bluuebunny/crossref_metadata_2025 huggingface dataset:
Varicella zoster virus reactivation following COVID-19 vaccination: a report of 3 cases
Authors: Saraiva Ana L , Vieira Ana R , Marinho Maria C , Zadorozhnya Oksana
Published: February 2022

Background

The advent of vaccination against COVID-19 brought great expectations for the control of the pandemic. As novel vaccines, much of the associated side effects were unknown. Currently, an increasing number of reports from side effects of COVID-19 vaccines have been published, namely on cutaneous reactions. These are of utmost importance to increase our knowledge about possible undesirable effects and its prevention.

Methods

We describe a series of 3 cases who presented with varicella zoster virus (VZV) reactivation following the first dose of 3 different COVID-19 vaccines.

Results

Three patients sought their Family Doctor after developing typical lesions of VZV reactivation, following a period of 3–13 days after COVID-19 vaccination. None was under immunosuppressive therapy. The 3 patients recovered in a few weeks and the subsequent doses of the vaccines were administered, without recurrence of the symptoms.

Conclusions

These cases highlight the possibility of VZV reactivation after the first dose of COVID-19 vaccines. Family Doctors should be aware of this event and play an important role informing and reassuring local communities for this possible vaccine reaction.
Is Sex as a Biological Variable Still Being Ignored in Preclinical Aging Research?
Authors: Carmody Colleen , Duesing Charlotte G , Kane Alice E , Mitchell Sarah J
Published: February 2022

Five years ago, the National Institute of Health (NIH) introduced a mandate to revolutionize the way sex as a biological variable (SABV) is considered in NIH-funded preclinical research. Given the known effects of sex on aging physiology, pathology, treatment response, and the effectiveness of interventions it is particularly important that SABV be considered in basic biology of aging research. Five years after this mandate, a significant amount of published work funded by the National Institute on Aging (NIA) is still not including mice of both sexes and/or not considering sex differences or comparisons in preclinical studies. Here we review a cross-section of recently published NIA-funded research to determine adherence to this mandate. We discuss the state of the preclinical aging field in terms of SABV and suggest strategies for improving adherence to the NIH mandate. It is imperative that we consider SABV and include males and females in all aspects of aging biology research to improve health outcomes for all.
Novel brain computed tomography perfusion for cerebral malperfusion secondary to acute type A aortic dissection
Authors: Inoue Yosuke , Inoue Manabu , Koga Masatoshi , Koizumi Shigeki , Yokawa Koki , Masada Kenta , Seike Yoshimasa , Sasaki Hiroaki , Yoshitani Kenji , Minatoya Kenji , Matsuda Hitoshi
Published: February 2022

OBJECTIVES

The management of acute type A aortic dissection with malperfusion syndrome remains challenging. To evaluate preoperative condition, symptoms might be subjective and objective evaluation of cerebral artery has not yet been established. For quantitative evaluation, this study focused on brain computed tomography perfusion (CTP), which has been recommended by several guidelines of acute ischaemic stroke.

METHODS

In the last 2 years, 147 patients hospitalized due to acute type A aortic dissection were retrospectively reviewed. Among the 23 (16%) patients with cerebral malperfusion, 14 who underwent brain CTP (6 preoperative and 8 postoperative) were enrolled. CTP parameters, including regional blood flow and time to maximum, were automatically computed using RApid processing of Perfusion and Diffusion software. The median duration from the onset to hospital arrival was 129 (31–659) min.

RESULTS

Among the 6 patients who underwent preoperative CTP, 4 with salvageable ischaemic lesion (penumbra: 8–735 ml) without massive irreversible ischaemic lesion (ischaemic core: 0–31 ml) achieved acceptable neurological outcomes after emergency aortic replacement regardless of preoperative neurological severity. In contrast, 2 patients with an ischaemic core of >50 ml (73, 51 ml) fell into a vegetative state or neurological death due to intracranial haemorrhage. CTP parameters guided postoperative blood pressure augmentation without additional supra-aortic vessel intervention in the 8 patients who underwent postoperative CTP, among whom 6 achieved normal neurological function regardless of common carotid true lumen stenosis severity.

CONCLUSIONS

CTP was able to detect irreversible ischaemic core, guide critical decisions in preoperative patients and aid in determining the blood pressure augmentation for postoperative management focusing on residual brain ischaemia.
Questionnaires assessing the anxiety alleviation benefits of indoor plants for self-isolated population during COVID-19
Authors: Yan Lianyu , Liu Fudan , Meng Xi
Published: February 2022

Indoor plants have great benefits to humans, including physical health, cognition and emotion through their repair and purification capabilities, but most of these positiv e effects have not been quantified and valued. In this study, the Corona Virus Disease 2019 (COVID-19), when people must be self-isolated at home and avoid outdoor activities in China, was utilized adequately and the influence of indoor plants was analyzed via the 2031 valid questionnaires, in which indoor plant status, interest degree, interaction frequency and anxiety alleviation were surveyed. Results showed that indoor plants were widely cultivated especially in the living room. Compared to before the COVID-19, the interest degree with indoor plants increased by ~33% and their overall interaction frequency increased by ~78% during the COVID-19. More than 70% of the surveyed people exhibited anxiety during the COVID-19, and the overall anxiety level was 1.17 (between ‘Slight anxiety’ and ‘Anxiety’). And ~61% of the surveyed people supported that indoor plants could alleviate self-isolation anxiety, and the anxiety alleviation degree was 0.79 (tend to ‘Releasing the certain anxiety’), which showed that indoor plants had also shown to have an indirect psychological effect on anxiety alleviation.
Can Unstructured Data Help to Create a More Inclusive Society?
Authors: Pakes Keren
Published: February 2022

