bluuebunny/crossref_metadata_2025 huggingface dataset:
Torula yeast has greater digestibility of amino acids and phosphorus, but not energy, compared with a commercial source of fish meal fed to weanling pigs
Authors: Lagos L Vanessa , Stein Hans H
Published: January 2020

Three experiments were conducted to test the hypothesis that the standardized ileal digestibility (SID) of AA, concentrations of DE and ME, and the standardized total tract digestibility (STTD) of P in a source of torula yeast are not different from values obtained in Menhaden fish meal. In experiment 1, six weanling barrows (initial BW: 11.7 ± 0.4 kg) were prepared with a T-cannula in the distal ileum and allotted to a replicated 3 × 3 Latin square design with 3 diets and 3 periods. In each period, there were 5 d of adaptation and 2 d of collection. Two cornstarch-based diets using the torula yeast or fish meal as the sole source of AA and a N-free diet were formulated. The SID of CP and all AA was greater (P < 0.05) in torula yeast than in fish meal. In experiment 2, 24 weanling barrows (initial BW: 14.4 ± 1.1 kg) were individually housed in metabolism crates and allotted to a corn-based diet or 2 diets based on a mixture of corn and torula yeast or corn and fish meal. Feces and urine samples were collected for 4 d following a 5-d adaptation period. There were 8 replicate pigs per diet and fecal and urine materials were collected. Results of this experiment indicated that there were no differences in the concentration of DE and ME (DM basis) between torula yeast and fish meal. In experiment 3, a total of 32 weanling barrows (initial BW: 11.9 ± 1.1 kg) were allotted to 4 diets and 8 replicate pigs per diet. Pigs were placed in individual metabolism crates. The torula yeast or fish meal were used in 2 diets containing either 0 or 500 units of microbial phytase. Feces samples were collected as described for experiment 2. The STTD of P in torula yeast was greater (P < 0.05) than in fish meal, but regardless of ingredient, there was no effect of the inclusion of phytase in the diets. In conclusion, the SID of AA and the STTD of P in torula yeast is greater than in fish meal, but values for the concentration of DE and ME in torula yeast are not different from those in fish meal. Therefore, the torula yeast that was used in the present experiments may be included at the expense of fish meal in diets fed to weanling pigs if the concentration of standardized ileal digestible AA is considered in the formulation.
Cost Effectiveness of DCISionRT for Guiding Treatment of Ductal Carcinoma in Situ
Authors: Raldow Ann C , Sher David , Chen Aileen B , Punglia Rinaa S
Published: January 2020

The DCISionRT test estimates the risk of an ipsilateral breast event (IBE) in patients with ductal carcinoma in situ (DCIS) as well as the benefit of adjuvant radiation therapy (RT). We determined the cost-effectiveness of DCISionRT using a Markov model simulating 10-year outcomes for 60-year-old women with DCIS based on nonrandomized data. Three strategies were compared: no testing, no RT (strategy 1); test all, RT for elevated risk only (strategy 2); and no testing, RT for all (strategy 3). We used utilities and costs from the literature and Medicare claims to determine incremental cost-effectiveness ratios and examined the number of women irradiated per IBE prevented. In the base-case scenario, strategy 1 was the cost-effective strategy. Strategy 2 was cost-effective compared with strategy 3 when the cost of DCISionRT was less than $4588. The number irradiated per IBE prevented were 8.37 and 15.46 for strategies 2 and 3, respectively, relative to strategy 1.
Drought stress modulates cuticular wax composition of the grape berry
Authors: Dimopoulos Nicolas , Tindjau Ricco , Wong Darren C J , Matzat Till , Haslam Tegan , Song Changzheng , Gambetta Gregory A , Kunst Ljerka , Castellarin Simone D
Published: January 2020

