bluuebunny/crossref_metadata_2025 huggingface dataset:
CMS Initiative to Reduce Potentially Avoidable Hospitalizations Among Long‐Stay Nursing Facility Residents: Lessons Learned
Authors: TYLER DENISE A. , FENG ZHANLIAN , GRABOWSKI DAVID C. , BERCAW LAWREN , SEGELMAN MICAH , KHATUTSKY GALINA , WANG JOYCE , GASDASKA ANGELA , INGBER MELVIN J.
Published: December 2022

Policy Points

Misaligned incentives between Medicare and Medicaid may result in avoidable hospitalizations among long‐stay nursing home residents.

Providing nursing homes with clinical staff, such as nurse practitioners, was more effective in reducing resident hospitalizations than providing Medicare incentive payments alone.

Context

In 2012, the Centers for Medicare and Medicaid Services implemented the Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents. In Phase 1 (2012 to 2016), clinical or education‐based interventions (Clinical‐Only) aimed to reduce hospitalizations among long‐stay nursing home residents. In Phase 2 (2016 to 2020), the Initiative also included a Medicare payment incentive for treating residents with certain conditions within the nursing home. Nursing homes participating in Phase 1 continued their previous interventions and received the incentive (Clinical + Payment) and others received the incentive only (Payment‐Only).

Methods

Mixed methods were used to determine the effectiveness of the Initiative and explore facilitators of and barriers to implementation that participating nursing homes experienced. We used telephone and in‐person interviews to investigate aspects of implementation and a difference‐in‐differences regression model framework comparing residents in participating and nonparticipating nursing homes to determine the effect of the Initiative on measures of utilization, expenditures, and quality.

Findings

Three key components were necessary for successful implementation of the Initiative—staff retention and leadership stability, leadership and staff support, and provider engagement and support. Nursing homes that lacked one or more of these three components experienced greater challenges. The Clinical‐Only intervention in Phase 1 was successful in reducing hospitalizations. We did not find evidence that the Clinical + Payment or Payment‐Only interventions were successful in reducing hospitalizations.

Conclusions

Reducing hospitalizations among nursing home residents hinges upon the availability and support of clinical staff who can provide ongoing education to direct‐care staff in the nursing home, as well as hands‐on care. Use of Medicare payment incentives alone to encourage on‐site treatment of residents was insufficient to reduce hospitalizations. Unless nursing homes are adequately staffed to treat residents with acute care needs, further reductions in hospitalizations will be difficult to achieve.
Inequalities in cesarean births between American Indian & Alaska Native people and White people
Authors: Gartner Danielle R. , Debbink Michelle P. , Brooks Jada L. , Margerison Claire E.
Published: December 2022

Objective

To explore population‐level American Indian & Alaska Native‐White inequalities in cesarean birth incidence after accounting for differences in cesarean indication, age, and other individual‐level risk factors.

Data Sources and Study Setting

We used birth certificate data inclusive of all live births within the United States between January 1 and December 31, 2017.

Study Design

We calculated propensity score weights that simultaneously incorporate age, cesarean indication, and clinical and obstetric risk factors to estimate the American Indian and Alaska Native‐White inequality.

Data Collection/Extraction Methods

Births to individuals identified as American Indian, Alaska Native, or White, and residing in one of the 50 US states or the District of Columbia were included. Births were excluded if missing maternal race/ethnicity or any other covariate.

Principal Findings

After weighing the American Indian and Alaska Native obstetric population to be comparable to the distribution of cesarean indication, age, and clinical and obstetric risk factors of the White population, the cesarean incidence among American Indian and Alaska Natives increased to 33.4% (95% CI: 32.0–34.8), 3.2 percentage points (95% CI: 1.8–4.7) higher than the observed White incidence. After adjustment, cesarean birth incidence remained higher and increased in magnitude among American Indian and Alaska Natives in Robson groups 1 (low risk, primary), 6 (nulliparous, breech presentation), and 9 (transverse/oblique lie).

Conclusions

The unadjusted lower cesarean birth incidence observed among American Indian and Alaska Native individuals compared to White individuals may be related to their younger mean age at birth. After adjusting for this demographic difference, we demonstrate that American Indian and Alaska Native individuals undergo cesarean birth more frequently than White individuals with similar risk profiles, particularly within the low‐risk Robson group 1 and those with non‐cephalic presentations (Robson groups 6 and 9). Racism and bias in clinical decision making, structural racism, colonialism, or other unidentified factors may contribute to this inequality.
Factors associated with subjective knee joint stiffness in people with knee osteoarthritis: A systematic review
Authors: Uritani Daisuke , Koda Hitoshi , Yasuura Yuuka , Kusumoto Aya
Published: December 2022

Introduction

Subjective knee stiffness is a common symptom in patients with knee osteoarthritis treated conservatively. However, the influencing factors or effects of knee joint stiffness are unknown. The aim of this study was to explore the factors associated with subjective knee stiffness in patients with knee osteoarthritis.

Methods

The MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PEDro databases were searched in November 2021. Prospective or retrospective cohort studies were included. The methodological quality of the selected articles was assessed using the Scottish Intercollegiate Guidelines Network checklist.