It’s an obvious but increasingly important fact: we live in a data-driven world, writes Keren Pakes, General Manager of The Bright Initiative.
How to Move Your IT Career Forward with Presales
Authors: Bell Tuuli
Published: February 2022

Your average salary as a presales consultant is between £55,000-£75,000, shares Dr Tuuli Bell, a sustainable presales specialist. But how steep is the learning curve, and what exactly is presales?
Inhibition of azole-resistant Aspergillus fumigatus biofilm at various formation stages by antifungal drugs, including olorofim
Authors: Kirchhoff Lisa , Dittmer Silke , Furnica Dan-Tiberiu , Buer Jan , Steinmann Eike , Rath Peter-Michael , Steinmann Joerg
Published: February 2022

Objectives

Interest in aspergillosis has increased over the past decades. An increase in the incidence of azole-resistant Aspergillus fumigatus strains has been reported; therefore, the need for novel therapeutic approaches is urgent. The formation of biofilms contributes to pathogen resistance. We investigated the biofilm formation capabilities of azole-resistant A. fumigatus and analysed the susceptibility of biofilms at various developmental stages to three antifungal agents.

Methods

Biofilm formation of 19 clinical A. fumigatus strains (3 azole-susceptible and 16 azole-resistant strains) was determined by crystal violet staining and by an XTT assay over a period of 48 h. We measured antibiofilm activity of voriconazole, amphotericin B and olorofim. These agents were added before adhesion, after adhesion, after germination and to mature fungal biofilm. Antibiofilm activity was assessed in an XTT assay and in confocal laser scan microscopy. Additionally, a growth–kinetic assay with planktonic A. fumigatus was performed.

Results

Each of the antifungal agents inhibited the metabolic activity of A. fumigatus biofilms when applied at early stages of biofilm formation. The mature biofilms were more resistant. Olorofim and voriconazole showed promising effects against A. fumigatus adhesion and germination, whereas the mature biofilm was not affected by treatment. In contrast, the biofilm of A. fumigatus showed amphotericin B susceptibility throughout the entire developmental process. The planktonic cells were susceptible to all three antifungal drug classes with an inhibition peak at 12 h after incubation.

Conclusions

This is the first known study to demonstrate the antibiofilm activity of olorofim, voriconazole and amphotericin B against azole-resistant A. fumigatus.
Behavioral and performance response associated with administration of intravenous flunixin meglumine or oral meloxicam immediately prior to surgical castration in bull calves
Authors: Cull Charley A , Rezac Darrel J , DeDonder Keith D , Seagren Jon E , Cull Brooke J , Singu Vijay K , Theurer Miles E , Martin Miriam , Amachawadi Raghavendra G , Kleinhenz Michael D , Lechtenberg Kelly F
Published: February 2022

The objective of this study was to determine the effects of flunixin meglumine or meloxicam on behavioral response and performance characteristics associated with surgical castration in crossbred bulls. Intact male Bos taurus calves (n = 252; averaging 176 kg) were randomly allocated into one of three treatment groups within pen: control (CON), flunixin meglumine (FLU; 2.2 mg/kg intravenous injection), or meloxicam (MEL; 2.0 mg/kg per os). The individual animal was the experimental unit. Calves were individually weighed on days 0 and 14 of the trial to evaluate performance outcomes. On study day 0, treatments were administered, according to their random allocation, immediately prior to surgical castration using the Henderson tool method. Visual analog scale (VAS) assessment and categorical attitude score (CAS) were collected on days −1, 0 (6 h post-castration), 1, 2, 3, and 4 in the study. The VAS was assigned using a 100 mm horizontal line with “normal” labeled at one end of the line and “moribund” at the other end of the horizontal line. The masked observer assigned a mark on the horizontal line based upon the observed severity of pain exhibited by that individual animal. The CAS was assigned by the same observer using five different categories with a score of 0 being “normal”. Average daily gain tended (P = 0.09) to be associated with the treatment group, and MEL had a greater (P = 0.04) average daily gain through day 14 compared with CON. A significant (P < 0.01) treatment by day interaction was indicated for VAS score, and MEL had lower VAS scores on days 0, 1, 2, and 3 post-castration compared with CON; FLU had lower VAS scores on days 0 and 1 compared with CON. A significant treatment by day interaction was not present (P = 0.25) for CAS. The FLU had lesser percent CAS ≥1 (17.5%; P = 0.05) compared with CON (29.4%); MEL has lesser percent CAS ≥1 observations (14.9%; P = 0.01) compared with CON. The median VAS increased as CAS was more severe. Results indicated MEL and FLU calves temporally improved behavioral responses following surgical castration with positive numerical trends for a 14 d average daily gain (ADG). The VAS system appeared to be an effective method of subjective evaluation of pain in beef calves in this study. Route of administration, duration of therapy, and low relative cost make oral meloxicam a reasonable analgesic treatment in calves when administered at the time of surgical castration.
Radioisotope-guided laparoscopy: a case report and description of an alternative surgical technique
Authors: Pinheiro Rodrigo Nascimento , Silvestrini Anderson Arantes , Rocha Gabriela El Haje Lobo , Heller Heloisa Lima , de Carvalho Gallo Pereira Camila , Furtado Rodrigo Guimarães
Published: February 2022

