bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequence-dependent inhibition of cGAS and TLR9 DNA sensing by 2′-O-methyl gapmer oligonucleotides
Authors: Valentin Roxane , Wong Christophe , Alharbi Arwaf S , Pradeloux Solène , Morros Makala P , Lennox Kim A , Ellyard Julia I , Garcin Aurélie J , Ullah Tomalika R , Kusuma Gina D , Pépin Geneviève , Li Hong-Mei , Pearson Jaclyn S , Ferrand Jonathan , Lim Rebecca , Veedu Rakesh N , Morand Eric F , Vinuesa Carola G , Behlke Mark A , Gantier Michael P
Published: May 2021

Oligonucleotide-based therapeutics have the capacity to engage with nucleic acid immune sensors to activate or block their response, but a detailed understanding of these immunomodulatory effects is currently lacking. We recently showed that 2′-O-methyl (2′OMe) gapmer antisense oligonucleotides (ASOs) exhibited sequence-dependent inhibition of sensing by the RNA sensor Toll-Like Receptor (TLR) 7. Here we discovered that 2′OMe ASOs can also display sequence-dependent inhibitory effects on two major sensors of DNA, namely cyclic GMP-AMP synthase (cGAS) and TLR9. Through a screen of 80 2′OMe ASOs and sequence mutants, we characterized key features within the 20-mer ASOs regulating cGAS and TLR9 inhibition, and identified a highly potent cGAS inhibitor. Importantly, we show that the features of ASOs inhibiting TLR9 differ from those inhibiting cGAS, with only a few sequences inhibiting both pathways. Together with our previous studies, our work reveals a complex pattern of immunomodulation where 95% of the ASOs tested inhibited at least one of TLR7, TLR9 or cGAS by ≥30%, which may confound interpretation of their in vivo functions. Our studies constitute the broadest analysis of the immunomodulatory effect of 2′OMe ASOs on nucleic acid sensing to date and will support refinement of their therapeutic development.
Cigarette Smoking and the Role of Menthol in Tobacco Use Inequalities for Sexual Minorities
Authors: Ganz Ollie , Delnevo Cristine D
Published: May 2021

Introduction

Cigarette smoking is disproportionately common among sexual minorities. While menthol market share has increased in the past decade, research on menthol cigarette smoking among sexual minorities is scant. For this study, we examined menthol cigarette smoking in the United States, by sex and sexual identity using a nationally representative sample of adults.

Aims and Methods

We pooled data from the 2015–2019 National Survey on Drug Use and Health. We used chi-square tests and multivariable logistic regression models to examine (1) past 30-day cigarette use, (2) past 30-day menthol use, and (3) menthol preference among adults who have smoked cigarettes in the past 30 days for the following groups: heterosexual/straight males, heterosexual/straight females, gay males, gay/lesbian females, bisexual males, and bisexual females. Data were analyzed in September 2020.

Results

Bivariate analyses revealed that prevalence of cigarette smoking and menthol cigarette smoking were higher among sexual minorities compared with heterosexual respondents, and that preference for menthol was highest among lesbian/gay and bisexual females who smoke. Multivariable models showed that compared with heterosexual females who smoke, odds of menthol preference were lower among heterosexual/straight and bisexual males who smoke, and higher among bisexual females.

Conclusions

Our study found that menthol preference was disproportionately high among sexual minorities who smoke—bisexual and gay/lesbian females who smoke in particular. Research is needed to understand why menthol use is common among sexual minorities who smoke.

Implications

Using data from a nationally representative study, this study makes a unique contribution to literature by identifying differences in menthol smoking between sexual minority subgroups. Specifically, we found that menthol smoking was highest among sexual minority females (ie, lesbian/gay and bisexual females) compared with other sexual minorities. These findings highlight the need for targeted interventions to prevent menthol cigarette initiation among sexual minorities, as well as to promote smoking cessation among sexual minorities who smoke menthol cigarettes, with an emphasis on sexual minority females. Future research should examine the impact of a potential menthol ban on these inequalities.
High School Seniors Who Used E-Cigarettes May Have Otherwise Been Cigarette Smokers: Evidence From Monitoring the Future (United States, 2009–2018)
Authors: Sokol Natasha A , Feldman Justin M
Published: May 2021

Introduction

Studies have indicated that youth who use e-cigarettes are more likely to progress to cigarette smoking; however, the likelihood that these youth would have used tobacco products in the pre-vaping era is unclear.

Aims and Methods

This study sought to determine whether youth who used e-cigarettes in 2014–2018 would have likely been smokers in the period preceding e-cigarette availability. Analyzing Monitoring the Future 12th grade data (United States, 2009–2018), we forecasted the prevalence of current smoking with logistic regression-derived propensity scores. Models predicted smoking for all subsequent years, incorporating sociodemographic, family, alcohol, and school-related variables, and a linear time trend. We compared forecasted to observed smoking prevalence annually, and prevalence of current e-cigarette use among nonsmokers across smoking propensity tertiles.

Results

Until 2014, observed smoking prevalence mirrored forecasted prevalence. Afterward, forecasted rates consistently overestimated prevalence. Among nonsmoking youth, e-cigarette use was lowest among those with lowest predicted probability of cigarette smoking (3.8%; 95% confidence interval [CI]: 3.3, 4.4) and highest among those with highest probability (23.5%; 95% CI: 22.2, 24.9).

