bluuebunny/crossref_metadata_2025 huggingface dataset:
Are extrafloral nectaries efficient against herbivores? Herbivory and plant defenses in contrasting tropical species
Authors: Pereira Cássio Cardoso , Boaventura Maria Gabriela , de Castro Gislene Carvalho , Cornelissen Tatiana
Published: May 2020

Aims

Plants have limited resources for defenses and species that invest in biotic defenses might exhibit leaves that invest less in other types of defenses. We have investigated whether plants that have few mechanical defenses, but have extrafloral nectaries (EFNs) patrolled by ants, are less prone to herbivory, compared with plants without EFNs that have tougher leaves.

Methods

Data from the literature were extracted to examine the reported levels of herbivory in plants with or without EFNs. In a savanna vegetation in southern Brazil, field data were collected in leaves from six tropical species and herbivory and specific leaf area (SLA) levels were measured. We further evaluated differences in herbivory and SLA among species and between plants with or without EFNs. In order to test the relationship between herbivory and leaf toughness we regressed average herbivory and average SLA per plant.

Important Findings

Plants exhibited variable levels of leaf damage, but plants without ant defenses experienced the highest levels of leaf area loss to herbivory. Levels of mechanical defenses were also variable among the plant species. Plants without EFNs were tougher, exhibiting lower values of SLA. Although plants without EFNs had more sclerophyllous leaves, this mechanical defense was not sufficient to impair and/or reduce herbivore feeding, suggesting that the biotic defenses performed by patrolling ants might be more effective than investment in mechanical defenses associated with leaf palatability.
TIMER2.0 for analysis of tumor-infiltrating immune cells
Authors: Li Taiwen , Fu Jingxin , Zeng Zexian , Cohen David , Li Jing , Chen Qianming , Li Bo , Liu X Shirley
Published: May 2020

Tumor progression and the efficacy of immunotherapy are strongly influenced by the composition and abundance of immune cells in the tumor microenvironment. Due to the limitations of direct measurement methods, computational algorithms are often used to infer immune cell composition from bulk tumor transcriptome profiles. These estimated tumor immune infiltrate populations have been associated with genomic and transcriptomic changes in the tumors, providing insight into tumor–immune interactions. However, such investigations on large-scale public data remain challenging. To lower the barriers for the analysis of complex tumor–immune interactions, we significantly improved our previous web platform TIMER. Instead of just using one algorithm, TIMER2.0 (http://timer.cistrome.org/) provides more robust estimation of immune infiltration levels for The Cancer Genome Atlas (TCGA) or user-provided tumor profiles using six state-of-the-art algorithms. TIMER2.0 provides four modules for investigating the associations between immune infiltrates and genetic or clinical features, and four modules for exploring cancer-related associations in the TCGA cohorts. Each module can generate a functional heatmap table, enabling the user to easily identify significant associations in multiple cancer types simultaneously. Overall, the TIMER2.0 web server provides comprehensive analysis and visualization functions of tumor infiltrating immune cells.
Evaluation of Using the Sphygmomanometer Test to Assess Pain Sensitivity in Chronic Pain Patients vs Normal Controls
Authors: Butler Seth , Draleau Kyle , Heinrich Ross , Nguyen Liem , Shbeeb David , Sigalovsky Daniel , Koh WoonYuen , Hull Stephen Z , Cao Ling
Published: May 2020

Objectives

Objectively measuring pain sensitivity has not been easy in primary care clinics. A sphygmomanometer test (a sensory test that measures an individual’s nociceptive response to pressure using a standard blood pressure cuff) has recently been established to test pain sensitivity. Here, we examined the feasibility of using the sphygmomanometer test with chronic pain patients.

Design

Population, observational study.

Settings

A community hospital multidisciplinary Pain Center and a private nonprofit university.

Subjects

Healthy controls and chronic pain patients were recruited.

Methods

All subjects underwent four pain sensitivity tests: a pressure algometer test, a cold pressure test, a heat sensitivity test, and a sphygmomanometer test. Participants then completed four established surveys for evaluating depression (Patient Health Questionnaire–9), anxiety (General Anxiety Disorder–7), fatigue (Fatigue Severity Scale), and pain catastrophizing (Pain Catastrophizing Scale).

Results

Although pain patients had significantly higher levels of depression, anxiety, fatigue, and pain catastrophizing, as well as reported pain scores, no significant differences in pain sensitivity were detected via any of the pain sensitivity tests. In the control but not the patient group, results from all pain sensitivity tests including the sphygmomanometer test were significantly correlated with each other. Unlike other pain sensitivity tests, the sphygmomanometer test did not correlate with measures of depression, anxiety, fatigue, or pain catastrophizing characteristics.

