bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Stand Age and Fertilization on the Soil Microbiome of Miscanthus × giganteus
Authors: Ma Lanying , Rocha Fernando Igne , Lee Jaejin , Choi Jinlyung , Tejera Mauricio , Sooksa-Nguan Thanwalee , Boersma Nicholas , VanLoocke Andy , Heaton Emily , Howe Adina
Published: November 2020

Yield of the perennial grass Miscanthus × giganteus has shown an inconsistent and unpredictable response to nitrogen (N) fertilizer, yet fertilization underpins the crop’s environmental and economic sustainability. The interactions among soil microbial communities, N availability, and Miscanthus × giganteus and management may explain changes in plant productivity. In this study, soil samples from different stand ages of Miscanthus × giganteus in a replicated chronosequence field trial were used to investigate the effects of stand age and N fertilizer rates on microbial community structure. We hypothesized that there is a definable Miscanthus × giganteus soil microbiome and that this community varies significantly with stand age and fertilization. Our results showed that the main phyla in soil microbial communities, regardless of plant age, are similar but microbial community structures are significantly different. The variation in observed microbial communities generally decreases with older stand ages. The amount of N fertilizer applied also affected the microbial community structure associated with different aged Miscanthus × giganteus. Specifically, the relative abundance of Proteobacteria (Alphaproteobacteria and Gammaproteobacteria) and Acidobacteria (subgroup Gp1) increased shortly after fertilization and was more associated with younger Miscanthus × giganteus. Furthermore, our results show a significant relationship between bacterial α diversity and fertilization rates and that this response is also affected by stand age. Overall, our results emphasize linkages between microbial community structure, plant age, and fertilization in Miscanthus × giganteus.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Inflammatory endotypes of CRSwNP and responses to COVID-19
Authors: Wang Ming , Wang Chengshuo , Zhang Luo
Published: November 2020

Purpose of review

Coronavirus disease 2019 (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly become a great public health hazard globally. Nasal epithelial cells are an important site for SARS-CoV-2 infection and replication. The purpose of this review is to summarize recent findings on the endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) and the potential impact of SARS-CoV-2 infection.

Recent findings

Endotypes of CRSwNP are characterized by type 1, type 2 and type 3 inflammation according to patterns of inflammatory cells and the cytokines expressed in nasal tissue. Nasal epithelial cells show the highest expression of angiotensin-converting enzyme 2 (ACE2), the receptor for attachment and entry of SARS-CoV-2 into host cells, among all investigated cells in the respiratory tree. SARS-CoV-2 infection likely leads to increased activation of T-helper-1 (Th1) cell responses. Recent studies further suggest that ACE2 may be upregulated by type 1 and downregulated by type 2 inflammatory cytokines in nasal epithelial cells.

Expression of ACE2 in nasal epithelial cells is influenced by inflammatory endotypes of CRSwNP. Type 1 inflammation in nasal tissue may increase the risk of SARS-CoV-2 infection by upregulating ACE2 expression. However, clinical association between CRSwNP and COVID-19 is still unclear.
Orthopaedic outcomes of prenatal versus postnatal repair of myelomeningocele
Authors: Swarup Ishaan , Talwar Divya , Howell Lori J. , Adzick N. Scott , Horn Bernard David
Published: November 2020

Myelomeningocele, characterized by extrusion of the spinal cord through a spinal canal defect, is the most common form of spina bifida, often resulting in lifelong disability and significant orthopaedic issues. A randomized controlled trial (RCT) has shown the efficacy of prenatal repair in decreasing the need for shunting and improving motor outcomes. However, no studies have evaluated the effects of prenatal repair on orthopaedic outcomes. The purpose of this study was to determine the rates of orthopaedic conditions in patients with prenatal and postnatal repair of myelomeningocele and compare the rates of treatment required. This study analyzes the relevant outcomes from a prospective RCT (Management of Myelomeningocele Study). Eligible women were randomized to prenatal or postnatal repair, and patients were evaluated prospectively. Outcomes of interest included rates of scoliosis, kyphosis, hip abnormality, clubfoot, tibial torsion, and leg length discrepancy (LLD) at 12 and 30 months. The need for orthopaedic intervention at the same time points was also evaluated. Statistical analyses included descriptive statistics and univariate analyses. Data for the full cohort of 183 patients were analyzed (91 prenatal, 92 postnatal). There were no differences in rates of scoliosis, kyphosis, hip abnormality, clubfoot or tibial torsion between patients treated with prenatal or postnatal repair. The rate of LLD was lower in the prenatal repair group at 12 and 30 months (7 vs. 16% at 30 months, P = 0.047). The rates of patients requiring casting or bracing were significantly lower in patients treated with prenatal repair at 12 and 30 months (78 vs. 90% at 30 months, P = 0.036). Patients treated with prenatal myelomeningocele repair may develop milder forms of orthopaedic conditions and may not require extensive orthopaedic management.
The regulators of BCR signaling during B cell activation
Authors: Wen Yue , Jing Yukai , Yang Lu , Kang Danqing , Jiang Panpan , Li Na , Cheng Jiali , Li Jingwen , Li Xingbo , Peng Zican , Sun Xizi , Miller Heather , Sui Zhiwei , Gong Quan , Ren Boxu , Yin Wei , Liu Chaohong
Published: November 2020

