bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemophagocytic Lymphohistiocytosis in Children: Clinical Profile and Outcome
Authors: Simon Anna C. , Delhi Kumar Chinnaiah Govindhareddy , Basu Debdatta , Ramesh Kumar Ramachandran
Published: March 2020

Objectives:

The objectives of this study were to describe the clinical and etiologic profile and outcomes of children with hemophagocytic lymphohistiocytosis (HLH) in a tertiary care hospital in South India.

Methods:

This is a combined 2-year prospective (2017 to 2018) and 5-year retrospective (2012 to 2016) descriptive study in which children from birth to 18 years who satisfied the HLH-2004 diagnostic criteria were included. Case details from patient records were analyzed.

Results:

Fifty-three cases were enrolled of which 20 were prospective and 33 were retrospective. Fever, hepatomegaly, anemia, and hyperferritinemia were the common presentations. Infectious triggers were found in 33 (62%) cases. Five cases were secondary to rheumatic diseases, and 8 were primary HLH. Bacterial (14 cases) followed by viral infections (10 cases) were the leading triggers. Scrub typhus (6 cases) and dengue (4 cases) were the most common infectious agents. Major complications include febrile neutropenia (38%) and multiorgan dysfunction (26%). One child developed secondary malignancy. The most frequently used immunosuppressive drug for the treatment of HLH was steroid (70%), while 28% of cases recovered with only supportive therapy. The overall mortality was 41%.

Conclusions:

Infections were the most common triggers for HLH of which tropical infectious agents constituted the majority. Treatment with steroids alone or regimens without cytotoxic drugs may result in resolution of secondary HLH with mild to moderate disease activity. Without stem cell transplant, primary HLH has a high mortality rate.
Occupational leptospirosis as an underreported disease in high-risk groups: implications for prevention and control measures
Authors: Ghasemian Abdolmajid , Fahim Abbas Aalaa , Mahdi Al-Saadi Aamal Ghazi , Salari Morteza , Memariani Hamed , Shokouhi Mostafavi Seyyed Khalil
Published: March 2020

Leptospirosis is a neglected zoonotic disease with no particular or verified symptoms, which has been underreported as an occupational infection. Leptospira interrogans serovar Icterohaemorrhagiae and L. interrogans serovar Grippotyphosa are the two major pathogenic serovars. Professionals who are in constant contact with animals and their residues, in water supply, rice mill, slaughtering houses, hospital sanitary places, strawberry picking, construction works, agriculture working, forest working and food industry are at highest risk. Factors related to occupational, environmental, and recreational aspects and the presence of wild reservoirs of leptospirosis will be discussed in this concise review. Noticeably, lack of early identification, international travelling, skin wounds, sanitary and washing habitations after contact with animals, delay in treatment, and unhealthy behaviors of adolescents contribute to the disease. Hence, public education for people's awareness is essential. For instance, farmers, students, forest keepers, veterinary surgeons or veterinarians, and abattoir workers should take care by wearing cloth, such as long trousers and a long-sleeved shirt, and simple gloves to hinder the infection acquisition through skin. For people engaged in water sports, covering skin abrasions with waterproof dressings and wearing protective clothing can prevent disease transmission. However, there is no same control strategy applicable to all epidemiological wards universally. Furthermore, ecoepidemiological and cultural characteristics should be well recognized.
Infertility After Cancer
Authors: Patterson Pandora , Perz Janette , Tindle Richard , McDonald Fiona E.J. , Ussher Jane M.
Published: March 2020

Background

Adolescents and young adults (AYAs) given a diagnosis of cancer who experience infertility concerns often report having poorer quality of life (QoL). However, the role of infertility-related stressors and illness acceptance on QoL is not clear.

Objective

The aim of this study was to describe the impact of psychosocial factors surrounding cancer treatment and infertility on QoL. We hypothesized that need for parenthood and infertility-related social concerns would be directly related to QoL and indirectly related to QoL through acceptance of illness.

Methods

Cancer patients/survivors (n = 178; 75.3% female) aged 15 to 29 years completed measures of QoL, acceptance of illness, infertility-related social concerns, and need for parenthood. Path analysis was used to test the hypothesized and subsequent models to determine the best fit for predictors of QoL.

Results

The final model explained 28.36% of the variance in QoL. Lower infertility-related social concerns were directly and indirectly related to higher QoL scores. Need for parenthood did not directly relate to QoL, instead relating directly to increased infertility-related social concerns. Higher acceptance of illness (β = .39) and older age (β = .19) were directly related to higher QoL scores. Female patients had higher need for parenthood (β = .17).

Conclusions

These findings suggest that social concerns and expectations surrounding infertility have a negative impact on AYA cancer survivors' and patients' QoL, which increases as AYAs approach socially normative parenting age.

Implications for Practice

Providing survivors with specialist support to manage their infertility-related social concerns and improve their acceptance of illness has the potential to improve their QoL.
Adapting and Going the Extra Mile
Authors: Ervik Bente , Brøndbo Birgit , Johansen May-Lill
Published: March 2020

Background

Despite significant developments in palliative care in recent decades, we still find important differences in access to and delivery of care in rural Norway.

Objective

The aim of this study was to explore what healthcare professionals consider necessary to provide equality in care for palliative patients in rural areas.

Methods

A qualitative approach with focus group discussions and individual interviews with 52 health professionals was used, starting with 5 uniprofessional focus groups of general practitioners and nurses/cancer nurses, followed by 5 interprofessional groups and 6 individual interviews. Interview transcripts were analyzed thematically.

