bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective Investigation of the Performance of 2 Gamma-Hydroxybutyric Acid Tests: DrugCheck GHB Single Test and Viva-E GHB Immunoassay
Authors: Smits Thomas A. , Gresnigt Femke M. J. , van Groen Bianca D. , Franssen Eric J. F. , Attema-de Jonge Milly E.
Published: July 2019

Background:

Gamma-hydroxybutyric acid (GHB) is a recreational drug with central nervous system depressing effects that is often abused. A urine GHB point-of-care test can be of great diagnostic value. The objective of this prospective study was to determine the performance of the new DrugCheck GHB Single Test and the Viva-E GHB immunoassay for urine samples in emergency department patients.

Methods:

Patients presented to the emergency department of the OLVG hospital in Amsterdam with a Glasgow Coma Scale score <15 and potential drug of abuse intoxication were included in the study. Between June 2016 and October 2017, 375 patients were included. Using the DrugCheck GHB Single Test (Express Diagnostics Int'l, Blue Earth, MN) and the Viva-E GHB immunoassay (Siemens Healthineers, The Hague, the Netherlands), patients' urine samples were tested for GHB (cutoff for a positive result, 10 or 50 mcg/mL GHB). To ensure quality, the results obtained were compared with those generated using a validated gas chromatography method. The tests were considered reliable if specificity and sensitivity were both >90%. Possible cross-reactivity with ethanol was investigated by analyzing ethanol concentrations in patients' samples.

Results:

Seventy percentage of the included patients was men, and the median age was 34 years old. The DrugCheck GHB Single Test's specificity and sensitivity were 90.0% and 72.9%, respectively, and using 50 mcg/mL as a cutoff value, its specificity and sensitivity improved to 96.7% and 75.0%, respectively. Serum and urine ethanol levels in the false-positive group were significantly higher compared with those in the true-negative group. The specificity and sensitivity of the Viva-E GHB immunoassay (cutoff value of 50 mcg/mL and excluding samples with ethanol levels ≥2.0 g/L) were 99.4% and 93.5%, respectively.

Conclusions:

The DrugCheck GHB Single Test's specificity was sufficient, whereas its sensitivity was poor, making it unsuitable for use at point-of-care. Contrarily, using 50 mcg/mL as the cutoff value and excluding samples with ethanol levels ≥2.0 g/L, the Viva-E GHB immunoassay showed acceptable results to detect clinically relevant GHB intoxications.
Speech Perception Growth Patterns in Prelingual Deaf Children With Bilateral Sequential Cochlear Implantation
Authors: Kim Yehree , Lee Jee Yeon , Lim Won Seob , Kwak Min Young , Seo Ji Won , Park Jun Woo , Lee Je Yeon , Kang Byung Chul , Kang Woo Seok , Ahn Joong Ho , Chung Jong Woo , Park Hong Ju
Published: July 2019

Objective:

To evaluate speech perception following the first (CI-1) and second (CI-2) cochlear implantation (CI) in children with sequential bilateral CI.

Study Design:

Retrospective.

Patients:

Seventy children with follow-up for 60 months post CI-1 and 36 months post CI-2.

Main Outcome Measures:

Word recognition score (WRS) was the main outcome. WRSs were compared by age at CI operation (group A ≤ 3.5 yr, B 3.6–8.6, for CI-1; group I ≤ 3.5 yr, II 3.6–7.0, III 7.1–13, IV > 13, for CI-2).

Results:

For CI-1, the WRS of group A exceeded 80% at 24 months post procedure, earlier than group B (54 mo). Group A also had a shorter period of CI-1 use up to the WRS plateau than group B. CI-2 showed an initial burst of WRS growth much earlier than CI-1. This initial burst was most robust within 3 months in group II, but modest in group IV. The periods of CI-2 use (11–17 mo) up to the WRS plateau were much shorter than CI-1 (40–64 mo). Group I did not show the best WRS at 1 month post CI but later exceeded the other groups.

Conclusion:

Children received an immediate benefit by a burst of WRS growth from CI-2 earlier than CI-1, even within 3 months, suggesting that CI-1 gets the auditory cortex ready to foster speech processing from CI-2. The CI-2 performance depends on age at CI-2 implantation and on CI-1 performance. Our current findings will be relevant for clinicians who are counselling parents on CI-2 surgery.
Long-term Outcomes of Bone Conduction Hearing Implants in Patients With Bilateral Microtia-atresia
Authors: Fan Xinmiao , Yang Tengyu , Niu Xiaomin , Wang Yibei , Fan Yue , Chen Xiaowei
Published: July 2019

Objectives:

To evaluate the long-term outcomes of three different types of bone conduction hearing implants (BCHI)—BAHA, Ponto, and Bonebridge—in Mandarin-speaking patients with bilateral microtia-atresia.

Methods:

This cohort study enrolled 59 patients affected by bilateral microtia-atresia, with an upper bone conduction threshold limit of 30 dB HL at frequencies of 0.5 to 4 kHz. All subjects underwent unilateral BCHI surgery, including 26 (18 males, 8 females, of mean age 8.7 ± 1.9 yr) implanted with BAHA devices; 10 (7 males, 3 females, of mean age 11.7 ± 2.8 yr) implanted with Ponto devices; and 23 (14 males, 9 females, of mean age 9.0 ± 1.8 yr) implanted with Bonebridge devices. The main outcome measures included long-term audiological benefits, patient satisfaction, and complications. Each subject acted as his or her own control.