B lymphocytes produce antibodies under the stimulation of specific antigens, thereby exerting an immune effect. B cells identify antigens by their surface B cell receptor (BCR), which upon stimulation, directs the cell to activate and differentiate into antibody generating plasma cells. Activation of B cells via their BCRs involves signaling pathways that are tightly controlled by various regulators. In this review, we will discuss three major BCR mediated signaling pathways (the PLC-γ2 pathway, PI3K pathway and MAPK pathway) and related regulators, which were roughly divided into positive, negative and mutual-balanced regulators, and the specific regulators of the specific signaling pathway based on regulatory effects.
Intensive care unit outcomes in patients with hematological malignancy
Authors: Rawson Jarrod Leigh , Fagan Fionnuala Mary , Burrough Georgin Claire , Tang Helen Michelle , Cuncannon Moire Alys , Ellem Katrina Louise , Enjeti Anoop Kumar
Published: November 2020

Hematological malignancies are usually life-limiting conditions. Limitations of care need to be decided early, based on acceptability to the patient, family, physician, and community. Inappropriate intensive care unit (ICU) admission is likely to result in significant physical, psychological, and economic burden. There is little published on the impact of non-acute preadmission disease factors on ICU outcomes in hematological malignancies.

Aim:

To identify baseline performance and disease-associated factors before admission to ICU in patients with hematological malignancy that contribute to subsequent ICU mortality.

Methods:

A retrospective analysis of electronic medical records, laboratory results, and Intensive Care data for all patients (n = 184) with hematological malignancy admitted to the Calvary Mater Hospital ICU between January 1, 2013 and June 30, 2017 was undertaken. Baseline age, gender, condition, Eastern Cooperative Oncology, and Charlson Comorbidity scores were compared to ICU outcome and overall survival. Disease-specific prognostic risk scores were compared to ICU outcome.

Results:

Overall, 73.9% survived the ICU admission, with 31.6% surviving at 12 months. Superior ejection fractions (>55%) and prognosis >12 months (based on disease-specific risk scores) were significantly associated with overall survival (P = 0.024 and P = 0.001). Induction and posttransplantation therapy were predictive of poor ICU survival outcome (P < 0.0001 and P = 0.041). APACHE scores were significant predictors of ICU mortality (P = 0.002 for APACHE II and P < 0.0001 for APACHE III).

Conclusion:

Survival outcomes for patients with hematological malignancy admitted to the ICU correlate with functional and comorbidity status. Disease-specific prognostic scores can assist in recognizing patients likely to benefit from ICU admission.
Mouse models to study genes involved in hematological malignancies
Authors: Przybylski Grzegorz K.
Published: November 2020

Hematological malignancies, including leukemia and lymphoma, consist a group of highly heterogeneous neoplasms characterized by numerous genetic lesions specific for the type of the disease. In order to understand, the role of a particular alteration in the development of a malignancy functional studies have to be carried out in vitro, in cell lines derived from primary cancer cells. Further efforts to understand the mechanisms underlying blood disorders including malignant transformation and progression relies on model organism research. Numerous transgenic mouse models, carrying human oncogenes have been generated resembling distinct types of hematological disorders. Recent technological advances revolutionized the generation of animal models making it much easier, faster, and precise. The introduction of the CRISPR-Cas9 technology allows for rapid generation of novel knockout or transgenic animals, and the development of conditional site- and time-specific Cre-Lox gene targeting technology, allows studying the function of genes which are relevant to normal hematopoiesis and development of hematological malignancies, but lethal when knocked out in embryonic cells. Besides the studies on gene function, mouse models of human leukemia allow for discovery and testing of novel antileukemic drugs. These new technologies are deepening our understanding of disease pathophysiology and treatment resistance, as well as are leading to novel therapeutic strategies for improved outcomes in patients.
Two-step protocol for regeneration of immunocompetent T cells from mouse pluripotent stem cells
Authors: Wang Tongjie , Lv Cui , Hu Fangxiao , Liu Lijuan , Wang Jinyong
Published: November 2020

Numerous efforts have been attempted to regenerate T cells in culture dish from pluripotent stem cells (PSCs). However, in vitro generated T cells exhibited extremely low activity and compromised immunocompetency in vivo. Here, we describe a two-step protocol for regenerating functional T cells using an inducible Runx1-Hoxa9-PSC (iR9-PSCs) line. The procedure mainly includes generation of induced hematopoietic progenitor cells (iHPCs) in vitro, transplantation, and development of functional induced T cells (iT) in vivo via transplantation. The entire induction process in vitro requires 21 days before iHPCs transplantation. The development of mature T cells in vivo takes 4 to 6 weeks post-transplantation. We provide a simple and reproducible approach for functional T cell regeneration from iR9-PSCs for research purpose.
The α1-adrenergic receptors in the amygdala regulate the induction of learned despair through protein kinase C-beta signaling
Authors: Fujita Shisui , Yoshida Satomi , Matsuki Tohru , Jaiswal Manoj Kumar , Seki Kenjiro
Published: November 2020

