bluuebunny/crossref_metadata_2025 huggingface dataset:
Mandating the COVID-19 Vaccine for U.S. Service Members: An Exploration of Ethical Arguments
Authors: Krick Jeanne A , Reese Tyler R
Published: September 2021

As the COVID-19 pandemic continues across the globe, the advent of novel vaccines has created a possible path to prepandemic life for many. Still, many individuals, including those in the U.S. military, remain hesitant about getting vaccinated. The U.S. Food and Drug Administration recently granted full approval to the Pfizer-BioNTech mRNA vaccine (Comirnaty). Consistent with messaging from President Biden, the Department of Defense leadership has instructed the military to prepare for mandatory vaccination. While many have praised this declaration, others have raised concerns regarding the suppression of individual service member autonomy. This commentary explains the different ethical principles relevant to individual autonomy and how they are understood in a military context and then explores the ethical arguments both for and against mandating vaccination for all U.S. service members.
A panoramic view of the circumgalactic medium in the photoionized precipitation model
Authors: Roy Manami , Nath Biman B , Voit G M
Published: September 2021

We consider a model of the circumgalactic medium (CGM) in which feedback maintains a constant ratio of cooling time to free-fall time throughout the halo, so that the entire CGM is marginally unstable to multiphase condensation. This ‘precipitation model’ is motivated by observations of multiphase gas in the cores of galaxy clusters and the haloes of massive ellipticals. From the model, we derive the density and temperature profiles for the CGM around galaxies with masses similar to the Milky Way. After taking into consideration the geometrical position of our Solar system in the Milky Way, we show that the CGM model is consistent with observed O vi, O vii, O viii column densities and the ratio of O vii and O viii column densities only if temperature fluctuations with a lognormal dispersion σln T ∼ 0.6–1.0 are included. We show that O vi column densities observed around star-forming galaxies require systematically greater values of σln T than around passive galaxies, implying a connection between star formation in the disc and the state of the CGM. Photoionization by an extragalactic ultraviolet background radiation does not significantly change these CGM features for galaxies like the Milky Way but has much greater and significant effects on the CGM of lower mass galaxies.
Connections between galaxy properties and halo formation time in the cosmic web
Authors: Zhang Youcai , Yang Xiaohu , Guo Hong
Published: September 2021

By linking galaxies in Sloan Digital Sky Survey to subhaloes in the ELUCID simulation, we investigate the relation between subhalo formation time and the galaxy properties, and the dependence of galaxy properties on the cosmic web environment. We find that central and satellite subhaloes have different formation time, where satellite subhaloes are older than central subhaloes at fixed mass. At fixed mass, the galaxy stellar-to-subhalo mass ratio is a good proxy of the subhalo formation time, and increases with the subhalo formation redshifts, especially for massive galaxies. The subhalo formation time is dependent on the cosmic web environment. For central subhaloes, there is a characteristic subhalo mass of ${\sim}10^{12} \, \mathrm{ h}^{-1}\,{\rm M}_\odot$, below which subhaloes in knots are older than subhaloes of the same mass in filaments, sheets, or voids, while above which it reverses. The cosmic web environmental dependence of stellar-to-subhalo mass ratio is similar to that of the subhalo formation time. For centrals, there is a characteristic subhalo mass of ${\sim}10^{12} \, \mathrm{ h}^{-1}\,{\rm M}_\odot$, below which the stellar-to-subhalo mass ratio is higher in knots than in filaments, sheets and voids, above which it reverses. Galaxies in knots have redder colours below $10^{12} \, \mathrm{ h}^{-1}\,{\rm M}_\odot$, while above $10^{12} \, \mathrm{ h}^{-1}\,{\rm M}_\odot$, the environmental dependence vanishes. Satellite fraction is strongly dependent on the cosmic web environment, and decreases from knots to filaments to sheets to voids, especially for low-mass galaxies.
Optimal Mitigation Policies in a Pandemic: Social Distancing and Working from Home
Authors: Jones Callum , Philippon Thomas , Venkateswaran Venky
Published: September 2021

We study an economy’s response to an unexpected epidemic. The spread of the disease can be mitigated by reducing consumption and hours worked in the office. Working from home is subject to learning-by-doing. Private agents’ rational incentives are relatively weak and fatalistic. The planner recognizes infection and congestion externalities and implements front-loaded mitigation. Under our calibration, the planner reduces cumulative fatalities by 48$\%$ compared to 24$\%$ by private agents, although with a sharper drop in consumption. Our model can replicate key industry and/or occupational-level patterns and explain how large variations in outcomes across regions can stem from small initial differences.
Estradiol influences adenosinergic signaling and nonrapid eye movement sleep need in adult female rats
Authors: Smith Philip C , Phillips Derrick J , Pocivavsek Ana , Byrd Carissa A , Viechweg Shaun S , Hampton Brian , Mong Jessica A
Published: September 2021