Prostate cancer is the second most frequent cancer type among men worldwide. With the development of Radiology and Nuclear Medicine technologies, early diagnosis is increasingly common, and the possibility of using new minimally invasive techniques increases. With a narrative review of the literature, this case report describes an alternative radioisotope-guided laparoscopy technique for tumors in the peritoneal cavity. There may be benefits in associating nuclear medicine techniques in the management of patients with non-palpable tumors that are difficult to locate in the peritoneal cavity, enabling the use of less invasive and safer surgical procedures for diagnosis, staging and treatment.
Disentangling the parameter space: the role of planet multiplicity in triggering dynamical instabilities on planetary systems around white dwarfs
Authors: Maldonado R F , Villaver E , Mustill A J , Chávez M
Published: February 2022

Planets orbiting intermediate- and low-mass stars are in jeopardy as their stellar hosts evolve to white dwarfs (WDs) because the dynamics of the planetary system changes due to the increase of the planet:star mass ratio after stellar mass-loss. In order to understand how the planet multiplicity affects the dynamical stability of post-main sequence (MS) systems, we perform thousands of N-body simulations involving planetary multiplicity as the variable and with a controlled physical and orbital parameter space:equal-mass planets; the same orbital spacing between adjacent planet’s pairs; and orbits with small eccentricities and inclinations. We evolve the host star from the MS to the WD phase following the system dynamics for 10 Gyr. We find that the fraction of dynamically active simulations on the WD phase for two-planet systems is $10.2^{+1.2}_{-1.0}$–$25.2^{+2.5}_{-2.2}$ ${{\rm per\,cent}}$ and increases to $33.6^{+2.3}_{-2.2}$–$74.1^{+3.7}_{-4.6}$ ${{\rm per\,cent }}$ for the six-planet systems, where the ranges cover different ranges of initial orbital separations. Our simulations show that the more planets the system has, the more systems become unstable when the star becomes a WD, regardless of the planet masses and range of separations. Additional results evince that simulations with low-mass planets (1, 10 M⊕) lose at most two planets, have a large fraction of systems undergoing orbit crossing without planet losses, and are dynamically active for Gyr time-scales on the WD’s cooling track. On the other hand, systems with high-mass planets (100, 1000 M⊕) lose up to five planets, preferably by ejections, and become unstable in the first few hundred Myr after the formation of the WD.
Neoproterozoic Eclogite-to Granulite-Facies Transition in the Ubendian Belt, Tanzania, and the Timescale of Continental Collision
Authors: Morita Isamu , Tsujimori Tatsuki , Boniface Nelson , Flores Kennet E , Aoki Shogo , Aoki Kazumasa
Published: February 2022

In collision-type orogens, where high-pressure and ultrahigh-pressure (HP–UHP) metamorphism usually occurs, deeply subducted continental slabs with eclogitized mafic rocks often undergo recrystallization/overprinting with various geothermal gradients after the peak conditions at lower-to-middle-crustal levels. During the crustal stabilization, the transition from eclogite-to granulite-facies is common. We conducted metamorphic petrology and zircon geochronology on (1) bimineralic and (2) partially granulitized eclogites from the Neoproterozoic Ufipa Terrane (Southwestern Tanzania). Microtextural relationships and mineral chemistry define three metamorphic stages: eclogite metamorphism (M1), HP granulite-facies overprinting (M2), and amphibolite-facies retrogression (M3). The bimineralic eclogite has a basaltic composition and lacks M2 minerals. In contrast, the kyanite eclogite is characterized by a gabbro-dioritic whole-rock composition and contains inherited magmatic zircon. Although the matrix is highly granulitized, garnet and kyanite contain eclogite-facies mineral inclusions. Phase equilibria modeling revealed P–T conditions of 2.1–2.6 GPa and 650–860°C for the M1 stage and 1.4–1.6 GPa and 750–940°C for the M2 stage. Zircon with eclogite-facies mineral inclusions from the bimineralic eclogite lacks Eu anomaly in the REE patterns and yielded the M1 eclogite metamorphic age of 588 ± 3 Ma. Zircon overgrowths surrounding the inherited Paleoproterozoic magmatic cores in kyanite eclogite yielded 562 ± 3 Ma. A weak negative Eu anomaly in the REE patterns and the absence of eclogitic mineral inclusions suggest the zircon growths at the M2 HP granulite-facies metamorphic stage. These new data indicate an eclogite-to granulite-facies transition time of 26 ± 4 million years (Myr), suggesting a rate of HP rock exhumation toward a lower crustal level of 0.7–1.5 mm/year. Furthermore, the density evolution model indicates that buoyant host orthogneiss with low-density gabbro-dioritic eclogite plays an important role in carrying high-density basaltic eclogite. Our 2D thermomechanical modeling also suggests that a slab break-off with a lower angle subduction of <20° triggers the exhumation of the HP slab sliver with 20–30 Myr eclogite-to granulite transition time of large HP–UHP terranes in major collision zones.
Activation and negative feedback regulation ofSlHY5transcription by the SlBBX20/21–SlHY5 transcription factor module in UV-B signaling
Authors: Yang Guoqian , Zhang Chunli , Dong Huaxi , Liu Xiaorui , Guo Huicong , Tong Boqin , Fang Fang , Zhao Yiyang , Yu Yunji , Liu Yue , Lin Li , Yin Ruohe
Published: February 2022

