequently, the contingency was manipulated by withdrawing the nesting material (experiment 1) or punishing the lever-press response with a mild electrical foot shock (experiment 2). Mice were then treated for 28 days with escitalopram (50 mg/kg/d) and retested. Our results indicate that (1) LNB mice generally made more operant responses compared to NNB controls, (2) withdrawal of nesting material and institution of punishment bolstered responding in LNB but not NNB mice and (3) escitalopram treatment tended to reduce increased responding in LNB mice following experimental manipulation, while normalizing the total number of lever-press counts in the LNB cohort. Therefore, LNB seems to diverge from NNB, not only as a spontaneous phenotype, but also in terms of the motivation to obtain nesting material, despite demotivating feedback. That such differences were abrogated by chronic escitalopram intervention, indicates that the uniquely motivated operant interactions displayed by LNB mice, may be founded upon serotonergic mechanisms, a finding in line with the neurobiological theory of obsessive-compulsive disorder.
Relationship between BRSK1 rs12611091 variant and age at natural menopause based on physical activity
Authors: Su Chun-Lang , Tsai Yi-Ling , Nfor Oswald Ndi , Liu Wen-Hsiu , Ho Chien Chang , Lung Chia-Chi , Lin Yi-Tien , Wang Lee , Liaw Yung-Po
Published: December 2019

Objectives:

The rs12611091 variant in the BR serine/threonine kinase 1 gene is one of the variants previously associated with age at natural menopause. So far, this variant has not been replicated in Taiwanese women. The purpose of this study was to determine the association between rs12611091 and age at natural menopause based on physical activity.

Methods:

A total of 1,758 women were eligible for analysis whose information about menopause was collected from the Taiwan Biobank. Multiple linear regression analysis was used for analysis.

Results:

The mean age (standard deviation) at natural menopause was 50.82 (3.59) years. Of the eligible participants, 56.94% were rs12611091 CC carriers, 36.69% were TC carriers, and 6.37% were TT carriers. Compared to CC carriers, TC and TT carriers were associated with early menopause (β = −0.42, P = 0.02 and −0.87, P = 0.01, respectively). There was a significant interaction between rs12611091 and physical activity (P for interaction = 0.02). Compared to rs12611091 CC carriers, TC and TT carriers who were physically inactive were significantly associated with earlier menopause (β = −0.88, P < 0.01 and −1.25, P = 0.02, respectively).

Conclusion:

We demonstrated that rs12611091 variant was associated with age at natural menopause especially among inactive women in Taiwan. That is, women with TC and TT genotypes who were physically inactive were significantly associated with earlier natural menopause compared to those with CC genotype.
Open Laparoscopic-assisted Repair of Abdominal Wall Hernia and Bulge
Authors: Nakamura Hideharu , Makiguchi Takaya , Atomura Daisuke , Yamatsu Yukie , Katoh Ryuji , Ogawa Hiroomi , Shirabe Ken , Yokoo Satoshi
Published: December 2019

Rectus abdominalis musculocutaneous (RAM) flaps have numerous uses in the treatment of large defects. However, flap harvesting can result in abdominal wall incisional hernia and bulge, which are challenging problems. Most of these problems occur below the arcuate line abdominal wall. However, there will be differences that are unique to each patient in the area of hernia or bulge. The open approach repair appears to be used most often, but the precise area of hernia and bulge is often not distinguished. This report describes a case that was treated using a new repair method, which had the clear advantage of allowing the precise area of abdominal wall weakness to be recognized. A 53-year-old man underwent left vertical RAM flap for reconstruction after tongue carcinoma resection. Six months after the operation, lower abdominal wall hernia and bulge were observed. Open laparoscopic-assisted repair was performed. Pneumoperitoneum led to distension of the abdominal cavity and outward stretching of the abdominal wall, so that the area of hernia and bulge protruded to a great degree. In this phase, by making the operating room slightly dark, the area became more clearly recognizable. When direct plication of the hernia and bulging area was required, the contralateral component separation technique was performed. This study describes an inventive repair procedure for abdominal wall hernia or bulge after RAM flap, with the combined advantages of open and laparoscopic repair.
What Is in a Number? Evaluating a Risk Assessment Tool in Immediate Breast Reconstruction
Authors: Frey Jordan D. , Salibian Ara A. , Bekisz Jonathan M. , Choi Mihye , Karp Nolan S. , Thanik Vishal D.
Published: December 2019

Background:

Ischemic complications after immediate breast reconstruction have devastating consequences; however, individual risk assessment remains challenging. We seek to develop an intraoperative assessment tool to assist in estimating risk of ischemic complications in immediate breast reconstruction.