Conclusions

Our results indicate the unique characteristics of the sphygmomanometer test as a pain sensitivity test, particularly when utilized for individuals with chronic pain. Multiple pain sensitivity tests that assess various sensory modalities are needed to evaluate pain sensitivities in chronic pain patients.
“If They Do Not Fulfill What They Have Promised, I Will Accuse Them”: Locating Indigenous Women and Their Influence in the California Missions
Authors: Rizzo Martin
Published: May 2020

In Indigenous California, women often held important roles of political and spiritual leadership. Spanish Franciscan colonialism imposed a patriarchal framework through the California missions. Through a close look of the lives of two Indigenous women who lived at Mission Santa Cruz, this article examines how Native women maintained power and influence within the mission communities. The stories of these two women, Yaquenonsat and Yuñan, intersect with difficult issues of rape and sexual violence, infanticide, sterility, abortion, and the impact of sexually transmitted disease. And yet, the article focuses on resistance and expressions of power—the two women played key roles in organizing and planning the assassination of the abusive Padre Quintana in 1812. This article proposes new methodological approaches to the chancery archives to trace the lives of these women and suggests new ways of analyzing stories of individuals and families within the missions to find the subtle ways of resistance and rebellion by Indigenous men and women.
Efficacy and Baseline Sensitivity of Succinate-Dehydrogenase-Inhibitor Fungicides for Management of Colletotrichum Crown Rot of Strawberry
Authors: Oliveira Michelle S. , Cordova Leandro G. , Peres Natalia A.
Published: May 2020

The current management of Colletotrichum crown rot (CCR) of strawberry, caused by Colletotrichum gloeosporioides sensu lato, relies on the use of a few fungicide classes, particularly QoI fungicides. Since resistance to QoI fungicides has recently been detected, alternative fungicide groups are needed to control this disease. Our objective was to evaluate the efficacy of succinate-dehydrogenase-inhibitor (SDHI) fungicides in managing CCR. Five SDHI fungicides, fluopyram, isofetamid, penthiopyrad, fluxapyroxad, and benzovindiflupyr, were applied 2 days before or 1 day after inoculation of cultivar Strawberry Festival. SDHI treatments were compared with the most common fungicides used for CCR management, i.e., thiophanate-methyl, pyraclostrobin, and captan. Benzovindiflupyr applied 1 day after inoculation was effective in reducing plant mortality and disease development. The baseline sensitivity of C. gloeosporioides isolates was determined in vitro using a spiral gradient dilution assay. The EC50 for benzovindiflupyr and penthiopyrad varied from 0.08 to 1.11 and 0.45 to 3.17 µg/ml, respectively, whereas the other SDHI fungicides did not inhibit fungal growth. If registered, benzovindiflupyr could serve as an alternative to manage CCR in Florida.
Hop Downy Mildew Caused by Pseudoperonospora humuli: A Diagnostic Guide
Authors: Purayannur Savithri , Miles Timothy D. , Gent David H. , Pigg Stacey , Quesada-Ocampo Lina M.
Published: May 2020

Downy mildew, caused by Pseudoperonospora humuli, is one of the most destructive diseases of hop. The purpose of this article is to provide an overview of the pathogen, the host range and geographical distribution, and the means to diagnose the disease. It is important to be able to diagnose downy mildew and distinguish it from other diseases for the timely application of suitable management practices. The procedures for laboratory propagation and maintenance of isolates are also presented.
Nonneoplastic Tracheal Abnormalities on CT
Authors: Aluja-Jaramillo Felipe , Gutiérrez Fernando R. , Rossi Santiago , Bhalla Sanjeev
Published: May 2020

Tracheal disorders can create clinical and imaging challenges. They are often misdiagnosed as other pulmonary disorders. Chest radiography has low sensitivity and specificity for proper identification of tracheal disorders. Multidetector-row CT (MDCT) has the inherent advantage of being able to provide high-quality multiplanar reformations, 3D volume-rendered images, virtual bronchoscopy, and minimum intensity projections. These can serve as a roadmap for bronchoscopy or surgical planning. The most important imaging sign of tracheal disease is thickening of the tracheal wall, and the most relevant sign to be evaluated for differential diagnosis is the distribution and appearance of wall thickening. Tracheal abnormalities may be classified based on the tracheal dimensions into increased diameter or decreased diameter to reduce the differential diagnosis. Increased diameter tracheal diseases may be subclassified into diffuse or focal diseases based on the area of involvement, thereby providing a more specific diagnosis.
Public Health Is Essential: COVID-19’s Learnable Moment for Medical Education
Authors: Maeshiro Rika , Carney Jan K.
Published: May 2020

The COVID-19 pandemic, an unprecedented challenge for this generation of physicians and for the health care system, has reawakened calls to strengthen the United States’ public health systems. This global event is also a “learnable moment” for medical education—an opportunity to decisively incorporate public health, including public health systems, through the continuum of medical education. Although medical educators have made progress in integrating public health content into medical curricula, “public health” is not a phrase that is consistently used in curricular standards, and public health colleagues are not identified as unique and critical partners to improve and protect health. The COVID-19 crisis has demonstrated how a strong public health system is necessary to support the health of patients and populations, as well as the practice of medicine. Partnerships between medical and public health communities, through individual- and population-based interventions, can also more effectively combat more common threats to health, such as chronic diseases, health inequities, and substance abuse.

To achieve a more effective medicine–public health relationship in practice, curricula across the continuum of medical education must include explanations of public health systems, the responsibilities of physicians to their local and state governmental public health agencies, and opportunities for collaboration. Medical education should also prepare physicians to advocate for public health policies, programs, and funding in order to improve and protect the health of their patients and communities. Pandemic COVID-19 demonstrates with laser focus that all physicians are part of public health systems and that public health content has a distinct and essential place across the continuum of medical education to prepare physicians to participate in, collaborate with, and advocate for public health systems.
Exercise-induced Hypoalgesia Is Impaired in Chronic Whiplash-associated Disorders (WAD) With Both Aerobic and Isometric Exercise
Authors: Smith Ashley , Ritchie Carrie , Warren Jacelle , Sterling Michele
Published: May 2020

Objectives:

Exercise-induced hypoalgesia (EIH) can be impaired in patients with chronic pain and may be dependent on exercise type. Factors predictive of EIH are not known. This study aimed to: (1) compare EIH in participants with chronic whiplash-associated disorders (WAD) to asymptomatic controls, (2) determine if EIH differs between aerobic and isometric exercise, (3) determine predictors of EIH.