Results

Twenty out of 1943 screened articles were included in this systematic review. Eighteen and two studies were rated as having acceptable and low quality, respectively. All the included studies measured subjective knee stiffness using the Western Ontario and McMaster Universities Osteoarthritis Index. The main findings were that worse preoperative subjective knee stiffness was associated with worse pain, subjective knee stiffness, and patient satisfaction at 1 year after total knee arthroplasty. In addition, worse subjective knee stiffness was associated with future degenerative changes in the knee joint, such as joint space narrowing and osteophyte growth progression.

Conclusion

Subjective knee stiffness may be associated with the prognosis after total knee arthroplasty and degenerative changes in the knee joint. Early detection and treatment of knee stiffness could lead to a good prognosis after total knee arthroplasty and prevent the progression of degenerative changes in the knee joint.
Circular RNA hsa_circ_0008003 promotes the progression of non–small‐cell lung cancer by sponging miR‐548I and regulating KPNA4 expression
Authors: Yang Wenshu , Yao Yingying , Yang Shuai , Ke Yaoqi
Published: December 2022

Objective

The study aimed to explore the effect of circ_0008003 on the progression of non–small‐cell lung cancer (NSCLC) and its underlying regulation mechanism.

Methods

Expression of hsa_circ_0008003, miRNA (miR)‐548I and karyopherin subunit α 4 (KPNA4) was examined by quantitative real‐time polymerase chain reaction. Cell viability and proliferation ability were detected by cell counting kit‐8 assay and 5‐ethynyl‐2′‐deoxyuridine assay, respectively. Flow cytometry was performed to monitor cell apoptosis. Western blot assay was used to evaluate the protein levels of KPNA4, Bax, and Bcl‐2. Cell migration and invasion were assessed by transwell assays. The targeted relationship between miR‐548I and hsa_circ_0008003 or KPNA4 was confirmed by dual‐luciferase reporter and RNA immunoprecipitation assays. Furthermore, the role of hsa_circ_0008003 in vivo was investigated by xenograft assay.

Results

Circ_0008003 expression was increased in NSCLC tissues and cell lines. Circ_0008003 knockdown reduced cell viability, migration, invasion, angiogenesis, and caused apoptosis in NSCLC cells. Moreover, miR‐548I was targeted by circ_0008003, and miR‐548I knockdown reversed the influence of circ_0008003 silence on NSCLC progression. KPNA4 was targeted by miR‐548I, and miR‐548I overexpression suppressed cell viability, migration, invasion, angiogenesis, and promoted cell apoptosis via decreasing KPNA4. In addition, circ_0008003 regulated KPNA4 expression via miR‐548I. Circ_0008003 knockdown decreased NSCLC cell growth in the xenograft model.

Conclusion

Circular RNA hsa_circ_0008003 promoted progression in NSCLC by sponging miR‐548I and regulating KPNA4 expression, hinting that circ_0008003 participates in NSCLC pathogenesis.
Effects of magnesium, phosphate, or zinc supplementation in intensive care unit patients—A systematic review and meta‐analysis
Authors: Vesterlund Gitte K. , Jensen Thomas S. , Ellekjaer Karen L. , Møller Morten H. , Thomsen Thordis , Perner Anders
Published: December 2022

Background

Low‐serum levels of magnesium, phosphate, and zinc are observed in many intensive care unit (ICU) patients, but clinical equipoise exists regarding supplementation strategies. We aimed to assess the desirable and undesirable effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients.

Methods

We conducted a systematic review with meta‐analysis of randomised clinical trials assessing the effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients. Primary outcomes were mortality and duration of mechanical ventilation. We registered the protocol, followed the Preferred Reporting Items for Systematic Review and Meta‐Analysis statement, used the Cochrane risk of bias 2 tool, and the grading of recommendations, assessment, development and evaluation (GRADE) approach for assessing the certainty of the evidence.

Results

We identified no low risk of bias trials. For magnesium supplementation, we included three trials (n = 235); the relative risk (RR) for mortality was 0.54, 95% confidence interval (CI) 0.30–0.96 compared to no supplementation (very low certainty of evidence). For zinc supplementation, two trials were included (n = 168); the RR for mortality was 0.73, 95% CI 0.41–1.28 compared to control. No trials assessed the effects of phosphate supplementation on mortality. For outcomes other than mortality, only zero or one trial was available.

Conclusions

In adult ICU patients, the certainty of evidence for the effects of supplementation with magnesium, phosphate, or zinc was very low. High‐quality trials are needed to assess the value of supplementation strategies in these patients.
Reducing unplanned general surgical readmissions: a review of the Australian and New Zealand National Surgical Quality Improvement Program Database
Authors: Pham Helen , Chen George , Hitos Kerry , Nahm Christopher B. , Sinclair Jane‐Louise , Johnston Emma , Hollands Michael , Lam Vincent , Pang Tony , Richardson Arthur
Published: December 2022

Background

Unplanned surgical readmissions are an important indicator of quality care and are a key focus of improvement programs. The aims of this study were to evaluate the factors that lead to unplanned hospital readmissions in patients undergoing general surgical procedures and to identify preventable readmissions.