Results:

Two years after BCHI surgery, the mean hearing thresholds in the BAHA, Ponto, and Bonebridge groups had improved to 22.6 ± 1.6 dB HL, 21.6 ± 1.2 dB HL, and 22.5 ± 1.5 dB HL, respectively. The mean percentages of subjects in these three groups recognizing speech at 65 dB SPL under quiet conditions were 97.7 ± 4.2%, 96.3 ± 1.1%, and 94.4 ± 9.4%, respectively, whereas the mean percentages recognizing speech under noise conditions (signal:noise ratio +5) were 87.0 ± 1.8%, 89.3 ± 9.3%, and 85.3 ± 4.7%, respectively. Questionnaires revealed patients’ benefits and satisfaction with this surgery. Three (11.5%) of 26 patients in the BAHA group and 1 (10%) of 10 in the Ponto group experienced skin irritation, but all recovered after local treatment. Five (19.2%) patients in the BAHA group and two (20%) in the Ponto experienced abutment extrusion about 6 months postoperatively, with all achieving good results after revision surgery to replace the abutment. One (3.8%) patient in the BAHA group experienced local chronic inflammation and underwent surgery to replace the BAHA with a Bonebridge implant. One (4.3%) patient in the Bonebridge group developed a local infection 3 months postoperatively and underwent implant removal.

Conclusions:

All three BCHIs were well tolerated after long-term follow-up, and all improved audiometric thresholds and the intelligibility of speech in the presence of both quiet and noise. These implants should be considered valid and safe options for the functional rehabilitation of patients with bilateral microtia-atresia.
Hemophagocytic Lymphohistiocytosis: A Rare Complication of an Ultrarare Lysosomal Storage Disease
Authors: Chabchoub Imen , Boudabbous Hela , Maaloul Ines , Ben Abdelaziz Rim , Ben Chehida Amel , Ayadi Lobna , Kamoun Thouraya , Tebib Neji , Boudaouara Tahia , Bekri Soumeya , Hachicha Mongia
Published: July 2019

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hyperinflammatory condition that may be triggered by infections, autoimmune and immunologic disorders, malignancies, and metabolic diseases. Early and accurate diagnosis of HLH and its underlying cause is of paramount importance for proper management and prognosis. We report the case of a Tunisian 21-month-old girl who initially presented clinical features of HLH related to a lysosomal acid lipase deficiency. The genetic sequence analysis of the LIPA gene revealed a never described homozygous mutation c.966G>C (p.Gln322His). The parents were heterozygous for this mutation. Enzyme replacement therapy was not provided for the patient. She received etoposide, corticosteroids, and cyclosporine for the HLH. She is waiting for hematopoietic stem cell transplantation. To the best of our knowledge, this is the second Tunisian case of secondary HLH complicating lysosomal acid lipase deficiency related to a new homozygous mutation: c.966G>C (p.Gln322His).
Gram-negative Bacteremia in Children With Hematologic Malignancies and Following Hematopoietic Stem Cell Transplantation: Epidemiology, Resistance, and Outcome
Authors: Vinker-Shuster Michal , Stepensky Polina , Temper Violeta , Shayovitz Vered , Masarwa Reem , Averbuch Diana
Published: July 2019

Gram-negative rod (GNR) infections adversely affect the outcome of patients with malignancies and following hematopoietic stem cell transplantation (HSCT). This retrospective observational study aimed to describe the epidemiology, outcome, and resistance patterns of GNR bacteremia in children with hematologic malignancies (HM) and after HSCT during the period spanning from 2010 to 2014 in a tertiary children’s hospital. A total of 270 children were included in the analysis; 65 (24%) developed 85 episodes of GNR bacteremia; the rate was 36/122 (29.5%) in post-HSCT and 29/178 (16.3%) in HM patients (P<0.05). Overall, 10% of the GNRs were carbapenem resistant. In multivariate analysis, prolonged neutropenia (≥7 d; odds ratio: 19.5, 95% confidence interval: 2.6-148.4) and total hospitalization for a duration of >30 days in the last 3 months (odds ratio: 17.5, 95% confidence interval: 1.4-224.4) were associated with carbapenem-resistant GNR bacteremia. Thirty-day mortality following GNR bacteremia was 0% in HM and 7/52 episodes (13.5%) in HSCT patients (P<0.05). Carbapenem-resistant versus carbapenem-sensitive bacteremia was associated with longer duration of bacteremia (mean: 3.8 vs. 1.7 d), higher risk for intensive care unit hospitalization (44.4% vs. 10.1%), and higher mortality rate (33% vs. 5.8%) (P<0.05). To summarize, GNR bacteremia was frequent, especially in post-HSCT children. Carbapenem resistance adversely affects patients’ outcome, increasing morbidity and mortality. Empirical antibiotic therapy must be adjusted to the local resistance patterns.
Rise Above
Authors: Lalani Nasreen , Duggleby Wendy , Olson Joanne
Published: July 2019

Family caregivers experience multiple transitions, resolutions, loss, and grief where their search for meaning becomes evident. Spirituality is an important dimension of palliative care, yet little attention has been given to this important aspect of spirituality especially among the family caregivers in a hospice setting. The study aimed to bring the hidden voices of family caregivers, their own spiritual experiences caring for their dying patients in a hospice setting, to guide and direct the care practices of health care professionals. An interpretive descriptive approach guided the study using a purposive sample of 18 family caregivers from a hospice in Karachi, Pakistan. Major themes were family love, attachment, and belongingness; honoring family values and dignity; acts of compassion and selfless service; and seeking God’s kindness and grace. Spirituality enabled family caregivers to uncover meaningful engagement and provided strength and peace while serving a dying family member in challenging caregiving situations such as adversity and limited resources. They highly valued the love, respect, and honor of the family; showed compassion; believed in God’s blessings; and experienced spiritual growth and self-transcendence. Spirituality was found to be a major resource of coping among family caregivers. Health care professionals need to integrate spirituality while developing family-centered interventions in hospice care.
Heart-Focused Anxiety Among Latinxs in Primary Care
Authors: Manning Kara , Rogers Andrew H. , Bakhshaie Jafar , Viana Andres G. , Lemaire Chad , Garza Monica , Ochoa-Perez Melissa , Zvolensky Michael J.
Published: July 2019

