bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in photoprotective strategy during winter in Eastern white pine and white spruce
Authors: Verhoeven Amy , Kornkven Joan
Published: October 2023

Conifers growing in temperate forests utilize sustained forms of thermal dissipation during winter to protect the photosynthetic apparatus from damage, which can be monitored via pronounced reductions in photochemical efficiency (Fv/Fm) during winter. Eastern white pine (Pinus strobus L.) and white spruce (Picea  glauca (Moench) Voss) are known to recover from winter stress at different rates, with pine recovering more slowly than spruce, suggesting different mechanisms for sustained dissipation in these species. Our objectives were to monitor pine and spruce throughout spring recovery in order to provide insights into key mechanisms for sustained dissipation in both species. We measured chlorophyll fluorescence, pigments, and abundance and phosphorylation status of key photosynthetic proteins. We found that both species rely on two forms of sustained dissipation involving retention of high amounts of antheraxanthin (A) + zeaxanthin (Z), one that is very slowly reversible and temperature independent and one that is more dynamic and occurs only on subzero days. Differences in protein abundance suggest that spruce, but not pine, likely upregulates cyclic or alternative pathways of electron transport involving the cytochrome b6f complex and photosystem I (PSI). Both species show an increased sustained phosphorylation of the D1 protein on subzero days, and spruce additionally shows dramatic increases in the sustained phosphorylation of light-harvesting complex II (LHCII) and other PSII core proteins on subzero days only, suggesting that a mechanism of sustained dissipation that is temperature dependent requires sustained phosphorylation of photosynthetic proteins in spruce, possibly allowing for direct energy transfer from PSII to PSI as a mechanism of photoprotection. The data suggest differences in strategy among conifers in mechanisms of sustained thermal dissipation in response to winter stress. Additionally, the flexible induction of sustained A + Z and phosphorylation of photosynthetic proteins in response to subzero temperatures during spring recovery seem to be important in providing photoprotection during transitional periods with high temperature fluctuation.
Evaluation of Soybean Genotypes (Glycine max and G. soja) for Resistance to the Root-Knot Nematode, Meloidogyne enterolobii
Authors: Schwarz Tanner , Gorny Adrienne
Published: October 2023

Potential resistance to the root-knot nematode (RKN) Meloidogyne enterolobii in 72 Glycine soja and 44 G. max soybean genotypes was evaluated in greenhouse experiments. Approximately 2,500 eggs of M. enterolobii were inoculated on each soybean genotype grown in a steam sterilized 1:1 sand to soil mixture. Sixty days postinoculation, plants were destructively harvested to determine the host status. The host status of each soybean genotype was determined by assessing root galling severity and calculating the final eggs per root system divided by the initial inoculum, or the reproduction factor (Rf). Five G. soja soybean genotypes were identified as resistant (Rf < 1) to M. enterolobii: ‘407202’, ‘407239’, ‘424083’, ‘507618’, and ‘639621’. None of the tested G. max soybean genotypes were identified as resistant to M. enterolobii. Some of the G. max genotypes determined to be susceptible to M. enterolobii include ‘Hagood’, ‘Avery’, ‘Rhodes’, ‘Santee’, and ‘Bryan’. The genotype ‘Bryan’ had the lowest Rf values among the group at 5.06 and 6.67 in two independent trials, respectively, which represents a five- to sixfold increase in reproduction of M. enterolobii. Plant genotypes resistant to RKNs are effective in managing the disease and preserving yield, cost-efficient, and environmentally sustainable, and host resistance is often regarded as the most robust management tactic for controlling plant-parasitic nematodes. Resistance to RKNs in soybean genotypes has been identified for other Meloidogyne species, yet there is currently limited data regarding soybean host status to the highly aggressive nematode M. enterolobii. This study adds to the knowledge of potential native resistance to M. enterolobii in wild and cultivated soybean.
Unravelling Species Diversity and Pathogenicity of Fusarium spp. Associated with Soybean Leaf and Root in Heilongjiang Province, China
Authors: Xu Xi , Shen Guijin , Teng Haolin , Zhao Junlei , Xiao Jialei , Guo Lifeng , Gao Yuan , Chen Jie , Wang Xiangjing , Xiang Wensheng , Zhao Junwei
Published: October 2023

Soybean (Glycine max L.) holds significant global importance and is extensively cultivated in Heilongjiang Province, China. Soybean can be infected by Fusarium species, causing root rot, seed decay, stem rot, and leaf blight. In 2021 to 2022, a field survey of soybean diseases was carried out in 11 regions of Heilongjiang Province, and 186 soybean leaves with leaf blight symptoms and 123 soybean roots with root rot symptoms were collected. Unexpectedly, a considerable number of Fusarium isolates were obtained not only from root samples but also from leaf samples. A total of 584 Fusarium isolates (416 from leaves and 168 from roots) were obtained and identified as 18 Fusarium species based on morphological features and multilocus phylogenetic analyses with tef1 and rpb2 sequences. Fusarium graminearum and Fusarium sp. 1 in FOSC were the dominant species within soybean leaf and root samples, respectively. Pathogenicity tests were conducted for all Fusarium isolates on both soybean leaves and roots. Results showed that F. graminearum, F. ipomoeae, F. citri, F. compactum, F. flagelliforme, F. acuminatum, and F. sporotrichioides were pathogenic to both soybean leaves and roots. F. solani, F. avenaceum, F. pentaseptatum, F. serpentinum, F. annulatum, and Fusarium sp. 1 in FOSC were pathogenic to soybean roots, not to leaves. To our knowledge, this is the first study to thoroughly investigate soybean-associated Fusarium populations in leaves and roots in Heilongjiang Province.
Low-dose Induction of Buprenorphine in Pregnancy: A Case Series
Authors: Junn Sue , Tugarinov Nicol , Mark Katrina
Published: October 2023

Background

Because of a risk of precipitated withdrawal occurring from buprenorphine induction in people who use fentanyl, low-dose inductions are becoming increasingly common. However, little evidence exists on the use of this method in pregnant people.