Materials and Methods:

A pre-post study investigated the effect of single sessions of submaximal aerobic treadmill walking and isometric knee extension on EIH in 40 participants with chronic WAD and 30 controls. Pressure pain thresholds were measured at the hand, cervical spine, and tibialis anterior. Pain intensity, reported previous week physical activity, temporal summation, and conditioned pain modulation (CPM) were measured at baseline.

Results:

Participants with WAD demonstrated impaired EIH. Although, the WAD participants demonstrated a partial EIH response (EIH induced at the hand during exercise), no EIH response was found immediately after exercise. There was no difference in EIH between exercise types. In the WAD group, moderate physical activity levels predicted EIH at the hand and high physical activity levels predicted impaired EIH at the neck. More efficient CPM predicted EIH at the hand and less efficient CPM predicted impaired EIH at the neck. These associations were found for isometric exercise only.

Discussion:

Individuals with chronic WAD have impaired EIH with both aerobic and isometric exercise. Higher levels of physical activity and less efficient CPM may be associated with impaired EIH. This may have implications for exercise prescription in this patient group.
Systemic Hyperthermia in Traumatic Brain Injury—Relation to Intracranial Pressure Dynamics, Cerebral Energy Metabolism, and Clinical Outcome
Authors: Svedung Wettervik Teodor M. , Engquist Henrik , Lenell Samuel , Howells Timothy , Hillered Lars , Rostami Elham , Lewén Anders , Enblad Per
Published: May 2020

Background:

Systemic hyperthermia is common after traumatic brain injury (TBI) and may induce secondary brain injury, although the pathophysiology is not fully understood. In this study, our aim was to determine the incidence and temporal course of hyperthermia after TBI and its relation to intracranial pressure dynamics, cerebral metabolism, and clinical outcomes.

Materials and Methods:

This retrospective study included 115 TBI patients. Data from systemic physiology (body temperature, blood pressure, and arterial glucose), intracranial pressure dynamics (intracranial pressure, cerebral perfusion pressure, compliance, and pressure reactivity), and cerebral microdialysis (glucose, pyruvate, lactate, glycerol, glutamate, and urea) were analyzed during the first 10 days after injury.

Results:

Overall, 6% of patients did not have hyperthermia (T>38°C) during the first 10 days after injury, whereas 20% had hyperthermia for >50% of the time. Hyperthermia increased from 21% (±27%) of monitoring time on day 1 to 36% (±29%) on days 6 to 10 after injury. In univariate analyses, higher body temperature was not associated with higher intracranial pressure nor lower cerebral perfusion pressure, but was associated with lower cerebral glucose concentration (P=0.001) and higher percentage of lactate-pyruvate ratio>25 (P=0.02) on days 6 to 10 after injury. Higher body temperature and lower arterial glucose concentration were associated with lower cerebral glucose in a multiple linear regression analysis (P=0.02 for both). There was no association between hyperthermia and worse clinical outcomes.

Conclusion:

Hyperthermia was most common between days 6 and 10 following TBI, and associated with disturbances in cerebral energy metabolism but not worse clinical outcome.
Immediate Improvement in Physical Function After Symptomatic Syndesmotic Screw Removal
Authors: Kohring Jessica M. , Greenstein Alexander , Gorczyca John T. , Judd Kyle T. , Soles Gillian , Ketz John P.
Published: May 2020

Objective:

To investigate the immediate impact of removing symptomatic syndesmotic screws on PROMIS outcomes and ankle range of motion (ROM) in patients who had previously undergone ankle fracture open reduction and internal fixation (ORIF) and syndesmotic fixation and later experienced functional limitations.

Design:

Prospective cohort study.

Setting:

Level 1—trauma center.

Patients/Participants:

Fifty-eight patients with ankle fractures with syndesmotic instability that required ORIF with syndesmotic fixation who underwent syndesmotic screw removal (SSR) and 71 patients who underwent ankle ORIF with syndesmotic fixation, but without screw removal during the same study period.

Intervention:

Symptomatic SSR for patients with functional limitations and decreased ankle ROM.

Main Outcome Measurements:

PROMIS physical function (PF) and pain interference T-scores and ankle ROM before and after screw removal.

Results:

Patients who underwent SSR had a statistically significant improvement in the PF T-score to 44.5 (P < 0.01) in the early postoperative period (mean 48 days) after screw removal. The screw removal occurred an average of 184 days after initial ORIF. This PF T-score change also met the minimally clinically important difference. There was a trend toward a significant improvement in PF T-scores for the SSR group as compared to the cohort group (44.5 vs. 41.6; P = 0.06) after screw removal. Removal of symptomatic implants resulted in an early mean improvement of total arc ankle ROM by 17 degrees (P < 0.01).