Conclusions

Youth e-cigarette use has increased rapidly, with high prevalence among nonsmoking youth. However, the decline in current smoking among 12th graders has accelerated since e-cigarettes have become available. E-cigarette use is largely concentrated among youth who share characteristics with smokers of the pre-vaping era, suggesting e-cigarettes may have replaced cigarette smoking.

Implications

Among nonsmoking youth, vaping is largely concentrated among those who would have likely smoked prior to the introduction of e-cigarettes, and the introduction of e-cigarettes has coincided with an acceleration in the decline in youth smoking rates. E-cigarettes may be an important tool for population-level harm reduction, even considering their impact on youth.
CRISPR/Cas systems versus plant viruses: engineering plant immunity and beyond
Authors: Ali Zahir , Mahfouz Magdy M
Published: May 2021

Molecular engineering of plant immunity to confer resistance against plant viruses holds great promise for mitigating crop losses and improving plant productivity and yields, thereby enhancing food security. Several approaches have been employed to boost immunity in plants by interfering with the transmission or lifecycles of viruses. In this review, we discuss the successful application of clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein (Cas) (CRISPR/Cas) systems to engineer plant immunity, increase plant resistance to viruses, and develop viral diagnostic tools. Furthermore, we examine the use of plant viruses as delivery systems to engineer virus resistance in plants and provide insight into the limitations of current CRISPR/Cas approaches and the potential of newly discovered CRISPR/Cas systems to engineer better immunity and develop better diagnostics tools for plant viruses. Finally, we outline potential solutions to key challenges in the field to enable the practical use of these systems for crop protection and viral diagnostics.
Effects of Physical Therapist Intervention on Pulmonary Function in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis
Authors: Rutka Magdalena , Adamczyk Waclaw M , Linek Paweł
Published: May 2021

Objective

The purpose of this study was to evaluate the effects of physical therapy on pulmonary function and respiratory muscle strength in children with cerebral palsy (CP).

Methods

A search of 10 databases was conducted for this systematic review. Initially, there were no language, study design, or time frame restrictions. All studies assessing the effect of physical therapy on the respiratory system in children with CP were included. Two reviewers independently extracted and documented data. The data extracted included description of the intervention (duration, therapeutic method) and study results (change of spirometric parameters, respiratory muscle strength). The effects of physical therapist treatment were calculated using software.

Results

A total of 269 children aged 5 to 18 years from 10 studies were included. The included studies consisted of 5 different therapeutic methods (inspiratory muscle training [IMT], aerobic training, swimming, respiratory exercise, exercise with elastic bands). Physical therapist intervention led to a significant increase in the maximal expiratory pressure (MEP) (I2 = 0%), peak expiratory flow (I2 = 0%), and maximum oxygen consumption (I2 = 37%). A separate analysis of the most frequently used therapy (IMT) showed a positive effect on MEP (I2 = 0%) and maximal inspiratory pressure (I2 = 35%).

Conclusion

Various forms of physical therapy have potential to demonstrate a positive effect on maximal inspiratory pressure, MEP, and peak expiratory flow in children with CP. There is no possibility to recommend the best method and duration of the physical therapy; however, it can be suggested that physical therapy should be applied for at least 4 weeks and include IMT.

Impact

CP is one of the most common causes of physical disabilities in children, and pulmonary dysfunction is the leading cause of death in people with CP. Thus, it is warranted to seek different approaches that may improve pulmonary function in people with CP. This review has shown that various forms of physical therapy have potential to improve the pulmonary function of children with CP.
RADON AND RADIUM MEASUREMENTS OF ESKIşEHIR SPA WATERS
Authors: Çetinkaya Hakan , Biçer Mustafa
Published: May 2021

In this study, radon and radium concentrations of spa waters around Eskişehir county were measured using E-Perm method. Radon and radium concentrations were determined between 0.75 ± 0.18 and 8.98 ± 0.80 Bq l−1, 3.44 ± 0.34 and 70.63 ± 4.13 mBq l−1, respectively. At the sampling time, indoor and outdoor background gamma radiation, pH, water temperature and conductivity were measured for the each sampling point. The annual effective dose a person is exposed to as a result of water consumption has been calculated for radon and radium. In addition, the dose exposed as a result of the transfer of radon in the water to the air and the inhalation of this air was also calculated.
Geographic Expansion of Banana Blood Disease in Southeast Asia
Authors: Ray Jane D. , Subandiyah Siti , Rincon-Florez Vivian A. , Prakoso Ady B. , Mudita I. W. , Carvalhais Lilia C. , Markus Jenny E. R. , O’Dwyer Cecilia A. , Drenth André
Published: May 2021

