bluuebunny/crossref_metadata_2025 huggingface dataset:
A study of cool core resiliency and entropy mixing in simulations of galaxy cluster mergers
Authors: Valdarnini R , Sarazin C L
Published: April 2021

We present results from a suite of binary merging cluster simulations. The hydrodynamical cluster simulations are performed employing a smoothed particle hydrodynamics formulation in which gradient errors are strongly reduced by means of an integral approach. We consider adiabatic as well as radiative simulations, in which we include gas cooling, star formation, and energy feedback from supernovae. We explore the effects of merging on the thermodynamic structure of the intracluster gas of the final merger remnant. In particular, we study how core entropy is generated during the merging and the stability properties of the initial cool-core profile against disruption. To this end, we consider a range of initial mass ratio and impact parameters. Final entropy profiles of our adiabatic merging simulations are in good accord with previous findings, with cool-cores being disrupted for all of the initial merging setups. For equal-mass off-axis mergers, we find that a significant contribution to the final primary core entropy is due to hydrodynamic instabilities generated by rotational motions, which are induced by tidal torques during the first pericentre passage. In radiative simulations, cool-cores are more resilient against heating processes; none the less, they are able to maintain their integrity only in the case of off-axis mergers with very unequal masses. We suggest that these results are robust against changes in the gas physical modelling, in particular to the inclusion of AGN thermal feedback.

Our findings support the view that the observed core cluster morphology emerges naturally in a merging cluster context, and conclude that the merging angular momentum is a key parameter in shaping the thermodynamical properties of the final merger remnant.
Beliefs About Perioperative Opioid and Alcohol Use among Elective Surgical Patients Who Report Unhealthy Drinking: A Qualitative Study
Authors: Fernandez Anne C , Lin Lewei A , Bazzi Angela R , Boissoneault Jeff , Borsari Brian , Blow Frederic
Published: April 2021

Objectives

Elective surgical patients with unhealthy alcohol use have unique pain management needs and addiction risk factors that are relevant to surgical preparation and recovery. This descriptive qualitative study sought to better understand patients' beliefs and behaviors related to opioid use, alcohol use, and pain management in the perioperative context.

Design

We conducted individual semi-structured interviews between July 2017 and March 2018.

Setting

A large Midwestern academic health system.

Subjects

Participants were elective surgical patients meeting unhealthy alcohol use criteria, recruited from the health system’s preoperative anesthesia clinic.

Method

Semistructured interview guides explored beliefs and behaviors relating to alcohol and opioid use, health status, and surgical care. Interview recordings were transcribed and coded for thematic analysis.

Results

Among 20 elective surgical patients (25% female), we identified three key themes regarding alcohol use, opioid use, and their co-use before and after surgery. First, desires and intentions to use opioids for postoperative pain management varied widely, even before opioids were prescribed. Second, some participants described alcohol as a preferred pain management strategy. Third, participants held a range of beliefs about the risks and benefits of alcohol and opioid co-use.

Conclusions

Appropriate assessment of beliefs and intentions regarding opioid and alcohol use could help identify patients most vulnerable to new opioid problems and unhealthy alcohol use in the context of perioperative surgical pain. These findings have important implications for perioperative pain management.
Superabsorbent poly(acrylic acid) and antioxidant poly(ester amide) hybrid hydrogel for enhanced wound healing
Authors: Zhang Jianhua , Hu Junfei , Chen Baoshu , Zhao Tianbao , Gu Zhipeng
Published: April 2021

Wound healing dressing is increasingly needed in clinical owing to the large quantity of skin damage annually. Excessive reactive oxygen species (ROS) produced through internal or external environmental influences can lead to lipid peroxidation, protein denaturation, and even DNA damage, and ultimately have harmful effects on cells. Aiming to sufficiently contact with the wound microenvironment and scavenge ROS, superabsorbent poly (acrylic acid) and antioxidant poly (ester amide) (PAA/PEA) hybrid hydrogel has been developed to enhance wound healing. The physical and chemical properties of hybrid hydrogels were studied by Fourier-transform infrared (FTIR) absorption spectrum, compression, swelling, degradation, etc. Besides, the antioxidant properties of hybrid hydrogels can be investigated through the free radical scavenging experiment, and corresponding antioxidant indicators have been tested at the cellular level. Hybrid hydrogel scaffolds supported the proliferation of human umbilical vein endothelial cells and fibroblasts, as well as accelerated angiogenesis and skin regeneration in wounds. The healing properties of wounds in vivo were further assessed on mouse skin wounds. Results showed that PAA/PEA hybrid hydrogel scaffolds significantly accelerated the wound healing process through enhancing granulation formation and re-epithelialization. In summary, these superabsorbent and antioxidative hybrid hydrogels could be served as an excellent wound dressing for full-thickness wound healing.
Phylogenomics and Historical Biogeography of Seahorses, Dragonets, Goatfishes, and Allies (Teleostei: Syngnatharia): Assessing Factors Driving Uncertainty in Biogeographic Inferences
Authors: Santaquiteria Aintzane , Siqueira Alexandre C , Duarte-Ribeiro Emanuell , Carnevale Giorgio , White William T , Pogonoski John J , Baldwin Carole C , Ortí Guillermo , Arcila Dahiana , Ricardo Betancur-R
Published: April 2021

