bluuebunny/crossref_metadata_2025 huggingface dataset:
On the origin of GW190425
Authors: Romero-Shaw Isobel M , Farrow Nicholas , Stevenson Simon , Thrane Eric , Zhu Xing-Jiang
Published: May 2020

The LIGO/Virgo collaborations recently announced the detection of a binary neutron star merger, GW190425. The mass of GW190425 is significantly larger than the masses of Galactic double neutron stars known through radio astronomy. We hypothesize that GW190425 formed differently from Galactic double neutron stars, via unstable ‘case BB’ mass transfer. According to this hypothesis, the progenitor of GW190425 was a binary consisting of a neutron star and a ∼4–$5\, {\mathrm{ M}_\odot }$ helium star, which underwent common-envelope evolution. Following the supernova of the helium star, an eccentric double neutron star was formed, which merged in ${\lesssim }10\, {\rm Myr}$. The helium star progenitor may explain the unusually large mass of GW190425, while the short time to merger may explain why similar systems are not observed in radio. To test this hypothesis, we measure the eccentricity of GW190425 using publicly available LIGO/Virgo data. We constrain the eccentricity at $10\, {\rm Hz}$ to be e ≤ 0.007 with $90{{\ \rm per\ cent}}$ confidence. This provides no evidence for or against the unstable mass transfer scenario, because the binary is likely to have circularized to e ≲ 10−4 by the time it was detected. Future detectors will help to reveal the formation channel of mergers similar to GW190425 using eccentricity measurements.
Exosomes and soluble secretome from hormone-treated endometrial epithelial cells direct embryo implantation
Authors: Gurung S , Greening D W , Catt S , Salamonsen L , Evans J
Published: May 2020

A successful pregnancy requires a synchronous dialogue between endometrium and embryo within the endometrial milieu. The aim of this study was to assess the role in the implantation of mediators in the endometrial milieu. Total secretome (TS), soluble secretome (SS) and small extracellular vesicles (containing exosomes) were generated from hormonally primed human endometrial epithelial cell culture medium. Human trophectoderm stem cell-derived spheroids were cultured with TS, SS or exosomes (30 µg/ml) on hormonally primed epithelial cells, with exosomes significantly increasing cell adhesion and outgrowth. Furthermore, F1 mouse 2-cell embryos were cultured in groups for 48 h followed by culture with each secretome fraction (30 µg/ml) for 48 h. Blastocyst cell number and hatching were quantified. In addition, blastocysts were further cultured on a fibronectin matrix for 72 h or transferred to recipient mice (with corresponding secretomes) with embryo implantation assessed after 6 days. Exosomes significantly increased total cell number in mouse embryos and complete hatching from zona pellucida, with both exosomes and SS significantly enhancing mouse embryo outgrowth. Importantly, exosomes increased the embryo implantation rate in comparison to other secretome fractions (normalized based on treatment amount) from the endometrial epithelia. These data indicate that endometrial epithelial exosomes support embryo growth, development and implantation while the SS has selective involvement specifically on mouse embryo outgrowth. This finding provides new insights into the molecular differences of endometrial secretome components in implantation and early embryo development and may implicate endometrial exosomes in the pathophysiology of implantation failure in infertility.
Dietary phytoestrogens and biomarkers of their intake in relation to cancer survival and recurrence: a comprehensive systematic review with meta-analysis
Authors: Micek Agnieszka , Godos Justyna , Brzostek Tomasz , Gniadek Agnieszka , Favari Claudia , Mena Pedro , Libra Massimo , Del Rio Daniele , Galvano Fabio , Grosso Giuseppe
Published: May 2020

Context

Recent studies have outlined the potential role of dietary factors in patients who have survived cancer.

Objective

The aim of this study was to summarize the evidence of the relation between dietary intake of phytoestrogens and their blood biomarkers and, overall, cancer-specific mortality and recurrence in patients with cancer.

Data Sources

A systematic search of PubMed, EMBASE, and Web of Science databases of studies published up to September 2019 was performed. Databases were searched for prospective and retrospective cohort studies reporting on dietary phytoestrogen intake and/or blood biomarkers and the outcomes investigated.

Data extraction

Data were extracted from each identified study using a standardized form.

Data analysis

Twenty-eight articles on breast, lung, prostate, and colorectal cancer, and glioma were included for systematic review. Given the availability of studies, a quantitative meta-analysis was performed solely for breast cancer outcomes. A significant inverse association among higher dietary isoflavone intake, higher serum/plasma enterolactone concentrations, and overall mortality and cancer recurrence was found. Among other cancer types, 2 studies reported that higher serum enterolactone and higher intake of lignans were associated with cancer-specific survival for colorectal cancer and glioma, respectively.

