bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation and Impact of Critical Care Pharmacist Addition to a Telecritical Care Network
Authors: Belcher Rachel M. , Blair Anastasia , Chauv Stephanie , Hoang Quang , Hickman Abby W. , Peng Melissa , Baldwin Margaret , Koch Logan , Nguyen Mark , Guidry David , Fontaine Gabriel V.
Published: January 2023

IMPORTANCE:

Critical care pharmacists when incorporated into the ICU team, have been shown to improve outcomes in critically ill patients by decreasing mortality, improving morbidity and reducing cost. As telehealth continues to evolve, the incorporation of a critical care pharmacist into a comprehensive telecritical care (TCC) service will allow increased comprehensive pharmacotherapeutic care for those in smaller, community or rural hospitals.

OBJECTIVES:

To describe the implementation of a TCC pharmacist into an established TCC network, classify interventions performed, and quantify cost avoidance generated through pharmacist interventions.

DESIGN:

Multicenter, observational cohort study and retrospective return on investment, performed between December 2019 and December 2021.

SETTING AND PARTICIPANTS:

Critically ill adult patients, admitted to an ICU located in any of our eight community hospitals (50 ICU beds) within a large, 25-hospital integrated healthcare system (563 ICU beds total) in the United States.

MAIN OUTCOMES AND MEASURES:

The TCC pharmacist service was implemented in 8-hour shifts, initially available 5 days per week, then expanded to 7 days per week. Critical care pharmacist interventions were categorized by clinical type established utilizing American Society of Health-System Pharmacists benchmarking standards and the latest cost avoidance data.

RESULTS:

During the 2-year analysis period, TCC pharmacists documented 2,838 interventions generating $1,664,254 of gross cost avoidance and a return on investment of 4.5:1.

CONCLUSIONS AND RELEVANCE:

It is feasible to implement a TCC pharmacist within an established TCC network. Our experience showed enhanced comprehensive care of critically ill patients located in community hospitals within a large, integrated healthcare system, demonstrated significant cost avoidance, and has led to other initiatives, including a collaborative clinical/operational partnership with Life Flight.
ACU&MOX-DATA: a platform for fusion analysis and visual display acupuncture multi-omics heterogeneous data
Authors: Wu Qiaofeng , Liu Shuqing , Zhang Ruibin , Tang Qiang , Dong Longcong , Li Sihui , Yu Shuguang
Published: January 2023

A new network platform named ACU&MOX-DATA (http://cbcb.cdutcm.edu.cn/ACU&MOX-DATA/) was recently set up and introduced. The purpose of this website is to integrate and analyze multi-omics data of acupuncture and moxibustion and serve as a disease, clinical, and laboratory experiment public database. Some existing functions and the future plan of the website were also discussed. This platform can help researchers to integrate analyses and visual interpretation of key scientific issues in acupuncture & moxibustion under the guidance of traditional Chinese medicine theory through heterogeneous and multi-level data fusion analysis.

Graphical abstract:

http://links.lww.com/AHM/A41.
Effects of acupuncture on angiogenesis-associated factor expression in ischemic brain tissue following cerebral infarction in rats
Authors: Sun Yajie , Li Jing , Georgi Rainer , Kolberg Bernhard , Yang Lihong
Published: January 2023

Background:

We aimed to investigate changes into the levels of angiogenesis-associated factors following cerebral infarction and acupuncture intervention and reveal the underlying molecular mechanisms involved in promoting angiogenesis.

Methods:

Model rats with middle cerebral artery occlusion (MCAO) were randomized into electroacupuncture (EA), model control (MC), and blank control (control) groups. Changes in the degree of neurological impairment following cerebral infarction and angiogenesis in the ischemic center and peripheral area were observed using immunofluorescence double-labeling. Reverse transcription-polymerase chain reaction (RT-PCR) and western blotting were used to detect changes in the Ang-1, Ang-2, PDGF-B, and bFGF levels. Moreover, the effects of EA intervention were evaluated.

Results:

The neurological severity score of each phase in the EA group was lower than that into the simultaneous phase in the MC group. The proliferation of vascular endothelial cells in the EA group was higher than that in the MC group at 12 hours to 7 days. The Ang-1 and Ang-2 mRNA and protein levels in the EA group were significantly higher than those in the MC group. PDGF-B levels in the EA group were significantly higher than those in the MC group at 3 to 6 hours and 3 to 12 days, and protein levels were high at 6 hours and 3 to 12 days. bFGF mRNA levels at 24 hours to 12 days and bFGF protein at 3 to 12 days were significantly elevated in the EA group than those in the MC group.

Conclusions:

EA at Shui Gou(DU 26) significantly improved the neurological symptoms of MCAO rats, promoted vascular endothelial cell proliferative activity around the infarct area, significantly advanced the time of proliferation of vascular endothelial cells, and upregulated the expression of angiogenesis-related factors, thereby promoting angiogenesis. Thus, EA may significantly improve the prognosis of cerebral infarction.

