bluuebunny/crossref_metadata_2025 huggingface dataset:
Technical Note: The comparison of pH and redox potential in different locations in the reticulo-rumen of growing beef steers supplemented with different levels of quebracho extract
Authors: Dias Batista Luiz F , Norris Aaron B , Adams Jordan M , Hairgrove Thomas B , Tedeschi Luis O
Published: September 2021

Rumen acidosis is a common metabolic disorder occurring when organic acid production exceeds clearance capacity, reducing ruminal pH. The occurrence of acidosis has been directly correlated to the ratio of concentrate to forage in the diet. However, rates of substrate fermentation and acid absorption vary at different locations in the reticulo-rumen. The objective of this study was to determine the pH and redox potential (Eh) in different locations of the reticulo-rumen using 16 ruminally cannulated steers (309 ± 43 kg) receiving different supplementation levels of quebracho extract (QT; Schinopsis balansae) within a grower type diet (CP: 13.4%; total digestible nutrients [TDN]: 70.4%; and ME: 2.55 Mcal/kg, dry matter [DM] basis). Animals were randomly assigned to one of four dietary treatments: QT at 0%, 1%, 2%, and 3% of DM (QT0, QT1, QT2, and QT3, respectively), containing about 0%, 0.7%, 1.4%, and 2.1% of condensed tannins (CT), DM basis, respectively. Animals were adapted to the basal diet for 12 d before being introduced to predetermined treatments for 4 weeks (wk), with diets provided twice daily to allow ad libitum intake. Weekly measurements of ruminal fluid pH and Eh were taken 4 h post-feeding using a portable pH meter with two probes (pH and redox) in four locations of the reticulo-rumen (reticulum, cranial sac, dorsal sac, and ventral sac). Data were analyzed using a random coefficients model with the pen as a random effect and wk as repeated measures, with DM intake included as a covariate. There was no interaction among treatments, location, and wk (P ≥ 0.882) on reticulo-ruminal pH. Overall, ruminal pH was lower for QT0 and QT1 compared to QT3 (P < 0.001). The pH in the reticulum was greater than those of the ventral and dorsal sacs (6.05 vs. 5.94, 5.89, respectively; P ≤ 0.001) but similar to cranial sac (6.00). Reticular pH was positively correlated with the ruminal locations (≥0.78; P < 0.001). The linear equation to estimate ruminal mean pH using reticulum pH had an intercept and slope different from zero (P ≤ 0.04), but CT (% DM) was not different from zero (P = 0.15), root mean square error of 0.15, and R2 of 0.778: 0.723 (±0.36) + 0.857 (±0.059) × reticulum pH + 0.033 (±0.023) × CT. The Eh was lower for QT0 in week 1 than all other treatments (P < 0.001). We concluded that reticulo-ruminal pH differs among locations in the rumen regardless of QT supplementation level and days on feed, with reticular pH being the highest.
Update on the Practice of Splinting During Acute Burn Admission From the ACT Study
Authors: Khor Desmond , Liao Junlin , Fleishhacker Zachary , Schneider Jeffrey C , Parry Ingrid , Kowalske Karen , Richard Reg , Wibbenmeyer Lucy
Published: September 2021

Burn scar contracture (BSC) is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in function. Despite a paucity of research addressing its efficacy, static splinting of affected joints is a common preventative practice. A survey of therapists performed 25 years ago showed a widely divergent practice of splinting during the acute burn injury. We undertook this study to determine the current practice of splinting during the index admission for burn injuries. This is a review of a subset of patients enrolled in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database. ACT was an observational multicenter study conducted from 2010 to 2013. The most commonly splinted joints (elbow, wrist, knee, and ankle) and their seven motions were included. Variables included patients’ demographics, burn variables, rehabilitation treatment, and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P < .05 was significant. Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. Splinting was associated with larger burns and increased injury severity on the patient level and increased involvement with burns requiring grafting in the associated cutaneous functional unit (CFU) on the joint level. The requirement for skin grafting in both analyses remained independently related to splinting, with requirement for grafting in the associated CFU increasing the odds of splinting six times (OR = 6.0, 95% CI = 3.8–9.3, P < .001). On average, splinting was initiated about a third into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50 ± 26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. The wrist was most frequently splinted joint being splinted with one third of wrists splinted (30.7%) while the knee was the least frequently splinted joint with 8.2% splinted. However, when splinted, the knee was splinted the most hours per day (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). Almost one third had splinting continued to discharge (20, 27%). The current practice of splinting, especially the initiation, hours of wear and duration of splinting following acute burn injury remains variable. Splinting is independently related to grafting, grafting in the joint CFU, larger CFU involvement and is more likely to occur around the time of surgery. A future study looking at splinting application and its outcomes is warranted.
Association of tumor burden with outcome in first-line therapy with nivolumab plus ipilimumab for previously untreated metastatic renal cell carcinoma
Authors: Ishihara Hiroki , Kondo Tsunenori , Nakamura Kazutaka , Nemoto Yuki , Tachibana Hidekazu , Fukuda Hironori , Yoshida Kazuhiko , Kobayashi Hirohito , Iizuka Junpei , Shimmura Hiroaki , Hashimoto Yasunobu , Tanabe Kazunari , Takagi Toshio
Published: September 2021

Objectives

To investigate the prognostic impact of tumor burden in patients receiving nivolumab plus ipilimumab as first-line therapy for previously untreated metastatic renal cell carcinoma (mRCC).

