bluuebunny/crossref_metadata_2025 huggingface dataset:
Paracoccidioides brasiliensis activates mesenchymal stem cells through TLR2, TLR4, and Dectin-1
Authors: Rodriguez-Echeverri Carolina , Puerta-Arias Juan David , González Ángel
Published: May 2020

Numerous researchers have described the potential of bone marrow-derived mesenchymal stem cells (BM-MSCs) for the treatment of various infectious and inflammatory diseases. However, contrary to what has been reported, the transplantation of BM-MSCs in a mouse model of Paracoccidioides brasiliensis-induced pulmonary fibrosis exacerbated the inflammatory process and fibrosis, worsening the course of the infection. The aim of this work was to determine whether P. brasiliensis exerts an immunomodulatory effect on BM-MSCs. The results indicate that P. brasiliensis can activate BM-MSCs through a mechanism dependent on TLR2, TLR4 and Dectin-1. In addition, it was found that these fungal cells can adhere and internalize within BM-MSCs. Nonetheless, this process did not affect the survival of the fungus and on the contrary, triggered the expression of inflammatory mediators such as IL-6, IL-17, TNF-α, and TGF-β. The present findings correlate with the loss of a fungicidal effect and poor control of the fungus, evidenced by the count of the colony-forming units. Previously reported in vivo results are thus confirmed, showing that P. brasiliensis induces an inflammatory profile in BM-MSCs when producing pro-inflammatory molecules that amplify such response.

Numerous researchers have described the potential of bone marrow-derived mesenchymal stem cells (BM-MSCs) for the treatment of various infectious and inflammatory diseases. However, contrary to what has been reported, the transplantation of BM-MSCs in a mouse model of Paracoccidioides brasiliensis-induced pulmonary fibrosis exacerbated the inflammatory process and fibrosis, worsening the course of the infection. The aim of this work was to determine whether P. brasiliensis exerts an immunomodulatory effect on BM-MSCs. The results indicate that P. brasiliensis can activate BM-MSCs through a mechanism dependent on TLR2, TLR4 and Dectin-1. In addition, it was found that these fungal cells can adhere and internalize within BM-MSCs. Nonetheless, this process did not affect the survival of the fungus and on the contrary, triggered the expression of inflammatory mediators such as IL-6, IL-17, TNF-α, and TGF-β. The present findings correlate with the loss of a fungicidal effect and poor control of the fungus, evidenced by the count of the colony-forming units. Previously reported in vivo results are thus confirmed, showing that P. brasiliensis induces an inflammatory profile in BM-MSCs when producing pro-inflammatory molecules that amplify such response.
Probing the absorption of gamma-rays by IR radiation from the dusty torus in FSRQs with the Cherenkov telescope array
Authors: Galanti Giorgio , Landoni Marco , Tavecchio Fabrizio , Covino Stefano
Published: May 2020

Within the classical emission model, where the emission region is placed within the broad line region (BLR), flat spectrum radio quasars (FSRQs) were believed not to emit photons with energies above few tens of GeV because of the absorption with the optical-UV photons from the BLR. However, photons with observed energies up to about $300 \, \rm GeV$ have been detected for few FSRQs, whose most iconic example is PKS 1441+25 at redshift z = 0.94. The most conservative explanation for these observations is that the emission occurs at distances comparable to the size of the dusty torus. In this case, absorption of high-energy gamma-ray photons for energies above $200{-}300 \, {\rm GeV}$ is dominated by the interaction with infrared radiation emitted by the torus. We investigate if current observational data about FSRQs in flaring state can give us information about: (i) the importance of the torus absorption and (ii) the properties of the torus i.e. its temperature and its geometry. We find that present data do not arrive at energies where the torus influence is prominent and as a result it is currently hardly possible to infer torus properties from observations. However, with dedicated simulations, we demonstrate that observations with the forthcoming Cherenkov Telescope Array (CTA) will be able to constrain the torus parameters (temperature and geometry).
From galactic nuclei to the halo outskirts: tracing supermassive black holes across cosmic history and environments
Authors: Izquierdo-Villalba David , Bonoli Silvia , Dotti Massimo , Sesana Alberto , Rosas-Guevara Yetli , Spinoso Daniele
Published: May 2020

We study the mass assembly and spin evolution of supermassive black holes (BHs) across cosmic time as well as the impact of gravitational recoil on the population of nuclear and wandering BHs (wBHs) by using the semi-analytical model L-Galaxies run on top of Millennium merger trees. We track spin changes that BHs experience during both coalescence events and gas accretion phases. For the latter, we assume that spin changes are coupled with the bulge assembly. This assumption leads to predictions for the median spin values of z = 0 BHs that depend on whether they are hosted by pseudo-bulges, classical bulges or ellipticals, being $\overline{a} \sim 0.9$, 0.7 and 0.4, respectively. The outcomes of the model display a good consistency with $z \le 4$ quasar luminosity functions and the $z = 0$ BH mass function, spin values, and BH correlation. Regarding the wBHs, we assume that they can originate from both the disruption of satellite galaxies (orphan wBH) and ejections due to gravitational recoils (ejected wBH). The model points to a number density of wBHs that increases with decreasing redshift, although this population is always $\rm {\sim}2\, dex$ smaller than the one of nuclear BHs. At all redshifts, wBHs are typically hosted in $\rm {\it M}_{halo} \gtrsim 10^{13} \, M_{\odot }$ and $\rm {\it M}_{stellar} \gtrsim 10^{10} \, M_{\odot }$, being orphan wBHs the dominant type. Besides, independently of redshift and halo mass, ejected wBHs inhabit the central regions (${\lesssim}\rm 0.3{\it R}_{200}$) of the host DM halo, while orphan wBH linger at larger scales (${\gtrsim}\rm 0.5{\it R}_{200}$). Finally, we find that gravitational recoils cause a progressive depletion of nuclear BHs with decreasing redshift and stellar mass. Moreover, ejection events lead to changes in the predicted local BH–bulge relation, in particular for BHs in pseudo-bulges, for which the relation is flattened at $\rm {\it M}_{bulge} \gt 10^{10.2}\, M_{\odot }$ and the scatter increase up to ${\sim}\rm 3\, dex$.
Inflation of migrated hot Jupiters
Authors: Mol Lous M , Miguel Y
Published: May 2020