Graphical abstract:

http://links.lww.com/AHM/A43.
Impact of Ultra High-risk Genetics on Real-world Outcomes of Transplant-eligible Multiple Myeloma Patients
Authors: Panopoulou Aikaterini , Easdale Sandra , Ethell Mark , Nicholson Emma , Potter Mike , Giotas Asterios , Woods Helena , Thornton Tracy , Pawlyn Charlotte , Boyd Kevin D. , Kaiser Martin F.
Published: January 2023

Refined prediction of early relapse following standard-of-care (SoC) autologous stem cell transplant (ASCT) in newly diagnosed multiple myeloma (NDMM) could inform real-world risk-stratified post-ASCT strategies. We investigated the impact of double hit genetics (≥2 adverse markers: t(4;14), t(14;16), t(14;20), gain(1q), del(17p)) on outcome in 139 NDMM patients who underwent SoC ASCT between January 2014 and October 2019 at our center. Double hit genetics were associated with a significantly shortened progression-free survival (hazard ratio [HR] = 4.27, P < 0.001) and overall survival (HR = 4.01, P = 0.03), and characterized most early relapses. Our results support the real-world utility of extended genetic profiling for improved risk prediction in NDMM.
Improvement of Soft Contact Lens Wettability After the Instillation of Hyaluronic Acid Eye Drops
Authors: Pastrana Cristina , Carpena-Torres Carlos , Rodríguez-Pomar Candela , Martin-Gil Alba , Carracedo Gonzalo
Published: January 2023

Purpose:

To evaluate the effect of the topical instillation of hyaluronic acid eye drops with different viscosity on soft contact lens wettability and comfort.

Methods:

A randomized and participant-masked study was performed, involving 20 participants (25.4±2.6 years). One eye wore hydrogel (ocufilcon D) contact lenses, and another eye wore silicone-hydrogel (somofilcon A) contact lenses. The in vivo wettability tear film surface quality (TFSQ) index and comfort were measured before and after the instillation of different eye drops: saline solution (control) and 0.1%, 0.2%, and 0.3% hyaluronic acid.

Results:

Compared with saline solution, the instillation of 0.1%, 0.2%, and 0.3% hyaluronic acid improved the in vivo wettability of the hydrogel contact lenses by decreasing their TFSQ mean for 5, 10, and 30 min, respectively (P<0.05). During silicone-hydrogel contact lens wear, the hyaluronic acid did not affect wettability because there were no changes in TFSQ mean (P≥0.05), but the 0.3% hyaluronic acid produced a decrease in comfort for the first 3 min (P<0.05).

Conclusions:

The instillation of hyaluronic acid eye drops increased the in vivo wettability of the hydrogel contact lens, and the duration of this effect was directly related to its concentration and viscosity.
Assessing the Quality of Patient Information for Cholesteatoma on the Video Sharing Platform YouTube
Authors: Reddy Rithvik , Cheng Horace , Jufas Nicholas , Patel Nirmal
Published: January 2023

Introduction

Cholesteatoma is common chronic ear condition that usually requires surgical treatment and long-term follow-up. The Internet helps patients find information about their medical conditions and assists in shared clinical decision making. This work aims to assess the quality of information on YouTube for cholesteatoma. We aim to assess the quality of the most popular cholesteatoma videos on YouTube using recognized scoring systems and determine if quality correlated with video likes and views.

Methods

The YouTube website was systematically searched on separate days with a formal search strategy to identify videos relevant to cholesteatoma. Each video was viewed and scored by three independent assessors using a novel Essential and Ideal Video Completeness criteria for cholesteatoma and the validated DISCERN tool. Popularity metrics were analyzed and compared with video popularity.

Results

A total of 90 YouTube videos were analyzed with an average 55,292 views per video with an average of 271 likes and 22 dislikes. The interrater correlation was moderate with Fleiss kappa score 0.42 (p < 0.01) using the Essential and Ideal Video Completeness criteria for cholesteatoma and interrater correlation coefficient was 0.78 (95% confidence interval, 0.58–0.90), indicating good reliability for DISCERN scores. The overall video quality was poor with higher DISCERN scores found from academic institutions.

Conclusion

YouTube content with regard to cholesteatoma is of poor quality. Videos with unclassified sources or more dislikes correlated with poor quality. Otology societies should be encouraged to publish high-quality YouTube videos on cholesteatoma and other ear conditions.
Polyhydramnios associated with congenital bilateral vocal cord paralysis: A case report
Authors: Choi Myeong Gyun , Kim Yoon Ha , Kim Jong Woon , Kim Tae Young , Park Seo Yeong , Bang Hee Young
Published: January 2023

Rationale:

Polyhydramnios may develop when the fetus cannot swallow amniotic fluid or the amount of fetal urine increases. Occasionally, unpredictable fetal abnormalities can be diagnosed postnatally. Bilateral vocal cord paralysis in the fetus may cause polyhydramnios, which could be related to impaired prenatal swallowing.

Patient concern:

A 36-year-old multipara underwent an emergent cesarean section because of polyhydramnios and active labor at 35 + 5 weeks of gestation and gave birth to a girl.

Diagnosis:

The neonate cried feebly and exhibited cyanosis as well as very weak response to stimuli. Chest retraction and stridor were observed. Laryngoscopic examination revealed no movement in both the vocal cords, and bilateral vocal cord paralysis was diagnosed.

Interventions:

When the baby was 40 days old, she underwent tracheostomy to alleviate the persistent stridor and oral feeding difficulties.

Outcomes:

She was discharged at the age of 60 days while in the tracheostomy state.