Drought events are a major challenge for many horticultural crops, including grapes, which are often cultivated in dry and warm climates. It is not understood how the cuticle contributes to the grape berry response to water deficit (WD); furthermore, the cuticular waxes and the related biosynthetic pathways are poorly characterized in this fruit. In this study, we identified candidate wax-related genes from the grapevine genome by phylogenetic and transcriptomic analyses. Developmental and stress response expression patterns of these candidates were characterized across pre-existing RNA sequencing data sets and confirmed a high responsiveness of the pathway to environmental stresses. We then characterized the developmental and WD-induced changes in berry cuticular wax composition, and quantified differences in berry transpiration. Cuticular aliphatic wax content was modulated during development and an increase was observed under WD, with wax esters being strongly up-regulated. These compositional changes were related to up-regulated candidate genes of the aliphatic wax biosynthetic pathway, including CER10, CER2, CER3, CER1, CER4, and WSD1. The effect of WD on berry transpiration was not significant. This study indicates that changes in cuticular wax amount and composition are part of the metabolic response of the grape berry to WD, but these changes do not reduce berry transpiration.
Gynoecium size and ovule number are interconnected traits that impact seed yield
Authors: Cucinotta Mara , Di Marzo Maurizio , Guazzotti Andrea , de Folter Stefan , Kater Martin M , Colombo Lucia
Published: January 2020

Angiosperms form the largest group of land plants and display an astonishing diversity of floral structures. The development of flowers greatly contributed to the evolutionary success of the angiosperms as they guarantee efficient reproduction with the help of either biotic or abiotic vectors. The female reproductive part of the flower is the gynoecium (also called pistil). Ovules arise from meristematic tissue within the gynoecium. Upon fertilization, these ovules develop into seeds while the gynoecium turns into a fruit. Gene regulatory networks involving transcription factors and hormonal communication regulate ovule primordium initiation, spacing on the placenta, and development. Ovule number and gynoecium size are usually correlated and several genetic factors that impact these traits have been identified. Understanding and fine-tuning the gene regulatory networks influencing ovule number and pistil length open up strategies for crop yield improvement, which is pivotal in light of a rapidly growing world population. In this review, we present an overview of the current knowledge of the genes and hormones involved in determining ovule number and gynoecium size. We propose a model for the gene regulatory network that guides the developmental processes that determine seed yield.
A balancing act: how plants integrate nitrogen and water signals
Authors: Araus Viviana , Swift Joseph , Alvarez Jose M , Henry Amelia , Coruzzi Gloria M
Published: January 2020

Nitrogen (N) and water (W) are crucial inputs for plant survival as well as costly resources for agriculture. Given their importance, the molecular mechanisms that plants rely on to signal changes in either N or W status have been under intense scrutiny. However, how plants sense and respond to the combination of N and W signals at the molecular level has received scant attention. The purpose of this review is to shed light on what is currently known about how plant responses to N are impacted by W status. We review classic studies which detail how N and W combinations have both synergistic and antagonistic effects on key plant traits, such as root architecture and stomatal aperture. Recent molecular studies of N and W interactions show that mutations in genes involved in N metabolism affect drought responses, and vice versa. Specifically, perturbing key N signaling genes may lead to changes in drought-responsive gene expression programs, which is supported by a meta-analysis we conduct on available transcriptomic data. Additionally, we cite studies that show how combinatorial transcriptional responses to N and W status might drive crop phenotypes. Through these insights, we suggest research strategies that could help to develop crops adapted to marginal soils depleted in both N and W, an important task in the face of climate change.
Gravitational waves from fast-spinning white dwarfs
Authors: Sousa Manoel F , Coelho Jaziel G , de Araujo José C N
Published: January 2020

Two mechanisms of gravitational waves (GWs) emission in fast-spinning white dwarfs (WDs) are investigated: accretion of matter and magnetic deformation. In both cases, the GW emission is generated by an asymmetry around the rotation axis of the star. However, in the first case, the asymmetry is due to the amount of accreted matter on the magnetic poles, while in the second case it is due to the intense magnetic field. We have estimated the GW amplitude and luminosity for three binary systems that have a fast-spinning magnetized WD, namely, AE Aquarii, AR Scorpii, and RX J0648.0−4418. We find that, for the first mechanism, the systems AE Aquarii and RX J0648.0−4418 can be observed by the space detectors BBO and DECIGO if they have an amount of accreted mass of δm ≥ 10−5 M⊙. For the second mechanism, the three systems studied require that the WD have a magnetic field above ∼109 G to emit GWs that can be detected by BBO. We also verified that, in both mechanisms, the gravitational luminosity has an irrelevant contribution to the spin-down luminosity of these three systems. Therefore, other mechanisms of energy emission are needed to explain the spin-down of these objects.
Multiwavelength consensus of large-scale linear bias
Authors: Pan Hengxing , Obreschkow Danail , Howlett Cullan , Lagos Claudia del P , Elahi Pascal J , Baugh Carlton , Gonzalez-Perez Violeta
Published: January 2020