Methods:

Patients undergoing immediate breast reconstruction were prospectively identified and evaluated with an intraoperative mastectomy flap ischemia risk assessment tool consisting of 8 binary questions. Breast measurements and patient demographics were recorded. Reconstructions were then prospectively evaluated postoperatively for ischemic complications. Outcomes were analyzed with significance set at P values <0.05.

Results:

Thirty-one patients underwent 45 immediate breast reconstruction. The majority of reconstructions were tissue expander based (64.4%) following therapeutic (62.2%) skin-sparing (93.3%) mastectomies. Average follow-up was 11.16 months. Sixteen reconstructions (35.6%) experienced an ischemic complication. The average total mastectomy flap ischemic risk score was 4.29. The correlation value of higher scores with increasing ischemic complications was 0.65. Reconstructions with scores greater than 5 had significantly higher rates of ischemic complications (P = 0.0025). Reconstructions with a score of >6 and >7 also had significantly higher rates of ischemic complications (P < 0.0001, each). The sensitivity and specificity of intraoperative mastectomy flap compromise were 81.25% and 62.07%.

Conclusions:

Ischemic complications after immediate breast reconstruction were positively correlated with higher scores using a clinical intraoperative mastectomy flap ischemia risk assessment tool. Scores greater than 5 seem to be a threshold value at which ischemic complications are significantly greater. This simple, easy-to-implement intraoperative tool may assist plastic surgeons in assessing risk and optimizing outcomes in immediate breast reconstruction.
Cenani-Lenz syndactyly in siblings with a novel homozygous LRP4 mutation and recurrent hypoglycaemia
Authors: Steel Edward , Hurst Jane A , Cullup Thomas , Calder Alistair , Sivakumar Branavan , Shah Pratik , Wilson Louise C
Published: December 2019

Cenani-Lenz syndactyly (CLS) is a rare autosomal recessive syndrome characterized by disorganized oligosyndactyly of upper and lower limbs as well as radioulnar synostosis. Structural renal abnormalities are also common. We report two affected brothers, born to orthodox Jewish parents, in whom we found a novel homozygous missense variant c.4910G>A; p.(Cys1637Tyr) in LRP4 situated in an EGF-like domain between the fourth beta-propeller and transmembrane domains. Both brothers have had recurrent ketotic hypoglycaemia which has not been associated previously. We present 3D computed tomographic imaging illustrating the limb abnormalities in detail.
The growing role of epigenetics in childhood cancers
Authors: Panditharatna Eshini , Filbin Mariella G.
Published: December 2019

Purpose of review

Altered epigenetics is central to oncogenesis in many pediatric cancers. Aberrant epigenetic states are induced by mutations in histones or epigenetic regulatory genes, aberrant expression of genes regulating chromatin complexes, altered DNA methylation patterns, or dysregulated expression of noncoding RNAs. Developmental contexts of dysregulated epigenetic states are equally important for initiation and progression of many childhood cancers. As an improved understanding of disease-specific roles and molecular consequences of epigenetic alterations in oncogenesis is emerging, targeting these mechanisms of disease in childhood cancers is increasingly becoming important.

Recent findings

In addition to disease-causing epigenetic events, DNA methylation patterns and specific oncohistone mutations are being utilized for the diagnosis of pediatric central nervous system (CNS) and solid tumors. These discoveries have improved the classification of poorly differentiated tumors and laid the foundation for future improved clinical management. On the therapeutic side, the first therapies targeting epigenetic alterations have recently entered clinical trials. Current clinical trials include pharmacological inhibition of histone and DNA modifiers in aggressive types of pediatric cancer.

Targeting novel epigenetic vulnerabilities, either by themselves, or coupled with targeting altered transcriptional states, developmental cell states or immunomodulation will result in innovative approaches for treating deadly pediatric cancers.
Tibial tubercle avulsion fractures in children
Authors: Franz Pia , Luderowski Eva , Tuca María
Published: December 2019

Purpose of review

To summarize and discuss the fundamentals of pediatric tibial tubercle avulsion fractures (TTAFs) including preferred imaging modalities, systems for fracture classification, frequently associated injuries, treatment options, outcomes, and common complications.

