bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic risk factors for endometriosis near estrogen receptor 1 and coexpression of genes in this region in endometrium
Authors: Marla S , Mortlock S , Houshdaran S , Fung J , McKinnon B , Holdsworth-Carson S J , Girling J E , Rogers P A W , Giudice L C , Montgomery G W
Published: December 2020

The etiology and pathogenesis of endometriosis are complex with both genetic and environmental factors contributing to disease risk. Genome-wide association studies (GWAS) have identified multiple signals in the estrogen receptor 1 (ESR1) region associated with endometriosis and other reproductive traits and diseases. In addition, candidate gene association studies identified signals in the ESR1 region associated with endometriosis risk suggesting genetic regulation of genes in this region may be important for reproductive health. This study aimed to investigate hormonal and genetic regulation of genes in the ESR1 region in human endometrium. Changes in serum oestradiol and progesterone concentrations and expression of hormone receptors ESR1 and progesterone receptor (PGR) were assessed in endometrial samples from 135 women collected at various stages of the menstrual cycle. Correlation between hormone concentrations, receptor expression and expression of genes in the ESR1 locus was investigated. The effect of endometriosis risk variants on expression of genes in the region was analyzed to identify gene targets. Hormone concentrations and receptor expression varied significantly across the menstrual cycle. Expression of genes in the ESR1 region correlated with progesterone concentration; however, they were more strongly correlated with expression of ESR1 and PGR suggesting coregulation of genes. There was no evidence that endometriosis risk variants directly regulated expression of genes in the region. Limited sample size and cellular heterogeneity in endometrial tissue may impact the ability to detect significant genetic effects on gene expression. Effects of these variants should be validated in a larger dataset and in relevant individual cell types.
A functional connection between translation elongation and protein folding at the ribosome exit tunnel in Saccharomyces cerevisiae
Authors: Rodríguez-Galán Olga , García-Gómez Juan J , Rosado Iván V , Wei Wu , Méndez-Godoy Alfonso , Pillet Benjamin , Alekseenko Alisa , Steinmetz Lars M , Pelechano Vicent , Kressler Dieter , de la Cruz Jesús
Published: December 2020

Proteostasis needs to be tightly controlled to meet the cellular demand for correctly de novo folded proteins and to avoid protein aggregation. While a coupling between translation rate and co-translational folding, likely involving an interplay between the ribosome and its associated chaperones, clearly appears to exist, the underlying mechanisms and the contribution of ribosomal proteins remain to be explored. The ribosomal protein uL3 contains a long internal loop whose tip region is in close proximity to the ribosomal peptidyl transferase center. Intriguingly, the rpl3[W255C] allele, in which the residue making the closest contact to this catalytic site is mutated, affects diverse aspects of ribosome biogenesis and function. Here, we have uncovered, by performing a synthetic lethal screen with this allele, an unexpected link between translation and the folding of nascent proteins by the ribosome-associated Ssb-RAC chaperone system. Our results reveal that uL3 and Ssb-RAC cooperate to prevent 80S ribosomes from piling up within the 5′ region of mRNAs early on during translation elongation. Together, our study provides compelling in vivo evidence for a functional connection between peptide bond formation at the peptidyl transferase center and chaperone-assisted de novo folding of nascent polypeptides at the solvent-side of the peptide exit tunnel.
Molecular underpinnings of ssDNA specificity by Rep HUH-endonucleases and implications for HUH-tag multiplexing and engineering
Authors: Tompkins Kassidy J , Houtti Mo , Litzau Lauren A , Aird Eric J , Everett Blake A , Nelson Andrew T , Pornschloegl Leland , Limón-Swanson Lidia K , Evans Robert L , Evans Karen , Shi Ke , Aihara Hideki , Gordon Wendy R
Published: December 2020

Replication initiator proteins (Reps) from the HUH-endonuclease superfamily process specific single-stranded DNA (ssDNA) sequences to initiate rolling circle/hairpin replication in viruses, such as crop ravaging geminiviruses and human disease causing parvoviruses. In biotechnology contexts, Reps are the basis for HUH-tag bioconjugation and a critical adeno-associated virus genome integration tool. We solved the first co-crystal structures of Reps complexed to ssDNA, revealing a key motif for conferring sequence specificity and for anchoring a bent DNA architecture. In combination, we developed a deep sequencing cleavage assay, termed HUH-seq, to interrogate subtleties in Rep specificity and demonstrate how differences can be exploited for multiplexed HUH-tagging. Together, our insights allowed engineering of only four amino acids in a Rep chimera to predictably alter sequence specificity. These results have important implications for modulating viral infections, developing Rep-based genomic integration tools, and enabling massively parallel HUH-tag barcoding and bioconjugation applications.
Why Temperature Screening for Coronavirus Disease 2019 With Noncontact Infrared Thermometers Does Not Work
Authors: Wright William F , Mackowiak Philip A
Published: December 2020

Coronavirus disease 2019 screening can evaluate large numbers of patients while reducing healthcare exposures and limiting further spread of the virus. Temperature screening has been a focal point of case detection during the pandemic because it is one of the earliest and most frequently reported manifestations of the illness. We describe important factors to consider of screened individuals as well as the measurement process and current outcomes. Optimal temperature-based screening involves both individual and environmental factors as well as reconsideration of the current fever threshold.
Impact of Rejection of Low-Quality Wound Swabs on Antimicrobial Prescribing: A Controlled Before–After Study
Authors: Marchand-Senécal Xavier , Brasg Ian A , Kozak Robert , Elligsen Marion , Vermeiren Christie , Corbeil Antoine J , Barker Kevin R , Katz Kevin , Powis Jeff E , Gold Wayne L , Leis Jerome A
Published: December 2020