The observed low densities of gas giant planets with a high equilibrium temperature (hot Jupiters) can be simulated in models when a fraction of the surface radiation is deposited deeper in the interior. Meanwhile, migration theories suggest that hot Jupiters formed further away from their host star and migrated inward. We incorporate disc migration in simulations of the evolving interior of hot Jupiters to determine whether migration has a long-lasting effect on the inflation of planets. We quantify the difference between the radius of a migrated planet and the radius of a planet that formed in situ as the radius discrepancy. We remain agnostic about the physical mechanism behind interior heating, but assume it scales with the received stellar flux by a certain fraction.

We find that the change in irradiation received from the host star while the planet is migrating can affect the inflation and final radius of the planet. Models with a high fraction of energy deposited in the interior (>5 per cent) show a significant radius discrepancy when the deposit is at higher pressures than $P=1 \, \mathrm{bar}$. For a smaller fraction of 1 per cent, there is no radius discrepancy for any deposit depth. We show that a uniform heating mechanism can cause different rates of inflation, depending on the migration history. If the forthcoming observations on mean densities and atmospheres of gas giants give a better indication of a potential heating mechanism, this could help to constrain the prior migration of such planets.
The Three Hundred project: shapes and radial alignment of satellite, infalling, and backsplash galaxies
Authors: Knebe Alexander , Gámez-Marín Matías , Pearce Frazer R , Cui Weiguang , Hoffmann Kai , De Petris Marco , Power Chris , Haggar Roan , Mostoghiu Robert
Published: May 2020

Using 324 numerically modelled galaxy clusters, we investigate the radial and galaxy–halo alignment of dark matter subhaloes and satellite galaxies orbiting within and around them. We find that radial alignment depends on distance to the centre of the galaxy cluster but appears independent of the dynamical state of the central host cluster. Furthermore, we cannot find a relation between radial alignment of the halo or galaxy shape with its own mass. We report that backsplash galaxies, i.e. objects that have already passed through the cluster radius but are now located in the outskirts, show a stronger radial alignment than infalling objects. We further find that there exists a population of well radially aligned objects passing very close to the central cluster’s centre that were found to be on highly radial orbit.
Structural basis for the recognition of transiently structured AU-rich elements by Roquin
Authors: Binas Oliver , Tants Jan-Niklas , Peter Stephen A , Janowski Robert , Davydova Elena , Braun Johannes , Niessing Dierk , Schwalbe Harald , Weigand Julia E , Schlundt Andreas
Published: May 2020

Adenylate/uridylate-rich elements (AREs) are the most common cis-regulatory elements in the 3′-untranslated region (UTR) of mRNAs, where they fine-tune turnover by mediating mRNA decay. They increase plasticity and efficacy of mRNA regulation and are recognized by several ARE-specific RNA-binding proteins (RBPs). Typically, AREs are short linear motifs with a high content of complementary A and U nucleotides and often occur in multiple copies. Although thermodynamically rather unstable, the high AU-content might enable transient secondary structure formation and modify mRNA regulation by RBPs. We have recently suggested that the immunoregulatory RBP Roquin recognizes folded AREs as constitutive decay elements (CDEs), resulting in shape-specific ARE-mediated mRNA degradation. However, the structural evidence for a CDE-like recognition of AREs by Roquin is still lacking. We here present structures of CDE-like folded AREs, both in their free and protein-bound form. Moreover, the AREs in the UCP3 3′-UTR are additionally bound by the canonical ARE-binding protein AUF1 in their linear form, adopting an alternative binding-interface compared to the recognition of their CDE structure by Roquin. Strikingly, our findings thus suggest that AREs can be recognized in multiple ways, allowing control over mRNA regulation by adapting distinct conformational states, thus providing differential accessibility to regulatory RBPs.
各国全谷物和膳食纤维推荐摄入量的综述
Authors: Miller Kevin Burke
Published: May 2020

这篇关于全谷物和膳食纤维推荐摄入量的综述于2018 年5 月11 日在中国北京的“全谷物、膳食纤维与健康”研讨会上公开发表的。该 综述反映了不同国家对全谷物和膳食纤维的定义以及其推荐摄入量之 间的差别。缺乏来自权威机构的一致的推荐摄入量可能会影响消费者 选择全谷物、膳食纤维饮食和其在区域内的全面实施。目前，很少有 国家提出具体的全谷物推荐摄入量，在那些有全谷物膳食指导的国家 中，建议也可能是模糊和定性的。增加全谷物摄入量和降低疾病风险 之间的联系已得到充分证明，因此，可为增加全谷物和膳食纤维摄入 提出明确的、可操作的饮食建议提供充足的证据。制定全谷物和全谷 物食品的统一标准，确保膳食指导建议得到落实。鼓励卫生和管理当 局:认可从全谷物和膳食纤维饮食建议中可获得的公共健康益处；研 究和讨论已有的全谷物原料、全谷物食品、膳食纤维定义；并采取最 佳方法为各地人口提供最佳的公共卫生服务。
When Should the People Decide? Public Support for Direct Democracy in Australia
Authors: Kildea Paul , Brown A J , Deem Jacob
Published: May 2020