Methods

We retrospectively evaluated 62 patients with IMDC intermediate- or poor-risk mRCC, treated with nivolumab plus ipilimumab as first-line therapy at five affiliated institutions. Tumor burden was defined as the sum of diameters of baseline targeted lesions according to the RECIST version.1.1. We categorized the patients into two groups based on the median value of tumor burden (i.e., high vs. low). The association of tumor burden with progression-free survival (PFS), overall survival (OS) and objective response rate (ORR) with nivolumab plus ipilimumab treatment was analyzed.

Results

The median tumor burden was 63.0 cm (interquartile range: 34.2–125.8). PFS was significantly shorter in patients with high tumor burden (n = 31) than in those with low tumor burden (n = 31) (median: 6.08 [95% CI: 2.73–9.70] vs. 12.5 [4.77–24.0] months, P = 0.0134). In addition, OS tended to be shorter in patients with high tumor burden; however, there was no statistically significant difference (1-year rate: 77.3 vs. 96.7%, P = 0.166). ORR was not significantly different between patients with high and low tumor burden (35 vs. 55%, P = 0.202). Multivariate analysis of PFS further showed that tumor burden was an independent factor (HR: 2.22 [95% CI: 1.11–4.45], P = 0.0242).

Conclusions

Tumor burden might be a useful factor for outcome prediction, at least for PFS prediction, in patients receiving nivolumab plus ipilimumab for mRCC. Further prospective studies are warranted to confirm our findings.
Travel vaccination examined through the tourism lens
Authors: Bauer Irmgard L
Published: September 2021

Travel vaccination hesitancy—a shared concern of travel medicine and tourism.
Introduction to the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents
Authors: Kennedy Sarah M. , Ehrenreich-May Jill
Published: September 2021

This chapter provides a brief historical and theoretical introduction to the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A), followed by practical guidance for using this volume to treat children and adolescents. The chapter situates transdiagnostic treatments within the historical development of evidence-based interventions for children and adolescents and distinguishes core-dysfunction–focused transdiagnostic treatments, such as the UP-C and UP-A, from other types of transdiagnostic treatments. The chapter reviews key core dysfunctions underlying emotional disorders that are addressed through treatment with the UP-C and UP-A. The authors discuss the rationale for this volume, which focuses on applications of the UP-C and UP-A to youth with diagnoses other than anxiety and depression and youth being treated in delivery settings outside of the standard weekly therapy format. Tips for using this volume in conjunction with the UP-C and UP-A therapist guide and workbooks are offered.
What's in the Syringe?
Authors: Jacobsen Juliet , Jackson Vicki , Greer Joseph , Temel Jennifer
Published: September 2021

What’s in the Syringe? Principles of Early Integrated Palliative Care, a guide for clinicians, teaches the psychological skills of outpatient palliative care. It does so based on a framework that articulates five challenges faced by patients through the illness trajectory. Each challenge forms the focus of a chapter. By helping patients meet each challenge, clinicians help them cope with serious illness. Patients thereby experience better quality of life and develop prognostic awareness. From this awareness, they can make informed medical and personal decisions. Each chapter focuses on clinical skills to support patients as they take up that challenge. Each chapter then ends with a discussion of how to collaborate with oncology colleagues around that challenge. Rich in illustrative examples and built around case-based chapters, the book draws on two decades of research and clinical experience.
The Rise and Fall of the Age of Psychopharmacology
Authors: Shorter Edward
Published: September 2021

This book focuses on the age of psychopharmacology that began in the 1950s, when science entered the study of drugs that affect the brain and mind. It reviews the recent fall of psychopharmacology as drug offerings became impoverished and diagnoses became distorted by a pseudoscientific system called the Diagnostic and Statistical Manual of Mental Disorders. It looks at new diagnoses, such as “major depression,” which have strayed increasingly from the real disorders of most patients. The book discusses the invasion of psychopharmacology by the pharmaceutical industry, which paid off commercially but not scientifically. It tells the story of the public health disaster of psychopharmacology, wherein psychiatry’s diagnoses and therapeutics have largely failed and greatly declined from earlier days.
DSM
Authors: Shorter Edward
Published: September 2021

The decline of psychopharmacology began with the growing view that many of the diagnoses in the official Diagnostic and Statistical Manual of Mental Disorders (DSM) did not really exist. The paper that began the revolution in diagnosis in psychiatry was written by a discussion group of residents led by John Feighner. Then the DSM was drawn up using the diagnostic criteria known as the “Feighner criteria,” which Fritz Henn admitted were based on Emil Kraepelin's work. The various editions of Kraepelin's textbook in the 1900s lumped all the mood disorders into one big basin: manic-depressive insanity. In contrast, the ideas of Karl Leonhard provided a revolutionary recasting of the major illnesses that dismissed the Kraepelinian illness pool and implemented a strict division on the basis of polarity: unipolar depression vs. bipolar disorder.
Trials
Authors: Shorter Edward
Published: September 2021