The charismatic trumpetfishes, goatfishes, dragonets, flying gurnards, seahorses, and pipefishes encompass a recently defined yet extraordinarily diverse clade of percomorph fishes—the series Syngnatharia. This group is widely distributed in tropical and warm-temperate regions, with a great proportion of its extant diversity occurring in the Indo-Pacific. Because most syngnatharians feature long-range dispersal capabilities, tracing their biogeographic origins is challenging. Here, we applied an integrative phylogenomic approach to elucidate the evolutionary biogeography of syngnatharians. We built upon a recently published phylogenomic study that examined ultraconserved elements by adding 62 species (total 169 species) and one family (Draconettidae), to cover ca. 25% of the species diversity and all 10 families in the group. We inferred a set of time-calibrated trees and conducted ancestral range estimations. We also examined the sensitivity of these analyses to phylogenetic uncertainty (estimated from multiple genomic subsets), area delimitation, and biogeographic models that include or exclude the jump-dispersal parameter ($j)$. Of the three factors examined, we found that the $j$ parameter has the strongest effect in ancestral range estimates, followed by number of areas defined, and tree topology and divergence times. After accounting for these uncertainties, our results reveal that syngnatharians originated in the ancient Tethys Sea ca. 87 Ma (84–94 Ma; Late Cretaceous) and subsequently occupied the Indo-Pacific. Throughout syngnatharian history, multiple independent lineages colonized the eastern Pacific (6–8 times) and the Atlantic (6–14 times) from their center of origin, with most events taking place following an east-to-west route prior to the closure of the Tethys Seaway ca. 12–18 Ma. Ultimately, our study highlights the importance of accounting for different factors generating uncertainty in macroevolutionary and biogeographic inferences.[Historical biogeography; jump-dispersal parameter; macroevolutionary uncertainty; marine fishes; syngnathiformes; ultraconserved elements].
CE: Providing Care for Caregivers During COVID-19
Authors: Morales Crystal , Brown Mary-Michael
Published: April 2021

Care for the Caregiver is a peer-to-peer program that provides support and guidance to clinicians who have experienced an unexpected and emotionally distressing event. Its development was preceded by communication and resolution programs that were endorsed by the Joint Commission in 2001, subsequently introduced at several U.S. medical centers, and in 2009 were incorporated within demonstration projects funded by the Agency for Healthcare Research and Quality. In August 2014, the authors introduced the Care for the Caregiver program across the MedStar Health System, which includes seven hospitals in Maryland and three in the District of Columbia. Here, they describe how the program was initially conceived and structured—and how it evolved in response to the current pandemic.
CE: Multisystem Inflammatory Syndrome in Children
Authors: Shields Kerry , Atlas Kristin , Farber Jessica Strohm , Lebet Ruth
Published: April 2021

The coronavirus disease 2019 (COVID-19) pandemic has impacted the health of children worldwide. Although overall mortality from COVID-19 in children remains low, an associated multisystem inflammatory disorder has emerged. The disorder has been recognized and named multisystem inflammatory syndrome in children (MIS-C) by the World Health Organization and the Centers for Disease Control and Prevention. This comprehensive review describes the epidemiology, pathophysiology, signs and symptoms, other potential diagnoses, and treatments relevant to MIS-C. The review also includes patient and family education and anticipatory guidance, and discusses nursing implications for nurses working in various roles and settings, including direct care, research, and public health.
Biologics in atopic dermatitis
Authors: Chan Susan
Published: April 2021

Purpose of review

Until recently there have been limited options for systemic therapy in atopic dermatitis, which is unresponsive to topical treatments. However, the last few years have seen a rapid progression in this field. The purpose of this review is to summarise some of the recent literature and ongoing studies in the field of biologicals in atopic dermatitis.

Recent findings

Dupilumab has been shown to be effective in moderate to severe atopic dermatitis and is now licensed in the USA and Europe. Tralokinumab is currently under review by the Food and Drug Administration and the European Medicines agency. Phase 2 and 3 studies are taking place with other biological therapies. There is increasing evidence for the use of biologicals in children and for their role in multisystem disease.

The recent breakthroughs in treatment represent an opportunity to resolve an unmet need; the management of atopic dermatitis which is unresponsive to topical therapy.
Opioid-related Emergency Department Visits During COVID-19 in a Large Health System
Authors: Hall Gavin T. , Cruz Daniel S. , Lank Patrick M. , McCarthy Danielle M. , Kim Howard S.
Published: April 2021

Objective:

Multiple states have reported increases in opioid overdose deaths during the coronavirus disease 2019 (COVID-19) pandemic, however little is known about opioid-related presentations to the emergency department (ED).

Methods:

This was a time series analysis of visits to 7 EDs in greater Chicago, Illinois from October 20, 2019 to July 25, 2020. We compared the number of ED visits for opioid-related diagnoses in the time period preceding the World Health Organization pandemic declaration (prepandemic period, October 20, 2019–July 3, 2020) to the time period following the World Health Organization declaration (pandemic period, March 8, 2020 to July 25, 2020) using a single-group interrupted time series analysis with Newey-West standard errors. We also present data on alcohol-related ED visits for comparison.

Results:

We evaluated a total of 177,405 visits across the 7 EDs during the study period. The mean number of weekly ED visits in the prepandemic and pandemic periods was 4841 and 4029 weekly visits, respectively. In the interrupted time series analysis, there was no significant immediate effect of the pandemic start on opioid-related ED visits (−0.44 visits per 1000 ED visits, 95% CI −2.47 to 1.58, P = 0.66), however, there was a significant immediate effect of the pandemic start on alcohol-related ED visits (−4.1, 95% CI: −8.25 to −0.01, P < 0.05).