Lessons:

Securing the airway of neonates with bilateral vocal cord paralysis, tracheoesophageal fistula, or muscular dystrophy, which can be detected after delivery in pregnant women with idiopathic polyhydramnios, is important. Therefore, pregnant women with idiopathic polyhydramnios must be attended to by experts, such as neonatologists, anesthesiologists, or otolaryngologists, who can secure the airway.
Atypical clinical and radiological presentations of lumbar spinal tuberculosis mimicking a spinal tumor: A case report
Authors: Miyamoto Kodai , Imada Hiroki , Yoshida Shinsuke , Oka Hideaki , Iida Shunpei , Saita Kazuo , Ogihara Satoshi
Published: January 2023

Introduction:

Tuberculosis (TB) is an important infectious disease worldwide. Classical spinal TB has specific radiological findings involving adjacent vertebral bodies with destruction of the intervertebral disc and involvement of paravertebral soft tissues with cold abscess formation. However, a few cases not exhibiting the radiological characteristics of TB spondylitis have been reported. We report a rare case of lumbar spinal TB with atypical clinical and radiological presentations that was difficult to differentiate from a malignant spinal tumor.

Patient concerns:

A 21-year-old man, who had immigrated to Japan from the Philippines 5 years ago, without a significant medical history, presented with back pain lasting 1 month and progression of gait disturbance 2 weeks prior to presentation.

Diagnosis:

Laboratory tests showed normal blood cell counts and normal value of C-reactive protein levels. Preoperative imaging studies indicated a possible spinal tumor. However, histopathologic findings of the epidural soft tissues at the first surgery led to the diagnosis of spinal mycobacterial infection. The diagnosis of spinal TB was confirmed by a positive culture of Mycobacterium tuberculosis obtained at the second surgery.

Interventions:

Given the progressive nature of neurologic deterioration, instead of needle biopsy, we proceeded with surgical intervention 8 days after admission; simultaneous neural decompression and open biopsy. Histological findings of the excised epidural soft tissues led to the diagnosis of spinal mycobacterial infection. We performed the second surgery involving additional resection of epidural soft tissues for further dural decompression and to obtain specimens for mycobacterial culture. Immediately after the second surgery, the patient commenced combination therapy with anti-tuberculous drugs.

Outcomes:

The patient demonstrated significant recovery of motor function in the lower extremities, and was able to run at 2 months after the second surgery. The epidural granulomas completely disappeared on magnetic resonance imaging 3 months postoperatively.

Conclusion:

Atypical clinical and radiological presentations of spinal TB present a challenge for appropriate diagnosis and early treatment. Even in developed countries where there are very few spinal TB patients, clinicians should be aware that spinal TB is an important differential diagnosis, especially in elderly patients or patients coming from countries with a middle-high prevalence of TB.
Invisible voices: experiences and perceptions of mothers and grandmothers caring for newborns with neonatal abstinence syndrome
Authors: Lao Amberly , Li Tessa , Battaglia Sarah , Berry Jessica , Artigas Valarie , Cong Xiaomei
Published: January 2023

Objective:

This study was designed to give mothers with opioid use disorder (OUD) and their families a “voice” in sharing their experiences surrounding the relationship with health care staff in the care of their newborn with neonatal abstinence syndrome (NAS) and aimed to identify their perceptions of the care received during their newborn’s hospitalization.

Methods:

A cross-sectional study was administered through Qualtrics online survey software. The survey questions with quantitative and qualitative components were developed and validated by the researchers to explore perceptions and experiences regarding the care the mother and the infant received, and their feelings about whether they were adequately educated and prepared to care for themselves and infant with NAS. A convenience sampling method was used to recruit mothers (18 years old and above) who gave birth to infants with NAS as well as their family members from the Department of Behavioral and Community Health in the Northeastern United States. Descriptive analysis methods were used to describe the quantitative survey data and thematic content analysis approach was used to explore the qualitative narrative data.

Results:

Twenty mothers were eligible for the study and a total of 10 mothers and 3 grandmothers participated in the final study. Primary outcomes for quantitative results from mothers were frustration based on how they were treated, the belief that the newborn required the neonatal intensive care unit, and the conclusion that they were treated inferiorly compared with mothers without OUD. Four major themes identified by the mothers were: judgment by the health care providers, trying to be a good mother, education needs of mothers to receive more information about NAS, and not understood by the health care providers and the need for training specified to caring for OUD during pregnancy and NAS. Results of the grandmothers’ study demonstrated a deficiency in personal knowledge about caring for an infant with NAS, and a belief that the mother was treated poorly due to her history.

Conclusions:

Women with OUD are blamed and stigmatized for their decisions and experience a lack of knowledge in caring for their infants. While further research is warranted in exploring these topics, the disparities between this population and health care providers may increase health risks for both the mother and newborn.
Compensation for Vitreous Chamber Elongation in Infancy and Childhood
Authors: Mutti Donald O. , Sinnott Loraine T. , Zadnik Karla ,   for the BIBS Study Group and the CLEERE Study Group
Published: January 2023

SIGNIFICANCE

The ratios of diopters of change in refractive error produced per millimeter of eye elongation (D/mm) are rarely those predicted from geometric optics because of changes in other ocular components. Quantifying this optical compensation in millimeters instead of ratios reveals some important principles about eye growth and refractive error.

PURPOSE

The study purpose was to sort total vitreous chamber elongation into millimeters that either contributed (uncompensated) or did not contribute to change in refractive error (compensated).