Hyperactivity of amygdala is observed in patients with major depressive disorder. Although the role of α
1-adrenoceptor in amygdala on fear memory has been well studied, the role of α
1-adrenoceptor in amygdala on depression-like behaviors remains unclear. Therefore, we investigated the effect of α
1A-adrenoreceptor in amygdala on despair behavior, evaluated by the immobility time during tail suspension test (TST), pharmacological intervention, and immunohistological methods. C57BL6/J mice given a bilateral intra-amygdala injection of artificial cerebrospinal fluid exhibited an increased duration of immobility in the latter half of both trials of TST with a 24-h interval, a phenomenon known as learned despair. Intra-amygdala injection of WB4101 (1.7 nmol/0.1 µl), an α
1 adrenoreceptor antagonist, but not propranolol (250 pmol/0.1 µl), a β-adrenoreceptor antagonist, blocked the induction of learned despair during TST. Immunostaining experiments revealed that ~61–75% of α
1A-adrenoreceptor-positive neurons were colocalized with GAD65/67 in amygdala, implying that the α
1-adrenoceptors in amygdala may enormously regulate the GABA release. Protein kinase C-beta (PKCβ) was predominantly expressed in the α
1A-adrenoreceptor-positive neurons in the BLA, whereas protein kinase C-epsilon (PKCε) was highly expressed with the α
1A-adrenoreceptor in the Central nucleus of amygdala. Intra-amygdala injection of ruboxistaurin (10 pmol/0.1 µl), a PKCβ inhibitor, blocked the induction of learned despair during TST, whereas neither TAT-εV1-2 (500 ng/0.1 μl), a cell-permeant PKCε inhibitory peptide, nor HBDDE (50 pmol/0.1 µl), an inhibitor of PKCα and -γ, affected the duration of immobility during TST. These data suggest that the α
1-adrenoreceptor in amygdala regulates the induction of learned despair via PKCβ.
Country-based Comparison of Atrial Fibrillation Patients' Preferences for Oral Anticoagulation: An Evaluation of Discrete Choice Experiments in Five Different Countries
Authors: Henry Maren , Wosnitza Melanie , Thate-Waschke Inga-Marion , Bauersachs Rupert , Ueng Kwo-Chang , Chang Kuan-Cheng , Wilke Thomas
Published: November 2020

The aim of this study was to examine atrial fibrillation (AF) patients' preferences regarding oral anticoagulation (OAC) characteristics and to investigate differences across 5 different countries. A multicenter discrete choice experiment was conducted in Germany, Sweden, Switzerland, Spain, and Taiwan. Study sites enrolled patients with nonvalvular AF who received continuous OAC therapy. The discrete choice experiment design considered the following 4 attributes with 2 attribute levels each: need for bridging (yes/no), interactions with food/alcohol (yes/no), need for regular international normalized ratio (INR) assessments, and frequency of intake (once/twice daily). Generally, patients (n = 1391) preferred treatment alternatives that were characterized by “no need of bridging,” “no need for regular INR controls,” “no interactions with food/alcohol,” and “once daily intake.” For this desired treatment regimen, patients were willing to accept a substantially higher travel distance/time. German patients with AF were strongly impacted in their hypothetical treatment decision by the frequency of intake (37.5%). Swedish patients on the other hand gave little importance to intake frequency (12.6%). In Switzerland, patients were especially concerned with food/alcohol interactions of the medication (34.7%), whereas this was the least important attribute for Taiwanese patients (18.9%), who ascribed the most homogenous importance to the different treatment attributes overall. In Spain, the need for regular INR assessments especially impacted the patient's treatment decision (31.9%). Patients of all countries attributed a moderate importance to the need for bridging (25.9%–34.2%). These findings may facilitate country-specific consideration of patients' preferences regarding OAC therapy, potentially increasing treatment acceptance on the patient's side with the ultimate goal of improving treatment adherence and persistence.
Quantitation of Tacrolimus in Human Whole Blood Samples Using the MITRA Microsampling Device
Authors: Undre Nasrullah , Hussain Imran , Meijer John , Stanta Johannes , Swan Gordon , Dawson Ian
Published: November 2020

Background:

The calcineurin inhibitor tacrolimus is a narrow therapeutic index medication, which requires therapeutic drug monitoring to optimize dose on the basis of systemic exposure. MITRA microsampling offers a minimally invasive approach for the collection of capillary blood samples from a fingerprick as an alternative to conventional venous blood sampling for quantitation of tacrolimus concentrations.

Methods:

A bioanalytical method for the quantitation of tacrolimus in human whole blood samples collected on MITRA tips was developed, using liquid–liquid extraction followed by liquid chromatography with tandem mass spectrometry detection. Validation experiments were performed according to the current Food and Drug Administration and European Medicines Agency guidelines on validation of bioanalytical methods. Validation criteria included assay specificity and sensitivity, interference, carryover, accuracy, precision, dilution integrity, matrix effect, extraction recovery, effect of hematocrit and hyperlipidemia, and stability.

Results:

All assay validation results were within the required acceptance criteria, indicating a precise and accurate tacrolimus quantitation method. The validated assay range was 1.00–50.0 ng/mL. No interference, carryover or matrix effect was observed. Extraction recovery was acceptable across the assay range. Samples were stable for up to 96 days at −20°C and 20°C, and 28 days at 40°C. Hematocrit, hyperlipidemia, and lot-to-lot differences in the nominal absorption volume of the 10-μL MITRA tips were shown not to influence tacrolimus quantitation by this assay method.