Results

We found local variations in organization, competence and access to palliative care, and challenging geographical conditions. It was essential to be proactive, flexible and willing to go the extra mile, but this may conceal the need for a stronger focus on competence and organization of palliative care. Access to written guidelines and practical tools was important, as was forming palliative teams for particular situations.

Conclusions

Palliative care needs strengthening in rural areas, and increased competence for all healthcare professionals is vital to increase equality in care. Geographical conditions require locally adapted solutions. Access to guidelines and interprofessional collaboration are essential.

Implications for Practice

Rural palliative care needs in Norway are improving, as exemplified by at least 1 cancer nurse assigned to each local authority, and access to guidelines and palliative tools and interprofessional collaboration.
The Future of Onboarding
Authors: Zackoff Matthew W. , Lin Li , Israel Keith , Ely Kelly , Raab Dana , Saupe Jennifer , Klein Melissa , Sitterding Mary
Published: March 2020

An immersive virtual reality curriculum was piloted with new nurse graduates that focused on improving clinical reasoning and situational awareness for pediatric respiratory distress and impending respiratory failure. Learnings from this pilot could inform strategies for development of standardized, efficient, and safe onboarding curricula to increase the likelihood of successful transition to practice.
Bilateral Total Knee Arthroplasty
Authors: Thomas Tonda , Coombs Nicholas C. , Mullette Elizabeth J. , Bick Tom , Brant Jeannine M.
Published: March 2020

BACKGROUND:

Total knee arthroplasty is on the rise. Some patients choose to undergo simultaneous bilateral total knee arthroplasty (simultaneous BTKA). No studies were found that examined which patients may be better candidates to successfully undergo this procedure.

PURPOSE:

The purpose of this study was to determine personal and comorbid characteristics of patients undergoing simultaneous BTKA that are predictive of length of stay (LOS) and discharge to a skilled nursing facility (SNF).

METHODS:

A retrospective database study of 125 patients post-simultaneous BTKA was conducted. Binary and multiple linear regression models identified personal and clinical predictors of LOS and SNF discharge.

RESULTS:

Body mass index (BMI) (p < .001) and SNF discharge (p = .025) were significant predictors of increased LOS and explained 18% of the variance. Older age, female sex, and presence of cardiopulmonary disease predicted SNF admission; 21% of the variance for SNF discharge was explained by the model.

CONCLUSION:

Patients with a high BMI should be carefully screened before undergoing simultaneous BTKA; older patients, women, and those with cardiopulmonary disease may benefit from early discharge planning for SNF transfer, thereby decreasing LOS and hospital utilization.
Expression of Secretory Phospholipase A2 Group IIa in Breast Cancer and Correlation to Prognosis in a Cohort of Advanced Breast Cancer Patients
Authors: Jespersen Sofie S. , Stovgaard Elisabeth S. , Nielsen Dorte , Christensen Troels D. , Buhl Anna S.K. , Christensen Ib J. , Balslev Eva
Published: March 2020

Secreted phospholipase A2 group IIa (sPLA2-IIa) has been shown to promote tumor genesis and cell proliferation. The properties of this group of enzymes are utilized in liposomal drug delivery of chemotherapy. sPLA2-IIa is also under investigation as a possible treatment target in itself, and as a prognostic marker. The expression of sPLA2-IIa in breast cancer has not been examined extensively, and never using immunohistochemistry. We sought to investigate the expression of sPLA2-IIa in a cohort of advanced breast cancer patients with correlation to known clinicopathologic risk factors and survival. Material from 525 breast cancer patients (426 primary tumors and 99 metastases or local recurrences) was examined for sPLA2-IIa expression using immunohistochemistry. Out of these, 262 showed expression of sPLA2-IIa. We found that there was no correlation to clinicopathologic characteristics, and no impact of sPLA2-IIa expression on prognosis. However, we found that a large proportion of patients in our study had high levels of sPLA2-IIa expression, and that sPLA2-IIa was equally expressed in primary tumors and metastases. These findings may be significant in the future development of liposomal drug delivery or targeted sPLA2-IIa treatment.
Biphasic Hyalinizing Psammomatous Renal Cell Carcinoma (BHP RCC)
Authors: Argani Pedram , Reuter Victor E. , Eble John N. , Vlatkovic Ljiljana , Yaskiv Oksana , Swanson David , Dickson Brendan C. , Antonescu Cristina R. , Matoso Andres , Gagan Jeffrey , Palsgrove Doreen N.
Published: March 2020

We report 8 cases of a distinctive, previously undescribed renal cell carcinoma associated with somatic mutations in the neurofibromin 2 (NF2) gene. All patients were adults, ranging from 51 to 78 years of age and of cases of known sex 6 of 7 were males. The carcinomas were predominantly unencapsulated, and all had a rounded, nodular interface with the native kidney. The neoplasms were all solid with papillary architecture evident in most cases (7/8), while 1 was only tubular. All cases were biphasic, characterized by larger and smaller carcinoma cells. The smaller cells clustered around basement membrane material similar to the characteristic pattern of the t(6;11) renal cell carcinoma associated with TFEB gene fusions. In 6 of 8 carcinomas, branching nodules of small cells clustered around basement membrane material within larger acini yielding a distinctive glomeruloid pattern. In 6 of 8 carcinomas, the small cells were focally spindle-shaped and unassociated with the basement membrane material. The stroma was sclerotic in all 8 carcinomas, and all 8 contained psammoma bodies that were abundant in 2. In some carcinomas, focal or predominant areas had a less distinctive appearance; 2 had areas that resembled clear cell renal cell carcinoma, 2 had high-grade eosinophilic areas, while 1 had branching tubular architecture that resembled mucinous tubular and spindle cell carcinoma. Two carcinomas demonstrated cellular necrosis. Although we have minimal clinical follow-up, 1 case presented with distant metastasis, progressed and resulted in patient death. While NF2 mutations may be found in other established renal cell carcinoma subtypes (often as secondary genetic alterations), they are potentially the genetic driver of this distinctive entity.
Feasibility and Reliability of Functional Mobility Measures in Children With Cri du Chat (5P−) Syndrome
Authors: Abbruzzese Laurel D. , Ruggeri Anneliese R. , Esquerre Jennifer C. , Patel Prina , Raske Lisa
Published: March 2020

Purpose:

To investigate feasibility and reliability of functional mobility measures in children with Cri du Chat syndrome (CdCS).