Conclusions:

Patients experienced an immediate and significant improvement in PF outcomes and ankle ROM after symptomatic SSR for ankle fracture ORIF with syndesmotic fixation.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Mibefradil Alleviates High-Glucose–induced Cardiac Hypertrophy by Inhibiting PI3K/Akt/mTOR-mediated Autophagy
Authors: Zhao Ling-Gong , Li Pei-Lin , Dai Ying , Deng Ji-Li , Shan Meng-Ya , Chen Bin , Zhang Ke-Bin , Guo Shao-Dong , Xu Zi-Hui
Published: May 2020

Cardiac hypertrophy causes heart failure and is associated with hyperglycemia in patients with diabetes mellitus. Mibefradil, which acts as a T-type calcium channel blocker, exerts beneficial effects in patients with heart failure. In this study, we explored the effects and mechanism of mibefradil on high-glucose–induced cardiac hypertrophy in H9c2 cells. H9c2 cells were incubated in a high-glucose medium and then treated with different concentrations of mibefradil in the presence or absence of the Akt inhibitor MK2206 or mTOR inhibitor rapamycin. Cell size was evaluated through immunofluorescence, and mRNA expression of cardiac hypertrophy markers (atrial natriuretic peptide, brain natriuretic peptide, and β-myosin heavy chain) was assessed by using quantitative real-time polymerase chain reaction. Changes in the expression of p-PI3K, p-Akt, and p-mTOR were evaluated using Western blotting, and autophagosome formation was detected using transmission electron microscopy. Our results indicate that mibefradil reduced the size of H9c2 cells, decreased mRNA expression of atrial natriuretic peptide, brain natriuretic peptide, and β-myosin heavy chain, and decreased the level of autophagic flux. However, MK2206 and rapamycin induced autophagy and reversed the effects of mibefradil on high-glucose–induced H9c2 cells. In conclusion, mibefradil ameliorated high-glucose–induced cardiac hypertrophy by activating the PI3K/Akt/mTOR pathway and inhibiting excessive autophagy. Our study shows that mibefradil can be used therapeutically to ameliorate cardiac hypertrophy in patients with diabetes mellitus.
Use of antidepressants with pharmacogenetic prescribing guidelines in a 10-year depression cohort of adult primary care patients
Authors: Jessel Chaten D. , Mostafa Sam , Potiriadis Maria , Everall Ian P. , Gunn Jane M. , Bousman Chad A.
Published: May 2020

Objective

To describe the usage patterns of antidepressants with published CYP2D6- and CYP2C19-based prescribing guidelines among depressed primary care patients and estimate the proportion of patients taking antidepressants not recommended for them based on their CYP2C19 and CYP2D6 genotype-predicted metabolizer status.

Methods

Medication use and pharmacogenetic testing results were collected on 128 primary care patients enrolled in a 10-year depression cohort study. At each 12-month interval, we calculated the proportion of patients that: (1) reported use of one or more of the 13 antidepressant medications (i.e. amitriptyline, citalopram, escitalopram, clomipramine, desipramine, doxepin, fluvoxamine, imipramine, nortriptyline, paroxetine, sertraline, trimipramine, venlafaxine) with published CYP2D6- and CYP2C19-based prescribing guidelines, (2) were taking an antidepressant that was not recommended for them based on their CYP2C19 and CYP2D6 genotype-predicted metabolizer phenotype, and (3) switched medications from the previous 12-month interval.

Results

The annual proportion of individuals taking an antidepressant with a CYP2D6- and CYP2C19-based prescribing guidelines ranged from 45 to 84%. The proportion of participants that used an antidepressant that was not recommended for them, based on available CYP2D6 and CYP2C19 metabolizer phenotype, ranged from 18 to 29% and these individuals tended to switch medications more frequently (10%) compared to their counterparts taking medication aligned with their metabolizer phenotype (6%).

Conclusion

One-quarter of primary care patients used an antidepressant that was not recommended for them based on CYP2D6- and CYP2C19-based prescribing guidelines and switching medications tended to be more common in this group. Studies to determine the impact of CYP2D6 and CYP2C19 genotyping on reducing gene-antidepressant mismatches are warranted.
Doripenem Pharmacokinetics in Hemodialysis
Authors: Phenphinan Sirin , Chaiyakum Aporanee , Subongkot Suphat , Aromdee Chantana , Rotjanapan Porpon , Assanatham Montira , Jaisue Siriluk
Published: May 2020

Background

Doripenem is a broad spectrum carbapenem with activity against gram-positive, gram-negative, and anaerobic bacteria. The drug concentration in target sites is an important determinant of carbapenem efficacy. Doripenem is primarily eliminated by kidneys and can be removed by hemodialysis. The purpose of this study was to determine the pharmacokinetics of doripenem in hemodialysis patients with moderate to severe infections.

Methods

This prospective, single-center study was conducted in end-stage renal disease patients undergoing hemodialysis and receiving doripenem. Low-flux hemodialysis was performed for 4 hours. Blood and dialysate samples were collected during hemodialysis and nonhemodialysis periods. The doripenem concentrations in plasma and dialysate were measured by reverse phase high performance liquid chromatography. The total amount of drug removed during hemodialysis was determined and the hemodialysis clearance of doripenem was calculated using PKSolver, the add-in program for Microsoft Excel. The appropriate dose of doripenem was estimated using Monte Carlo simulation.