Methods

We conducted a case series of all pregnant people treated for opioid use disorder with low-dose buprenorphine induction at the University of Maryland Medical Center between January 1, 2021, and August 22, 2022. Primary outcome was completion of induction regimen. Secondary outcomes were self-report of withdrawal, continuation of buprenorphine until delivery, and return to or continuation of illicit opioid use.

Results

Six pregnant people were prescribed a total of 10 buprenorphine inductions. Five of the 6 pregnant people (83.3%) completed at least 1 induction, none of whom experienced precipitated withdrawal. Two of 6 (33.3%) continued buprenorphine until the time of delivery, and 1 of 6 (16.7%) abstained from illicit opioid use.

Conclusions

The low-dose buprenorphine induction regimen described was successful in 5 of 6 pregnant individuals. Further research, particularly regarding continuation rates, is needed.
The Validity and Reliability of the SINBAD Classification System for Diabetic Foot Ulcers
Authors: Brocklehurst Jonathan D.
Published: October 2023

Diabetic foot ulcers (DFUs) are a serious and costly complication of diabetes mellitus with a global prevalence of 6.3% and cost of £8,800 per unhealed DFU in the National Health Service. The three main types of DFU are neuropathic, ischemic, and neuroischemic, with an estimated prevalence of 35%, 15%, and 50%, respectively. Because 85% of lower-limb amputations in patients with diabetes are preceded by a DFU, the task of reducing the current and future burden of DFUs on an international level is of crucial importance. Classification of a DFU is an important and complex process with many independent variables that influence the wound severity. Correct classification of a DFU is important to prevent deterioration in the short term and lower-limb amputation in the long term. Both the accuracy of the clinician’s interpretation of categorical data from a classification model and grasp of contextual risk factors can refine diagnoses. The term SINBAD is an acronym for six independent variables: site, ischemia, neuropathy, bacterial infection, area, and depth. This system uses comprehensive parameters with strict criteria to facilitate quick and accurate clinical decisions to prevent lower-limb amputation. In addition to providing quantitative measurement, SINBAD also spotlights the multifaceted characteristics of DFUs. By evaluating the validity and reliability of the SINBAD classification system, its applicability for the assessment of DFUs and prevention of lower-limb amputation can be better understood.
Preliminary Guidelines for Replacing Word-Recognition in Quiet With Speech in Noise Assessment in the Routine Audiologic Test Battery
Authors: Fitzgerald Matthew B. , Gianakas Steven P. , Qian Z. Jason , Losorelli Steven , Swanson Austin C.
Published: October 2023

Objectives:

For decades, monosyllabic word-recognition in quiet (WRQ) has been the default test of speech recognition in routine audiologic assessment. The continued use of WRQ scores is noteworthy in part because difficulties understanding speech in noise (SIN) is perhaps the most common complaint of individuals with hearing loss. The easiest way to integrate SIN measures into routine clinical practice would be for SIN to replace WRQ assessment as the primary test of speech perception. To facilitate this goal, we predicted classifications of WRQ scores from the QuickSIN signal to noise ratio (SNR) loss and hearing thresholds.

Design:

We examined data from 5808 patients who underwent audiometric assessment at the Stanford Ear Institute. All individuals completed pure-tone audiometry, and speech assessment consisting of monaural WRQ, and monaural QuickSIN. We then performed multiple-logistic regression to determine whether classification of WRQ scores could be predicted from pure-tone thresholds and QuickSIN SNR losses.

Results:

Many patients displayed significant challenges on the QuickSIN despite having excellent WRQ scores. Performance on both measures decreased with hearing loss. However, decrements in performance were observed with less hearing loss for the QuickSIN than for WRQ. Most important, we demonstrate that classification of good or excellent word-recognition scores in quiet can be predicted with high accuracy by the high-frequency pure-tone average and the QuickSIN SNR loss.

Conclusions:

Taken together, these data suggest that SIN measures provide more information than WRQ. More important, the predictive power of our model suggests that SIN can replace WRQ in most instances, by providing guidelines as to when performance in quiet is likely to be excellent and does not need to be measured. Making this subtle, but profound shift to clinical practice would enable routine audiometric testing to be more sensitive to patient concerns, and may benefit both clinicians and researchers.
ABC-AF-Stroke score predicts thromboembolism in non-anticoagulated patients following successful atrial fibrillation ablation: a report from the Chinese Atrial Fibrillation Registry
Authors: Wang Yufeng , Jiang Chao , He Liu , Du Xin , Guo Xueyuan , Tang Ribo , Sang Caihua , Long Deyong , Dong Jianzeng , Hijazi Ziad , Lip Gregory Y.H. , Ma Changsheng
Published: October 2023

Background:

The age, biomarkers, and clinical history (ABC)-atrial fibrillation (AF)-Stroke score have been proposed to refine stroke risk stratification, beyond what clinical risk scores such as the CHA2DS2-VASc score can offer. This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations.