Blood disease in bananas caused by Ralstonia syzygii subsp. celebesensis is a bacterial wilt causing significant crop losses in Indonesia and Malaysia. Disease symptoms include wilting of the plant and red-brown vascular staining, internal rot, and discoloration of green banana fruit. There is no known varietal resistance to this disease in the Musa genus, although variation in susceptibility has been observed, with the popular Indonesian cooking banana variety Kepok being highly susceptible. This study established the current geographic distribution of Blood disease in Indonesia and confirmed the pathogenicity of isolates by Koch’s postulates. The long-distance distribution of the disease followed an arbitrary pattern indicative of human-assisted movement of infected banana materials. In contrast, local or short-distance spread radiated from a single infection source, indicative of dispersal by insects and possibly contaminated tools, water, or soil. The rapid expansion of its geographical range makes Blood disease an emerging threat to banana production in Southeast Asia and beyond.
Resistance-Breaking Tomato Spotted Wilt Virus Variant that Recently Occurred in Pepper in South Korea is a Genetic Reassortant
Authors: Kwon Sun-Jung , Cho Young-Eun , Kwon Oh-Hun , Kang Hyung-Gon , Seo Jang-Kyun
Published: May 2021

Tomato spotted wilt virus (TSWV) is a destructive viral pathogen in various crops, including pepper. Although the single dominant gene Tsw has been utilized in pepper breeding to confer resistance to TSWV, the occurrence of TSWV variants that overcome Tsw-mediated resistance has been reported in various countries after several years of growing resistant cultivars. In this study, we determined the complete genome sequence of a resistance-breaking TSWV variant (TSWV-YI) that recently emerged in pepper in South Korea. TSWV-YI infected all of the resistant pepper cultivars tested. The phylogenetic and recombination analyses of the complete TSWV-YI genome sequence showed that it is a reassortant that acquired its L and M RNA segments from the existing South Korean TSWV population and its S RNA in an isolate from another country. Given that TSWV-YI is a resistance-breaking variant, it appears that reassortment of the S RNA led to the emergence of this variant that breaks the Tsw gene in pepper grown in South Korea. Our results suggest that resistance-breaking TSWV variants are a potential threat to pepper production in South Korea and that strategies to manage these variants should be developed to ensure sustainable pepper production.
Evidence that Xylella fastidiosa is the Causal Agent of Almond Leaf Scorch Disease in Alicante, Mainland Spain (Iberian Peninsula)
Authors: Marco-Noales E. , Barbé S. , Monterde A. , Navarro-Herrero I. , Ferrer A. , Dalmau V. , Aure C. M. , Domingo-Calap M. L. , Landa B. B. , Roselló M.
Published: May 2021

In 2017, Xylella fastidiosa, a quarantine plant-pathogenic bacterium in Europe, was detected in almond trees associated with leaf scorch symptoms in Alicante, a Mediterranean area in southeastern mainland Spain. The bacterium was detected by serological and molecular techniques, isolated in axenic culture from diseased almond trees, and identified as X. fastidiosa subsp. multiplex sequence type (ST) 6. Inoculation experiments on almond plants in greenhouse trials with a characterized strain of X. fastidiosa subsp. multiplex ST6 isolated in the outbreak area have proved that it was able to multiply and systemically colonize inoculated plants. Disease symptoms characteristic of leaf scorch like those observed in the field were observed in the inoculated almond trees after 1 year. Furthermore, the pathogen was reisolated and identified by molecular tests. With the fulfillment of Koch’s postulates, we have demonstrated that X. fastidiosa is the causal agent of the almond leaf scorch disease in the Alicante outbreak.
Spray-Induced Gene Silencing as a Potential Tool to Control Potato Late Blight Disease
Authors: Kalyandurg Pruthvi B. , Sundararajan Poorva , Dubey Mukesh , Ghadamgahi Farideh , Zahid Muhammad Awais , Whisson Stephen C. , Vetukuri Ramesh R.
Published: May 2021

Phytophthora infestans causes late blight disease on potato and tomato and is currently controlled by resistant cultivars or intensive fungicide spraying. Here, we investigated an alternative means for late blight control by spraying potato leaves with double-stranded RNAs (dsRNA) that target the P. infestans genes essential for infection. First, we showed that the sporangia of P. infestans expressing green fluorescent protein (GFP) can take up in vitro synthesized dsRNAs homologous to GFP directly from their surroundings, including leaves, which led to the reduced relative expression of GFP. We further demonstrate the potential of spray-induced gene silencing (SIGS) in controlling potato late blight disease by targeting developmentally important genes in P. infestans such as guanine-nucleotide binding protein β-subunit (PiGPB1), haustorial membrane protein (PiHmp1), cutinase (PiCut3), and endo-1,3(4)-β-glucanase (PiEndo3). Our results demonstrate that SIGS can potentially be used to mitigate potato late blight; however, the degree of disease control is dependent on the selection of the target genes.

[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 .
The Role of Primary Care in the Initiation of Opioid Use Disorder Treatment in Statewide Public and Private Insurance
Authors: Gertner Alex K. , Rotter Jason S. , Holly Margaret E. , Shea Christopher M. , Green Sherri L. , Domino Marisa Elena
Published: May 2021

Objective:

To determine if individuals newly diagnosed with opioid use disorder (OUD) who saw a primary care provider (PCP) before or on the date of diagnosis had higher rates of medication treatment for OUD (MOUD).

Methods:

Observational study using logistic regression with claims data from Medicaid and a large private insurer in North Carolina from January 2014 to July 2017.