Gonadal steroids and gender are risk factors for sleep disruptions and insomnia in women. However, the relationship between ovarian steroids and sleep is poorly understood. In rodent models, estradiol (E2) suppresses sleep in females suggesting that E2 may reduce homeostatic sleep need. The current study investigates whether E2 decreases sleep need and the potential mechanisms that govern E2 suppression of sleep. Our previous findings suggest that the median preoptic nucleus (MnPO) is a key nexus for E2 action on sleep. Using behavioral, neurochemical, and pharmacological approaches, we tested whether (1) E2 influenced the sleep homeostat and (2) E2 influenced adenosine signaling in the MnPO of adult female rats. In both unrestricted baseline sleep and recovery sleep from 6-h sleep deprivation, E2 significantly reduced nonrapid eye movement (NREM) sleep-delta power, NREM-slow wave activity (NREM-SWA, 0.5–4.0 Hz), and NREM-delta energy suggesting that E2 decreases homeostatic sleep need. However, coordinated with E2-induced changes in physiological markers of homeostatic sleep was a marked increase in MnPO extracellular adenosine (a molecular marker of homeostatic sleep need) during unrestricted and recovery sleep in E2-treated but not oil control animals. While these results seemed contradictory, systemically administered E2 blocked the ability of CGS-21680 (adenosine A2A receptor agonist) microinjected into the MnPO to increase NREM sleep suggesting that E2 may block adenosine signaling. Together, these findings provide evidence that E2 may attenuate the local effects of the A2A receptors in the MnPO, which in turn may underlie estrogenic suppression of sleep behavior as well as changes in homeostatic sleep need.
Variation in type two taste receptor genes is associated with bitter tasting phenylthiocarbamide consumption in mature Targhee and Rambouillet rams
Authors: Davenport Kimberly M , Taylor J Bret , Henslee Dillan , Southerland Claire , Yelich Joel , Ellison Melinda J , Murdoch Brenda M
Published: September 2021

Bitter taste perception in sheep can lead to avoidance of specific types of forage, such as sagebrush, which is present on many rangeland grazing systems in the Intermountain West. In humans, bitter taste perception is influenced by variation in several TAS2R genes, including more extensively studied TAS2R38 and TAS2R16. We hypothesize that variation in taste receptor genes in sheep is associated with bitter taste. Therefore, the objective of this study was to examine variation in TAS2R genes in relation to consumption of a bitter tasting compound phenylthiocarbamide (PTC) which determines bitter “taster” and “non-taster” status in humans. Rambouillet and Targhee rams (n = 26) were offered various concentrations of PTC solution (0.2–12.29 mM) and water in a side-by-side presentation during two experiments. Blood was collected for DNA isolation and sequencing. Nineteen TAS2R genes were amplified and sequenced with long read Oxford Nanopore MinION technology. A total of 1,049 single nucleotide polymorphisms (SNPs) and 26 haplotypes were identified in these genes. Of these, 24 SNPs and 11 haplotypes were significantly (P < 0.05) associated with PTC consumption in TAS2R3, TAS2R5, TAS2R8, TAS2R9, TAS2R16, TAS2R31-like, TAS2R38, TAS2R39, and TAS2R42-like. Over 50% of the SNPs resulted in a change in amino acid sequence and several resided in potential regulatory regions, which could have downstream functional consequences and influence bitter taste perception in sheep. Further research is needed to validate these associations and elucidate the mechanisms that link variation in TAS2R genes to bitter taste perception in sheep. This may enable producers to select sheep more likely to consume bitter forage such as sagebrush as a flock and rangeland management strategy.
VII Shakespeare
Authors: Rendall Edward B M , Smith Peter J , Parsons Elinor , Tarantino Elisabetta , Stelzer Emanuel , Bell Shirley , Haworth Ben , Lim Vanessa , O’Brien Sheilagh Ilona , Wilkinson Kate
Published: September 2021

This chapter has four sections: 1. Editions and Textual Studies; 2. Shakespeare in the Theatre; 3. Shakespeare on Screen; 4. Criticism. Section 1 is by Edward B.M. Rendall; section 2 is by Peter J. Smith; section 3 is by Elinor Parsons; section 4(a) is by Elisabetta Tarantino; section 4(b) is by Emanuel Stelzer; section 4(c) is by Shirley Bell; section 4(d) is by Ben Haworth; section 4(e) is by Vanessa Lim; section 4(f) is by Sheilagh Ilona O'Brien; section 4(g) is by Kate Wilkinson.
Are Surgical Guideline Changes in Diverticulitis Care Associated With Decreased Inpatient Healthcare Expenditure?
Authors: Lin Saunders , Dewey Elizabeth N. , Tsikitis V. Liana
Published: September 2021

Objective:

To examine possible associations in inpatient healthcare expenditure and guideline changes in the surgical management of diverticulitis, in terms of both cost per discharge and total aggregate costs of care.

Background:

Medical costs throughout the healthcare system continue to rise due to increased prices for services, increased quantities of high-priced technologies, and an increase in the amount of overall services.

Methods:

We used a retrospective case-control design using the Healthcare Cost and Utilization Project National Inpatient Sample to evaluate cost per discharge and total aggregate costs of diverticulitis management between 2004 and 2015. The year 2010 was selected as the transition between the pre and postguideline implementation period.

Results:

The sample consisted of 450,122 unweighted (2,227,765 weighted) inpatient discharges for diverticulitis. Before the implementation period, inpatient costs per discharge increased 1.13% in 2015 dollars (95% confidence intervals [CI] 0.76% to 1.49%) per quarter. In the postimplementation period, the costs per discharge decreased 0.27% (95% CI –0.39% to –0.15%) per quarter. In aggregate, costs of care for diverticulitis increased 0.61% (95% CI 0.28% to 0.95%) per quarter prior to the guideline change, and decreased 0.52% (95% CI –0.87% to –0.17) following the guideline change.