Recent findings

Although TTAFs amount to fewer than 1% of all physeal injuries in children, the incidence is increasing, likely because of greater participation in high-level athletics.

TTAFs tend to occur in adolescents nearing skeletal maturity who engage in sports with repetitive jumping. The most popular classification system was proposed by Ogden, which defines five fracture types based on the fracture pattern and extent of fragment displacement. Treatment can be nonsurgical or surgical, and indications depend on fracture type. Most fractures are surgical candidates and can be repaired with open reduction and internal fixation (ORIF) or arthroscopy. Arthroscopic approaches can reveal associated soft tissue injuries, such as meniscal tears, and confirm articular reduction. The most common postoperative complication is irritation because of hardware. With proper treatment, both nonsurgical and surgical outcomes are excellent. TTAFs have high rates of union and patients typically return to sports.
Evaluation of Contamination Risk by the cobas e 602 Serology Module Before Viral Load Testing on the cobas 6800 System
Authors: Rodriguez Pedro L. , McCune Stephen , Sakai Leah , Engstrom-Melnyk Julia , Marins Ed
Published: December 2019

Background

Diagnosis of HCV, HBV, and HIV involves antibody screening followed by confirmation and/or treatment decision using nucleic acid tests. However, minimal data exist evaluating the risk of nucleic acid cross-contamination on serology devices upstream of molecular testing despite the potential clinical and laboratory workflow advantages of single specimen vial testing for both procedures.

Methods

We conducted a checkerboard study investigating the potential risk of HCV, HBV, and HIV nucleic acid cross-contamination on 480 negative specimens by a serology screening instrument that uses disposable tips for sample transfer, rather than a fixed needle, before molecular testing.

Results

Nucleic acid contamination was observed in 0 of 480 negative specimens when processed with alternating high-titer HCV, HBV, or HIV specimens on the serology platform.

Conclusions

This study suggests that specimens analyzed by a serology instrument using disposable tips for sample transfer may be suitable for direct primary specimen reflex testing by a sensitive nucleic acid confirmatory test.
Media-Based Research on Selfie-Related Deaths in Italy
Authors: Gioia Sara , Mirtella Dora , Franceschetto Lisa , Lancia Massimo , Suadoni Fabio , Cingolani Mariano
Published: December 2019

Background

The incidence of taking selfies and sharing them on social media as well as selfie-related dangerous behaviors is increasing, particularly among young people, also leading to selfie-related trauma and death. This study was performed to obtain epidemiological characteristics of selfie-related mortality in Italy.

Methods

Scientific literature and Italian media were reviewed.

Results

Twelve victims from 11 events, from 2014 to 2018, were analyzed (sex, age, accident types, the nationality, the Italian region where the incident took place, if the person involved was indigenous or a tourist, the dynamics and the causa mortis, if other people have been involved in the selfie, and if other people were deceased). The majority of selfie victims were male teenagers, the average age was 23.6 years, the most preferred site of taking selfies was the natural environment followed by the railway one, the most frequently reported event or accident type was falling from a height, and the most frequent causes of selfie-related deaths were multitrauma and drowning.

Conclusions

Selfie-related deaths in Italy appear to be an issue and appear to be increasing. Particularly, male teenagers and young adults are at high risk for selfie-related deaths. Measures should be taken to reduce their incidence.
Caring for Children With Medical Complexity With the Emergency Information Form
Authors: Larson Ingrid A. , Colvin Jeffrey D. , Hoffman Amber , Colliton William Scott , Shaw Ryan J.
Published: December 2019

Background and Objective

The American Academy of Pediatrics recommends an emergency information form (EIF) for children with medical complexity (CMC) to facilitate emergency care. We sought to increase the EIF completion rate at our children's hospital's CMC clinic and to evaluate the effect on caregiver and emergency department (ED) provider opinion of preparation, comfort, and communication.

Methods

We used a pre/post–quality improvement design. The main outcomes were (1) the proportion of completed EIFs and (2) caregiver and ED provider opinion of preparation, comfort, and communication, using a Likert scale survey (1, low; 5, high).