Key Results:

Between 2014 and 2017, the prevalence of diagnosed OUD increased by 47% among Medicaid enrollees and by 76% among the privately insured. Over the same time period, the percent of people with an OUD who received MOUD fell among both groups, while PCP involvement in treatment increased. Of Medicaid enrollees receiving buprenorphine, the percent receiving buprenorphine from a PCP increased from 32% in 2014 to 39% in 2017. Approximately 82% of people newly diagnosed with OUD had a PCP visit in the 12 months before diagnosis in Medicaid and private insurance. Those with a prior PCP visit were not more likely to receive MOUD. Seeing a PCP at diagnosis was associated with a higher probability of receiving MOUD than seeing an emergency provider but a lower probability than seeing a behavioral health specialist or other provider type.

Conclusions:

People newly diagnosed with OUD had high rates of contact with PCPs before diagnosis, supporting the importance of PCPs in diagnosing OUD and connecting people to MOUD. Policies and programs to increase access to MOUD and improve PCPs’ ability to connect people to evidence-based treatment are needed.
Internet Addiction and Its Relation to Emotional Intelligence and Resilience Among a Sample of Egyptian University Students
Authors: Nagy Abdelhamid Nahla E. , Abdelsamea Mohamed Afaf M. , Shaker Ibrahim Nermin M. , Adel Abdelgawad Ahmed , Abd El Moneam Mohamed H. , Marzouk Sarah A.I.
Published: May 2021

Introduction:

Internet addiction (IA) had recently become the focus of interest to most clinicians and researchers. Indeed, this topic was not thoroughly studied in previous researches.

Objectives:

The authors of the current study aimed to investigate the rates of IA, understand its demographic and clinical correlates, and illustrate the interplay between IA, emotional intelligence (EI) and resilience among a sample of Egyptian university students.

Methods:

A total of 400 male and female university students from the Faculty of Medicine and Faculty of Literature, Ain Shams University were included in the current study. Participants were assessed using an informative designed questionnaire for sociodemographic data, Young Internet Addiction Test, The Schutte Self Report Emotional Intelligence Test (SSEIT), and The Resilience Scale (RS).

Results:

Two hundred eighty-nine (72.2%) participants were labeled the diagnosis of IA with varying degree of severity. Participants with IA scored significantly lower in the total score and all the subscores of SSEIT and RS (P>0.001). A significant negative correlation was found between all the domains of the Internet Addiction Test and both SSEIT and RS total score and all the subscores. By multiple logistic regression analysis, EI (odds ratio=0.81, P>0.001) and resilience (odds ratio=0.91, P=0.002) were the only factors predicting IA.

Conclusion:

Low scores of EI and resilience could predict the susceptibility to IA, suggesting that treatment strategies enhancing these factors would be of great value to be included in the programs targeted for the management of IA.
Living Well After Amputation: Lessons in Innovation, Peer Support, and Health Policy
Authors: Cain Jeffrey J. , Ignaszewski Daniel , Blymire Carol
Published: May 2021

Currently 2.1 million people in the United States live with limb loss, with 185,000 amputations occurring every year. Amputation numbers are expected to rise with increasing age, diabetes, and vascular disease in our population. Advancements in surgical techniques and prosthetic technology have created the potential for amputees to live active and productive lives. Connecting new amputees with peer support resourses has been shown to improve rehabilitation outcomes. Resources from the Amputee Coalition include the National Limb Loss Resource Center, the Certified Peer Visitor program, a support group network, publications, and advocacy programs. Insurance companies have increased limits on appropriate access to advanced surgical techniques and prosthetic technology. Data on the care of amputation has become dated with additional research needed on incidence, prevention, standards for rehabilitation, and outcomes for surgery and prosthetic devices. Advocacy efforts have been successful in passing laws mandating insurance coverage for prosthetic care in 21 states with a need for additional advocacy on state and federal levels. Team based care and collaboration across disciplines is key to successful outcomes for both individual patient care and for advocacy in our health care system.
Nurses' and Physicians' Distress, Burnout, and Coping Strategies During COVID-19: Stress and Impact on Perceived Performance and Intentions to Quit
Authors: Lou Nigel Mantou , Montreuil Tina , Feldman Liane S. , Fried Gerald M. , Lavoie-Tremblay Mélanie , Bhanji Farhan , Kennedy Heather , Kaneva Pepa , Harley Jason M.
Published: May 2021

Introduction:

Health care providers (HCPs) have experienced more stress and burnout during COVID-19 than before. We compared sources and levels of stress, distress, and approaches to coping between nurses and physicians, and examined whether coping strategies helped mitigate the negative impact of stress and intentions to quit.

Methods:

Using a cross-sectional study design, burnout was measured with the Maslach Burnout Inventory. Psychological distress was measured using the Depression, Anxiety, and Stress Scale. A self-reported survey was used to evaluate stressors, impact on perceived performance, and intentions to quit. The data were analyzed using t-tests and linear regression models.

Results:

Responses of 119 HCPs were analyzed. Findings suggest that (1) compared to physicians, nurses experienced a higher level of distress and burnout, and used more maladaptive coping strategies. (2) Both nurses and physicians experienced more distress and burnout during COVID-19 than before. (3) Adaptive coping strategies moderated the negative impact of stress on work performance (4) Adaptive coping strategies moderated the negative effect of stress on burnout, which in turn reduced intentions to quit. Stress negatively impacted work performance and burnout only for those with low, but not high, levels of adaptive coping strategies.