Conclusions:

Despite reductions in overall ED visit volumes and alcohol-related visits during COVID-19, the number of opioid-related visits was not significantly reduced during the early pandemic. These data reinforce the need to provide comprehensive treatment services for opioid use disorder during the co-occurring COVID-19 and opioid crises.
LIM domain only 1: an oncogenic transcription cofactor contributing to the tumorigenesis of multiple cancer types
Authors: Zhao Guo-Fa , Du Li-Qin , Zhang Lei , Jia You-Chao
Published: April 2021

The LIM domain only 1 (LMO1) gene belongs to the LMO family of genes that encodes a group of transcriptional cofactors. This group of transcriptional cofactors regulates gene transcription by acting as a key “connector” or “scaffold” in transcription complexes. All LMOs, including LMO1, are important players in the process of tumorigenesis. Unique biological features of LMO1 distinct from other LMO members, such as its tissue-specific expression patterns, interacting proteins, and transcriptional targets, have been increasingly recognized. Studies indicated that LMO1 plays a critical oncogenic role in various types of cancers, including T-cell acute lymphoblastic leukemia, neuroblastoma, gastric cancer, lung cancer, and prostate cancer. The molecular mechanisms underlying such functions of LMO1 have also been investigated, but they are currently far from being fully elucidated. Here, we focus on reviewing the current findings on the role of LMO1 in tumorigenesis, the mechanisms of its oncogenic action, and the mechanisms that drive its aberrant activation in cancers. We also briefly review its roles in the development process and non-cancer diseases. Finally, we discuss the remaining questions and future investigations required for promoting the translation of laboratory findings to clinical applications, including cancer diagnosis and treatment.
Melanoma-specific expression of the tumor suppressor proteins p16 and PTEN is a favorable prognostic factor in established melanoma brain metastases
Authors: Trembath Dimitri G. , Ivanova Anastasia , Krauze Michal T. , Kirkwood John M. , Nikolaishvilli-Feinberg Nana , Moschos Stergios J.
Published: April 2021

PTEN and p16 frequently undergo (epi)genetic aberrations in melanoma resulting in decreased, or absent, protein levels. We investigated the prognostic significance of these tumor suppressor genes in melanoma brain metastases (MBMs). Immunohistochemical analysis was performed on archived tissue sections from craniotomies. Expression of PTEN and p16 was semiquantitatively scored (0–3 scale) in melanoma cells, glia, TILs, and endothelial cells of tumor-associated vessels and was compared among the different brain tumor cell compartments. Overall survival (OS) analysis was performed according to PTEN and p16 protein expression in melanoma cells. 58 patients (median age 56, 37 male) underwent craniotomy for MBMs before February 2014. The OS of patients with decreased, or absent, protein expression (0, 1+) of PTEN and p16 in melanoma cells was significantly shorter compared to that of patients with high (2+, 3+) expression (median OS 2.40 vs. 10.75 months and 4.1 vs. 8.1 months, respectively; Gehan-Breslow-Wilcoxon test P = 0.026 and P = 0.037, respectively). PTEN and p16 protein expression were significantly lower in TILs compared to melanoma cells (Mann–Whitney test P = 0.023 and P < 0.0001, respectively). Low/absent protein expression of PTEN/p16 is an adverse prognostic factor in MBMs. Surprisingly, expression of both PTEN and p16 proteins was significantly lower in TILs compared to melanoma cells. Proliferating (p16 absent/low) TILs within the brain with or without an active PI3K-Akt pathway (PTEN absent/low) may represent a favorable host response in MBMs. Thus, treatment of patients with MBMs with CDK4/6 or PI3K pathway inhibitors may result in an unfavorable, bystander, off-target effect on host immune response.
Health Impact and Cost-effectiveness Assessment for the Introduction of Universal Varicella Vaccination in Switzerland
Authors: Heininger Ulrich , Pillsbury Matthew , Samant Salome , Lienert Florian , Guggisberg Patrik , Gani Ray , O’Brien Elliott , Pawaskar Manjiri
Published: April 2021

Background:

Varicella, caused by the varicella-zoster virus, is a highly contagious infectious disease with substantial health and economic burden to society. Universal varicella vaccination (UVV) is not yet recommended by the Swiss National Immunization Program, which instead recommends catch-up immunization for children, adolescents and adults 11–40 years of age who have no reliable history of varicella or are varicella-zoster virus-IgG seronegative. The objective of this study was to perform an assessment of health impact and cost-effectiveness comparing UVV with current practice and recommendations in Switzerland.

Methods:

A dynamic transmission model for varicella was adapted to Switzerland comparing 2 base-case schedules (no infant vaccination and 10% coverage with infant vaccination) to 3 different UVV schedules using quadrivalent (varicella vaccine combined with measles-mumps-rubella) and standalone varicella vaccines administered at different ages. Modeled UVV coverage rates were based on current measles-mumps-rubella coverage of approximately 95% (first dose) and 90% (second dose). Direct medical costs and societal perspectives were considered, with cost and outcomes discounted and calculated over a 50-year time horizon.