In this controlled before–after study, wound swabs were only processed for culture, identification, and susceptibility testing if a quality metric, determined by the Q score, was met. Rejection of low-quality wound swabs resulted in a modest decrease in reflexive antibiotic initiation while reducing laboratory workload and generating few clinician requests.
The Addition of Real-time Ultrasound Visual Feedback to Manual Facilitation Increases Serratus Anterior Activation in Adults With Painful Shoulders: A Randomized Crossover Trial
Authors: McKenna Leanda J , Bonnett Luke , Panzich Kelly , Lim Jacinta , Hansen Snorre K , Graves Anna , Jacques Angela , Williams Sian A
Published: December 2020

Objective

Serratus anterior (SA) muscle activation may be decreased with subacromial pain syndrome. The purpose of this study was to determine whether the addition of real-time ultrasound (RTUS) visual feedback increased activation of SA in adults with painful shoulders in comparison to manual facilitation alone.

Methods

This assessor-blinded, 2-period, randomized cross-over trial was conducted in a university medical imaging laboratory. Adults with mild-moderate unilateral subacromial pain received both interventions in random order with at least 1-week washout between interventions. Fourteen participants were randomized to receive manual facilitation with RTUS first, and 13 were randomized to receive manual facilitation alone first. Fifteen repetitions of a supine ``serratus punch'' were facilitated by RTUS visual feedback with manual facilitation or by manual facilitation alone. Levels of SA activation via surface electromyography were normalized to a maximum voluntary isometric contraction.

Results

A total of 25 participants completed the full trial of both interventions. Data from 25 participant periods for RTUS with manual facilitation and data from 26 participant periods for manual facilitation only were analyzed. The predicted marginal mean difference between interventions was 55.5% (95% CI = 13.9% to 97.1%) in favor of the addition of RTUS feedback. No adverse effects occurred.

Conclusion

RTUS visual feedback increases SA activation in adults with painful shoulders compared with manual facilitation alone.

Impact

Determining if RTUS can improve SA muscle activation may help clinicians improve physical therapist interventions for subacromial pain syndrome.
The impact of the COVID-19 pandemic on the medical care and health-care behaviour of patients with lupus and other systemic autoimmune diseases: a mixed methods longitudinal study
Authors: Sloan Melanie , Gordon Caroline , Harwood Rupert , Lever Elliott , Wincup Chris , Bosley Michael , Brimicombe James , Pilling Mark , Sutton Stephen , Holloway Lynn , D’Cruz David
Published: December 2020

Objective

The aim was to explore the self-reported impact of the COVID-19 pandemic on changes to care and behaviour in UK patients with systemic autoimmune rheumatic diseases, to help ensure that patient experiences are considered in future pandemic planning.

Methods

This was a longitudinal mixed methods study, with a cohort completing baseline surveys in March 2020 and follow-up surveys in June 2020 (n = 111), combined with thematic analysis of the LUPUS UK forum and participant interviews (n = 28).

Results

Cancellations of routine care and difficulties in accessing medical support contributed to some participants deteriorating physically, including reports of hospitalizations. The majority of participants reported that fear of COVID-19 and disruptions to their medical care had also adversely impacted their mental health. Feeling medically supported during the pandemic was correlated with multiple measures of mental health and perceptions of care, including the Warwick–Edinburgh mental well-being score (r = 0.44, P = 0.01). Five themes were identified: detrimental reduction in care; disparities in contact and communication (medical security vs abandonment sub-theme); perceived and actual endangerment; the perfect storm of reduced clinician ability to help and increased patient reticence to seek help; and identifying the patients most vulnerable to reduced medical care.

Conclusion

The diversion of resources away from chronic disease care was perceived by many participants to have caused adverse outcomes. Fear about increased vulnerability to COVID-19 was high, contributing to health-care-avoidant behaviours. This study also highlights the influence of clinician accessibility and patients feeling medically supported on multiple measures of physical and mental health.
Transesophageal echocardiography for perioperative management in thoracic surgery
Authors: Kim Kevin K. , Krause Martin , Brandes Ivo F. , Khanna Ashish K. , Bartels Karsten
Published: December 2020

Purpose of review

Perioperative transesophageal echocardiography (TEE) is most often employed during cardiac surgery. This review will summarize some of the recent findings relevant to TEE utilization during thoracic surgical procedures.

Recent findings

Hemodynamic monitoring is a key component of goal-directed fluid therapy, which is also becoming more common for management of thoracic surgical procedures. Although usually not required for the anesthetic management of common thoracic surgeries, TEE is frequently used during lung transplantation and pulmonary thromboendarterectomy. Few clinical studies support current practice patterns, and most recommendations are based on expert opinion.

Currently, routine use of TEE in thoracic surgery is often limited to specific high-risk patients and/or procedures. As in other perioperative settings, TEE may be utilized to elucidate the reasons for acute hemodynamic instability without apparent cause. Contraindications to TEE apply and have to be taken into consideration before performing a TEE on a thoracic surgical patient.
Association of Leptin and Dried Fruit Mix and Nuts With Craving During Smoking Cessation
Authors: Silva Thayzis d.P. , Gomes Arthur d.S. , de Melo Marcela M. , de Oliveira Taillan M. , Galil Arise G.d.S. , Percegoni Nathércia , Fonseca Vilma A.d.S. , Bastos André N. , de Aguiar Aline S.
Published: December 2020

Objective:

The objective of this study was to assess dried fruit mix and nuts and their effect on craving associated with the serum leptin of tobacco smokers.