Conclusions:

The bioanalytical method validated in this study is appropriate and practical for the quantitation of tacrolimus in human whole blood samples collected using the MITRA microsampling device.
Antirotational plating combined with bone grafting for nonisthmal femoral shaft nonunion after intramedullary nailing: a retrospective study
Authors: Ma Xianzhi , Liu Ying , Zhou Qiyun , Ma Jianwu , Wang Kai
Published: November 2020

Objective:

Exchange nailing for aseptic femoral shaft nonunion is currently a standard orthopedic treatment modality. However, according to recent studies there is occasionally a high failure rate when exchange nailing is used. In the present study, augmentative locked plating and bone graft was used as an alternative method for treating such cases. The purpose of this study was to report the treatment outcomes of antirotational plating (ARP) combined with bone grafting with a retained nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing.

Materials and Methods:

Fifty-three patients presenting with nonisthmal femoral shaft nonunion after femoral nailing were selected (according to inclusion criteria) for a retrospective study from April 2012 to June 2016. All patients received treatment with ARP entailing a nail left in situ and combined with bone grafting. Main result measures include union time, union rate, and operation time, amount of bleeding during operation. Follow-ups, including radiologic and clinical function examinations, were carried out at 1, 2, 3, 4, 6, and 12 months after surgery and then once a year, to monitor callus growth and functional recovery of the injured limb.

Results:

All patients achieved bone union by 6.4 months clinically (4–8 mo) on average and 5.2 months radiologically (2–16 mo), without any intervening measures during follow-up. Mean operation time was 99.3±27.8 minutes (range=50–215 min), and mean blood loss was 494.9±281.3 mL (20–1400 mL). The average follow-up time was 18.7 months (12–26 mo). All patients in the current study achieved bone union (100%). We observed no postoperative complications, such as failure of internal fixation, infections, angular or rotational malunion. Physicians removed the intramedullary nail and plate from 5 patients 11–16 months after the operation without any refracture. During the last follow-up, all patients could flex their knees >100 degrees.

Conclusions:

AR with a nail left in situ, combined with bone grafting, is an effective treatment option for nonisthmal femoral shaft nonunions.
Effect of 808-nm Laser Photobiomodulation Treatment in Blepharitis Rat Model
Authors: Kim Hoon , Kim Hong-Bee , Seo Jae-Hwi , Kim Hongbin , Cho Kyong Jin
Published: November 2020

Purpose:

Blepharitis, simply defined as eyelid inflammation, is one of the common ocular conditions associated with discomfort and irritation. Because blepharitis causes meibomian gland dysfunction and dry eye, this study aimed to confirm the effect of photobiomodulation (PBM) on blepharitis.

Methods:

A total of 20 rats were randomly assigned to 4 equal groups, including control, blepharitis, PBM, and eye drop. Blepharitis was induced in rats by injecting complete Freund's adjuvant in the eyelid margins. PBM intervention was given every 3 days after blepharitis induction. Clinical signs including tear volume, tear breakup time (TBUT), meibomian gland swelling, fluorescein, telangiectasia, and meibomian gland secretion scores were measured every week, and the rats were killed for histological analysis after 4 weeks. Immunohistochemistry was performed to compare the level of inflammatory cytokines, interleukin-1β and tumor necrosis factor-α, and terminal deoxynucleotidyl transferase dUTP nick end labeling staining on retina was performed to observe any retinal damage.

Results:

Tear volume and TBUT increased with PBM intervention, and with improved eyelid swelling, corneal staining, telangiectasia, and meibomian gland secretion scores increased. Hematoxylin and eosin staining showed no structural abnormalities of meibomian gland caused by blepharitis induction. Immunohistochemistry revealed that the levels of inflammatory cytokines interleukin-1β and tumor necrosis factor-α were lowered with PBM treatment in both eyelid and conjunctiva. Terminal deoxynucleotidyl transferase dUTP nick end labeling staining showed no retinal damage.

Conclusions:

Laser PBM at 808 nm was effective in alleviating ocular signs and controlling inflammation in blepharitis rat model. The in vivo results suggest that PBM has the potential to be used in treating blepharitis patients.
Evaluating Ceftriaxone 80 mg/kg Administration by Rapid Intravenous Infusion—A Clinical Service Evaluation
Authors: Patel Sanjay , Green Helen , Gray Jacqueline , Rutter Michelle , Bevan Amanda , Hand Kieran , Jones Christine E. , Faust Saul N.
Published: November 2020

In pediatric ambulatory care, the speed of medication infusion can have major impact on healthcare staff workload and the number of children able to be treated by services designed to reduce inpatient length of stay. In many regions of the world, local and supraregional guidelines allow ceftriaxone infusions of ≥50 mg/kg in infants and children up to 12 years of age to be given over 10 minutes. The generic European summary of product characteristics for ceftriaxone does not state a specific infusion time for this dose range, although 1 manufacturers’ summary of product characteristics in the United Kingdom states a 30-minute minimum infusion time. We conducted a formal service evaluation of a change in practice at a large UK pediatric children’s hospital and demonstrated the clinical feasibility, safety, and high parent satisfaction of 10-minute ceftriaxone infusions for prescribed doses ≥50 mg/kg. This approach can improve patient flow within hospital-based ambulatory services as well as by community nursing teams administering antibiotics at home.
Bacille Calmette-Guérin Vaccine-induced Osteomyelitis in Immunocompetent Children
Authors: Miseviciene Valdone , Liakaite Gintare , Suciliene Elena , Ivaskeviciene Inga
Published: November 2020