Results:

UVV would reduce the number of varicella cases by 88%–90%, hospitalizations by 62%–69% and deaths by 75%–77%. UVV would increase direct medical costs by Swiss Franc (CHF) 39–49 (US $43–54) per capita and costs from a societal perspective by CHF 32–40 (US $35–44). Incremental quality-adjusted life-years per capita increased by 0.0012–0.0014. Incremental cost-effectiveness ratios for the UVV schedules versus the base-case were CHF 31,194–35,403 (US $34,452–39,100) per quality-adjusted life-year from the direct medical cost perspective and CHF 25,245–29,552 (US $27,881–32,638) from the societal perspective.

Conclusions:

UVV appears highly effective and cost-effective when compared with current clinical practice and recommendations in Switzerland from both a direct medical costs perspective and societal perspective.
High Rates of Antibiotic Nonsusceptibility in Gram-negative Urinary Tract Infection in Children With Risk Factors Occurring in the Preceding Month
Authors: Hain Gavriel , Goldbart Aviv , Sagi Orli , Ben-Shimol Shalom
Published: April 2021

Background:

Choosing an empiric treatment for urinary tract infections (UTIs) requires epidemiologic data on antibiotic nonsusceptibility (ANS) rates, and risk factors for UTI and ANS in the individual patient. We assessed ANS in community-acquired UTI, and its association with risk factors exposure (previous antibiotic treatment, UTI and hospital visit) <1 month or 1–11 months before the current UTI episode.

Methods:

This was a retrospective, cohort study. Children <2 years with hospital visits and a positive urine culture obtained <48 hours from hospital admission whose culture yielded Gram-negative bacteria during the years 2015–2016, were included.

Results:

Of the overall 744 episodes, 80% were Escherichia coli. Overall ANS rates were 66% for ampicillin; 27%–29% for amoxicillin/clavulanic acid, cephalosporins (indicating extended-spectrum beta-lactamase) and trimethoprim–sulfamethoxazole; 14% for nitrofurantoin; 5%–6% for gentamicin, ciprofloxacin and piperacillin/tazobactam; and <1% for meropenem and amikacin. Higher ANS rates were associated with Bedouin (vs. Jewish) ethnicity, exposure to risk factors <1 month, and to a lesser extent during the 1–11 months before the studied UTI episode. In episodes with risk factors <1 month, ANS rates were 81% for ampicillin; 47%–58% for amoxicillin/clavulanic acid, cephalosporins and trimethoprim–sulfamethoxazole; 19% for nitrofurantoin; 12%–23% for gentamicin, ciprofloxacin and piperacillin/tazobactam; and 2% for meropenem and amikacin.

Conclusions:

Previous antibiotic treatment, hospital admission and UTI, especially <1 month before the current episode, and Bedouin ethnicity, were all associated with high rates of ANS. These findings are important and may assist the treating physician in choosing an adequate empiric treatment for UTI.
Longitudinal study of early adaptation to the coronavirus disease pandemic among youth with chronic pain and their parents: effects of direct exposures and economic stress
Authors: Law Emily F. , Zhou Chuan , Seung Fiona , Perry Frankie , Palermo Tonya M.
Published: April 2021

The novel coronavirus disease (COVID-19) has caused prolonged disruptions in daily life for many communities. Little is known about the impact of the COVID-19 pandemic on the health and well-being of youth with chronic pain and their families. We conducted a longitudinal, mixed-methods study to characterize early adaptation to the COVID-19 pandemic among 250 families of youth (ages 12-21 years) diagnosed with chronic headache (64%) or other chronic pain conditions (36%) and to determine whether direct exposures to COVID-19 and secondary economic stress modified symptom trajectories. Youth and parents reported on pain interference, anxiety, depression, and insomnia symptoms at 4 waves of data collection from April 2020 to July 2020. We also collected qualitative data on the impact of the pandemic on the youth's pain problem. Nearly half of our sample (49.6%) experienced direct exposures to COVID-19. Secondary economic stress was also common, affecting 44.4% of families. Symptom trajectories for pain, insomnia, depression, and anxiety remained stable or improved for most participants, indicating adaptive adjustment. However, overall symptom burden was high with persistent and clinically elevated depression, anxiety, and insomnia symptoms common among youth and parents. Direct exposures to COVID-19 did not modify symptom trajectories. However, youth pain interference and parent insomnia worsened in families who experienced secondary economic stress. Qualitative data revealed perceived benefits and harms from school closures on the youth's pain problem. Our findings of high symptom burden suggest that pediatric pain clinicians should offer distance assessment and treatment (eg, through telemedicine) to avoid pandemic-related disruptions in pain care.
A Comparison of Instructional Methods on Clinical Reasoning in Entry-Level Physical Therapy Students: A Pilot Study
Authors: Kobal Kara L. , Rubertone Patricia P. , Kelly Stephanie Piper , Finley Margaret
Published: April 2021

Introduction.

The primary aim of this study was to provide a comparison of the effects of 2 commonly used pedagogical approaches (paper-based case studies vs authentic patient experiences) on clinical reasoning and critical thinking of second-year entry-level physical therapy students.

Current literature reveals a lack of consistency in how clinical reasoning is taught and assessed in physical therapist education. There is a need for evidence-based approaches to develop clinical reasoning in entry-level physical therapy students in the United States.

Subjects.

Twenty-three students in their second year of a Doctor of Physical Therapy (DPT) degree program participated in this study.

Methods.