There is a public health need to better characterize the individual-based differences that may be involved in the expression and maintenance of psychological and related health problems among Latinx individuals. One individual difference factor that may be relevant to the nexus of psychological and physical concerns is heart-focused anxiety. The current study sought to evaluate the potential explanatory relevance of heart-focused anxiety as an important individual difference factor for anxiety, depression, pain experience, and functional impairment. Participants included 158 Latinx adults (M
age = 39.26, SD = 13.19; 85.4% female) from a primary health clinic. Results indicated that heart-focused anxiety was significantly related to anxious arousal, pain intensity, pain disability, and functional impairment. However, no significant effects were evident for depressive symptoms. These data indicate that heart-focused anxiety may be an underrecognized cognitive factor relevant to better understanding anxiety and pain among Latinx adults in primary care.
Case Report: Transient Dorsal Midbrain Syndrome as the Initial Presentation of Multiple Sclerosis
Authors: Malloy Kelly A. , Draper Erin M. , Maglione Ashley Kay
Published: July 2019

SIGNIFICANCE

Prompt neuroimaging is important to identify multiple sclerosis lesions in the appropriate clinical setting. However, despite a normal brain MRI finding, a diagnosis of multiple sclerosis still must be considered in cases of dorsal midbrain syndrome, even if it is transient.

PURPOSE

The purpose of this case report is to present a patient with a transient presentation of dorsal midbrain syndrome, resolving within 1 week of initial symptoms, which was ultimately attributed to multiple sclerosis in the setting of a normal enhanced brain MRI study.

CASE REPORT

A 33-year-old man with new-onset visual complaints was found to have upgaze paresis, eyelid retraction, and pupillary light-near dissociation suggestive of dorsal midbrain syndrome. Within days, enhanced brain MRI was completed and showed a normal finding, and the clinical features of dorsal midbrain syndrome had resolved. Subsequent spine imaging and lumbar puncture lead to an ultimate diagnosis of multiple sclerosis.

CONCLUSIONS

There have been a few reported cases of dorsal midbrain syndrome as the presenting feature of multiple sclerosis. This case is unique because it reports a transient presentation of dorsal midbrain syndrome, documented to have resolved only days after initial presentation, which was ultimately attributed to multiple sclerosis.
Black Mamba Death
Authors: Blumenthal Ryan , Scholtz Pieter Evelyn Pienaar , Shuttleworth Jenna-lee
Published: July 2019

We present the case of a male adult who was admitted to an emergency department after having sustained envenomation from a black mamba (Dendroaspis polylepis). According to the available history, a single fang hooked his right index finger, post venom extraction. After administering antivenom in the accident and emergency department, further vials were transfused in the intensive care unit. An urticarial rash was noted, which was thought to be related to the antivenom. The victim remained in a coma for 3 days, after which he was declared dead. A medicolegal postmortem examination was performed 4 days after death because of logistical reasons. The complexities of differentiating acute envenomation from black mamba versus early acute reactions to polyvalent antivenom administration are highlighted in this case study.
Pediatric Pain Assessment in the Emergency Department
Authors: Lawson Simone L. , Hogg Melanie M. , Moore Charity G. , Anderson William E. , Osipoff Paul S. , Runyon Michael S. , Reynolds Stacy L.
Published: July 2019

Objective

This study aimed to assess the agreement between patients presenting to the pediatric emergency department (ED) with acute pain and their caregivers when using the Wong-Baker FACES (WBF) and Faces Pain Scale–Revised (FPS-R).

Methods

This was a prospective, observational study examining patients 3 to 7.5 years old presenting to a pediatric ED with acute pain. Participants completed the WBF and FPS-R twice during their ED evaluation. Caregivers rated their child's pain using both the WBF and FPS-R at the same time points. Intraclass correlations (ICCs) were calculated between caregiver and child reports at each time point, and Bland-Altman plots were created.

Results

Forty-six subjects were enrolled over 5 months. Mean age was 5.5 ± 1.2 years. Average initial child pain scores were 6.6 ± 2.8 (WBF) and 6.1 ± 3.3 (FPS-R), and repeat scores were 3.3 ± 3.4 (WBF) and 3.1 ± 3.3 (FPS-R). Average initial caregiver pain scores were 6.3 ± 2.4 (WBF) and 6.2 ± 2.3 (FPS-R), and repeat scores were 3.4 ± 2.0 (WBF) and 3.4 ± 2.1 (FPS-R). On initial assessment, ICCs between children and caregivers using the FPS-R and WBF were 0.33 and 0.22, respectively. On repeat assessment, the ICCs were 0.31 for FPS-R and 0.26 for WBF. Bland-Altman plots showed poor agreement but no systematic bias.

Conclusion

There was poor agreement between caregivers and children when using the WBF and FPS-R for assessment of acute pain in the ED. Caregiver report should not be used as a substitute for self-report of pain if possible.
Developing and Testing the Diagnostic Accuracy of a Brief Nursing Dysphagia Screen
Authors: Groppo-Lawless Sarah , Davies Claire C. , Lengerich Alex
Published: July 2019

Purpose

The aim of the study was to develop and test the Groppo-Lawless nurse-initiated screen designed to identify patients diagnosed with pneumonia who are at risk for dysphagia.