METHODS

Participants were infants in the Berkeley Infant Biometry Study (n = 271, ages 3 months to 6 years) or schoolchildren in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (n = 456 emmetropes and 522 myopes, ages 6 to 14 years). Refractive error was measured using cycloplegic retinoscopy in infants (cyclopentolate 1%) and cycloplegic autorefraction in schoolchildren (tropicamide 1% or combined with cyclopentolate 1%). Axial dimensions were assessed using A-scan ultrasonography. Uncompensated millimeters were estimated from ratios of change in refractive error per millimeter of elongation using Gullstrand eye models. Compensated millimeters were the difference between measured elongation and uncompensated millimeters.

RESULTS

Compensated millimeters exceeded uncompensated millimeters in emmetropic children across ages, but uncompensated millimeters exceeded compensated millimeters in myopic children. Compensated millimeters were highest in infancy and decreased with age, reaching less than 0.10 mm per year by age 10 years in both myopic and emmetropic children. There were no statistically significant differences in compensated millimeters between myopic and emmetropic children between ages 8 and 14 years (P values from .17 to .73).

CONCLUSIONS

The ability of the ocular components, primarily crystalline lens, to compensate for vitreous elongation is independent of the higher demands of myopic eye growth. The limited compensation after age 10 years suggests the target for elongation in myopia control needed to arrest myopia progression may be that seen in emmetropes or less.
One-year Efficacy of the Defocus Incorporated Multiple Segment Lens in Chinese Myopic Children
Authors: Long Wen , Chen Kezhe , Yu Shuiming , Liang Ziqi , Zheng Bingru , Zeng Junwen , Cui Dongmei
Published: January 2023

SIGNIFICANCE

These data demonstrate that defocus incorporated multiple segment (DIMS) lens reduces myopia progression in children during the first year of use.

PURPOSE

This study aimed to investigate the efficacy of DIMS myopia control spectacle lens in Chinese myopic children aged 6 to 15 years.

METHODS

This is a retrospective study of 1-year longitudinal data. A total of 180 Chinese myopic children were selected from patients at Zhongshan Ophthalmic Center, Sun Yat-sen University, from February 2018 to January 2021. One group consisted of 90 children aged 6 to 15 years, with spherical equivalent refraction −0.50 to −7.75 D (−3.82 ± 1.57 D) and fitted with the DIMS lens. The other group consisted of 90 children fitted with single-vision spectacle lenses and matched with the DIMS group for age, sex, refraction, and progression of myopia in the previous year. One-year myopia progression was measured retrospectively in two groups. Unpaired t test was used to compare the myopia progression between the DIMS group and the control group. Pearson correlation was used to explore the relationship between myopia progression, age, and baseline refraction.

RESULTS

After 1 year of DIMS lens wear, myopia progression was significantly lower in the DIMS group (−0.51 ± 0.50 vs. −0.85 ± 0.51 D, P < .001). Myopia progression was positively correlated with age in both groups. The difference between the DIMS and control groups was more pronounced for children aged 10 to 15 years than for children aged 6 to 9 years.

CONCLUSIONS

This study confirms that the DIMS lens reduces myopia progression during the first year of use. Efficacy seems to increase with age.
Improvements in disability and function in people with lower-limb amputation one year after prosthesis osseointegration
Authors: Davis-Wilson Hope C. , Christiansen Cory L. , Gaffney Brecca M. M. , Lev Guy , Enabulele Eseosa , Stoneback Jason W.
Published: January 2023

Background:

People with lower-limb amputation (LLA) are routinely prescribed a socket prosthesis; however, many socket prosthesis users experience severe complications with the fit of their prosthesis including residual limb wounds and pain. Osseointegration is a procedure that creates a direct connection between the bone and prosthetic limb through a bone-anchored prosthesis, eliminating the need for a socket interface. It is offered as a secondary procedure to people with LLA who experience significant complications with socket prostheses.

Objectives:

To evaluate change in disability and function 1 year postosseointegration compared with preosseointegration in people with LLA.

Study design:

Single group, pretest, and post-test.

Methods:

Twelve participants (9 transfemoral and 3 transtibial amputations, age: 44 ± 10 years, 7 female participants, 14 ± 12 years since amputation) with unilateral LLA underwent osseointegration with press-fit implants. Disability was measured with the World Health Organization Disability Assessment Schedule 2.0, and function was measured with both Prosthetic Limb Users Mobility Survey and the Activities-Specific Balance Confidence Scale. Questionnaires were administered preosseointegration and 1 year postosseointegration. Paired t tests assessed change in outcomes between time points.

Results:

Postosseointegration, participants demonstrated reduced disability measured with World Health Organization Disability Assessment Schedule 2.0 (%Δ = −52.6, p = 0.01), improved mobility measured with Prosthetic Limb Users Mobility Survey (%Δ = 21.8, P < 0.01), and improved balance confidence measured with the Activities-Specific Balance Confidence Scale (%Δ = 28.4, P < 0.01).