Methods:

Nine children with CdCS and 9 children with typical development (TD) completed the Timed Up and Go, 5 times sit-to-stand test, Timed Floor to Stand, and 4 Square Step Test. Feasibility was determined using testing time and need for modifications. Intraclass correlation coefficients were calculated for intrarater and interrater reliability.

Results:

Children with CdCS required modifications to complete all tests. One child with CdCS completed the 4 Square Step Test. Good reliability was found for both groups.

Conclusions:

The Timed Up and Go, 5 times sit-to-stand test, and Timed Floor to Stand are feasible and reliable tools for children with TD between ages of 5 and 15 years; however, may require modifications to the protocols to be feasible in children with CdCS. The 4 Square Step Test is not a feasible tool for children with CdCS.
Psychometric Properties of Clinical Tests of Balance and Vestibular-Related Function in Children With Cerebral Palsy
Authors: Almutairi Anwar B. , Christy Jennifer B. , Vogtle Laura
Published: March 2020

Purpose:

The purpose of this study was to establish the psychometric properties of clinical tests of balance and vestibular-related function in children with cerebral palsy (CP), aged 7 to 12 years, Gross Motor Function Classification System levels I to III.

Methods:

Forty-two children with CP and 33 children with typical development were examined using Clinical Dynamic Visual Acuity Test, Modified Clinical Test of Sensory Interaction on Balance, Head Impulse Test, Bucket Test, and Northeastern State University College of Optometry oculomotor test. A subgroup was tested twice for reliability. Reference tests included rotary chair and sensory organization test.

Results:

Most children with CP had central rather than peripheral vestibular dysfunction. Clinical tests except Northeastern State University College of Optometry oculomotor test had moderate to good reliability, good sensitivity but poor specificity to identify central vestibular-related impairments.

Conclusions:

Tests of balance and vestibular-related function may help guide clinical management of children with CP.
Intravoxel Incoherent Motion Diffusion-Weighted Imaging of Lung Cancer: Comparison Between Turbo Spin-Echo and Echo-Planar Imaging
Authors: Wan Qi , Lei Qiang , Wang Peng , Hu Jianfeng , Zhang Tianjing , Yu Deng , Li Xinchun , Liang Changhong
Published: March 2020

Objective

The aim of the study was to compare intravoxel incoherent motion diffusion-weighted imaging (DWI) for evaluating lung cancer using single-shot turbo spin-echo (TSE) and single-shot echo-planar imaging (EPI) in a 3T MR system.

Methods

Both single-shot TSE-DWI and single-shot EPI-DWI were scanned twice respectively for 15 patients with lung cancer. Distortion ratio, signal-to-noise ratio, and contrast-to-noise ratio were compared between the 2 techniques. The Bland-Altman analysis was performed to analyze reproducibility between the parameters of TSE-DWI and EPI-DWI. Short-term test-retest repeatability, as well as interobserver agreement, was evaluated using the coefficient of variation (CV) and the intraclass correlation coefficient (ICC).

Result

Turbo spin-echo DWI has lower signal-to-noise ratio and similar contrast-to-noise ratio compared with EPI-DWI. Distortion ratio of TSE-DWI was significantly smaller than that of EPI-DWI. The apparent diffusion coefficient (ADC) and true diffusivity (D) of TSE-DWI showed higher values than those of EPI-DWI. The Bland-Altman analysis showed unacceptable limits of agreement between these 2 sequences. Test-retest repeatability was good for ADC and D of EPI-DWI (CV, 14.11%–16.60% and 17.08%–19.53%) and excellent for ADC and D of TSE-DWI (CV, 4.8%–6.19% and 6.05%–8.71%), but relatively poor for perfusion fraction (f) and pseudo-diffusion coefficient (D*) (CV, 25.95%–27.70% and 56.92%–71.84% for EPI, 23.67%–28.67% and 60.85%–70.17% for TSE). For interobserver agreement, both techniques were good to excellent in ADC and D (The lower limit of 95% confidence interval for ICC was almost all greater than 0.75), whereas D* and f had higher interobserver variabilities with D* of TSE-DWI showing poorest reproducibility (ICC, −0.27 to 0.12).

Conclusions

Lung DWI or IVIM using TSE could provide distortion-free images and improve the test-retest robustness of ADC and D as compared with EPI-DWI; however, it might exert a negative effect on perfusion parameter D*.
Diffusion Tensor Imaging of Microstructural Changes in the Gray and White Matter in Patients With Crigler-Najjar Syndrome Type I
Authors: Razek Ahmed Abdel Khalek Abdel , Taman Saher Ebrahiem , El Regal Mohamed Ezz , Megahed Ahmed , Elzeny Sherine , El Tantawi Noha
Published: March 2020

Purpose

This study aimed to evaluate the role of diffusion tensor imaging of microstructural changes in gray and white matter in Crigler-Najjar syndrome type I.