Results

Six patients were eligible for the study. The fraction of doripenem eliminated via hemodialysis was 51.31%. The mean total amount of doripenem removed by 4 hours of hemodialysis was 1472.06 ± 861 mg at a removal rate of 6.13 ± 3.59 mg/min. Hemodialysis drug clearance volume was 26.06 ± 14.59 L/h. The recommended doripenem dose estimated from the simulation was 250 mg infused every 12 hours during hemodialysis and 250 mg infused every 48 hours for nonhemodialysis periods.

Conclusions

A low-flux dialyzer removes about half of the total amount of doripenem in blood circulation for 4 hours. Therefore, drug dosage adjustment is required for end-stage renal disease patients undergoing hemodialysis.
Neurohormonal Blockade During Left Ventricular Assist Device Support
Authors: Imamura Teruhiko , Mehta Priya , Nguyen Ann , Chung Ben , Narang Nikhil , Rodgers Daniel , Raikhelkar Jayant , Smith Bryan , Song Tae , Ota Takeyoshi , Jeevanandam Valluvan , Kim Gene , Sayer Gabriel , Uriel Nir
Published: May 2020

Neurohormonal blockade (NHB) is the mainstay of therapy for patients with systolic heart failure (HF). However, the efficacy in patients with left ventricular assist devices (LVADs) remains unknown. Of all, 114 LVAD patients (57 [48, 65] years old and 78% male) were enrolled and followed during the early period (6 months after index discharge), and 98 were followed during the late period (6–12 months following index discharge). Of them, 46% were on beta-blocker (BB), 49% on angiotensin-converting enzyme inhibitor (ACEi) and/or angiotensin II receptor blocker (ARB), and 51% on aldosterone antagonist at baseline. Prevalence of BB and ACEi/ARB use increased during the study period. During the early period, similar event rates were found irrespective of the NHB uses. During the late period, BB was associated with reduced HF readmission, and ACEi/ARB was associated with reduced HF readmission and gastrointestinal bleeding (p < 0.05 for all). In conclusion, BB and ACEi/ARB use during the late period was associated with a reduction in HF recurrence in LVAD patients. Further prospective randomized control trials are warranted to clarify the utility of NHB therapy in LVAD patients.
The Risk of Vitamin D Deficiency, Osteoporosis, and Fractures in Acute Pancreatitis
Authors: Abou Saleh Mohannad , Alkhayyat Motasem , Mansoor Emad , Khoudari George , Simons-Linares C. Roberto , Vargo John , Chahal Prabhleen , Stevens Tyler
Published: May 2020

Objectives

A few past studies have found increased utilization of 25-hydroxyvitamin D and prevalence of osteoporosis in acute pancreatitis (AP). Our aim was to obtain a survey of bone diseases after a sentinel episode of AP.

Methods

A database (Explorys), an aggregate of electronic health record from 26 integrated United States healthcare systems, was queried. A cohort of patients with a Systematized Nomenclature of Medicine—Clinical Terms diagnosis of AP between 2014 and 2019, after excluding patients with selected medical conditions and medications that are associated with poor bone health, was identified. The prevalence of new diagnoses of vitamin D deficiency (VDD), osteoporosis, and fractures in the study cohort was evaluated. Age-, race-, and sex-based distributions and risk factors were determined through univariate and multivariate analyses.

Results

Of the 36,087,380 individuals in the database, we identified 256,580 (0.71%) with AP. In multivariate analysis, patients with AP were more likely to develop VDD (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.24–1.26; P < 0.0001), osteoporosis (OR, 1.89; CI, 1.81–1.85; P < 0.0001), and fractures (OR, 1.58; 95% CI, 1.57–1.59; P < 0.0001).

Conclusions

Acute pancreatitis was associated with increased risk of VDD, osteoporosis, and fractures.
Diazoxide Preconditioning of Nonhuman Primate Pancreas Improves Islet Isolation Outcomes by Mitochondrial Protection
Authors: Wang Yong , Qi Meirigeng , McGarrigle James J. , Xing Yuan , Mendoza-Elias Joshua E. , Bochenek Matt , Marchese Enza , He Yi , Oberholzer Jose
Published: May 2020

Objectives

Previously, we showed that diazoxide (DZ), an effective ischemic preconditioning agent, protected rodent pancreas against ischemia-reperfusion injury. Here, we further investigate whether DZ supplementation to University of Wisconsin (UW) solution during pancreas procurement and islet isolation has similar cytoprotection in a preclinical nonhuman primate model.

Methods

Cynomolgus monkey pancreata were flushed with UW or UW + 150 μM DZ during procurement and preserved for 8 hours before islet isolation.

Results

First, a significantly higher islet yield was observed in UW + DZ than in UW (57,887 vs 23,574 IEq/pancreas and 5396 vs 1646 IEq/g). Second, the DZ treated islets had significantly lower apoptotic cells per islet (1.64% vs 9.85%). Third, DZ significantly inhibited ROS surge during reperfusion with a dose-response manner. Fourth, DZ improved in vitro function of isolated islets determined by mitochondrial potentials and calcium influx in responses to glucose and KCI. Fifth, the DZ treated islets had much higher cure rate and better glycemia control in diabetic mice transplant model.