The Bacille Calmette-Guérin (BCG)-induced osteomyelitis is an extremely rare systemic adverse reaction after BCG vaccination in immunocompetent children and the correct diagnosis is frequently missed. We present 4 clinical cases of BCG-induced osteomyelitis reported over a 10-year period in a high-TB incidence country Lithuania. A brief review of clinical, management and treatment features of the disease is given.
Rehabilitation After Shoulder Instability Surgery: Keys for Optimizing Recovery
Authors: Shanley Ellen , Peterson Sarah K.
Published: November 2020

The specific approach to rehabilitation after surgical management of the unstable shoulder is dependent on the severity and chronicity of the instability. Establishing dynamic stability throughout the athlete’s functional range of movement is critical to a successful outcome. The pace progression is guided by surgical (technique, injury pattern, and strength of repair) and patient factors (healing potential, prior health status, and psychosocial factors). The primary goal of treatment is to restore function and return the athlete to sport. The process should be guided by surpassing functional criteria for progression and tissue healing time.
Service Involvement Across Multiple Sectors Among People Who Use Opioids, Methamphetamine, or Both, United States—2015–2018
Authors: Howell Benjamin A. , Bart Gavin , Wang Emily A. , Winkelman Tyler N.A.
Published: November 2020

Background:

The fourth wave of the opioid crisis is characterized by increased use and co-use of methamphetamine. How opioid and methamphetamine co-use is associated with health care use, housing instability, social service use, and criminal justice involvement has not been studied and could inform future interventions and partnerships.

Objectives:

To estimate service involvement across sectors among people who reported past year opioid and methamphetamine co-use, methamphetamine use, opioid use, or neither opioid nor methamphetamine use.

Research Design:

We examined 2015–2018 data from the National Survey on Drug Use and Health. We used multivariable negative binomial and logistic regression models and predictive margins, adjusted for sociodemographic and clinical characteristics.

Subjects:

Nonelderly US adults aged 18 or older.

Measures:

Hospital days, emergency department visits, housing instability, social service use, and criminal justice involvement in the past year.

Results:

In adjusted analyses, adults who reported opioid and methamphetamine co-use had 99% more overnight hospital days, 46% more emergency department visits, 2.1 times more housing instability, 1.4 times more social service use, and 3.3 times more criminal justice involvement compared with people with opioid use only. People who used any methamphetamine, with opioids or alone, were significantly more likely be involved with services in 2 or more sectors compared with those who used opioids only (opioids only: 11.6%; methamphetamine only: 19.8%; opioids and methamphetamine: 27.6%).

Conclusions:

Multisector service involvement is highest among those who use both opioids and methamphetamine, suggesting that partnerships between health care, housing, social service, and criminal justice agencies are needed to develop, test, and implement interventions to reduce methamphetamine-related morbidity.
Microbiome modulation as a novel therapeutic approach in chronic kidney disease
Authors: Sumida Keiichi , Lau Wei Ling , Kovesdy Csaba P. , Kalantar-Zadeh Kamyar , Kalantar-Zadeh Kourosh
Published: November 2020

Purpose of review

Gut dysbiosis has been implicated in the pathogenesis of chronic kidney disease (CKD). Interventions aimed at restoring gut microbiota have emerged as a potential therapeutic option in CKD. This review summarizes the current evidence on gut microbiota-targeted strategies in patients with CKD.

Recent findings

A growing number of studies have shown that plant-based diets, low-protein diets, prebiotic, probiotic, and synbiotic supplementation, and constipation treatment may lead to favorable alterations in the gut microbiota. Current evidence suggests that the implementation of both plant-based and low-protein diets has potential benefits for the primary prevention of CKD, and for slowing CKD progression, with minimal risk of hyperkalemia and/or cachexia. The use of prebiotics, probiotics, and synbiotics and laxatives may have beneficial effects on uremic toxin generation, but their evidence is limited for the prevention and treatment of CKD. Recent advances in diagnostic technologies (e.g., high-throughput sequencing and nanotechnology) could enhance rapid diagnosis, monitoring, and design of effective therapeutic strategies for mitigating gut dysbiosis in CKD.

Plant-based and low-protein diets, prebiotic, probiotic, and synbiotic supplementation, and constipation treatment represent novel gut microbiota-targeted strategies in the conservative management of CKD, which could improve clinical outcomes in CKD.
Window to His World: Using a Patient’s YouTube Channel to Help Diagnose Chronic Mania
Authors: INCE H. YAVUZ , STREETER CALE C. , MAKSIMOWSKI MICHAEL
Published: November 2020