Materials and Methods:

This is a clinical intervention study with a nonprobabilistic sample (n=23). The intervention group (IG) received 30 g of dried fruit and mix, and the control group (CG) received standard interventions. Test craving was analyzed using the Questionnaire of Smoking Urges (QSU-Brief). Serum leptin was assessed at the beginning and after 3 weeks. The data was tested using the SPSS program through the Shapiro-Wilk, unpaired Student t, or Mann-Whitney tests and multivariate linear regression.

Results:

The study showed significant difference between initial and final weights and body mass indices. The IG showed a high degree of smoking dependence. The IG showed reduced craving. In the CG, median serum leptin levels showed increased craving in the second and third weeks.

Conclusions:

Our results establish that craving decreased among smokers only in the IG. In the CG, above-median serum leptin levels reported a greater sense of pleasure in the second week. And in the third week, they experienced difficulties maintaining abstinence.
Comparison of Two-level Cervical Disc Replacement Versus Two-level Anterior Cervical Discectomy and Fusion in the Outpatient Setting
Authors: Doan Matthew K. , Chung Andrew S. , Makovicka Justin L. , Hassebrock Jeffrey D. , Polveroni Thomas M. , Patel Karan A.
Published: December 2020

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to evaluate the safety of two-level cervical disc replacement (CDR) in the outpatient setting.

Summary of Background Data.

Despite growing interest in CDR, limited data exist evaluating the safety of two-level CDR in the outpatient setting.

Methods.

The National Surgical Quality Improvement Program (NSQIP) database was queried for all two-level anterior cervical discectomy and fusion (ACDF) and CDR procedures between 2015 and 2018. Demographics, comorbidities, and 30-day postoperative complication rates of outpatient two-level CDR were compared to those of inpatient two-level CDR and outpatient two-level ACDF. Radiographic data are not available in the NSQIP.

Results.

A total of 403 outpatient CDRs were compared to 408 inpatient CDRs and 4134 outpatient ACDFs. Outpatient CDR patients were older and more likely to have pulmonary comorbidities compared to inpatient CDR (P < 0.03). Outpatient CDR patients were less likely to have an American Society of Anesthesiologists class ≥2 and have hypertension compared to outpatient ACDF patients (P < 0.0001). Outpatient CDR had a lower 30-day readmission rate (0.5% vs. 2.5%, P = 0.02) and lower 30-day reoperation rate (0% vs. 1%, P = 0.047) compared to inpatient CDR. Outpatient CDR had a lower readmission rate (0.5% vs. 2.1%, P = 0.03) compared to outpatient ACDF, but there was no difference in reoperation rates between the two procedures (0% vs. 0.8%, P = 0.07). Outpatient CDR had an overall complication rate of 0.2%, inpatient CDR had a complication rate of 0.9%, and outpatient ACDF had a complication rate of 1.3%. These differences were not significant.

Conclusion.

To our knowledge, this is the largest multicenter study examining the safety of two-level outpatient CDR procedures. Outpatient two-level CDR was associated with similarly safe outcomes when compared to inpatient two-level CDR and outpatient two-level ACDF. This suggests that two-level CDR can be performed safely in the outpatient setting.

Level of Evidence: 3
Current and future landscape of poly (ADP-ribose) polymerase inhibition resistance
Authors: Hinchcliff Emily , Chelariu-Raicu Anca , Westin Shannon N.
Published: December 2020

Purpose of review

To highlight relevant strategies to overcome poly(ADP-ribose) polymerase (PARP) inhibitor resistance and present key clinical trials.

Recent findings

The use of PARP inhibition (PARPi) for frontline maintenance offers substantial clinical benefit in patients with homologous recombination-deficient tumors. However, expanding PARPi from recurrent therapy to frontline maintenance may potentially result in more PARPi resistant tumors earlier in the treatment continuum and data for the use of PARPi after PARPi remain limited. Clinical evidence demonstrates tumors may develop resistance to PARPi through demethylation of the BRCA promoter or BRCA reversion mutations. Multiple clinical trials investigating therapeutic strategies to overcome resistance, such as combinations of PARPi with antiangiogenic drugs, PI3K/AKT/mTOR, or MEK inhibitors have already been reported and more are ongoing. Furthermore, increasing the amount of DNA damage in the tumor using chemotherapy or cell cycle inhibitors such as ATM, ATR/CHK1/WEE1 is also under exploration.

There is increasing clinical interest to identify options to enhance PARPi efficacy and overcome adaptive resistance. PARPi represent a class of drugs that have significantly impacted the treatment and maintenance of ovarian cancer; as the use of PARPi increases, better understanding of resistance mechanisms is essential.
The adrenal medulla in cardiovascular medicine: an untold story
Authors: Esler Murray D. , Jennings Garry , Schlaich Markus , Lambert Gavin , Thompson Jane , Lambert Elisabeth , Guo Ling , Alvarenga Marlies , Esler Danielle , Eikelis Nina , Kaye David
Published: December 2020

