bluuebunny/crossref_metadata_2025 huggingface dataset:
Impacts of a Balanced Omega 6:3 Diet on Fatty Acid Deposition in White and Brown Adipose Tissue and Circulating Plasma in the Hibernating Arctic Ground Squirrel
Authors: Rice Sarah , Mikes Monica , Drew Kelly , Bibus Doug
Published: April 2020

Hibernators, such as arctic ground squirrels (AGS), fuel the majority of all their metabolic needs from fat deposits through the hibernation season (Dark 2005). Natural fatty acid profiles of free‐ranging AGS have omega 6:3 ratios close to 1:1, showing a far higher consumption of omega 3 fatty acids than captive animals, fed a standard Mazuri rodent chow (which have omega 6:3 ratios close to 8:1). Specific concentrations of omega 6 polyunsaturated fatty acids (PUFAs) enhance hibernation (Frank 2008) and absence of essential fatty acids reduce time in torpor (Florant 1993). To our knowledge, only three studies have investigated the impact of omega 3s on hibernation physiology (Giroud 2018, Frank 2004, and Hill and Florant 2000). In other species, high consumption of omega 3 fatty acids show dose‐dependent lowering of serum triglycerides with other health benefits (Balk 2006). How increased consumption of omega 3 fatty acids impact brown adipose tissue deposition and fatty acid profiles in tissue and serum related to storage and utilization in hibernating AGS is unknown.

A group of wild juvenile AGS (female=12, male=12) were fed either a test diet, with an omega 6:3 ratio of 1.3:1, or a standard chow control diet, with an omega 6:3 ratio of 8:1, from mid‐July (after trapping and quarantine) till animals entered hibernation (August–September). Tissues were collected mid‐December at three specific physiological states of hibernation: early torpor, late torpor and arousal. Total lipid fatty acid profiles of plasma, brown adipose and white adipose tissue were quantified by GC analysis. Axillar brown adipose tissue was dissected and weighed.

Preliminary results show a significant increase in axillar brown adipose tissue mass in the omega 6:3 balanced diet animals (p<0.038). Preliminary data also indicates increased percentages of circulating levels of polyunsaturated fatty acids in plasma of hibernating AGS compared to summer or fall animals (p<0.01). Full fatty acid analysis is pending.

In conclusion, our preliminary results indicate a balanced diet of omega 6:3 (1:3:1) in hibernating Arctic Ground Squirrels may enhance brown adipose tissue deposition.

Support or Funding Information

This work was supported by NIH 20GM103395, UL1GM118991, TL4GM118992, or RL5GM118990. This work was performed in conformance with the FASEB Statement of Principles for animals used in research.

This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Kinetics of Reactive Oxygen Species and Total Antioxidant Capacity during Moderate Treadmill Running after 8 Weeks of Endurance Training
Authors: Yoon Aram , Hughley Timothy , Williams Richard H.
Published: April 2020

The purpose of this study is to investigate the effect of aerobic exercise intensity on the kinetics of reactive oxygen species and total antioxidant capacity during the moderate intensity of treadmill running. Twelve healthy collegiate male students participated and were randomly divided into two groups. Each group of subjects trained at 80% and 50% HRmax respectively for 30 min per session, 3 times per week for 8 weeks. After 48 hours of the training session, treadmill running task was imposed on each group at 70% of VO2max for 90 minutes. Metabolic data were monitored using a gas analysis system. Blood samples were taken from the finger before exercise and after 30 minutes, 60 minutes, and 90 minutes of exercise for measuring the blood lactate, derivatives of Reactive Oxygen Metabolites (d‐ROM), and biological antioxidant potential (BAP). All data were analyzed by two‐way ANOVA of SPSS 18.0. The differences between pre and post training were significant in d‐ROM and BAP (p<.05). The changes of d‐ROM were significantly increased by aerobic training, and there were significant differences among exercise durations (p<.05). The changes of BAP were not significantly different between training intensity groups, and there were significant differences among exercise durations (p<.05). As shown above, the occurrence of d‐ROM and BAP were altered by training intensity and exercise duration. In other words, the occurrence of reactive oxygen by high intensive training was abundant and there were significant changes in 30 minutes of exercise based on exercise duration. On the other hand, there were significant changes in total antioxidant capacity in 60 minutes of exercise based on exercise duration. In conclusion, low‐intensity training and within 60 minutes of exercise might be suitable in the point of defending the cellular damage caused by exercise.