In tomato (Solanum lycopersicum) and other plants, the photoreceptor UV-RESISTANCE LOCUS 8 regulates plant UV-B photomorphogenesis by modulating the transcription of many genes, the majority of which depends on the transcription factor ELONGATED HYPOCOTYL 5 (HY5). HY5 transcription is induced and then rapidly attenuated by UV-B. However, neither the transcription factors that activate HY5 transcription nor the mechanism for its attenuation during UV-B signaling is known. Here, we report that the tomato B-BOX (BBX) transcription factors SlBBX20 and SlBBX21 interact with SlHY5 and bind to the SlHY5 promoter to activate its transcription. UV-B-induced SlHY5 expression and SlHY5-controlled UV-B responses are normal in slbbx20 and slbbx21 single mutants, but strongly compromised in the slbbx20 slbbx21 double mutant. Surprisingly, UV-B responses are also compromised in lines overexpressing SlBBX20 or SlBBX21. Both SlHY5 and SlBBX20 bind to G-box1 in the SlHY5 promoter. SlHY5 outcompetes SlBBX20 for binding to the SlHY5 promoter in vitro, and inhibits the association of SlBBX20 with the SlHY5 promoter in vivo. Overexpressing 35S:SlHY5-FLAG in the WT background inhibits UV-B-induced endogenous SlHY5 expression. Together, our results reveal the critical role of the SlBBX20/21-SlHY5 module in activating the expression of SlHY5, the gene product of which inhibits its own gene transcription under UV-B, forming an autoregulatory negative feedback loop that balances SlHY5 transcription in plants.
Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial
Authors: Liew Bernard X W , de-la-Llave-Rincón Ana I , Scutari Marco , Arias-Buría José L , Cook Chad E , Cleland Joshua , Fernández-de-las-Peñas César
Published: February 2022

Objective

The purpose of this study was to develop a data-driven Bayesian network approach to understand the potential multivariate pathways of the effect of manual physical therapy in women with carpal tunnel syndrome (CTS).

Methods

Data from a randomized clinical trial (n = 104) were analyzed comparing manual therapy including desensitization maneuvers of the central nervous system versus surgery in women with CTS. All variables included in the original trial were included in a Bayesian network to explore its multivariate relationship. The model was used to quantify the direct and indirect pathways of the effect of physical therapy and surgery on short-term, mid-term, and long-term changes in the clinical variables of pain, related function, and symptom severity.

Results

Manual physical therapy improved function in women with CTS (between-groups difference: 0.09; 95% CI = 0.07 to 0.11). The Bayesian network showed that early improvements (at 1 month) in function and symptom severity led to long-term (at 12 months) changes in related disability both directly and via complex pathways involving baseline pain intensity and depression levels. Additionally, women with moderate CTS had 0.14-point (95% CI = 0.11 to 0.17 point) poorer function at 12 months than those with mild CTS and 0.12-point (95% CI = 0.09 to 0.15 point) poorer function at 12 months than those with severe CTS.

Conclusion

Current findings suggest that short-term benefits in function and symptom severity observed after manual therapy/surgery were associated with long-term improvements in function, but mechanisms driving these effects interact with depression levels and severity as assessed using electromyography. Nevertheless, it should be noted that between-group differences depending on severity determined using electromyography were small, and the clinical relevance is elusive. Further data-driven analyses involving a broad range of biopsychosocial variables are recommended to fully understand the pathways underpinning CTS treatment effects.

Impact

Short-term effects of physical manual therapy seem to be clinically relevant for obtaining long-term effects in women with CTS.
Exploring Inertial-Based Wearable Technologies for Objective Monitoring in Sports-Related Concussion: A Single-Participant Report
Authors: Powell Dylan , Stuart Samuel , Godfrey Alan
Published: February 2022

Objective

Challenges remain in sports-related concussion (SRC) assessment to better inform return to play. Reliance on self-reported symptoms within the Sports Concussion Assessment Tool means that there are limited data on the effectiveness of novel methods to assess a player’s readiness to return to play. Digital methods such as wearable technologies may augment traditional SRC assessment and improve objectivity in making decisions regarding return to play.

Methods

The participant was a male university athlete who had a recent history of SRC. The single-participant design consisted of baseline laboratory testing immediately after SRC, free-living monitoring, and follow-up supervised testing after 2 months. The primary outcome measures were from traditional assessment (eg, Sports Concussion Assessment Tool and 2-minute instrumented walk/gait test; secondary outcome measures were from remote (free-living) assessment with a single wearable inertial measurement unit (eg, for gait and sleep).