Discussion:

The current findings of HCPs' challenges, risks, and protective factors provide valuable information (1) on COVID-19's impact on HCPs, (2) to guide the distribution of institutional supportive efforts and recommend adaptive coping strategies, and (3) to inform medical education, such as resilience training, focusing on adaptive coping approaches.
Clinical reasoning in anaphylactic shock: addressing the challenges faced by anaesthesiologists in real time
Authors: Gouel-Cheron Aurelie , Neukirch Catherine , Kantor Elie , Malinovsky Jean-Marc , Tacquard Charles , Montravers Philippe , Mertes Paul-Michel , Longrois Dan
Published: May 2021

Acute hypersensitivity reactions to drugs occur infrequently during anaesthesia and the peri-operative period. When clinical presentation includes the classical triad, erythema, cardiovascular abnormalities and increased airway pressure, the diagnosis is evident and the challenge is to prescribe a therapeutic regimen according to guidelines and to manage refractory signs in a timely manner. In many situations, however, the initial clinical signs are isolated, such as increased airway pressure or arterial hypotension. Rendering a differential diagnosis with causes and mechanisms other than acute hypersensitivity reactions (AHRs) is difficult, delaying treatment with possible worsening of the clinical signs, and even death, in previously healthy individuals. In these difficult diagnostic situations, clinical reasoning is mandatory, and guidelines do not explicitly explain the elements on which clinical reasoning can be built. In this article, based on clinical evidence whenever available, experimental data and pathophysiology, we propose algorithms that have been evaluated by experts. The goal of these algorithms is to provide explicit elements on which the differential diagnosis of AHRs can be made, accelerating the implementation of adequate therapy.
A core outcome set for genitourinary symptoms associated with menopause: the COMMA (Core Outcomes in Menopause) global initiative
Authors: Lensen Sarah , Bell Robin J. , Carpenter Janet S. , Christmas Monica , Davis Susan R. , Giblin Karen , Goldstein Steven R. , Hillard Tim , Hunter Myra S. , Iliodromiti Stamatina , Jaisamrarn Unnop , Khandelwal Sunila , Kiesel Ludwig , Kim Bobae V. , Lumsden Mary Ann , Maki Pauline M. , Mitchell Caroline M. , Nappi Rossella E. , Niederberger Craig , Panay Nick , Roberts Helen , Shifren Jan , Simon James A. , Stute Petra , Vincent Amanda , Wolfman Wendy , Hickey Martha
Published: May 2021

Objective:

Genitourinary symptoms, such as vaginal dryness and pain with sex, are commonly experienced by postmenopausal women. Comparing treatments for these genitourinary symptoms are restricted by the use of different outcome measures in clinical trials and the omission of outcomes, which may be relevant to women. The aim of this project was to develop a Core Outcome Set (COS) to be reported in clinical trials of treatments for genitourinary symptoms associated with menopause.

Methods:

We performed a systematic review of randomized controlled trials of treatments for genitourinary symptoms associated with menopause and extracted their outcomes. This list was refined and entered into a two-round modified Delphi survey, which was open to clinicians, researchers, and postmenopausal women from November 2019 to March 2020. Outcomes were scored on a nine-point scale from “not important” to “critically important.” The final COS was determined following two international consensus meetings.

Results:

A total of 26 unique outcomes were included in the Delphi process, which was completed by 227 participants of whom 58% were postmenopausal women, 34% clinicians, and 8% researchers. Predefined thresholds were applied to the Delphi scores to categorize outcomes by importance, which informed the e consensus meetings, attended by 43 participants from 21 countries. The final COS includes eight outcomes: (1) pain with sex, (2) vulvovaginal dryness, (3) vulvovaginal discomfort or irritation, (4) discomfort or pain when urinating, (5) change in most bothersome symptom, (6) distress, bother or interference of genitourinary symptoms, (7) satisfaction with treatment, (8) side effects of treatment.

Conclusion:

These eight core outcomes reflect the joint priorities of postmenopausal women, clinicians, and researchers internationally. Standardized collection and reporting of these outcomes in clinical trials will facilitate the comparison of different treatments for genitourinary symptoms, advance clinical practice, and ultimately improve outcomes for symptomatic women.

Video Summary:

http://links.lww.com/MENO/A765.
Trends in cause-related comorbidities in hospitalized patients with secondary hypertension in China from 2013 to 2016: a retrospective analysis of hospital quality monitoring system data
Authors: Zhang Long , Li Jianping , Li Nanfang , Sun Ningling , Xie Liangdi , Han Qinghua , Li Yong , Lu Xin Zheng , Sun Pengfei , Li Yuxi , Shi Ying , Wang Haibo , Zhang Yan , Chen Hu , Huo Yong
Published: May 2021

Background:

Secondary hypertension has emerged as a major public health problem in China. Early diagnosis and treatment can significantly improve the clinical outcomes. However, data on the current cause composition in China are seldom reported.