Although chronic mania has been investigated, with several case reports and systematic retrospective cohort studies in the literature, it not a widely recognized entity. No specific definition for chronic mania is provided in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Furthermore, it is challenging to identify patients with chronic mania unless they come to the attention of the legal or medical system. We present the case of a manic patient who was hospitalized and subsequently found to have a YouTube channel that he had been using to promote his self-invented religion for over 2 years. Consent was obtained from the patient to review this YouTube channel for collateral information. From these videos, the patient was seen to be chronically circumstantial in his thought processes, grandiose in his ideas, highly energetic, distractible, preoccupied with religion, and talking with elaborate and rapid speech. A significant improvement in his symptoms was observed after administration of oral risperidone, with his scores on the Young Mania Rating Scale and Brief Psychiatric Rating Scale also showing improvement. To our knowledge, this is the first case in the literature in which an online video-sharing service was used longitudinally to facilitate diagnosis of a mental illness. We suggest that technology has great potential to improve our diagnostic tools, especially for disorders such as chronic mania the diagnosis of which relies primarily on self-report and collateral information.
Commentary on “Window to His World: Using a Patient’s YouTube Channel to Help Diagnose Chronic Mania”
Authors: GARAKANI AMIR
Published: November 2020

Although chronic mania has been investigated, with several case reports and systematic retrospective cohort studies in the literature, it not a widely recognized entity. No specific definition for chronic mania is provided in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Furthermore, it is challenging to identify patients with chronic mania unless they come to the attention of the legal or medical system. We present the case of a manic patient who was hospitalized and subsequently found to have a YouTube channel that he had been using to promote his self-invented religion for over 2 years. Consent was obtained from the patient to review this YouTube channel for collateral information. From these videos, the patient was seen to be chronically circumstantial in his thought processes, grandiose in his ideas, highly energetic, distractible, preoccupied with religion, and talking with elaborate and rapid speech. A significant improvement in his symptoms was observed after administration of oral risperidone, with his scores on the Young Mania Rating Scale and Brief Psychiatric Rating Scale also showing improvement. To our knowledge, this is the first case in the literature in which an online video-sharing service was used longitudinally to facilitate diagnosis of a mental illness. We suggest that technology has great potential to improve our diagnostic tools, especially for disorders such as chronic mania the diagnosis of which relies primarily on self-report and collateral information.
Therapeutic Risk Management for Violence: Clinical Risk Assessment
Authors: WORTZEL HAL S. , BORGES LAUREN M. , BARNES SEAN M. , NAZEM SARRA , MCGARITY SUZANNE , CLARK KAILY , BAHRAINI NAZANIN H. , MATARAZZO BRIDGET B.
Published: November 2020

Violence risk assessment is a requisite component of mental health treatment. Adhering to standards of care and ethical and legal requirements necessitates a cogent process for conducting (and documenting) screening, assessment, and management of other-directed violence risk. In this 5-part series, we describe a model for achieving therapeutic risk management of the potentially violent patient, with essential elements involving a clinical interview augmented by structured screening or assessment tools; risk stratification in terms of temporality and severity; chain analysis to intervene on the functions of violent ideation and behavior; and development of a personalized safety plan. This first column of the series focuses on essential aspects of the clinical interview.
Race, History of Abuse, and Homelessness Are Associated With Forced Medication Administration During Psychiatric Inpatient Care
Authors: THOMAS TINA E. , LANE SCOTT D. , ELKHATIB RANIA M. , HAMILTON JANE E. , PIGOTT TERESA A.
Published: November 2020

Objective:

Although previous research has suggested that racial disparities exist in the administration of forced medication (FM) in psychiatric inpatients, data remain scarce regarding other contributing variables. Therefore, this study examined sociodemographic and clinical variables associated with FM administration in psychiatric inpatients.

Methods:

Electronic medical records from 57,615 patients admitted to an academic psychiatric hospital between 2010 and 2018 were reviewed to identify patients who received FM. These records indicated that FM petitions were requested and approved for ∼6200 patients. Patients were excluded from the analysis if they met the following exclusion criteria: under 18 years of age, presence of intellectual/developmental disability, dementia, or other neurological condition, or primary diagnosis of a nonpsychiatric medical condition or a substance-induced mood or psychotic disorder. After data on those patients were excluded, the final sample included records from 2569 patients (4.5% of the total records) in which the administration of FM was petitioned for and approved. The FM group was compared with a control group of 2569 patients matched in terms of age, sex, and admission date (no-forced medication group; NFM) via propensity scoring matching. Group comparisons (FM vs. NFM group) examined sociodemographic factors (race, age, sex, living situation), clinical features (diagnosis, substance abuse, history of abuse), and outcomes (length of stay, readmission rate). Regression analyses examined the association between FM and sociodemographic, clinical, and outcome variables.

Results:

Compared with the NFM group, the FM group contained significantly more African Americans (P<0.001), homeless individuals (P<0.001), and individuals with histories of abuse (P<0.001). Having received FM was a significant predictor of a longer length of stay (P<0.001) and higher readmission rates (P<0.001).

Discussion:

These results suggest that FM is more likely to be instituted in psychiatric inpatients who are of a minority race (African American), are in a homeless living situation, and/or have a history of abuse. Moreover, FM may be associated with poorer clinical outcomes at least as measured by the length of stay and higher readmission rates. We discuss possible reasons for these results and the importance of culturally competent and trauma-focused care.
Lithium Prescribing and Therapeutic Drug Monitoring in Bipolar Disorder: A Survey of Current Practices and Perspectives
Authors: FERNANDES VIRGINIA , AL-SUKHNI MAYCE , LAWSON ANDREA , CHANDLER GREGORY
Published: November 2020

Objective:

The goal of this survey study was to assess specific aspects of lithium therapy for bipolar disorder, including psychiatrists’ prescribing practices, understanding of therapeutic drug monitoring, and concerns and perspectives regarding lithium therapy.