Methods

A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database from 2016 to 2020 at a tertiary hospital was conducted to identify patients undergoing a general surgical procedure. Various perioperative parameters were studied to identify risk factors and reasons for unplanned readmission. Preventable readmissions were identified.

Results

A total of 3069 patients underwent a general surgical procedure. Of these, the overall unplanned readmission rate was 8.8% (n = 247). The most common reason for readmission was associated with surgical site infections (n = 112, 44.3%) followed by pain (n = 50, 20.2%), with over 45% deemed as preventable readmissions. Factors associated with increased risk of readmission included older age, longer index length of stay, prolonged operative time, elective procedures, higher ASA score and contaminated procedures.

Conclusion

Unplanned readmissions are more likely to occur in patients who develop postoperative complications. Understanding factors associated with readmissions may facilitate targeted quality improvement projects that reduce hospital readmission after surgery.
All work intensity is not created equal: Effort motives, job satisfaction and quit intentions at a grocery chain
Authors: Avgoustaki Argyro , Frankort Hans T. W.
Published: December 2022

Prior research has shown that the well‐being of employees engaged in intensive work can vary with the discretion their jobs afford regarding how and when to carry out the work. This article explores a different avenue. It argues that well‐being also varies with employees’ individual motives for working intensively. The article introduces self‐determination theory to the domain of work intensity and focuses on two hypotheses. The first is whether intensive work driven by explicit or implicit incentives is more positively associated with an employee's job satisfaction than intensive work driven by job demands. The second is whether intensive work driven by intrinsic motives is more positively associated with job satisfaction than that driven by explicit or implicit incentives. In both these cases, the article also examines whether equivalent effects exist on (reduced) quit intentions. Original data from a major Greek grocery chain provide corroborative evidence that is robust to a rich set of covariates, including increasingly demanding adjustments for job discretion. The findings contribute to a more complete understanding of why differences in well‐being exist among employees performing intensive work, with implications for workers and employers.
Circular RNA circ0104103 inhibits colorectal cancer progression through interactions with HuR and miR‐373‐5p
Authors: Tan Pei , Sun Huiling , Xu Mu , Liu Xiangxiang , Qin Jian , Nie Junjie , Qin Xiaodan , Wang Shukui , Pan Yuqin
Published: December 2022

Emerging evidence has suggested that circular RNAs (circRNAs) have vital functions during the initiation and progression of various diseases. However, circRNA potential mechanisms in colorectal cancer (CRC) are largely unknown. Here, we sought to investigate the role and underlying regulatory mechanism of circ0104103 in CRC. circ0104103 was validated by quantitative RT‐PCR (qRT‐PCR) and Sanger sequencing. Gain‐ and loss‐of‐function assays in cell lines and mouse xenograft models were utilized to investigate the effects of circ0104103 in CRC. RNA pull‐down assays, RNA immunoprecipitation assays, bioinformatics analyses, RNA FISH, and luciferase reporter assays were used to elucidate the potential mechanism of circ0104103 in CRC. We identified circ0104103, which is strongly downregulated in CRC tissues and cell lines. Functional studies revealed that circ0104103 inhibited CRC cell growth, migration, and invasion both in vitro and in vivo. Mechanistically, circ0104103 binds to HuR, a functional RNA‐binding protein commonly expressed in CRC. HuR binds to the 3′UTR of LACTB mRNA to facilitate stabilization and increase its expression. Moreover, circ0104103 was verified as a competing endogenous RNA (ceRNA) via negative regulation of miR‐373‐5p to increase LACTB expression, resulting in inhibiting the occurrence and progression of CRC. Taken together, our study revealed that circ0104103 acts as a tumor suppressor and may be a novel biomarker and therapeutic target in CRC.
Antidepression of Xingpijieyu formula targets gut microbiota derived from depressive disorder
Authors: Li Yannan , Yang Lixuan , Li Junnan , Gao Wei , Zhao Zhonghui , Dong Kaiqiang , Duan Wenzhe , Dai Baoan , Guo Rongjuan
Published: December 2022

Objective

This investigation aims to determine the antidepressant role of Xingpijieyu formula (XPJYF) mediated via gut microbiota (GM)–brain axis.

Methods

We collected fecal microbiota from patients with depressive disorder (DD) and cultured microbiota in vitro. Some of microbiota were transplanted into germ‐free rats with the intragastric administration of XPJYF grain at the dose of 1.533 g/kg/day. The behaviors were studied by forced swimming test, open field test, sucrose preference test, and body weight. Products of hypothalamus–pituitary–adrenocortical (HPA) axis, neurotransmitter, and serum cytokines were investigated by enzyme linked immunosorbent assay. Glial fibrillary acidic protein (GFAP), a biomarker of astrocyte, was quantified using immunofluorescence. Microbiota culturing in vitro after XPJYF treatment was analyze by 16 s RNA sequencing technology. We used lipopolysaccharide (LPS) to mimic activated rat primary astrocyte in vitro. Brain‐derived neurotrophic factor (BDNF), cytokines, and oxidative stress factors were determined by western blotting, and glycometabolism in astrocyte was investigated by 2‐deoxy‐D‐glucose (2‐DG) uptake, adenosine triphosphate (ATP), and glucose‐1‐phosphate (G1P) kits.