This article examines the strength of support for direct democracy among Australian citizens, both in general and, in a world-first, across different specific topics. Analysing data from the Australian Constitutional Values Survey, we investigate whether that support is higher among people who are more educated and politically interested (in line with a ‘cognitive mobilisation’ hypothesis) or those who are dissatisfied with politics, with low levels of political trust (‘political disaffection’). The article finds that Australians widely support the use of direct democracy, but especially with respect to constitutional issues and matters of principle that they feel they can readily engage with, whereas parliaments are still seen as best placed to decide more technical matters. The article also finds that support for direct democracy is strongest among politically disaffected citizens, in ways that suggest greater use of direct democracy may have a role to play in addressing decline in political trust in Australia.
THE FREQUENCIES OF X-RAY EXAMINATIONS AND CT SCANS: FINDINGS FROM A SAMPLE INVESTIGATION IN JIANGSU, CHINA
Authors: Du Xiang , Wang Jin , Zhu BaoLi
Published: May 2020

Objective: The present study was performed to evaluate the frequencies of two kinds of examinations using a proportional sample of 262 medical institutions and to observe the factors affecting the amount of examination-related exposure. The other aim of the present study was to observe the relationship between X-ray and CT frequency with GDP per capita, which could indicate the connection between medical exposure practice and economy. Methods: A random sample was taken from a pool of 316 medical institutions, and correlation analyses were performed to identify the factors affecting the amount of examination-related exposure. A representative sample of 262 medical institutions, proportional to the distribution of hospitals across grades, was used, and a multiple linear regression model was constructed. Results: The frequencies of X-ray examinations and CT scans were 523 per 1000 people and 223 per 1000 people, respectively. The two kinds of radio-diagnostic examinations showed different patterns in their relationships with GDP per capita. The factors correlated with the amounts of exposure due to the two kinds of examinations and the outpatient and equipment numbers showed distinctive patterns in the group of grade three institutions. Conclusions: The improvement in the economy has caused a rapid increase in the use of radio-diagnostic examinations. The differences in factors correlated with the two types of examinations may stem from the workload statuses of CT scans and X-ray examinations in grade three hospitals.
Understanding the most commonly billed diagnoses in primary care
Authors: Rogers Julia
Published: May 2020

Hypertension is a preventable cause of poor health outcomes. This first article in a series about the most commonly billed diagnoses in primary care settings explores the pathophysiology, diagnostic evaluation, and management of hypertension. Relevant billing issues are addressed.
Pathogen Genomics in Public Health
Authors: Armstrong Gregory L. , MacCannell Duncan R. , Taylor Jill , Carleton Heather A. , Neuhaus Elizabeth B. , Bradbury Richard S. , Posey James E. , Gwinn Marta
Published: May 2020

(Abstracted from N Engl J Med 2019;381:2569–2580)

Next-generation sequencing (NGS) can quickly characterize microbes and help scientists understand how they are transmitted. Public health agencies have been utilizing pathogen genomics in order to better identify the cause of infectious diseases.
The Impact of Severe Maternal Morbidity on Very Preterm Infant Outcomes
Authors: Zeitlin Jennifer , Egorova Natalia N. , Janevic Teresa , Hebert Paul L. , Lebreton Elodie , Balbierz Amy , Howell Elizabeth A.
Published: May 2020

(Abstracted from J Pediatr 2019;215:56–63)

Severe maternal morbidity is defined as a life-threatening diagnosis or lifesaving procedure during delivery. It occurs more often in very preterm deliveries, as opposed to term deliveries.
Testing of Patients and Support Persons for Coronavirus Disease 2019 (COVID-19) Infection Before Scheduled Deliveries
Authors: Bianco Angela , Buckley Ayisha B. , Overbey Jessica , Smilen Scott , Wagner Brian , Dinglas Cheryl , Loudon Holly , Garely Alan , Brodman Michael , Stone Joanne
Published: May 2020

OBJECTIVE:

To evaluate the rate of coronavirus disease 2019 (COVID-19) infection with the use of universal testing in our obstetric population presenting for scheduled deliveries, as well as the concordance or discordance rate among their support persons during the initial 2-week period of testing. Additionally, we assessed the utility of a screening tool in predicting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing results in our cohort.

METHODS:

This was an observational study in which all women who were scheduled for a planned delivery within the Mount Sinai Health system from April 4 to April 15, 2020, were contacted and provided with an appointment for themselves as well as their support persons to undergo COVID-19 testing 1 day before their scheduled delivery. Both the patients and the support persons were administered a standardized screen specific for COVID-19 infection by telephone interview. Those support persons who screened positive were not permitted to attend the birth. All patients and screen-negative support persons underwent SARS-CoV-2 testing.

RESULTS:

During the study period, 155 patients and 146 support persons underwent SARS-CoV-2 testing. The prevalence of asymptomatic COVID-19 infection was 15.5% (CI 9.8–21.2%) and 9.6% (CI 4.8–14.4%) among patients and support persons, respectively. The rate of discordance among tested pairs was 7.5%. Among patients with COVID-19 infection, 58% of their support persons also had infection; in patients without infection, fewer than 3.0% of their support persons had infection.