Objective:

To describe the trends in cause-related comorbidities in hospitalized patients with secondary hypertension in China from 2013 to 2016.

Methods:

This was a retrospective analysis based on the national Hospital Quality Monitoring System (HQMS) database, which collects information from the front pages of in-hospital medical records. Hospitalized patients with secondary hypertension from 746 tertiary hospitals that consistently uploaded data to the HQMS from 2013 to 2016 were enrolled. All diagnoses were identified using International Classification of Diseases version 10 (ICD-10) diagnostic codes. Descriptive analyses were used to determine the proportions of secondary hypertension causes and changing trends over 4 years.

Result:

The study collected data on 402 371 hospitalized patients with secondary hypertension from the HQMS during 2013–2016. Secondary hypertension caused by renal parenchymal disease ranked first and accounted for more than 50%. Obstructive sleep apnea syndrome (OSAS) followed closely with a rate of approximately 25%. Primary aldosteronism presented the highest proportion among all causes of endocrine hypertension. Regarding longitudinal changes over time, the rates of renal hypertension showed a significant downward trend from 2013 to 2016 (P < 0.001). In contrast, OSAS, endocrine hypertension, renal vascular disease, and aorta diseases maintained a significant upward trend from 2013 to 2016 (P < 0.001). The rates of these diseases in women with common secondary hypertension was higher than that of men, except in patients with OSAS (P < 0.001). In addition, renal parenchymal diseases and renal vascular diseases gradually decreased with age, whereas OSAS and aortic diseases gradually increased with age. The proportion of endocrine hypertension in the middle-aged group was higher than the other two age groups.

Conclusion:

The study provides important information on the changing trends of cause rate of secondary hypertension modified by age and sex in China during 2013–2016. Renal parenchymal disease is still the most common cause of secondary hypertension with a decreasing trend, followed by OSAS with an increasing trend.
Evaluating Ineffective Treatments: A Proposed Model for Discussing Futility in Psychiatric Illness
Authors: Coulter Andrew , Schuermeyer Isabel , Sola Christopher
Published: May 2021

Background

Treatment futility and terminality discussions arise rarely in psychiatric practice, frequently instilling apprehension, as there is little written that defines these terms in relation to mental illness. It therefore remains uncertain how to deal with cases that are refractory to multimodal interventions and that demonstrate limited improvement or even a worsening trajectory. Any viable solution needs to respect patient autonomy and maintain both beneficence and nonmaleficence, while taking into account the strained resources of the mental health care system as a whole.

Objective

This article reviews historical conflicts surrounding the notion of futility in psychiatric disorders, and proposes and elaborates a set of six criteria that psychiatrists can use in working through these difficult cases. Given the potential controversy involving futility in psychiatry, it proves helpful to understand its similarity to the notion of futility in standard medical contexts. This article also works through some of the common concerns or objections regarding the application of futility in psychiatric contexts.

Conclusions

Futility in psychiatric illness is a concept that the psychiatric community needs to understand and address, given the limited treatment options available to our field, as well as the limitations of health care resources. The proposed framework allows for ethically appropriate treatment decisions for treatment-resistant patients—respecting their individual wishes while ensuring appropriate care.
FAMILIAL EXUDATIVE VITREOTINOPATHY–LIKE FEATURES IN STICKLER TYPE IV ASSOCIATED WITH NOVEL VARIANTS IN COL9A1
Authors: Alsubaie Hamad F. , Magliyah Moustafa S. , AlRaddadi Osama , AlZaid Abdulrahman , Nowilaty Sawsan R.
Published: May 2021

Background/Purpose:

To report a case of Stickler Type IV with familial exudative vitreoretinopathy phenotype.

Methods:

Retrospective case report.

Results:

A 24-year-old woman presented with right eye exotropia and decreased vision. She had no facial or typical retinal features of Stickler syndrome but complained of right-sided hearing loss and right-sided neck pain. Examination of the right eye showed a chronic combined exudative and traction retinal detachment with temporal retinal dragging associated with far temporal retinal exudations and fibrovascular proliferations. The left eye had an attached retina with large areas of peripheral temporal retinal nonperfusion on fluorescein angiography, sharply demarcated by end circulation vascular pruning and mild peripheral vascular leakage, consistent with familial exudative vitreoretinopathy phenotype. Genetic analysis identified two heterozygous c.1052C>A and c.1349A>G variants in COL9A1, but did not disclose any mutation in genes classically associated with familial exudative vitreoretinopathy.

Conclusion:

Familial exudative vitreoretinopathy–like retinal vascular features can be the presenting sign in patients with Stickler syndrome Type IV.
Challenges in management of the Boston Keratoprosthesis Type 1
Authors: Koo Ellen H. , Hannush Sadeer B.
Published: May 2021

Purpose of review

The Boston Keratoprosthesis Type 1 was pioneered by Claes Dohlman several decades ago. Since its inception, the device has undergone multiple revisions to address challenges associated with retroprosthetic membrane formation, retention, extrusion, stromal melt and endophthalmitis. Although visual outcomes and retention rates have improved, challenges, especially glaucoma, remain.