Results

The university athlete (age = 20 years, height = 175 cm, weight = 77 kg [176.37 lb]) recovered and returned to play 20 days after SRC. Primary measures returned to baseline levels after 12 days. However, supervised (laboratory-based) wearable device assessment showed that gait impairments (increased step time) remained even after the athlete was cleared for return to play (2 months). Similarly, a 24-hour remote gait assessment showed changes in step time, step time variability, and step time asymmetry immediately after SRC and at return to play (1 month after SRC). Remote sleep analysis showed differences in sleep quality and disturbance (increased movement between immediately after SRC and once the athlete had returned to play [1 month after SRC]).

Conclusion

The concern about missed or delayed SRC diagnosis is growing, but methods to objectively monitor return to play after concussion are still lacking. This report showed that wearable device assessment offers additional objective data for use in monitoring players who have SRC. This work could better inform SRC assessment and return-to-play protocols.

Impact

Digital technologies such as wearable technologies can yield additional data that traditional self-report approaches cannot. Combining data from nondigital (traditional) and digital (wearable) methods may augment SRC assessment for improved return-to-play decisions.

Lay Summary

Inertia-based wearable technologies (eg, accelerometers) may be useful to help augment traditional, self-report approaches to sports-related concussion assessment and management by better informing return-to-play protocols.
Competency-Based Education and Practice in Physical Therapy: It’s Time to Act!
Authors: Timmerberg Jean Fitzpatrick , Chesbro Steven B , Jensen Gail M , Dole Robin L , Jette Diane U
Published: February 2022

Competency-based education (CBE) is a concept, a philosophy, and an approach to educational design where learner progression occurs when competency is demonstrated. It assumes a set of standard defined performance outcomes for any level of professional practice—students, residents, or practicing physical therapists. Those outcomes are based on the health needs of society and guide the curricular design, implementation, and evaluation of health professions education programs. Lack of a CBE framework—with no required demonstration of competence throughout one’s career—has the potential to lead to variation in physical therapists’ skills and to unwarranted variation in practice, potentially hindering delivery of the highest quality of patient care. CBE requires a framework that includes a commonly understood language; standardized, defined performance outcomes at various stages of learner development; and a process to assess whether competence has been demonstrated. The purpose of this perspective article is to (1) highlight the need for a shared language, (2) provide an overview of CBE and the impetus for the change, (3) propose a shift toward CBE in physical therapy, and (4) discuss the need for the profession to adopt a mindset requiring purposeful practice across one’s career to safely and most efficiently practice in a given area. Utilizing a CBE philosophy throughout one’s career should ensure high-quality and safe patient care to all—patient care that can adapt to the changing scope of physical therapist practice as well as the health care needs of society. The physical therapy profession is at a point at which we must step up the transition to a competency-based system of physical therapist education.
Diameters of phloem sieve elements can predict stem growth rates of woody plants
Authors: Tang Yunjia , Yin Shijiao , Pace Marcelo R , Gerolamo Caian S , Nogueira Anselmo , Zuntini Alexandre R , Lohmann Lúcia G , Plath Martin , Liesche Johannes
Published: February 2022

Understanding forest dynamics is crucial to addressing climate change and reforestation challenges. Plant anatomy can help predict growth rates of woody plants, contributing key information on forest dynamics. Although features of the water-transport system (xylem) have long been used to predict plant growth, the potential contribution of carbon-transporting tissue (phloem) remains virtually unexplored. Here, we use data from 347 woody plant species to investigate whether species-specific stem diameter growth rates can be predicted by the diameter of both the xylem and phloem conducting cells when corrected for phylogenetic relatedness. We found positive correlations between growth rate, phloem sieve element diameter and xylem vessel diameter in liana species sampled in the field. Moreover, we obtained similar results for data extracted from the Xylem Database, an online repository of functional, anatomical and image data for woody plant species. Information from this database confirmed the correlation of sieve element diameter and growth rate across woody plants of various growth forms. Furthermore, we used data subsets to explore potential influences of biomes, growth forms and botanical family association. Subsequently, we combined anatomical and geoclimatic data to train an artificial neural network to predict growth rates. Our results demonstrate that sugar transport architecture is associated with growth rate to a similar degree as water-transport architecture. Furthermore, our results illustrate the potential value of artificial neural networks for modeling plant growth under future climatic scenarios.
Molecular diagnosis contribution for personalized medicine
Authors: Luengo Olga , Galvan-Blasco Paula , Cardona Victoria
Published: February 2022

Purpose of review

The purpose of the current review is to highlight the most recent findings in molecular allergy and its applicability in precision medicine for allergic patients.

Recent findings

Molecular allergy provides useful information in areas of respiratory allergy (house dust mites, pet dander and pollen allergy), food allergy (tree nuts, peanuts, fruits and vegetables), hymenoptera venom allergy and others, in order to improve management of patients. Regional differences in sensitization profiles, assay characteristics and interpretation of molecular sensitization in relation to whole extracts and total immunoglobulin E need to be taken into account. Studies of the impact of such strategies are needed.