Methods:

A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry (CAFR) between 2013 and 2019 were included. Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk. The ABC-AF-Stroke score was evaluated in terms of discrimination, including concordance index (C-index), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), clinical utilization by decision curve analysis (DCA), and calibration by comparing the predicted risk with the observed annualized event rate.

Results:

After a median follow-up of 3.5 years, 64 patients experienced thromboembolism events. Age, prior history of stroke/transient ischemic attack (TIA), high-sensitivity cardiac troponin T (cTnT-hs), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were independently associated with thromboembolism risk. The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index (0.67, 95% confidence interval [CI]: 0.59–0.74 vs. 0.60, 95% CI: 0.52–0.67, P = 0.030) and reclassification capacity. The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score. The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population.

Conclusions:

In this real-world study enrolling non-anticoagulated AF patients following successful ablations, age, prior history of stroke/TIA, level of NT-proBNP, and cTnT-hs were independently associated with an increased risk of thromboembolism. The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score in predicting thromboembolism risk.
Mechanisms of Immune Tolerance and Inflammation via Gonadal Steroid Hormones in Preterm Birth
Authors: Shen Yongmei , Li Yaqi , Cao Jiasong , Li Wen , Lin Qimei , Wang Jianxi , Wei Zhuo , Chang Ying
Published: October 2023

In 2019, preterm births (PTB) accounted for approximately 0.66 million deaths globally. PTB is also associated with a significantly higher risk of mortality and long-term complications for newborns. Long-term studies associated several factors, including disruption of immune tolerance and inflammation, with PTB. However, the pathogenesis of PTB remains unclear. Gonadal steroid hormones are critical for pregnancy maintenance and regulation of immune and inflammatory responses. However, it is not clear how unbalanced gonadal steroid hormones, such as imbalanced estrogen/androgen or estrogen/progesterone contribute to PTB. In this review, we discuss how gonadal steroid hormones mediate dysfunction in immune tolerance and inflammatory responses, which are known to promote the occurrence of PTB, and provide insight into PTB prediction.
Factors of Fetal Origin in the Regulation of Labor Initiation and Preterm Birth
Authors: Ding Longkun , Gao Lu
Published: October 2023

Preterm birth is the leading cause of mortality and morbidity in newborns and children under 5 years-of-age. In order to improve the survival rate and quality of preterm infants, there is critical need to identify the specific mechanisms underlying the initiation of labor. Pregnancy represents a period of constant interactive dialog between mother and fetus. A disturbance in the pattern of maternal-fetal communication can induce physiological or pathological labor. Although a number of studies have investigated the contributions of maternal factors to the initiation of labor, the concept that fetal organ development and maternal adaptation are coordinated has emerged over recent years, thus emphasizing that factors of fetal origin may serve as hormonal signals for the initiation of labor. In this review, we summarize and discuss several specific mechanisms by which factors of fetal origin may influence parturition during term or preterm labor, including the specific regulation of fetal organs, including the lungs and accessory organs during pregnancy. Future research may focus on the specific pathways by which signals from the fetal lungs and other fetal organs interact with the maternal system to initiate eventual labor.
Using the Delphi Technique to Achieve Consensus on Prevention and Treatment of Preterm Single Birth in China
Authors: Li Taishun , Liu Zhe , Yang Huixia , Hu Yali
Published: October 2023

Objective

This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.

Methods

Based on the scoping literature review and the 2014 edition of preterm birth of Clinical Diagnosis and Treatment guidelines, we generated the Delphi survey statements with five evaluation dimensions, including the definition of preterm birth, exclusion of risk factors for preterm birth, prevention, and prediction of preterm birth, treatment of preterm birth, and evaluation of intervention outcomes of preterm birth. Obstetric experts from the Obstetrics and Gynecology Branch of the Chinese Medical Association formed the expert group for this survey. All the obstetric experts participated two-round modified Delphi survey via an anonymous online survey and an online panel. Mean scores, rank sum, full score ratio, and the lowest score ratio were calculated to reflect the concentration of expert opinions. The coefficient of variation and Kendall W coefficient were used to reflect the expert opinion coordination degree of the survey statement.

Results

The expert response rate for both rounds of surveys was 100% (41/41). Experts reached an agreement on 36 statements in five dimensions of preterm birth prevention and treatment in the first round of the survey and reached a consensus on the remaining 13 statements in the second round. A total of 49 statements (mean scores ≥3, full score ratio ≥20%, coefficient of variation ≤0.3) were explicitly included in this guideline to form recommendations, while the remaining three clinical issues that did not reach a consensus require further determination based on evidence quality. The Kendall W coefficient in the two rounds of the Delphi survey were 0.20 (P < 0.001) and 0.29 (P < 0.001).