Results

Emergency information form completion increased from 3.1% (4/133) before the intervention to 47.0% (78/166) after (P < 0.001). Twenty-three providers completed presurveys, and 8 completed postsurveys. Seventy-two caregivers completed presurveys, and 38 completed postsurveys (25 with ED visit and 13 without). There were no changes in preparation, comfort, or communication for caregivers who had an ED visit after the intervention. For those without a postintervention ED visit, caregiver median scores rose for preparation (4 [interquartile range {IQR}, 3–5] vs 5 [IQR, 4–5], P = 0.02) and comfort (4 [IQR, 2.25–5] vs 5 [IQR, 4–5], P = 0.05). After the intervention, ED providers had increased median communication scores (3 [IQR, 2.75–4.25] vs 5 [IQR, 4–5], P = 0.02), whereas scores of preparation and comfort were unchanged.

Conclusion

A quality improvement project at a CMC clinic increased EIF completion, caregiver preparation and comfort, and ED provider communication in emergencies.
The Osteoarticular Infection in a Pediatric Emergency Setting
Authors: Boccuzzi Elena , Buonsenso Danilo , Ferro Valentina , Raucci Umberto , Reale Antonino , Piga Simone , Deriu Daniele , Krzysztofiak Andrzej
Published: December 2019

Objectives

The study aimed to evaluate the emergency department (ED) presentation of children with a diagnosis of osteomyelitis, septic arthritis, or both.

Methods

A retrospective single-center study was conducted on all children aged between 1 month and 18 years evaluated in the ED over a 7-year period and having a final diagnosis of osteoarticular infection. One hundred seventeen patients were enrolled.

Results

Only 39.3% of patients were admitted after the first evaluation, and only 45.3% had a proper diagnosis of admission. Pain was the only symptom reported by all. White cell count, C-reactive protein level, and erythrocytes sedimentation rate were normal in 49.5%, 21.4%, and 17.1% of children, respectively. X-ray findings were unremarkable in 48% of cases. Clinical and bone structural sequelae were described in 19.23% and 56.86% of all cases. No statistically significant differences were found among osteomyelitis, arthritis, and the combination of both regarding all considered variables, except for structural outcomes resulting more significant in the third group. Significant differences were evident in clinical manifestations, blood examinations, and findings of osteolysis between patients diagnosed within and after 1 week since the disease onset. Finally, questionable differences between white blood cells and C-reactive protein level were found among patients younger than 5 years and older ones, whereas a history of trauma was more often reported in the second group.

Conclusions

The difficulty in recognizing osteoarticular infection in a pediatric ED can be due to the possible lack of the classic signs and symptoms, and the absence of specific laboratory and radiologic findings.
Molecular Magnetic Resonance Imaging of Fibrin Deposition in the Liver as an Indicator of Tissue Injury and Inflammation
Authors: Atanasova Iliyana , Sojoodi Mozhdeh , Leitão Helena S. , Shuvaev Sergei , Geraldes Carlos F.G.C. , Masia Ricard , Guimaraes Alexander S. , Tanabe Kenneth K. , Fuchs Bryan C. , Caravan Peter
Published: December 2019

Rationale and Objectives

Liver inflammation is associated with nonalcoholic steatohepatitis and other pathologies, but noninvasive methods to assess liver inflammation are limited. Inflammation causes endothelial disruption and leakage of plasma proteins into the interstitial space and can result in extravascular coagulation with fibrin deposition. Here we assess the feasibility of using the established fibrin-specific magnetic resonance probe EP-2104R for the noninvasive imaging of fibrin as a marker of liver inflammation.

Methods

Weekly 100 mg/kg diethylnitrosamine (DEN) dosing was used to generate liver fibrosis in male rats; control animals received vehicle. Magnetic resonance imaging at 1.5 T with EP-2104R, a matched non–fibrin-binding control linear peptide, or the collagen-specific probe EP-3533 was performed at 1 day or 7 days after the last DEN administration. Imaging data were compared with quantitative histological measures of fibrosis and inflammation.

Results

After 4 or 5 DEN administrations, the liver becomes moderately fibrotic, and fibrosis is the same if the animal is killed 1 day (Ishak score, 3.62 ± 0.31) or 7 days (Ishak score, 3.82 ± 0.25) after the last DEN dose, but inflammation is significantly higher at 1 day compared with 7 days after the last DEN dose (histological activity index from 0–4, 3.54 ± 0.14 vs 1.61 ± 0.16, respectively; P < 0.0001). Peak EP-2104R signal enhancement was significantly higher in animals imaged at 1 day post-DEN compared with 7 days post-DEN or control rats (29.0% ± 3.2% vs 22.4% ± 2.0% vs 17.0% ± 0.2%, respectively; P = 0.017). Signal enhancement with EP-2104R was significantly higher than control linear peptide at 1 day post-DEN but not at 7 days post-DEN indicating specific fibrin binding during the inflammatory phase. Collagen molecular magnetic resonance with EP-3533 showed equivalent T1 change when imaging rats 1 day or 7 days post-DEN, consistent with equivalent fibrosis.