Conclusions

This study showed a strong mitochondrial protection of DZ on nonhuman primate islets against ischemia-reperfusion injury that provides strong evidence for its clinical application in islet and pancreas transplantation.
Improving Quality With Emergency Department Throughput in a Critical Access Hospital
Authors: Probus Kimberly A. , Smith Todd B.
Published: May 2020

OBJECTIVE

The study objective was to determine the impact of specific measures to reduce the length of stay (LOS) in an emergency department (ED) in a critical access hospital (CAH).

BACKGROUND

Despite mandates to reduce bottlenecks by increasing throughput, many EDs are not successful. Strategies available to larger hospitals may not be feasible for resource-limited CAHs.

METHODS

Interventions were implemented to decrease ED LOS in a rural CAH. Through retrospective chart reviews from time periods both preimplementation and postimplementation, the LOS was determined and compared using 2-sample t tests.

RESULTS

Significant decreases were found between the groups in mean LOS times, as well as specific time intervals within the overall LOS time for nursing-centric activities and incidence of patients leaving prior to treatment completion.

CONCLUSIONS

A significant decrease in LOS resulted from numerous actions taken to improve patient flow. Results may be used to enhance patient flow and decrease LOS in other CAHs, improving quality and access to care.
A Combination of Self-debriefing and Instructor-led Debriefing Improves Team Effectiveness in Health Science Students
Authors: Rueda-Medina Blanca , Gómez-Urquiza Jose Luis , Molina-Rivas Esther , Tapia-Haro Rosa , Aguilar-Ferrándiz María Encarnación , Correa-Rodríguez María
Published: May 2020

Background

Debriefing is considered a critical component of simulation-based learning, but the differences between different debriefing methods remain unclear.

Purpose

The purpose of the study was to investigate the effectiveness of the debriefing assessment, problem-solving process, and team effectiveness among students who received instructor-led debriefing, self-debriefing, and combined debriefing.

Methods

An experimental design was conducted with 250 students (nursing, physiotherapy, and occupational therapy). Differences in the Debriefing Experience Scale (DES), Problem Solving Inventory (PSI), and Communication and Teamwork Skills (CATS) assessment between the groups were measured.

Results

In nursing students, the combined debriefing group had the highest scores for the CATS assessment (P < .001) and for the coordination (P < .001), cooperation (P = .012), and communication (P = .002) categories. No significant differences were observed between debriefing groups for DES or PSI.

Conclusions

Combined debriefing improves communication and team skills in students. Educators might promote combined debriefing after simulation sessions as it seems to improve team effectiveness.
Pediatric Emergency Medicine Training in Procedural Sedation
Authors: Sims Morgan J. , Robinson Lauren C. , Titus M. Olivia , Jackson Benjamin F.
Published: May 2020

Objectives

Pediatric procedural sedation (PS) has been performed with increasing frequency by pediatric emergency physicians for recent years. Accreditation Council for Graduate Medical Education Pediatric Emergency Medicine fellowship core competency requirements do not specify the manner in which fellows should become proficient in pediatric PS. We surveyed the variety of training experience provided during fellowship and whether those surveyed felt that their training was sufficient.

Methods

A 35-question survey offered to pediatric emergency fellows and recent (within 10 years) graduates collected data on pediatric PS training during fellowship. A follow-up questionnaire was sent to fellowship directors at programs where fellow or graduate respondents stated that a sedation curriculum that existed asked details of their program.

Results

There were 95 respondents to the survey, 62% of which had completed pediatric emergency medicine fellowship training. Of respondents, 65% reported having a formal sedation curriculum during fellowship. Of those who participated in a formal curriculum, 82% of respondents felt comfortable performing sedation, whereas the remaining 18% required additional preceptorship and/or more formal training to feel proficient. Fifty-six percent of respondents reported having to complete a set number of sedations before being allowed to sedate independently. Of 17 programs contacted, 9 fellowship directors responded. All 9 included didactics, 6 (66.6%) of 9 included evidence-based medicine literature review, and 6 (66.6%) of 9 included simulation. Other modalities used included supervised clinical experience in a pediatric sedation unit, a 2-week rotation with a hospital sedation team, online sedation modules, and precepted sedations using each pharmacologic agent including nitrous oxide, ketamine, propofol, and ketamine-propofol combination. Ketamine was the most frequently used agent for sedation (87%).

Conclusions

Pediatric emergency medicine fellowship requirements lack a clearly defined pathway for training in PS. Data collected from both current and former fellows depict inconsistency in training experience and suboptimal comfort level in performing these procedures. We suggest that fellows receive a more comprehensive and varied experience with multiple teaching modalities to improve proficiency with this critical and complex aspect of emergency pediatric care.
Improvement of Electronic Health Record Integrated Transition Planning Tools in Primary Care
Authors: Rusley Jack , Tomaszewski Kathy , Kim Julia , Robinson Larnce , Rose Kadi-Ann , Aronin Caroline , Molloy Matthew , Arrington-Sanders Renata
Published: May 2020

Introduction:

The transition from pediatric to adult care is under-studied in primary care. Electronic health record-integrated transition planning tools (ETPTs) can facilitate the transition. We tested whether ETPTs and clinician reminders increase the frequency of transition discussions during adolescent well-visits.

Methods:

In an academic adolescent medicine primary care practice serving a predominantly African American, Medicaid-insured population, we developed 4 ETPTs—readiness assessment, plan template, information handout, and diagnosis code. We used Plan-Do-Study-Act quality improvement cycles to implement ETPTs and measure outcomes. Each cycle added a new layer of clinician support: (1) ETPT training, (2) visual reminders, (3) incentives, and (4) daily reminders. The primary outcome was the proportion of well-visits in which “any ETPT use” occurred. We collected data via chart review and used run charts and regression analyses with multiple comparisons to detect differences between cycles. Clinicians-provided feedback was elicited.