Conclusions:

This is the first study to investigate any associations between evidence-based guidelines meant to decrease surgical utilization and inpatient healthcare costs. Decreased inpatient costs of diverticulitis management may be associated with guideline changes to reduce surgical intervention for diverticulitis, both in regards to cost per discharge and aggregate costs of care.
Unilateral Sacral Fractures Demonstrate Slow Recovery of Patient-Reported Outcomes Irrespective of Treatment
Authors: Mullis Brian H. , Agel Julie , Jones Clifford , Lowe Jason , Vallier Heather , Teague David , Kempton Laurence , Schmidt Andrew , Friess Darin , Morshed Saam , Miller Anna N. , Leighton Ross , Tornetta Paul
Published: September 2021

Objectives:

To report functional outcomes of unilateral sacral fractures treated both operatively and nonoperatively.

Design:

Prospective, multicenter, observational study.

Setting:

Sixteen Level 1 trauma centers.

Patients/Participants:

Skeletally mature patients with unilateral zone 1 or 2 sacral fractures categorized as displaced nonoperative (DN), displaced operative (DO), nondisplaced nonoperative (NN), and nondisplaced operative (NO).

Main Outcome Measurements:

Pelvic displacement was documented on injury plain radiographs. Short Musculoskeletal Function Assessment (SMFA) scores were obtained at baseline and at 3, 6, 12, and 24 months after injury. Displacement was defined as greater than 5 mm in any plane at the time of injury.

Results:

Two hundred eighty-six patients with unilateral sacral fractures were initially enrolled, with a mean age of 40 years and mean injury severity score of 16. One hundred twenty-three patients completed the 2-year follow-up as follows: 29 DN, 30 DO, 47 NN, and 17 NO with 56% loss to follow-up at 2 years. Highest dysfunction was seen at 3 months for all groups with mean SMFA dysfunction scores: 25 DN, 28 DO, 27 NN, and 31 NO. The mean SMFA scores at 2 years for all groups were 13 DN, 12 DO, 17 NN, and 17 NO.

Conclusions:

All groups (operative/nonoperative and displaced/nondisplaced) reported worst function 3 months after injury, and all but (DN) continued to recover for 2 years after injury, with peak recovery for DN seen at 1 year. No functional benefit was seen with operative intervention for either displaced or nondisplaced injuries at any time point.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Subspecialty Fellowship Training Is Not Associated With Better Outcomes in Fixation of Low-Energy Femoral Neck Fractures—An Analysis of the Fixation Using Alternative Implants for the Treatment of Hip Fractures Database
Authors: DeAngelis Ryan D. , Stein Matthew K. , Minutillo Gregory T. , Mehta Nikhilesh G. , Schemitsch Emil H. , Bzovsky Sofia , Sprague Sheila , Bhandari Mohit , Swiontkowski Marc , Donegan Derek J. , Mehta Samir ,   on behalf of the FAITH Investigators
Published: September 2021

Objectives:

To compare risk of reoperation for femoral neck fracture patients undergoing fixation with cancellous screws (CSs) or sliding hip screws based on surgeon fellowship (trauma-fellowship-trained vs. non–trauma-fellowship-trained).

Design:

Retrospective review of Fixation using Alternative Implants for the Treatment of Hip fractures data.

Setting:

Eighty-one centers across 8 countries.

Patients/Participants:

Eight hundred nineteen patients ≥50 years old with low-energy hip fractures requiring surgical fixation.

Intervention:

Patients were randomized to CS or sliding hip screw group in the initial dataset.

Main Outcome Measurements:

The primary outcome was risk of reoperation. Secondary outcomes included death, serious adverse events, radiographic healing, discharge disposition, and use of ambulatory devices postoperatively.

Results:

There was no difference in risk of reoperation between the 2 surgeon groups (P > 0.05). Patients treated by orthopaedic trauma surgeons were more likely to be overweight/obese and have major medical comorbidities (P < 0.05). There was a higher risk of serious adverse events, higher likelihood of radiographic healing, and higher odds of discharge to a facility for patients treated by trauma-fellowship-trained surgeons (P < 0.05).

Conclusions:

Based on these data, risk of reoperation for low-energy femoral neck fracture fixation is equivalent regardless of fellowship training. The higher likelihood of radiographic healing noted in the trauma-trained group does not seem to have a major clinical implication because it did not affect risk of reoperation between the 2 groups. Patient-specific factors present preinjury, such as body habitus and medical comorbidities, may account for the lower odds of discharge to home and higher risk of postoperative medical complications for patients treated by orthopaedic trauma surgeons.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Targeting cyclin-dependent kinase 4/6 as a therapeutic approach for mucosal melanoma
Authors: Shi Chao-ji , Xu Sheng-ming , Han Yong , Zhou Rong , Zhang Zhi-yuan
Published: September 2021

Mucosal melanoma is a rare but devastating subtype of melanoma which typically has a worse prognosis than other melanoma subtypes. Large-scale next-generation sequencing studies, including our recent research, have also proved that the molecular landscape and potential oncogenic drivers of mucosal melanoma remain distinct from that of cutaneous melanoma. Recently, a number of selective cyclin-dependent kinase 4 (CDK4)/6 inhibitors have been approved for clinical application in breast cancer or entered phase III clinical trial in other solid tumors. Additionally, we have revealed that the dysregulation of cell cycle progression, caused by CDK4 amplification, is a key genetic feature in half of mucosal melanoma and targeting of CDK4 in selected mucosal melanoma patients is a potentially promising direction for precision cancer treatment by using molecular-characterized mucosal melanoma patient-derived-xenograft models. This review summarizes the current literature regarding CDK4/6 dysregulation in mucosal melanoma, preclinical and clinical studies of CDK4/6 inhibitors and potential combinational strategies in treating mucosal melanoma.
The anti-nociceptive activity of naringenin passes through L-arginine/NO/cGMP/KATP channel pathway and opioid receptors
Authors: Moradi Naser , Fakhri Sajad , Farzaei Mohammad Hosein , Abbaszadeh Fatemeh
Published: September 2021