This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
ECG Assessment of Cardiac Function Before, During, and After a 1 km Swim
Authors: Wilson Ted , Bergen Silas R. , Johnson Bruce D. , Harrison Micheal F.
Published: April 2020

Assessments of electrocardiographic (ECG) responses during swimming activities are impossible without mobile waterproof recording units and rarely completed. This preliminary study characterized changes in the ventricular diastolic, PR‐, QT‐, and RR‐intervals that occurred during a 1 km indoor swim in 78°F water with a waterproof Actiwave ECG recording system (CamNtech Inc., Boerne, TX) and the .epf data files were analyzed with software from ADInstruments Inc. (Colorado Springs CO). Values within times expressed as mean ± SE with significance evaluated using ANOVA and repeated measures. Competitive club swimmers (3 male, 1 female) with an age, height, and weight of 51 ± 3 years, 175 ± 4 cm, and 83 ± 8 kg, with a BMI of 27 ± 2 completed the 1 km swim (44 laps × 75 foot laps) using a standard crawl in 17.9 ± 1.3 minutes using 10.5 ± 0.50 arm cycles/second. A continuous ECG with waveform was obtained and measurements were performed 120 and 30 seconds before swim, during the swim (at end of lap‐1, ‐22 and ‐43), and at 30 and 300 seconds post‐completion. Heart rate (from RR‐interval) −120, and −30 seconds prior to the swim, at end of swim lap 1, 22 and 43, and during recovery 30 and 300 seconds post swim was 68 ± 5, 73 ± 6, 107 ± 3, 142 ± 4, 147 ± 5, 132 ± 8 and 89 ± 3 beats/minute (P<0.0001). Respective QT‐intervals were 392 ± 14, 374 ± 13, 307 ± 38, 259 ± 15, 254 ± 2, 255 ± 14, and 338 ± 6 msec (n = 2 at lap‐1, and n = 3 at lap‐22) (P<0.0001). Respective ventricular diastole time was 509 ± 61, 468 ± 61, 253 ± 45, 166 ± 10, 166 ± 7, 204 ± 25 and 339 ± 26 msec (P<0.0001). Respective PR‐Intervals were 130 ± 12, 127 ± 12, 111 ± 18, 111 ± 2, 105 ± 14, 107 ± 15 and 125 ± 18 msec (P<0.094). Heart rate increased and duration of ventricular diastole decreased between lap 1 and 22, and was relatively stable between lap 22 and the end of lap 43. This study determined that with appropriate waterproof equipment a continuous ECG record can be collected from swimming athletes and used to provide an accurate assessment swim‐associated changes in cardiac function.

This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Intrathecal Morphine versus Intrathecal Hydromorphone for Analgesia after Cesarean Delivery
Authors: Sharpe Emily E. , Molitor Rochelle J. , Arendt Katherine W. , Torbenson Vanessa E. , Olsen David A. , Johnson Rebecca L. , Schroeder Darrell R. , Jacob Adam K. , Niesen Adam D. , Sviggum Hans P.
Published: April 2020

Background

Intrathecal opioids are routinely administered during spinal anesthesia for postcesarean analgesia. The effectiveness of intrathecal morphine for postcesarean analgesia is well established, and the use of intrathecal hydromorphone is growing. No prospective studies have compared the effectiveness of equipotent doses of intrathecal morphine versus intrathecal hydromorphone as part of a multimodal analgesic regimen for postcesarean analgesia. The authors hypothesized that intrathecal morphine would result in superior analgesia compared with intrathecal hydromorphone 24 h after delivery.

Methods

In this single-center, double-blinded, randomized trial, 138 parturients undergoing scheduled cesarean delivery were randomized to receive 150 µg of intrathecal morphine or 75 µg of intrathecal hydromorphone as part of a primary spinal anesthetic and multimodal analgesic regimen; 134 parturients were included in the analysis. The primary outcome was the numerical rating scale score for pain with movement 24 h after delivery. Static and dynamic pain scores, nausea, pruritus, degree of sedation, and patient satisfaction were assessed every 6 h for 36 h postpartum. Total opioid consumption was recorded.

Results

There was no significant difference in pain scores with movement at 24 h (intrathecal hydromorphone median [25th, 75th] 4 [3, 5] and intrathecal morphine 3 [2, 4.5]) or at any time point (estimated difference, 0.5; 95% CI, 0 to 1; P = 0.139). Opioid received in the first 24 h did not differ between groups (median [25th, 75th] oral morphine milligram equivalents for intrathecal hydromorphone 30 [7.5, 45.06] vs. intrathecal morphine 22.5 [14.0, 37.5], P = 0.769). From Kaplan–Meier analysis, the median time to first opioid request was 5.4 h for hydromorphone and 12.1 h for morphine (log-rank test P = 0.200).

Conclusions

Although the hypothesis was that intrathecal morphine would provide superior analgesia to intrathecal hydromorphone, the results did not confirm this. At the doses studied, both intrathecal morphine and intrathecal hydromorphone provide effective postcesarean analgesia when combined with a multimodal analgesia regimen.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Meta-Analysis on the Identification of Linguistic and Emotional Prosody in Cochlear Implant Users and Vocoder Simulations
Authors: Everhardt Marita K. , Sarampalis Anastasios , Coler Matt , Başkent Deniz , Lowie Wander
Published: April 2020

Objectives:

This study quantitatively assesses how cochlear implants (CIs) and vocoder simulations of CIs influence the identification of linguistic and emotional prosody in nontonal languages. By means of meta-analysis, it was explored how accurately CI users and normal-hearing (NH) listeners of vocoder simulations (henceforth: simulation listeners) identify prosody compared with NH listeners of unprocessed speech (henceforth: NH listeners), whether this effect of electric hearing differs between CI users and simulation listeners, and whether the effect of electric hearing is influenced by the type of prosody that listeners identify or by the availability of specific cues in the speech signal.