Conclusions

Dietary phytoestrogens may play a role in survival from breast cancer ; evidence regarding other cancers is too limited to draw any conclusions.
Wages and the Value of Nonemployment*
Authors: Jäger Simon , Schoefer Benjamin , Young Samuel , Zweimüller Josef
Published: May 2020

Nonemployment is often posited as a worker’s outside option in wage-setting models such as bargaining and wage posting. The value of nonemployment is therefore a key determinant of wages. We measure the wage effect of changes in the value of nonemployment among initially employed workers. Our quasi-experimental variation in the value of nonemployment arises from four large reforms of unemployment insurance (UI) benefit levels in Austria. We document that wages are insensitive to UI benefit changes: point estimates imply a wage response of less than $0.01 per $1.00 UI benefit increase, and we can reject sensitivities larger than $0.03. The insensitivity holds even among workers with low wages and high predicted unemployment duration, and among job switchers hired out of unemployment. The insensitivity of wages to the nonemployment value presents a puzzle to the widely used Nash bargaining model, which predicts a sensitivity of $0.24–$0.48. Our evidence supports wage-setting models that insulate wages from the value of nonemployment.
4Visual Culture
Authors: Lewis India
Published: May 2020

This chapter addresses books published in the field of visual culture in 2019 and is divided into three sections: 1. Race and Art; 2. Art and the Body; 3. Art in Eastern Europe The books under review cover a broad range of subjects within their specialities, but reflect general trends in contemporary writing and study in the field of visual culture. The first section looks at two publications that deal with the black experience in art: Darby English’s To Describe a Life: Notes from the Intersection of Art and Race Terror and The Place Is Here, edited by Nick Aikens and Elizabeth Robles. The second section examines books that see art through bodies: Bauhaus Bodies: Gender, Sexuality, and Body Culture in Modernism’s Legendary Art School, edited by Elizabeth Otto and Patrick Rössler; Sculpture, Sexuality and History: Encounters in Literature, Culture and the Arts from the Eighteenth Century to the Present, edited by Jana Funke and Jess Grove; and Queer Difficulty in Art and Poetry: Rethinking the Sexed Body in Verse and Visual Culture, edited by Jongwoo Jeremy Kim and Christopher Reed. The third and final section looks at publications about art and eastern Europe: Marta Filipová’s Modernity, History, and Politics in Czech Art and Klara Kemp-Welch’s Networking the Bloc: Experimental Art in Eastern Europe, 1965–1981.
In Memoriam
Authors: Maynard C. Douglas
Published: May 2020

CDR's longtime Editor-in-Chief Robert E. Campbell MD, died on February 2, 2020, at the age of 88. The following remarks are excerpts from a tribute to Dr. Campbell delivered at his memorial service.
Ketamine and Magnesium for Refractory Neuropathic Pain
Authors: Pickering Gisèle , Pereira Bruno , Morel Véronique , Corriger Alexandrine , Giron Fatiha , Marcaillou Fabienne , Bidar-Beauvallot Assiya , Chandeze Evelyne , Lambert Céline , Bernard Lise , Delage Noémie
Published: May 2020

Background

Ketamine is often used for the management of refractory chronic pain. There is, however, a paucity of trials exploring its analgesic effect several weeks after intravenous administration or in association with magnesium. The authors hypothesized that ketamine in neuropathic pain may provide pain relief and cognitive–emotional benefit versus placebo and that a combination with magnesium may have an additive effect for 5 weeks.

Methods

A randomized, double-blind, crossover, placebo-controlled study (NCT02467517) included 20 patients with neuropathic pain. Each ketamine-naïve patient received one infusion every 35 days in a random order: ketamine (0.5 mg/kg)/placebo or ketamine (0.5 mg/kg)/magnesium sulfate (3g) or placebo/placebo.

The primary endpoint was the area under the curve of daily pain intensity for a period of 35 days after infusion. Secondary endpoints included pain (at 7, 15, 21 and 28 days) and health-related, emotional, sleep, and quality of life questionnaires.

Results

Daily pain intensity was not significantly different between the three groups (n = 20) over 35 days (mean area under the curve = 185 ± 100, 196 ± 92, and 187 ± 90 pain score-days for ketamine, ketamine/magnesium, and placebo, respectively, P = 0.296). The effect size of the main endpoint was −0.2 (95% CI [−0.6 to 0.3]; P = 0.425) for ketamine versus placebo, 0.2 (95% CI [−0.3 to 0.6]; P = 0.445) for placebo versus ketamine/magnesium and -0.4 (95% CI [−0.8 to 0.1]; P = 0.119) for ketamine versus ketamine/magnesium. There were no significant differences in emotional, sleep, and quality of life measures. During placebo, ketamine, and ketamine/magnesium infusions, 10%, 20%, and 35% of patients respectively reported at least one adverse event.

Conclusions

The results of this trial in neuropathic pain refuted the hypothesis that ketamine provided pain relief at 5 weeks and cognitive–emotional benefit versus placebo and that a combination with magnesium had any additional analgesic effect.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Plaque Characteristics on CT Angiography Do Not Improve the Ability to Predict Hemodynamic Instability During and After Carotid Angioplasty and Stenting
Authors: Jensen Samuel K. , Eesa Muneer , Walker Andrew , Archer David P. , Davis Melinda J.
Published: May 2020

Background:

Hemodynamic instability is commonly seen during carotid angioplasty and stenting. Although prophylactic treatment with anticholinergics is beneficial, selected use in high-risk patients is desirable. This study examines whether plaque characteristics on computed tomography angiography in addition to demographic factors improve predictive capability.

Methods:

We retrospectively collected information from 298 carotid angioplasty procedures between January 2013 and December 2018. Nine individuals were excluded due to a previous ipsilateral endarterectomy. Our primary outcome was a decrease of 20% or more in heart rate or blood pressure at angioplasty. Data were analyzed using χ2 tests and regression statistics.

Results:

Of the 289 patients included for analysis, 57 had intraoperative instability and 26 had postoperative instability. Radiologist interpretation was found to have a risk ratio of 1.63 (95% confidence interval: 1.00-2.65) for intraoperative instability (P=0.080). Intraoperative instability was significantly associated with subsequent postoperative instability (P=0.005). Our regression model included previous endarterectomy and diabetes as predictive factors with a sensitivity of 11.3% and a specificity of 100.0%. Anticholinergic usage was associated with hypotension without coexisting bradycardia with a risk ratio of 2.36 (95% confidence interval: 1.06-5.26; P=0.047).