Conclusions:

Participants report less disability and greater function in their prosthesis postosseointegration. Osseointegration is a novel procedure for people experiencing complications with their socket prosthesis, and this study is the first to show improvements in disability postosseointegration.
Brief Report: Detection of Urine Lipoarabinomannan Is Associated With Proinflammatory Innate Immune Activation, Impaired Host Defense, and Organ Dysfunction in Adults With Severe HIV-Associated Tuberculosis in Uganda
Authors: Cummings Matthew J. , Bakamutumaho Barnabas , Jain Komal , Price Adam , Owor Nicholas , Kayiwa John , Namulondo Joyce , Byaruhanga Timothy , Muwanga Moses , Nsereko Christopher , Nayiga Irene , Kyebambe Stephen , Che Xiaoyu , Sameroff Stephen , Tokarz Rafal , Wong Wai , Postler Thomas S. , Larsen Michelle H. , Lipkin W. Ian , Lutwama Julius J. , O'Donnell Max R.
Published: January 2023

Background:

The immunopathology of disseminated HIV-associated tuberculosis (HIV/TB), a leading cause of critical illness and death among persons living with HIV in sub-Saharan Africa, is incompletely understood. Reflective of hematogenously disseminated TB, detection of lipoarabinomannan (LAM) in urine is associated with greater bacillary burden and poor outcomes in adults with HIV/TB.

Methods:

We determined the relationship between detection of urine TB-LAM, organ dysfunction, and host immune responses in a prospective cohort of adults hospitalized with severe HIV/TB in Uganda. Generalized additive models were used to analyze the association between urine TB-LAM grade and concentrations of 14 soluble immune mediators. Whole-blood RNA-sequencing data were used to compare transcriptional profiles between patients with high- vs. low-grade TB-LAM results.

Results:

Among 157 hospitalized persons living with HIV, 40 (25.5%) had positive urine TB-LAM testing. Higher TB-LAM grade was associated with more severe physiologic derangement, organ dysfunction, and shock. Adjusted generalized additive models showed that higher TB-LAM grade was significantly associated with higher concentrations of mediators reflecting proinflammatory innate and T-cell activation and chemotaxis (IL-8, MIF, MIP-1β/CCL4, and sIL-2Ra/sCD25). Transcriptionally, patients with higher TB-LAM grades demonstrated multifaceted impairment of antibacterial defense including reduced expression of genes encoding cytotoxic and autophagy-related proteins and impaired cross-talk between innate and cell-mediated immune effectors.

Conclusions:

Our findings add to emerging data suggesting pathobiological relationships between LAM, TB dissemination, innate cell activation, and evasion of host immunity in severe HIV/TB. Further translational studies are needed to elucidate the role for immunomodulatory therapies, in addition to optimized anti-TB treatment, in this often critically ill population.
Enhancing Self-Management of Percutaneous Endoscopic Gastrostomy Tubes Through the Implementation of a Standardized Education and Assessment Pathway
Authors: Reardon Joyce , Truax Alexis-Evelyn , Naranian Taline , Liu Louis W. C.
Published: January 2023

Intraduodenal infusion of levodopa–carbidopa intestinal gel by percutaneous endoscopic gastrostomy tube with jejunal extension is a treatment option to reduce motor and nonmotor complications in patients with advanced Parkinson's disease when oral therapy no longer provides sufficient benefit. Medication management is of central focus; however, there was no standardized patient education on stoma-site care and tube maintenance, leading to the development of stoma-site complications. As a quality improvement (QI) initiative, a standardized education and assessment pathway was developed and implemented in an urban academic outpatient clinic to enhance patient self-management and reduce stoma-site complications. A retrospective chart review was conducted to establish baseline incidence of cutaneous stoma-site complications. QI interventions were implemented using a rapid-cycle improvement model. Routine stoma assessments by a nurse who specializes in wound, ostomy, and continence care were implemented at set points, and patient education on PEG tube care and maintenance was reinforced at each session. Results demonstrated a significant reduction in moderate-to-severe tube and stoma-site–related complication. Implementation of a similar standardized education and assessment pathway in patients with percutaneous endoscopic gastrostomy tubes may lead to a decrease in stoma-site–related complications and overall better patient self-management.
ARTERIAL HYPEROXIA AND MORTALITY IN PATIENTS UNDERGOING VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION
Authors: Celińska-Spodar Małgorzata , Załęska-Kocięcka Marta , Banaś Sławomir , Kołsut Piotr , Kowalik Ilona , Kuśmierczyk Mariusz , Kuśmierski Krzysztof , Litwiński Paweł , Sitkowska-Rysiak Ewa , Szymański Jarosław , Stępińska Janina
Published: January 2023

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can easily lead to supranormal oxygenation. The impact of hyperoxygenation beyond the early VA-ECMO support phase is unexplored. We sought to investigate its association with short- and long-term mortality. Methods: A total of 10,615 arterial blood gases of 179 patients undergoing VA-ECMO between 2013 and 2018 in our cardiosurgical tertiary center were analyzed for partial pressure of oxygen (PaO2) and its association with in-hospital, 90-day, and 1-year mortality. Patients were stratified into terciles (T) based on PaO2. Results: The median systemic PaO2 during VA-ECMO was 122 mm Hg (Q1–Q3, 111–158 mm Hg) and was significantly higher in 90-day nonsurvivors versus survivors (134 mm Hg [Q1–Q3, 114–175 mm Hg] vs. 114 mm Hg [Q1–Q3, 109–136 mm Hg]; P < 0.001). The incidence of mortality increased at all time points tested after VA-ECMO implantation along with the increasing terciles of PaO2. The lowest mortality rates were noted for patients with median PaO2 values of <115 mm Hg (T1), whereas patients with median PaO2 values of >144 mm Hg (T3) had the highest mortality rates. Bonferroni multiple testing analysis found the T3 of PaO2 to be a predictor of decreased 90-day survival in comparison with T1 (P < 0.001) and T2 (P = 0.002). Multivariable Cox regression analyses for in-hospital, 90-day, and 1-year mortality showed a significant association of the T3 compared with the T2 and the T1 of PaO2 to mortality across all endpoints. Conclusion: Hyperoxygenation during VA-ECMO might be associated with increased all-cause mortality. The results of our study further document the known toxicity of hyperoxygenation in general critical care patients and mark the need to focus specifically on VA-ECMO patients.
Cost Effectiveness of Concurrent Midurethral Sling at the Time of Prolapse Repair: Results From a Randomized Controlled Trial
Authors: Wang Rui , Tulikangas Paul , Sappenfield Elisabeth C.
Published: January 2023