Results

Microbiota composition during 8 mg/ml of XPJYF (H12‐8) for 12 h showed the more consistency. Lactococcus is enriched in DD‐derived microbiota composition, and Biffdobacterium and Lactobacillus in H12‐8 group. GLUCOSE1PMETAB‐PWY and PWY‐7328 of which biofunctions were dominantly encoded by Biffdobacterium were the top two of altered pathways. XPJYF improved behaviors and repressed astrocyte activation in depression rats. XPJYF elevated 2‐DG uptake, ATP, glucose‐1‐phosphate, and brain‐derived neurotrophic factor (BDNF), and inhibited cytokines and oxidative stress in LPS‐induced astrocyte.

Conclusion

XPJYF treatment targets inflammation, activation, and glycometabolim in astrocyte via gut microbiota modulation, thereby improve animal behaviors, HPA axis dysfunction, and neurotransmitter synthesis in depression rats.
Oxymatrine ameliorates white matter injury by modulating gut microbiota after intracerebral hemorrhage in mice
Authors: Li Jing , Liang Jianhao , Zeng Meiqin , Sun Kaijian , Luo Yunhao , Zheng Huaping , Li Feng , Yuan Wen , Zhou Hongwei , Liu Junshan , Sun Haitao
Published: December 2022

Introduction

White matter injury (WMI) significantly affects neurobehavioral recovery in intracerebral hemorrhage (ICH) patients. Gut dysbiosis plays an important role in the pathogenesis of neurological disorders. Oxymatrine (OMT) has therapeutic effects on inflammation‐mediated diseases. Whether OMT exerts therapeutic effects on WMI after ICH and the role of gut microbiota involved in this process is largely unknown.

Methods

Neurological deficits, WMI, gut microbial composition, intestinal barrier function, and systemic inflammation were investigated after ICH. Fecal microbiota transplantation (FMT) was performed to elucidate the role of gut microbiota in the pathogenesis of ICH.

Results

OMT promoted long‐term neurological function recovery and ameliorated WMI in the peri‐hematoma region and distal corticospinal tract (CST) region after ICH. ICH induced significant and persistent gut dysbiosis, which was obviously regulated by OMT. In addition, OMT alleviated intestinal barrier dysfunction and systemic inflammation. Correlation analysis revealed that gut microbiota alteration was significantly correlated with inflammation, intestinal barrier permeability, and neurological deficits after ICH. Moreover, OMT‐induced gut microbiota alteration could confer protection against neurological deficits and intestinal barrier disruption.

Conclusions

Our study demonstrates that OMT ameliorates ICH‐induced WMI and neurological deficits by modulating gut microbiota.
Minimally invasive para‐aortic lymph node dissection in left‐sided colonic and rectal cancer: experience based on a high‐volume centre
Authors: Sun Yanwu , Deng Yu , Lin Yu , Zhong Jingming , Lin Huiming , Weizhong Jiang , Huang Ying , Chi Pan
Published: December 2022

Aim

There is no established consensus on the optimal surgical approach to para‐aortic lymph node (PALN) dissection in patients with colorectal cancer. This study aimed to demonstrate the technical and oncological safety of minimally invasive PALN dissection for left‐sided colonic and rectal cancer patients with clinically suspected infrarenal PALN metastasis.

Method

One hundered and one patients who underwent primary tumour resection and minimally invasive (laparoscopic n = 92, robotic n = 9) PALN dissection for left‐sided colonic and rectal cancer were included. Logistic regression analysis was used to identify risk factors for PALN metastasis. Survival outcomes were evaluated using the Kaplan–Meier (log‐rank) method.

Results

Para‐aortic lymph node metastasis was pathologically confirmed in 23 patients (22.8%). Postoperative complications occurred in 22 patients (21.8%). Pathological N2 stage (OR = 9.337, p = 0.003) and inferior mesenteric artery LN metastasis (OR = 7.499, p = 0.009) were independently associated with PALN metastasis. The median follow‐up time was 32 months (range 3–92 months). In all patients, the 5‐year overall survival (OS) and progression‐free survival (PFS) rates were 76.1% and 69.5%, respectively. The 5‐year OS and PFS rates in patients with PALN metastasis were 49.8% and 47.5%, respectively. Patients with PALN metastasis had lower 5‐year OS (p = 0.023) and PFS rates (p = 0.035) than those without PALN metastasis.

Conclusion

Minimally invasive PALN dissection had acceptable postoperative complications and may be oncologically beneficial in selected patients with clinically suspicious PALN metastasis.
Follow‐up to low‐dose fenfluramine for Sunflower syndrome: A non‐randomized controlled trial
Authors: Patel Sandip , Geenen Kennedy R. , Dowless Dana , Bruno Patricia L. , Thiele Elizabeth A.
Published: December 2022

Aim

This study reports on the long‐term results for an initial cohort of patients with Sunflower syndrome who enrolled in an open‐label study of low‐dose fenfluramine as well as the short‐term results of a second cohort.