Patient and Methods

A prospective study was conducted on 10 patients with Crigler-Najjar syndrome type I and 10 age- and sex-matched children who underwent diffusion tensor imaging of the brain. Mean diffusivity (MD) and fractional anisotropy (FA) of gray and white matter were measured.

Results

There was a significantly higher MD of the gray matter regions including the globus pallidus, thalamus, caudate head, substantia nigra, and dentate nucleus in patients versus controls (P = 0.007, 0.001, 0.014, 0.003, and 0.002), respectively. The areas under the curve (AUC) of MD of the globus pallidus and thalamus used to differentiate patients from controls were 0.93 and 0.925, respectively. There was a significant difference in MD of the frontal white matter and posterior limb of the internal capsule in patients versus controls (P = 0.001 and 0.02), respectively. The AUCs of MD of these regions used to differentiate patients from controls were 0.82 and 0.8. There was a significant difference in FA of the frontal white matter and posterior limb of the internal capsule in patients versus controls (P = 0.006 and 0.006), respectively. The AUCs of FA of these regions were 0.83 and 0.85, respectively. The MD of the globus pallidus correlated with serum bilirubin (r = 0.87 and P = 0.001).

Conclusion

Diffusion tensor imaging can detect microstructural changes of deep gray matter and some regions of white matter in Crigler-Najjar syndrome type I.
Assessment of the Effectiveness of the Vaginal Contrast Media in Magnetic Resonance Imaging for Detection of Pelvic Pathologies: A Meta-analysis
Authors: Unlu Ebru , Virarkar Mayur , Rao Sujaya , Sun Jia , Bhosale Priya
Published: March 2020

Objective

Magnetic resonance imaging (MRI) is an excellent modality for pelvic imaging. The anatomy of uterine cavity and vagina is optimally evaluated when the walls, which may spontaneously be collapsed, are distended. Distension of these cavities during pelvic MRI for evaluation of gynecologic diseases has been conducted with vagina, filled with ultrasound gel or saline solution. In this meta-analysis, we aim to assess the effectiveness of vaginal contrast media in MRI for improving the detection of pelvic pathologies.

Methods

The PubMed, MEDLINE, EMBASE, Web of Science, Google Scholar, Science Citation Index, and Cochrane Library databases were systematically searched through March 2019 for studies of the accuracy of MRI using vaginal contrast media in the diagnosis and staging of pelvic pathologies. Four eligible studies of a total of 120 patients were included in the meta-analysis. The sensitivity rates and relative risk for MRI, before and after vaginal contrast medium administration, were pooled, and their 95% confidence intervals (CIs) were determined.

Results

The pooled sensitivity rate for MRI before administering intravaginal contrast medium in detecting pelvic pathologies was 63% (95% CI, 54%–72%), and that after was 89% (95% CI, 83%–93%). The interstudy heterogeneity rate (assessed using theI2statistic) was relatively low: 13% (P= 0.33) and 0% (P= 0.45) before and after vaginal contrast medium use, respectively. The average relative risk was 1.54 (SD, 0.22; 95% CI, 1.18–1.89; median, 1.50; range, 1.34–1.80). This demonstrated that, on average, the sensitivity rate for MRI in detecting pelvic disorders increased by 54% after the use of a vaginal contrast medium.

Conclusions

Use of vaginal contrast media improved the diagnostic ability of MRI in identifying pelvic pathologies.
Pitanguy Ligamentous Flap: A New Method to Prevent Supratip Deformity in Rhinoplasty
Authors: Ercin Burak Sercan , Bicer Ahmet , Bilkay Ufuk
Published: March 2020

Background:

A supratip deformity (SD) is an iatrogenic convexity that occurs in the cephalic region of the nasal tip. SD is still a major problem after rhinoplasty surgery.

Objectives:

With the method we have described a ligamentous flap was used to create a supratip transition, with adjustable sharpness, while the refinements of the tip rotation and definition were ensured. The aim of the study is to present the results of this technique, which, to the best of our knowledge, has been described here for the first time.

Methods:

Our ligamentous flap technique was applied to 24 patients between August 2017 and March 2018. All of the patients were evaluated in terms of the formation of an SD, a hanging columella, tip projection, and the loss of rotation at the postoperative followups. The photos of patients were evaluated by another independent plastic surgeon and patients themselves at 3 months after the surgery.

Results:

There were no early or late complications, such as an infection, excessive bleeding, or prolonged edema. Moreover, SDs, hanging columellas, tip projections, and rotational losses, which would require revisions, were not detected in any of the patients. Postoperative scores given by the patients and surgeons were significantly higher than the preoperative values (P < 0.05). Only 2 patients required minor revisions due to dorsal irregularities in the upper 1/3 of the nasal segment.

Conclusion:

The early results of this Pitanguy composite flap technique, which can be easily applied in every case with thin or thick skin in an open rhinoplasty, are promising. However, there is a need for an evaluation of the long-term results, as well as the advantages and disadvantages in a larger case series.

Level of Evidence:

Level IV.
The Face of War: Maxillofacial Patients in the Syrian Civil War
Authors: Ghantous Yasmine , Bahouth Hany , Rachmiel Adi , Abdelraziq Murad , Joachim Michael V. , Abu-El-Na’aj Imad
Published: March 2020

The type of the armed conflict on the Syrian battle field acquired several types of injuries; including injuries that were caused by explosive, shrapnel and blast injuries.

In the current study, the authors conducted an overview of maxillofacial patients, who mainly suffered from ballistic injuries in term of injuries, reconstruction, and management.