Participants were randomly assigned to a control group or to receive 1 of 2 supplemental learning activities (paper-based case studies or authentic patient experiences). Outcomes measured preintervention and postintervention included the Health Science Reasoning Test with Numeracy (HSRT-N) and the Self-Assessment of Clinical Reasoning and Reflection (SACRR). Data analysis included a comparison of effect sizes of change scores between groups and correlational analysis of pretest scores and student factors.

Results.

Authentic patient experiences demonstrated a moderate to large effect size for improved HSRT-N scores on 5 of 8 subscales, compared with paper-based case studies. Authentic patient experiences demonstrated a moderate effect size for improved SACRR scores compared with the control group.

Discussion and Conclusion.

The use of authentic patient experiences may be more effective than paper-based case studies for improving critical thinking and clinical reasoning in an entry-level DPT curriculum.
Physiological responses to carbohydrate overfeeding
Authors: Walhin Jean-Philippe , Gonzalez Javier T. , Betts James A.
Published: April 2021

Purpose of review

To consider emerging research into the physiological effects of excessive dietary carbohydrate intake, with a particular focus on interactions with physical activity.

Recent findings

A single episode of massive carbohydrate overload initiates physiological responses to stimulate additional peptide hormone secretion by the gut and the conversion of carbohydrate into lipid by the intestine, liver and adipose tissue. These acute responses maintain glycaemic control both via increased oxidation of carbohydrate (rather than lipid) and via nonoxidative disposal of surplus carbohydrate into endogenous glycogen and lipid storage depots. Sustained carbohydrate overfeeding therefore results in a chronic accumulation of lipid in the liver, skeletal muscle and adipose tissue, which can impair insulin sensitivity and cardiometabolic health in general. Beyond any direct effect of such lipid deposition on body mass/composition, there is not yet clear evidence of physiologically meaningful metabolic or behavioural adaptations to carbohydrate overfeeding in terms of other components of energy balance. However, regular physical exercise can mitigate the negative health effects of carbohydrate overfeeding, independent of any effect on the net carbohydrate surplus.

Research in this area has advanced understanding regarding the mechanisms of weight gain and associated health outcomes within the modern context of an abundant supply of dietary carbohydrate.
Ketogenic diet therapy in Alzheimer's disease: an updated review
Authors: Lilamand Matthieu , Mouton-Liger François , Paquet Claire
Published: April 2021

Purpose of review

Ketogenic diets (KD) are validated treatments of pharmacoresistant epilepsy. Their interest in neurodegenerative diseases such as Alzheimer's disease (AD) has been suggested, because ketone bodies may reduce neuroinflammation, improve neurotransmitters transport pathway, synaptic maintenance, and reduce brain β-amyloid deposition. In this updated review, we aimed at critically examining the evidence of the past 2 years regarding KD or ketogenic supplements (KS) on cognitive and biological/neuropathological outcomes. We conducted our search in preclinical studies (animal models of AD) or in humans with or without cognitive impairment.

Recent findings

Overall, 12 studies were included: four in animal models of AD and eight in humans. In preclinical studies, we found additional evidence for a decrease in cerebral inflammation as well as in specific features of AD: β-amyloid, aggregates of tau protein under KD/KS. Several AD mouse models experienced clinical improvements. Human studies reported significant cognitive benefits, improved brain metabolism and biomarkers change under KD/KS, despite rather short-term interventions. Adherence to KD or KS was acceptable with frequent, but minor gastrointestinal adverse effects.

The present review gathered additional evidence for both pathophysiological and clinical benefits of KS/KD in AD. Further studies are warranted with a biomarker-based selection of AD participants and long-term follow-up.
Vitamin K and vascular calcification
Authors: Lees Jennifer S. , Mark Patrick B. , Witham Miles D.
Published: April 2021

Purpose of review

Vascular calcification is a common and important cardiovascular risk factor in patients with chronic kidney disease (CKD). Recent advances in the understanding of the biology of vascular calcification implicate vitamin K-dependent proteins as important regulators in this process. This review highlights recent key advances in vascular biology, epidemiology, and clinical trials in this rapidly evolving field.

Recent findings

Vitamin K deficiency is associated with increasing severity of vascular calcification among patients with CKD, but the relationship with cardiovascular disease and mortality is inconsistent. Vitamin K may reduce calcification propensity by improving the activity of vitamin K-dependent calcification inhibitors or by down-regulating components of the innate immune system to reduce inflammation. However, recent randomized controlled trials in patients with diabetes, CKD, renal transplant, and on hemodialysis have failed to demonstrate improvement in vascular calcification or stiffness after vitamin K treatment.

Current evidence does not support a clinically useful role for vitamin K supplementation to prevent or reverse vascular calcification in patients with CKD. Knowledge gaps remain, particularly whether higher doses of vitamin K, longer duration of supplementations, or use a vitamin K as a part of a package of measures to counteract vascular calcification might be effective.
Update on apolipoprotein B
Authors: Sniderman Allan , Langlois Michel , Cobbaert Christa
Published: April 2021

Purpose of review

The 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines concluded that apolipoprotein B (apoB) was a more accurate measure of cardiovascular risk and a better guide to the adequacy of lipid lowering than low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (HDL-C). Also, they stated that apoB can be measured more accurately than LDL-C or non-HDL-C. This strong endorsement of the central role of apoB contrasts with the limited endorsement of apoB by the 2018 American College of Cardiology/American Heart Association Multisociety Guidelines. Nevertheless, both retained LDL-C as the primary metric to guide statin/ezetimibe/Proprotein convertase subtilisin/kexin type 9 (PCSK9) therapy.