We model the large-scale linear galaxy bias bg(x, z) as a function of redshift z and observed absolute magnitude threshold x for broad-band continuum emission from the far-infrared to ultraviolet, as well as for prominent emission lines, such as the H α, H β, Ly a, and [O ii] lines. The modelling relies on the semi-analytic galaxy formation model galform, run on the state-of-the-art N-body simulation surfs with the Planck 2015 cosmology. We find that both the differential bias at observed absolute magnitude x and the cumulative bias for magnitudes brighter than x can be fitted with a five-parameter model: bg(x, z) = a + b(1 + z)e(1 + exp [(x − c)d]). We also find that the bias for the continuum bands follows a very similar form regardless of wavelength due to the mixing of star-forming and quiescent galaxies in a magnitude-limited survey. Differences in bias only become apparent when an additional colour separation is included, which suggest extensions to this work could look at different colours at fixed magnitude limits. We test our fitting formula against observations, finding reasonable agreement with some measurements within 1σ statistical uncertainties, and highlighting areas of improvement. We provide the fitting parameters for various continuum bands, emission lines, and intrinsic galaxy properties, enabling a quick estimation of the linear bias in any typical survey of large-scale structure.
Classifying galaxies according to their Hi content
Authors: Andrianomena Sambatra , Rafieferantsoa Mika , Davé Romeel
Published: January 2020

We use machine learning to classify galaxies according to their Hi content, based on both their optical photometry and environmental properties. The data used for our analyses are the outputs in the range z = 0 − 1 from Mufasa cosmological hydrodynamic simulation. In our previous paper, where we predicted the galaxy Hi content using the same input features, Hi rich galaxies were only selected for the training. In order for the predictions on real observation data to be more accurate, the classifiers built in this study will first establish if a galaxy is Hi rich ($\rm {log(M_{H{\small I}}/M_{*})} > -2$) before estimating its neutral hydrogen content using the regressors developed in the first paper. We resort to various machine learning algorithms and assess their performance with some metrics such as accuracy, f1, AUC PR, precision, specificity and log loss. The performance of the classifiers, as opposed to that of the regressors in previous paper, gets better with increasing redshift and reaches their peak performance around z = 1 then starts to decline at even higher z. Random Forest method, the most robust among the classifiers when considering only the mock data for both training and test in this study, reaches an accuracy above $98.6 \%$ at z = 0 and above $99.0 \%$ at z = 1, which translates to a AUC PR above $99.93\%$ at low redshift and above $99.98\%$ at higher one. We test our algorithms, trained with simulation data, on classification of the galaxies in RESOLVE, ALFALFA and GASS surveys. Interestingly, SVM algorithm, the best classifier for the tests, achieves a precision, the relevant metric for the tests, above $87.60\%$ and a specificity above $71.4\%$ with all the tests, indicating that the classifier is capable of learning from the simulated data to classify Hi rich/Hi poor galaxies from the real observation data. With the advent of large Hi 21 cm surveys such as the SKA, this set of classifiers, together with the regressors developed in the first paper, will be part of a pipeline, a very useful tool, which is aimed at predicting Hi content of galaxies.
Embedded operator splitting methods for perturbed systems
Authors: Rein Hanno
Published: January 2020