Conclusions:

Individuals without a previous contralateral endarterectomy and/or history of diabetes are at lower risk of hemodynamic instability. The addition of computed tomography angiographic variables does not improve this prediction. Future prospective, randomized work is required to improve our ability to identify and treat individuals at high risk of instability during carotid angioplasty and stenting.
Perioperative Use of Cefazolin and Indomethacin for Physical Examination–Indicated Cerclages to Improve Gestational Latency
Authors: Premkumar Ashish , Sinha Nikita , Miller Emily S. , Peaceman Alan M.
Published: May 2020

OBJECTIVE:

To evaluate gestational latency in individuals who did and did not receive perioperative cefazolin and indomethacin after physical examination–indicated cerclage.

METHODS:

This is a retrospective cohort study of all pregnant women with a singleton gestation who underwent physical examination–indicated cerclage placement and delivered at Northwestern Memorial Hospital from 2009 to 2018. Physical examination–indicated cerclage was performed in the setting of painless cervical dilation of at least 1 cm between 16 0/7 and 23 6/7 weeks of gestation. After 2014, our practice universally implemented perioperative prophylaxis of cefazolin and indomethacin. Individuals were categorized based on exposure to perioperative prophylaxis. The primary outcome was pregnancy latency at least 28 days after cerclage placement. Secondary outcomes included median latency; median gestational age at delivery; preterm birth before 28 weeks of gestation; preterm prelabor rupture of membranes; chorioamnionitis; and median birth weight. Multivariable analyses were performed, as well as a sensitivity analysis using propensity score matching.

RESULTS:

Cerclages were placed in 142 people: 72 (50.7%) received perioperative prophylaxis. Baseline demographics were not significantly different between groups. On multivariable analyses, individuals who received perioperative prophylaxis had a higher incidence of achieving a pregnancy latency at 28 days or more (adjusted relative risk [aRR] 1.21, 95% CI 1.05–1.40). Individuals who received perioperative prophylaxis had a significant improvement in gestational latency (+17.8 days, 95% CI 1.4–34.2 days) and birth weight (+489.8 g, 95% CI 64.6–915.0 g), with no differences in other outcomes. On sensitivity analysis, individuals receiving perioperative prophylaxis had a higher incidence of achieving a pregnancy latency at 28 days or more, (aRR 1.17, 95% CI 1.01–1.36) with no differences in other outcomes.

CONCLUSION:

Perioperative use of cefazolin and indomethacin prophylaxis during physical examination–indicated cerclage placement is associated with a significant prolongation in gestational latency without an increase in incidence of chorioamnionitis.
Effect of Digital Step Counter Feedback on Mobility After Cesarean Delivery
Authors: Ganer Herman Hadas , Kleiner Ilia , Tairy Daniel , Gonen Noa , Ben Zvi Masha , Kovo Michal , Bar Jacob , Weiner Eran
Published: May 2020

OBJECTIVE:

To assess the effect of a personalized repeated feedback approach using digital step counters (pedometers) on mobility after cesarean delivery in high-risk patients.

METHODS:

This was a randomized controlled trial at a tertiary university hospital. Patients who underwent cesarean delivery and were defined as high risk for thromboembolic events were asked to wear a pedometer around their wrists postpartum for 48 hours. Patients were randomized to the feedback group, which received personalized feedback by the research staff regarding their mobility at three set timepoints, or the control group, which received standard care. The number of steps taken by patients was compared between the groups and served as the primary outcome. Secondary outcomes included patient reported pain, physical and mental recovery, and overall satisfaction. Sample size was predetermined to detect a 25% between-group difference in the primary outcome.

RESULTS:

From December 2018 to July 2019, 215 patients were recruited, randomized and completed follow-up—108 in the feedback group and 107 in the control group. Patients' demographics and intrapartum course were similar between the groups. The number of steps taken was significantly higher in the feedback group compared with the control group: 5,918±3,116 vs 4,161±2,532 steps, P<.001. Pain scores were similar between the groups, as was analgesic consumption. Patients in the feedback group reported a significantly easier physical and mental postpartum recovery and were significantly more satisfied with their delivery experience. Postpartum complications did not differ between the groups.

CONCLUSION:

In high-risk patients after cesarean delivery, mobility was improved by using a personalized feedback approach. Enhanced mobility was not associated with a higher rate of complications or pain and was positively associated with patient satisfaction.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03724760.
Functional and Structural Integrity of Frontoparietal Connectivity in Traumatic and Anoxic Coma
Authors: Peran Patrice , Malagurski Briguitta , Nemmi Federico , Sarton Benjamine , Vinour Hélène , Ferre Fabrice , Bounes Fanny , Rousset David , Mrozeck Segolène , Seguin Thierry , Riu Béatrice , Minville Vincent , Geeraerts Thomas , Lotterie Jean Albert , Deboissezon Xavier , Albucher Jean François , Fourcade Olivier , Olivot Jean Marc , Naccache Lionel , Silva Stein
Published: May 2020

Objectives:

Recovery from coma might critically depend on the structural and functional integrity of frontoparietal networks. We aimed to measure this integrity in traumatic brain injury and anoxo-ischemic (cardiac arrest) coma patients by using an original multimodal MRI protocol.

Design:

Prospective cohort study.

Setting:

Three Intensive Critical Care Units affiliated to the University in Toulouse (France).