Overall, 53 maxillofacial Syrian patients were treated. The most prominent injury was soft tissue lacerations (21/97) and in terms of hard tissue injuries, the most prominent site was the mandible (N = 19) while the ramus and the body presented the most common sub-sites of injury. Hard tissue injuries were treated either by close or open reduction to obtain primary stabilization.

From the psychological aspect, most of the patients suffered from guilt for leaving the combat area, those patients were mostly males in their 20s or 30s. On the other hand, older patients suffered mainly from depression, stress, and fear of returning to their home land.

To conclude, the Syrian civil war has several characteristics that defer from other combats. Thus, the management of Syrian patients has to be tailored accordingly.
Formal Training Efforts to Develop Simulation Educators
Authors: Paige Jane B. , Graham Leslie , Sittner Barbara
Published: March 2020

Summary Statement

Formal training for educators who use simulation-based education (SBE) is required by standards of best practice, simulation guidelines, regulatory, and accrediting bodies. Training efforts to establish educator competency for SBE are being offered. However, a systematic review of this body of literature has yet to be conducted. The purpose of this integrative review was to appraise formal training efforts of educators who use SBE. The aims were to summarize the training topics, describe the structure of training programs, and explore evaluation methods of educators. The New World Kirkpatrick Model guided the review. A PRISMA search approach yielded 2007 citations of which 38 met inclusion criteria. Analysis supports a formalized training process that uses a combination of didactic material, time for repetitive practice, and ongoing feedback with longitudinal and scaffolded delivery approaches. An identified gap in the literature is threshold levels for determining competency of educators. Recommendations for planning simulation training programs are provided.
Participant Perspectives on the Contributions of Physical, Psychological, and Sociological Fidelity to Learning in Interprofessional Mental Health Simulation
Authors: Naismith Laura M. , Kowalski Christopher , Soklaridis Sophie , Kelly Alyssa , Walsh Catharine M.
Published: March 2020

Introduction

Simulation has been identified as a key training modality to enhance interprofessional care for patients with co-occurring physical and mental illnesses. Fidelity is an important instructional design consideration for interprofessional simulation; however, research examining the contribution of physical, psychological, and sociological fidelity in achieving learning outcomes remains limited. This qualitative study explored the relationship between fidelity and learning from the perspective of interprofessional simulation course participants.

Methods

Semistructured interviews were conducted with participants from the Interprofessional Simulations of Patient Experiences Across the Care Continuum - Child and Youth course. Consistent with grounded theory, data collection and analysis proceeded in an iterative fashion and emergent themes were identified by the research team through a process of constant comparative analysis.

Results

Data saturation was reached after 10 interviews. High psychological fidelity allowed participants to engage in the simulation scenarios in ways that were congruent with their professional roles, which supported individual practice change. Tasks that were too closely aligned with their clinical experiences sometimes, however, limited new learning opportunities. Selective manipulations of sociological fidelity seemed to support learning outcomes related to understanding and appreciating the roles and responsibilities of other health professionals. Physical fidelity was less essential.

Conclusions

Psychological and sociological fidelity were perceived by participants as being most critical to learning in interprofessional mental health simulation. Improving our understanding of how simulation works in this context is important to effectively direct the efforts of learners, instructors, and designers toward maximizing the benefit of simulation-based learning in a cost-efficient manner.
Inspiring Young Learners Toward a Career in Healthcare Using Simulation
Authors: Yeh Vicky J.-H. , Mukhtar Fareeda , Rajesh Aashish , Baloul Mohamed S. , Chandra Abhishek , Shaikh Nizamuddin , Backstrom Courtney , Rivera Mariela , Asirvatham Usha , de Azevedo Rafael , Farley David R.
Published: March 2020

Summary Statement

To inspire young learners toward a career in healthcare and provide them opportunities to learn lifesaving skills, a hospital-based simulation center collaborated with a local middle school to develop a 88-minute simulation-based educational activity. The activity consisted of eight 10-minute stations on lifesaving and basic medical skills. One hundred fifty students participated. Evaluation surveys showed students favored stations with extensive hands-on activities and valued the opportunity to interact with health professionals. Students also reported more interest in science careers after the visit. This collaborative effort is time-efficient and low-budget simulation-based learning experience that had an immediate impact on middle school students.
Early single-dose exosome treatment improves neurologic outcomes in a 7-day swine model of traumatic brain injury and hemorrhagic shock
Authors: Williams Aaron M. , Wu Zhenyu , Bhatti Umar F. , Biesterveld Ben E. , Kemp Michael T. , Wakam Glenn K. , Vercruysse Claire A. , Chtraklin Kiril , Siddiqui Ali Z. , Pickell Zachary , Dekker Simone E. , Tian Yuzi , Liu Baoling , Li Yongqing , Buller Benjamin , Alam Hasan B.
Published: March 2020

BACKGROUND

Early single-dose treatment with human mesenchymal stem cell–derived exosomes promotes neuroprotection and promotes blood-brain barrier integrity in models of traumatic brain injury (TBI) and hemorrhagic shock (HS) in swine. The impact of an early single dose of exosomes on late survival (7 days), however, remains unknown. We sought to evaluate the impact of early single-dose exosome treatment on neurologic outcomes, brain lesion size, inflammatory cytokines, apoptotic markers, and mediators of neural plasticity in a 7-day survival model.

METHODS

Yorkshire swine were subjected to a severe TBI (8-mm cortical impact) and HS (40% estimated total blood volume). After 1 hour of shock, animals were randomized (n = 4/cohort) to receive either lactated Ringer's (5 mL) or lactated Ringer's with exosomes (1 × 1012 exosome particles). After an additional hour of shock, animals were resuscitated with normal saline. Daily neurologic severity scores were compared. At 7 days following injury, lesion size, inflammatory markers, and mediators of inflammation (NF-κB), apoptosis (BAX), and neural plasticity (brain-derived neurotrophic factor) in brain tissue were compared between groups.