CONCLUSION:

We found that more than 15% of asymptomatic maternity patients tested positive for SARS-CoV-2 infection despite having screened negative with the use of a telephone screening tool. Additionally, 58% of their asymptomatic, screen-negative support persons also tested positive for SARS-CoV-2 infection. Alternatively, testing of the support persons of women who had tested negative for COVID-19 infection had a low yield for positive results. This has important implications for obstetric and newborn care practices as well as for health care professionals.
Rates and Risk Factors for Failure of Surgical Repair of the Knee Extensor Mechanism
Authors: Roberts Aaron , Ketz John
Published: May 2020

Objectives:

To evaluate rates and risk factors for failed surgical repair of the knee extensor mechanism.

Design:

Retrospective cohort study.

Setting:

Academic medical center.

Patients/Participants:

Two hundred ninety-four patients and a total of 303 extensor mechanism repairs were included. This encompassed 113 quadriceps tendon repairs (QTR), 112 fracture repairs (FR), and 68 patellar tendon repairs (PTR).

Main Outcome Measurement:

Repair failure.

Results:

There were 6 failures (5%) in the QTR group, 21 failures (17%) in the FR group, and 2 failures (3%) in the PTR group. The difference in failure rates between the groups was significant (P = 0.001), but the rate of revision fixation or repair was not (P = 0.315). In the QTR group, a history of inflammatory arthritis was found to be significantly different between patients who had repair failure and patients who did not (P = 0.014) with a relative risk for failure of 17.8 (confidence interval 4.5–70.4). In the FR group, patient age (P = 0.001) and comorbid diabetes mellitus (P = 0.046) were found to be significantly different between patients with and without repair failure in univariate analysis, but only patient age (P = 0.005) was significant in multiple logistic regression analysis. The relative risk for FR failure was 6.6 (confidence interval 2.3–18.3) for age greater than 60. No risk factors for failure were identified in the PTR group.

Conclusions:

Overall, patients with fractures were more likely experience repair failure than patients with tendon injuries, but all patients underwent similar rates of reoperation. Inflammatory arthritis in patients with QTRs and older patient age in FRs are risk factors for repair failure.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Stepcut Calcaneal Lengthening Osteotomy in the Management of Stage IIB Adult-acquired Flatfoot Deformity: Surgical Technique and Review of Literature
Authors: Metikala Sreenivasulu , Mahmoud Karim , Young Kelsey , Lee Wonyong , Wapner Keith L.
Published: May 2020

The treatment principles in the surgical management of stage IIB adult-acquired flatfoot deformity include rebalancing of soft-tissues, correction of deformity and preservation of subtalar joint motion. Traditional medial displacement calcaneal osteotomy addresses hindfoot valgus but has no influence on forefoot abduction. The lateral calcaneal lengthening osteotomy can achieve satisfactory improvement of forefoot abduction and uncovering of the talonavicular but cannot efficiently manage hindfoot valgus when performed in isolation. We describe stepcut calcaneal lengthening osteotomy with a “Z” design, which is essentially a combination of the above techniques with an additional full-thickness transverse cut made along the long axis of calcaneus that has the ability to obtain deformity correction of forefoot and hindfoot through a single incision.

Level of Evidence: Diagnostic Level V—Expert Opinion. See Instructions for Authors for a complete description of levels of evidence.
How to Diagnose Surgical Site Infection After Fracture Surgery: We Have a Problem!
Authors: Johnson Aaron J. , O’Toole Robert V.
Published: May 2020

Infections after fracture are often devastating complications and despite widespread efforts to these infections, there are still 100,000 cases of reported fracture-related infection yearly in the United States. Although infection after fracture surgery is common, there is important uncertainty regarding various aspects of diagnosing these infections including a lack of standardization of what the definition of an infection should be in this setting. Most infections after fracture surgery present with obvious clinical signs of infection, but sometimes the signs are more subtle. Furthermore, it is not possible to obtain diagnostic tissue samples before taking the patient to the operating room for debridement thus potentially making it difficult to know what the best surgical strategy should be. When treating infections, clinicians attempt to determine definitively whether the patient is infected, how much surgical debridement is necessary, what pathogen they need to treat, and how many surgical debridements are needed. Diagnostic uncertainty affects all of these aspects of care and can cause unnecessary surgery, delayed surgical debridement, inadequate site control, and difficulty determining when the patient has cleared their infection. The purpose of this manuscript will be to evaluate the current diagnostic tests available to answer each of the above questions, and the available evidence supporting their use.
Satellite cell proliferation and myofiber cross-section area increase after electrical stimulation following sciatic nerve crush injury in rats
Authors: Xing Hua-Yi , Liu Nan , Zhou Mou-Wang
Published: May 2020

Background

Electrical stimulation has been recommended as an effective therapy to prevent muscle atrophy after nerve injury. However, the effect of electrical stimulation on the proliferation of satellite cells in denervated muscles has not yet been fully elucidated. This study was aimed to evaluate the changes in satellite cell proliferation after electrical stimulation in nerve injury and to determine whether these changes are related to the restoration of myofiber cross-section area (CSA).

Methods

Sciatic nerve crush injury was performed in 48 male Sprague-Dawley rats. In half (24/48) of the rats, the gastrocnemius was electrically stimulated transcutaneously on a daily basis after injury, while the other half were not stimulated. Another group of 24 male Sprague-Dawley rats were used as sham operation controls without injury or stimulation. The rats were euthanized 2, 4, and 6 weeks later. After 5-bromo-2’-deoxyuridine (BrdU) labeling, the gastrocnemia were harvested for the detection of paired box protein 7 (Pax7), BrdU, myofiber CSA, and myonuclei number per fiber. All data were analyzed using two-way analysis of variance and Bonferronipost-hoctest.