Recent findings

This essay will review the most important recent advances in knowledge about apoB with particular emphasis on the results of Mendelian randomization studies and a new discordance analysis in subjects on statin therapy. We will also lay out why using LDL-C to guide the adequacy of lipid lowering therapy represents an interpretive error of the results of the statin/ezetimibe/PCSK9 inhibitor randomized clinical trials and therefore why apoB should be the primary metric to guide statin/ezetimibe/PCSK9 therapy.

There is now a robust body of evidence demonstrating the superiority of apoB over LDL-C and non-HDL-C as a clinical marker of cardiovascular risk. LDL-C is not the appropriate marker to assess the benefits of statin/ezetimibe/PCSK9 therapy.
Physician Perspectives about Telemedicine
Authors: Lee Jennifer A. , Di Tosto Gennaro , McAlearney Fiona A. , Miller Steven , Mezoff Ethan , Venkatesh Rajitha D. , Huang Jeannie , Lightdale Jenifer R. , Volney Jaclyn , McAlearney Ann Scheck
Published: April 2021

Objective:

Use of telemedicine in pediatric gastroenterology has increased dramatically in response to the coronavirus disease 2019 (COVID‐19) pandemic. The goal of this study was to systematically assess the usability of telemedicine in the field of pediatric gastroenterology.

Methods:

The previously validated Telehealth Usability Questionnaire was distributed to physician pediatric gastroenterologist members of North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Physician demographic and practice characteristics were collected. Data were analyzed using descriptive, linear mixed‐effect, and ordinary least squares regression methods.

Results:

One hundred sixty pediatric gastroenterologists completed the survey. The majority were from academic practice (77%) with experience ranging from trainee (11%) to over 20 years of clinical practice (34%). Most (82%) had no experience with telemedicine before the pandemic. The average usability score (scale 1–5) was 3.87 (σ = 0.67) with the highest domain in the usefulness of telemedicine (μ = 4.29, σ = 0.69) and physician satisfaction (μ = 4.13, σ = 0.79) and the lowest domain in reliability (μ = 3.02, σ = 0.87). When comparing trainees to attending physicians, trainees’ responses were almost one point lower on satisfaction with telemedicine (trainee effect = −0.97, Bonferroni adjusted 95% confidence interval = −1.71 to −0.23).

Conclusion:

Pediatric gastroenterologists who responded to the survey reported that the technology for telemedicine was usable, but trainees indicated lower levels of satisfaction when compared to attending physicians. Future study is needed to better understand user needs and the impacts of telemedicine on providers with different levels are experience to inform efforts to promote implementation and use of telemedicine beyond the pandemic.
A Quasi-Experimental Study of the Effect of Ginger Tea on Preventing Nausea and Vomiting in Patients With Gynecological Cancers Receiving Cisplatin-Based Regimens
Authors: Wazqar Dhuha Y. , Thabet Hala A. , Safwat Amany M.
Published: April 2021

Background

Cancer patients receiving chemotherapy experience acute and delayed nausea and vomiting. These side effects obligate the patients to use pharmacological and nonpharmacological methods. The effect of ginger tea as an antiemetic modality on preventing chemotherapy-related nausea and vomiting has not been confirmed in previous studies.

Objective

The aim of this study was to assess the effect of ginger tea, when given together with the standard antiemetic regimen, on preventing nausea and vomiting in patients with gynecological cancers receiving cisplatin-based regimens.

Methods

This study used a quasi-experimental research design with 2 groups (control and intervention groups, 50 participants each). A sociodemographic and medical survey and the Modified Rhodes Index of Nausea, Vomiting, and Retching were used to collect the data. Descriptive analyses, t test, and χ
2 test were used to analyze the data.

Results

The total mean Modified Rhodes Index of Nausea, Vomiting, and Retching scores were lower in the intervention group in all measurements compared with the control group, and the differences between the total mean scores for symptom experience, development, and distress between the groups were statistically significant in the third (P < .05), fourth (P < .01), and fifth (P < .05) measurements. No ginger-related side effects were noted in this study.

Conclusions

Ginger tea reduced the experience, development, and distress of nausea, vomiting, and retching in the intervention group. The use of ginger tea may be recommended for chemotherapy-associated nausea and vomiting in cancer patients receiving cisplatin-based regimens.

Implications for Practice

Oncology nurses can lead the implementation of ginger tea intervention to prevent chemotherapy-related nausea and vomiting.
“Elbow-Lock” Chest Compression Method in the Setting of Single Rescuer Pediatric Cardiopulmonary Resuscitation
Authors: Kang Ji-Hun , Jang Yun-Deok , Han Kang , Jung Eun-Kyung , Yu Jae-Kwang , Ji Jae-Gu , Lee Si-Won , Yoon Yoo Sang , Kim Yang-Weon
Published: April 2021

Background

We designed a new 1-handed chest compression method, the “elbow-lock” chest compression (ELCC), for a single rescuer in pediatric cardiopulmonary resuscitation (CPR). Then, we compared the effectiveness between the ELCC and standard chest compression (SCC) method.

Methods

This prospective, randomized controlled, crossover simulation trial studied 34 emergency medical professionals, including physicians, nurses, and EMTs. We compare the quality of chest compression and fatigue point time between the ELCC and the SCC.