Conclusions

EP-2104R can specifically detect fibrin associated with inflammation in a rat model of liver inflammation and fibrosis.
Using patient self-checklist to improve the documentation of risk of postoperative nausea and vomiting: an implementation project
Authors: Zheng Zhen , Layton Jennifer , Stelmach Wanda , Crabbe Julie , Ma Jason , Briedis Juris , Atme Jeanette , Bourne Debra , Hau Raphael , Cleary Sonja , Xue Charlie C.
Published: December 2019

Background and aims:

Postoperative nausea and vomiting (PONV) is a common surgical complication, affecting 30–50% of patients and 80% in high risk populations. Successful prevention and management of PONV relies on accurately assessing individual risk prior to surgery. A valid and reliable Apfel score is commonly used to assess patients’ risk. It is however challenging to translate this evidence into clinical practice. This evidence-based project aimed to identify the current practice of assessing and documenting the risk factors of PONV prior to surgery, and to develop strategies to improve the practice.

Methods:

The project had three phrases, including forming a team and conducting the baseline audit; identifying problems and developing strategies; and conducting a follow-up tool to assess the impact on compliance with best practice. A research team was formed. A baseline audit was conducted at a public hospital in Victoria in June 2016 to examine PONV risk assessment practice through checking medical files of surgical patients. A getting research into practice audit and feedback tool was used to identify barriers, implementation strategies, stakeholders and resources. After implementation, a second audit was conducted between June and October 2017. Audit criteria were based on a reliable and valid Apfel score.

Results:

At baseline, accurate PONV risk could only be calculated from 8% of patient files with no file formally recording the risk factors. The proportion of patients with three risk factors preoperatively, indicating high PONV risk, was 5.3%. Barriers identified were the perceived lack of necessity to record the risk, time constraint and too much paperwork. A self-checklist for risk assessment was developed to enable patients to check their own level of risk. Its face validity, construct validity and accuracy were examined. The checklist was then implemented for patients to complete prior to surgery. A number of strategies were used to improve the implementation. The second audit of 1308 files showed that at the end of audit period, 74% of patients had risk assessment conducted and documented postimplementation. 16.8% of the patients were identified as having high PONV risk, nearly triple the number identified at baseline.

Conclusion:

A simple self-checklist of PONV risk was implemented. It greatly improved PONV risk assessment and documentation in a public hospital in Australia and enabled the identification of patients at high risk.
Single Cell Profiling of Acute Kidney Injury Reveals Novel Transcriptional Signatures, Mixed Identities and Epithelial-to-Stromal Crosstalk
Authors: Rudman-Melnick Valeria , Adam Mike , Potter Andrew , Chokshi Saagar M. , Ma Qing , Drake Keri A. , Schuh Meredith P. , Kofron J. Matthew , Devarajan Prasad , Potter S. Steven
Published: December 2019

Acute kidney injury (AKI) is a rapid decline of renal function, with an incidence of up to 67% of intensive care unit patients. Current treatments are merely supportive, emphasizing the need for deeper understanding that could lead to improved therapies. We used single cell RNA sequencing,in situhybridization and protein expression analyses to create comprehensive renal cell specific transcriptional profiles of multiple AKI stages. We revealed that AKI induces marked dedifferentiation, renal developmental gene activation and mixed identities in injured renal tubules. Moreover, we identified potential pathologic crosstalk between epithelial and stromal cells, and several novel genes involved in AKI. We also demonstrated the definitive effects of age on AKI outcome, and showed that renal developmental genes hold a potential as novel AKI markers. Moreover, our study provides the resource power which will aid in unraveling the molecular genetics of AKI.
Altered active control of step width in response to mediolateral leg perturbations while walking
Authors: Reimold Nicholas K. , Knapp Holly A. , Henderson Rachel E. , Wilson Landi , Chesnutt Alyssa N. , Dean Jesse C.
Published: December 2019