Unlike noradrenaline, the sympathetic neurotransmitter which overflows to the circulation, adrenaline (ADR) is a secreted hormone, with a low plasma concentration, and plasma concentration for biological action a log order lower than that of noradrenaline. The venous drainage of the left adrenal medulla into the left renal vein does expose this vein to uniquely high plasma ADR concentrations and possible risk of thrombosis at high rates of ADR secretion. There is typically a different timeframe for adrenal medullary and sympathetic nervous system responses: ADR release is short term in contrast with sympathetic activation persisting for years in heart failure and hypertension. The historic view of Walter Cannon, subject to recent review, that the sympathoadrenal system is a unified biological system, was deconstructed further with demonstration of frequent mismatching of adrenal medullary and sympathetic nervous responses. Under gravity stimulation with standing, there is prompt sympathetic activation without ADR release. In many diseases, notably obesity, hypertension, heart failure and depressive illness, an activated sympathetic nervous system and silent adrenal medulla coexist. The therapeutic corollary of this is that ADR blockade is much less commonly needed clinically than pharmacological antagonism of the sympathetic nervous system.
Neck-to-height ratio and arterial stiffness in Chinese adults: cross-sectional associations in a community-based cohort
Authors: Yang Xulong , Chen Shuohua , Zhou Zhe , Qiu Yumin , Zhang Jianning , Wu Yuntao , Xing Aijun , Huang Zhe , Xu Shiyue , Wu Shouling , Tao Jun
Published: December 2020

Objectives:

The aim of this study was to investigate the association between neck-to-height ratio (NHR) and arterial stiffness in adults from a community-based Chinese cohort in a cross-sectional study.

Methods:

We conducted cross-sectional analysis using data from the Kailuan study, a population-based cohort research. Altogether, 18 972 individuals were included in the analysis. Brachial ankle pulse wave velocity (baPWV), anthropometric indexes and cardiovascular risk factors were recorded. Data were analyzed by multiple lineal regression model.

Results:

NHR was positively associated with baPWV after adjusted for age, sex, blood pressure, heart rate, BMI, waist–hip ratio, current smoking, fasting blood glucose, serum cholesterol, uric acid, high-sensitivity C reactive protein and creatinine clearance (β = 5.76, P < 0.001), while the association of neck circumference and baPWV was NS after adjusting the variables mentioned above. In subgroups analysis, the association between NHR and baPWV did not reach statistical significance in female, while in males, the association was significant. Interaction effects were observed among BMI stratifications and the individuals with metabolic syndrome and history of cardiovascular events (P for intereaction = 0.002, 0.038 and 0.003, respectively).

Conclusion:

The current study demonstrated for the first time that NHR was positively associated with baPWV in community-based population, NHR might be a promising independent predictor for cardiovascular disease.
CHANGES IN SUBFOVEAL CHOROIDAL THICKNESS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT THERAPY FOR DIABETIC MACULAR EDEMA
Authors: Moon Ka Young , Choi Shin Young , Song Ji Hun
Published: December 2020

Purpose:

To investigate changes in subfoveal choroidal thickness (SFCT) and their relationship with best-corrected visual acuity and optical coherence tomography parameters after intravitreal dexamethasone implant injection for diabetic macular edema.

Methods:

Eighty-one eyes treated with dexamethasone implant injection for diabetic macular edema were evaluated for best-corrected visual acuity, central macular thickness, SFCT, and optical coherence tomography parameters at baseline and Weeks 7 and 14.

Results:

The mean baseline SFCT significantly decreased at Weeks 7 (P < 0.001) and 14 (P < 0.001). At Week 7, each 1-µm reduction in central macular thickness and five Early Treatment Diabetic Retinopathy Study letters (−0.1 logarithm of the minimal angle of resolution) improvement were associated with SFCT reductions of 0.09 (P = 0.002) and 3.91 (P = 0.044) µm, respectively. At Week 14, each 1-µm reduction in central macular thickness was associated with a 0.14-µm reduction in SFCT (P < 0.001). Eyes with good functional and anatomical responses exhibited significantly greater SFCT reductions. Subretinal fluid resulted in greater SFCT changes (P = 0.039) and better best-corrected visual acuity (P = 0.033) at Week 7. A continuous ellipsoid zone/interdigitation zone layer was associated with a smaller mean SFCT at Week 7 (P = 0.002) and better best-corrected visual acuity at Weeks 7 and 14 (both, P < 0.001).

Conclusion:

Changes in SFCT after dexamethasone implant injection therapy for diabetic macular edema may predict anatomical and functional outcomes and correlate with optical coherence tomography features that are known as predictors of treatment response.
NEOVASCULAR COMPLICATIONS FROM CYTOMEGALOVIRUS NECROTIZING RETINOPATHY IN PATIENTS AFTER HAPLOIDENTICAL HEMATOPOIETIC STEM CELL TRANSPLANTATION
Authors: Long Ze , Hou Jing , Miao Heng
Published: December 2020

Purpose:

To report the incidence and clinical features of neovascular complications from cytomegalovirus (CMV) necrotizing retinopathy in patients after haploidentical hematopoietic stem cell transplantation.

Methods:

Thirty-nine patients (58 eyes) of CMV necrotizing retinopathy after haploidentical hematopoietic stem cell transplantation in our institute between January 2018 and June 2020 were retrospectively reviewed, and cases that developed neovascular complications during follow-up were identified and described.

Results:

Two (2 eyes) cases that developed neovascular glaucoma from CMV necrotizing retinopathy were identified. Both of them manifested as granular peripheral retinitis, panretinal occlusive vasculitis, and some degree of intraocular inflammation, which were consistent with chronic retinal necrosis. Insidious progression of isolated immune-mediated occlusive vasculitis that could only be observed on fundus fluorescein angiography without active retinitis or intraocular inflammation was recognized to be the cause in one of two cases.