It is common in classical mechanics to encounter systems whose Hamiltonian H is the sum of an often exactly integrable Hamiltonian H0 and a small perturbation ϵH1 with ϵ ≪ 1. Such near-integrability can be exploited to construct particularly accurate operator splitting methods to solve the equations of motion of H. However, in many cases, for example in problems related to planetary motion, it is computationally expensive to obtain the exact solution to H0. In this paper, we present a new family of embedded operator splitting (EOS) methods which do not use the exact solution to H0, but rather approximate it with yet another, EOS method. Our new methods have all the desirable properties of classical methods which solve H0 directly. But in addition they are very easy to implement and in some cases faster. When applied to the problem of planetary motion, our EOS methods have error scalings identical to that of the often used Wisdom–Holman method but do not require a Kepler solver, nor any coordinate transformations, or the allocation of memory. The only two problem specific functions that need to be implemented are the straightforward kick and drift steps typically used in the standard second-order leap-frog method.
The effect of CO−H2O collisions in the rotational excitation of cometary CO
Authors: Faure A , Lique F , Loreau J
Published: January 2020

We present the first accurate rate coefficients for the rotational excitation of CO by H2O in the kinetic temperature range 5–100 K. The statistical adiabatic channel method (SACM) is combined with a high-level rigid-rotor CO−H2O intermolecular potential energy surface. Transitions among the first 11 rotational levels of CO and the first 8 rotational levels of both para-H2O and ortho-H2O are considered. Our rate coefficients are compared to previous data from the literature and they are also incorporated in a simple non-LTE model of cometary coma including collision-induced transitions, solar radiative pumping and radiative decay. We find that the uncertainties in the collision data have significant influence on the CO population distribution for H2O densities in the range 103–108 cm−3. We also show that the rotational distribution of H2O plays an important role in CO excitation (owing to correlated energy transfer in both CO and H2O), while the impact of the ortho-to-para ratio of H2O is found to be negligible.
Dextran sulfate sodium mouse model of inflammatory bowel disease evaluated for systemic genotoxicity via blood micronucleus and Pig-a gene mutation assays
Authors: Kirby Christopher , Baig Ayesha , Avlasevich Svetlana L , Torous Dorothea K , Tian Shuchang , Singh Priyanka , Bemis Jeffrey C , Saubermann Lawrence J , Dertinger Stephen D
Published: January 2020

Inflammatory bowel disease (IBD) is an important risk factor for gastrointestinal cancers. Inflammation and other carcinogenesis-related effects at distal, tissue-specific sites require further study. In order to better understand if systemic genotoxicity is associated with IBD, we exposed mice to dextran sulfate sodium salt (DSS) and measured the incidence of micronucleated cells (MN) and Pig-a mutant phenotype cells in blood erythrocyte populations. In one study, 8-week-old male CD-1 mice were exposed to 0, 1, 2, 3 or 4% w/v DSS in drinking water. The 4-week in-life period was divided into four 1-week intervals—alternately on then off DSS treatment. Low volume blood samples were collected for MN analysis at the end of each week, and cardiac blood samples were collected at the end of the 4-week period for Pig-a analyses. The two highest doses of DSS were observed to induce significant increases in reticulocyte frequencies. Even so, no statistically significant treatment-related effects on the genotoxicity biomarkers were evident. While one high-dose mouse showed modestly elevated MN frequencies during the DSS treatment cycles, it also exhibited exceptionally high reticulocyte frequencies (e.g. 18.7% at the end of the second DSS cycle). In a second study, mice were treated with 0 or 4% DSS for 9–18 consecutive days. Exposure was continued until rectal bleeding or morbidity was evident, at which point the treatment was terminated and blood was collected for MN analysis. The Pig-a assay was conducted on samples collected 29 days after the start of treatment. The initial blood specimens showed highly elevated reticulocyte frequencies in DSS-exposed mice (mean ± SEM = 1.75 ± 0.10% vs. 13.04 ± 3.66% for 0 vs. 4% mice, respectively). Statistical analyses showed no treatment-related effect on MN or Pig-a mutant frequencies. Even so, the incidence of MN versus reticulocytes in the DSS-exposed mice were positively correlated (linear fit R2 = 0.657, P = 0.0044). Collectively, these results suggest that in the case of the DSS CD-1 mouse model, systemic effects include stress erythropoiesis but not remarkable genotoxicity. To the extent MN may have been slightly elevated in a minority of individual mice, these effects appear to be secondary, likely attributable to stimulated erythropoiesis.
Immunological characteristics and possible pathogenic role of urinary CD11c+ macrophages in lupus nephritis
Authors: Kim Jihye , Jeong Ji Hye , Jung Jaehyung , Jeon Hanwool , Lee Seungjoo , Lim Joon Seo , Go Heounjeong , Oh Ji Seon , Kim Yong-Gil , Lee Chang-Keun , Yoo Bin , Hong Seokchan
Published: January 2020