Patients:

We longitudinally recruited 43 coma patients (Glasgow Coma Scale at the admission < 8; 29 cardiac arrest and 14 traumatic brain injury) and 34 age-matched healthy volunteers. Exclusion criteria were disorders of consciousness lasting more than 30 days and focal brain damage within the explored brain regions. Patient assessments were conducted at least 2 days (5 ± 2 d) after complete withdrawal of sedation. All patients were followed up (Coma Recovery Scale-Revised) 3 months after acute brain injury.

Interventions:

None.

Measurements and Main Results:

Functional and structural MRI data were recorded, and the analysis was targeted on the posteromedial cortex, the medial prefrontal cortex, and the cingulum. Univariate analyses and machine learning techniques were used to assess diagnostic and predictive values. Coma patients displayed significantly lower medial prefrontal cortex–posteromedial cortex functional connectivity (area under the curve, 0.94; 95% CI, 0.93–0.95). Cardiac arrest patients showed specific structural disturbances within posteromedial cortex. Significant cingulum architectural disturbances were observed in traumatic brain injury patients. The machine learning medial prefrontal cortex–posteromedial cortex multimodal classifier had a significant predictive value (area under the curve, 0.96; 95% CI, 0.95–0.97), best combination of subregions that discriminates a binary outcome based on Coma Recovery Scale-Revised).

Conclusions:

This exploratory study suggests that frontoparietal functional disconnections are specifically observed in coma and their structural counterpart provides information about brain injury mechanisms. Multimodal MRI biomarkers of frontoparietal disconnection predict 3-month outcome in our sample. These findings suggest that fronto-parietal disconnection might be particularly relevant for coma outcome prediction and could inspire innovative precision medicine approaches.
Patient and physician perspectives on training to improve communication through secure messaging
Authors: Hefner Jennifer L. , Sieck Cynthia J. , Walker Daniel M.
Published: May 2020

Purpose

The aim of the study was to incorporate the perspectives of both patients and providers into the development of training to improve the exchange of secure messages through a patient portal as well as to identify management strategies that support patient engagement.

Methodology

Three patient focus groups (17 patients) and interviews with 21 ambulatory physicians across 17 outpatient clinics at a large Midwestern academic medical center using Epic MyChart were performed. Rigorous thematic analysis was guided by the Systems Engineering Initiative for Patient Safety 2.0 framework adapted to patient portal implementation.

Results

Patients and physicians identified strategies at the patient, portal, physician, and health system levels that could help each group navigate the portal to communicate via secure messages more efficiently. Patient-focused training strategies included multimodal materials addressing how to navigate portal features and direction on when, what, and how to message. Changes to the format of the messaging feature and pop-ups with communication tips were also frequently mentioned. Physician and clinic-level strategies focused on how the clinic and health system management could enhance physician training on the patient-facing portal features and on how to manage patient care within the portal. Physicians also requested that the health system administration standardize physician and care team work processes related to secure messages within the portal and communicate clear management expectations of physician portal management.

Conclusion

As communication via secure messaging has become more common, our study identified patient, physician, portal and health system-level management and training strategies to enhance patient portal use.

Practice Implications

Health system administrators and outpatient clinic management could implement these strategies to clarify the rules of engagement in the collaborative work of incorporating a patient portal into the primary care workflow and facilitating provider and patient use.
Use of Commercially Available Optically Stimulated Luminescence Dosimeter As Extremity Dose Estimator
Authors: Georgeson David L. , Christiansen Byron H.
Published: May 2020

In 2009, Idaho National Laboratory (INL) transitioned to an external dosimetry program using optically stimulated luminescent (OSL) technology. This process led to the introduction of the Landauer, Inc., nanoDot dosimeter and MicroStar reader to INL’s radiological control program. At the time, a small, self-contained, single chip OSL dosimeter that could be easily read in the field was recognized as having many potential applications for a radiological control program. The ability to achieve a realistic extremity-dose estimate in the field shortly following work where significant exposure is expected is a much sought-after capability at INL. It was proposed to employ the Landauer nanoDot dosimeter as a supplemental extremity monitor as an alternative to time-motion dose analyses based on direct radiation measurements, which had proven to be inaccurate and operationally inefficient. Additionally, this process does not involve the nanoDot in the US Department of Energy Laboratory Accreditation Program (DOELAP) process, which significantly reduces operational complexity. A dose conversion value for the nanoDot dosimeter was derived from direct comparisons with a DOELAP-accredited extremity dosimeter. The geometry or placement of the nanoDot relative to the accredited extremity dosimeter was kept as proximate as possible to best replicate the expected results from the accredited extremity dosimeter. Upon implementation, the nanoDot has proven to be effective in providing reasonable and timely extremity-dose estimates for operational control.
Descemet Membrane Detachment After Penetrating Keratoplasty for Keratoconus
Authors: Kit Vivienne , Kriman Jaime , Vasquez-Perez Alfonso , Muthusamy Kirithika , Thaung Caroline , Tuft Stephen
Published: May 2020

Purpose:

To describe the risk factors, management, and outcome of delayed Descemet membrane (DM) detachment after penetrating keratoplasty (PK) for keratoconus.

Methods:

We report 7 eyes from 6 cases and combine these data with 7 previous case reports identified by a search of PubMed.