Conclusion:

Neovascular glaucoma developed in 5.1%/cases and 3.4%/eyes complicated by CMV chronic retinal necrosis and vasculitis in patients after haploidentical hematopoietic stem cell transplantation, which warrants the needs for long-term follow-up. Immune-mediated CMV vasculitis could be an isolated manifestation in patients with a minimal immune deviation and may only be found on fundus fluorescein angiography, which emphasizes the importance of fundus fluorescein angiography on a regular basis during follow-up.
A New Technique of Pars Plana Vitrectomy With Microinterventional Nucleus Disassembly to Reduce the Energy of Fragmatome Lensectomy for Posteriorly Dislocated Crystalline Lens Removal
Authors: Jimenez Jorge A. , Yanoga Fatoumata , Ohr Matthew P.
Published: December 2020

Purpose:

To describe a novel technique of lens disassembly in posteriorly dislocated crystalline lens removal.

Methods:

A microinterventional microfilament loop device was introduced through the sclerotomy created for the fragmatome to cleave the lens into smaller, manageable pieces.

Results:

Five cases were performed with this technique with improved visual acuity and no complications.

Conclusion:

The use of microinterventional nucleus disassembly during pars plana vitrectomy for retained lens material is a novel approach with potential advantages including decreased operating time and reduced complications secondary to excessive production of ultrasound energy.
Canaloplasty and trabeculotomy ab interno with the OMNI system combined with cataract surgery in open-angle glaucoma: 12-month outcomes from the ROMEO study
Authors: Hirsch Louis , Cotliar Jeremy , Vold Steven , Selvadurai Deepan , Campbell Anita , Ferreira Gabriel , Aminlari Ardalan , Cho Andrew , Heersink Sebastian , Hochman Michael , Gallardo Mark , Williamson Blake , Phan Ryan , Nelson Cade , Dickerson Jaime E.
Published: December 2020

Purpose:

To provide safety and effectiveness outcomes 12 months postsurgically for sequential canaloplasty and trabeculotomy with the OMNI system combined with cataract surgery in mild-to-moderate open-angle glaucoma (OAG).

Setting:

Eleven ophthalmology practices and surgery centers located in 8 U.S. states.

Design:

Retrospective, multicenter, single arm.

Methods:

Twelve surgeons contributed 81 patients meeting eligibility criteria: OAG, 12-month follow-up, and medicated intraocular pressure (IOP) 36 mm Hg or less on 4 or less medications preoperatively. Analysis was stratified by baseline IOP: more than 18 mm Hg (Group 1) and 18 mm Hg (Group 2) or less. Success was defined as proportion with 20% reduction or greater in IOP or IOP between 6 and 18 mm Hg (inclusive) and on the same or fewer medications without secondary surgical intervention (SSI). Other endpoints included mean IOP and medications at 12 months. Safety included corrected distance visual acuity and adverse events (AEs).

Results:

Of the 81 patients included, primary success was met by 79% in Group 1 and 81% in Group 2. The mean IOP was reduced in Group 1 (21.9 to 15.1 mm Hg, P < .0001) and remained controlled in Group 2 (14.1 to 13.4 mm Hg, P = .3177). Medications went from 2.0 ± 1.3 to 1.1 ± 1.1 in Group 1 and from 1.6 ± 1.3 to 0.9 ± 1.2 in Group 2. AEs were typical for cataract or angle surgery: mild inflammation (11%), IOP spikes (5%), and hyphema (4%). Four patients (5%) required an SSI.

Conclusions:

The OMNI system provided effective IOP reduction, sustained IOP control, and meaningful medication reduction for up to 12 months postoperative.
Antimicrobial resistance in ICUs: an update in the light of the COVID-19 pandemic
Authors: Cantón Rafael , Gijón Desirèe , Ruiz-Garbajosa Patricia
Published: December 2020

Purpose of review

To describe current antimicrobial resistance in ESKAPE Gram-negative microorganisms and their situation in the ICUs, the implication of the so-called high-risk clones (HiRCs) involved in the spread of antimicrobial resistance as well as relevance of the COVID-19 pandemic in the potential increase of resistance.

Recent findings

Extended-spectrum and carbapenemase producing Enterobacterales and multidrug and extensive drug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii have increased worldwide. Sequence type (ST)131 Escherichia coli, ST258, ST11, ST10, ST147 and ST307 Klebsiella pneumoniae, ST111, ST175, ST235 and ST244 P. aeruginosa HiRCs are responsible for this increase in the ICUs, and some of them are implicated in the emergence of resistance mechanisms affecting new antimicrobials. A similar situation can be found with European clonal complex 1 and clonal complex 2 of A. baumannii. The high use of antimicrobials during the COVID-19 pandemic, particularly in ICUs, might have a negative influence in future trends of antimicrobial resistance.

The increase of antimicrobial resistance in ICUs is mainly due to the spread of HiRCs and is exemplified with the ESKAPE Gram-negative microorganisms. The COVID-19 pandemic might have a negative impact in the increase of antimicrobial resistance and should be monitored through specific surveillance studies in ICUs.
Macronutrients, microbiome and precision nutrition
Authors: O’Grady John , Shanahan Fergus
Published: December 2020

Purpose of review

Precision nutrition and personalized diets are gaining popularity in nutritional science and medicine. To fully appreciate their potential benefits, a deep understanding of both macronutrients and nutrient–microbe interactions is required.