As a promising flavonoid, naringenin has shown potential anti-inflammatory and antioxidant properties mainly in inflammatory pain models by oral administration. Therefore, we investigated the antinociceptive activity of this compound by intraperitoneally (i.p.) administration, as well as, associated mechanism of action considering the involvement of L-arginine/nitric oxide (NO)/cyclic GMP (cGMP)/potassium channel (KATP) pathway and opioid receptors. The antinociceptive effect of naringenin was evaluated in male NMRI mice using formalin test at early and late phases. To assess the involvement of L-arginine/NO/cGMP/KATP pathway and opioid receptors, mice were pretreated i.p. with L-arginine (NO precursor), S-nitroso-N-acetylpenicillamine (SNAP, NO donor), N(gamma)-nitro-L-arginine methyl ester (L-NAME, inhibitor of nitric oxide synthase), sildenafil (inhibitor of phosphodiesterase enzyme), glibenclamide (KATP channel blocker) and naloxone (an opioid receptor antagonist), respectively 20 min before administration of the most effective dose of naringenin. Naringenin showed a dose-dependent antinociceptive effect at both early and late phases of the formalin test. The dose of 100 mg/kg of naringenin was identified as the most effective dose and selected for further experiments. Our mechanistic evaluations showed that L-arginine, SNAP and sildenafil could enhance the antinociceptive effects of naringenin, revealing the critical role of NO and cGMP during its antinociceptive effect. On the other hand, glibenclamide and naloxone could mitigate the antinociceptive potential of naringenin at both phases of formalin test, which confirmed the associated role of KATP channels and opioid receptors. In conclusion, naringenin could be a promising antinociceptive agent acting through opioid receptors and L-arginine/NO/cGMP/KATP channel pathway.
Compounded Bioidentical Hormones: Myths and Realities
Authors: Santoro Nanette , Liss Jill
Published: September 2021

The spectacular success of compounded bioidentical hormone therapy is a product of the unanticipated negative-to-neutral findings of the Women’s Health Initiative hormone trial and the peculiarities of their regulatory status. By not having to provide scientific evidence of safety and efficacy, a requirement for all Food and Drug Administration (FDA)-approved hormone therapy products, the industry’s relatively unfettered marketing now accounts for about one third of menopausal hormone therapy prescriptions. Clinicians are often caught in the middle between patient beliefs and a desire to practice evidence-based medicine. Strategies are needed to redirect patients towards truly safe and effective treatment for their menopausal symptoms.
Coronary plaque features on CTA can identify patients at increased risk of cardiovascular events
Authors: Andreini Daniele , Conte Edoardo , Serruys Patrick W.
Published: September 2021

Purpose of review

Multicenter studies showed that the characterization of coronary atherosclerosis by coronary computed tomography (CT) angiography (CCTA) provides independent and incremental prognostic value above and beyond traditional measures of coronary artery disease (CAD) and is able to identify patients at risk of future event. Aim of the present review is to expound the major imaging plaque features associated with increased risk of coronary event and to review the data supporting the usefulness of CCTA as tool for plaque assessment and for monitoring the changes in atherosclerotic burden.

Recent findings

The evaluation of coronary atherosclerosis, including the measurement of imaging risk scores (e.g. CT-adapted Leaman score) was demonstrated as independent long-term predictor of acute coronary events. In particular, qualitative (remodelling index, low-attenuation plaque, napkin-ring sign, small spotty calcifications) and quantitative (plaque burden, total-, noncalcific- and fibrofatty plaque volume) plaque features were associated with increased risk. CCTA was also demonstrated to accurately quantify plaque volume vs. intravascular ultrasound and findings from PARADIGM and EVAPORATE studies supported the use of CCTA as noninvasive tool to follow the effect of medication on plaque progression/regression. Finally, interesting relationship between plaque features, coronary physiology and biomarkers have been described.

Latest guidelines on the management of patients with stable CAD recommended CCTA in Class I of evidence, particularly when ‘information on atherosclerosis are desired’, underlining the usefulness of CCTA to characterize and quantify the atherosclerotic burden.
OCULAR MANIFESTATIONS OF ASP38ALA AND THR59LYS FAMILIAL TRANSTHYRETIN AMYLOIDOSIS
Authors: Choi Kyung Jun , Son Ki Young , Kang Se Woong , Kim Darae , Choi Jin Oh , Kim Hee Jin , Kim Jung Sun , Jeon Eun Seok , Kim A Young , Kang Min Chae , Kim Sang Jin
Published: September 2021

Purpose:

To describe the ophthalmic manifestations of familial transthyretin amyloidosis (FTA) mutations, including Asp38Ala and Thr59Lys, which have not been previously reported to have ocular involvement.

Methods:

This is an observational case series of prospectively collected data of 16 patients with FTA who were taking tafamidis for mild peripheral neuropathy and underwent a comprehensive ophthalmic examination at a single tertiary center, between January 2013 and March 2020. The ocular involvement of each FTA mutation type and the specific manifestations were the main outcome measures.