Results

Participants who performed the ELCC method maintained a proper depth of compression compared with SCC method (50.0 ± 0.3 mm vs 40.5 ± 0.4 mm, P < 0.001). However, the 2 methods did not differ in terms of compression velocity since neither reached the standard velocity (96.7 ± 7.1/minutes vs 91.7 ± 7.0/minutes, P < 0.016). With respect to the overall score, ELCC was more effective than the SCC (91.6 ± 3.7% vs 85.3 ± 8.8%, P = 0.002). In addition, the fatigue point time was slower in the ELCC group than the SCC group (7.3 ± 0.3/minutes vs 6.1 ± 0.4/minutes, P < 0.001).

Conclusions

The single rescuer ELCC method is an effective alternative to the SCC method for pediatric CPR because the ELCC method can prevent elbow flexion.

Trial registration: Our research is simulation manikin study. So we do not need to “trial registration”
Hard as Iron
Authors: Rickner Shannon S. , Feng Sing-Yi
Published: April 2021

Cases of severe iron toxicity have become increasingly rare; most cases are intentional ingestions by late adolescents and adults who present within 12 hours of ingestion. We present a case of an adolescent girl with metabolic acidosis, hypoglycemia, obtundation, and liver and renal failure of undifferentiated etiology who was eventually discovered to have overdosed on ferrous sulfate tablets 4 days before arrival. The diagnosis was made because the patient had an elevated transferrin concentration in the setting of a minimally elevated serum iron concentration and faint radio-opacities on abdominal plain film imaging. This case presents many diagnostic challenges and treatment dilemmas and is a rare report of survival in delayed presentation of severe toxicity.
Understanding the Second Victim Experience Among Multidisciplinary Providers in Obstetrics and Gynecology
Authors: Rivera-Chiauzzi Enid , Finney Robyn E. , Riggan Kirsten A. , Weaver Amy L. , Long Margaret E. , Torbenson Vanessa E. , Allyse Megan A.
Published: April 2021

Objective

The aim of the study was to determine the prevalence of second victim experience (SVE) among obstetrics and gynecology (OBGYN) clinical and nonclinical healthcare workers and compare healthcare workers who did and did not identify as a second victim (SV) in the last year.

Methods

The validated Second Victim Experience and Support Tool and additional questions designed to explore SVE topics specific to OBGYN healthcare workers were administered to a multidisciplinary group.

Results

Of 571 individuals sent a survey link, 205 completed the survey: 117 worked in obstetrics (OB), 73 in gynecology (GYN), and 15 in both areas. Overall, 44.8% of respondents identified as an SV sometime during their career, 18.8% within the last 12 months. Among nonclinical staff respondents, 26.7% identified as an SV during their career and 13.3% in the last 12 months. Respondents who identified as an SV in the last 12 months reported experiencing significantly more psychological and physical distress, a greater degree to which colleague and institutional support were perceived as inadequate, decreased professional self-efficacy, and increased turnover intentions. The most common events identified as likely triggers for SVE were fetal or neonatal loss (72.7%) and maternal death (68.2%) in OB and patient accusations or complaints (69.3%) in GYN.

Conclusions

Among survey respondents, there was a high prevalence of SVs in OBGYN staff, distributed equally between OB and GYN. Nonclinical healthcare workers also identified as SVs. The OBGYN departments should consider using the Second Victim Experience and Support Tool to screen for potential SV among their healthcare workers to provide additional support after events.
Effect of Digital Adherence Tools on Adherence to Antiretroviral Treatment Among Adults Living With HIV in Kilimanjaro, Tanzania: A Randomized Controlled Trial
Authors: Sumari-de Boer I. Marion , Ngowi Kennedy M. , Sonda Tolbert B. , Pima Francis M. , Masika, Bpharm Lyidia V. , Sprangers Mirjam A. G. , Reiss Peter , Mmbaga Blandina T. , Nieuwkerk Pythia T. , Aarnoutse Rob E.
Published: April 2021

Background:

Lifelong adherence to antiretroviral treatment remains challenging for people living with HIV (PLHIV). The aim of this study was to investigate whether any of 2 digital adherence tools could improve adherence among PLHIV in Kilimanjaro, Tanzania.

Methods:

We performed a parallel 3-arm, nonblinded, randomized controlled trial with 1:1:1 allocation. We included adults aged between 18 and 65 years, living in Kilimanjaro region, and who were on antiretroviral treatment for at least 6 months. Their adherence, as judged by the study nurses, had to be suboptimal. In one arm, participants received reminder short message service (SMS) texts, followed by a question SMS. In the second arm, participants received a real-time medication monitoring (RTMM) device (Wisepill) with SMS reminders. In the third arm, participants received standard care only. The primary outcome of mean adherence over 48 weeks was compared between arms using between-group t tests in a modified intention-to-treat analysis.

Results:

In each arm, we randomized 83 participants: data of 82 participants in the RTMM arm, 80 in the SMS arm, and 81 in the standard care arm were analyzed. The average (over 48 weeks) adherence in the SMS, RTMM, and control arms was 89.6%, 90.6%, and 87.9% for pharmacy refill; 95.9%, 95.0%, and 95.2% for self-report in the past week; and 97.5%, 96.6%, and 96.9% for self-report in the past month, respectively (P values not statistically significant).

Conclusions:

Receiving reminder SMS or RTMM combined with feedback about adherence levels and discussion of strategies to overcome barriers to adherence did not improve adherence to treatment and treatment outcome in PLHIV.