Results:

DM detachment occurred at a median of 25 years (range, 7–33 years) after PK. One individual had bilateral detachments. There was typically a mild ocular discomfort accompanied in some cases by a rapid onset of visual blur. Cases were often treated for allograft rejection before a DM detachment was suspected and confirmed by optical coherence tomography. Detachments were limited to the donor tissue in 11 eyes, but a DM break was identified at the time of onset in only 4 eyes. Thinning of the host corneal rim with ectasia was reported in 8 eyes (57%). In 3 eyes, the detachment resolved spontaneously, but in 2 eyes, a detachment was still present at 12 months. Gas tamponade to reattach the DM was performed in 9 eyes and was effective in 4 eyes. Five eyes underwent a repeat PK or endothelial keratoplasty. Histology showed fibroblastic proliferation on the stromal surface of the folded DM.

Conclusions:

The cause for DM detachment many years after PK is unknown, although progressive thinning of the host cornea and secondary graft ectasia may be implicated. Gas tamponade can be effective, but a repeat keratoplasty might be necessary. DM detachment should be included in the differential diagnosis for late-onset corneal edema after PK.
YAG Laser Treatment for Epithelial Ingrowth in Descemet Membrane Endothelial Keratoplasty Interface
Authors: Jenkins Sabrina G. , Jun Albert S. , Woreta Fasika A. , Srikumaran Divya
Published: May 2020

Purpose:

To present a case of epithelial ingrowth in the graft-host interface after Descemet membrane endothelial keratoplasty (DMEK) surgery that was successfully treated with a yttrium aluminum garnet (YAG) laser.

Methods:

A 53-year-old white woman underwent uncomplicated combined cataract and DMEK surgery in her right eye. At her regularly scheduled 6-month follow-up visit, an asymptomatic dense white interface opacity was observed. Confocal imaging confirmed the presence of epithelial cells. After initial close observation, the opacity was noted to be slowly growing and the patient underwent YAG laser treatment for the opacity.

Results:

The patient remained stable 4 months postlaser treatment with no recurrence of epithelial ingrowth.

Conclusions:

YAG laser treatment may be a safe and effective way to treat early-stage epithelial ingrowth in the interface after DMEK surgery.
Time to Positivity of Neonatal Blood Cultures for Early-onset Sepsis
Authors: Kuzniewicz Michael W. , Mukhopadhyay Sagori , Li Sherian , Walsh Eileen M. , Puopolo Karen M.
Published: May 2020

Background:

In newborns at risk for early-onset sepsis, empiric antibiotics are often initiated while awaiting the results of blood cultures. The duration of empiric therapy can be guided by the time to positivity (TTP) of blood cultures. The objective of the study was to determine the TTP of neonatal blood cultures for early-onset sepsis and the factors which may impact TTP.

Methods:

Observational study of blood cultures growing pathogenic species obtained within 72 hours of birth from infants born at 23–42 weeks gestation, at 19 hospitals in Northern California, Boston, and Philadelphia. TTP was defined as the time from blood culture collection to the time organism growth was reported by the microbiology laboratory.

Results:

A total of 594 blood cultures growing pathogenic bacteria were identified. Group B Streptococcus and Escherichia coli accounted for 74% of blood culture isolates. Median TTP was 21.0 hours (interquartile range, 17.1–25.3 hours). Blood cultures were identified as positive by 24 hours after they were obtained in 68% of cases; by 36 hours in 94% of cases; and by 48 hours in 97% of cases. Neither the administration of maternal intrapartum antibiotic prophylaxis, gestational age <35 weeks, nor blood culture system impacted median TTP.

Conclusions:

Pathogens are isolated by 36 hours after blood culture collection in 94% of neonatal early blood cultures, regardless of maternal antibiotic administration. TTP information can inform decisions regarding the duration of empiric neonatal antibiotic therapies.
Nonspecific Symptoms in Children Referred to a Lyme Borreliosis Center
Authors: Zomer Tizza P. , Bruinsma Reitze A. , Vermeeren Yolande M. , Landman Gijs W. , van Hees Babette C. , van Bemmel Thomas , van Kooten Barend
Published: May 2020

Background:

Nonspecific symptoms in children suspected of Lyme borreliosis (LB) are challenging for clinicians. We assessed whether nonspecific symptoms are more prevalent among children with positive immunoglobulin G (IgG) serology or a history of clinical LB.

Methods:

We included children (<18 years) suspected of LB who visited the Lyme Center Apeldoorn of Gelre Hospital between 2008 and 2017. Serum samples were taken, and questionnaires on nonspecific symptoms completed. Clinical data were collected from patients’ medical records. The prevalence of nonspecific symptoms was compared between patients with positive versus negative IgG serology and between patients with versus without previous LB with the χ2 and Fisher exact tests with Bonferroni correction. A history of LB was anamnestically determined. Patients with active Lyme manifestations were excluded.

Results:

Included were 149 children (66% female; median age 13 years); 29 (19%) had positive IgG serology; 36 (24%) had previous LB; 12 (8%) had both. Common nonspecific symptoms were sleep disturbances (58%), severe fatigue (57%) and headache (42%). The prevalence of nonspecific symptoms was similar in children with positive versus negative IgG serology. None of the nonspecific symptoms occurred more frequently in children with previous LB compared with children without. More prevalent in children without previous LB were sleep disturbances (40 vs. 66%; P = 0.002) and tingling (6 vs. 34%; P < 0.001).