Design

This is a two-phase methodological study.

Methods

Phase 1 involved three steps. First, risk factors (n = 27) for dysphagia were identified from the literature. Next, frequency of these risk factors was calculated from a chart review of patients diagnosed with pneumonia (N = 301). Finally, frequency of risk factors among those patients who failed the 3-oz water trial (n = 56) were calculated, and a five-item instrument, the Groppo-Lawless Dysphagia Screen, was constructed. In Phase 2, nurses’ results using the screen were compared to blinded results of speech-language pathologists.

Findings

Sensitivity (81.1%), specificity (96.4%), and diagnostic odds ratio (22.43) were calculated.

Conclusions/Clinical Relevance

Given the strong psychometric properties of this screen, its use by nurses may increase the number of appropriate speech-language pathologist referrals among patients diagnosed with pneumonia.
Total Neoadjuvant Therapy in Rectal Cancer
Authors: Petrelli Fausto , Trevisan Francesca , Cabiddu Mary , Sgroi Giovanni , Bruschieri Lorenza , Rausa Emanuele , Ghidini Michele , Turati Luca
Published: July 2019

Background:

The addition of induction chemotherapy to concomitant neoadjuvant chemoradiation in locally advanced rectal cancer could increase pathological downstaging and act on occult micrometastatic disease, leading ultimately to a better outcome. A systematic review was carried out of the existing literature on the treatment outcomes of total neoadjuvant therapy (TNT) on locally advanced rectal cancer. TNT was defined as chemotherapy using cycles of induction and/or consolidation in conjunction with standard chemoradiotherapy prior to surgery.

Methods:

A systematic search of PubMed, Embase, and the Cochrane Library was performed according to the PRISMA statement up until January 2019. The primary endpoints were complete pathologic response (pCR), disease-free survival, and overall survival rates.

Results:

A total of 28 studies (3 retrospective and 25 prospective for a total of 3579 patients) were included in the final analysis (n = 2688 treated with TNT and n = 891 with neoadjuvant chemoradiotherapy therapy). The pooled pCR rate was 22.4% (95% CI 19.4%–25.7%) in all patients treated with TNT (n = 27 studies with data available). In n = 10 comparative studies with data available, TNT was found to increase the odds of pCR by 39% (1.40, 95% CI 1.08–1.81,P= 0.01).

Conclusions:

The addition of induction or consolidation chemotherapy to standard neoadjuvant chemoradiotherapy results in a higher pCR rate. Given that the comparative analysis was derived from few randomized publications, large confirmatory trials should be carried out before a strong recommendation is made in favor of TNT.
Patients Remain at High Risk of Gallstones Development Late (10 y) After Sleeve Gastrectomy?
Authors: Csendes Attila , Csendes Paula , Orellana Omar , Cuneo Nicole , Figueroa Manuel , Martinez Gustavo
Published: July 2019

Background:

Sleeve gastrectomy (SG) is an established bariatric procedure which produces substantial and rapid weight loss and hence can lead to an increase in gallstones development.

Objectives:

To demonstrate the early and late appearance of gallstones after SG.

Materials and Methods:

A prospective protocol was established in consecutive patients submitted to SG. Clinical and ultrasound evaluations were performed early (1 to 2 y) and late after surgery (over 6 y).

Results:

From 109 patients included, 13 (13.1%) had a previous and 10 (10.1%) had simultaneous cholecystectomy at the time of SG. Therefore, 86 patients were submitted to surveillance. Seven patients were unreachable, leaving 79 patients for late follow-up. Forty-five patients (57%) had alithiasic gallbladder late after surgery, whereas 34 patients (43%) showed appearance of gallstone. From them, 53% developed gallstones late after surgery (mean, 7.5 y). Among the group with early development of stones, 69% were symptomatic and in the latter group only 17%.

Conclusions:

Study with 92% of follow-up late after SG demonstrated a 43% development of gallstones: half earlier and half late after surgery. We emphasize the need for late control to detect the real appearance of gallstones after SG.
Quality of Life and Urinary Incontinence Symptoms in Women Undergoing Bariatric Surgery: A Combined Case-Cohort Study
Authors: Durigon Keller Kalina , La Rosa Valentina Lucia , Cerentini Taís Marques , Machado de Souza Cislaine , Langlois Costa Filipe , Viana da Rosa Patricia , da Silva Klahr Patrícia , de Almeida Pereira Elvio , Telles da Rosa Luis Henrique
Published: July 2019

Objective

Obese women with large abdominal volume may present with elevated intra-abdominal and intravesical pressure due to their high body mass index (BMI), which leads to an imbalance in the mechanism responsible for urinary continence. Thus, these women have a 2-fold chance of developing urinary incontinence (UI) than nonobese women. Because increased BMI represents a risk factor for UI development, we hypothesize that its reduction could alleviate or decrease the symptoms of this condition in obese women. Therefore, the aim of this study was to describe the impact of weight loss on the severity of UI symptoms and quality of life (QoL) in women undergoing bariatric surgery.

Methods

This was a combined case-cohort study lasting 1 year, with 26 obese women aged 18 to 59 years who underwent bariatric surgery and presented preoperative UI. The participants’ BMI was calculated, their UI was assessed through the International Consultation on Incontinence Questionnaire–Short Form, and QoL by the King’s Health Questionnaire. Reassessments were performed at 3, 6, 9, and 12 postoperative months.