Importance

The relative cost per improvement in quality of life can help guide decisions about adding a midurethral sling at the time of prolapse surgery.

Objective

This study aimed to assess the cost-effectiveness of prophylactic midurethral slings placed at the time of prolapse surgery to reduce de novo urinary incontinence based on a randomized controlled trial.

Study Design

Costs and effectiveness were collected as part of a planned secondary analysis from the Outcomes following vaginal Prolapse repair and mid Urethral Sling (OPUS) trial, where 337 women without symptomatic stress urinary incontinence were randomly assigned to a midurethral sling or sham incisions during vaginal prolapse surgery. Within-trial cost-effectiveness analysis was performed from the societal perspective. Effectiveness was measured in quality-adjusted life-years (QALYs) and de novo urinary incontinence. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.

Results

Within-trial societal costs were higher for the sling group than for the control group ($18,170 [95% confidence interval (CI), $16,420–$19,920] vs $15,700 [95% CI, $14,110–$17300], P = 0.041). The changes in QALY were 0.04 (95% CI, 0.02–0.06) versus 0.03 (95% CI, 0.02–0.05; P = 0.54). The incremental cost-effectiveness ratio for prophylactic sling was $309,620/QALY. This is above the generally accepted range of willingness-to-pay thresholds of $50,000 to $150,000/QALY. At 1 year, urinary incontinence was more common in the control group, and the cost to prevent 1 case was $91. The probability that prophylactic sling is cost-effective is 24%.

Conclusions

Prophylactic sling placed during vaginal prolapse surgery reduced the rate of de novo urinary incontinence, but was not cost-effective.
Exploring Patient Perspectives Surrounding Telemedicine Versus In-Person Preoperative Visits
Authors: Davenport Abigail , Brunn Elizabeth , Creswell Michael , Sholklapper Tamir , Ringel Nancy , Gutman Robert
Published: January 2023

Importance

Telemedicine was increasingly used to provide patients with an alternative to in-office visits during the COVID-19 pandemic. While previous studies have described the role of telemedicine for preoperative visits for other surgical specialties, the role of this modality in preoperative visits for gynecologic surgery has not been thoroughly explored.

Objectives

The aims of the study are to explore and compare patient experience, decision making, and satisfaction among women undergoing telemedicine or in-person preoperative visits.

Study Design

This was a qualitative study of women who underwent a preoperative appointment with a urogynecologic surgeon or minimally invasive gynecologic surgeon at a single academic institution from April to May of 2021. Data were collected using semistructured phone interviews, which focused on visit content, visit type decision making, surgical preparedness/confidence, and past surgical experiences. Interviews were thematically analyzed until theoretical saturation was achieved in accordance with grounded theory.

Results

Theoretical saturation occurred with 20 interviews. Participants were evenly divided between in-person and telemedicine visits. Major themes included visit content, experience/quality, surgeon perception, and surgical preparedness. Advantages of telemedicine visits were convenience and safety. Advantages of in-person visits were social factors, perceived medical or surgical severity, and preoperative physical examination. Disadvantages for telemedicine visits included technology concerns and difficulty accessing preoperative materials. The disadvantage of an in-person visit was the inability to have family present because of COVID hospital policy restrictions. Participants in both groups felt prepared for surgery and reported high satisfaction with their care.

Conclusions

Decision making for selecting an in-person or telemedicine visit is complex and involves balancing multiple advantages and disadvantages. Participant experience was similar for both visit types with high satisfaction.
rhMYDGF Alleviates I/R-induced Kidney Injury by Inhibiting Inflammation and Apoptosis via the Akt Pathway
Authors: Wang Jingwen , Ma Ruiyang , Wang Ying , Zhang Shucong , Wang Jiale , Zheng Jin , Xue Wujun , Ding Xiaoming
Published: January 2023

Background.

Renal ischemia/reperfusion (I/R) injury is one of the crucial factors affecting the outcome of renal transplantation. In recent years, myeloid-derived growth factor (MYDGF) has received a lot of attention for its extensive beneficial effects on cardiac repair and protection of cardiomyocytes from cell death. Therefore, we hypothesized that the recombinant human MYDGF (rhMYDGF) protein might play an essential role in safeguarding renal I/R injury.

Methods.

In vivo experiments were conducted using a mouse unilateral I/R model. Mice were pretreated with rhMYDGF by intraperitoneal injection to study the potential mechanism of renal protection. In vitro, we established hypoxia/reoxygenation and H2O2 treatment models to pretreat cells with rhMYDGF. The expression levels of oxidative stress, inflammation, and apoptosis-related factors in tissues and cells were detected. Finally, we explored the role of the protein kinase B (Akt) pathway in the renal protective mechanism of rhMYDGF.