Conclusions:

Nonspecific symptoms were not more prevalent in children with positive IgG serology nor in children with previous LB, where some were significantly less prevalent. Hence, questionnaires on nonspecific symptoms cannot be used to identify children for serologic testing in Lyme centers.
Cost-analysis of Withdrawing Immunoprophylaxis for Respiratory Syncytial Virus in Infants Born at 33–35 Weeks Gestational Age in Quebec
Authors: Papenburg Jesse , Saleem Mahwesh , Teselink Johannes , Li Abby , Caouette Georges , Massé Édith , Lanctôt Krista L.
Published: May 2020

Background:

In 2015, the Quebec Ministry of Health limited palivizumab prophylaxis for respiratory syncytial virus (RSV) in premature infants to those born at <33 weeks gestational age (wGA), unless other indications were present. We compared RSV-related costs for 2 seasons before the change (2013–2014, 2014–2015) and 2 seasons after (2015–2016, 2016–2017) in premature infants 33–35 wGA.

Methods:

Using payer and societal perspectives, costs associated with hospitalizations for RSV and lower respiratory tract infection (LRTI) in infants born at 33–35 wGA were estimated. Inputs were from a 2013–2017 retrospective cohort study in 25 Quebec hospitals of RSV/LRTI hospitalizations among infants <6 months old at the start of, or born during, the RSV season. Resource utilization data (hospital stay, procedures, visits, transportation, out-of-pocket expenses and work productivity) were collected from charts and parent interviews allowing estimation of direct and indirect costs. Costs, including palivizumab administration, were derived from provincial sources and adjusted to 2018 Canadian dollars. Costs were modeled for preterm infants hospitalized for RSV/LRTI pre- and postrevision of guidelines and with matched term infants hospitalized for RSV/LRTI during 2015–2017 (comparator).

Results:

Average total direct and indirect costs for 33–35 wGA infants were higher postrevision of guidelines ($29,208/patient, 2015–2017; n = 130) compared with prerevision ($16,976/patient, 2013–2015; n = 105). Total costs were higher in preterm infants compared with term infants (n = 234) postrevision of guidelines ($29,208/patient vs. $10,291/patient).

Conclusions:

Immunoprophylaxis for RSV in infants born at 33–35 wGA held a cost advantage for hospitalizations due to RSV/LRTI.
Change of Eyelid Parameters in Patients With Marin-Amat Syndrome
Authors: Chao Yu-Jang , Tsai Chieh-Chih , Huang Yu-Yun , Lin Che-Yu , Yu Wei-Kuang , Kau Hui-Chuan , Liu Catherine Jui-Ling
Published: May 2020

Purpose:

Marin-Amat syndrome is an acquired facial synkinesis manifesting as involuntary eyelid closure on jaw movement. The authors investigate the clinical features, especially the quantitative changes in eyelid parameters of patients with Marin-Amat syndrome.

Methods:

Patients with Marin-Amat syndrome between 2015 and 2017 in a medical center were collected. Clinical features and the change of eyelid parameters, including margin reflex distance 1 (MRD-1), margin reflex distance 2 (MRD-2), and palpebral fissure height, were evaluated.

Results:

There were 5 men and 3 women with a mean age of 76 years. All had a history of facial palsy. The mean time to onset of Marin-Amat syndrome was 4.4 years after facial palsy. Seven patients (87.5%) developed subsequent ipsilateral facial spasm after facial palsy. Most patient complaints were ptosis (62.5%) and ptosis on eating (37.5%). The mean palpebral fissure height of involved eyes decreased from 5.88 to 2 mm on jaw opening (p = 0.011), which resulted from decrease in MRD-1 (from 2.06 to 0.06 mm, p = 0.012) and MRD-2 (from 3.81 to 1.94 mm; p = 0.012). Botulinum toxin A (Botox) injection into the periorbital orbicularis muscle in 6 patients significantly relieved the change of palpebral fissure height on jaw opening compared with that before injection (9.9% vs. 68.6 %, p = 0.027).

Conclusions:

Most patients with Marin-Amat syndrome present with ptosis and might be overlooked or underestimated. The reduction in palpebral fissure height in our patients with Marin-Amat syndrome was due to involuntary orbicularis oculi muscle contraction, resulting in decrease of both the MRD-1 and MRD-2 on jaw opening.
Imbalance of proresolving lipid mediators in persistent allodynia dissociated from signs of clinical arthritis
Authors: Allen Benjamin L. , Montague-Cardoso Karli , Simeoli Raffaele , Colas Romain A. , Oggero Silvia , Vilar Bruno , McNaughton Peter A. , Dalli Jesmond , Perretti Mauro , Sher Emanuele , Malcangio Marzia
Published: May 2020

Rheumatoid arthritis-associated pain is poorly managed, often persisting when joint inflammation is pharmacologically controlled. Comparably, in the mouse K/BxN serum-transfer model of inflammatory arthritis, hind paw nociceptive hypersensitivity occurs with ankle joint swelling (5 days after immunisation) persisting after swelling has resolved (25 days after immunisation). In this study, lipid mediator (LM) profiling of lumbar dorsal root ganglia (DRG), the site of sensory neuron cell bodies innervating the ankle joints, 5 days and 25 days after serum transfer demonstrated a shift in specialised proresolving LM profiles. Persistent nociception without joint swelling was associated with low concentrations of the specialised proresolving LM Maresin 1 (MaR1) and high macrophage numbers in DRG. MaR1 application to cultured DRG neurons inhibited both capsaicin-induced increase of intracellular calcium ions and release of calcitonin gene-related peptide in a dose-dependent manner. Furthermore, in peritoneal macrophages challenged with lipopolysaccharide, MaR1 reduced proinflammatory cytokine expression. Systemic MaR1 administration caused sustained reversal of nociceptive hypersensitivity and reduced inflammatory macrophage numbers in DRG. Unlike gabapentin, which was used as positive control, systemic MaR1 did not display acute antihyperalgesic action. Therefore, these data suggest that MaR1 effects observed after K/BxN serum transfer relate to modulation of macrophage recruitment, more likely than to direct actions on sensory neurons. Our study highlights that, in DRG, aberrant proresolution mechanisms play a key role in arthritis joint pain dissociated from joint swelling, opening novel approaches for rheumatoid arthritis pain treatment.
Illness Perception After Heart Valve Surgery
Authors: Hansen Malene Haugaard , Primdahl Jette , Riber Lars , Ekholm Ola , Kristensen Katrine Lawaetz , Thrysoee Lars , Thorup Charlotte Brun , Mols Rikke , Christensen Anne Vinggaard , Rasmussen Trine Bernholdt , Berg Selina Kikkenborg , Borregaard Britt
Published: May 2020