In the years after 1980, drug trials departed increasingly from the concept of treating real patients. Clinical trials accompanied psychopharmacology as a basic means of gathering evidence in the field, but they also served as the premier means of evasion and distortion used fraudulently and covertly to corrupt the evidence base of psychopharmacology. The fundamental problem in running clinical trials of depression treatments was that the “patients” were considered heterogeneous or “fantasy patients” who really had nothing. Leo Hollister recommended that depression trials be confined to patients with serious or “endogenous” depression, who were the minority of patients encountered in clinical practice.
Journals
Authors: Shorter Edward
Published: September 2021

This chapter examines the enormous leverage that ad sales gave to the pharmaceutical industry in the publication of journals. It details how it started to dawn on the editors that there was something fishy about the uniformly positive results in the use of prescribed drugs. It also mentions Richard Smith, former editor of the British Medical Journal, who noted that up to three-quarters of trials published in the major journals were funded by the pharmaceutical industry. The chapter explains how studies funded by companies were more likely to have results favorable to them than studies funded by other sources and covers the tricks that the companies used to achieve such results. It refers to Mickey Nardo’s observation that peer-reviewed journals got thicker as articles about the phenomenology of mental illness were replaced with reviews of medications and endless clinical trials.
Clinical Medical Ethics and the Historical Background of Shared Decision Making
Authors: Siegler Mark
Published: September 2021

In 1982, the concept of physician-patient accommodation was renamed shared decision making by the President’s Commission for the Study of Ethical Problems in Medicine. Since then, shared decision making has replaced thousands of years of paternalistic physician-controlled medicine and has emerged as the prevailing model of the doctor-patient relationship in the United States. The President’s Commission’s perspective was closely based on the development of clinical medical ethics (CME) in the early 1970s. CME addresses clinical issues such as truth telling, informed consent, confidentiality, and end-of-life care, and must be practiced by licensed clinicians in their routine, daily encounters with more than 40 million inpatients and about 1.5 billion outpatients in the United States each year. The central goal of CME is to improve the quality of patient care by identifying and contributing to the resolution of ethical problems in the practice of clinical medicine; this goal is frequently achieved by shared decision making.
Withholding and withdrawing life-sustaining treatment (including artificial nutrition and hydration)
Authors: Ko Danielle , Evans-Barns Hannah , Blinderman Craig
Published: September 2021

Life-sustaining treatment is any treatment that serves to prolong life without reversing the underlying medical condition. It includes cardiopulmonary resuscitation, mechanical ventilation, haemodialysis, left ventricular assist devices, antibiotics, and artificial nutrition and hydration. The appropriate use of life-sustaining treatment in seriously ill patients is a controversial topic that continues to generate intense debate among the public, as well as healthcare professionals, bioethicists, lawyers, governments, and religious institutions. This chapter offers a practical guide and sets out important questions clinicians ought to consider before making the decision to withhold or withdraw life-sustaining treatment.
Cognitive Dimensions of Major Depressive Disorder
Authors: Baune Bernhard T.
Published: September 2021

Cognitive Dimensions of Major Depressive Disorder (MDD) examines the key clinical and pathophysiological characteristics and treatment options of MDD. The volume emphasizes that while the traditional model of depression implicates mood as the primary symptom cluster, a more recently published conceptual understanding of depression has been extended to consider cognitive function as more than just a symptom. It furthers our understanding of the central role of the cognitive dimension for the pathophysiology, diagnosis, and treatment of MDD. It reviews the key cognitive dimensions of depression comprising impaired cognitive and emotional processes of cognitive function, emotion processing, and social cognitive processing. It focuses on the cognitive and emotional dimensions of depression and offers extended and novel diagnostic and treatment approaches ranging from pharmacological to psychological interventions targeting those dimensions of depression.
Cognitive dimensions of major depressive disorder
Authors: Baune Bernhard T.
Published: September 2021

Major depressive disorder is characterized by impaired affect, cognitive dysfunction, and significant psychosocial impairment that persists from weeks to years. Cognitive symptoms are pervasive, affecting functioning in several domains, including reduced executive functioning, attention, memory, learning, psychomotor speed, and verbal processing. Recent evidence suggests that cognitive dysfunction persists following symptomatic remission, highlighting the need to treat cognition separately from mood symptoms. Residual cognitive deficits may contribute to ongoing occupational and social dysfunction and promote suicide ideation. In addition, retention of cognitive impairment may interact with existing emotional and social vulnerability, increasing the risk of recurrent depressive episodes. The chapter characterizes the domains of emotional, nonemotional, and social cognitive function in major depressive disorder. It examines the domains and descriptors of nonemotional cognitive function. It evaluates the important relationship between cognitive deficits and psychosocial function, as well as the clinical interactions between ‘cold’ and ‘hot’ cognitive function. It extends our understanding of the social cognitive function and its implications for social performance and impact on emotional and empathic performance.
Pharmacological interventions for cognitive dysfunction
Authors: Baune Bernhard T.
Published: September 2021