Results:

Six of 16 patients with FTA manifested ocular involvement. Ocular involvement was noted in two of three patients with Glu89Lys mutations having retinal deposits, retinal hemorrhages, and corneal opacity. Three of nine patients with Asp38Ala mutations and one of two patients with Thr59Lys mutations showed ocular involvement that had not been previously described. The ophthalmic findings included glaucoma, anterior lens capsule opacity, vitreous opacity, and retinal deposits. The decrease in vascular flow due to perivascular cuffing of the amyloid deposits was detected by optical coherence tomography angiography.

Conclusion:

The current study newly described that two transthyretin mutation types of FTA, Asp38Ala and Thr59Lys, may manifest with ocular findings such as anterior lens capsule opacity and retinal deposits.
COST ANALYSIS OF SCLERAL BUCKLE, PARS PLANA VITRECTOMY, AND PARS PLANA VITRECTOMY WITH SCLERAL BUCKLE FOR RETINAL DETACHMENT REPAIR
Authors: Belin Peter J. , Yannuzzi Nicholas A. , Wagley Sushant , Smiddy William E. , Ryan Edwin H.
Published: September 2021

Purpose:

To compare the cost and utility of scleral buckle (SB), pars plana vitrectomy (PPV), and PPV with SB (PPV/SB) for moderately complex rhegmatogenous retinal detachment repair.

Methods:

Cost-utility analysis using data from the Primary Retinal Detachment Outcomes Study. The model estimated costs, lifetime utility, and lifetime cost per quality-adjusted life year for treatment of moderately complex rhegmatogenous retinal detachment with SB, PPV, or PPV/SB. Data from the Centers for Medicare and Medicaid Services were used to calculate costs in hospital and ambulatory surgery center settings.

Results:

Total costs (2020 US dollars) for repair of a moderately complex rhegmatogenous retinal detachment in hospital (ambulatory surgery center) settings were $5,975 ($3,774) for the SB group, $8,125 ($5,082) for the PPV group, and $7,551 ($4,713) for the PPV/SB group. The estimated lifetime quality-adjusted life years gained were 5.4, 4.7, and 4.7 in the SB, PPV, and PPV/SB groups, respectively. The cost per quality-adjusted life year for hospital and ambulatory surgery center settings was $1,106 a ($699) for the SB group, $1729 ($1,081) for the PPV group, and $1,607 ($1,003) for the PPV/SB group.

Conclusion:

Scleral buckle, PPV, and PPV/SB yielded very favorable cost-utility results for the repair of moderately complex rhegmatogenous retinal detachment, with slightly better results for SB, compared with current willingness to pay standards.
Use of Topical Cyclosporine 0.1% in Therapeutic Penetrating Keratoplasty for Fungal Keratitis
Authors: Chatterjee Samrat , Agrawal Deepshikha
Published: September 2021

Purpose:

The efficacy and safety of topical cyclosporine 0.1% in preventing early graft failure after therapeutic penetrating keratoplasty (TPK) in eyes with fungal keratitis were evaluated.

Methods:

This prospective case series included patients with fungal keratitis undergoing TPK from May to December 2019 who were treated with cyclosporine A 0.1% eye drops (tCSA group). We compared the outcome with a historical cohort of patients who were treated conventionally (CT group) with topical prednisolone acetate 1% eye drops started 3 weeks after surgery.

Results:

There were 20 patients (male: 13; female: 7) in the tCSA group and 28 patients in the CT group (male: 23; female: 5). The number of clear grafts 3 months postoperatively was 10 (50%) in the tCSA group and 4 (14.3%) in the CT group (P = 0.011). The mean logarithm of the minimum angle of resolution best-corrected visual acuity was 1.49 ± 0.74 in the tCSA group and 2.10 ± 0.62 in the CT group (P = 0.003). There were 5 patients (17.9%) with recurrence of the primary fungal infection in the CT group, 4 of whom were using topical prednisolone. There was no recurrence in the tCSA group. A logistic regression analysis revealed higher odds of a clear graft at 3 months postoperatively with topical cyclosporine 0.1% [odds ratio: 14.35 (95% confidence interval, 2.38–86.5), P = 0.004].

Conclusions:

Postoperative treatment with topical cyclosporine 0.1% seems to increase graft survival and postoperative vision with reduced risk of recurrence of primary infection in eyes with fungal keratitis undergoing TPK.
Acute Keratoconjunctivitis Resulting From Coinfection With Avian Newcastle Virus and Human Adenovirus
Authors: Prajna N. Venkatesh , Lalitha Prajna , Chen Cindi , Zhong Lina , Lietman Thomas M. , Doan Thuy , Seitzman Gerami D.
Published: September 2021

Purpose:

The aim of this study was to report a case of human keratoconjunctivitis caused by both Newcastle disease virus (NDV) and human adenovirus.

Methods:

A 32-year-old-man presented with an acute unilateral keratoconjunctivitis that resolved with corneal scarring. On presentation, his conjunctival swab was collected for metagenomic sequencing.

Results:

The highest number of pathogen sequencing reads in the conjunctival sample mapped to the NDV. The second highest number of reads mapped to human adenovirus. Confirmation testing with directed reverse-transcription polymerase chain reaction also identified NDV in the specimen.

Conclusions:

Newcastle conjunctivitis has not been reported for more than 40 years. Mixed infections, including zoonotic pathogens, may be more common than realized.
Examining Corneal Tissue Exportation Fee and Its Impact on Equitable Allocation
Authors: Machin Heather , Sutton Gerard , Baird Paul N.
Published: September 2021

Although an estimated 23% of all global corneal transplants occur because corneal tissue is moved from one nation to another (export and import), the fee structures, fees charged, and use of reimbursement or profit models, to support this practice, have not been evaluated. This article describes the fee structures and determines whether they support or hinder the equitable allocation of corneal tissue.