Results.

In this study, we found that intraperitoneal injection of 1.25 μg rhMYDGF could significantly improve renal function of I/R mice, and reduce oxidative stress, inflammation, and apoptosis. For the human proximal tubular epithelial cell line and human kidney cell line, pretreatment with 0.3 μg/mL rhMYDGF for 24 h significantly downregulated oxidative stress, inflammation, and apoptosis via the phosphorylation of Akt, which could be ameliorated by LY294002.

Conclusions.

rhMYDGF protects kidney from I/R injury by attenuating oxidative stress, inflammation, and apoptosis through the activation of the Akt pathway.
An Eye on CAUTI Prevention: Bridging the Gap in the Prevention of Catheter-Associated Urinary Tract Infections
Authors: Yeruva Karthik , West Nat , Powell Warseal
Published: January 2023

Problem

The United States Healthcare Systems is burdened heavily by healthcare-associated infections (HAI), as they pose significant risks for increased mortality and morbidity. The most common type of HAI is urinary tract infection (UTI), and these infections are preventable (Strassle et al., 2019). According to the CDC (2021), 12-16% of hospitalized adults will at some point require catheterization; and each day an indwelling catheter remains in place increases the patient’s risks of adverse outcomes by 3-7%. CAUTIs have been linked to increased mortality and morbidity rates across the world. The Centers for Disease Control report urinary tract infections (UTI) lead to more than 13,000 deaths each year (Centers for Disease Control [cdc], 2021).

Objective

This quality improvement (QI) project will focus on the prevention of hospital-acquired UTIs, specifically those infections related to indwelling devices such as foley catheters. The purpose of this manuscript is to review the current evidence-based literature related to CAUTI prevention, trial an intervention that parallels the literature in a local hospital and evaluate those results.

Design

The researcher focused on the problem of CAUTI, analyzed current evidence-based practices related to prevention, developed a plan to execute a high-value improvement tool, and evaluated its effectiveness.

Setting

QI project took place in a local community hospital. The focus area was the medical-surgical ICU.

Participants

The participants were nursing staff and nursing managers on the medical surgical units, specifically those in positions with unique or direct involvement with insertion, removal, or monitoring of foley catheters. The subjects in this quality improvement project included adult patients hospitalized in the medical surgical intensive care unit (ICU).

Interventions

A CAUTI GPS screening tool was used to identify current prevention practices and/or any roadblocks to the prevention of CAUTI within the facility. Then, TAP (targeted assessment for prevention) strategy was implemented, which prompted expedited removal of indwelling catheters and/or the use of external drainage devices where indicated.

Results

There was a marked increase in attention to and prompt removal of indwelling foleys throughout the critical care unit. The facility had no hospital-acquired CAUTI during the project period.

Conclusions

There must be an impetus to inspire compliance. If healthcare workers adhere to prevention guidelines, CAUTIs are preventable. When leadership team members within hospital systems are enthusiastic about CAUTI prevention, the organization as a whole has increased motivation (Chenoweth et al., 2014).
Exposure to oxacillin subinhibitory concentrations andin vitroinduction of resistance expression in heteroresistant and non-heteroresistant oxacillin-susceptiblemecA-positiveStaphylococcus aureus(OS-MRSA)
Authors: Schimidt Denise Braga , Póvoa Helvécio Cardoso Corrêa
Published: January 2023

Resistance expression can occur as a consequence of irrational use of antibiotics, since this implies dissemination of subinhibitory concentration (sub-MICs) in different environments and generates a selective pressure. The study aimed to evaluate thein vitroinfluence of selective pressure on antibiotic resistance expression in two oxacillin-susceptiblemecA-positiveStaphylococcus aureus(OS-MRSA), through exposure to oxacillin sub-MICs. One heteroresistant OS-MRSA strain and a non-heteroresistant strain, both isolated from nasal colonization were exposed to two-fold serial dilutions of oxacillin (0,125 a 256 μg/mL) during seven consecutive days. Disc diffusion test was used to determine the susceptibility to several antibiotics and population analysis profile (PAP) was used to evaluate the expression of oxacillin resistance before and after antibiotic exposure. Susceptibility to non-β-lactam antibiotics was not altered but changes in phenotypic expression of penicillin and oxacillin resistance were observed. Both OS-MRSA strains began to express homoresistance (oxacillin MIC = 256 μg/mL) and had no penicillin zone inhibition after induction, different from that was observed before oxacillin exposure, which suggested increased in β-lactamase production.In vitroselective pressure with oxacillin stimulated β-lactamase production and led phenotypic expression of oxacillin resistance in heteroresistant and non-heteroresistant OS-MRSA, which became homoresistant. This reinforces the impact that irrational use of antibiotics has on individuals colonized byS. aureusand on the population, emphasizing that the emergence and spread of resistance to antibiotics represent a process of evolution in response to selective antimicrobial pressure.
The Adr1 transcription factor directs regulation of the ergosterol pathway and azole resistance in C.albicans
Authors: Shrivastava Manjari , Kouyoumdjian Gaëlle S. , Kirbizakis Eftyhios , Ruiz Daniel , Henry Manon , Vincent Antony T , Sellam Adnane , Whiteway Malcolm
Published: January 2023