Conclusion

The five dimensions and 49 statements, agreed upon through a two-round Delphi study, determined the recommended statements to be included in the updated guidelines for the prevention and treatment of preterm birth in China. The defined lower limit is set at ≥28 gestational weeks; however, an update has been made to the definition of premature birth, specifying that “with the consent of the mother and her family, treatment is not abandoned for viable infants ≥26 gestational weeks.”
Predicting the Risk of Preterm Birth Throughout Pregnancy Based on a Novel Transcriptomic Signature
Authors: Ran Yuxin , Huang Dongni , Yin Nanlin , Wen Yanqing , Jiang Yan , Liu Yamin , Qi Hongbo
Published: October 2023

Objective

This study focused on the prediction of preterm birth (PTB). It aimed to identify the transcriptomic signature essential for the occurrence of PTB and evaluate its predictive value in early, mid, and late pregnancy and in women with threatened preterm labor (TPTL).

Methods

Blood transcriptome data of pregnant women were obtained from the Gene Expression Omnibus database. The activity of biological signatures was assessed using gene set enrichment analysis and single-sample gene set enrichment analysis. The correlation among molecules in the interleukin 6 (IL6) signature and between IL6 signaling activity and the gestational week of delivery and latent period were evaluated by Pearson correlation analysis. The effects of molecules associated with the IL6 signature were fitted using logistic regression analysis; the predictive value of both the IL6 signature and IL6 alone were evaluated using receiver operating characteristic curves and pregnancy maintenance probability was assessed using Kaplan-Meier analysis. Differential analysis was performed using the DEseq2 and limma algorithms.

Results

Circulatory IL6 signaling activity increased significantly in cases with preterm labor than in those with term pregnancies (normalized enrichment score (NES) = 1.857, P = 0.001). The IL6 signature (on which IL6 signaling is based) was subsequently considered as the candidate biomarker for PTB. The area under the curve (AUC) values for PTB prediction (using the IL6 signature) in early, mid, and late pregnancy were 0.810, 0.695, and 0.779, respectively; these values were considerably higher than those for IL6 alone. In addition, the pregnancy curves of women with abnormal IL6 signature differed significantly from those with normal signature. In pregnant women who eventually had preterm deliveries, circulatory IL6 signaling activity was lower in early pregnancy (NES = −1.420, P = 0.031) and higher than normal in mid (NES = 1.671, P = 0.002) and late pregnancy (NES = 2.350, P < 0.001). In women with TPTL, the AUC values for PTB prediction (or PTB within 7 days and 48 hours) using the IL6 signature were 0.761, 0.829, and 0.836, respectively; the up-regulation of IL6 signaling activity and its correlation with the gestational week of delivery (r = −0.260, P = 0.001) and latency period (r = −0.203, P = 0.012) were more significant than in other women.

Conclusion

Our findings suggest that the IL6 signature may predict PTB, even in early pregnancy (although the predictive power is relatively weak in mid pregnancy) and is particularly effective in symptomatic women. These findings may contribute to the development of an effective predictive and monitoring system for PTB, thereby reducing maternal and fetal risk.
Clinical Parameters in the First 5 Minutes after Birth Have a Predictive Value for Survival of Extremely Preterm Infants
Authors: Torrejón-Rodríguez Laura , Solaz-García Álvaro , Lara-Cantón Inmaculada , Pinilla-González Alejandro , Aguar Marta , Vento Máximo
Published: October 2023

Extreme preterm infants (<28 weeks' gestation) often require positive pressure ventilation with oxygen during postnatal stabilization in the delivery room. To date, optimal inspired fraction of oxygen (FiO2) still represents a conundrum in newborn care oscillating between higher (>60%) and lower (<30%) initial FiO2. Recent evidence and meta-analyses have underscored the predictive value for survival and/or relevant clinical outcomes of the Apgar score and the achievement of arterial oxygen saturation measured by pulse oximetry ≥85% at 5 minutes after birth. New clinical trials comparing higher versus lower initial FiO2 have been launched aiming to optimize postnatal stabilization of extreme preterm while avoiding adverse effects of hypoxemia or hyperoxemia.
Validation of AGA clinical care pathway and AASLD practice guidance for nonalcoholic fatty liver disease in a prospective cohort of patients with type 2 diabetes
Authors: Ajmera Veeral , Tesfai Kaleb , Sandoval Erick , Lopez Scarlett , Cervantes Vanessa , Madamba Egbert , Bettencourt Ricki , Manousou Pinelopi , Richards Lisa , Loomba Rohit
Published: October 2023

Background and Aims:

Recently, the American Gastroenterological Association and the American Association for the Study of Liver Diseases developed clinical pathways to evaluate populations at high risk for NAFLD. We assessed the diagnostic performance of the new guidance in a well-phenotyped cohort of patients with Type 2 diabetes mellitus (T2DM).

Approach and Results:

This prospective study enrolled patients age ≥50 years with T2DM. Participants underwent a standardized clinical research visit with MRI and ultrasound-based assessment of liver fat and stiffness and Enhanced Liver Fibrosis (ELF) testing. Of 417 participants (36% men) with T2DM with FIB-4 and MRE data, the prevalence of NAFLD was 64% and 12% had advanced fibrosis (MRE≥3.63 kPa). Applying the American Gastroenterological Association pathway of FIB-4 and vibration-controlled transient elastography, the false negative rate was 3.3% and 18% would qualify for specialty referral. Applying the FIB-4 + ELF American Association for the Study of Liver Diseases pathway, the false negative rate was 4.5%, but 50% would qualify for specialty referral. Applying higher ELF cut points improved the pathway, yielding a similar false negative rate of 4.9% but decreased specialty referral to 27%.