Method

We conducted a single‐center, open‐label study at the Massachusetts General Hospital. We analyzed the effect of fenfluramine on handwaving seizure frequency at monthly intervals during a 4‐month core study period for the second patient cohort, and we evaluated the long‐term (>2 years) effect of fenfluramine for the initial patient cohort.

Results

Eight of the 10 patients from the second cohort provided analyzable seizure data. These patients experienced a 33% median reduction in seizure frequency during the core study, as compared to the previously reported 79% for the initial cohort (n = 9). Of the seven patients from the first cohort who remain on fenfluramine in the extension study, five continue to experience benefit. Fenfluramine was overall well tolerated with minimal side effects, reduced appetite and fatigue being the primary adverse events, and no evidence of cardiac valvulopathy or pulmonary hypertension.

Interpretation

This study suggests fenfluramine can be an effective, durable, and well‐tolerated antiseizure medication option for patients with Sunflower syndrome.
Long‐term outcomes for females with early‐onset dystrophinopathy
Authors: Houwen‐van Opstal Saskia L. S. , Tak Ramon O. , Pelsma Maaike , van den Heuvel Frederik M. A. , van Duyvenvoorde Hermine A. , Cup Edith H. C. , Sie Lilian T. L. , Vles Johan S. H. , de Groot Imelda J. M. , Voermans Nicol C. , Willemsen Michel A. A. P.
Published: December 2022

Aim

To study long‐term disease course for females with early‐onset dystrophinopathy, including common (female) symptoms, challenges in social participation, the need for care, and current healthcare management to support guideline development.

Method

Twelve females with early‐onset dystrophinopathy were followed for a median period of more than 17 years (range 1–36).

Results

One patient died owing to end‐stage cardiac failure. Cardiac abnormalities were observed in three of the remaining 11 participants. Respiratory function was reduced in seven of 10 participants. Fatigue, myalgia, lower back pain, and arthralgia were reported in more than six of the participants. Functional status varied from exercise intolerance to wheelchair dependency. Most or all of the 10 participants reported restrictions in participation in work (n = 10), household duties (n = 10), sports (n = 9), and education (n = 8). Only a few participants received followed‐up pulmonary (n = 2) or rehabilitation (n = 3) care.

Interpretation

Females with early‐onset dystrophinopathy experience a wide range of impairments, comorbidities, limitations in activities, and restrictions in social participation. The whole spectrum should be acknowledged in the healthcare setting. Neuromuscular and cardiac follow‐up are indispensable. Additional respiratory assessment and rehabilitation care are expected to improve health status and support daily activities and participation.

What this paper adds

No standard diagnostic procedures seem to exist for female patients suspected for dystrophinopathy.

Female participants with early‐onset dystrophinopathy experienced a broad scope of burdening symptoms, such as fatigue, myalgia, lower back pain, and arthralgia.

None of participants worked full time, all felt restricted in paid work, and most felt restricted in education.

Most participants showed decreased lung function, while only one was symptomatic.

Availability of rehabilitation care may improve support for daily activities and participation for females with early‐onset dystrophinopathy.
Languages of origin and education in Europe: A systematic review
Authors: Alcántara Astrid Codana , Sánchez‐Martí Angelina , Rovira Jordi Pàmies
Published: December 2022

European education policies have tended to cultivate linguistic hegemony and preserve cultural uniformity, which has made it difficult for schools to support different cultural backgrounds. This has contributed to the promotion of artificial monolingual interactions that reinforce linguistic decapitalisation processes. The aim of the review on which this article reports was to investigate the treatment and education of languages of origin in Europe. We present findings from a systematic review of scientific articles published during the period 2010–2020. The main findings indicate that language and nationality are equated in European discourses and that public policies are promoted accordingly. These articulations draw on models that alternate between assimilationism and multiculturalism. Both assimilationist and multiculturalist approaches are detrimental to the supposed objective: that of promoting multilingualism. Thus, it is urgent that a consensus be reached, and certain public policies and educational practices promoted which are respectful of linguistic diversity, since the future social cohesion of our multicultural societies depends on this.
Impaired adaptive immune response in COVID‐19 convalescent patients with hematological malignancies
Authors: Kalicińska Elżbieta , Szymczak Donata , Andrasiak Iga , Milanowska Aneta , Kiraga Aleksandra , Majeranowski Alan , Jabłonowska Paula , Rybka Justyna , Maciej Zaucha , Wróbel Tomasz
Published: December 2022

Objectives

The immune dysregulation during SARS‐CoV‐2 has the potential to worsen immune homeostasis after recovery. Patients with hematological malignancies with COVID‐19 have changes both in the innate and adaptive immune responses. Little is known about the severity of immune dysfunction following recovery from COVID‐19 in hematological patients.