Design:

Records were found by searching the PubMed Central, Web of Science, Scopus, Science Direct, and PsycINFO databases (January 2018) using the search terms “cochlear implant prosody” and “vocoder prosody.” Records (published in English) were included that reported results of experimental studies comparing CI users’ and/or simulation listeners’ identification of linguistic and/or emotional prosody in nontonal languages to that of NH listeners (all ages included). Studies that met the inclusion criteria were subjected to a multilevel random-effects meta-analysis.

Results:

Sixty-four studies reported in 28 records were included in the meta-analysis. The analysis indicated that CI users and simulation listeners were less accurate in correctly identifying linguistic and emotional prosody compared with NH listeners, that the identification of emotional prosody was more strongly compromised by the electric hearing speech signal than linguistic prosody was, and that the low quality of transmission of fundamental frequency (f

0
) through the electric hearing speech signal was the main cause of compromised prosody identification in CI users and simulation listeners. Moreover, results indicated that the accuracy with which CI users and simulation listeners identified linguistic and emotional prosody was comparable, suggesting that vocoder simulations with carefully selected parameters can provide a good estimate of how prosody may be identified by CI users.

Conclusions:

The meta-analysis revealed a robust negative effect of electric hearing, where CIs and vocoder simulations had a similar negative influence on the identification of linguistic and emotional prosody, which seemed mainly due to inadequate transmission of f

0
cues through the degraded electric hearing speech signal of CIs and vocoder simulations.
Opioid and Benzodiazepine Withdrawal Syndromes in Trauma ICU Patients: A Prospective Exploratory Study
Authors: Arroyo-Novoa Carmen Mabel , Figueroa-Ramos Milagros I. , Balas Michele , Rodríguez Pablo , Puntillo Kathleen A.
Published: April 2020

Objectives:

Trauma ICU patients may require high and/or prolonged doses of opioids and/or benzodiazepines as part of their treatment. These medications may contribute to drug physical dependence, a response manifested by withdrawal syndrome. We aimed to identify risk factors, symptoms, and clinical variables associated with probable withdrawal syndrome.

Design:

Prospective exploratory observational study.

Setting:

Trauma ICU in large medical center in Puerto Rico.

Participants:

Fifty patients who received opioids and/or benzodiazepines for greater than or equal to 5 days.

Measurements and Main Results:

Using an opioid/benzodiazepine withdrawal syndrome checklist developed from research in adult ICU patients, the Diagnostic and Statistical Manual of Mental Disorders-5, and the International Classification of Diseases, 10th Edition, we evaluated patients at baseline and for 72 hours after drug weaning was initiated. Patients received opioid/benzodiazepine (88%), opioid (10%), or benzodiazepine (2%). Probable withdrawal syndrome occurred in 44%, questionable withdrawal syndrome in 20%, and no withdrawal syndrome in 18 (36%). Signs that were more frequent in the probable withdrawal syndrome group were agitation, diarrhea, fever, tachypnea, lacrimation, and hyperactive delirium. Patients who developed probable withdrawal syndrome spent almost double the amount of time receiving mechanical ventilation, and length of stay was higher in both ICU and hospital when compared with patients in the other two groups. Age, cumulative opioid dose amounts, and previous drug (opioid/benzodiazepine, cannabis, cocaine, or heroin) use were associated with odds of developing withdrawal syndrome. With the addition of Richmond Agitation-Sedation Scale and delirium to the multilevel analysis, older age no longer had its protective effect, whereas increase in Richmond Agitation-Sedation Scale scores, delirium presence, and increased duration of mechanical ventilation were associated with higher odds of withdrawal syndrome.

Conclusions:

We identified probable withdrawal syndrome in a sample of trauma ICU patients through observation of several associated symptoms. Significant factors associated with withdrawal syndrome found in this study should be considered when caring for patients being weaned from opioids and/or benzodiazepines. Further validation of the opioid/benzodiazepine withdrawal syndrome checklist is recommended.
Extracorporeal Membrane Oxygenation as a Bridge to Chimeric Antigen Receptor T-cell Therapy for Severe Refractory Sepsis in the Setting of Relapsed Refractory Pediatric Acute Lymphoblastic Leukemia: A Case Report
Authors: Stoner Alyssa , Miller Jenna O. , Flatt Terrie , Wallisch Jessica S.
Published: April 2020

Background:

Pediatric oncology patients with sepsis are at higher risk of morbidity and mortality compared with pediatric patients without malignancy. Historically, patients with relapsed and/or refractory disease were not considered candidates for aggressive life support strategies including extracorporeal membrane oxygenation support.

Case Summary:

We report a 4-year-old female with relapsed refractory pre-B cell acute lymphoblastic leukemia preparing for chimeric antigen receptor T cell therapy with tisagenlecleucel who was admitted with fever and neutropenia. She progressed to refractory septic shock secondary to Escherichia coli bacteremia and required escalation of hemodynamic support to venoarterial extracorporeal membrane oxygenation cannulation. She cleared her E. coli bacteremia, was decannulated, subsequently received her chimeric antigen receptor T-cell therapy, and was declared disease free 1 month from her initial presentation.