Methods:

A 14-item survey was electronically distributed to 225 staff psychiatrists at 8 academic hospitals.

Results:

The survey was completed by 85 psychiatrists (38% of the 225 psychiatrists to whom the survey was distributed), with between 81 and 85 respondents completing the different items. When asked about the agents with which they initiated therapy, 49 (61%) reported initiating therapy with an atypical antipsychotic and 34 (42%) reported starting with lithium therapy in 50% or more of patients newly diagnosed with bipolar disorder. When prescribing lithium, most of the respondents (n=68, 82%) reported that they used once daily dosing, and 67 respondents (79%) indicated that they ordered lithium blood levels 12 hours postdose. When interpreting lithium levels, 46 respondents (55%) reported “always” changing a clinically stable patient’s lithium dose when the level was above the therapeutic range, compared with 4 (5%) who reported always changing the dose when the level was below the therapeutic range. When asked about their concerns regarding lithium therapy, more than half of the respondents reported that they were especially concerned about toxicity, organ dysfunction, and other adverse effects, as well as therapeutic drug monitoring.

Conclusion:

Shifts in prescribing practices, inconsistent interpretation of lithium levels, and concerns about safety and therapeutic drug monitoring highlight the need for evidence-informed guidelines reflective of current practice.
Attempted Suicide in a Woman With Steroid-responsive Encephalopathy Associated With Autoimmune Thyroiditis: A Case Report
Authors: FATICA JACK P. , HUSSAIN NUZHAT , KHAN ASFAND , YADAV SANJAY
Published: November 2020

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a rare phenomenon that manifests with nonspecific psychiatric and neurological signs and symptoms, an elevated serum thyroid peroxidase antibody level, and a positive treatment response to corticosteroids. Current literature describes highly varied presentations of the disease, which makes its diagnosis a challenging endeavor. The psychiatric symptoms of SREAT, in particular, are very difficult to ascribe to the correct diagnosis, as there are few laboratory or imaging modalities available to workup these manifestations. As a result, authors have attempted to compose rough guidelines that would help clinicians more easily recognize SREAT, which is important given the wide accessibility and efficacy of the main treatment for this condition. We present the case of a young woman diagnosed with SREAT who presented after a suicide attempt. Although signs and symptoms of depression, psychosis, and mania have been well described as potential manifestations of the disorder, attempted suicide as a primary presentation of SREAT has not been well captured in the current literature. In fact, it appears that suicidal thoughts and attempts are not nearly as prevalent as would be expected given the high prevalence of psychiatric signs and symptoms in the disorder, but rather, they appear to be quite rare phenomena. In this case report, we identify other articles in the literature that address suicidal thoughts or attempts in association with SREAT. The patient described in our report is one of the only cases of a suicide attempt in the context of a primarily depressed state as a result of SREAT.
Three-Dimensional Computed Tomographic Study on the Vessels of the Zygomatic Region: Arterial Variations and Clinical Relevance
Authors: Zhao Wei-Rui , Duan Jing , Chen Chun-Lin , Luo Cheng-En , Zhan Wen-Feng , Kong Xiang-Xue , Luo Sheng-Kang
Published: November 2020

Background:

Injection-based techniques for “cheek augmentation” have gained popularity in recent years. The aim of this study was to perform a topographic analysis of the depth and distribution of the vessels in the zygomatic region to facilitate clinical procedures.

Methods:

The external carotid arteries of seven cadaveric heads were infused with lead oxide contrast medium. The facial and superficial temporal arteries of another 12 cadaveric heads were injected sequentially with the same medium. Computed tomographic scanning was then performed, and three-dimensional computed tomographic scans were reconstructed using validated algorithms.

Results:

The vessels on the zygomatic arch received a double blood supply from across the upper and lower borders of the arch, and the number of the vessels varied from one to four. Ninety percent of the vessels on the zygomatic arch were at a depth of 1 to 2.5 mm, and 75 percent were at a depth of 10 to 30 percent of the soft-tissue thickness. The vessels were concentrated on the midline of the zygomatic arch and the lateral margin of the frontal process. All samples showed a vessel travel along the lateral margin of the frontal process that eventually merged into the superior marginal arcades.

Conclusions:

This study reported a topographic analysis of the depth and distribution of the vessels in the zygomatic region based on three-dimensional scanning. The results indicated that injection on the zygomatic arch should be performed deep to the bone, and the vascular zones anterior or posterior to the midline of the zygomatic arch were relatively safe injection areas.
Implementation of Novel Protocols in an Ophthalmic Ambulatory Surgical Center to Resume Surgical Procedures During COVID-19
Authors: Berkenstock Meghan K. , Ishii Lisa , Giessler Brian , Quaty John , Biggs Madalyn , Buck Pamela , Ebrado Alfred , Kalendek Laurie , Lazoff Karen , Martin Michael , McCullough Chanda , Jampel Henry , Scott Adrienne W.
Published: November 2020

Background and Objectives:

With the resumption of elective ophthalmic surgery during COVID-19, revised protocols were mandated to protect both staff and patients from transmission while increasing case numbers. We discuss a widely generalizable and in-depth protocol intended to safely allow the restart of elective procedures in 2 dedicated ophthalmic ambulatory surgical centers (ASCs) using monitored anesthesia care.