Clinical Trial Number:

PACTR201712002844286.
Pregnancy Promotes the Recurrence of Cerebellar Hemangioblastoma?
Authors: Zhang Shiqiang , Wang Yue , Yu Xiaoxiang , Chen Bo , Zhang Bo
Published: April 2021

Cerebellar hemangioblastomas with pregnancy is rare, but coexistence of pregnancy and recurrent cerebellar hemangioblastomas is rather rare. And coexistence of other diseases during pregnancy usually leads to misdiagnosis because of pregnancy reaction. A 29-year-old woman, at the 8th week of pregnancy, complained of nausea, vomiting, and episodic posterior occipital pain and was misdiagnosed pregnancy reaction without any special treatment during her several visits to local hospital. The patient was diagnosed cerebellar hemangioblastomas 14 years ago, after surgery, she received regular re-examination without recurrence. At the 15th week of pregnancy, the situation of the patient got worse, and she was admitted to our hospital. Brain magnetic resonance imaging showed a lesion in cerebellum. It was considered to be cerebellar hemangioblastomas and was confirmed finally by postoperative pathological examination. In clinical practice, differential diagnosis is of great importance during pregnancy because many other diseases can mimic pregnancy reaction. In this patient, the intracranial hypertension caused by recurrent cerebellar hemangioblastomas was misdiagnosed as pregnancy reaction and it was suggested that the change of hormones, neuroendocrine, and cardiovascular function promoted the recurrence of cerebellar hemangioblastomas.
The trauma surgeon: A career of purpose and value
Authors: Christmas Ashley Britton
Published: April 2021

Hereinafter is the article for the 2021 Eastern Association for the Surgery of Trauma presidential address, which was delivered in a virtual format. It is my hope that I have served Eastern Association for the Surgery of Trauma well through the years, and I have no doubt that this organization will continue its great path under the leadership of President Jeff Claridge, a true leader of character and value for whom I have great respect. It has truly been an honor and a privilege to serve this great beloved organization. Hopefully, this address brings word of inspiration, value, and encouragement to those who serve so selflessly every day as members of our respective trauma teams.
Three “Red Lines” for Pattern Recognition-Based Differential Diagnosis Using Optical Coherence Tomography in Clinical Practice
Authors: Petzold Axel
Published: April 2021

Background:

Optical coherence tomography (OCT) devices for imaging of the eye are broadly available. The test is noninvasive, rapid, and well-tolerated by patients. This creates a large number of OCT images and patient referrals. Interpretation of OCT findings at the interface between neurological and ophthalmologic conditions has become a key skill in the neuro-ophthalmology service. Similar to the interpretation of visual fields, recogntion of the vertical and horizontal medians are helpful. A third “red line” is added, which will be reviewed here.

Evidence:

Levels 1a to 5 evidence.

Acquisition:

Literature research.

Results:

There is level 1a evidence that neurodegeneration of the brain is associated with inner retinal layer atrophy. Predominantly, this is driven by retrograde (trans-synaptic) axonal degeneration from the brain to the eye. This process typically stops at the level of the inner nuclear layer (INL). Anterograde (Wallerian) axonal degeneration from the eye to the brain can trespass the INL. The geography of atrophy and swelling of individual macular retinal layers distinguishes prechiasmal from postchiasmal pathology. The emerging patterns are a front–back “red line” at the INL; a vertical “red line” through the macula for chiasmal/postchiasmal pathology; and a horizontal “red line” through the macular for pathology pointing to the optic disc. This is summarized by illustrative case vignettes.

Conclusions:

The interpretation of patterns of individual retinal layer atrophy (3 “red lines”) needs to be combined with recognition of localized layer thickening (edema, structural) at the macula. Certain macular patterns point to pathology at the level of the optic disc. This requires revision of the optic disc OCT and will guide need for further investigations. The 3 “red lines” proposed here may be found useful in clinical practice and the related mnemonics (“half moon,” “sunset,” “rainbow”) for teaching.
Characteristic Visual Field Defect From Lateral Geniculate Body Stroke
Authors: Naguib Mina M. , Woodland Matthew B. , Foroozan Rod
Published: April 2021

A 58-year-old man presented with a complaint of subjective visual field loss on the right side and hypertensive emergency. Examination revealed a right homonymous hemianopia. Computed tomography imaging revealed an acute stroke of the left lateral geniculate body. A few months later, automated perimetry revealed characteristic visual field changes associated with this lesion. In this report, the anatomy, pathophysiology, clinical findings, and previously reported etiologies of lateral geniculate body lesions are reviewed.
Myelin Oligodendrocyte Glycoprotein Antibody–Associated Optic Neuritis—A Review
Authors: Kaushik Megha , Burdon Michael A.
Published: April 2021

Our understanding of demyelinating optic neuritis has substantially evolved over the past 2 decades. With advancements in serological testing, antibodies against myelin oligodendrocyte glycoprotein (MOG) have been recently discovered in a distinct subset of demyelinating neuroinflammatory disease. Although MOG-immunoglobulin G (IgG)–associated disorder (MOGAD) has previously been seen as a component of neuromyelitis optica spectrum disorder (NMOSD), evidence increasingly suggests that it should be distinguished as a separate condition. The distinction of MOGAD from aquaporin-4 IgG NMOSD is imperative as treatment plans need to be tailored to its unique disease course and prognosis. The purpose of this review is to explore the nature and outcomes of MOGAD optic neuritis to help guide acute and long-term immunosuppressive treatment decisions.