Objectives

Kidney-infiltrating immune cells can contribute to the pathogenesis of lupus nephritis (LN). We investigated the immunological characteristics of CD11c+ macrophages and their functions associated with the pathogenesis of LN.

Methods

CD11c+ macrophages were examined in the urine samples of patients with LN. Phenotypic markers and pro-inflammatory cytokine expression levels were analysed by flow cytometry. To determine the origin of urinary macrophages, peripheral monocytes were treated with sera from patients with systemic lupus erythematosus (SLE). The pathogenic role of CD11c+ macrophages in tubulointerstitial damage was investigated using SLE sera-treated monocytes and HK-2 cells.

Results

Urinary CD11c+ macrophages expressed pro-inflammatory cytokines, such as IL-6 and IL-1β, and resembled infiltrated monocytes rather than tissue-resident macrophages with respect to surface marker expression. CD11c+ macrophages had high expression levels of the chemokine receptor CXCR3, which were correlated with cognate chemokine IP-10 expression in urinary tubular epithelial cells. When treated with sera from SLE patients, peripheral monocytes acquired the morphological and functional characteristics of urinary CD11c+ macrophages, which was blocked by DNase treatment. Finally, SLE sera-treated monocytes induced fibronectin expression, apoptosis and cell detachment in HK-2 cells via production of IL-6.

Conclusion

CD11c+ macrophages may be involved in the pathogenesis of tubulointerstitial injury in LN.
Citrus reticulata CrRAP2.2 Transcriptional Factor Shares Similar Functions to the Arabidopsis Homolog and Increases Resistance to Xylella fastidiosa
Authors: Pereira Willian , Takita Marco , Melotto Maeli , de Souza Alessandra
Published: January 2020

Xylella fastidiosa is a worldwide multihost pathogen that causes diseases in different crops. It is considered a new global threat and substantial efforts have been made in order to identify sources of resistance. Indeed, many genes have been associated with resistance to X. fastidiosa, but without functional validation. Here, we describe a C. reticulata gene homologous to the transcriptional factor RAP2.2 from Arabidopsis thaliana that increases resistance to citrus variegated chlorosis (CVC). This gene was previously detected in C. reticulata challenged with X. fastidiosa. Bioinformatics analysis together with subcellular localization and auto-activation assays indicated that RAP2.2 from C. reticulata (CrRAP2.2) is a transcriptional factor orthologous to AtRAP2.2. Thus, we used A. thaliana as a model host to evaluate the functional role of CrRAP2.2 in X. fastidiosa resistance. The inoculation of X. fastidiosa in the A. thaliana rap2.2 mutant resulted in a larger bacterial population, which was complemented by CrRAP2.2. In addition, symptoms of anthocyanin accumulation were higher in the mutant, whose phenotype was restored by CrRAP2.2, indicating that they have conserved functions in plant defense response. We therefore transformed C. sinensis with CrRAP2.2 and verified a positive correlation between CVC resistance and gene expression in transgenic lines. This is the first study using A. thaliana as model host that characterizes the function of a gene related to X. fastidiosa defense response and its application in genetic engineering to obtain citrus resistance to CVC.
Soilborne Phytophthora and Pythium Diversity From Rhododendron in Propagation, Container, and Field Production Systems of the Pacific Northwest
Authors: Weiland Jerry E. , Scagel Carolyn. F. , Grünwald Niklaus J. , Davis E. Anne , Beck Bryan R. , Foster Zachary S. L. , Fieland Valerie J.
Published: January 2020