Results

The percentages of Pax7-positive nuclei (10.81 ± 0.56%) and BrdU-positive nuclei (34.29 ± 3.87%) in stimulated muscles were significantly higher compared to those in non-stimulated muscles (2.58 ± 0.33% and 1.30 ± 0.09%, respectively, Bonferronit = 15.91 and 18.14,P < 0.05). The numbers of myonuclei per fiber (2.19 ± 0.24) and myofiber CSA (1906.86 ± 116.51 μm2) were also increased in the stimulated muscles (Bonferronit = 3.57 and 2.73,P < 0.05), and both were positively correlated with the Pax7-positive satellite cell content (R2 = 0.52 and 0.60,P < 0.01). There was no significant difference in the ratio of myofiber CSA/myonuclei number per fiber among the three groups.

Conclusions

Our results indicate that satellite cell proliferation is promoted by electrical stimulation after nerve injury, which may be correlated with an increase in myonuclei number and myofiber CSA.
Nurses' Attitude, Behavior, and Knowledge Regarding Protective Lung Strategies of Mechanically Ventilated Patients
Authors: Asmar Imad T. , Alrajoub Belal M. , Almahmoud Omar H. , Nakhleh Dina N. , Makharzeh Sara I. , Falaneh Yazeed M.
Published: May 2020

The management of critically ill patients is complicated and often involves complex devices including mechanical ventilators (MVs), which may be associated with many complications. Protective lung strategies (PLSs) are used to prevent complications associated with MVs, but nurses may not possess adequate knowledge to optimize the efficacy of PLSs. This article reports findings from what is thought to be the first study in Palestine that explores critical care nurses' knowledge about PLSs. The purpose of this study was to assess the critical care nurses' attitude, behavior, and knowledge regarding PLSs of mechanically ventilated patients. This descriptive, cross-sectional study was conducted at both public and private hospitals in Palestine. The sample included nurses who worked in intensive care units and cardiac care units and utilized a previously developed and validated questionnaire. The result of the study concludes that the majority of the Palestinian critical care nurses agree with the utilization or application of PLSs but have a severe lack of knowledge about the strategies. This highlights the need to provide additional educational programs related to the optimum use of mechanical ventilation.
Parental Expectations Are Associated with Children's Sleep Duration and Sleep Hygiene Habits
Authors: Jarrin Denise C. , Abu Awad Yara , Rowe Hillary , Noel Neressa A. O. , Ramil Joanne , McGrath Jennifer J.
Published: May 2020

Objective:

Although parents recognize the importance of sleep, most have a limited understanding of children's sleep needs. This study examined whether parental expectations about sleep were linked to children and adolescent's sleep duration and sleep hygiene.

Method:

Participants included 376 unique parent-child dyads. Parents (mean age = 47.0 years, SD = 6.7) estimated the number of hours of sleep their children (mean age = 13.0 years, SD = 2.2; 9–17 years) needed. These estimates were age-matched with recommended pediatric guidelines of the American Academy of Sleep Medicine and the National Sleep Foundation to yield 3 groups: expect less (8%–11%), expect appropriate (85%–89%), and expect more (3%–4%). Sleep duration for school nights and weekends were reported by children and parents. Sleep hygiene included sleep-promoting practices (quiet, dark bedroom, regular bed/wake times, consistent routine) and sleep-interfering practices (physiological arousal, presleep worry, alcohol/smoking intake, daytime napping, screen time).

Results:

Most parents (68.7%) endorsed that children do not get enough sleep. Linear and logistic regressions were used to assess the impact of parental expectations. For every additional hour of sleep expected, children slept between 15.5 (parent-report 95% confidence interval [CI], 9.0–22.0) and 17.9 minutes (child-report 95% CI, 9.7–26.2) longer on school nights, adjusted for age, sex, puberty, and parental education. For parents who expected less sleep than recommended, their children had the shortest sleep duration, least favorable sleeping environments, and greater presleep worry.

Conclusion:

Parental sleep expectations were directly linked to children's sleep duration. Pediatricians and primary care providers can mobilize knowledge to optimally convey accurate information about developmental sleep needs and recommended hours to parents to promote longer sleep.
ASSOCIATION OF VITREORETINAL LYMPHOMA WITH SYSTEMIC LYMPHOMA
Authors: Mashayekhi Arman , Dalvin Lauren A. , Lim Li-Anne S. , Ancona-Lezama David , Mazloumi Mehdi , Chang Michael , Shields Carol L. , Shields Jerry A.
Published: May 2020

Purpose:

To determine the association between vitreoretinal lymphoma and systemic lymphoma (SL).

Methods:

Single-center retrospective review of medical records.

Results:

Of 95 patients with vitreoretinal lymphoma, 18 (19%) had associated SL (SL group) and 77 (81%) were not associated with SL (no SL group). The most common sites of SL were skin (n = 5), testis (n = 2), liver and breast (n = 2), and others (n = 9). A comparison (SL group vs. [vs.] no SL group) revealed no difference in demographic or ocular findings at initial visit. In the SL group, SL occurred before the onset of ocular symptoms in 14 (78%) patients with mean interval of 86 months (median 61, range 5–286 months) or after ocular symptoms in 4 (22%) patients with mean interval of 19 months (median 12, range 7–44 months). A comparison revealed no difference in overall frequency of pre-existing or eventual central nervous SL (50% vs. 53%, P = 0.99); however, the SL group demonstrated central nervous SL more often after onset of ocular symptoms (78% vs. 17%, P = 0.001). A comparison found no difference in treatment methods, response of vitreoretinal lymphoma to treatment, final visual outcome, or death rate.