Results:

Any ETPT use increased from 0% to 45% between baseline and cycle 4. The odds of any ETPT use was ten times larger in cycle 4 compared to cycle 1 (odds ratio 10.09, 95% confidence interval 2.29–44.44, P = 0.002) and 22 times larger in cycle 4 than cycle 2 (odds ratio 21.99, 95% confidence interval 3.96–122.00, P < 0.001). Clinicians identified time constraints and lack of sociocultural relevance as barriers to uptake.

Conclusions:

Daily reminders combined with training and visual reminders were effective in increasing the use of ETPTs in primary care. Future interventions should adapt existing transition tools to the needs of target populations and create regular reminders to facilitate uptake.
Urinary Reflux Into the Prostate Gland and Seminal Vesicles
Authors: Hekimsoy Turkay , Gorur Gozde Daglioz , Isgoren Serkan , Uslu Hande , Demir Hakan
Published: May 2020

A 64-year-old man with lung cancer underwent 18F-FDG PET/CT for restaging, which demonstrated intense 18F-FDG uptake in the right lobe of prostate gland and seminal vesicles, indicating a potential prostate cancer. In 68Ga-PSMA PET/CT, intense uptake in the right lobe of prostate gland and seminal vesicles was also observed but decreased in postmictional delayed images. Magnetic resonance imaging showed high signal intensity of urine in the same areas of uptakes. 18F-FDG and 68Ga-PSMA PET/CT findings in the prostate gland and seminal vesicles were considered to be a result of urinary reflux possibly because of the patient’s previous transurethral resection.
Contractility and Myofibrillar Content in Skeletal Muscle are Decreased During Post-Sepsis Recovery, But Not During the Acute Phase of Sepsis
Authors: Crowell Kristen T. , Lang Charles H.
Published: May 2020

Convalescence in humans after severe sepsis occurs over weeks to months and is associated with prolonged functional disabilities and impaired quality-adjusted survival. While much is known regarding the acute early phase of sepsis, there is a knowledge gap pertaining to restoration of muscle mass and function after elimination of the septic nidus. We used a sepsis-recovery model—where cecal-ligation-puncture (CLP) was performed in adult male mice followed 24 h later by removal of the cecum and antibiotic treatment—to assess changes in the abundance of muscle contractile proteins and function during the acute phase of sepsis (24 h post-CLP) and during the recovery phase (day 10 post-CLP). Although body weight and food consumption decreased acutely with sepsis, both had normalized by day 10; however, extensor digitorum longus mass remained decreased 10%. During acute sepsis, there were few contractile defects or significant changes in contractile proteins. In contrast, during sepsis recovery, specific maximum isometric twitch and specific maximum tetanic force were decreased ≈50%, compared with time-matched pair-fed controls, and defects were independent of the concomitant reduction in muscle mass. Force generation in sepsis-recovery mice was decreased 30% with increasing stimulus frequency. Contractile defects during sepsis-recovery were associated with 50% to 90% reductions in thin filament (troponin T, troponin I, tropomyosin, α-sarcomeric actin), thick filament (myosin heavy and myosin light chains), Z-disc (α-actinin 3), and M-band (myomesin-2) proteins, but no change in the intermediate filaments desmin and vimentin. During sepsis recovery, myofibrillar protein synthesis did not differ from control, but synthesis of sarcoplasmic proteins was increased 60%. These data suggest intrinsic defects in muscle contractile function exist during the recovery phase of sepsis and may negatively impact convalescence.
Arachidonic Acid-Dependent Pathway Inhibition in Platelets: its Role in Multiple Injury-Induced Coagulopathy and the Potential Mechanisms
Authors: Tang Yao , Huang Sunhua , Lin Wenhao , Wen Ke , Lin Zhexuan , Han Ming
Published: May 2020

Background:

Our previous study demonstrated the types of platelet dysfunction varied at early stage (∼3 h) in trauma-induced coagulopathy (TIC) caused by different types of injuries. And arachidonic acid (AA)-dependent pathway inhibition in platelet seemed to be specific for TIC caused by multiple injury (MI). The aim of this research was to further study AA-dependent pathway inhibition in platelets in a rat model of TIC caused by MI and to explore its potential mechanisms.

Methods:

Sprague-Dawley rat model of TIC caused by MI was established. We used thrombelastography with platelet mapping as a measure of platelet function to assess the inhibitory extent of AA-dependent activation pathway. Flow cytometry was used to determine the expression of activation-dependent granular protein P-selectin (CD62P). In addition, the plasma levels of 6-Keto-prostaglandin F1 alpha (6-Keto-PGF1α), Prostaglandin E2, and Thromboxane B2 were assessed by enzyme-linked immuno sorbent assay.

Results:

The inhibition rate of AA-dependent pathway after injury was significantly higher than that of control. The maximum amplitude decreased in the MI group, compared with that of control. The percentage of CD62P expression in the MI group was remarkably lower than that of control after AA treatment. The plasma concentrations of 6-Keto-PGF1α and PGE2 increased in the MI group.