The chapter Pharmacological interventions for cognitive dysfunction in major depressive disorder (MDD) reviews a broad range of antidepressants that show differential efficacy in exerting improving and impairing effects on cognitive function in MDD, as well as potential side-effects on cognition. The chapter explores new targets and pharmacological agents that are under increasing investigation for cognitive effects in MDD. It identifies methodological challenges of cognition trials in MDD that need to be overcome to improve the evidence base. To conclude, it highlights results from new network meta-analyses on the relative effects of antidepressants on cognitive function assessed with commonly used cognitive tests.
Interventions for social cognitive deficits
Authors: Baune Bernhard T.
Published: September 2021

Interventions for social cognitive deficits establishes the large impact these deficits exert on psychosocial functioning in major depressive disorder. The chapter reviews a variety of impairments of social cognition and how these may influence psychosocial functioning in the key domains of social performance, emotional/empathic performance, general cognitive functioning, and quality of life. It introduces multiple treatment modalities including antidepressant medication, psychotherapeutic approaches, and procedural interventions with potential treatment efficacy on facial affect recognition, interpretation of affective pictures, theory of mind performance, and prosody. It reviews evidence indicating that many current therapies are shown to have a normalizing effect on the accuracy of interpretation and the reduction of underlying negative interpretative bias. It concludes from evaluating the literature that certain antidepressants seem to correct facial affect recognition deficits, and several psychotherapeutic approaches appear well-suited for addressing impaired theory of mind or mood-congruent interpretive biases.
Altering the Binding Properties of PRDM9 Partially Restores Fertility across the Species Boundary
Authors: Davies Benjamin , Gupta Hinch Anjali , Cebrian-Serrano Alberto , Alghadban Samy , Becker Philipp W , Biggs Daniel , Hernandez-Pliego Polinka , Preece Chris , Moralli Daniela , Zhang Gang , Myers Simon , Donnelly Peter
Published: September 2021

Sterility or subfertility of male hybrid offspring is commonly observed. This phenomenon contributes to reproductive barriers between the parental populations, an early step in the process of speciation. One frequent cause of such infertility is a failure of proper chromosome pairing during male meiosis. In subspecies of the house mouse, the likelihood of successful chromosome synapsis is improved by the binding of the histone methyltransferase PRDM9 to both chromosome homologs at matching positions. Using genetic manipulation, we altered PRDM9 binding to occur more often at matched sites, and find that chromosome pairing defects can be rescued, not only in an intersubspecific cross, but also between distinct species. Using different engineered variants, we demonstrate a quantitative link between the degree of matched homolog binding, chromosome synapsis, and rescue of fertility in hybrids between Mus musculus and Mus spretus. The resulting partial restoration of fertility reveals additional mechanisms at play that act to lock-in the reproductive isolation between these two species.
A new therapeutic approach with tocilizumab in a 39-year-old patient with recurrent diabetic myonecrosis
Authors: Wagemann Judith , Keller Sarah , Noriega Maria de las Mercedes , Stenzel Werner , Schneider Udo , Krusche Martin
Published: September 2021

We report the case of a 39-year-old female patient with acute painful swelling of the left thigh and symmetric muscle weakness in both upper legs. The patient had a history of long-standing, poorly controlled type 1 diabetes which required dialysis. Serum inflammatory markers were highly elevated. Magnetic resonance imaging (MRI) indicated necrotic or inflammatory colliquation. As antibiotic therapy did not lead to clinical improvement, a successful anti-inflammatory therapy with prednisolone was initiated. Three months later, the patient presented with a new onset of progressive and painful muscle swelling of the right thigh. MRI showed pronounced swelling of the right adductor muscles and inflammatory markers were massively elevated. In the absence of autoantibodies or any infectious agents and the recurrent symptomatology, relapsing diabetogenic myonecrosis was diagnosed. Initially, clinical improvement could only be achieved with high-dose glucocorticosteroids. Intravenous immunoglobulins did not show an effect, whereas serological and clinical remission was achieved after we administered tocilizumab intravenously. Diabetic myonecrosis is a rare complication of long-term, poorly controlled diabetes mellitus. Acute muscle pain and elevated inflammatory markers should prompt suspicion. Contralateral muscle involvement is also suggestive of the disease. The optimisation of diabetes treatment is crucial in order to prevent further disease complications.
Urinary biomarkers predict progression and adverse outcomes of acute kidney injury in critical illness
Authors: Duff Stephen , Irwin Ruairi , Cote Jean Maxime , Redahan Lynn , McMahon Blaithin A , Marsh Brian , Nichol Alistair , Holden Sinead , Doran Peter , Murray Patrick T
Published: September 2021

Background

Acute kidney injury (AKI) is common in hospitalized patients and is associated with high morbidity and mortality. The Dublin Acute Biomarker Group Evaluation study is a prospective cohort study of critically ill patients (n = 717). We hypothesized that novel urinary biomarkers would predict progression of AKI and associated outcomes.

Methods

The primary (diagnostic) analysis assessed the ability of biomarkers levels at the time of early Stage 1 or 2 AKI to predict progression to higher AKI stage, renal replacement therapy (RRT) or death within 7 days of intensive care unit admission. In the secondary (prognostic) analysis, we investigated the association between biomarker levels and RRT or death within 30 days.