Conclusion:

We found 19% of patients with vitreoretinal lymphoma demonstrate related SL, and there was no difference in demographics, clinical features, or response to treatment, compared to those not associated with SL.
STELLATE UNILATERAL NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS: A MULTIMODAL IMAGING ANALYSIS AND CASE REPORT
Authors: Montano Margarita , Alfaro D. Virgil , Quiroz-Reyes Miguel A. , Lima-Gómez Virgilio , Bonilla Luisa A. , Chew-Bonilla Alan , Monares-Zepeda Gerardo
Published: May 2020

Purpose:

To describe a case of stellate nonhereditary idiopathic foveomacular retinoschisis in a middle-aged woman and to depict the classic retinal fluorangiography (FA) findings, structural characteristics using macular spectral-domain optical coherence tomography angiographic data of vascular and perfusion density using optical coherence tomography angiography (OCT-A), and standardized multifocal electroretinography (mfERG) findings.

Methods:

This is a case report of a 53-year-old ophthalmologist who was incidentally diagnosed with unilateral idiopathic foveomacular retinoschisis. Stellate nonhereditary idiopathic foveomacular retinoschisis is defined as a foveal elevation without alternative explanation for retinoschisis. FA, spectral-domain optical coherence tomography, optical coherence tomography angiography, and multifocal electroretinography were used as tools to obtain an integral multimodal diagnosis of this entity.

Results:

Clinical examination and multimodal imaging were able to detect unilateral idiopathic retinoschisis, revealing a stellate pattern of retinal concentric cysts with minimal changes in vascular and perfusion density metrics and confirming the absence of bridging vessels. There were consistent FA findings, with almost unaltered foveal changes. Multifocal electroretinography depicted a subtle reduction in dark-adapted a-wave and b-wave amplitudes.

Conclusion:

Improvements and innovations in technology for ophthalmic diagnosis have revolutionized our capacity for diagnostic decision-making. Spectral-domain optical coherence tomography and optical coherence tomography angiography are useful tools for diagnosis and follow-up assessment. This fortuitous case gives a window on the importance of a routine specialized ophthalmic examination and how multimodal imaging can depict important and specific findings not evident from a clinical point of view. The subtle but important changes observed in optical coherence tomography angiography and multifocal electroretinography will help better define this clinical entity.
Comparison of 1-Year Effectiveness of Trabecular Microbypass Stent implantation (iStent) in Conjunction With Phacoemulsification Among Mild, Moderate, and Severe Primary Open-angle Glaucoma Patients
Authors: Chansangpetch Sunee , Ittarat Mantapond , Yang Shuo , Fisher Ann C. , Singh Kuldev , Lin Shan C. , Chang Robert T.
Published: May 2020

Precis:

The study compared 1-year effectiveness of single trabecular microbypass stent (iStent) implantation with phacoemulsification among glaucoma severities in primary open-angle glaucoma. The study found that mild glaucoma had greater success rate and lower number of medications compared with moderate and severe glaucoma.

Purpose:

To evaluate the effectiveness of iStent implantation in combination with cataract surgery in moderate to severe glaucoma compared with mild glaucoma.

Methods:

Medical charts of primary open-angle glaucoma subjects undergoing 1 iStent implantation were retrospectively reviewed. Glaucoma was classified on the basis of mean deviation (MD) of the preoperative standard automated perimetry into mild (MD>−6 dB), moderate (MD −6 to −12 dB), and severe (MD<−12 dB). Mixed effect regression models were performed to determine the effect of iStent at 1 year. The outcomes included as follows: (1) intraocular pressure (IOP) and the number of medications, (2) eyes with IOP ≤ severity-based target (18 mm Hg for mild, 15 mm Hg for moderate, 12 mm Hg for severe) (2A) without medication, and (2B) with medication reduction.

Results:

In total, 104 eyes from 89 subjects were analyzed. Cataract combined with iStent surgery significantly lowered the number of medications in all groups and significantly decreased IOP in moderate and severe glaucoma (P<0.05). There was significantly higher number of medications in moderate (β: 0.58,P=0.002) and severe (β: 1.20,P<0.001) compared with mild glaucoma. Eyes with moderate glaucoma had significantly lower rate of success (criterion 2A) compared with mild glaucoma [odds ratio (OR): 0.008,P=0.047]. Eyes with moderate and severe glaucoma had significantly lower rates of success (criterion 2B) (moderate vs. mild OR: 0.002,P=0.028; severe vs. mild OR: 0.026,P=0.026).