Rhododendron root rot is a severe disease that causes significant mortality in rhododendrons. Information is needed about the incidence and identity of soilborne Phytophthora and Pythium species causing root rot in Pacific Northwest nurseries in order to better understand the disease etiology and to optimize disease control strategies. The last survey focusing solely on soilborne oomycete pathogens in rhododendron production was conducted in 1974. Since then, advances in pathogen identification have occurred, new species may have been introduced, pathogen communities may have shifted, and little is known about Pythium species affecting this crop. Therefore, a survey of root-infecting Phytophthora and Pythium species was conducted at seven nurseries from 2013 to 2017 to (i) document the incidence of root rot damage at each nursery and stage of production, (ii) identify soilborne oomycetes infecting rhododendron, and (iii) determine whether there are differences in pathogen diversity among nurseries and production systems. Rhododendrons from propagation, container, and field systems were sampled and Phytophthora and Pythium species were isolated from the roots and collar region. Root rot was rarely evident in propagation systems, which were dominated by Pythium species. However, severe root rot was much more common in container and field systems where the genus Phytophthora was also more prevalent, suggesting that Phytophthora species are the primary cause of severe root rot and that most contamination by these pathogens comes in after the propagation stage. In total, 20 Pythium species and 11 Phytophthora species were identified. Pythium cryptoirregulare, Pythium aff. macrosporum, Phytophthora plurivora, and Phytophthora cinnamomi were the most frequently isolated species and the results showed that Phytophthora plurivora has become much more common than in the past. Phytophthora diversity was also greater in field systems than in propagation or container systems. Risks for Phytophthora contamination were commonly observed during the survey and included placement of potting media in direct contact with field soil, the presence of dead plants that could serve as continuous sources of inoculum, and the presence of excess water as a result of poor drainage, overirrigation, or malfunctioning irrigation equipment. In the past, research on disease development and root rot disease control in rhododendron focused almost exclusively on Phytophthora cinnamomi. More research is needed on both of these topics for the other root-infecting species identified in this survey.
CE: Mitigating the Dangers of Polypharmacy in Community-Dwelling Older Adults
Authors: Gabauer Jaclyn
Published: January 2020

Polypharmacy, the use by a patient of multiple medications, contributes to adverse drug events, hospitalizations, geriatric syndromes, and increased health care costs. In the United States, polypharmacy is increasingly widespread, particularly among community-dwelling adults over age 62. In 2005-2006, 31% of such adults used five or more prescription drugs and 8.4% used medication combinations associated with potential interactions. By 2010-2011, 36% used five or more prescription drugs and 15% used potentially problematic drug combinations. Reducing the dangers of polypharmacy, however, requires clinicians to broaden their focus, considering not only the number of drugs a patient takes, but also the prescription of potentially inappropriate medications and potential prescribing omissions. This article explores the factors that contribute to polypharmacy and discusses its negative physiological, psychological, and economic effects. It also describes strategies for reducing polypharmacy, including both “explicit” approaches, which are grounded in the findings of literature reviews and expert opinion, and “implicit” approaches, which are based on the provider's interpretation of clinical data and the patient's medication regimen.
EBP 2.0: Implementing and Sustaining Change: The Evidence-Based Practice and Research Fellowship Program
Authors: Tucker Sharon J. , Gallagher-Ford Lynn , Jang Elisa
Published: January 2020

This is the sixth article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series—Evidence-Based Practice, Step by Step—published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes—one of the most challenging steps in the EBP process.
Nonpharmacologic Interventions Effective for Dementia-Associated Aggression and Agitation
Authors: Rosenberg Karen
Published: January 2020

According to this study:

Certain nonpharmacologic interventions can be used instead of pharmacologic interventions for managing aggression and agitation in people with dementia.
Modest Weight Loss Increases Chance of Type 2 Diabetes Remission
Authors: Rosenberg Karen
Published: January 2020

According to this study:

In patients with newly diagnosed type 2 diabetes, a modest weight loss of 10% or more is strongly associated with remission at five years.
Transporting Children to Safety After Volcanic Eruption
Authors: Mueller Michael R. , Suresh Mithun , Rizzo Julie A. , Cancio Leopoldo C. , VanFosson Christopher A.
Published: January 2020