Background

Illness perception is composed of thoughts, ideas, and beliefs about illness, and a negative illness perception is known to be associated with poor outcomes. Among men and women, clinical outcomes after heart valve surgery are known to differ, but knowledge about differences in illness perception is sparse.

Objectives

The aim of this study is to describe the differences in illness perception among men and women after open heart valve surgery and to identify sociodemographic and clinical characteristics associated with worse illness perception in men and women.

Methods

In a national cross-sectional study combined with register-based clinical and sociodemographic information, data on illness perception were collected with the Brief Illness Perception Questionnaire.

Worse illness perception was defined as the worst quartile of each item of the Brief Illness Perception Questionnaire. Multiple logistic regression analyses were conducted to explore characteristics associated with worse illness perception.

Results

Of 1084 eligible patients, 32% (n = 349) completed the questionnaire (67% men; mean age, 68 years). Compared with men, women reported significantly worse scores of illness perception in 6 of 8 items. Furthermore, being female, age, length of stay, and comorbidity were associated with worse illness perception (worse quartile of scores). Age, higher educational level, and comorbidity were found to be associated with worse illness perception for men and length of stay for women.

Conclusion

After open heart valve surgery, illness perception differs among men and women, with women having worse illness perception. Among the total population, being female, age, a longer length of stay, and comorbidity were also associated with worse illness perception.
Effects of Auricular Acupressure in Patients on Hemodialysis
Authors: JUNG Eun Sook , CHANG Ae Kyung
Published: May 2020

Background

Although studies on the effectiveness of self-management in limiting fluid intake in patients on hemodialysis have been conducted extensively, xerostomia, which is a powerful stimulus of fluid intake, has received scarce attention.

Purpose

The purpose of this study was to examine the effects of a 4-week auricular acupressure treatment on xerostomia, salivary flow rate, interdialytic weight gain, constipation, and diet-related quality of life in patients on hemodialysis in Korea.

Methods

This was a randomized controlled trial. Sixty patients on hemodialysis were randomly assigned to either the experimental group (n = 30) or the control group (n = 30). The experimental group received an auricular acupressure intervention, which included the application of skin tape with a Semen vaccariae seed on the five auricular acupoints, including the large intestine (CO7), San Jiao (CO17), middle triangular fossa (TF3), spleen (CO13), and upper tragus (TG1), for 4 weeks. The control group received only the application of skin tape without a seed on the same auricular acupoints for the same period. The outcome variables were as follows: xerostomia, measured using the visual analog scale; salivary flow rate, measured using the unstimulated whole saliva absorbed in oral cotton; interdialytic weight gain; the constipation assessment scale score; and the Quality of Life Related to Dietary Change Questionnaire results.

Results

The experimental group scored significantly better than the control group in terms of xerostomia (p = .004), salivary flow rate (p = .010), constipation (p = .009), and diet-related quality of life (p < .001).

Conclusions/Implications for Practice

Auricular acupressure may be an important tool for alleviating the negative symptoms of xerostomia and for improving quality of life in patients on hemodialysis. Nurses caring for patients on hemodialysis with both xerostomia and constipation may teach auricular acupressure to help patients self-manage their discomfort.
Variations in follow-up after atrial fibrillation ablation
Authors: Wood Kathryn A. , Barnes Angel H.
Published: May 2020

Background:

A multidisciplinary patient-centered approach using evidence-based care is recommended in recent atrial fibrillation (AF) guidelines to achieve quality patient outcomes. Professional society guidelines are conflicting and vague in recommendations on timing of follow-up after AF ablation.

Purpose:

The aim of this secondary analysis was to examine whether the type and timing of follow-up care after AF ablation affected patient outcomes.

Methods:

A 2-year, longitudinal, pilot study to explore patient experiences during the first 6 months following an AF ablation was conducted. Patients completed surveys and phone interviews before ablation, and at 1, 3, and 6 months after the ablation. Pearson correlations and repeated-measures analysis of variance were used for comparison of outcomes over time.

Results:

The sample (N = 20) had a mean age of 65 (± 7) years, was 55% female, 35% paroxysmal AF, and 65% persistent AF pre-ablation. Timing of follow-up visits following AF ablation varied widely. Patients reported many concerns and difficulties reflecting the lack of knowledge and unrealistic expectations of post-ablation recovery. Better outcomes were noted in those who were seen at 1-week post-ablation by a nurse practitioner (NP) compared with those who were not seen until 1 or 3 months after ablation by a physician.