Methods:

A single-center review of protocols and practices designed to limit COVID-19 transmission.

Results:

All patients were tested within 72 hours prior to the procedure with a COVID-19 nasal swab to assess for active disease. A distance of 6 ft between each stretcher and the staff within the ASC was maintained when possible. Preoperative anesthetizing and dilating eye drops were administered from multiuse bottles without contact with surfaces. Surgical cases were restarted at a reduced capacity of a maximum of 7 per day to distance patient arrivals. Removal of waiting room chairs and the creation of new break areas allowed for social distancing.

Conclusion:

As recommendations change on the basis of an increased understanding of the COVID-19 virus, ophthalmologists and ASC staff need to tailor protocols and workflows to limit transmission of virus with resumption of ocular surgery.
Freeze-dried plasma for major trauma – Systematic review and meta-analysis
Authors: Mok Garrick , Hoang Richard , Khan Montaha Wajid , Pannell Dylan , Peng Henry , Tien Homer , Nathens Avery , Callum Jeannie , Karkouti Keyvan , Beckett Andrew , da Luz Luis Teodoro
Published: November 2020

BACKGROUND

Treatment of acute trauma coagulopathy has shifted toward rapid replacement of coagulation factors with frozen plasma (FP). There are logistic difficulties in providing FP. Freeze-dried plasma (FDP) may have logistical advantages including easier storage and rapid preparation time. This review assesses the feasibility, efficacy, and safety of FDP in trauma.

STUDY DESIGN AND METHODS

Studies were searched from Medline, Embase, Cochrane Controlled Trials Register, ClinicalTrials.gov, and Google Scholar. Observational and randomized controlled trials (RCTs) assessing FDP use in trauma were included. Trauma animal models addressing FDP use were also included. Bias was assessed using validated tools. Primary outcome was efficacy, and secondary outcomes were feasibility and safety. Meta-analyses were conducted using random-effect models. Evidence was graded using Grading of Recommendations Assessment, Development, and Evaluation profile.

RESULTS

Twelve human studies (RCT, 1; observational, 11) and 15 animal studies were included. Overall, studies demonstrated moderate risk of bias. Data from two studies (n = 119) were combined for meta-analyses for mortality and transfusion of allogeneic blood products (ABPs). For both outcomes, no difference was identified. For mortality, pooled odds ratio was 0.66 (95% confidence interval, 0.29–1.49), with I
2 = 0%. Use of FDP is feasible, and no adverse events were reported. Animal data suggest similar results for coagulation and anti-inflammatory profiles for FP and FDP.

CONCLUSION

Human data assessing FDP use in trauma report no difference in mortality and transfusion of ABPs in patients receiving FDP compared with FP. Data from animal trauma studies report no difference in coagulation factor and anti-inflammatory profiles between FP and FDP. Results should be interpreted with caution because most studies were observational and have heterogeneous population (military and civilian trauma) and a moderate risk of bias. Well-designed prospective observational studies or, preferentially, RCTs are warranted to answer FDP’s effect on laboratory (coagulation factor levels), transfusion (number of ABPs), and clinical outcomes (organ dysfunction, length of stay, and mortality).

LEVEL OF EVIDENCE

Systematic review and meta-analysis, level IV.
The m6A methyltransferase METTL3 promotes LPS-induced microglia inflammation through TRAF6/NF-κB pathway
Authors: Wen Linbao , Sun Wei , Xia Dayong , Wang Yanming , Li Junpeng , Yang Song
Published: November 2020

Objectives

Microglia are the main effectors in the inflammatory process of the central nervous system. Once overactivated, microglia may release pro-inflammatory cytokines (IL-1β, IL-6, TNF-α and IL-18, etc.) and accelerate neurodegeneration. Here, we aimed to explore the mechanism of how m6A methyltransferase METTL3 affects the inflammatory response of microglia, appropriately inhibiting the overactivation of microglia.

Materials and methods

Lipopolysaccharide (LPS) was used to construct a cellular inflammation model in vitro. To evaluate the expression of METTL3 and inflammatory cytokines (IL-1β, IL-6, TNF-α and IL-18) in cells, RT-PCR and ELISA were carried out. The related protein (TRAF6, NF-κB and I-κB) expression was examined adopting Western blot. Dot blot experiment was used to assess the effect of regulating METTL3 on the m6A level. Methylated RNA immunoprecipitation reaction was used to measure the effect of METTL3 on the m6A level of TRAF6 mRNA 3′-UTR. The co-immunoprecipitation experiment (IP) proved that METTL3 combines with TRAF6.

Results

In LPS-mediated microglial inflammation, METTL3 expression was increased, and the expression of inflammatory cytokines (IL-1β, IL-6, TNF-α and IL-18) and inflammatory proteins (TRAF6 and NF-κB) were upregulated. METTL3 level was positively correlated with TRAF6, and the two proteins could bind to each other. Overexpression of METTL3 promoted the activation of the TRAF6-NF-κB pathway in an m6A-dependent manner, and inhibiting NF-κB attenuated METTL3-mediated microglial activation.

Conclusion

METTL3 promotes LPS-induced microglial inflammation by activating the TRAF6-NF-κB pathway.