Recent findings

The Boston Keratoprosthesis Type I device has seen an increase in popularity because of the improvement in rates of retention and visual rehabilitation. Recent outcome studies have allowed clinicians to identify diagnoses and indications that can lead to more favorable results with the Boston Keratoprosthesis Type I device.

The Boston Keratoprosthesis Type I device continues to play a vital role in visual rehabilitation for eyes with very low chance of realistic allograft survival -- such as in eyes where corneal grafting is considered high-risk: eyes with corneal limbal stem cell failure, extensive deep corneal stromal neovascularization, and multiple allograft failures. This review article summarizes the perioperative and postoperative challenges, as well as other considerations associated with the device.
Association Between the “COVID-19 Occupational Vulnerability Index” and COVID-19 Severity and Sequelae Among Hospital Employees
Authors: Navarro-Font Xavier , Kales Stefanos N. , Vicente-Herrero Ma Teófila , Rueda-Garrido Juan Carlos , del Campo Ma Teresa , Reinoso-Barbero Luis , Fernandez-Montero Alejandro
Published: May 2021

Objectives:

In addition to personal and health related factors, healthcare workers have an increased risk due to their work. We assessed the association of the score of the Occupational Vulnerability Index with the risk of suffering a severe COVID-19 and sequelae.

Methods:

Retrospective observational study carried out in healthcare workers. Among 119 employees infected, the COVID-19 Occupational Vulnerability Index (composed of 29 items regarding personal health, working conditions, and ability to comply with preventive measures) was calculated and correlated with COVID-19 severity/sequelae.

Results:

Workers with higher scores (six to seven points) had a significantly increased risk of developing severe disease (OR = 9.73; 95% CI, 1.53 to 35.56) and clinical sequelae (OR = 5.22; 95% CI, 1.80 to 15.16) than those with lower scores (0 to 3).

Conclusion:

The “COVID-19 Occupational Vulnerability Index” may predict the risk of severe COVID-19 disease and clinical sequelae among healthcare workers.
Postoperative Rehabilitation of Chronic Lateral Ankle Instability: A Systematic Review
Authors: Clements Aurora , Belilos Eleanor , Keeling Laura , Kelly Michael , Casscells Nicholas
Published: May 2021

Chronic lateral ankle instability often causes adults to require a surgical intervention with subsequent physical therapy to assist with returning to their prior level of function. This systematic review is hoping to provide an up to date understanding of surgical procedures performed to correct chronic lateral ankle instability and establish a protocol for others to follow when treating adults who are status-post chronic lateral ankle instability surgery. This review looked at level I to III research studies that included surgical interventions to correct chronic lateral ankle instability as well as a rehabilitation protocol. This study found implementation of a rehabilitation protocol after surgical intervention could improve balance and subjective functional outcomes. It also determined that early weight-bearing may allow for early strengthening as range of motion returns faster. Further research is required utilizing larger randomized studies to better evaluate the outcomes of specific rehabilitation protocols in this patient population.
Postoperative Rehabilitation of Anterior Glenohumeral Joint Instability Surgery: A Systematic Review
Authors: Lloyd Gregory , Day Jonathan , Lu Jana , Lincoln Andrew , Attanasio Sarah , Svoboda Steven
Published: May 2021

Anterior glenohumeral instability is the most common form of shoulder instability. The systematic review summarizes the latest research on rehabilitation after Bankart repair. Inclusion criteria included postoperative rehabilitation and published in English between 2000 and 2019. Studies were excluded if they were addresses, comments, or editorials, or included other shoulder injuries or cadaver models. Two rounds of review using Rayyan QCRI software were performed for screening and full text search, and the articles were graded for levels of evidence. Of the 1982 articles, 14 articles were included with levels of evidence 1 through 4. Both arthroscopic and open Bankart repair have demonstrated improving functional outcomes and reducing recurrence rates of anterior shoulder instability. Accelerated postoperative rehabilitation may be comparable to a conventional protocol for arthroscopic repair, and the subscapularis musculature involvement during open repair can impact the timeframe. Strong evidence supports 4 phases of rehabilitation and future clinical trials are needed to compare different programs.
Postoperative Rehabilitation Following Achilles Tendon Repair: A Systematic Review
Authors: Gould Heath P. , Bano Joseph M. , Akman Jennifer L. , Fillar Allison L.
Published: May 2021

The optimal postoperative management of Achilles tendon (AT) rupture remains unknown. The past 2 decades have witnessed a trend toward less rigid immobilization, earlier weightbearing, and accelerated functional rehabilitation postoperatively. The objective of this study was to identify all high-quality studies pertaining to rehabilitation after AT repair and characterize the various rehabilitation protocols that have been described. A systematic review of the English-language literature was performed according to PRISMA guidelines. All included studies represented level 1, 2, or 3 evidence and examined postoperative rehabilitation protocols following the repair of an acute AT rupture. A total of 1187 subjects were included. Surgical technique, rehabilitation protocol, and outcome assessment varied widely between studies. Early postoperative weightbearing with less rigid immobilization appears to accelerate short-term functional recovery. An aggressive rehabilitation program may also be advantageous in the short term, but further studies are needed to determine the long-term effects of these accelerated physical therapy and return-to-play protocols.
Postoperative Rehabilitation of Multidirectional Instability Surgery: A Systematic Review
Authors: Ayoub Catherine C. , Berardino Kevin , Tsou Harry , Mottla Jay , Svoboda Steven J.
Published: May 2021