RESULTS

Exosome-treated animals had significantly lower neurologic severity scores (first 4 days; p < 0.05) and faster neurologic recovery. At 7 days, exosome-treated animals had significantly smaller (p < 0.05) brain lesion sizes. Exosome-treated animals also had significantly lower levels of inflammatory markers (interleukin [IL]-1, IL-6, IL-8, and IL-18) and higher granulocyte-macrophage colony-stimulating factor levels compared with the control animals, indicating specific impacts on various cytokines. The BAX and NF-κB levels were significantly lower (p < 0.05) in exosome-treated animals, while brain-derived neurotrophic factor levels were significantly higher (p < 0.05) in the exosome-treated animals.

CONCLUSION

In a large animal model of TBI and HS, early single-dose exosome treatment attenuates neurologic injury, decreases brain lesion size, inhibits inflammation and apoptosis, and promotes neural plasticity over a 7-day period.
Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference
Authors: Mehta Neil , Bhangui Prashant , Yao Francis Y. , Mazzaferro Vincenzo , Toso Christian , Akamatsu Nobuhisa , Durand Francois , Ijzermans Jan , Polak Wojciech , Zheng Shusen , Roberts John P. , Sapisochin Gonzalo , Hibi Taizo , Kwan Nancy Man , Ghobrial Mark , Soin Avi
Published: March 2020

Liver transplantation (LT) offers excellent long-term outcome for certain patients with hepatocellular carcinoma (HCC), with a push to not simply rely on tumor size and number. Selection criteria should also consider tumor biology (including alpha-fetoprotein), probability of waitlist and post-LT survival (ie, transplant benefit), organ availability, and waitlist composition. These criteria may be expanded for live donor LT (LDLT) compared to deceased donor LT though this should not adversely affect the double equipoise in LDLT, namely ensuring both acceptable recipient outcomes and donor safety. HCC patients with compensated liver disease and minimal tumor burden have low urgency for LT, especially after local-regional therapy with complete response, and do not appear to derive the same benefit from LT as other waitlist candidates. These guidelines were developed to assist in selecting appropriate HCC patients for both deceased donor LT and LDLT.
Short- and Long-term Outcomes of Kidney Transplants From Very Small (≤15 kg) Pediatric Donors With Acute Kidney Injury
Authors: Troppmann Christoph , Santhanakrishnan Chandrasekar , Fananapazir Ghaneh , Sageshima Junichiro , Troppmann Kathrin M. , Perez Richard V.
Published: March 2020

Background.

Kidneys from small deceased pediatric donors with acute kidney injury (AKI) are commonly discarded owing to transplant centers’ concerns regarding potentially inferior short- and long-term posttransplant outcomes.

Methods.

We retrospectively analyzed our center’s en bloc kidney transplants performed from November 2007 to January 2015 from donors ≤15 kg into adult recipients (≥18 y). We pair-matched grafts from 27 consecutive donors with AKI versus 27 without AKI for donor weight, donation after circulatory death status, and preservation time.

Results.

For AKI versus non-AKI donors, median weight was 7.5 versus 7.1 kg; terminal creatinine was 1.7 (range, 1.1–3.3) versus 0.3 mg/dL (0.1–0.9). Early graft loss rate from thrombosis or primary nonfunction was 11% for both groups. Delayed graft function rate was higher for AKI (52%) versus non-AKI (15%) grafts (P = 0.004). Median estimated glomerular filtration rate was lower for AKI recipients only at 1 and 3 months (P < 0.03). Graft survival (death-censored) at 8 years was 78% for AKI versus 77% for non-AKI grafts. Late proteinuria rates for AKI versus non-AKI recipients with >4 years follow-up were not significantly different.

Conclusions.

Small pediatric donor AKI impacted early posttransplant kidney graft function, but did not increase risk for early graft loss and decreased long-term function. The presently high nonutilization rates for en bloc kidney grafts from very small pediatric donors with AKI appear therefore unjustified. Based on the outcomes of the present study, we infer that the reluctance to transplant single kidneys from larger pediatric donors with AKI lacks a rational basis as well. Our findings warrant further prospective study and confirmation in larger study cohorts.
Effect of Antidepressants on Psychotic Symptoms in Parkinson Disease: A Review of Case Reports and Case Series
Authors: Sid-Otmane Lamia , Huot Philippe , Panisset Michel
Published: March 2020

Objectives

The treatment of Parkinson disease (PD) psychosis remains a challenge. Only a few treatments eliciting significant relief of psychotic symptoms have passed the test of randomized controlled trials.

Methods

Here, we conducted a review of the literature on the effect of antidepressants on PD psychosis. Because there is no randomized controlled trial that assessed the antipsychotic effects of antidepressants in PD, only case reports, case series, and open-label trials were available to review. Because of the scarce literature, statistical analysis could not be performed.

Results

The following antidepressants alleviated hallucinations in PD: amoxapine, citalopram, clomipramine, escitalopram, mianserin, mirtazapine, and venlafaxine. The antidepressants were generally well tolerated, with the exception of amoxapine, which exacerbated parkinsonism.