Molecular allergy diagnosis represents a major contribution for personalized medicine. It aids in the assesment of risk prediction, disease severity, genuine/cross-reactive sensitization, and finally to apply precise management strategies.
Safety Issues Associated With the Clinical Application of PCSK9 Inhibitors: Current Findings
Authors: Wang Dan , Zhang Daqing
Published: February 2022

Reduction in low-density lipoprotein cholesterol levels is the cornerstone of treatment and prevention of atherosclerotic cardiovascular diseases. Currently, high-intensity statins are being used as the first-line therapy to lower low-density lipoprotein cholesterol levels, as they improve the prognosis of patients with atherosclerotic cardiovascular disease and those in high-risk groups. However, in some patients, the expected reduction in cholesterol is not achieved despite aggressive treatment with statins. Moreover, some patients cannot tolerate the dosage or show poor response or compliance to statins. Therefore, combination therapies with statins and other medications should be considered. Recently, several clinical trials have shown that the use of proprotein convertase subtilisin/kexin type 9 inhibitors with or without statins and/or other lipid-lowering drugs can significantly reduce low-density lipoprotein cholesterol levels, sometimes to extremely low levels. Therefore, to facilitate appropriate prescription of these new lipid-lowering drugs, we systemically evaluated the safety issues associated with these inhibitors and extremely low low-density lipoprotein cholesterol levels.
Perforator-based Adipofascial Flaps and ADM: A Novel Combined Approach to Distal Lower Extremity Defects
Authors: Losco Luigi , Sereni Simone , Aksoyler Dicle , Spadoni Davide , Bolletta Alberto , Cigna Emanuele
Published: February 2022

Background:

Due to the wide spectrum of lower extremity defect presentation, various reconstructive techniques are available. Classic adipofascial flaps are still a second choice. The authors described a new multistage reconstructive approach with perforator-based pedicled adipofascial flap.

Methods:

This retrospective study analyzed data of 23 patients undergoing adipofascial flap reconstruction after distal leg trauma between June 2017 and January 2020. A reconstructive approach with an adipofascial flap followed by a skin graft was used in all patients. Patients were divided into two treatment groups, and in only one treatment group, an acellular dermal matrix was placed above the adipofascial flap during the first stage of the reconstruction. Negative pressure wound therapy was applied to both groups. Surgical technique, outcomes, and complications were discussed.

Results:

All patients achieved complete healing, and no flap loss was reported. Minor complications occurred in four patients; all were treated conservatively on outpatient basis. The surgical and aesthetic results were evaluated as satisfactory from both patients and professionals. However, the group treated with acellular dermal matrix showed a lower complication rate, and resulted significantly more satisfied with the overall results and in several domains of the questionnaire administered postoperatively (P < 0.05).

Conclusions:

The adipofascial flap is a safe and effective approach for the reconstruction of small-to-medium-sized defects of the distal lower extremity. Our two-stage reconstructive approach maximizes the pearls offered by the established technique; the dermal matrix guarantees a layered reconstruction optimizing the surgical and aesthetic outcomes of the skin graft with minimal donor site morbidity.
THREE-YEAR TREATMENT OUTCOMES OF AFLIBERCEPT VERSUS RANIBIZUMAB FOR DIABETIC MACULAR EDEMA
Authors: Gabrielle Pierre-Henry , Nguyen Vuong , Creuzot-Garcher Catherine , Arnold Jennifer J. , Mehta Hemal , Duran Mónica Asencio , Bougamha Walid , Carreño Ester , Viola Francesco , Squirrell David , Barthelmes Daniel , Gillies Mark
Published: February 2022

Purpose:

Compare the 3-year outcomes of ranibizumab versus aflibercept in eyes with diabetic macular edema in daily practice.

Methods:

This was a retrospective analysis of naive diabetic macular edema eyes starting intravitreal injections of ranibizumab (0.5 mg) or aflibercept (2 mg) from January 1, 2013 to December 31, 2017 that were collected in the Fight Retinal Blindness! Registry.

Results:

We identified 534 eyes (ranibizumab—267 and aflibercept—267) of 402 patients. The adjusted mean (95% confidence interval) visual acuity change of +1.3 (−0.1 to 4.2) letters in the ranibizumab group and +2.4 (−0.2 to 5.1) letters (P = 0.001) in the aflibercept group at 3 years was not clinically different. However, the adjusted mean CST change seemed to remain significantly different throughout the 3-year period with higher reductions in favor of aflibercept (−87.8 [−108.3 to −67.4] µm for ranibizumab vs. −114.4 [−134.4 to −94.3] for aflibercept; P < 0.01). When baseline visual impairment was moderate (visual acuity ≤68 Early Treatment Diabetic Retinopathy Study letters), we found a faster improvement in visual acuity in eyes treated with aflibercept up until 18 months of treatment than eyes treated with ranibizumab, which then stayed similar until 36 months of treatment, whereas there was no apparent difference when baseline visual impairment was mild (visual acuity ≥69 Early Treatment Diabetic Retinopathy Study letters). The rate of serious adverse events was low.