Methods

Here, we performed a comprehensive analysis of the lymphocyte subsets in peripheral blood mononuclear cells by FACS Canto II in 55 patients, including 42 with hematological malignancies 4–6 weeks after COVID‐19.

Results

Hematological COVID‐19 convalescents had deep reduction in CD3+ T cells, including helper T cells (CD3 + CD4+), naïve helper T cells (CD3 + CD4 + CD45RA+), and memory CD4+ T cells among with extremely low levels of Treg cells and decreased expression of both TCRα/β and TCRγ/δ. Severe immune dysregulation in hematological convalescents was expressed by increased activation of T lymphocytes, both as elevated levels of activated T cells (CD3 + HLA‐DR+) and activated cytotoxic T cells (CD3 + CD8 + HLA‐DR+).

Conclusions

Our findings showed a profound impairment of the adaptive immune response in hematological convalescents which might be a result of persistent activation of T cells. Convalescents with lymphoid malignancies showed more pronounced depletion of key T lymphocytes subpopulations in creating an effective adaptive response and immune memory.
Of reaflac and rapina: accusations of violence in two Old English lawsuits and the Libellus Æthelwoldi
Authors: Hanlon Brittany
Published: December 2022

This article examines the meaning and function of the Old English noun reaflac in two tenth‐century lawsuit documents, Sawyer 877 and Sawyer 1211. It suggests that reaflac was the vernacular counterpart to the Latin terms violentia and rapina. Such connected terminology suggests that a collection of now lost tenth‐century Old English charters, like S 877 and S 1211 in form, was the original source for the twelfth‐century Ely house chronicle, the Libellus Æthelwoldi. Charter draftsmen purposefully selected a language of violence in order to delegitimize a rival party’s claim to an estate, regardless of whether any acts of violence had taken place. Reaflac formed part of this narrative strategy in early English lawsuit documents because of its association with contemporary discourses on moralized wrongdoing.
Percutaneous full endoscopic foraminotomy for treatment of cervical spinal nerve compression in horses using a uniportal approach: Feasibility study
Authors: Swagemakers Jan‐Hein , Van Daele Peter , Mageed Mahmoud
Published: December 2022

Background

Cervical spinal nerve insult can be a sequel of osteoarthropathy in horses due to enlargement of the articular processes (AP).

Objectives

To describe the percutaneous endoscopic cervical foraminotomy procedure in horses.

Study design

Ex vivo experimental study and clinical case report.

Methods

The technique was performed in three equine cadavers and in two clinical cases with history of forelimb lameness located in the caudal cervical region. Briefly, the horse was positioned in lateral recumbency, with the affected AP joint uppermost. Under fluoroscopic guidance, the endoscopic instruments (Ø 6.9 mm, length 207 mm, 25° angle of vision) were positioned at the dorsal bony margin of the intervertebral foramen (IVF). The bone was freed from soft tissues and removed using diamond various burrs, hence widening the IVF. The bone drilling was continued until the medial cortical surface of the caudal AP was removed. Thereafter, the endoscope was removed and the skin portal was closed.

Results

The average of operation time in clinical cases was 98 ± 24 min. The horses recovered smoothly from the operation. At 12‐month follow‐up, the clinical signs had resolved completely without recurrence.

Main limitation

Small number of clinical cases and absence of post‐mortem examination or histopathology performed in the cadaver study to assess possible iatrogenic injuries.

Conclusion

Cervical spinal nerve decompression via minimal invasive foraminotomy is feasible in horses. More research is required before this procedure can be recommended in clinical cases.
Differentiation of self, anxiety, triangling and distress: A test of Bowen theory
Authors: Murdock Nancy L. , Flynn Mia C. , Bresin Romana C.
Published: December 2022

Based in Bowen theory (Kerr, 2019; Kerr & Bowen, 1988), this study examined differentiation of self as a moderator of the relationship between anxiety and current triangling among a sample of adolescents. It also explored the relationship between specific triangle subtypes and psychological symptoms. We hypothesized that higher levels of anxiety would be associated with higher levels of triangling, and that this relationship would be weaker for participants who report higher levels of differentiation of self. Additionally, we hypothesized that psychological symptoms would be significantly lower for those who indicated a balanced triangle configuration to characterize their family structure (as compared to those selecting scapegoating, cross‐generational coalition or mediator patterns). Results partially supported our hypotheses; differentiation performed as a moderator in two analyses, but not in others. Higher levels of psychological symptoms were associated with experience with mediator and cross‐generational triangling.
A nuclear pore complex‐associated regulation of SUMOylation in meiosis
Authors: Yang Hui‐Ju , Asakawa Haruhiko , Li Fu‐An , Haraguchi Tokuko , Shih Hsiu‐Ming , Hiraoka Yasushi
Published: December 2022