Implications for practice:

Atrial fibrillation ablation is routinely performed in the United States, yet there seems to be a lack of standardization concerning the type and timing of follow-up care after AF ablation. These preliminary findings support a standardized approach to include an NP visit at one week after AF ablation to achieve quality AF patient outcomes.
Diagnostic accuracy of strain imaging in predicting myocardial viability after an ST-elevation myocardial infarction
Authors: Mghaieth Zghal Fathia , Boudiche Selim , Haboubi Sofiane , Neji Henda , Ben Halima Manel , Rekik Bassem , Mechri Mehdi , Ouali Sana , Hantous Saoussen , Mourali Mohamed Sami
Published: May 2020

In the acute phase of ST-elevation myocardial infarction (STEMI) viability imaging techniques are not validated and/or not available.

This study aimed to evaluate the ability of strain parameters assessed in the acute phase of STEMI, to predict myocardial viability after revascularization.

Thirty-one STEMI patients whose culprit coronary artery was recanalized and in whom baseline echocardiogram showed an akinesia in the infarcted area, were prospectively included. Bidimensional left ventricular global longitudinal strain (GLS), and territorial longitudinal strain (TLS) in the territory of the infarct related artery were obtained within 24 hours from admission. Delayed enhancement (DE) cardiac magnetic resonance imaging (CMR) was used as a reference test to assess post-revascularization myocardial viability. DE-CMR was performed 3 months after percutaneous coronary intervention. According to myocardial viability, patients were divided into 2 groups; CMR viable myocardium patients with more than half of infarcted segments having a DE <50% (group V) and CMR nonviable myocardium patients with half or more of the infarcted segments having a DE >50% (group NV).

GLS and TLS were lower in group V compared to group NV (respectively: −14.4% ± 2.9% vs −10.9% ± 2.4%, P = .002 and −11.0 ± 4.1 vs −3.2 ± 3.1, P = .001). GLS was correlated with DE-CMR (r = 0.54, P = .002) and a cut off value of −13.9% for GLS predicted viability with 86% sensitivity (Se) and 78% specificity (Sp). TLS showed the strongest correlation with DE-CMR (r = 0.69, P < .001). A cut off value of −9.4% for TLS yielded a Se of 78% and a Sp of 95% to predict myocardial viability.

GLS and TLS measured in the acute phase of STEMI predicted myocardial viability assessed by 3 months DE-CMR. They are prognostic indicators and they can be used to guide the priority and usefulness of percutaneous coronary intervention in these patients.
Extracorporeal shock wave therapy versus corticosteroid injection for chronic plantar fasciitis
Authors: Zhao Jie , Luo Wen Ming , Li Tingting
Published: May 2020

Background:

The outcomes of corticosteroid injection (CSI) and extracorporeal shock wave therapy (ESWT) as primary treatment of plantar fasciitis have been debated. This study was conducted to compare and evaluate the therapeutic effects of ultrasound-guided CSI versus medium frequency ESWT in the treatment of plantar fasciitis among Chinese population.

Methods:

This study was a single-center, randomized, and double-blinded trial. The study protocol was approved by local ethics committee board and subsequently registered in Research Registry. Eighty patients with unilateral plantar fasciitis were randomized to receive either ESWT (3 times once per week) (n = 40) or CSI treatment (a single 1-mL dose of betamethasone sodium plus 0.5 mL of prilocaine under ultrasound guidance by injection into the plantar fascia) (n = 40). The primary outcome measures were visual analog scale and Foot Function Index scores. Secondary outcome measures included the heel tenderness index score and plantar fascia thickness as obtained by ultrasound examination. All of the assessments were performed at baseline and 1, 3, and 6 months after treatment.

Results:

This is a randomized controlled trial evaluating the efficacy of CSI versus ESWT in the treatment of plantar fasciitis. This study has limited inclusion and exclusion criteria and a well-controlled intervention.

Conclusions:

The results of this trial will provide more evidence on which method can better treat plantar fasciitis.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5428).
Comparison between ticagrelor versus clopidogrel in long term outcomes of Taiwanese diabetic subjects with acute coronary syndrome undergoing successful revascularization
Authors: Wang Cheng-An , Hsieh Yi-Chen , Huang Chun-Yao , Liu Ju-Chi , Hsieh Ming-Hsiung , Lin Yung-Kuo , Yeh Jong-Shiuan
Published: May 2020

Although previous clinical trials demonstrated that ticagrelor could reduce cardiovascular events and mortality versus clopidogrel in patients with acute coronary syndrome (ACS), the real-world evidence of its clinical impacts on East Asian Diabetic population has rarely been investigated.

Between November 2013 and June 2015, 1534 patients were recruited into the Acute Coronary Syndrome-Diabetes Mellitus Registry of the Taiwan Society of Cardiology (TSOC ACS-DM registry). After propensity score matching, a total of 730 patients undergoing successful revascularization and discharged on ticagrelor (N = 365) or clopidogrel (N = 365) were analyzed. The primary and secondary endpoints were all-cause mortality and re-hospitalization, respectively. The all-cause death associated with ticagrelor vs clopidogrel was 3.6% vs 7.4% (adjusted hazard ratio (HR) 0.34 [0.15–0.80];P = .0138) at 24 months. The re-hospitalization rate at 24 months was 38.9% vs 39.2% (P = .3258).

For diabetic patients with ACS, ticagrelor provided better survival benefit than clopidogrel without an increase of re-hospitalization in 24 months after successful percutaneous coronary intervention. This study in real-world circumstance provided valuable complementary data to externally validate platelet inhibition and patient outcomes (PLATO) finding especially in Asian diabetic population.