Conclusion:

Aflibercept and ranibizumab were both effective and safe for diabetic macular edema over 3 years.
VALIDATION OF A DEEP LEARNING-BASED ALGORITHM FOR SEGMENTATION OF THE ELLIPSOID ZONE ON OPTICAL COHERENCE TOMOGRAPHY IMAGES OF AN USH2A-RELATED RETINAL DEGENERATION CLINICAL TRIAL
Authors: Loo Jessica , Jaffe Glenn J. , Duncan Jacque L. , Birch David G. , Farsiu Sina
Published: February 2022

Purpose:

To assess the generalizability of a deep learning-based algorithm to segment the ellipsoid zone (EZ).

Methods:

The dataset consisted of 127 spectral-domain optical coherence tomography volumes from eyes of participants with USH2A-related retinal degeneration enrolled in the RUSH2A clinical trial (NCT03146078). The EZ was segmented manually by trained readers and automatically by deep OCT atrophy detection, a deep learning-based algorithm originally developed for macular telangiectasia Type 2. Performance was evaluated using the Dice similarity coefficient between the segmentations, and the absolute difference and Pearson's correlation of measurements of interest obtained from the segmentations.

Results:

With deep OCT atrophy detection, the average (mean ± SD, median) Dice similarity coefficient was 0.79 ± 0.27, 0.90. The average absolute difference in total EZ area was 0.62 ± 1.41, 0.22 mm2 with a correlation of 0.97. The average absolute difference in the maximum EZ length was 222 ± 288, 126 µm with a correlation of 0.97.

Conclusion:

Deep OCT atrophy detection segmented EZ in USH2A-related retinal degeneration with good performance. The algorithm is potentially generalizable to other diseases and other biomarkers of interest as well, which is an important aspect of clinical applicability.
Examining the Implementation of the National Protocol for Sexual Assault Medical Forensic Examinations
Authors: Langness Mel , Zweig Janine M. , Tiry Emily , Henderson Erica , Stahlmann Nicole , Bastomski Sara
Published: February 2022

The National Protocol for Sexual Assault Medical Forensic Examinations, Adult/Adolescent, 2nd edition, or SAFE Protocol, is a voluntary guide that assists local and state jurisdictions with their responses to sexual assault by institutionalizing best practices around survivor care and evidence collection, particularly for sexual assault nurse examiners (SANEs) completing medical forensic examinations. We examined the uptake of the SAFE Protocol in communities across the United States by analyzing data from a set of national surveys of forensic nursing programs and victim advocates within the same communities. We studied four implementation outcomes: the acceptability, adoption, reach, and sustainability of the SAFE Protocol. SANEs and advocates reported that stakeholders responding to sexual assault—including forensic nurses, advocates, law enforcement, and prosecutors—have high implementation of the Protocol, which indicates how important individual stakeholder engagement is in actively facilitating the adoption of it. However, when information from SANEs and advocates from the same community are compared, the extent to which the SAFE Protocol is reported to be implemented with fidelity across U.S. jurisdictions is mixed.
Time-Varying Risk Factors Associated With the Progress of Functional Recovery and Psychological Distress in First-Ever Stroke Patients
Authors: Liu Kuei Fen , Lin Hung Ru , Lee Tzu-Ying , Lin Kuan Chia
Published: February 2022

BACKGROUND: Evaluation of stroke recovery outcome is crucial and a major goal of clinical practice. A recovery trajectory model serves as a prognostic tool that enables development of effective intervention and long-term management to improve poststroke recovery outcomes. This study explored time-varying risk factors associated with the progression of functional recovery and psychological distress poststroke. METHODS: Participants were patients with first-ever stroke who underwent assessment for activities of daily living, psychological distress, and social support at the onset (within 72 hours) and at 1, 3, and 6 months. A generalized estimation equation was used to account for the correlation between the repeated measurements. RESULTS: Of the 101 patients, 60.4% were men, and the mean (SD) age was 63.06 (13.12) years. Over time, the physical functions of patients after stroke significantly increased, and anxiety and depression significantly decreased. Approximately 50% of patients achieved full functional recovery after 6 months. The time-varying risk factors for National Institutes of Health Stroke Scale scores and depression levels affected the trajectory of functional recovery during follow-up. Factors associated with patient anxiety levels were National Institutes of Health Stroke Scale scores and depression levels. Factors associated with patient depression levels included education, anxiety, and social support levels. CONCLUSION: This study demonstrates the progression of time-varying risk factors for functional recovery and psychological distress in patients with first-ever stroke. We recommend that nurses work with patients and their families in the early poststroke stages to identify comprehensive goals based on individual needs and related factors at different stages and that they educate patients on what is required for them to regain independence.
Outcome of Total Colonic Aganglionosis Involving the Small Bowel Depends on Bowel Length, Liver Disease, and Enterocolitis
Authors: Payen Elise , Talbotec Cécile , Chardot Christophe , Capito Carmen , Khen‐Dunlop Naziha , Sarnacki Sabine , Lacaille Florence , Lambe Cecile , Goulet Olivier
Published: February 2022

Objectives:

Total colonic aganglionosis involving the small bowel is a rare form of Hirschsprung disease. We aim to analyse the long‐term outcomes, digestive autonomy, and complications, to suggest recommendations for prevention and treatment.

Methods:

All patients born between 2000 and 2015 followed in our centre were retrospectively included. We analysed the length of aganglionosis, surgical procedures, growth, duration of parenteral nutrition (PN), enterocolitis, liver disease, intestinal transplantation.