Conclusion:

Validation of the American Gastroenterological Association clinical pathway in a prospectively recruited cohort with T2DM revealed a low false negative rate and avoided specialty referral in a large percentage of patients. The American Association for the Study of Liver Diseases pathway with FIB-4 + ELF resulted in a high rate of specialty referral, which improved with the utilization of higher ELF cut points and may serve as an alternative for primary care and endocrinology clinics without access to vibration-controlled transient elastography.
Exploratory Data Analysis of the Groundwater Contaminants at the Former Panna Maria Uranium Recovery Facility
Authors: Harvey Mark C. , Glenn Griesinger Nancy L.
Published: October 2023

The former Panna Maria mill was a uranium recovery facility that operated from 1979 to December 1992. Sulfuric acid leach was used to process several tons of ore daily. Therefore, the groundwater was sampled at the site to monitor the concentration of background chemical pollutants. The purpose of this study was to perform exploratory data analysis to evaluate whether the arsenic, nickel, selenium, sulfate, and uranium concentrations were in accord with state-regulated groundwater drinking standards at the site. To accomplish this, a substitution method was used to replace concentration values that were below measurable ranges of well monitoring units. Additionally, random forest regression was employed to account for missing not-at-random values in the dataset. Groundwater samples collected in wells before the facility began operations were used to determine an upper bound on background pollutants consistent with US Environmental Protection Agency Standards. The upper tolerance limit comprising 90% of the groundwater sample at a confidence coefficient of 95% was used to establish alternate concentration limits for each chemical based on well data from the National Uranium Resource Hydrogeochemical and Stream Sediment Reconnaissance program. Results obtained in this analysis establish a baseline on the chemical concentrations in the background groundwater at the former Panna Maria mill.
CLOSURE OF A CHRONIC TRAUMATIC MACULAR HOLE AFTER PHACOEMULSIFICATION SURGERY
Authors: Bonnell Alyssa C. , Ohan Masis A. , Feng Shu
Published: October 2023

Purpose:

To report a case of chronic traumatic macular hole closure after an uncomplicated phacoemulsification surgery.

Methods:

Retrospective chart review with optical coherence tomography imaging.

Results:

Forty-two-year-old woman with a 20-year history of a traumatic macular hole and cataract in the right eye underwent an uncomplicated phacoemulsification surgery. After surgery, the patient was prescribed prednisolone acetate 1% four times per day, which was tapered off by postoperative month 1. By postoperative month 1, the full-thickness macular hole had closed.

Conclusion:

This unique case illustrates the closure of a full-thickness macular hole after cataract surgery. We hypothesize that the closure of the macular hole was aided by the use of topical steroids in the postoperative period, allowing for resolution of the cystic intraretinal fluid and hole closure.
Sex as a biological variable in acute kidney injury
Authors: Dahiya Anita , Pannu Neesh , Soranno Danielle E.
Published: October 2023

Purpose of review

The purpose of this review is to provide an overview of the preclinical and clinical studies investigating sex as a biological variable, as well as the impact of gender, on the development of and progression of acute kidney injury (AKI).

Recent findings

Despite a matched degree of ischemia-reperfusion AKI based on measured glomerular filtration rates, male and female mice demonstrated important sex biases in cardiorenal outcomes (1). Although the 2012 Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for AKI reported that female sex is associated with increased rates of hospital acquired AKI, subsequent meta-analyses do not show increased risk of AKI in women. Recent large scale, multicenter epidemiologic studies suggest males have higher rates of hospital acquired AKI. However, women have been consistently shown to have worse renal outcomes after AKI. There may be also be gender-based differences in presentation to care and management.

Sex is an important biological variable in animal models of acute kidney injury. The impact of sex on AKI likely varies based on the etiology of AKI. Preclinical studies demonstrate the nuances of sex chromosomes, sex hormones and epigenetic factors on AKI, however these have not been well studied in humans. Gender may also impact processes of care, treatment and clinical outcomes related to AKI. The scientific rigor and reproducibility of translational studies benefit from the consideration of sex and gender.
Adults are just big kids: pediatric considerations for adult critical care nephrology
Authors: Starr Michelle C. , Gilley Stephanie P. , See Emily J. , Slagle Cara , Soranno Danielle E.
Published: October 2023

Purpose of review

In recent years, there has been growing attention to pediatric kidney health, especially pediatric acute kidney injury (AKI). However, there has been limited focus on the role of pediatric AKI on adult kidney health, specifically considerations for the critical care physician.

Recent findings

We summarize what is known in the field of pediatric AKI to inform adult medical care including factors throughout the early life course, including perinatal, neonatal, and pediatric exposures that impact survivor care later in adulthood.

The number of pediatric AKI survivors continues to increase, leading to a higher burden of chronic kidney disease and other long-term co-morbidities later in life. Adult medical providers should consider pediatric history and illnesses to inform the care they provide. Such knowledge may help internists, nephrologists, and intensivists alike to improve risk stratification, including a lower threshold for monitoring for AKI and kidney dysfunction in their patients.
Automated external defibrillators and the link to first responder systems
Authors: Jonsson Martin , Berglund Ellinor , Müller Michael P.
Published: October 2023

Purpose of review

Automated external defibrillators are a very effective treatment to convert ventricular fibrillation (VF) in out-of-hospital cardiac arrest. The purpose of this paper is to review recent publications related to automated external defibrillators (AEDs).