Transcription factors play key roles in cellular regulation and are critical in the control of drug resistance in the fungal pathogenCandida albicans. We found that activation of the transcription factor C4_02500C_A (Adr1) conferred significant resistance against fluconazole. InSaccharomyces cerevisiae, Adr1 is a carbon-source-responsive zinc-finger transcription factor required for transcription of the glucose-repressed geneADH1and of genes required for ethanol, glycerol, and fatty acid utilization. Motif scanning of promoter elements suggests that Adr1 may be rewired in fungi and governs the ergosterol synthesis pathway inC. albicans. Because previous studies have identified the zinc-cluster transcription factor Upc2 as a regulator of the ergosterol pathway in both fungi, we examined the relationship of Adr1 and Upc2 in sterol biosynthesis inC. albicans. Phenotypic profiles of eitherADR1andUPC2modulation inC. albicansshowed differential growth in the presence of fluconazole; eitheradr1orupc2homozygous deletion results in sensitivity to the drug while their activation generates a fluconazole resistant strain. The rewiring from ergosterol synthesis to fatty acid metabolism involved all members of the Adr1 regulon except the alcohol dehydrogenase Adh1, which remains under Adr1 control in both circuits and may have been driven by the lifestyle ofS. cerevisiae, which requires the ability to both tolerate and process high concentrations of ethanol.
The RALF Signaling Pathway Regulates Cell Wall Integrity during Pollen Tube Growth in Maize
Authors: Zhou Liang-Zi , Wang Lele , Ge Zengxiang , Mergner Julia , Li Xingli , Küster Bernhard , Längst Gernot , Qu Li-Jia , Dresselhaus Thomas
Published: January 2023

Autocrine signaling pathways regulated by RAPID ALKALINIZATION FACTORs (RALFs) control cell wall integrity during pollen tube germination and growth in Arabidopsis. To investigate the role of pollen-specific RALFs in another plant species, we combined gene expression data with phylogenetic and biochemical studies to identify candidate orthologs in maize. We show that Clade IBZmRALF2/3mutants, but not that of Clade IIIZmRALF1/5caused cell wall instability in the sub-apical region of the growing pollen tube. ZmRALF2/3 are mainly located to the cell wall and are partially able to complement the pollen germination defect of their Arabidopsis orthologs AtRALF4/19. Mutations inZmRALF2/3compromise pectin distribution pattern leading to altered cell wall thickness, hyperphosphorylation of ZmPEX cell wall proteins and pollen tube burst. Clade IB, but not Clade III ZmRALFs are capable to interact with pollen-specific CrRLK1L receptor kinases ZmFERL4/7/9 and GPI-anchored co-receptors ZmLLG1/2 at similar binding affinities. In contrast, binding affinity to ZmPEX2/4 cell wall proteins is about five times higher. Based on these data, we now propose a dosage-dependent model showing how Clade IB RALFs act as extracellular sensors to regulate cell wall integrity and thickness during pollen tube growth in plants.

One sentence summary

Pollen-specific RALFs interact at different binding affinities with receptor kinases, GPI-anchored proteins and cell wall proteins to regulate cell wall integrity during pollen tube growth in maize.
Emphasis on quality in iNaturalist plant collections enhances learning and research utility
Authors: McNair Mason C. , Sexton Chelsea M. , Zenoble Mark
Published: January 2023

Following the switch to remote online teaching in the wake of the COVID-19 pandemic, the plant taxonomy course at the University of Georgia (UGA) switched to iNaturalist for the specimen collection portion of the course requirements. Building off extant rubrics, the instructors designed project guidelines for a fully online plant collection experience to alleviate plant awareness disparity. Researchers collected stratified samples from the UGA iNaturalist project along with four other institutions’ projects to determine if rubrics and project guidelines could improve the quality of observations to make them useful in plant science research. The specific rubric was shown to improve quality of iNaturalist observations. Researchers found that iNaturalist increased engagement as a student-centered tool but did not enhance their manual keying skills as the app uses automatic identification. Instructors recommend continuing to use iNaturalist to supplement physical collection and keying along with a detailed rubric and guidelines for collection.
Investigating variant and expression of CVD genes associated phenotypes among high-risk Heart Failure patients
Authors: Ahmed Zeeshan , Zeeshan Saman , Persaud Nicholas , Liang Bruce T.
Published: January 2023

Cardiovascular disease (CVD) is a leading cause of premature mortality in the US and the world. CVD comprises of several complex and mostly heritable conditions, which range from myocardial infarction to congenital heart disease. Here, we report our findings from an integrative analysis of gene expression, disease-causing gene variants, and associated phenotypes among CVD populations, with a focus on high-risk Heart Failure (HF) patients. We built a cohort using electronic health records (EHR) of consented patients with available samples, and then performed high-throughput whole-genome and RNA sequencing (RNA-seq) of key genes responsible for HF and other CVD pathologies. We also incorporated a translational aspect to our study by integrating genomics findings with patient medical records. This involved linking ICD-10 codes with our gene expression and variant data to identify associations with HF and other CVDs. Our in-depth gene expression analysis revealed differentially expressed genes associated with HF (41 genes) and other CVDs (23 genes). Furthermore, a variant analysis of whole-genome sequence data of CVD patients identified genes with altered gene expression (FLNA, CST3, LGALS3, and HBA1) with functional and nonfunctional mutations in these genes. Our study highlights the importance of an integrative approach that leverages gene expression, genetic mutations, and clinical data that will allow the prioritization of key driver genes for complex diseases to improve personalized healthcare.