Methods:

We conducted grounded theory semistructured interviews, purposively inviting participants until themed saturation was met. Sentiment analysis was used to determine opinion.

Results:

We interviewed n = 92 global eye tissue and eye bank professionals. We determined that corneal tissue, which is exported, costs between US $100 and US $6000 or is provided as gratis. Collectively, interviewees indicated that, globally, there were no fixed fee structures in place, and the fee was influenced by multiple factors on both export and import sides. They indicated that ultimately corneas were allocated based on the importers' ability to pay the price determined by the exporting eye bank.

Discussion:

Allocation of corneal tissue, which is exported, is influenced by the fees charged by the exporters to meet their bottom line and the funds available to importers. Therefore, export allocation is not equitable, with those who can pay a higher fee, prioritized. Steps to guide and support exporters with the development of fee structures that promote equitable allocation are essential. This will assist both export and import eye bank development, corneal tissue access development, and those awaiting a corneal transplant.
Bronchoscopy and Pathology Findings in an Unusual Case of Allergic Bronchopulmonary Mycosis
Authors: Li Yongqun , Zhang Caiyun , Zhang Chunyang
Published: September 2021

The diagnosis of allergic bronchopulmonary mycosis (ABPM) is usually made on clinical, serologic, and roentgenographic findings. However, the indicators in such diagnostic criteria still lack specificity, which results in a high rate of misdiagnosis. A 47-year-old woman was diagnosed with “tuberculosis” or “pneumonia” for 10 years and after thoracoscopic right upper lung resection the following chest CT showed right lung atelectasis. Brown sputum was seen in the right bronchus via bronchoscopy. Reviewing the surgical pathology specimen, the bronchi were found to be generally cystic dilated, and a large amount of mucus was retained and formed a mucus plug. The final diagnosis of the case was ABPM. The current diagnostic criteria of ABPM do not emphasize the role of bronchoscopy and pathological examination, but bronchoscopy and pathological examination still have important value for some atypical cases with suspected ABPM.
Addressing Lesbian, Gay, Bisexual, Transgender, and Queer Health in Physical Therapy Education
Authors: Morton Ryan C. , Ge Weiqing , Kerns Lucy , Rasey Jacob
Published: September 2021

Introduction.

The objectives were to determine doctor of physical therapy (DPT) student comfort level, attitudes, and preparedness to address lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health in the United States.

Methods.

The research design was a cross-sectional nonexperimental national survey of DPT students in the United States The survey was administered online using SurveyGizmo. Participants included 1,015 DPT students.

Results.

Most respondents (91.7%, n = 931) reported that they felt comfortable treating patients who identify as lesbian, gay, and bisexual and 75.7% (n = 768) indicated that they felt comfortable treating patients who identify as transgender. An overwhelming majority (96.7%, n = 982) agreed that it was the responsibility of all health care providers to care for patients who identify as LGBTQ+. Conversely, only 20.6% (n = 209) agreed that their entry-level DPT programs had prepared them to care for patients who identify as LGBTQ+. About two-thirds of the respondents (66.0%, n = 670) indicated that they were interested in receiving further education about LGBTQ+ health. Ordinal logistic regression analysis indicated that some demographical factors, including age, gender, number of years in a physical therapy program, and respondent's sexual orientation, had impacts on some of the responses with statistical significance.

Discussion.

Doctor of physical therapy students reported high comfort level and positive attitudes toward patients who identify as LGBTQ+ but feel underprepared by their entry-level DPT programs to treat this population and demonstrate an interest in more training.

Conclusion.

Improvements in education on LGBTQ+ health are needed in entry-level DPT programs to provide high-quality graduates as workforce in the health care system.
Introducing the American Society for Bone and Mineral Research multistakeholder group secondary fracture prevention recommendations: Nurse practitioners play an important role
Authors: Alexander Ivy M. , Bowka Linda , Hannafon Freda , Lake Anne , Williams Kathy , Woodburn Marcia
Published: September 2021

Sequelae after an osteoporosis-related fracture include significant morbidity and mortality. Preventing repeat fractures is an important aspect of mitigating these sequelae. As highlighted in the American Society for Bone and Mineral Research multistakeholder coalition's Secondary Fracture Prevention: Consensus Clinical Recommendations, nurse practitioners play an important role in secondary fracture prevention. With a focus on education, longitudinal relationships with patients, and expertise in coordinating and managing care, nurse practitioners are uniquely qualified to run Fracture Liaison Services and help close the gap to care in secondary fracture prevention.
Emerging clinical perspectives in cystic fibrosis liver disease
Authors: Athwal Varinder S. , Scott Jennifer A. , Fitzpatrick Emer , Rowland Marion
Published: September 2021

Purpose of review

Liver disease (CFLD) as a complication of cystic fibrosis is recognized as a more severe disease phenotype in both children and adults. We review recent advances in understanding the disease mechanism and consider the implications of new strategies for the diagnosis and management of cystic fibrosis in those with evidence of clinically significant liver disease.