Conclusions:

Combined phacoemulsification with iStent seems to have a better IOP-lowering and medication-lowering effect in mild glaucoma cases versus those with moderate and severe glaucoma. This difference was found in real-world data over one-year follow-up period. Long-term studies with defined IOP goals and medication removal protocols are warranted.
Tanezumab for chronic low back pain: a randomized, double-blind, placebo- and active-controlled, phase 3 study of efficacy and safety
Authors: Markman John D. , Bolash Robert B. , McAlindon Timothy E. , Kivitz Alan J. , Pombo-Suarez Manuel , Ohtori Seiji , Roemer Frank W. , Li David J. , Viktrup Lars , Bramson Candace , West Christine R. , Verburg Kenneth M.
Published: May 2020

This randomized, double-blind, phase 3 study (56-week treatment; 24-week follow-up) assessed tanezumab in patients with chronic low back pain and history of inadequate response to standard-of-care analgesics (NCT02528253). Patients received placebo, subcutaneous tanezumab (5 or 10 mg every 8 weeks), or oral tramadol prolonged-release (100-300 mg/day). Primary endpoint was change in low back pain intensity (LBPI) at week 16 for tanezumab vs placebo. Key secondary endpoints were proportion of patients with ≥50% decrease in LBPI at week 16, change in Roland Morris Disability Questionnaire at week 16, and change in LBPI at week 2 for tanezumab vs placebo. Adverse events and joint safety were assessed through weeks 56 and 80, respectively. Tanezumab 10 mg met the primary endpoint by significantly improving LBPI at week 16 vs placebo; least squares (LS) mean (95% CI) difference = −0.40 (−0.76 to −0.04; P = 0.0281). Tanezumab 10 mg significantly improved all key secondary endpoints. Tanezumab 5 mg did not meet the primary endpoint (LS mean [95% CI] treatment difference vs placebo = −0.30 [−0.66 to 0.07; P = 0.1117]), preventing formal testing of key secondary endpoints for this dose. The proportion of patients with ≥50% improvement in LBPI at week 16 was 37.4% in the placebo group, 43.3% in the tanezumab 5 mg group (Odds ratio [95% CI] vs placebo = 1.28 [0.97 to 1.70; P = 0.0846]), and 46.3% in the tanezumab 10 mg group (Odds ratio [95% CI] vs placebo = 1.45 [1.09 to 1.91; P = 0.0101]). Prespecified joint safety events were more frequent with tanezumab 10 mg (2.6%) than tanezumab 5 mg (1.0%), tramadol (0.2%), or placebo (0%). Seven patients, all in the tanezumab 10 mg group (1.4%), underwent total joint replacement. In conclusion, tanezumab 10 mg significantly improved pain and function vs placebo in patients with difficult-to-treat chronic low back pain. Tanezumab was associated with a low rate of joint safety events, some requiring joint replacement.
Social Perception Predicts Awareness of Illness in Persons With Schizophrenia
Authors: Feyer Frida K. , Andersson Stein , Büchmann Camilla B. , Melle Ingrid , Andreassen Ole A. , Vaskinn Anja
Published: May 2020

Lack of clinical insight in patients with schizophrenia is an obstacle to optimal treatment. Social cognition is one of several variables central to insight deficits in schizophrenia. The aim of this study was to investigate clinical insight in relation to one domain of social cognition, social perception, while controlling for effects of nonsocial cognition and symptom severity. Clinical insight was measured in 55 patients with schizophrenia or schizoaffective disorder, using the Birchwood Insight Scale. Relationships across domains were used to assess social perception. Social perception predicted one of three subscales of clinical insight, “awareness of illness,” and was the only unique contributor to this subscale. This indicates that social perception is linked to clinical insight through awareness of illness. More research is needed to fully understand the relationship between social and nonsocial cognition and symptoms in relation to clinical insight.
Exploring Practices of Bedside Shift Report and Hourly Rounding. Is There an Impact on Patient Falls?
Authors: Sun Carolyn , Fu Caroline J. , O'Brien Jessica , Cato Kenrick D. , Stoerger Lauren , Levin Alan
Published: May 2020

OBJECTIVE

To describe the relationship of inpatient falls to bedside shift report (BSR) and hourly rounding (HR).

BACKGROUND

Falls are a major healthcare concern. Although measures such as BSR and HR are reported to reduce falls, studies are often based on self-reported data related to nurse compliance with protocols for HR and bedside report.

METHODS

Observational data were collected on nursing tasks, including BSR and HR.

RESULTS

Nine thousand six hundred ninety-three observations were recorded on 11 units at 4 hospitals over 281 shifts. Falls were associated with shift and day of the week but not BSR, HR, or the frequency of encounters with the patient. The regression model included frequency with patient, shift, day of week, and HR.

CONCLUSIONS

Increased nurse frequency with patient may signal increased fall risks. Bedside shift report and HR may require robust and sustained interventions to provide lasting effects.
Using Objective Structured Clinical Examination as a Teaching Tool in a Hybrid Advanced Health Assessment Course
Authors: Champlin Andrea M. , Roberts Lisa R. , Pueschel Robin D. , Saunders Jasmine S.D. , Huerta Gloria M. , Yang Joanna
Published: May 2020

Background

Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care.

Problem

Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD.

Approach

This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions.

Outcomes

Data revealed that students' ability to identify 3 DDs correctly during the summative health assessment objective structured clinical examination was inconsistent. Qualitative data revealed students lacked understanding on how to use results from the physical assessment to formulate a DD.