Results

In total, 186 patients had an AKI within 7 days of admission. In the primary (diagnostic) analysis, 8 of the 14 biomarkers were independently associated with progression. The best predictors were cystatin C [adjusted odds ratio (aOR) 5.2; 95% confidence interval (CI) 1.3–23.6], interleukin-18 (IL-18; aOR 5.1; 95% CI 1.8–15.7), albumin (aOR 4.9; 95% CI 1.5–18.3) and neutrophil gelatinase-associated lipocalin (NGAL; aOR 4.6; 95% CI 1.4–17.9). Receiver-operating characteristics and net reclassification index analyses similarly demonstrated improved prediction by these biomarkers. In the secondary (prognostic) analysis of Stages 1–3 AKI cases, IL-18, NGAL, albumin and monocyte chemotactic protein-1 were also independently associated with RRT or death within 30 days.

Conclusions

Among 14 novel urinary biomarkers assessed, cystatin C, IL-18, albumin and NGAL were the best predictors of Stages 1–2 AKI progression. These biomarkers, after further validation, may have utility to inform diagnostic and prognostic assessment and guide management of AKI in critically ill patients.
Evaluation of Potential Cryptocurrency Development Ability in Terrorist Financing
Authors: Wang Shacheng , Zhu Xixi
Published: September 2021

Terrorist financing is the economic basis of terrorist activities and the lifeline of terrorist organizations. In recent years, terrorist organizations have gradually come to use cryptocurrency to finance their activities based on traditional ways of raising funds. The anonymity of cryptocurrency is attractive to terrorist organizations, but its use remains at a low level. To explore the future development ability of cryptocurrency in terrorist financing, we study its internal characteristics and development status, as well as the supervisory systems of international organizations. This study hopes to enhance our understanding of the potential risks of cryptocurrency and serve as a reference for the fight against terrorist financing in the international community.
‘Rapid Counseling’ with single-session therapy for patients with COVID-19: An alternative treatment before doing mental health self-care strategy with meditation
Authors: Situmorang Dominikus David Biondi
Published: September 2021

The author suggests that mental health experts provide ‘rapid counseling’ as psychological help for individuals who need counseling in this COVID-19 outbreak, as one of the steps to be taken to get rid of this national and global crisis, in particular for patients with COVID-19.
Cardiac Abnormalities in Children with Pre-Dialysis Chronic Kidney Disease in a Resource-Limited Setting: A Cross-Sectional Observational Study
Authors: Bhagat Naveen , Dawman Lesa , Naganur Sanjeev , Tiewsoh Karalanglin , Kumar Basant , Sharawat Indar Kumar , Gupta Krishan Lal
Published: September 2021

Background

Cardiovascular disease is the leading cause of morbidity and mortality in children with chronic kidney disease (CKD). We aim to estimate the prevalence of cardiac abnormalities in children up to age 16 years with CKD and their association with various risk factors.

Methods

This cross-sectional observational study was conducted on 107 CKD children. We assessed the systolic and diastolic function using 2D echocardiographic evaluation and M-mode measurements of the left ventricle (LV) indexed for BSA and z-scores were calculated. Results were compared with age, sex, stage of CKD, anaemia, estimated glomerular filtration rate (eGFR) and various laboratory parameters.

Results

LV diastolic dysfunction was seen in 88%, followed by increased LV dimensions in 33.6%, LV systolic dysfunction in 16%, right ventricle systolic dysfunction in 11.2% while increased pulmonary artery (PA) systolic pressure was seen in 9.3% of cases. LV dimensions correlated directly with parathormone levels and inversely with eGFR, serum calcium and haemoglobin levels. Left ventricular hypertrophy correlated directly with parathormone while inversely with eGFR, serum calcium and haemoglobin. Ejection fraction directly correlated to eGFR and serum calcium while inversely related to parathormone. Left PA pressure directly correlated with age and inversely with eGFR. Right ventricular systolic function assessed by tricuspid annular plane systolic excursion correlated inversely with haemoglobin.

Conclusion

LV diastolic dysfunction and increased LV dimensions were the most common cardiac abnormality in children with CKD. LV dimensions correlated directly with parathormone levels and inversely with eGFR, serum calcium and haemoglobin. Diastolic dysfunction positively correlated with serum creatinine and parathormone levels.
Rust (Puccinia emaculata) Management and Impact on Biomass Yield in Switchgrass
Authors: Bowen K. L. , Hagan A. K. , Miller H. B.
Published: September 2021