Recent findings

Microbiome science has reaffirmed the importance of dietary fiber in microbial and host health. Additional macronutrients, digestible carbohydrate, protein and fat also influence the composition and diversity of the microbiome and, therefore, microbial response to dietary intervention. Attention to macronutrient source, dose, microbial effect and metabolite production allows the development of more established links between diet and health.

The degree to which human diets need to be personalized for optimal health is still uncertain but a one-size-fits-all diet seems unlikely. However, for personal or precision nutrition to fulfill its promise, greater attention to the details of nutrient–microbe interactions will be required.
Pivoting Nursing Research and Scholarship During the COVID-19 Pandemic
Authors: Abshire Demetrius A. , McDonnell Karen K. , Donevant Sara B. , Corbett Cynthia F. , Tavakoli Abbas S. , Felder Tisha M. , Pinto Bernardine M.
Published: December 2020

Background

The global COVID-19 pandemic has brought numerous challenges for conducting the human subjects research needed to advance science and improve health.

Objectives

The purpose of this article is to discuss how a college of nursing at a large public university in the southeast United States has responded to the challenges of conducting research during the novel COVID-19 pandemic.

Methods

Seven faculty researchers at the University of South Carolina College of Nursing share their experiences in overcoming the unique challenges of conducting research because of the COVID-19 pandemic. Strategies to overcome the challenges posed by COVID-19 are presented within the context of the research process, career implications, communication, and maintaining morale.

Results

Fears of COVID-19 and social distancing measures have hindered participant recruitment, enrollment, and involvement in ongoing studies. Increasing virtual technology use and enhancing safety precautions have assisted researchers to overcome barriers. Scholarly writing has increased for some faculty members whose studies have been stalled by the pandemic, yet others have seen a decline because of additional personal responsibilities. The careers of faculty members across all ranks have been uniquely affected by the pandemic. With most faculty working remotely, enhanced communication strategies at the university and college have supported the research enterprise. Morale has been adversely affected, but a variety of personal and collegial efforts have helped faculty cope and preserve a sense of normalcy during this devastating pandemic.

Discussion

Faculty and their ability to conduct the research needed to inform clinical and public health practice have been adversely affected by the COVID-19 pandemic. Despite the challenges of conducting research during this unprecedented crisis, faculty and institutions are taking novel steps to ensure the continuity of scientific progress for improving the health and well-being of patients and populations.
Feasibility of a Nonmydriatic Ocular Fundus Camera in an Outpatient Neurology Clinic
Authors: Irani Neha K. , Bidot Samuel , Peragallo Jason H. , Esper Gregory J. , Newman Nancy J. , Biousse Valérie
Published: December 2020

Objective:

To determine the feasibility of nonmydriatic fundus photography in the neurology outpatient setting and to record frequency of clinically relevant fundus findings.

Methods:

Over 5 weeks, fundus photographs were obtained using a nonmydriatic fundus camera in both eyes of adult patients attending our general neurology and headache clinics. A neurologist, who had received 15 minutes of training on the use of the camera, took the photographs. Quality of photographs was graded. Photographs were reviewed by 2 neuro-ophthalmologists. Treating neurologists completed a survey on the use of this technology in the neurology clinic. Feasibility parameters including ease, comfort, speed, quality, and clinical relevance of nonmydriatic fundus photography was assessed.

Results:

We obtained 505 fundus photographs of 206 patients. Median time to completion of photographs per patient was 2.12 minutes. Mean rating for ease, comfort, and speed was 9.7 out of 10. Among these, 160 had normal and 44 had abnormal findings. In 114 of 206 patients, neurologists relied on photographs for ocular fundus assessment. In the remaining 92 patients, 18 patients had abnormal photographs, of which neurologists missed the abnormality in 14 (78%). All neurologists preferred nonmydriatic fundus photography over direct ophthalmoscopy.

Conclusions:

Using nonmydriatic fundus photography in an outpatient neurology clinic is feasible without disrupting patient flow or causing patient discomfort. Findings of optic nerve pallor, optic nerve swelling, or normal optic nerves were particularly relevant to these patients seen for headaches or demyelinating disease and helped inform immediate diagnosis and management.
Nonatrial Fibrillation was Associated With Early Neurological Improvement After Intravenous Thrombolysis With rt-PA in Patients With Acute Ischemic Stroke
Authors: Liu Jie , Huang Jiaqi , Xu Huimin , Dai Haibin
Published: December 2020

Background:

Intravenous thrombolysis is the only approved pharmacological treatment for acute ischemic stroke (AIS) patients, but the immediate response to thrombolysis varies by patient.

Objective:

To investigate the factors associated with early neurological improvement (ENI) after the administration of intravenous recombinant tissue plasminogen activator (rt-PA) treatment to AIS patients within 4.5 hours of onset.

Methods:

Demographics, onset to treatment time, risk factors, and clinical and laboratory data of 209 AIS patients undergoing intravenous rt-PA therapy at a Chinese hospital between January 2013 and August 2016 were retrospectively analyzed. The National Institutes of Health Stroke Scale (NIHSS) score was recorded before thrombolytic therapy, 24 hours after the treatment, and 7 days after the treatment to evaluate the recovery of neurological function. ENI was defined as a ≥4-point decrease in NIHSS score compared with baseline or a score of 0 or 1 at 24 hours and 7 days. A multivariate logistic regression analysis was performed to assess the outcomes.