Recent findings

Evidence suggests that the prevalence of CFLD has not declined with the introduction of newborn screening. Furthermore, children with CFLD, who have been diagnosed with cystic fibrosis following newborn screening continue to have a much higher mortality rate compared with those with no liver disease. There is further data suggesting noncirrhotic obliterative portal venopathy as the predominant pathological mechanism in the majority of children and young adults receiving a liver transplantation. Little progress has been made in developing an accurate noninvasive test for early diagnosis or monitoring disease progression in CFLD. The benefit of new modulator therapies is not well understood in those with established CFLD, whereas the risk of hepatotoxicity as a complication of treatment must be carefully monitored.

Better understanding of the pathophysiology of CFLD would allow a standardized approach to diagnosis, with the potential to improve outcomes for those with CFLD.
Plasma and urine biomarkers in chronic kidney disease: closer to clinical application
Authors: Zabetian Azadeh , Coca Steven G.
Published: September 2021

Purpose of review

Chronic kidney disease (CKD) is a silent disease, causing significant health and economic burden worldwide. It is of strong clinical value to identify novel prognostic, predictive, and pharmacodynamic biomarkers of kidney function, as current available measures have limitations. We reviewed the advances in biomarkers in CKD over the preceding year.

Recent findings

The most frequently studied prognostic plasma biomarkers during recent year were plasma TNFR1, TNFR2, KIM1 and urinary MCP-1 and EGF. New biomarkers such as plasma WFDC2, MMP-7, EFNA4, EPHA2 may also have potential to serve as prognostic biomarkers. There is a shortage of data on biomarkers that are predictive of response to treatments. Data on novel biomarkers to serve as pharmacodynamic biomarkers are limited, but there are emerging data that plasmaTNFR1, TNFR2, KIM-1 are not only prognostic at baseline, but can also contribute to time-updated response signals in response to therapy.

Data continue to emerge on applicable biomarkers for prognostic clinical risk stratification, prediction of therapeutic response and assessment of early efficacy of interventions. Although more studies are needed for refinement and specific clinical utility, there seems to be sufficient data to support clinical implementation for some biomarkers.
Lifestyle interventions for preventing and ameliorating CKD in primary and secondary care
Authors: Kelly Jaimon T. , Su Guobin , Carrero Juan-Jesus
Published: September 2021

Purpose of review

Despite the growth in chronic kidney disease (CKD) epidemics, evidence-based lifestyle recommendations for primary prevention of CKD are limited by reliance on observational studies and predominantly pilot clinical trials.

Recent findings

Emerging data have shown lifestyle modification strategies for primary CKD prevention with the most evidence favoring a healthy dietary pattern (rich in fruit, vegetables, potassium and have a higher plant-based to animal protein ratio), and diet low in sodium, being physically active, avoiding tobacco smoking, moderating alcohol consumption and maintaining a healthy body weight. The way these behavioral interventions can be implemented in practice should consider their synergistic benefit as well as mechanisms to facilitate long-term behavior change. Sustaining long-term behavior change remains a challenge in practice, particularly due to a lack of healthcare resources and behavior relapse. Some suggestions to mitigate this include ensuring adequate time is spent in intervention codesign and planning, utilizing adaptive trial/intervention designs with regular intervention tailoring for intervention dose, intensity, duration, and modality.

A number of modifiable lifestyle behaviors consistently associate with developing CKD in the community. The current evidence base, despite its inherent limitations, may inform both public health recommendations and clinical practice.
Role of gut–kidney axis in renal diseases and IgA nephropathy
Authors: Monteiro Renato C. , Berthelot Laureline
Published: September 2021

Purpose of review

Growing evidence show the importance of gut/kidney axis in renal diseases. Advances in gut microbiome sequencing, associated metabolites, detection of gut permeability and inflammation provide new therapeutic strategies targeting gut for kidney diseases and particularly for Immunoglobulin A (IgA) nephropathy (IgAN).

Recent findings

The diversity and composition of gut flora have been recently deeply explored in kidney diseases. Modulation and depletion of microbiota in animal models allowed the understanding of molecular mechanisms involved in the crosstalk between gut, immune system and kidney. New clinical trials in order to positively modulate microbiota result in improvement of gastrointestinal disorders and inflammation in patients suffering with kidney diseases.

The investigation of gut alterations in kidney diseases open new therapeutic strategies. In IgAN, targeted treatments for intestinal inflammation and modifications of gut microbiota seem promising.
Hemiplegic-Migraine–like Attacks as First Manifestation of Diffuse Leptomeningeal Glioneuronal Tumor: A Case Report
Authors: Fetta Anna , Pruccoli Jacopo , Biasucci Giacomo , Parisi Roberto , Toni Francesco , Melchionda Fraia , Cordelli Duccio M.
Published: September 2021

Background:

Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a low-grade tumor characterized by diffuse leptomeningeal infiltrates. Symptoms are usually secondary to hydrocephalus. Hemiplegic migraine (HM)-like episodes have never been associated with DLGNT, but they have been reported with different inflammatory and tumoral entities involving leptomeninges.

Observations:

We report the case of a 10-year-old boy with recurrent episodes of right hyposthenia, aphasia, and headache lasting hours to days with complete remission. The electroencephalogram during the attack showed diffuse slower activity on the left hemisphere, which improved together with the symptoms. DLGNT was discovered during a follow-up magnetic resonance imaging and confirmed by biopsy.