Recent findings

Much of the recent research focus on ways to utilize publicly available AEDs included in different national/regional registers. More and more research present positive associations between engaging volunteers to increase the use of AEDs. There are only a few recent studies focusing on professional first responders such as fire fighters/police with mixed results. The use of unmanned aerial vehicles (drones) lacks clinical data and is therefore difficult to evaluate. On-site use of AED shows high survival rates but suffers from low incidence of out-of-hospital cardiac arrest (OHCA).

The use of public AEDs in OHCA are still low. Systems focusing on engaging volunteers in the cardiac arrest response have shown to be associated with higher AED usage. Dispatching drones equipped with AEDs is promising, but research lacks clinical data. On-site defibrillation is associated with high survival rates but is not available for most cardiac arrests.
Efficacy of acupuncture or moxibustion in treating senile insomnia compared with a control group: A systematic review and meta-analysis
Authors: Hu Wenjiao , Zhou Hao , Zeng Yue , Zeng Qian , Huang Zubo , Wang Chao
Published: October 2023

Introduction:

This systematic review and meta-analysis aimed to assess the efficacy of acupuncture or moxibustion therapy in senile insomnia patients.

Methods:

A comprehensive literature search was conducted using 7 electronic databases to identify randomized controlled trials reported on the use of acupuncture or moxibustion therapy in insomnia. The time frame was set from database establishment to March 11, 2023. The RevMan (version 5.3) and STATA (version 17.0) software were used to evaluate the quality of the included randomized controlled trials and perform a meta-analysis. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Subgroup analysis was performed based on different intervention methods. The I2 statistic was used to assess heterogeneity among studies.

Results:

A total of 20 studies conducted between 2007 and 2022 were included, involving 1677 patients with senile insomnia. In terms of efficacy, acupuncture or moxibustion alone was significantly better than western drugs (RR = 1.12; 95% CI, 1.06–1.20), acupuncture combined with drugs was better than drugs alone (RR = 1.20; 95% CI, 1.12–1.29), and acupuncture combined with cognitive behavior therapy intervention (CBT-I) was significantly better than CBT-I alone (RR = 1.52; 95% CI, 1.07–2.17). In terms of Pittsburgh Sleep Quality Index scores, acupuncture or moxibustion alone was more effective than western drugs (MD = −1.82; 95% CI, −2.37 to −1.26), acupuncture combined with drugs was more effective than drugs alone (MD = −3.10; 95% CI, −4.25 to −1.95), and acupuncture was significantly more effective than sham acupuncture (MD = −4.18; 95% CI, −5.85 to −2.51) and psychological intervention (MD = −3.54; 95% CI, −4.33 to −2.75) in improving sleep quality.

Conclusions:

This meta-analysis revealed that acupuncture or moxibustion alone or combination with other therapies(drugs, CBT-I or psychological intervention) has high clinical efficacy and can improve the sleep quality of patients with senile insomnia. However, further well-designed studies are warranted to verify these findings.
A review of cost-effectiveness analysis: From theory to clinical practice
Authors: Michelly Gonçalves Brandão Sara , Brunner-La Rocca Hans-Peter , Pedroso de Lima Antonio Carlos , Alcides Bocchi Edimar
Published: October 2023

Cost-effectiveness analysis has long been practiced; registries date back to the United States of America War Department in 1886. In addition, everyone does intuitive cost-effectiveness analyses in their daily lives. In routine medical care, health economic assessment becomes increasingly important due to progressively limited resources, rising demands, population increases, and continuous therapeutic innovations. The health economic assessment must analyze the outcomes and costs of actions and technologies as objectively as possible to guarantee efficient assessment of novel interventions for Public Health Policy. In other words, it is necessary to determine how much society or patients are willing to or able to pay for novel interventions compared with existing alternatives, given the available resources. In addition, increased cost may displace other health care services already provided in case of fixed budget health care systems. To conduct such analyses, researchers must use standard methodologies and interpretations in light of regional characteristics according to social and economic determinants as well as clinical practice. Such an approach may be essential for transforming the current healthcare system to a value-based model. In this narrative review, concepts of the importance of and some approaches to health economic evaluation in clinical practice will be discussed.
Lung and bone metastases patterns in limb osteosarcoma: Surgical treatment of primary site improves overall survival
Authors: Liu Binbin , Tang Liyuan , Peng Ningning , Wang Liguo
Published: October 2023