Results:

Of the 209 AIS patients treated by intravenous thrombolysis with rt-PA, low-density lipoprotein (LDL) levels were significantly lower (P<0.05) in patients with ENI. The multivariable analysis showed that non-atrial fibrillation (AF) was independently associated with ENI at 24 hours and 7 days after thrombolysis. An overall 40.3% non-AF patients had ENI 24 hours after thrombolysis (odds ratio=2.501, 95% confidence interval: 1.204-5.198; P=0.014), and 65.9% non-AF patients had ENI 7 days after thrombolysis (odds ratio=2.953, 95% confidence interval: 1.434-6.081; P=0.003). Onset to treatment time was an independent predictor (P<0.05) for ENI at 7 days after thrombolysis. The NIHSS score and diastolic blood pressure on admission were associated with symptomatic intracerebral hemorrhagic transformation.

Conclusions:

Non-AF was independently associated with ENI after intravenous thrombolysis in AIS patients, but non-AF was not associated with the occurrence of symptomatic intracerebral hemorrhage. Onset to treatment time was an independent predictor of ENI at 7 days after thrombolysis in AIS patients.
The Rehabilitation Medicine Scientist Training Program
Authors: Morse Leslie R. , Morgenroth David C. , Boninger Michael L. , Whyte John
Published: December 2020

The shortage of physician-scientists in physical medicine and rehabilitation remains a critical problem. The Rehabilitation Medicine Scientist Training Program was developed in 1995 to provide structured career development training for aspiring rehabilitation medicine researchers. Initially funded by a 5-yr K12 grant from the National Institutes of Health National Center for Medical Rehabilitation Research, the structure was revised in 2001, continued in a stable format through three additional funding cycles (2001–2006, 2006–2012, and 2012–2016), and was again revised to a research education program (National Institutes of Health R25) model in 2019. With this change in format of the Rehabilitation Medicine Scientist Training Program, we now report the productivity of funded trainees and discuss future directions informed by the Rehabilitation Medicine Scientist Training Program’s current R25 structure.
The Importance of Personally Reviewing Imaging for Clinical Correlation
Authors: Berlin Evan , Malave Jose , Whitacre Ross , Sullivan William
Published: December 2020

A 64-yr-old man with a history of previous motor vehicle collision with chronic back pain presented as a referral to an outpatient spine clinic with a 3-yr history of bilateral lower limb weakness and numbness that progressed to severe bilateral foot drop. He had been seen by another practitioner from a different hospital 2 yrs prior who performed an electromyography that was interpreted as possible primary lateral sclerosis. His clinical picture was difficult to interpret as it did not fit any of the disease patterns, such as a motor neuron disease, suggested by previous electromyography. Repeated magnetic resonance imaging revealed multifactorial canal stenosis at L3-L4 and L4-L5 with foraminal stenosis. The ordering physician reviewed the magnetic resonance imaging of lumbar spine and noticed possible spinal canal stenosis in the lower thoracic region, not noted by the radiologist, and ordered a magnetic resonance imaging of thoracic spine for further evaluation. Overall, this is an interesting case of a patient who had prolonged weakness and numbness in his lower limbs that, although he underwent extensive workup, was misdiagnosed. It is important to realize that thoracolumbar disc herniations can cause mixed upper motor neuron and lower motor neuron signs. This case emphasizes the importance of reviewing the patient’s imaging personally and correlating the imaging to the clinic presentation.
Epithelioid Hemangioma of Vertebra Mimicking Metastasis on FDG PET/CT in a Patient With Renal Cell Cancer
Authors: Yanagisawa Fumi , Amano Yasuo , Omori Yuko , Takagi Ryo , Tang Xiaoyan
Published: December 2020

Vertebral epithelioid hemangioma is a rare vascular tumor composed of the many vessels lined by distinct epithelioid endothelial cells. We present the case of a patient with renal cell cancer (RCC) and suspicious vertebral metastasis presenting with back pain, who was later found to have epithelioid hemangioma. FDG PET/CT demonstrated uptake of FDG not only in RCC, but also in the sixth thoracic vertebral body. The SUVmax of the vertebra was more than twice as high as RCC. This report indicates importance of quantitative assessment of FDG uptake, as well as combined use of MRI.
Demonstration of Double Bladder Diverticula on Bone Scan
Authors: Bian Qianyu , Luo Lingling , Jin Xiaomao , Yao Xiaobo
Published: December 2020

A 75-year-old man with suspected prostate cancer underwent a 99mTc-MDP bone scan to exclude the possibility of bone metastasis. Scans revealed areas of increased tracer uptake in a symmetric distribution on both sides of the pelvis. Further SPECT/CT imaging showed focal 99mTc-MDP accumulation within 2 cystic lesions on both sides of the bladder. Subsequent x-ray cystography showed contrast agent filling within both cystic lesions, which suggested double bladder diverticula. Eventually, these 2 cystic lesions were confirmed by surgery and pathology as double congenital bladder diverticula.
Two Cases of Decreased 123I-Metaiodobenzylguanidine Lung Uptake in Metaiodobenzylguanidine Scintigraphy While Taking Selective Serotonin Reuptake Inhibitor/Serotonin Noradrenaline Reuptake Inhibitor
Authors: Adaniya Shinobu , Takahashi Miwako , Koyama Keitaro , Ogane Kenichiro , Momose Toshimitsu
Published: December 2020