Results

We found no significant association between BMI reduction and prevalence and severity of UI. However, the 8-point reduction in BMI was sufficient to decrease the severity of UI. Quality of life improved significantly in 7 of the 9 domains evaluated.

Conclusions

According to the results of our study, we can conclude that the reduction in the prevalence and severity of UI together with weight loss induced by bariatric surgery was more evident in the first 3 months postoperatively, impacting positively the QoL of these women.
One-year mortality in geriatric trauma patients: Improving upon the geriatric trauma outcomes score utilizing the social security death index
Authors: Ross Samuel W. , Adeyemi Folarin M. , Zhou Michael , Minhajuddin Abu T. , Porembka Matthew R. , Cripps Michael W. , Phelan Herbert A.
Published: July 2019

BACKGROUND

Geriatric Trauma Outcomes Score (GTOS) predicts in-patient mortality in geriatric trauma patients and has been validated in a prospective multicenter trial and expanded to predict adverse discharge (GTOS II). We hypothesized that these formulations actually underestimate the downstream sequelae of injury and sought to predict longer-term mortality in geriatric trauma patients.

METHODS

The Parkland Memorial Hospital Trauma registry was queried for patients 65 years or older from 2001 to 2013. Patients were then matched to the Social Security Death Index. The primary outcome was 1-year mortality. The original GTOS formula (variables of age, Injury Severity Score [ISS], 24-hour transfusion) was tested to predict 1-year mortality using receiver operator curves. Significant variables on univariate analysis were used to build an optimal multivariate model to predict 1-year mortality (GTOS III).

RESULTS

There were 3,262 patients who met inclusion. Inpatient mortality was 10.0% (324) and increased each year: 15.8%, 1 year; 17.8%, 2 years; and 22.6%, 5 years. The original GTOS equation had an area under the curve of 0.742 for 1-year mortality. Univariate analysis showed that patients with 1-year mortality had on average increased age (75.7 years vs. 79.5 years), ISS (11.1 vs. 19.1), lower GCS score (14.3 vs. 10.5), more likely to require transfusion within 24 hours (11.5% vs. 31.3%), and adverse discharge (19.5% vs. 78.2%; p < 0.0001 for all). Multivariate logistic regression was used to create the optimal equation to predict 1-year mortality: (GTOSIII = age + [0.806 × ISS] + 5.55 [if transfusion in first 24 hours] + 21.69 [if low GCS] + 34.36 [if adverse discharge]); area under the curve of 0.878.

CONCLUSION

Traumatic injury in geriatric patients is associated with high mortality rates at 1 year to 5 years. GTOS III has robust test characteristics to predict death at 1 year and can be used to guide patient centered goals discussions with objective data.

LEVEL OF EVIDENCE

Prognostic, level III.
Influence of prehospital physician presence on survival after severe trauma: Systematic review and meta-analysis
Authors: Knapp Jürgen , Häske David , Böttiger Bernd W. , Limacher Andreas , Stalder Odile , Schmid Annina , Schulz Stephanie , Bernhard Michael
Published: July 2019

BACKGROUND

As trauma is one of the leading causes of death worldwide, there is great potential for reducing mortality in trauma patients. However, there is continuing controversy over the benefit of deploying emergency medical systems (EMS) physicians in the prehospital setting. The objective of this systematic review and meta-analysis is to assess how out-of-hospital hospital management of severely injured patients by EMS teams with and without physicians affects mortality.

METHODS

PubMed and Google Scholar were searched for relevant articles, and the search was supplemented by a hand search. Injury severity in the group of patients treated by an EMS team including a physician had to be comparable to the group treated without a physician. Primary outcome parameter was mortality. Helicopter transport as a confounder was accounted for by subgroup analyses including only the studies with comparable modes of transport. Quality of all included studies was assessed according to the Cochrane handbook.

RESULTS

There were 2,249 publications found, 71 full-text articles assessed, and 22 studies included. Nine of these studies were matched or adjusted for injury severity. The odds ratio (OR) of mortality was significantly lower in the EMS physician-treated group of patients: 0.81; 95% confidence interval (CI): 0.71–0.92. When analysis was limited to the studies that were adjusted or matched for injury severity, the OR was 0.86 (95% CI, 0.73–1.01). Analyzing only studies published after 2005 yielded an OR for mortality of 0.75 (95% CI, 0.64–0.88) in the overall analysis and 0.81 (95% CI, 0.67–0.97) in the analysis of adjusted or matched studies. The OR was 0.80 (95% CI, 0.65–1.00) in the subgroup of studies with comparable modes of transport and 0.74 (95% CI, 0.53–1.03) in the more recent studies.

CONCLUSION

Prehospital management of severely injured patients by EMS teams including a physician seems to be associated with lower mortality. After excluding the confounder of helicopter transport we have shown a nonsignificant trend toward lower mortality.

LEVEL OF EVIDENCE

Systematic review and meta-analysis, level III.
Ketamine/propofol admixture vs etomidate for intubation in the critically ill: KEEP PACE Randomized clinical trial
Authors: Smischney Nathan Jerome , Nicholson Wayne T. , Brown Daniel R. , Gallo De Moraes Alice , Hoskote Sumedh S. , Pickering Brian , Oeckler Richard A. , Iyer Vivek N. , Gajic Ognjen , Schroeder Darrell R. , Bauer Philippe R.
Published: July 2019

BACKGROUND

Periintubation hypotension is associated with poor outcomes in the critically ill. We aimed to determine if an admixture of ketamine and propofol for emergent endotracheal intubation in critically ill patients was superior to etomidate. Primary endpoint was the change in mean arterial pressure from baseline to 5 minutes postdrug administration.