Conclusions:

This is the first report of HM-like attacks in DLGNT. We discuss the pathogenetic hypotheses of our case and previously reported cases of “symptomatic” HM with leptomeningeal involvement.
An Assessment on the Effectiveness of the Immature Granulocyte Percentage in Predicting Internal Organ Involvement Among Children With Henoch-Schönlein Purpura
Authors: Güngör Tülin , Özdel Semanur , Çakici Evrim K. , Yazilitaş Fatma , Bağlan Esra , Karakaya Deniz , Çelikkaya Evra , Bülbül Mehmet
Published: September 2021

Henoch-Schönlein purpura (HSP) is the most common childhood systemic vasculitis. The present study aims to investigate the effectiveness of the immature granulocyte (IG) percentage as a new marker for predicting internal organ involvement in HSP. This study included 75 patients below 18 years old who were diagnosed with HSP. The mean age was 7.48±2.77 years. The male/female ratio was 1.14. The findings showed that 35 (46.7%) of the patients had an internal organ involvement. The mean IG percentage was 0.88±0.68 among the patient group with HSP internal organ involvement, while it was 0.31±0.15 in the group without internal organ involvement, and a significant difference was determined between the 2 groups (P=0.000). The findings showed that the patients with renal involvement had the highest mean IG percentage (IG; 1.00±0.21). When the cutoff value for the IG percentage was specified as 0.45 to predict internal organ involvement, the sensitivity was 77.1%, and the specificity was 85%. In this study, the findings showed that IG percentage increased among patients with internal organ involvement in HSP and that its sensitivity, specificity, and predictive values were higher in predicting internal organ involvement compared with other markers.
Low-dose Ketamine Infusion for Pediatric Hematology/Oncology Patients: Case Series and Literature Review
Authors: Yu Helena , Chen Allen , Chen Eric , Long L. Stephen , Agrawal Anurag K.
Published: September 2021

Management of refractory pain in pediatric sickle cell disease (SCD) and oncology is reliant on opioids though high opioid dosing increases side effects and tachyphylaxis. We introduced low-dose ketamine infusion (LDKI) to our inpatient unit to determine if LDKI was tolerable. We subsequently hypothesized that LDKI would improve pain scores. We reviewed inpatients from LDKI initiation in March 2014 through October 2017, with the day before LDKI initiation compared with the day of LDKI initiation and 2 subsequent days. For patients with SCD, the LDKI admission was compared with up to 3 admissions in the prior year for a vaso-occlusive event. Nineteen patients (12 oncology, 7 SCD) with a median age of 14.6 years received LDKI for a median of 6 days at a median initial dose of 0.06 mg/kg/h (1.1 µg/kg/min). There was no change in pain scores or opioid utilization when comparing the day before LDKI initiation with subsequent days. No patient discontinued LDKI because of intolerability. For patients with SCD, there was a median 32% reduction in cumulative pain scores when comparing the LDKI admission with prior admissions. LDKI is well tolerated for refractory pediatric cancer-related and sickle cell-related pain.
Peripheral Nucleated Red Blood Cells and Mortality in Critically Ill Children
Authors: Pedersen Sasia J.V. , Chok Rozalyn , McKillop Sarah , Rojas-Vasquez Martha , Duff John P. , Szkotak Artur , Bruce Aisha A.
Published: September 2021

The present retrospective cohort study examines whether there is an association between circulating nucleated red blood cells (nRBCs) and mortality in critically ill children. nRBCs are erythropoietic progenitor cells not found in peripheral blood of healthy adults and children beyond the neonatal period. The presence of circulating nRBCs is associated with poor prognosis in adults and neonates, though little is known about their significance in children. Admissions to both the general and cardiac pediatric intensive care unit at the Stollery Children’s Hospital in Edmonton, Alberta between January 1, 2015 and December 31, 2017 were examined, and logistic regression was performed to ascertain the association between the peak absolute nRBC counts and in-hospital mortality in critically ill children. A total of 2065 admissions were included. The number of admissions with detectable nRBCs was 386 (prevalence: 13.9%), and the number of deaths was 93 (mortality: 4.5%). A statistically significant association was found between the absolute value of nRBC peak and intensive care unit mortality (odds ratio=1.37; 95% confidence interval: 1.13-1.67; P=0.002) as well as hospital mortality (odds ratio=1.38; 95% confidence interval: 1.12-1.70; P=0.003) independent of the Pediatric Index of Mortality 3 score (PIM3). This result warrants more attention to nRBC values and their potential clinical use.
Treatment-related Correlates of Growth in Children With Sickle Cell Disease in the DISPLACE Cohort
Authors: Galadanci Najibah A. , Sohail Maira , Akinyelure Oluwasegun P. , Kanter Julie , Ojesina Akinyemi I.
Published: September 2021

Reduced growth and delayed maturation have been described in children with sickle cell disease (SCD). This study investigated growth and hemolysis in children with SCD in the DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) cohort. The database includes 5287 children, of which, 3305 had at least 2 growth measurements over a 5-year period. Body mass index was converted to z-scores (zBMI), and 19.8%, 66.1%, 14.2% of children were classified as underweight, normal, and overweight/obese, respectively. Multivariable analysis of growth was conducted and included variables: age, sex, blood pressure, hemoglobin, reticulocyte count, treatment with chronic red cell transfusion therapy (CRCT), or hydroxyurea therapy. Baseline hemoglobin levels were associated with the lower odds of being underweight (odds ratio [OR]=0.93, 95% confidence interval [CI]: 0.86-0.99), and higher odds of being overweight/obese (OR: 1.26, 95% CI: 1.17-1.36) compared with normal zBMI. CRCT was associated with being overweight/obese at baseline (OR: 1.85, 95% CI: 1.31-2.60). Overall, results showed that children who were underweight improved regardless of therapy over the 2-year time period. However, children on CRCT are at higher risk for being overweight and should be monitored closely.