123I-metaiodobenzylguanidine scintigraphy is used to differentiate Lewy body disease from other neurodegenerative disorders. We identified 2 cases with remarkably changed pulmonary uptake between 2 metaiodobenzylguanidine scintigraphies; pulmonary uptake was reduced when patients were taking selective serotonin reuptake inhibitor/serotonin noradrenaline reuptake inhibitor and preserved during the medication-naive or withdrawal state, suggesting that pulmonary uptake involves not only the noradrenaline transporter, but also the serotonin transporter. Pulmonary accumulation may affect the heart-to-mediastinum ratio as the region of interest on the planner image is usually placed on the heart and includes part of the lung. Therefore, we should pay attention to the medication state of patients with decreased pulmonary uptake.
Hallucination, imagery, dreaming: reassembling stimulus-independent perceptions based on Edmund Parish's classic misperception framework
Authors: Waters Flavie , Barnby Joseph M. , Blom Jan Dirk
Published: December 2020

Within the broad field of human perception lies the category of stimulus-independent perceptions, which draws together experiences such as hallucinations, mental imagery and dreams. Traditional divisions between medical and psychological sciences have contributed to these experiences being investigated separately. This review aims to examine their similarities and differences at the levels of phenomenology and underlying brain function and thus reassemble them within a common framework. Using Edmund Parish's historical work as a guiding tool and the latest research findings in the cognitive, clinical and computational sciences, we consider how different perspectives may be reconciled and help generate novel hypotheses for future research.

This article is part of the theme issue ‘Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation’.
Reconciling competing mechanisms posited to underlie auditory verbal hallucinations
Authors: Thakkar Katharine N. , Mathalon Daniel H. , Ford Judith M.
Published: December 2020

Perception is not the passive registration of incoming sensory data. Rather, it involves some analysis by synthesis, based on past experiences and context. One adaptive consequence of this arrangement is imagination—the ability to richly simulate sensory experiences, interrogate and manipulate those simulations, in service of action and decision making. In this paper, we will discuss one possible cost of this adaptation, namely hallucinations—perceptions without sensory stimulation, which characterize serious mental illnesses like schizophrenia, but which also occur in neurological illnesses, and—crucially for the present piece—are common also in the non-treatment-seeking population. We will draw upon a framework for imagination that distinguishes voluntary from non-voluntary experiences and explore the extent to which the varieties and features of hallucinations map onto this distinction, with a focus on auditory-verbal hallucinations (AVHs)—colloquially, hearing voices. We will propose that sense of agency for the act of imagining is key to meaningfully dissecting different forms and features of AVHs, and we will outline the neural, cognitive and phenomenological sequelae of this sense. We will conclude that a compelling unifying framework for action, perception and belief—predictive processing—can incorporate observations regarding sense of agency, imagination and hallucination.

This article is part of the theme issue ‘Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation’.
Why do imagery and perception look and feel so different?
Authors: Koenig-Robert Roger , Pearson Joel
Published: December 2020

Despite the past few decades of research providing convincing evidence of the similarities in function and neural mechanisms between imagery and perception, for most of us, the experience of the two are undeniably different, why? Here, we review and discuss the differences between imagery and perception and the possible underlying causes of these differences, from function to neural mechanisms. Specifically, we discuss the directional flow of information (top-down versus bottom-up), the differences in targeted cortical layers in primary visual cortex and possible different neural mechanisms of modulation versus excitation. For the first time in history, neuroscience is beginning to shed light on this long-held mystery of why imagery and perception look and feel so different.

This article is part of the theme issue ‘Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.
LUTS-V: A New Simplified Score for Assessing Lower Urinary Tract Symptoms in Men
Authors: Silva Caroline Santos , de Araujo Ueslei Menezes , Alvaia Mateus Andrade , Freitas Kátia Santana , Gomes Cristiano Mendes , Júnior José de Bessa
Published: December 2020

OBJECTIVE

To validate a new simplified score for the assessment of men with LUTS (LUTS-V).

METHODS

We made adjustments to the VPSS, resulting in a new simplified instrument (LUTS visual score – LUTS-V). In a pilot study, LUTS-V was administered to 50 men to identify interpretation issues. We used the International Prostate Symptom Score (IPSS) as the gold standard to validate the new tool in 306 men. The total IPSS and LUTS-V scores for each subject were evaluated and we used Bland-Altman analysis and Pearson’s correlation plot to assess the agreement between the scores. A ROC curve was utilized to determine the diagnostic accuracy of LUTS-V and its diagnostic properties were described in terms of sensitivity, specificity, positive and negative predictive values.

RESULTS

Median age was 59 [52-67] years and, according to the IPSS, 26 (8.7%) patients had severe symptoms, while 99 (33%) had moderate symptoms, and 175 (58.3%) had mild symptoms. We found a positive correlation between the IPSS and LUTS-V (r = 0.72; p < 0.0001). Bland-Altman analysis showed good agreement between the two questionnaires. We found LUTS-V to have a diagnostic accuracy to detect more severe cases of 83% (95% CI: [78-87%]; p < 0.001), as estimated by the area under the ROC curve. The cut-off value of ≥ 4 points was the best threshold, with a sensitivity of 74% and a specificity of 78%, which resulted in a negative predictive value of 81% and a positive predictive value of 71% in this scenario. Median completion time was 0.51 [0.41-1.07] min for LUTS-V and 2.5 [2.2-3.4] min for the IPSS (p < 0.0001). In addition, 91.5% of patients completed the questionnaires with no help, while the other 8.5% were interviewed.

CONCLUSION

LUTS-V is a simple, self-administered tool with a significant discriminating power to identify patients with moderate to severe symptoms.