Rust, putatively caused by Puccinia emaculata, is a widespread and potentially damaging disease of switchgrass, a crop produced as feedstock for livestock and bioenergy. Azoxystrobin, chlorothalonil, and myclobutanil were applied at 1-, 2-, 3-, or 4-week intervals for 12 to 14 weeks to the vegetatively propagated switchgrass cultivar Cloud Nine to assess fungicide selection and application interval for the control of rust as well as the impact of this disease on switchgrass biomass yield. Although rust severity significantly differed among study years, azoxystrobin and myclobutanil were often equally and more effective than chlorothalonil at controlling rust, with superior disease control coming at shorter application intervals compared with extended application intervals. Year, product, application interval, and product × interval significantly impacted dry biomass yield, which was greatest in 2016 and lowest in 2014. Dry biomass yield protection was significantly better with azoxystrobin and myclobutanil applications than with chlorothalonil or no fungicide. Linear regression models with the final disease rating, as well as with the area under disease progress curve in each year, were significant, but coefficients of determination were low to moderate (0.21 < R2 < 0.60), indicating that rust response and subsequent disease impact on dry biomass yield were impacted by other factors. From our models, an estimated 3 to 5% biomass decline was calculated for each 10% increment in rust-related leaf necrosis observed at the final September rating date. With rust-related leaf necrosis ≥80% by 1 September in each of 4 study years, biomass yield may be reduced by 24 to 40% if rust problems are not managed in switchgrass crops.
Inhibitory interneurons with differential plasticities at their connections tune excitatory–inhibitory balance in the spinal nociceptive system
Authors: Cathenaut Lou , Leonardon Benjamin , Kuster Robin , Inquimbert Perrine , Schlichter Rémy , Hugel Sylvain
Published: September 2021

Networks of the dorsal horn of the spinal cord process nociceptive information from the periphery. In these networks, the excitation–inhibition balance is critical to shape this nociceptive information and to gate it to the brain where it is interpreted as pain. Our aim was to define whether short-term plasticity of inhibitory connections could tune this inhibition–excitation balance by differentially controlling excitatory and inhibitory microcircuits. To this end, we used spinal cord slices from adult mice expressing enhanced green fluorescent protein (eGFP) under the GAD65 promoter and recorded from both eGFP+ (putative inhibitory) and eGFP− (putative excitatory) neurons of lamina II while stimulating single presynaptic GABAergic interneurons at various frequencies. Our results indicate that GABAergic neurons of lamina II simultaneously contact eGFP− and eGFP+ neurons, but these connections display very different frequency-dependent short-term plasticities. Connections onto eGFP− interneurons displayed limited frequency-dependent changes and strong time-dependent summation of inhibitory synaptic currents that was however subjected to a tonic activity-dependent inhibition involving A1 adenosine receptors. By contrast, GABAergic connections onto eGFP+ interneurons expressed pronounced frequency-dependent depression, thus favoring disinhibition at these synapses by a mechanism involving the activation of GABAB autoreceptors at low frequency. Interestingly, the balance favors inhibition at frequencies associated with intense pain, whereas it favors excitation at frequencies associated with low pain. Therefore, these target-specific and frequency-specific plasticities allow to tune the balance between inhibition and disinhibition while processing frequency-coded information from primary afferents. These short-term plasticities and their modulation by A1 and GABAB receptors might represent an interesting target in pain-alleviating strategies.
Evaluation of Prognosis of Coma Patients With Acute Brain Injury by Electroencephalogram Bispectral Index Monitoring
Authors: Shi Dan , Shen Chen , Wu Jiayu , Xu Feng , Feng Zhizhong , Xiang Dingchao , Li Jianjun , Chen Junhui
Published: September 2021

Background:

The high mortality rate of comatose patients with traumatic brain injury is a prominent public health issue that negatively impacts patients and their families. Objective, reliable tools are needed to guide treatment decisions and prioritize resources.

Objective:

This study aimed to evaluate the prognostic value of the bispectral index (BIS) in comatose patients with severe brain injury.

Methods:

This was a retrospective cohort study of 84 patients with severe brain injury and Glasgow Coma Scale (GCS) scores of 8 and less treated from January 2015 to June 2017. Sedatives were withheld at least 24 hr before BIS scoring. The BIS value, GCS scores, and Full Outline of UnResponsiveness (FOUR) were monitored hourly for 48 hr. Based on the Glasgow Outcome Scale (GOS) score, the patients were divided into poor (GOS score: 1–2) and good prognosis groups (GOS score: 3–5). The correlation between BIS and prognosis was analyzed by logistic regression, and the receiver operating characteristic curves were plotted.

Results:

The mean (SD) of the BIS value: 54.63 (11.76), p = .000; and GCS score: 5.76 (1.87), p = .000, were higher in the good prognosis group than in the poor prognosis group. Lower BIS values and GCS scores were correlated with poorer prognosis. Based on the area under the curve of receiver operating characteristic curves, the optimal diagnostic cutoff value of the BIS was 43.6, and the associated sensitivity and specificity were 85.4% and 74.4%, respectively.

Conclusion:

Taken together, our study indicates that BIS had good predictive value on prognosis. These findings suggested that BIS could be used to evaluate the severity and prognosis of severe brain injury.
Community outreach for immigrant adults with diabetes and chronic kidney disease
Authors: Hain Debra
Published: September 2021

There is a critical need to discover health-promoting strategies to address a growing Hispanic immigrant adult population with diabetes who are at risk or have chronic kidney disease. Fellows are uniquely positioned to lead research efforts focused on community outreach to recruit this population to a kidney health clinic. Innovative models of care are important to provide care to a population who may not seek medical attention. The author collaborated with a registered renal dietician to develop a kidney health clinic. Funding from the American Nephrology Nurses Association enabled a feasibility study to recruit patients and test the effects of a model of care on patient related and health care system outcomes.
Aortic aneurysm in Nigeria
Authors: Adekanmi Ademola Joseph , Baiyewu Lateef Ayodele , Ngene Samuel Osobuchi
Published: September 2021

Background:

Aortic aneurysm was previously reported to be uncommon in the black African. However, with lifestyle modifications and continuous improvement and availability of diagnostic facilities and structures in Sub-Saharan African countries, a surge in the incidence of aortic aneurysms is expected. This current study is aimed at exploring the cases of aortic aneurysms and the outcome of their management in Nigeria, the most populous country in Black Africa.