During human walking, step width is predicted by mediolateral motion of the pelvis, a relationship that can be attributed to a combination of passive body dynamics and active sensorimotor control. The purpose of the present study was to investigate whether humans modulate the active control of step width in response to a novel mechanical environment. Participants were repeatedly exposed to a force-field that either assisted or perturbed the normal relationship between pelvis motion and step width, separated by washout periods to detect the presence of potential after-effects. As intended, force-field assistance directly strengthened the relationship between pelvis displacement and step width. This relationship remained strengthened with repeated exposure to assistance, and returned to baseline afterward, providing minimal evidence for assistance-driven changes in active control. In contrast, force-field perturbations directly weakened the relationship between pelvis motion and step width. Repeated exposure to perturbations diminished this negative direct effect, and produced larger positive after-effects once the perturbations ceased. Both of these results provide evidence of gradual changes in active control in response to perturbations. In the longer term, these methods may be useful for improving deficits in the active control of step width often observed among clinical populations with poor walking balance.
Neonatal granulocytic MDSCs possess phagocytic properties during bacterial infection
Authors: Seman Brittany G. , Vance Jordan K. , Witt Michelle R. , Robinson Cory M.
Published: December 2019

Myeloid-derived suppressor cells (MDSCs) are an immunosuppressive cell type found in high abundance in early life. Currently, there has been limited mechanistic understanding of MDSC phagocytosis of bacteria and the corresponding consequences in the context of acute infection. We set out to determine whether human granulocytic MDSCs have phagocytic capacity that is comparable to other professional phagocytes. To investigate these properties, we utilized fluorescent confocal microscopy, flow cytometry, and bacterial burden assays. We demonstrate that human granulocytic MDSCs phagocytoseE. coliO1:K1:H7, and subsequently traffic the bacteria into acidic compartments similar to other phagocytes. However, MDSCs were significantly less efficient at bacterial uptake and killing compared to monocytes. This activity is associated with an inflammatory response, but the amount of TNFα gene and protein expression was reduced in infected MDSCs compared to monocytes. Interestingly, we also found that MDSCs release DNA (MeDNA) into the extracellular space that resembles neutrophil extracellular traps. We found that MeDNA had some impact on bacterial viability in single cultures, with an increase in bacterial recovery in MDSCs treated with DNAse. However, MeDNA did not impact the ability of monocytes to eliminate bacteria in co-cultures, suggesting that MDSC extracellular DNA does not compromise monocyte function. Overall, our data reveals mechanistic insight into MDSC activity during infection that includes the kinetics and efficiency of bacterial uptake, elimination through trafficking to acidified compartments, and inflammatory contributions relative to primary human monocytes. These results enhance our understanding of MDSC contributions during acute bacterial infection and identify host-directed targets for immune intervention to improve outcomes and reduce susceptibility to infection early in life.
Alternating regimes of motion in cell motility models
Authors: Guisoni Nara , Mazzitello Karina I. , Diambra Luis
Published: December 2019

Cellular movement is a complex dynamic process, resulting from the interaction of multiple elements at the intra and extra-cellular levels. This epiphenomenon presents a variety of behaviors, which can include normal and anomalous diffusion or collective migration. In some cases cells can get neighborhood information through chemical or mechanical cues. A unified understanding about how such information can influence the dynamics of cell movement is still lacking. In order to improve our comprehension of cell migration we consider a cellular Potts model where cells move actively in the direction of a driving field. The intensity of this driving field is constant, while its orientation can evolves according to two alternative dynamics based on the Ornstein-Uhlenbeck process. In the first case, the next orientation of the driving field depends on the previous direction of the field. In the second case, the direction update considers the mean orientation performed by the cell in previous steps. Thus, the latter update rule mimics the ability of cells to perceive the environment, avoiding obstacles and thus increasing the cellular displacement. Our results indicate that both dynamics introduce temporal and spatial correlations in cell velocity in a friction coefficient and cell density dependent manner. Furthermore, we observe alternating regimes in the mean square displacement, with normal and anomalous diffusion. The crossovers between superdiffusive and diffusive regimes, are strongly affected by both the driving field dynamics and cell-cell interactions. In this sense, when cell polarization update grants information about the previous cellular displacement decreases the duration of the diffusive regime, in particular for high density cultures.
Induction of Recurrent Break Cluster Genes in Neural Progenitor Cells Differentiated from Embryonic Stem Cells In Culture
Authors: Tena Aseda , Zhang Yuxiang , Kyritsis Nia , Devorak Anne , Zurita Jeffrey , Wei Pei-Chi , Alt Frederick W.
Published: December 2019