Multidirectional instability (MDI) of the shoulder is managed with surgery when conservative rehabilitation fails. The optimal postsurgical management of MDI is not well understood. The purpose of this study is to create a systematic review evaluating postsurgical rehabilitation protocols treating MDI. Articles were included if a postsurgical rehabilitation protocol was described following surgical treatment for MDI. Identified articles underwent 2 phases of screening by blinded team members. Remaining articles had their level of evidence determined by a predefined grading system, ranging from levels I to V. Articles with evidence levels I to IV were included in analysis. Of the 163 articles identified in the literature, 9 were included in this study. Surgical techniques examined in these articles include capsular plication, rotator interval closure, and capsular shift. Rehabilitation protocols were evaluated for duration of treatment and physical therapy modalities. Article results were evaluated for subjective and objective measures of protocol success. Overall, there is a lack of evidence to indicate the optimal rehabilitation protocol post-MDI surgery. Further research is needed to compare rehabilitation protocols following specific surgical procedures to determine their effect on postsurgical patient outcomes.
Postoperative Rehabilitation of Anterior Cruciate Ligament Reconstruction: A Systematic Review
Authors: Nelson Christopher , Rajan Lavan , Day Jonathan , Hinton Richard , Bodendorfer Blake M.
Published: May 2021

Recent studies have investigated the various components of postoperative rehabilitation protocols following anterior cruciate ligament reconstruction (ACLR). The objective of this article was to access and summarize the latest evidence for postoperative rehabilitation protocols following ACLR to evaluate common timeframes, number of phases, exercises, as well as the length of rehabilitation protocol. Common interventions include vibration training, open-chain and closed-chain exercises, electrical stimulation, postoperative bracing, and aquatic therapy. The eligibility criteria included English-language articles published from 2000 to 2019 pertaining to rehabilitation following ACLR, excluding addresses, commentaries, and editorials. Two blinded reviewers screened, graded, and extracted data from articles. Recommendations on various aspects of rehabilitation were summarized. A total of 3651 articles were retrieved from the database search, and 62 level 1 to 2 studies were available for extraction. On the basis of the evidence, vibration training can be safely incorporated into the postoperative rehabilitation protocol following ACLR. Accelerated rehabilitation may give patients short-term functional benefits. Open kinetic chain exercises may have additional strength and endurance benefits. Postoperative bracing does not confer additional benefits. Long-term use of neuromuscular electrical stimulation seems to be more beneficial than short-term use. Aquatic rehabilitation may be beneficial in the early phases of anterior cruciate ligament rehabilitation.
Postoperative Rehabilitation of Posterior Glenohumeral Joint Instability Surgery: A Systematic Review
Authors: Koczan Barbra , Stryder Brandon , Mitchell Carter
Published: May 2021

Posterior glenohumeral (GH) joint instability is uncommon compared with anterior and multidirectional instability. A variety of surgical techniques are used to treat posterior GH instability. As a result, there are numerous rehabilitation protocols that vary greatly. The objective of this review was to define, evaluate and compare the postsurgical rehabilitation protocols for patients treated surgically for posterior GH instability. The review contains articles that outline a rehabilitation protocol following a surgical repair of posterior GH instability. A multidatabase search was conducted. Two independent, blinded reviewers decided on inclusion and exclusion of each study, with a second round to resolve conflicts. Data was extracted from the pertinent studies after the grading of evidence was conducted by 2 reviewers. Sixteen studies of the original 859 were included. Most studies included a 3-phase to 4-phase protocol that consisted of immobilization, remobilization, strength training, and sport-specific training. A review of current literature shows a paucity of high-quality studies regarding outcomes of rehabilitation following surgery for posterior GH instability. Most studies had favorable results, with most patients returning to their presurgical level of activity.
Carb-conscious: the role of carbohydrate intake in recovery from exercise
Authors: Gonzalez Javier T. , Wallis Gareth A.
Published: May 2021

Purpose of review

The present review summarized evidence on the role of carbohydrates in recovery from exercise within the context of acute and chronic effects on metabolism and performance.

Recent findings

Recent studies demonstrate that, in contrast to recovery of muscle glycogen stores, the recovery of liver glycogen stores can be accelerated by the co-ingestion of fructose with glucose-based carbohydrates. Three recent studies suggest this can extend time-to-exhaustion during endurance exercise tests. However, periodically restricting carbohydrate intakes during recovery from some training sessions to slow the recovery of liver and muscle glycogen stores may, over time, result in a modest increase in the ability to oxidize fat during exercise in a fasted state. Whether this periodized strategy translates into a performance advantage in the fed state remains to be clearly demonstrated.

To maximize recovery of glycogen stores and the capacity to perform in subsequent endurance exercise, athletes should consider ingesting at least 1.2 g carbohydrate per kilogram body mass per hour – for the first few hours of recovery – as a mixture of fructose and glucose-based carbohydrates. However, if a goal is increased capacity for fat oxidation, athletes should consider restricting carbohydrate intakes during recovery from some key training sessions.

Video abstract

http://links.lww.com/COCN/A15