Conclusion:

Platelets inhibition was observed in TIC caused by MI at early stage after injury, which might be partially attributed to AA-dependent activation pathway dysfunction. The increase of plasma Prostacyclin and PGE2 levels may contribute to the inhibition process.
Applying Principles From Aviation Safety Investigations to Root Cause Analysis of a Critical Incident During a Simulated Emergency
Authors: Imach Sebastian , Eppich Walter , Zech Alexandra , Kohlmann Thorsten , Prückner Stephan , Trentzsch Heiko
Published: May 2020

Summary Statement

Safety investigations in aviation aim to identify potential root causes. They use structured techniques to analyze information from flight data and cockpit voice recorders. Full-scale medical simulations using audiovisual recordings provide similar possibilities. During a simulated cardiac arrest, an incident related to use of the defibrillator (automated external defibrillator) occurred with emergency medical services (EMS) providers. Treatment interventions and dialogs during the incident were extracted from audiovisual recordings and transferred into a transcript of events.

Knowing indicated treatment measures, the team adhered to automated external defibrillator voice prompts rather than follow their own assessment. Cardiopulmonary resuscitation was on hold for 72% of the time. Time to first defibrillation was delayed by 2:17 minutes. Transcript allowed us to identify faulty decision-making, loss of leadership, and automation bias as possible root causes. Use of RCA methodology during medical simulation improves understanding of critical incidents and can contribute to training of EMS personnel and education of instructors.
Physiological synchrony predicts observational threat learning in humans
Authors: Pärnamets Philip , Espinosa Lisa , Olsson Andreas
Published: May 2020

Understanding how information about threats in the environment is shared and transmitted between individuals is crucial for explaining adaptive, survival-related behaviour in humans and other animals, and for developing treatments for phobias and other anxiety disorders. Research across species has shown that observing a conspecific’s, a ‘demonstrator’s,’ threat responses causes strong and persistent threat memories in the ‘observer’. Here, we examined if physiological synchrony between demonstrator and observer can serve to predict the strength of observationally acquired conditioned responses. We measured synchrony between demonstrators’ and observers’ phasic electrodermal signals during learning, which directly reflects autonomic nervous system activity. Prior interpersonal synchrony predicted the strength of the observer’s later skin conductance responses to threat predicting stimuli, in the absence of the demonstrator. Dynamic coupling between an observer’s and a demonstrator’s autonomic nervous system activity may reflect experience sharing processes facilitating the formation of observational threat associations.
Pollination by hoverflies in the Anthropocene
Authors: Doyle Toby , Hawkes Will L. S. , Massy Richard , Powney Gary D. , Menz Myles H. M. , Wotton Karl R.
Published: May 2020

Pollinator declines, changes in land use and climate-induced shifts in phenology have the potential to seriously affect ecosystem function and food security by disrupting pollination services provided by insects. Much of the current research focuses on bees, or groups other insects together as ‘non-bee pollinators’, obscuring the relative contribution of this diverse group of organisms. Prominent among the ‘non-bee pollinators’ are the hoverflies, known to visit at least 72% of global food crops, which we estimate to be worth around US$300 billion per year, together with over 70% of animal pollinated wildflowers. In addition, hoverflies provide ecosystem functions not seen in bees, such as crop protection from pests, recycling of organic matter and long-distance pollen transfer. Migratory species, in particular, can be hugely abundant and unlike many insect pollinators, do not yet appear to be in serious decline. In this review, we contrast the roles of hoverflies and bees as pollinators, discuss the need for research and monitoring of different pollinator responses to anthropogenic change and examine emerging research into large populations of migratory hoverflies, the threats they face and how they might be used to improve sustainable agriculture.
Halomonas lactosivorans sp. nov., isolated from salt-lake sediment
Authors: Ming Hong , Ji Wei-li , Li Meng , Zhao Zhuo-li , Cheng Li-jiao , Niu Ming-ming , Zhang Ling-yu , Wang Yan , Nie Guo-xing
Published: May 2020

A bacteria strain, designated CFH 90008T, was isolated from a salt lake sediment sample collected from Yuncheng city, Shanxi Province, PR China. Strain CFH 90008T was Gram-stain-negative, strictly aerobic, motile with lateral flagella and rod-shaped. Colonies were yellow, circular and smooth. Phylogenetic analyses based on 16S rRNA gene sequences indicated that strain CFH 90008T belonged to the genus

Halomonas

, showing highest sequence similarity to

Halomonas daqingensis

DQD2-30T (98.6 %),

Halomonas saliphila

LCB169T (98.5 %),

Halomonas desiderata

FB2T (98.1 %) and

Halomonas kenyensis

AIR-2T (98.0 %). Good growth was observed at 10–50 °C, pH 6.0–9.0 and with NaCl concentration from 1.0 to 12.0 % (w/v). The predominant quinone was Q9. The major fatty acid (>10 %) was C18 : 1 ω7c, C16 : 0 and C16 : 1 ω7c. The genome of strain CFH 90008T was 4.36 Mbp with a genomic DNA G+C content of 66.7 mol%. Based on low average nucleotide identity and DNA–DNAhybridization results, chemotaxonomic characteristics, and differential physiological properties, strain CFH 90008T could not be classified into any recognized species of the genus

Halomonas

. Therefore, a new species, for which the name Halomonas lactosivorans sp. nov. is proposed. The type strain is CFH 90008T (=DSM 103220T=KCTC 52281T).