Conclusion:

The ability to provide chimeric antigen receptor T-cell therapy at designated institutions can augment extracorporeal membrane oxygenation candidacy discussions in oncology patients with relapsed disease and may make extracorporeal membrane oxygenation candidacy for oncology patients with refractory sepsis more favorable.
Utilization of a Resuscitative Care Unit for Initial Triage, Management, and Disposition of Minor Intracranial Hemorrhage
Authors: Joseph Jacob R. , Haas Nathan L. , Joseph John R , Heth Jason , Szerlip Nicholas J. , Bassin Benjamin S.
Published: April 2020

Objectives:

Management of minor intracranial hemorrhage typically involves ICU admission. ICU capacity is increasingly strained, resulting in increased emergency department boarding of critically ill patients. Our objectives were to implement a novel protocol using our emergency department–based resuscitative care unit for management of management of minor intracranial hemorrhage patients in the emergency department setting, to provide timely and appropriate critical care, and to decrease inpatient ICU utilization.

Design:

Retrospective analysis of prospectively collected data.

Setting:

Single large academic medical center in the United States

Patients:

Adult patients presenting to the emergency department with management of minor intracranial hemorrhage managed via our resuscitative care unit-management of minor intracranial hemorrhage protocol from September 2017 to April 2019.

Intervention:

Implementation of a resuscitative care unit-management of minor intracranial hemorrhage protocol.

Measurements and Main Results:

Demographic data, need for vasoactive infusions in the emergency department, emergency department and hospital length of stay, emergency department disposition, and 30-day outcomes (readmission, mortality, need for neurosurgical procedure) were collected. Fifty-five patients were identified, with mean age 67.1 ± 20.0 years. Mean Glasgow Coma Scale on presentation was 14.8 ± 0.5, and 66% had a history of trauma. Locations of hemorrhage were subdural (42%), intraparenchymal (35%), subarachnoid (15%), intratumoral (7%), and intraventricular (2%). Nineteen patients (35%) were discharged from the emergency department, 22 (40%) were admitted to general care, and 14 (26%) were admitted to intensive care. In discharged patients, there was no mortality or neurosurgical interventions at 30 days. In a subgroup analysis of 36 patients with a traumatic mechanism, 18 (50%) were able to be discharged from the emergency department after management in the resuscitative care unit.

Conclusions:

Initial management of emergency department patients with minor intracranial hemorrhage in a resuscitative care unit appears safe and feasible and was associated with a substantial rate of discharge from the emergency department (35%) and a low rate of admission to an inpatient ICU (26%). Use of this strategy was associated with rapid initiation of ICU-level care, which may help alleviate the challenge of increasing emergency department boarding time of critically ill patients facing many institutions.
Antiphospholipid syndrome: a clinical perspective
Authors: Zuo Yu , Shi Hui , Li Chun , Knight Jason S.
Published: April 2020

Antiphospholipid syndrome (APS) is a thromboinflammatory disease with a variety of clinical phenotypes. Primary thrombosis prophylaxis should take an individualized risk stratification approach. Moderate-intensity vitamin K antagonist such as warfarin remains the primary strategy for secondary thrombosis prophylaxis among APS patients, especially for patients with predominantly venous disease. For now, direct oral anti-coagulants should be avoided in most APS patients, especially those with history of arterial manifestations. Obstetric APS management should be tailored based on an individual patient's antiphospholipid antibody profile, and obstetric and thrombotic history. Pharmacological agents beyond anticoagulants may be considered for the management of microthrombotic and nonthrombotic manifestations of APS, although more data are needed. A relatively recent discovery in the area of APS pathogenesis is the implication of neutrophil extracellular traps in thrombin generation and initiation of inflammatory cascades. APS is a complex thromboinflammatory disease with a broad clinical spectrum. Personalized therapy according to an individual's unique thrombosis and obstetric risk should be advocated.
Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis
Authors: Chen Jing-Yu , Qiao Kun , Liu Feng , Wu Bo , Xu Xin , Jiao Guo-Qing , Lu Rong-Guo , Li Hui-Xing , Zhao Jin , Huang Jian , Yang Yi , Lu Xiao-Jie , Li Jia-Shu , Jiang Shu-Yun , Wang Da-Peng , Hu Chun-Xiao , Wang Gui-Long , Huang Dong-Xiao , Jiao Guo-Hui , Wei Dong , Ye Shu-Gao , Huang Jian-An , Zhou Li , Zhang Xiao-Qin , He Jian-Xing
Published: April 2020

Background

Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.

Methods

From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.

Results

Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.

Conclusions

LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.
A Phase 1 Study of SLC-0111, a Novel Inhibitor of Carbonic Anhydrase IX, in Patients With Advanced Solid Tumors
Authors: McDonald Paul C. , Chia Stephen , Bedard Philippe L. , Chu Quincy , Lyle Michael , Tang Liren , Singh Madhu , Zhang Zaihui , Supuran Claudiu T. , Renouf Daniel J. , Dedhar Shoukat
Published: April 2020

Objectives:

SLC-0111 is an ureido-substituted benzenesulfonamide small molecule inhibitor of carbonic anhydrase IX. The objectives of this first-in-human Phase 1 study were to determine the safety and tolerability of SLC-0111 in patients with advanced solid tumors and to establish the recommended Phase 2 dose for future clinical investigations.