Methods:

A systematic literature search of all articles on Aortic aneurysm in as well as from Nigeria will be conducted using several electronic databases including PubMed, African Journal Online, Google Scholar, Cochrane Library, MEDLINE and Scopus. The search will span the period from the database inception to June 2021. Only studies retrievable in the English language will be included. The primary outcome will be the mortality rate, while secondary outcomes will include the size of the aneurysm, type of aneurysm, diagnostic imaging findings, and management. The identified studies will be screened and de-duplicated by two independent researchers using Rayyan Qatar Computing Research Institute software, while the third author will be a tiebreaker. Statistical analysis will be performed using STATA version 16. The Grades of Recommendation, Assessment, Development and Evaluation system will be used to evaluate the quality of evidence.

Results:

The epidemiological dynamics, clinico-radiological pattern and profile, management strategies and outcomes of all documented cases of Aortic aneurysm in Nigeria, will be systemically evaluated.

Conclusion:

This study will provide indigenous data that will be beneficial to the practice of all cardiovascular specialists- cardiologists, surgeons, radiologist and interventionists; evaluating and managing patients with Aortic aneurysms within Nigeria and other settings with a similar genealogical profile within Africa and other parts of the world.

Ethics and Dissemination:

Ethical approval not required as study is a review, analysis and synthesis of already published data

PROSPERO registration number:

CRD42021258646
Implementing a Midline Catheter Program in an Acute Care Hospital
Authors: Keleekai-Brapoh Nowai , Fernandes Nicole , Richards Ann , Gilpin Cornelia
Published: September 2021

Midline catheters are a viable alternative to central vascular access devices in appropriate patients. Successful midline catheter programs require robust surveillance plans to monitor for appropriateness of use and complications, including bloodstream infections. This retrospective study evaluated the impact of implementing a midline catheter program in a midsize teaching medical center in the northeastern United States from January 2014 to May 2019. After implementation, the midline catheter utilization rate was 5.6% with bloodstream infections and other complication rates of 0.44 and 6.57 per 1000 midline catheter days, respectively. Results further revealed a reduction in central vascular access device utilization from 17.8% to 14.5% (P < .001).
Treatment Options for COVID-19–Related Guillain-Barré Syndrome
Authors: Goudarzi Sogand , Esmaeeli Shooka , Valencia Juan D. , Lu Maegan E. , Hales Riley R. , Fehnel Corey R. , Conley Christopher M. , Quraishi Sadeq A. , Nozari Ala
Published: September 2021

Background:

Central nervous system complications are reported in an increasing number of patients with Coronavirus Disease 2019 (COVID-19). COVID-19–related Guillain-Barré syndrome (GBS) is of particular importance given its association with higher mortality rates and prolonged respiratory failure.

Review Summary:

We conducted a systematic review of published cases for COVID-19–related GBS, and provide a summary of clinical management strategies for these cases. Sixty-three studies, including 86 patients, were included. Seventy-six cases with reported outcome data were eligible for the outcome analysis. Ninety-nine percent of patients were diagnosed with COVID-19 before diagnosis of GBS (median: 14 d prior, interquartile range: 7 to 20). Intravenous immunotherapy (intravenous immunoglobulin: 0.4 g/kg/d for 5 d) was the most frequently used treatment approach. The review indicated that the outcome was not favorable in 26% of cases (persistent neurological deficits). A mortality rate of 3.5% was observed in patients with COVID-19–related GBS.

Conclusions:

Although evidence to support specific treatments is lacking, clinicians should consider the benefits of immunotherapy and plasma exchange in addition to the standard antimicrobial and supportive therapies for patients who meet the diagnostic criteria for acute sensory and motor polyradiculoneuritis. Intravenous immunoglobulin treatment alone is not shown to result in improved outcomes or mortality. More extensive studies aimed at exploring the neurological manifestations and complications of COVID-19 and distinctive treatment options for COVID-19–related GBS are warranted.
Variants of Avellis Syndrome Due to Medulla Oblongata Infarction
Authors: Kumral Emre , Çetin Fatma E.
Published: September 2021

Introduction:

Avellis syndrome is classically defined as a neurological disorder characterized by paralysis of the soft palate and vocal cords on one side, and a loss of sensation of pain and temperature sense on the other side. Between 2010 and 2020, 5400 patients with ischemic stroke were admitted to the Stroke Unit and prospectively entered in our Stroke Registry.