The nuclear pore complex (NPC) provides a permeable barrier between the nucleoplasm and cytoplasm. In a subset of NPC constituents that regulate meiosis in the fission yeast Schizosaccharomyces pombe, we found that nucleoporin Nup132 (homolog of human Nup133) deficiency resulted in transient leakage of nuclear proteins during meiosis I, as observed in the nup132 gene‐deleted mutant. The nuclear protein leakage accompanied the liberation of the small ubiquitin‐like modifier (SUMO)‐specific ubiquitin‐like protease 1 (Ulp1) from the NPC. Ulp1 retention at the nuclear pore prevented nuclear protein leakage and restored normal meiosis in a mutant lacking Nup132. Furthermore, using mass spectrometry analysis, we identified DNA topoisomerase 2 (Top2) and RCC1‐related protein (Pim1) as the target proteins for SUMOylation. SUMOylation levels of Top2 and Pim1 were altered in meiotic cells lacking Nup132. HyperSUMOylated Top2 increased the binding affinity at the centromeres of nup132 gene‐deleted meiotic cells. The Top2‐12KR sumoylation mutant was less localized to the centromeric regions. Our results suggest that SUMOylation of chromatin‐binding proteins is regulated by the NPC‐bound SUMO‐specific protease and is important for the progression of meiosis.
Understanding support systems for Parkinson's disease management in community settings: A cross‐national qualitative study
Authors: Soilemezi Dia , Palmar‐Santos Ana , Navarta‐Sánchez M. Victoria , Roberts Helen C. , Pedraz‐Marcos Azucena , Haahr Anita , Sørensen Dorthe , Bragstad Line K. , Hjelle Ellen G. , Haavaag Silje Bjørnsen , Portillo Mari Carmen
Published: December 2022

Background

Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long‐term conditions such as Parkinson's disease.

Objective

This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships.

Methods

A mixed‐methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta‐ethnography approach was used to analyse and synthesize cross‐national findings.

Results

A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services.

Conclusions

Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory.

Patient or Public Contribution

Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings.
Research on the corrosion behavior of low carbon mold flux on submerged nozzle refractory
Authors: Yang Xin , Zhang Liguo , Han Xiao , Cao Dong , Zhu Xiaolei , Zhang Junkai , He Zhijun
Published: December 2022

In this paper, the wetting and corrosion behavior between medium and low carbon mold flux and Al2O3‐ZrO2‐C nozzle refractory were studied through a high‐temperature wetting experiment. Combined with microstructure analysis, the corrosion mechanism of low carbon mold flux on nozzle slag line material was clarified. The results show that the wettability of low‐carbon mold flux and Al2O3‐ZrO2‐C nozzle refractory is better, compared with the traditional medium carbon mold flux, the contact angle between low‐carbon mold flux and Al2O3‐ZrO2‐C material is smaller and the mold flux spreads faster on the nozzle surface at the same temperature range. According to the microstructure analysis, the corrosion degree of low‐carbon protective slag on the ZrO2‐C material of the nozzle slag line is serious, and the corrosion depth is large. Due to the influence of carbon content, the wettability between low‐carbon mold flux and ZrO2‐C material of the nozzle slag line is better, which provides favorable kinetic conditions for the dissolution and penetration of low‐carbon mold flux into the nozzle. In addition, compared with medium carbon slag, the carbon concentration difference between low‐carbon mold flux and nozzle material is larger, resulting in greater diffusion driving force of carbon atoms, which affects the wetting, dissolution, and chemical reaction of the interface between the two phases.
Treatment of Out-of-Hospital Status Epilepticus
Authors: Carl Bazil
Published: December 2022

A Comparison of Lorazepam, Diazepam, and Placebo for the Treatment of Out-of-Hospital Status Epilepticus

Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, Ulrich S, Gottwald MD, O'Neil N, Neuhaus JM, Segal MR, Lowenstein DH

N Engl J Med 2001;345:631–637

Background

It is uncertain whether the administration of benzodiazepines by paramedics is an effective and safe treatment for out-of-hospital status epilepticus.

Methods

We conducted a randomized, double-blind trial to evaluate intravenous benzodiazepines administered by paramedics for the treatment of out-of-hospital status epilepticus. Adults with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures received intravenous diazepam (5 mg), lorazepam (2 mg), or placebo. An identical second injection was given if needed.

Results

Of the 205 patients enrolled, 66 received lorazepam, 68 received diazepam, and 71 received placebo. Status epilepticus had been terminated on arrival at the emergency department in more patients treated with lorazepam (59.1 percent) or diazepam (42.6 percent) than patients given placebo (21.1 percent) (P=0.001). After adjustment for covariates, the odds ratio for termination of status epilepticus by the time of arrival in the lorazepam group as compared with the placebo group was 4.8 (95 percent confidence interval, 1.9 to 13.0). The odds ratio was 1.9 (95 percent confidence interval, 0.8 to 4.4) in the lorazepam group as compared with the diazepam group and 2.3 (95 percent confidence interval, 1.0 to 5.9) in the diazepam group as compared with the placebo group. The rates of respiratory or circulatory complications (indicated by bag valve-mask ventilation or an attempt at intubation, hypotension, or cardiac dysrhythmia) after the study treatment was administered were 10.6 percent for the lorazepam group, 10.3 percent for the diazepam group, and 22.5 percent for the placebo group (P=0.08).