METHODS

Emergent-use, stratified (shock status and unit type), multiunit, randomized, parallel-group superiority clinical trial was conducted at a tertiary academic medical center. Adult medical/surgical and transplant/oncologic intensive care unit patients undergoing emergent intubation were assigned randomly to receive either ketamine/propofol admixture (0.5 mg/kg of ketamine and propofol each) or reduced dose etomidate (0.15 mg/kg) for emergent intubation.

RESULTS

One hundred sixty participants were randomized, and 152 (79 ketamine/propofol admixture, 73 etomidate) were included in the intention-to-treat analysis. There was no statistically significant difference in mean arterial pressure change from baseline to 5 minutes postdrug administration (treatment difference [ketamine/propofol admixture—etomidate]: −2.1 mm Hg; 95% confidence interval, −6.9 mm Hg to +2.7 mm Hg; p = 0.385). In addition, no statistically significant difference was demonstrated in the change of mean arterial pressure from baseline at 10 minutes and 15 minutes postdrug administration, no statistical difference in the use of new-onset vasoactive agents or difficulty of intubation between groups. More patients in the etomidate group required non–red blood cell transfusions (16 [22%] vs. 8 [10%], p = 0.046). For patients who had adrenal testing performed, more patients in the etomidate group developed immediate adrenal insufficiency (13 [81%] of 16 vs. 5 [38%] of 13, p = 0.027). Serious adverse events were rare, 2 (3%) (cardiac arrest, hypotension) in ketamine/propofol admixture and 4 (5%) (hypertension, hypotension) in etomidate (p = 0.430).

CONCLUSION

In a heterogeneous critically ill population, ketamine/propofol admixture was not superior to a reduced dose of etomidate at preserving per-intubation hemodynamics and appears to be a safe alternative induction agent in the critically ill.

LEVEL OF EVIDENCE

Therapeutic/Care Management, level II.

TRIAL REGISTRY

ClinicalTrials.gov, NCT02105415, Ketamine/Propofol Admixture “Ketofol” at Induction in the Critically Ill Against Etomidate: KEEP PACE Trial, IRB 13-000506, Trial Registration: March 31, 2014
Robert Boyle's anonymous ‘Crosey-Crucian’ identified: The German alchemist and religious dissenter Peter Moritz
Authors: Zuber Mike A. , Penman Leigh T. I.
Published: July 2019

Using previously neglected manuscript sources, this paper sheds light on a puzzling episode in the later life of Robert Boyle and the early career of his laboratory assistant Ambrose Godfrey. Currently, the only account of their disappointing encounter with an unnamed German adept derives from Godfrey's lost manuscript treatise ‘An Apology and Letter touching a Crosey-Crucian’, excerpts of which were published in 1858. Based on a comparison between that source and the papers of the virtually forgotten chymical practitioner and convicted heretic Peter Moritz (1638–
ca.
1700), the authors argue that Godfrey's anonymous ‘Crosey-Crucian’ was none other than Moritz himself. The first part establishes that various significant and seemingly insignificant details agree precisely and thus corroborate this identification. The second part focuses on those passages among Moritz's papers that contain explicit evidence of his dealings with both Boyle and Godfrey, a sheet of notes and a lengthy epistolary ‘Memorial’ to an unnamed addressee. The authors contend that Moritz's ‘Memorial’ is a version of the same document that the adept sought to deliver to Boyle who refused to accept it, according to Godfrey's ‘Apology’. For this reason, and on the basis of strong internal evidence, Boyle is identified as the intended recipient of Moritz's ‘Memorial’. Taken together, these two identifications solve a long-standing riddle in Boyle scholarship and introduce a significant addition to his extant correspondence.
On the convergence and accuracy of the cardiovascular intrinsic frequency method
Authors: Tavallali Peyman , Hou Thomas Y. , Rinderknecht Derek G. , Pahlevan Niema M.
Published: July 2019

In this paper, we analyse the convergence, accuracy and stability of the intrinsic frequency (IF) method. The IF method is a descendant of the sparse time frequency representation methods. These methods are designed for analysing nonlinear and non-stationary signals. Specifically, the IF method is created to address the cardiovascular system that by nature is a nonlinear and non-stationary dynamical system. The IF method is capable of handling specific nonlinear and non-stationary signals with less mathematical regularity. In previous works, we showed the clinical importance of the IF method. There, we showed that the IF method can be used to evaluate cardiovascular performance. In this article, we will present further details of the mathematical background of the IF method by discussing the convergence and the accuracy of the method with and without noise. It will be shown that the waveform fit extracted from the signal is accurate even in the presence of noise.
Maize residues changes soil fungal composition and decrease soil microbial co-ocurrence networks complexity
Authors: Cobo-Díaz José F. , Legrand Fabienne , Le Floch Gaétan , Picot Adeline
Published: July 2019