Conclusion

The findings of this project corroborate those from the literature that suggest we should teach APRN students DD skills explicitly.
Resident Trainees Increase Surgical Time: A Comparison of Obstetric and Gynaecologic Procedures in Academic Versus Community Hospitals
Authors: McGee Jacob , Winick-Ng Jennifer , McClure J. Andrew , Penava Deborah , Lovett Erin , Vinden Chris , McKeown Megan
Published: May 2020

(Abstracted from J Obstet Gynaecol Can 2020;42:430–438)

Obstetrics and gynecology residents experience a myriad of professional competency and growth by performing procedures in operative rooms. Canadian residents in obstetrics/gynecology (OB/GYN) undergo 5 years of training at teaching hospitals and have the opportunity to assist with many common surgical procedures.
Adverse Birth Outcomes and Birth Telomere Length: A Systematic Review and Meta-analysis
Authors: Niu Zhongzheng , Li Karen , Xie Chuanbo , Wen Xiaozhong
Published: May 2020

(Abstracted from J Pediatr 2019;215:64–74)

Fetal growth restriction (FGR) and preterm birth are associated with an increase in morbidity and mortality during infancy. Growth-restricted and preterm newborns are also at an increased risk of developing obesity, hypertension, non–insulin-dependent diabetes, and atherosclerosis later in life.
Hydrocarbon Intoxication in Children
Authors: Tenenbaum Ariel , Rephaeli Rotem , Cohen-Cymberknoh Malena , Aberbuch Diana , Rekhtman David
Published: May 2020

Objectives

Hydrocarbon intoxication in children still occurs, although it is preventable. It may cause a variety of clinical manifestations, involving the respiratory system and the nervous system. Our goal was to investigate all cases of hydrocarbon poisoning in children hospitalized in the Hadassah-Hebrew university hospitals in Jerusalem due to exposure to hydrocarbon in 2 decades.

Methods

We retrieved the clinical and sociodemographic characteristics of all children who were admitted to our hospitals because of hydrocarbon intoxication in 2 decades.

Results

One hundred seventy-two children were hospitalized, primarily because of ingestion of kerosene. In most cases, the poisons were stored in a bottle or other easily accessible container. Boys were more likely than girls to be hospitalized. Most of the children were of Arab origin in families with more than 3 children. Coughing, vomiting, and a decrease in conscious state were common at presentation, followed by fever and dyspnea. The clinical course was usually mild to moderate and self-resolving. Some children were treated with oxygen, fluids, and antibiotics. The main result of hydrocarbon poisoning was chemical pneumonitis, and many had pathological chest x-rays. Only one severe case resulted in death.

Conclusions

Hydrocarbon intoxication results in a variety of clinical manifestations and can be life-threatening. Most cases of poisoning could have been easily prevented if the substances were kept out of the reach of children.
Response to COVID-19: Minimizing Risks, Addressing Challenges and Maintaining Operations in a Complex Academic Radiology Department
Authors: Pedrosa Ivan , Browning Travis , Kwon Jeannie K. , Morriss Michael , Matsler Lacy , Pinho Marco C. , Lamus Daniel , Pillai Anil , Karow Sweta Patel , Garinn Jon , Brewington Cecelia , Zeikus Eric , Rofsky Neil M.
Published: May 2020

The coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid response plans to minimize risks of infection in the workforce while ensuring maintenance of essential functions of radiology departments. Plan adoption is, however, challenged by the need to coordinate with institutional efforts, a rapidly expanding number of patients, and the diversity of clinical and administrative functions in the department. Here, we describe the implementation of a response plan in an academic radiology department, challenges encountered, and tactics used to address these challenges.
Low-Grade Myofibroblastic Sarcoma Demonstrated on 99mTc-MDP Bone Scan and 18F-FDG PET/CT
Authors: Hou Wenxiu , Su Minggang , Li Qianrui , Tian Rong
Published: May 2020

A 24-year-old woman with left hip pain for 4 months was admitted. Radiographs of the left hip showed a radiolucent lesion in the proximal femur. The lesion demonstrated hypointensity on T1-weighted and high intensity on T2-weighted fat saturated images. 99mTc-MDP bone scan and 18F-FDG PET/CT illustrated intense radiotracer accumulation at the osteolytic lesion. Postoperative pathology confirmed a low-grade myofibroblastic sarcoma (LGMS). LGMS is a rare neoplasm, which often occurred in the head and neck region. Our case suggested that LGMS should be considered in the differential diagnosis of proximal femur lesion on 99mTc-MDP bone scan and 18F-FDG PET/CT.
68Ga-DOTATATE Uptake in an Endolymphatic Sac Tumor
Authors: Lou Robert , Lazor Jillian W. , Baraban Ezra , Ware Jeffrey B. , Cooper Kumarasen , Pantel Austin R.
Published: May 2020

After dedicated CT and MRI, 68Ga-DOTATATE PET/CT was performed in a patient with a temporal bone mass with primary diagnostic considerations of an endolymphatic sac tumor versus a glomus jugulotympanicum paraganglioma. The 68Ga-DOTATATE PET showed mild radiotracer uptake in the mass (SUVmax, 10.9). After surgical resection, pathology revealed an endolymphatic sac tumor. Immunohistochemical staining demonstrated somatostatin receptor type 2A expression in the vasculature of the mass, but not in the tumor cells.
Laboratory-Proven Asymptomatic SARS-CoV-2 (COVID-19) Infection on 18F-FDG PET/CT
Authors: Krebs Simone , Petkovska Iva , Ho Alan L. , Ulaner Gary A.
Published: May 2020

An 87-year-old man with primary salivary duct carcinoma and hepatic metastases was referred for restaging. 18F-FDG PET/CT demonstrated new FDG-avid ground-glass opacities with intralobular septal thickening in both lungs with a peripheral dominant distribution. This was interpreted as a pattern highly suggestive of COVID-19 pneumonia, and the referring physician was contacted. The patient was currently asymptomatic and without clinical evidence of active pneumonia. However, the patient tested positive for COVID-19 using real-time reverse transcription–polymerase chain reaction. This case demonstrates that even asymptomatic outpatients undergoing PET/CT should be evaluated for radiologic findings suggestive of COVID-19 during this pandemic.