Materials and Methods:

Using a 3+3 design, dose escalation started at 500 mg oral daily dosing of SLC-0111 in cohort 1 and increased to 1000 and 2000 mg in cohorts 2 and 3. Drug-related adverse events (AEs) were monitored to determine safety and tolerability. Pharmacokinetic analyses assessed plasma concentrations of single and repeated doses of SLC-0111. RECIST 1.1 criteria were used to assess disease progression.

Results:

No dose-limiting toxicities were reported and patients dosed at ≤1000 mg exhibited fewer drug-related AEs ≥ grade 3 and fewer AEs such as nausea and vomiting, compared with the 2000-mg cohort. Forty-one percent of patients experienced dose interruptions or discontinuation and the majority (71%) of these occurred in the 2000-mg cohort. Mean C
max and AUC(0-24) values for single doses were similar at the 1000-mg and 2000-mg dose levels. Mean T
max and T
1/2 values of SLC-0111 were similar after single and repeated dosing. Power-law analysis of C
max and AUC0-24 showed that exposure to SLC-0111 was generally dose proportional. No objective responses were observed, but stable disease >24 weeks was observed in 2 patients.

Conclusions:

SLC-0111 was safe in patients with previously treated, advanced solid tumors. The safety and pharmacokinetic data support 1000 mg/d as the recommended phase 2 dose for SLC-0111.
ECHO Autism: Integrating Maintenance of Certification with Extension for Community Healthcare Outcomes Improves Developmental Screening
Authors: Bellesheim Katherine R. , Kizzee Richard L. , Curran Alicia , Sohl Kristin
Published: April 2020

Objective:

Recent estimates indicate that most pediatricians do not consistently meet the American Academy of Pediatrics developmental screening guidelines, contributing to the delay of vital evaluations and interventions for autism spectrum disorder (ASD). Our objective was to evaluate the utility of Maintenance of Certification (MOC) Quality Improvement (QI) training designed to improve developmental screening rates in underserved, rural primary care practices. Trainings on best screening practices were disseminated to primary care providers (PCPs) through Extension for Community Healthcare Outcomes (ECHO) Autism, a virtual learning network.

Method:

Across 2 cohorts, 24 PCPs were enrolled in MOC Part 4 training modules delivered through the ECHO Autism QI Learning Network. Throughout the 12 months of enrollment, PCPs reported information on general and ASD-specific developmental screenings conducted at 18- and 24-month well-child visits. A 1-year follow-up was conducted to assess the maintenance of screening rates.

Results:

Baseline rates for general and ASD-specific developmental screenings were 53.3% and 68.3%, respectively. By the end of the 12-month learning module, screening rates increased significantly for general development (88.6%) and ASD-specific screenings (99.0%). At the 1-year follow-up, the rate for general developmental screening was 96.7% and for ASD-specific screening was 97.1%.

Conclusion:

Maintenance of Certification Part 4 training delivered through the ECHO Autism QI Learning Network was found to be incentivizing and highly effective in shaping and maintaining PCP developmental screening practices. Improved screening rates show promise in decreasing time to critical developmental evaluations, interventions, and resources. Our methodology is likely transferable to other ECHO communities and may facilitate expedient implementation of best practice standards in primary care.
A Patient With Tricyclic Antidepressant Overdose With Catecholamine-Resistant Hypotension Rescued With Angiotensin II
Authors: Ferdowsali Jacqueline , Ferdowsali Kameron
Published: April 2020

This case report explores the novel use of angiotensin II (Giapreza) for the treatment of vasodilation in the setting of a tricyclic overdose. The purpose of this case is to describe how the use of angiotensin II can improve hemodynamic parameters and result in a dose reduction of other catecholamine vasopressors in vasodilatory shock. The use of angiotensin II is new to clinical practice and has the potential to change outcomes for patients.
Modifiable factors associated with postoperative delirium after hip fracture repair
Authors: Poeran Jashvant , Cozowicz Crispiana , Zubizarreta Nicole , Weinstein Sarah M. , Deiner Stacie G. , Leipzig Rosanne M. , Friedman Joseph I. , Liu Jiabin , Mazumdar Madhu , Memtsoudis Stavros G.
Published: April 2020

BACKGROUND

Postoperative delirium in hip fracture patients is common and is associated with substantial morbidity and consumption of resources.

OBJECTIVE

Using data from the USA, we aimed to examine the relationship between postoperative delirium and (modifiable) peri-operative factors mentioned in the American Geriatrics Society Best Practice Statement on Postoperative Delirium in Older Adults, stratified by ‘young old’ (<80 years) and ‘old-old’ (≥80 years) categories.

DESIGN

Retrospective cohort study from 2006 to 2016.

SETTING

Population-based claims data from the USA.

PARTICIPANTS

Patients undergoing 505 152 hip fracture repairs between 2006 and 2016 as recorded in the Premier Healthcare Database.