Fusarium graminearum(Fg) can cause different diseases in cereals and maize crops worldwide, and a correct management of previous crop residues could decrease disease incidence and/or severity. Bacterial, fungal andFusariumcommunities were studied by metabarcoding approach in 8 agricultural fields with wheat-maize rotation system in Brittany, France, during three years. Additionally, shift in microbial communities were evaluated under mesocosm experiments in soils amended or not with maize residues and/orFgisolate. Bacterial communities composition were highly influenced by crop soil origin in both environmental and mesocosm soils, while bacteria co-occurrence network complexity was decreased by maize residues in environmental samples andFgtreatment in mesocosm samples. Maize residues altered slightly bacteria-fungi co-occurrence networks, while all treatments on mesoscosm experiments showed lower complexity in bacteria-fungi networks than Control Soil treatment. A clear input of fungal generaEpicoccum,Fusarium,Vishniacozyma,Articulospora,Papiliotrema,Sarocladium,Xenobotryosphaeria,Ramularia,Cladosporium,CryptococcusandBullerafrom maize residues to soil were observed for both environmental and mesocosm samples. Moreover, an increase ofF. graminearumandF. avenaceumwas observed in soils whe maize residues were presented. Finally, microbial co-occurrence networks reported some OTUs significant correlated toFusariumspp. OTUs, such as those assigned toEpicoccum,VishniacozymaandSarocladiumfungal genera, previously reported as efficient biocontrol agents versusFusariumspp. Moreover, a decrease of complexity was observed for soil bacterial and bacterial-fungal networks due to maize addition in both environmental and mesocoms communities.
Comparative hormonal regulatory pathway of the drought responses in relation to glutamate-mediated proline metabolism in Brassica napus
Authors: La Van Hien , Lee Bok-Rye , Islam Md. Tabibul , Park Sang-Hyun , Bae Dong-Won , Kim Tae-Hwan
Published: July 2019

Proline metabolism influences metabolic and signaling pathway in regulating plant stress responses. This study aimed to characterize the physiological significance of glutamate (Glu)-mediated proline metabolism in the drought stress responses, focusing on the hormonal regulatory pathway. The responses of cytosolic Ca2+ signaling, proline metabolism and redox components to the exogenous application of Glu in well-watered or drought-stressed plants were interpreted in relation to endogenous hormone status and their signaling genes. Drought-enhanced abscisic acid (ABA) were concomitant with ROS and proline accumulation, accompanied by decreased NAD(P)H/NAD(P)+ and GSH/GSSG ratios. Exogenous Glu-feeding under drought resulted in an increase of salicylic acid (SA) with an antagonistic decrease of ABA. Glu-enhanced SA coincided with the highest expression of SA synthesis related gene ICS1 and Ca2+-dependent protein kinase CPK5. SA-enhanced CPK5 expression was closely associated with further enhancement of proline synthesis-related genes (P5CS1, P5CS2, and P5CR) expression. The Glu-activated proline synthesis was responsible for the reset of reducing potential with enhanced expression of redox regulating genes TRXh5 and GRXC9 in a SA-mediated NPR1- and/or PR1-dependent manner. These results clearly indicate that Glu-activated interplay between SA- and CPK5-signaling and Glu-enhanced proline synthesis are crucial in the amelioration of drought stress in B. napus.

Highlight

Drought-induced oxidative stress and symptom are developed by ABA-dependent manner

Glu-application increases endogenous SA level with an antagonistic decrease of ABA

Drought-induced proline accumulation was further enhanced by exogenous Glu-application

Glu-enhanced proline synthesis accompanied with SA-mediated regulatory pathway

Glu-enhanced SA-modulated proline metabolism is an integrated process of redox control
Long live the king: chromosome-level assembly of the lion (Panthera leo) using linked-read, Hi-C, and long read data
Authors: Armstrong Ellie E. , Taylor Ryan W. , Miller Danny E. , Kaelin Christopher , Barsh Gregory , Hadly Elizabeth A. , Petrov Dmitri
Published: July 2019

The lion (Panthera leo) is one of the most popular and iconic feline species on the planet, yet in spite of its popularity, the last century has seen massive declines for lion populations worldwide. Genomic resources for endangered species represent an important way forward for the field of conservation, enabling high-resolution studies of demography, disease, and population dynamics. Here, we present a chromosome-level assembly for the captive African lion from the Exotic Feline Rescue Center as a resource for current and subsequent genetic work of the sole social species of thePantheraclade. Our assembly is composed of 10x Genomics Chromium data, Dovetail Hi-C, and Oxford Nanopore long-read data. Synteny is highly conserved between the lion, otherPantheragenomes, and the domestic cat. We find variability in the length and levels of homozygosity across the genomes of the lion sequenced here and other previous published resequence data, indicating contrasting histories of recent and ancient small population sizes and/or inbreeding. Demographic analyses reveal similar histories across all individuals except the Asiatic lion, which shows a more rapid decline in population size. This high-quality genome will greatly aid in the continuing research and conservation efforts for the lion.
Traveling cortical netwaves compose a mindstream
Authors: Hülsmann Ernst Rudolf M.
Published: July 2019

The brain creates a physical response out of signals in a cascade of streaming transformations. These transformations occur over networks, which have been described in anatomical, cyto-, myeloarchitectonic and functional research. The totality of these networks has been modelled and synthesised in phases across a continuous time-space-function axis, through ascending and descending hierarchical levels of association1-3via changing coalitions of traveling netwaves4-6, where localised disorders might spread locally throughout the neighbouring tissues. This study quantified the model empirically with time-resolving functional magnetic resonance imaging of an imperative, visually-triggered, self-delayed, therefor double-event related response task. The resulting time series unfold in the range of slow cortical potentials the spatio-temporal integrity of a cortical pathway from the source of perception to the mouth of reaction in and out of known functional, anatomical and cytoarchitectonic networks. These pathways are consolidated in phase images described by a small vector matrix, which leads to massive simplification of cortical field theory and even to simple technical applications.
Muc5b-deficient mice develop early histological lung abnormalities
Authors: Valque Hélène , Gouyer Valérie , Duez Catherine , Leboeuf Christophe , Marquillies Philippe , Lebert Marc , Plet Ségolène , Ryffel Bernhard , Janin Anne , Gottrand Frédéric , Desseyn Jean-Luc
Published: July 2019