Osteosarcoma (OS) is one of the most prevalent malignant bone tumors. The proportion of patients with limb OS was relatively high. Lung metastasis (LM) and bone metastasis are the first and second most common metastatic types of OS, respectively. A total of 270 new cases of LM, 55 new cases of bone metastases (BM), and 36 new cases of lung and BM were diagnosed in the surveillance, epidemiology and end results database from 2010 to 2019. Univariate and multivariate logistic regression analyses were used to identify the risk factors for lung and/or BM, and Cox regression analyses were performed to identify the prognostic factors for lung and/or BM. Kaplan–Meier curves and log-rank tests were used to analyze the overall survival of limb OS patients with lung and/or BM. Female sex, telangiectatic OS type, central OS type, T3 stage, N1 stage, BM, surgical treatments, radiotherapy and chemotherapy were significantly correlated with LM. T3 stage, LM, liver metastases, and radiotherapy significantly correlated with BM. The small cell OS type, T2 stage, T3 stage, N1 stage, liver metastases, and radiotherapy were significantly correlated with lung and BM. Among limb OS patients with LM, the mean survival months of older age, black race, N1 stage, BM, brain metastases, no surgery, and no chemotherapy were lower than those of the control group. In limb OS patients with LM and BM, the mean survival months in the no surgery group was lower than in the surgery group. T stage and radiotherapy significantly influence the occurrence of limb OS with lung and/or BM. Surgery at the primary site has been shown to be effective in improving the survival rate of patients with lung and/or BM.
Online Experiences, Internet-Fostered Connection, Resilience, and Adjustment Among Adolescent Siblings of Children With Cancer
Authors: Wawrzynski Sarah E. , Cloyes Kristin G. , Arasteh Kamyar , Guo Jia-Wen , Linder Lauri , Reblin Maija , Alderfer Melissa A.
Published: October 2023

Background

Pediatric cancer disrupts the lives of siblings in many ways, including physical separations from family and friends that increase risk for distress. Research suggests that siblings use technology and social media to connect with friends and family and seek social support and interaction. However, this may expose siblings to negative online experiences that can erode self-esteem, reducing resilience.

Objective

This study explored the relationship between online experiences, internet-fostered connection, resilience, and psychosocial health among siblings of children with cancer.

Methods

Participants included adolescent siblings (N = 81; aged 12-17 years) of children with cancer. Most were female (56.8%), and 50.6% represented racially or ethnically minoritized groups. Online experiences, social media use, resilience, and psychosocial health were self-reported and analyzed using structural equation modeling.

Results

A majority of siblings reported moderate to severe posttraumatic stress symptoms (PTSSs) (59%) and elevated emotional and behavioral difficulties (EBDs) (53%). Experiencing more positive online experiences was associated with greater perceived connection to family and friends online, but not resilience, PTSSs, or EBDs. In contrast, higher negative online experience scores were significantly associated with more PTSSs and EBDs. In addition, the association between negative online experiences and EBDs was significantly mediated by a negative association between negative online experiences and resilience.

Conclusions

Although social media may be a valuable tool for helping siblings of children with cancer garner social support, negative online experiences may be detrimental to their adjustment.

Implications for Practice

Efforts should be made to preserve and foster resilience among siblings who use social media for support.
Team communication improves patient safety
Authors: Chu Ruby
Published: October 2023

SBAR and TeamSTEPPS are structured communication tools that nurses should use in clinical settings to improve communication and overall patient satisfaction.
Applicability of the FDA-approved Immunohistochemical Panel for Identification of MMRd Phenotype in Uterine Endometrioid Carcinoma
Authors: Adachi Sumiyo , Kimata Jun-ichiro , Hanami Kyota , Adachi Katsuyuki , Igarashi Toshio , Liang Shan-Guang , Ishida Yasuo , Fujino Takashi , Yamazaki Kazuto
Published: October 2023

Recently, the US Food and Drug Administration (FDA) approved the Ventana MMR RxDx Panel as the first immunohistochemical companion diagnostic test for identification of tumors with mismatch repair (MMR) status. The aim of this study was to investigate the accuracy of this test in comparison with polymerase chain reaction (PCR)-based microsatellite instability (MSI) analysis. We assessed the MMR/MSI concordance rate in 140 cases of endometrioid carcinoma. MMR status was evaluated by immunohistochemistry (MMR-IHC), and MSI status was evaluated by PCR-based analysis (MSI-PCR). Potential molecular mechanisms responsible for MSH6 staining variations were also analyzed. Immunohistochemistry showed that 34 tumors (24.3%) were MMRd; these included 26 with combined MLH1/PMS2 loss, 2 with combined MSH2/MSH6 loss, and 6 with isolated MSH6 loss. Heterogeneous MSH6 loss was found in 10 tumors and was recognized only in tumors with combined MLH1/PMS2 loss. Eight of 10 tumors with heterogeneous MSH6 loss harbored MSH6 C8 tract instability, suggesting a secondary somatic event after MLH1/PMS2 loss. MSI-PCR revealed that 102 tumors were MSS, 4 were MSI-low, and 34 were MSI-high. Consequently, MMR-IHC and MSI-PCR showed perfect concordance (kappa=0.080, P<0.0001). However, 10 of the 34 MSI-high tumors, including the 6 tumors with isolated MSH6 loss, showed only minimal microsatellite shift by MSI-PCR, which may have been erroneously interpreted as MSS or MSI-low. On the basis of these findings, we consider that the FDA-approved immunohistochemical panel can detect MMR variations consistently and is more accurate than MSI-PCR for determining the applicability of immune checkpoint inhibitors for treatment of endometrioid carcinomas.
Skull Base Osteomyelitis in Children
Authors: Michelson-Farkash Carmela , Ashkenazi-Hoffnung Liat , Yalek Alexander , Shiran Shelly I. , Klivitsky Amir , Grisaru-Soen Galia
Published: October 2023

Objectives

We describe 10 new cases of otogenic (n = 8) and nonotogenic (n = 2) skull base osteomyelitis (SBO) in previously healthy children and review the literature on SBO in the pediatric population.