MAIN OUTCOMES AND MEASURES

The main outcome was postoperative delirium; modifiable factors of interest were peri-operative opioid use (high, medium or low; <25th, 25 to 75th or >75th percentile of oral morphine equivalents), anaesthesia type (general, neuraxial, both), use of benzodiazepines (long acting, short acting, both), pethidine, nonbenzodiazepine hypnotics, ketamine, corticosteroids and gabapentinoids. Multilevel models assessed associations between these factors and postoperative delirium, in the full cohort, and separately in those aged less than 80 and at least 80 years. Odds ratios (ORs) and Bonferroni-adjusted 95% confidence intervals (95% CIs) are reported.

RESULTS

Overall, postoperative delirium incidence was 15.7% (n = 79 547). After adjustment for relevant covariates, the use of long-acting (OR 1.82, CI 1.74 to 1.89) and combined short and long-acting benzodiazepines (OR 1.56, CI 1.48 to 1.63) and ketamine (OR 1.09, CI 1.03 to 1.15), in particular, was associated with increased odds for postoperative delirium, while neuraxial anaesthesia (OR 0.91 CI 0.85 to 0.98) and opioid use (OR 0.95, CI 0.92 to 0.98 and OR 0.88, CI 0.84 to 0.92 for medium and high dose compared with low dose) were associated with lower odds; all P < 0.05. When analysing data separately by age group, effects of benzodiazepines persisted, while opioid use was only relevant in those aged less than 80 years.

CONCLUSION

We identified modifiable factors associated with postoperative delirium incidence among patients undergoing hip fracture repair surgery.
Testing the endometrium: is there enough evidence to justify clinical use?
Authors: Rahmati Mona , Macklon Nick
Published: April 2020

Purpose of review

Embryo implantation remains the limiting factor in assisted reproduction outcomes. To date research has mainly focused on improving embryo quality, numbers and selection as the route to improve treatment results. However, with success rates plateauing, interest in the possibility of modulating the endometrial factor is increasing, and a number of biomarkers are now available that offer the possibility of assessing endometrial function.

Recent findings

In this review, we review recent evidence for the efficacy of a number of these biomarkers, with emphasis on those that aim to enable improvement in embryo/endometrial developmental synchrony endometrium and that offer an assessment of the degree of immune activation of the endometrium. The emerging field of reproductive tract microbiome analysis is also considered. Finally, nascent biomarkers of materno-foetal dialogue, including noncoding RNAs, microvesicles and endometrial glycans are discussed.

Tests of potential clinical value are emerging, but further validation studies are required. The usage of innovative endometrial biomarkers provides the possibility of targeted therapies rather than the blind empirical approaches to face embryo implantation failure. It also enables the possibility of randomized controlled trials of interventions targeting the individual cause rather empirical treatments of undiagnosed recurrent implantation failure.
Visit-to-visit blood pressure variability in patients with type 2 diabetes with and without previous history of cardiovascular disease
Authors: Radaelli Maria Grazia , Ciardullo Stefano , Perra Silvia , Cannistraci Rosa , Bianconi Eleonora , Muraca Emanuele , Zerbini Francesca , Manzoni Giuseppina , Grassi Guido , Mancia Giuseppe , Lattuada Guido , Perseghin Gianluca
Published: April 2020

Objective:

Visit-to-visit variability in SBP is a risk factor for cardiovascular disease (CVD) in type 2 diabetes (T2DM) but little is known on whether in T2DM this differs according to presence or absence of previous CVD.

Methods:

We retrospectively assessed the coefficient of variation (standard deviation/mean) of mean SBP (SBP-CV) in 970 patients (44% with established CVD) attending at least four times our secondary care diabetes clinic in 2015–2016 to estimate their risk of CVD-related events using the 10-year UKPDS Risk Engine.

Results:

Patients with established CVD had a higher SBP-CV (10.3 ± 4.8%) than patients without CVD (8.9 ± 4.3%; P < 0.001) as confirmed by the progressively higher prevalence of established CVD in tertiles of SBP-CV (36.6, 46.1, and 52.0%; P < 0.001), in association with more aggressive and complex drug regimens. On the basis of the 10-year UKPDS Risk Engine, higher SBP-CV values were associated with increased risks of the CVD outcomes regardless of the previous history of CVD in multivariate models.

Conclusion:

Visit-to-visit variability of SBP was greater in T2DM patients with that in those without previous history of CVD, and maintained an independent association with higher estimated risk of CVD-related events regardless of the history of CVD, suggesting that its prognostic significance is relevant in the entire CVD continuum of patients with T2DM.
INTRARETINAL HYPERREFLECTIVE LINES
Authors: Amoroso Francesca , Mrejen Sarah , Pedinielli Alexandre , Tabary Sandrine , Souied Eric H. , Gaudric Alain , Cohen Salomon Y.
Published: April 2020

Purpose:

To report intraretinal hyperreflective lines related to various macular conditions.

Methods:

All cases were imaged with color photographs, autofluorescence images, and spectral-domain optical coherence tomography, some with fluorescein and/or indocyanine green angiography. Demographic data, imaging, course and outcome were retrospectively analyzed.