Gel-forming mucins are the main organic component responsible for physical properties of the mucus hydrogels. While numerous biological functions of these mucins are well documented, specific physiological functions of each mucin are largely unknown. To investigatein vivofunctions of the gel-forming mucin Muc5b, which is with Muc5ac the major secreted airway mucin, we generated mice in which Muc5b was disrupted and maintained in the absence of environmental stress. Adult Muc5b-deficient mice displayed bronchial hyperplasia and metaplasia, interstitial thickening, alveolar collapse, immune cell infiltrates, fragmented and disorganized elastin fibers and collagen deposits that were for approximately one fifth of mice associated with altered pulmonary function leading to respiratory failure. These lung abnormalities start early in life, as demonstrated for one fourth 2-day-old Muc5b-deficient pups. Thus, the mouse mucin Muc5b is essential for maintaining normal lung function.
Medial prefrontal decoupling from the default mode network benefits memory
Authors: Müller N.C.J. , Dresler M. , Janzen G. , Beckmann C.F. , Fernández G , Kohn N.
Published: July 2019

In the last few years the involvement of the medial prefrontal cortex (mPFC) in memory processing has received increased attention. It is centrally involved when we use prior knowledge (schemas) to improve learning of new material. With the mPFC also being one of the core hubs of the default mode network (DMN) and the DMN’s role in memory retrieval, we decided to investigate whether the mPFC in a schema paradigm acts independently of the DMN. We tested this with data from a cross-sectional developmental study. During retrieval of schema items, the mPFC decoupled from the DMN with the degree of decoupling predicting memory performance. This finding suggests that a demand specific reconfiguration of the DMN supports schema memory. Additionally, we found that in the control condition, which relied on episodic memory, activity in the parahippocampal gyrus was positively related to memory performance. We interpret these results as a demand specific network reconfiguration of the DMN: a decoupling of the mPFC to support schema memory and a decoupling of the parahippocampal gyrus facilitating episodic memory. This supports the notion of dynamic reconfiguration of brain networks in response to task demands in the sense of process specific alliances.
Precise annotation of human, chimpanzee, rhesus macaque and mouse mitochondrial genomes using 5’ and 3’ end small RNAs
Authors: Cheng Zhi , Ji Haishuo , Jin Xiufeng , Wang Bo , Yau Tungon , Chen Ze , Chen Defu , Bu Wenjun , Sun Daqing , Gao Shan
Published: July 2019

Using 5’ and 3’ end small RNAs, we annotated human, chimpanzee, rhesus macaque and mouse mitochondrial genomes at 1 base-pair (bp) resolution to cover both strands of the mammalian mitochondrial genome entirely without leaving any gaps or overlaps. The precise annotation of all coding and non-coding genes (e.g. ncMT1, MDL2 and MDL1AS) led to the discovery of novel functions and mechanisms of mitochondrion. In this study, we defined the conserved sequence block (CSB) region to span five CSBs (CSB1, CSB2, CSB3, LSP and HSP) and identified the motifs of five CSBs in the mitochondrial displacement loop (D-loop) regions of 52 mammals. The conserved arrangement of these five CSBs in 17 primates inspired us to investigate the function of the mtDNA D-loop, which has been puzzling scientists for more than 50 years. We found that 5’ sRNAs of MDL1AS control the expression levels of mitochondrial genes as a whole by a negative feedback mechanism. Thus, the precise annotations of three CSBs (CSB2, LSP and HSP) in more species will help to understand the function of the mtDNA D-loop. The precision annotation of animal mitochondrial genomes also provides abundant information for studying the molecular phylogenetics and evolution of animals.
Convergent changes in gene expression associated with repeated transitions between hummingbird and bee pollinated flowers
Authors: Serrano-Serrano Martha L. , Marcionetti Anna , Perret Mathieu , Salamin Nicolas
Published: July 2019

The repeated evolution of convergent floral shapes and colors in angiosperms has been largely interpreted as the response to pollinator-mediated selection to maximize attraction and efficiency of specific groups of pollinators. The genetic mechanisms contributing to certain flower traits have been studied in detail for model system species, but the extent by which flowers are free to vary and how predictable are the genetic changes underlying flower adaptation to pollinator shifts still remain largely unknown.

Here, we aimed at detecting the genetic basis of the repeated evolution of flower phenotypes associated with pollinator shifts. We assembled and comparedde novotranscriptomes of three phylogenetic independent pairs of Gesneriaceae species, each with contrasting flower phenotype adapted to either bee or hummingbird pollination. We assembled and analyzed a total of 14,059 genes and we showed that changes in expression in 550 of them was associated with the pollination syndromes. Among those, we observed genes with function linked to floral color, scent, shape and symmetry, as well as nectar composition. These genes represent candidates genes involved in the build-up of the convergent floral phenotypes.

This study provides the first insights into the molecular mechanisms underlying the repeated evolution of pollination syndromes. Although the presence of additional lineage-specific responses cannot be excluded, these results suggest that the convergent evolution of genes expression is involved in the convergent build-up of the pollination syndromes. Future studies aiming to directly manipulate certain genes will integrate our knowledge on the key genes for floral transitions and the pace of floral evolution.

Data availability

Raw Illumina reads will be available in the Sequence Read Archive (SRA) in NCBI database. The assembled transcriptomes and their annotation will by available in DRYAD repository. Details and accession ID will be provided at the time of the manuscript acceptance.