Conclusions

Benzodiazepines are safe and effective when administered by paramedics for out-of-hospital status epilepticus in adults. Lorazepam is likely to be a better therapy than diazepam.
Functional MRI of Interictal EEG Activity
Authors: Lesser Ronald P.
Published: December 2022

Simultaneous EEG and Functional MRI of Epileptic Activity: A Case Report

Baudewig J, Bittermann HJ, Paulus W, Frahm J Clin

Neurophysiol 2001;112:1196–1200

Objectives

Attempts to localize the source of epileptic activity by linking electroencephalographic (EEG) abnormalities to blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) signal alterations are hampered mainly by EEG distortions during MRI, subject motion, and unknown hemodynamic response characteristics.

Methods

Using T2*-weighted echo-planar imaging at 2.0 T (2 s temporal resolution, 2 × 2 × 4 mm(3) spatial resolution), this work demonstrates strategies to alleviate some of these problems while studying a patient who had idiopathic generalized epilepsy with poly-spike and slow-wave complexes.

Results

Continuous EEG recordings during dynamic MRI (500 ms scanning, 1500 ms delay) and post-examination derivation of an EEG reference function for MRI analysis revealed positive BOLD MRI responses with temporal characteristics similar to those obtained for functional challenges.

Conclusions

The ability to map focal epileptic activity and/or associated cognitive processing provides new potential for both epilepsy research and clinical patient management. Spatio-Temporal Imaging of Focal Interictal Epileptiform Activity Using EEG-Triggered Functional MRI Krakow K, Lemieux L, Messina D, Scott CA, Symms MR, Duncan JS, Fish DR Epileptic Disord 2001;3:67–74 EEG-triggered, blood oxygen level-dependent functional MRI (BOLD-fMRI) was used in 24 patients with localization-related epilepsy and frequent interictal epileptiform discharges (spikes) to identify those brain areas involved in generating the spikes, and to study the evolution of the BOLD signal change over time. The location of the fMRI activation was compared with the scalp EEG spike focus and the structural MR abnormality. Twelve patients (50%) had an fMRI activation concordant with the EEG focus and structural brain abnormalities where present (n = 7). In 2 other patients, the fMRI activation was non-concordant with electroclinical findings. The remaining 10 patients (41.7%) showed no significant fMRI activation. These patients had significantly lower mean spike amplitudes compared to those with positive fMRI results (p = 0.03). The time course of the BOLD response was studied in 3 patients and this revealed a maximum signal change 1.5 to 7.5 sec after the spike. In conclusion, EEG-triggered fMRI can directly identify the generators of interictal epileptiform activity, with high spatial resolution, in selected patients with frequent spikes. The superior spatial resolution obtainable through EEG-triggered fMRI may provide an additional non-invasive tool in the presurgical evaluation of patients with intractable focal seizures.
Gabaergic Interneuron Reorganization during the Late Period May Contribute to Hippocampal Epileptogenesis
Authors: Benardo Larry S.
Published: December 2022

Alterations of Hippocampal GABAergic System Contribute to Development of Spontaneous Recurrent Seizures in the Rat Lithium-Pilocarpine Model of Temporal Lobe Epilepsys

Andre V, Marescaux C, Nehlig A, Fritschy JM

Hippocampus 2001;11:452–468

Reorganization of excitatory and inhibitory circuits in the hippocampal formation following seizure-induced neuronal loss has been proposed to underlie the development of chronic seizures in temporal lobe epilepsy (TLE). Here, we investigated whether specific morphological alterations of the GABAergic system can be related to the onset of spontaneous recurrent seizures (SRS) in the rat lithium-pilocarpine model of TLE. Immunohistochemical staining for markers of interneurons and their projections, including parvalbumin (PV), calretinin (CR), calbindin (CB), glutamic acid decarboxylase (GAD), and type 1 GABA transporter (GAT1), was performed in brain sections of rats treated with lithium-pilocarpine and sacrificed after 24 h, during the silent phase (6 and 12 days), or after the onset of SRS (10–18 days after treatment). Semiquantitative analysis revealed a selective loss of interneurons in the stratum oriens of CA1, associated with a reduction of GAT1 staining in the stratum radiatum and stratum oriens. In contrast, interneurons in CA3 were largely preserved, although GAT1 staining was also reduced. These changes occurred within 6 days after treatment and were therefore insufficient to cause SRS. In the dentate gyrus, extensive cell loss occurred in the hilus. The pericellular innervation of granule cells by PV-positive axons was markedly reduced, although the loss of PV-interneurons was only partial. Most strikingly, the density of GABAergic axons, positive for both GAD and GAT1, was dramatically increased in the inner molecular layer. This change emerged during the silent period, but was most marked in animals with SRS. Finally, supernumerary CB-positive neurons were detected in the hilus, selectively in rats with SRS. These findings suggest that alterations of GABAergic circuits occur early after lithium-pilocarpine-induced status epilepticus and contribute to epileptogenesis. In particular, the reorganization of GABAergic axons in the dentate gyrus might contribute to synchronize hyperexcitability induced by the interneuron loss during the silent period, leading to the onset of chronic seizures.