Results:

Forty-nine eyes of 43 patients (16 men and 27 women) were included. Hyperreflective vertical lines (38 eyes) or curvilinear lines along the Henle fiber layer (11 eyes) were present in association with various macular conditions: adult vitelliform dystrophy or pattern dystrophy (24 eyes) frequently associated with an epiretinal membrane (six eyes) and/or thick choroid (nine eyes), age-related maculopathy or macular degeneration (nine eyes), partial resorption of subretinal or intraretinal hemorrhages (five eyes), idiopathic macular microhole (two eyes), vitreomacular traction (three eyes), multiple evanescent white dot syndrome (three eyes), fundus flavimaculatus (two eyes), and pachychoroid pigment epitheliopathy (one eye). The lines fully vanished in cases of hemorrhages, multiple evanescent white dot syndrome or resolution of vitreomacular traction, but usually persisted with gradual thinning in the other conditions.

Conclusion:

The present series showed that intraretinal hyperreflective lines could occur in various inflammatory, degenerative, or tractional conditions. They could reflect a previously unrecognized reaction to various photoreceptor, Müller cell, and/or retinal pigment epithelium damage.
The nurse practitioner as a bridge to interprofessional research team collaboration in rural community clinics
Authors: Ferguson Laurie Anne , Arnold Connie , Morris James , Rademaker Alfred , Davis Terry
Published: April 2020

Clinical health outcomes and health disparities can be improved through interprofessional collaborations among multidisciplinary clinicians, health care services researchers, and patients. Bridging gaps between community clinics and urban academic centers allows added valuable perspectives that can lead to improved care and extend clinical research. Nurse practitioners (NPs) who serve as primary care providers in many rural community clinics can facilitate access to clinical trials for patients who are rarely included in health care services research as well as coordinate interprofessional research team collaboration. A NP working in a rural clinic can assist academic-based research teams in designing feasible strategies to address disparities and improve health care of underserved populations. The purpose of this article was to provide an example of a rural provider/urban academic research team collaborating to conduct a health literacy-directed randomized controlled trial to improve colorectal cancer screening in isolated rural community clinics.
Hepatitis C virus screening at a Veterans Administration Hospital in New York City
Authors: Rostata-Pesola Helen , Olender Lynda , Leon Nikki , Aytaman Ayse , Hoffman Renee , Pesola Gene R.
Published: April 2020

Background:

Asymptomatic hepatitis C virus (HCV) infection has the highest prevalence in “baby boomers” born in 1945 through 1965. New York State mandates that all persons born during this period be screened at least once for hepatitis C.

Local problem:

Military veteran HCV screening is often missed during primary care visits.

Methods:

After baseline screening, provider education with and without an HCV education dashboard of information in the Electronic Medical Record system was used to determine if screening proportions could be improved. The Chi-square and Z-test for independent proportions compared after with before education screening. The odds ratio compared after versus before screening odds.

Interventions:

Two interventions were tested. One was provider education with a 30-minute lecture. The second was the lecture with addition of an HCV education computer dashboard.

Results:

The Chi-square test and Z-test comparing the month immediately after provider education was significant for increased screening (p < .01) compared with baseline. There was a 2.04-fold (95% confidence interval, 1.31–3.20) greater odds of screening in the month after education. If two or more months went by after education, the effect of education no longer improved screening proportions. Provider education plus the use of HCV education dashboard did not improve screening from baseline to the month immediately after screening (p = .95).

Conclusion:

Provider education significantly improved HCV screening the month immediately after education, then regressed toward baseline. Adding an HCV education dashboard to education did not improve screening. To maintain elevated screening proportions, provider screening education must be reinforced on a frequent basis for sustained effect.
Functional imaging in ectopic Cushing syndrome
Authors: Grigoryan Seda , Avram Anca M. , Turcu Adina F.
Published: April 2020

Purpose of review

Ectopic adrenocorticotropic hormone (ACTH)-secreting tumors are commonly small, yet they often lead to fulminant forms of Cushing syndrome. High-resolution functional imaging modalities, such as [68Ga]-DOTATATE, have been recently introduced in clinical practice for the identification of neuroendocrine tumors. In this review, we focus on the performance of [68Ga]-DOTATATE as a tool for localizing primary and metastatic sources of ectopic Cushing syndrome (ECS).

Recent findings

Prompt surgical removal of ectopic ACTH-secreting tumors is the mainstay of therapy in patients with ECS. Detecting such tumors with conventional cross-sectional imaging is often unsuccessful, owing to their small size. [68Ga]-DOTATATE has been approved in 2016 by the Federal Drug Administration for imaging well differentiated neuroendocrine tumors. Data regarding the performance of [68Ga]-DOTATATE for detecting ectopic ACTH-secreting tumors remain limited, in part owing to the recent introduction of this imaging modality in clinical practice, and in part because of the low prevalence of ECS. Nevertheless, [68Ga]-DOTATATE has been reported to be useful in identifying primary and metastatic ectopic ACTH-secreting lesions that were not apparent on other imaging studies, impacting the clinical care of many patients with ECS.

[68Ga]-DOTATATE-based imaging, which targets the somatostatin receptors abundantly expressed in neuroendocrine tumors, has generally high, although variable resolution in detecting the source(s) of ECS.
Is Referral to Home Health Rehabilitation After Inpatient Rehabilitation Facility Associated With 90-Day Hospital Readmission for Adult Patients With Stroke?
Authors: Hong Ickpyo , Knox Sara , Pryor Loree , Mroz Tracy M. , Graham James E. , Shields Meredith F. , Reistetter Timothy A.
Published: April 2020

Objective

We examined the association between home health rehabilitation referral and 90-day risk-adjusted hospital readmission after discharge from inpatient rehabilitation facilities among adult patients recovering from stroke (N = 1219).