Mild replication stress enhances appearance of dozens of robust recurrent genomic break clusters, termed RDCs, in cultured primary mouse neural stem and progenitor cells (NSPCs). Robust RDCs occur within genes (“RDC-genes”) that are long and have roles in neural cell communications and/or have been implicated in neuropsychiatric diseases or cancer. We sought to develop anin vitroapproach to determine whether specific RDC formation is associated with neural development. For this purpose, we adapted a system to induce neural progenitor cell (NPC) development from mouse embryonic stem cell (ESC) lines deficient for XRCC4 plus p53, a genotype that enhances DNA double-strand break (DSB) persistence to enhance detection. We tested for RDCs by our genome wide DSB identification approach that captures DSBs genome-wide via their ability to join to specific genomic Cas9/sgRNA-generated bait DSBs. In XRCC4/p53-deficient ES cells, we detected 7 RDCs, which were in genes, with two RDCs being robust. In contrast, in NPCs derived from these ES cell lines, we detected 29 RDCs, a large fraction of which were robust and associated with long, transcribed neural genes that were also robust RDC-genes in primary NSPCs. These studies suggest that many RDCs present in NSPCs are developmentally influenced to occur in this cell type and indicate that induced development of NPCs from ES cells provides an approach to rapidly elucidate mechanistic aspects of NPC RDC formation.

SIGNIFICANCE STATEMENT

We previously discovered a set of long neural genes susceptible to frequent DNA breaks in primary mouse brain progenitor cells. We termed these genes RDC-genes. RDC-gene breakage during brain development might alter neural gene function and contribute to neurological diseases and brain cancer. To provide an approach to characterize the unknown mechanism of neural RDC-gene breakage, we asked whether RDC-genes appear in neural progenitors differentiated from embryonic stem cells in culture. Indeed, robust RDC-genes appeared in neural progenitors differentiated in culture and many overlapped with robust RDC-genes in primary brain progenitors. These studies indicate thatin vitrodevelopment of neural progenitors provides a model system for elucidating how RDC-genes are formed.
Prediction-based highly sensitive CRISPR off-target validation using target-specific DNA enrichment
Authors: Kang Seung-Hun , Lee Wi-jae , An Ju-Hyun , Lee Jong-Hee , Kim Young-Hyun , Kim Hanseop , Oh Yeounsun , Park Young-Ho , Jin Yeung Bae , Jun Bong-Hyun , Hur Junho K , Kim Sun-Uk , Lee Seung Hwan
Published: December 2019

CRISPR effectors, which comprise a CRISPR-Cas protein and a guide (g)RNA derived from the bacterial immune system, are widely used to induce double-strand breaks in target DNA and activate the in-vivo DNA repair system for target-specific genome editing. When the gRNA recognizes genomic loci with sequences that are similar to the target, deleterious and often carcinogenic mutations can occur. Off-target mutations with a frequency below 0.5% remain mostly undetected by current genome-wide off-target detection techniques. In this study, we developed a method to effectively detect extremely small amounts of mutated DNA based on predicted off-target-specific amplification. We used various genome editors, including CRISPR-Cpf1, Cas9, and an adenine base editor, to induce intracellular genome mutations. The CRISPR amplification method detected off-target mutations at a significantly higher rate (1.6∼984 fold increase) than did an existing targeted amplicon sequencing method. In the near future, CRISPR amplification in combination with genome-wide off-target detection methods will allow to detect genome editor-induced off-target mutations with high sensitivity and in a non-biased manner.
Collective turnover: organization design and processes or contagion effects?
Authors: Kraichy David , Schmidt Joseph
Published: December 2019

Purpose

Using organization-level data, the purpose of this paper is to investigate whether and how turnover spreads at different job levels (i.e. managers, non-managers) and how vacancy rate and manager span of control precipitate continued turnover.

Design/methodology/approach

Organization-level longitudinal data were collected quarterly from 40 Canadian organizations on various HR metrics from 2009 to 2012, totaling 232 observations. The authors used covariate balance propensity score (CBPS) weighting to make stronger causal inferences.