Conclusions

Whereas the conclusions that can be drawn on the efficacy of antidepressants at reducing PD psychosis are limited because of the poor quality of the reported studies, it is encouraging to notice that there are positive anecdotal reports. Further studies are needed to confirm the potential of these drugs and also to determine if a subtype of patients or of psychotic features may be more likely to be improved by antidepressants.
Life-Threatening Serotonin Syndrome Precipitated by Discontinuation of Serotonin-Dopamine Antagonist in the Presence of Serotonergic Agents: A Case Report
Authors: Ishida Takuto , Uchida Hiroyuki , Kaneko Satoru , Sugiyama Kazuhiro , Hamabe Yuichi , Mimura Masaru , Suzuki Takefumi
Published: March 2020

Introduction

Serotonin syndrome is caused by excessive activation of serotonin (5-hydroxytryptamine [5-HT]) neurotransmission. Although the discontinuation of antipsychotics with 5-HT2 receptor antagonistic characteristics could theoretically result in serotonin syndrome, there have been very few reports on the syndrome thus far.

Case Presentation

A 75-year-old woman with somatoform disorder was transferred to our emergency room because of pyrexia, unconsciousness, and myoclonus with hyperreflexia. She had been taking milnacipran and perospirone for 10 years and had started taking duloxetine 2 months before the event. Thereafter, she suffered diaphoresis, gait disturbance, and tremor. Her psychiatrist advised her to stop taking perospirone, because of suspicion of extrapyramidal symptoms, a day before admission. The clinical diagnosis of serotonin syndrome was made based on her symptoms while using serotonergic agents. Her symptoms were so severe that she was transferred to the intensive care unit, where supportive care was successful.

Conclusions

Discontinuation of antipsychotics that are 5-HT2 receptor antagonists may lead to serotonin syndrome in patients who take serotonergic agents. As extrapyramidal symptoms and serotonin toxicity share some clinical features, detailed drug history and physical examination are necessary for successful treatment.
A case report of polymicrobial bacteremia with Weissella confusa and comparison of previous treatment for successful recovery with a review of the literature
Authors: Spiegelhauer Malene Roed , Yusibova Melodi , Rasmussen Ida Kirstine Bull , Fuglsang Kristian Asp , Thomsen Kim , Andersen Leif Percival
Published: March 2020

Weissella confusa

is a Gram-positive coccus and a commensal bacterium of the human gastrointestinal tract with a potential to cause invasive infections. We report the presence of

W. confusa

in the blood of a 25-year-old male patient with Crohn’s disease, short bowel syndrome treated with home parenteral nutrition, and a history of recurrent bloodstream infections, admitted to our hospital with fever and malaise. A polymicrobial culture of

W. confusa

and

Aeromonas hydrophila

was identified from blood, for which treatment with meropenem and metronidazole was initiated. The literature was searched for previous cases of infection with

W. confusa

. In total, 14 reports describing infection of 28 patients were found, most cases presenting with bacteremia. The previous reports have described variable susceptibility to antibiotics; however, all were reported to be vancomycin resistant. Because of its similarities to other vancomycin-resistant cocci, isolates of

W. confusa

might be difficult to identify with traditional methods. Infection may be facilitated by its natural vancomycin resistance, leading to severe infection in hosts with underlying diseases. We describe the treatment of previous cases of infection and suggest treatment methods shown effective in other cases. Vancomycin is often used as treatment of infection with Gram-positive organisms, but this may need to be reevaluated, as several pathogenic bacteria are intrinsically vancomycin resistant. A review on reported treatments of bacteremia by

W. confusa

suggests the use of daptomycin, amoxicillin-clavulanate or piperacillin/tazobactam as recommendable antibiotic regimens.
Emendation of circumscriptions of taxa in the Lists of Changes in Taxonomic Opinion
Authors: Oren Aharon , Garrity George M.
Published: March 2020

In the past 3 years, a large number of emendations of circumscriptions of species, subspecies and higher taxa were published outside the International Journal of Systematic and Evolutionary Microbiology (IJSEM) that only marginally modify the earlier circumscription and may not meet the requirements of Rule 35 of the International Code of Nomenclature of Prokaryotes. Thus far, these emendations were included in the Lists of Changes in Taxonomic Opinion in the IJSEM. The list editors propose to list in the future only meaningful emendations that in their opinion significantly modify the diagnostic characters or the circumscription of taxa.
Bacillus salinus sp. nov., isolated from commercial solar salt
Authors: Kang Heeyoung , Kang Jinkyeong , Cha Inseong , Kim Haneul , Joung Yochan , Jang Tae Yong , Joh Kiseong
Published: March 2020

Two strains of Gram-stain-positive, strictly aerobic, motile, spore-forming, rod-shaped, moderately halotolerant bacteria, designated as HMF5848T and HME7618, were isolated from salt/brine and subjected to a polyphasic taxonomic investigation. Growth of both yellow-coloured strains occurred in the presence of 1–9 % NaCl (w/v; optimum, 2–3 %), at 15–45 °C (optimum, 37 °C) and pH 6–9 (optimum, pH 7). The major fatty acids were iso-C15 : 0, iso-C16 : 0 and anteiso-C15 : 0. The cell-wall peptidoglycan was meso-diaminopimelic acid. The only respiratory quinone was menaquinone-7. The major polar lipids were diphosphatidylglycerol, phosphatidylglycerol, four unidentified glycolipids, three unidentified phospholipids and two unidentified polar lipids. DNA G+C content was 37.4 mol%. Phylogenetic trees based on 16S rRNA gene sequences showed that strains HMF5848T and HME7618 clustered with

Bacillus luteolus

YIM 93174T. Strains HMF5848T showed the highest 16S rRNA gene sequence similarities to

Bacillus humi

LMG 22167T (96.1 %),

Bacillus isabeliae

CVS-8T (96.0 %) and

Bacillus luteolus

YIM 93174T (96.0 %). The values of in silico DNA–DNA hybridization and average nucleotide identity between strains HMF5848T and