Design

A secondary data analysis of the 2005–2006 Stroke Recovery in Underserved Population database. A logistic regression model, multilevel model, and the propensity score inverse probability weighting model were used to evaluate the risk of 90-day rehospitalization between patients with stroke who received a referral for home health rehabilitation and those who did not receive a home health rehabilitation referral at inpatient rehabilitation facility discharge.

Results

The regression, multilevel, and propensity score inverse probability weighting models indicated that inpatient rehabilitation facility patients with stroke who received home health rehabilitation referral had substantially lower odds of 90-day rehospitalization after inpatient rehabilitation facility discharge compared with those who were not referred to home health (odds ratio = 0.325, 95% confidence interval = 0.138–0.764; odds ratio = 0.340, 95% confidence interval = 0.139–0.832; odds ratio = 0.407, 95% confidence interval = 0.183–0.906, respectively).

Conclusions

Our findings suggest the importance of continuation of care (home health) after hospitalization and intense inpatient rehabilitation for stroke. Additional research is needed to establish appropriate use criteria and explore potential underuse of home health services as well as the benefits for follow-up outpatient services for those who do not qualify for home health at inpatient rehabilitation facility discharge.
Interventions to Reduce Problems Related to the Readability and Comprehensibility of Drug Packages and Labels: A Systematic Review
Authors: Simas da Rocha Bruno , Garcia Moraes Cassia , Miyake Okumura Lucas , da Cruz Fernanda , Sirtori Lisana , da Silva Pons Emilia
Published: April 2020

Objective

The aim of the study was to evaluate the effectiveness of interventions designed to reduce problems with readability and comprehensibility in drug labels.

Methods

A systematic review of observational and experimental studies was conducted using MEDLINE (via PubMed), Embase, and Scopus databases. Two independent reviewers selected articles and collected data about study design, interventions, and outcomes.

Results

Of 1786 studies screened, 17 were included in this systematic review. The main findings were described according to the type of intervention in the drug package or label: color-coded labels (7 studies); changes in information layout (5 studies); changes in font size (3 studies); and interventions involving look-alike/sound-alike (LASA) drugs (3 studies). Color changes were important both for healthcare professionals to improve safety in hospital practice and for medication users to differentiate between the types of insulin. Layout changes were effective and included highlighting key information, such as medication name, dose, and instructions. Increased font size yielded good results in the recognition and identification of medications mainly for the population with impaired vision. This review was limited by the heterogeneity of interventions and populations studied, as well as the small number of high-quality studies, which prevented meta-analysis across any one intervention or outcome.

Conclusions

All studies reported positive results for the proposed interventions. In the case of LASA drug names, the use of resources beyond Tall Man lettering (such as color and highlighting) reduced recognition errors, which may contribute to the development of new strategies to improve safety in the use of LASA drugs.
Machine Learning Analysis Reveals Novel Neuroimaging and Clinical Signatures of Frailty in HIV
Authors: Paul Robert H. , Cho Kyu S. , Luckett Patrick , Strain Jeremy F. , Belden Andrew C. , Bolzenius Jacob D. , Navid Jaimie , Garcia-Egan Paola M. , Cooley Sarah A. , Wisch Julie K. , Boerwinkle Anna H. , Tomov Dimitre , Obosi Abel , Mannarino Julie A. , Ances Beau M.
Published: April 2020

Background:

Frailty is an important clinical concern for the aging population of people living with HIV (PLWH). The objective of this study was to identify the combination of risk features that distinguish frail from nonfrail individuals.

Setting:

Machine learning analysis of highly dimensional risk features was performed on a clinical cohort of PLWH.

Methods:

Participants included 105 older (average age = 55.6) PLWH, with at least a 3-month history of combination antiretroviral therapy (median CD4 = 546). Predictors included demographics, HIV clinical markers, comorbid health conditions, cognition, and neuroimaging (ie, volumetrics, resting-state functional connectivity, and cerebral blood flow). Gradient-boosted multivariate regressions were implemented to establish linear and interactive classification models. Model performance was determined by sensitivity/specificity (F1 score) with 5-fold cross validation.

Results:

The linear gradient-boosted multivariate regression classifier included lower current CD4 count, lower psychomotor performance, and multiple neuroimaging indices (volumes, network connectivity, and blood flow) in visual and motor brain systems (F1 score = 71%; precision = 84%; and sensitivity = 66%). The interactive model identified novel synergies between neuroimaging features, female sex, symptoms of depression, and current CD4 count.

Conclusions:

Data-driven algorithms built from highly dimensional clinical and brain imaging features implicate disruption to the visuomotor system in older PLWH designated as frail individuals. Interactions between lower CD4 count, female sex, depressive symptoms, and neuroimaging features suggest potentiation of risk mechanisms. Longitudinal data-driven studies are needed to guide clinical strategies capable of preventing the development of frailty as PLWH reach advanced age.