Findings

The organization-level data provided limited support for turnover spreading at different job levels. Instead, vacancy rate predicted subsequent non-manager turnover rates, whereas span of control predicted subsequent manager turnover rates.

Practical implications

The implications of this research are twofold. First, to offset continued turnover among non-managers, it may be wise for organizations to fill vacancies promptly, particularly when unfilled positions affect job demands and resources of those who remain. Second, to minimize ongoing manager turnover, organizations may benefit from redesigning work units to have smaller manager-to-employee ratios.

Originality/value

This study adds to the collective turnover literature by demonstrating that organizational factors play a substantive role in predicting continued manager and non-manager turnover. Moreover, by using longitudinal data and CBPS weighting, this research allowed for establishing temporal precedence and greater confidence that these factors play a causal role. Lastly, this research highlights how the factors precipitating collective turnover differ between managers and non-managers.
Three-dimensional fatigue crack growth simulation of embedded cracks using s-version FEM
Authors: Tomaru Shuji , Takahashi Akiyuki
Published: December 2019

Purpose

Since the most of structures and structural components suffers from cyclic loadings, the study on the fatigue failure due to the crack growth has a great importance. The purpose of this paper is to present a three-dimensional fatigue crack growth simulation of embedded cracks using s-version finite element method (SFEM). Using the numerical results, the validity of the fitness-for-service (FFS) code evaluation method is verified.

Design/methodology/approach

In this paper, three-dimensional fatigue crack propagation analysis of embedded cracks is performed using the SFEM. SFEM is a numerical analysis method in which the shape of the structure is represented by a global mesh, and cracks are modeled by local meshes independently. The independent global and local meshes are superimposed to obtain the displacement solution of the problem simultaneously.

Findings

The fatigue crack growth of arbitrary shape of cracks is slow compared to that of the simplified circular crack and the crack approximated based on the FFS code of the Japan Society of Mechanical Engineers (JSME). The results tell us that the FFS code of JSME can provide a conservative evaluation of the fatigue crack growth and the residual life time.

Originality/value

This paper presents a three-dimensional fatigue crack growth simulation of embedded cracks using SFEM. Using this method, it is possible to apply mixed mode loads to complex shaped cracks that are closer to realistic conditions.
Health implications of job-related stress, motivation and satisfaction in higher education faculty and administrators
Authors: Mohammed Denelle , Chan Edrea , Ahmad Rezwan , Dusic Aleksandar , Boglarsky Cheryl , Blessinger Patrick , Zeine Rana
Published: December 2019

Purpose

The purpose of this paper is to analyze job-related stress, motivation and satisfaction in higher education institutions, and assesses their implications on health in various industries including higher education. In total, 52 higher education faculty and administrators from institutions in more than 16 countries participated in the study that utilized the organizational surveys, Organizational Effectiveness Inventory® from human synergistics. Subgroup analysis was done to compare faculty and administrators; males to females, private, public, for-profit and not-for-profit institutions.

Design/methodology/approach

To assess health implications, 160 respondents employed in seven industries were surveyed using a custom medical/stress questionnaire to collect self-reported data on levels of job-related stress, motivation and satisfaction as well as the presence of several medical conditions, including myocardial infarction, stroke, angina pectoris/coronary heart disease, hypertension, gastro-esophageal reflux disease and diabetes mellitus. The results from each of the two surveys were statistically analyzed separately.

Findings

Results show undesirable levels of job-related stress, motivation and satisfaction in some segments of higher education employees; as well as associations between poorer health and high stress levels. The study established a potential justification consequently, the authors recommend organizational offerings of: stress relief programs; health fairs and health club memberships; stress management workshops; use of mobile apps for stress relief; job description reviews to eliminate work-related demands; changes to managerial styles that align with the culture of employees; re-evaluation of organizational structure; and enhanced communication amongst workplace management and employees.

Research limitations/implications

Limitations of this study include small sample sizes and the presence of confounding factors that were not considered. In addition, this study did not look into whether occupational position or occupational difficulty compromised the nature of work causing employees to experience lower levels of satisfaction, since the extent to which employees feel satisfied with their work may influence their physical well-being.

Originality/value

There are a number of factors that can affect employees with regards to medical illnesses in a job-related setting. There are three factors in particular that have been shown to negatively affect the health of employees: job-related stress; motivation; and satisfaction. These effects have not been studied in depth in faculty and administrators of higher education institutions, hence this study seeks to achieve that.