Results:

Twenty‐five patients were followed for a median of 10.9 years. Fifteen patients had less than 80 cm of ganglionic small bowel (SB) with a median of 20 cm. Ten patients had more than 80 cm of ganglionic sB with a median of 115 cm. The median PN duration was significantly shorter for patients with more than 80 cm: 0.9 versus 7.5 years in those with less than 80 cm (P < 0.001). No patient with less than 80 cm was weaned off PN, except 1 who underwent intestinal transplantation. Ten patients with less than 80 cm develop enterocolitis on the excluded segment, leading to emergency entero‐colectomy in 5. Liver disease was more frequent in patients with less than 80 cm (11 vs 0). Three patients required combined liver‐intestine transplantation; 2 underwent an isolated intestinal transplantation.

Conclusions:

Digestive autonomy was possible in most patients with more than 80 cm of ganglionic SB. The more severe complication was enterocolitis. Liver disease compromised long‐term survival without transplantation. Both complications should be prevented by early diversion and enterectomy of the whole aganglionic segment. Follow‐up in or together with a multidisciplinary intestinal rehabilitation centre is suggested.
Patterns of Healthcare Services Among Children With Advanced Cancer in Concurrent Hospice Care
Authors: Svynarenko Radion , Lindley Lisa C. , Mooney-Doyle Kim , Mendola Annette , Naumann Wendy C. , Mack Jennifer W.
Published: February 2022

Background

Children with advanced cancer have access to comprehensive cancer care and hospice care if they enroll in concurrent hospice care. However, little is known about the patterns of nonhospice healthcare services used by these children.

Objective

The aim of this study was to examine the patterns of nonhospice healthcare services among children with cancer in concurrent hospice care.

Methods

This study was a retrospective cohort analysis of 2011-2013 Medicaid claims data from 862 pediatric cancer patients. Data were analyzed using descriptive statistics and latent class analysis (LCA).

Results

Children used 120 388 healthcare services, including inpatient and outpatient hospital services, laboratories and x-rays, durable medical equipment, medications, and others. These services clustered into 2 classes with moderate-intensity (57.49%) and high-intensity (42.50%) healthcare service use. Children in the high-intensity cluster were more likely to reside in the South with comorbidities, mental/behavioral health conditions, and technology dependence and were less likely to have solid tumors, compared with the moderate-intensity group.

Conclusions

Nonhospice healthcare services clustered together in 2 distinct classes, providing critical insight into the complexity of the healthcare use among children with cancer in concurrent hospice care.

Implications for Practice

Understanding that pediatric patients in concurrent care may have different healthcare service patterns may assist oncology nurses caring for children with advanced cancer. These findings also have policy implications.
Implementing a Departure Lounge
Authors: Barone Melanie , Miller Jeremy , Long Meredith Sumi , Buckles Jenny , Hain Patricia , Dubovsky Alan , High Heidi , De La Cruz Pamela , Williams Marleen , Coleman Bernice
Published: February 2022

This column presents the development of a Departure Lounge at Cedars Sinai Medical Center as a mechanism to assist in addressing capacity constraints. Departure lounges have been presented as an option to improve hospital throughput by providing a safe space for discharged patients to wait once medical and nursing care has been completed.
Internship Program Receives Return on Investment From Nurse Professional Development Efforts
Authors: Roush Kelli , Opsahl Angela
Published: February 2022

Our current economy necessitates attention to nursing professional development programs that positively impact the fiscal budget. This project evaluated the cost-effectiveness of the patient care internship program designed to attract and retain nursing talent in a Midwest hospital system. Nurse leaders partnered with nursing faculty to recruit student nurses and prepare them to transition to the registered nurse role. The program had cost savings to the organization greater than $200,000 over a 2-year period.
Overview of Patient Safety Culture in Bosnia and Herzegovina With Improvement Recommendations for Hospitals
Authors: Draganović Šehad , Offermanns Guido
Published: February 2022

Objectives

This study investigates the patient safety culture (PSC) in Bosnia and Herzegovina (BiH). We identify factors that contribute to higher patient safety and improved reporting of adverse events, thereby developing recommendations to improve PSC.

Methods

The study used a correlation design based on cross-sectional surveys in the healthcare sector of BiH (N = 2617). We analyzed the correlation between 9 PSC factors, 4 background characteristics (explanatory variables), and 2 outcome variables (patient safety grade and number of events reported). We also analyzed the variance to determine perceived differences in PSC across the various staff roles in hospitals.

Results

The highest rated PSC factors were Hospital handoffs and transitions and Hospital management support for patient safety and the lowest rated factor was Nonpunitive response to error. Each of the 9 factors showed considerable potential to improve from a hospital, department, and outcome perspective. A comparison of the various employee positions shows significant differences in the PSC perceptions of managers versus nurses and doctors as well as nurses versus doctors.

Conclusions

We found average scores for most PSC factors, leaving the considerable potential for improvement. Compared with the number of events reported and background characteristics, it is evident that PSC factors contribute significantly to patient safety. These factors are essential for the targeted development of PSC. We propose evidence-based practices as recommendations for improving patients’ safety factors.