B. humi

DSM 16318T were 25.8 and 69.7 %, respectively. On the basis of phylogenetic, physiological and chemotaxonomic properties, strain HMF5848T represents a novel species, Bacillus salinus sp. nov. The type strain is HMF5848T (=KCTC 43010T=CECT 9695T).
Aquabacterium lacunae sp. nov., isolated from a freshwater pond
Authors: Chen Wen-Ming , Chen Tzu-Ying , Kwon Soon-Wo , Sheu Shih-Yi
Published: March 2020

A novel bacterial strain, designated KMB7T, isolated from a freshwater pond in Taiwan, was characterized using a polyphasic taxonomic approach. Cells were Gram-stain-negative, motile by means of a single polar flagellum, rod-shaped and formed cream colonies. Optimal growth occurred at 25 °C, pH 7, and in the absence of NaCl. Phylogenetic analyses based on 16S rRNA gene sequences and an up-to-date bacterial core gene set (92 protein clusters) indicated that strain KMB7Tis affiliated with species in the genusAquabacterium. The 16S rRNA gene sequence similarity indicated that strain KMB7Tis closely related to species within the genusAquabacterium(95.2–97.6 % sequence similarity) and is most similar toA. fontiphilumCS-6T(97.6 %), followed byA. parvumB6T(97.5 %). The average nucleotide identity and digital DNA–DNA hybridization identity between strain KMB7Tand the closely related strains were 74.6–78.0 % and 19.0–21.2 %, respectively. The major fatty acids of strain KMB7Twere summed feature 3 (C16 : 1 ω7cand/or C16 : 1 ω6c), C18 : 1 ω7cand C16 : 0. The polar lipid profile consisted of a mixture of phosphatidylethanolamine, phosphatidylglycerol, phosphatidylserine, diphosphatidylglycerol and four unidentified phospholipids. The sole isoprenoid quinone was ubiquinone-8 (Q-8). Genomic DNA G+C content of strain KMB7Twas 65.4 %. On the basis of phenotypic and genotypic properties and phylogenetic inference, strain KMB7Tshould be classified in a novel species of the genusAquabacterium, for which the nameAquabacterium lacunaesp. nov. is proposed. The type strain is KMB7T(=BCRC 81156T=LMG 30924T=KCTC 62867T).
N-glycosylation of infectious bronchitis virus M41 spike determines receptor specificity
Authors: Bouwman K. M. , Habraeken N. , Laconi A. , Berends A. J. , Groenewoud L. , Alders M. , Kemp V. , Verheije M. H.
Published: March 2020

Infection of chicken coronavirus infectious bronchitis virus (IBV) is initiated by binding of the viral heavily N-glycosylated attachment protein spike to the alpha-2,3-linked sialic acid receptor Neu5Ac. Previously, we have shown that N-glycosylation of recombinantly expressed receptor binding domain (RBD) of the spike of IBV-M41 is of critical importance for binding to chicken trachea tissue. Here we investigated the role of N-glycosylation of the RBD on receptor specificity and virus replication in the context of the virus particle. Using our reverse genetics system we were able to generate recombinant IBVs for nine-out-of-ten individual N-glycosylation mutants. In vitro growth kinetics of these viruses were comparable to the virus containing the wild-type M41-S1. Furthermore, Neu5Ac binding by the recombinant viruses containing single N-glycosylation site knock-out mutations matched the Neu5Ac binding observed with the recombinant RBDs. Five N-glycosylation mutants lost the ability to bind Neu5Ac and gained binding to a different, yet unknown, sialylated glycan receptor on host cells. These results demonstrate that N-glycosylation of IBV is a determinant for receptor specificity.
The bacterial neurometabolic signature of the gut microbiota of young children with autism spectrum disorders
Authors: Averina Olga V. , Kovtun Alexey S. , Polyakova Svetlana I. , Savilova Anastasia M. , Rebrikov Denis V. , Danilenko Valery N.
Published: March 2020

Introduction. The human gut microbiota is currently seen as an important factor that can promote autism spectrum disorder (ASD) development in children.

Aim. This study aimed to detect differences in the taxonomic composition and content of bacterial genes encoding key enzymes involved in the metabolism of neuroactive biomarker compounds in the metagenomes of gut microbiota of children with ASD and neurotypical children.

Methodology. A whole metagenome sequencing approach was used to obtain metagenomic data on faecal specimens of 36 children with ASD and 21 healthy neurotypical children of 3–5 years old. Taxonomic analysis was conducted using MetaPhlAn2. The developed bioinformatics algorithm and created catalogue of the orthologues were applied to identify bacterial genes of neuroactive compounds in the metagenomes. For the identification of metagenomic signatures of children with ASD, Wilcoxon's test and adjustment for multiple comparisons were used.

Results. Statistically significant differences with decreases in average abundance in the microbiota of ASD children were found for the genera

Barnesiella

and

Parabacteroides

and species

Alistipes putredinis

,

B. caccae

, Bacteroides intestinihominis,

Eubacterium rectale

,

Parabacteroides distasonis

and

Ruminococcus lactaris

. Average relative abundances of the detected genes and neurometabolic signature approach did not reveal many significant differences in the metagenomes of the groups that were compared. We noted decreases in the abundance of genes linked to production of GABA, melatonine and butyric acid in the ASD metagenomes.

Conclusion. For the first time, the neurometabolic signature of the gut microbiota of young children with ASD is presented. The data can help to provide a comparative assessment of the transcriptional and metabolomic activity of the identified genes.