Case Report:

A total of 216 patients with magnetic resonance imaging–proven ischemic lesions restricted to the medulla oblongata were identified. Among them, 5 patients had Avellis syndrome with a small medullary infarction. There was paralysis of the soft palate and vocal cords in all patients, but besides of loss of pain sensation and temperature sense, there were also partial disturbances in position and vibration senses in 3 patients. Different types of neuro-ophthalmologic findings were observed in 4 patients. In 5 patients, the cause of medulla oblongata infarct was microscopic polyangiitis vasculitis, neuro-Behçet disease, vertebral artery dissection, small vessel disease, and neurobrucellosis small vessel vasculitis.

Conclusions:

Avellis syndrome may present with additional neurological findings besides its classic definition. Apart from atherosclerotic disease, rare causes should be investigated in detail in small ischemic medullary lesions.
The lost microbes of COVID-19: Bifidobacterium, Faecalibacterium depletion and decreased microbiome diversity associated with SARS-CoV-2 infection severity
Authors: Hazan Sabine , Stollman Neil , Bozkurt Huseyin , Dave Sonya , Papoutsis Andreas J. , Daniels Jordan , Barrows Brad D. , Quigley Eamonn MM , Borody Thomas J.
Published: September 2021

Objective

The study objective was to compare gut microbiome diversity and composition in SARS-CoV-2 polymerase chain reaction (PCR)-positive patients whose symptoms ranged from asymptomatic to severe, versus PCR-negative exposed controls.

Design

Using a cross-sectional design, we performed shotgun next-generation sequencing (NGS) on stool samples to evaluate gut microbiome composition and diversity in both patients with SARS-CoV-2 PCR- confirmed infections, that had presented to Ventura Clinical Trials for care from March 2020 through October 2021, and SARS-CoV-2 PCR-negative exposed controls. Patients were classified as being asymptomatic or having mild, moderate, or severe symptoms based on NIH criteria. Exposed controls were individuals with prolonged or repeated close contact with patients with SARS-CoV-2 infection or their samples, e.g. household members of patients or frontline healthcare workers. Microbiome diversity and composition were compared between patients and exposed controls at all taxonomic levels.

Results

Compared with controls (n=20), severely symptomatic SARS-CoV-2 infected patients (n=28) had significantly less bacterial diversity (Shannon Index, P=0.0499; Simpson Index, P=0.0581), and positive patients overall had lower relative abundances of Bifidobacterium (P<0.0001), Faecalibacterium (P=0.0077), and Roseburium (P=0.0327), while having increased Bacteroides (P=0.0075). Interestingly, there was an inverse association between disease severity and abundance of the same bacteria.

Conclusion

We hypothesize that low bacterial diversity and depletion of Bifidobacterium genera either before or after infection led to reduced pro-immune function, thereby allowing SARS-CoV-2 infection to become symptomatic. This particular dysbiosis pattern may be a susceptibility marker for symptomatic severity from SARS-CoV-2 infection and may be amenable to pre-, intra-, or post infection intervention.Keywords: SARS-CoV-2, COVID, Microbiome, Bifidobacterium, Faecalibacterium, Bacteriodes, Shannon Index, Simpson Index, Severity, Microbiota

Registration

clinicaltrials.govNCT04031469 (PCR -) and 04359836 (PCR+)
Significant Sparse Polygenic Risk Scores across 813 traits in UK Biobank
Authors: Tanigawa Yosuke , Qian Junyang , Venkataraman Guhan , Justesen Johanne Marie , Li Ruilin , Tibshirani Robert , Hastie Trevor , Rivas Manuel A.
Published: September 2021

We present a systematic assessment of polygenic risk score (PRS) prediction across more than 1,500 traits using genetic and phenotype data in the UK Biobank. We report 813 sparse PRS models with significant (p < 2.5 × 10−5) incremental predictive performance when compared against the covariate-only model that considers age, sex, types of genotyping arrays, and the principal component loadings of genotypes. We report a significant correlation between the number of genetic variants selected in the sparse PRS model and the incremental predictive performance (Spearman’s ρ = 0.61, p = 2.2 × 10−59 for quantitative traits, ρ = 0.21, p = 9.6 × 10−4 for binary traits). The sparse PRS model trained on European individuals showed limited transferability when evaluated on non-European individuals in the UK Biobank. We provide the PRS model weights on the Global Biobank Engine (https://biobankengine.stanford.edu/prs).

Author summary

Polygenic risk scores (PRSs), an approach to estimate genetic predisposition on disease liability by aggregating the effects across multiple genetic variants, has attracted increasing research interest. While there have been improvements in the predictive performance of PRS for some traits, the applicability of PRS models across a wide range of human traits has not been clear. Here, applying penalized regression using Batch Screening Iterative Lasso (BASIL) algorithm to more than 269,000 individuals of white British ancestry in UK Biobank, we systematically characterize PRS models across more than 1,500 traits. We report 813 traits with PRS models of statistically significant predictive performance. While the statistical significance does not necessarily directly translate into clinical relevance, we investigate the properties of the 813 significant PRS models and report a significant correlation between predictive performance and estimated SNP-based heritability. We find that the number of genetic variants selected in our sparse PRS model is significantly correlated with the incremental predictive performance in both quantitative and binary traits. Our transferability assessment of PRS models in UK Biobank revealed that the sparse PRS models trained on individuals of European ancestry had a lower predictive performance for individuals of African and Asian ancestry groups.