Methods

We retrospectively analyzed the medical records of 10 children (age range 0.9–12.8 years) discharged with a diagnosis of SBO between 2015 and 2020 in 2 children's hospitals in central Israel.

Results

Five patients presented with fever and 5 with otological signs and symptoms. All 10 children underwent a comprehensive clinical evaluation, imaging studies (computerized tomography or magnetic resonance imaging) and laboratory investigations. The physical examination revealed neurologic findings, including nuchal rigidity, papilledema, and apathy, in 4 patients. All 8 otogenic patients underwent surgical intervention and the 2 nonotogenic patients, who were diagnosed as having deep neck and throat infections, responded well to treatment consisting of antibiotics without surgery.

Conclusions

Early diagnosis of pediatric SBO can be challenging because the symptoms are often nonspecific. The final diagnosis relies mainly on imaging, preferably magnetic resonance imaging. Surgical intervention is usually mandatory in the otogenic patients, whereas the nonotogenic patients respond well to medical management alone.
Evaluation of Hemostatic Devices in a Randomized Porcine Model of Junctional Hemorrhage and 72-Hour Prolonged Field Care
Authors: Pratt Gilbert A. , Kishman Adam J. , Glaser Jacob J. , Castro Cecilia , Lorenzen Alejandra L. , Cardin Sylvain , Tiller Michael M. , McNeal Neal D. , Neidert Leslie E. , Morgan Clifford G.
Published: October 2023

Background

Hemorrhage control in prolonged field care (PFC) presents unique challenges that drive the need for enhanced point of injury treatment capabilities to maintain patient stability beyond the Golden Hour. To address this, two hemostatic agents, Combat Gauze (CG) and XSTAT, were evaluated in a porcine model of uncontrolled junctional hemorrhage for speed of deployment and hemostatic efficacy over 72-hours.

Methods

The left subclavian artery and subscapular vein were isolated in anesthetized male Yorkshire swine (70-85 kg) and injured via 50% transection, followed by 30-seconds of hemorrhage. CG (n = 6) or XSTAT (n = 6) was administered until bleeding stopped and remained within subjects for observation over 72-hours. Physiologic monitoring, hemostatic efficacy, and hematological parameters were measured throughout the protocol. Gross necropsy and histology were performed following humane euthanasia.

Results

Both CG and XSTAT maintained hemostasis throughout the full duration of the protocol. There were no significant differences between groups in hemorrhage volume (CG: 1021.0 ± 183.7 mL vs XSTAT: 968.2 ± 243.3 mL), total blood loss (CG: 20.8 ± 2.7% vs XSTAT: 20.1 ± 5.1%), or devices used (CG: 3.8 ± 1.2 vs XSTAT: 5.3 ± 1.4). XSTAT absorbed significantly more blood than CG (CG: 199.5 ± 50.3 mL vs XSTAT: 327.6 ± 71.4 mL), and was significantly faster to administer (CG: 3.4 ± 1.6 min vs XSTAT: 1.4 ± 0.5 min). There were no significant changes in Activated Clot Time, Prothrombin Time, or International Normalized Ratio between groups or compared to BSLN throughout the 72-hour protocol. Histopathology revealed no evidence of micro-thromboemboli or disseminated coagulopathies across evaluated tissues in either group.

Conclusion

CG and XSTAT demonstrated equivalent hemostatic ability through 72-hours, with no overt evidence of coagulopathies from prolonged indwelling. Additionally, XSTAT offered significantly faster administration and the ability to absorb more blood. Taken together, XSTAT offers logistical and efficiency advantages over CG for immediate control of junctional non-compressible hemorrhage, particularly in a tactical environment. Additionally, extension of indicated timelines to 72-hours allows translation to PFC.

Level of Evidence

N/A, Basic Science
Feasibility of Timed Up and Go Administered via Telerehabilitation in Older Adults
Authors: Karim Rania , Jasper Amie , Uy Samuel John Montecalvo , Tayag Eleazar , Vitente Arvie C. , Lazaro Rolando
Published: October 2023

Introduction:

This study aimed to explore the feasibility of telehealth-obtained Timed Up and Go (TUG).

Methods:

The TUG was administered twice during 1 visit. The TUG distance as set up by the participant was compared with the TUG set up by a rater. A second rater scored the TUG virtually, and a third rater scored session recordings twice, 30 days apart.

Results:

There was a strong and significant correlation between the face-to-face and virtually obtained TUG scores using the patient-identified distances (r = 0.994; 95% confidence interval, 0.957-0.999).

Discussion:

Virtual TUG measurements are comparable with those measured face-to-face.
Telehealth Implementation and Teaching Strategies During COVID-19 and Beyond in Gait, Balance, and Mobility Clinic for Community-Dwelling Older Adults
Authors: Hajela Nupur , Kwon Bryan , Penson Katiria Alexandra , Lee Alan
Published: October 2023

COVID-19 provided an opportunity to determine the effectiveness of telehealth physical therapy as part of a pro bono gait balance and mobility clinic. The aim of this case study is 2-folds—(1) to provide evidence for clinicians on telehealth physical therapy implementation while using mobile health platform and remote patient monitoring for a community-dwelling older adult with gait and balance disorder and (2) to provide evidence for clinical educators on telehealth-based teaching strategies to implement virtual clinical education for treating geriatric patient population. It is also important to note that this telehealth clinic model may be applicable outside of this patient population as well.