The Fuego volcano eruption near Guatemala City, Guatemala, on June 3, 2018, left more than 150 dead and hundreds more injured or missing. Local officials quickly identified a need for burn care among the injured and asked the international community for assistance. By the morning of June 4, members of the U.S. Army's Burn Flight Team were placed on high alert in preparation for an evacuation mission to bring injured Guatemalans to the United States for specialized burn care. The mission required seven RNs, three respiratory therapists, a burn surgeon, two intensivists, an anesthesiologist, and an operations officer in order to successfully evacuate six critically injured pediatric burn patients to the Shriners Hospitals for Children–Galveston in Galveston, Texas. This article describes details of each stage of the mission and includes a discussion of key aspects of logistics and patient care posed by such evacuations.
Learn to Manage Yourself
Authors: Sherman Rose O.
Published: January 2020

It's the first step in learning to manage others.
No Room for Error: Reflections on My Sister
Authors: Vaez Kelly
Published: January 2020

An NP ponders the vulnerability of the seriously mentally ill.
Family Planning Training at Catholic and Other Religious Hospitals: A National Survey
Authors: Guiahi Maryam , Teal Stephanie , Kenton Kimberly , DeCesare Julie , Steinauer Jody
Published: January 2020

(Abstracted from Am J Obstet Gynecol 2019; DOI: 10.1016/j.ajog.2019.09.012)

The Accreditation Council for Graduate and Medical Education (ACGME) has recognized family planning and abortion training as essential components of all obstetrics and gynecology residency programs, regardless of institutional affiliation, and has stipulated that such training be a comprehensive part of their planned curriculum (“routine training”). It has also been recognized by ACGME that residents who have religious or moral objections to abortion training may decline (“opt-out”) of training.
Food allergy: how expensive are they?
Authors: Dyer Ashley A. , Negris Olivia R. , Gupta Ruchi S. , Bilaver Lucy A.
Published: January 2020

Purpose of review

Food allergy remains a disease of global public health significance well known to impact social, emotional, and financial well being. This review aims to summarize the existing literature focused on the direct, indirect, and intangible costs of food allergy at the household and healthcare system levels, and begin to discuss how emerging treatment and prevention strategies may be leveraged to comprehensively care for the food allergic population with the efficient use of health resources.

Recent findings

Food allergy imposes significant costs to multiple stakeholders and largely impact families at the household level. Recent studies elucidate the need to balance the household management of food allergy with the efficient use of health resources. Overall, it remains critical that safe foods and medications remain affordable while further exploring the cost-effectiveness of early introduction, emerging food allergy therapies, and the wider use of stock epinephrine to adequately meet the public health needs of the food-allergic community.

Better understanding how the cost of food allergy impacts populations will help to inform more progressive policies aimed at lessening socioeconomic disparities and ultimately improve quality of life for children and adults with food allergies.
Molecular diagnosis usefulness for idiopathic anaphylaxis
Authors: Cardona Victoria , Guilarte Mar , Labrador-Horrillo Moises
Published: January 2020

Purpose of review

Molecular diagnosis has become an indispensable tool in allergy. In suspected idiopathic anaphylaxis, it is mandatory to extend the diagnostic search to its limits. The current review evaluates how molecular diagnosis allows to identify a number of difficult to prove potential culprits.

Recent findings

Depending on different geographical areas, it has been shown that the number of anaphylaxis labelled as idiopathic may decrease by the use of molecular diagnosis. The most relevant allergens identified are alpha-gal, omega-5-gliadin, Anisakis, lipid transfer proteins and oleosins. The role of cofactors has been shown to be relevant in a high proportion of cases. Mast cell disorders should always be ruled out.

There is a need to provide further molecular diagnostic tests for use in clinical practice to identify sensitization to allergens not well represented in current commercial assays.
Improving Diagnosis Through Education
Authors: Olson Andrew P.J. , Graber Mark L.
Published: January 2020

Diagnosis is the cornerstone of providing safe and effective medical care. Still, diagnostic errors are all too common. A key to improving diagnosis in practice is improving diagnosis education, yet formal education about diagnosis is often lacking, idiosyncratic, and not evidence based. In this Invited Commentary, the authors describe the outcomes of a national consensus project to identify key competencies for diagnosis and the themes that emerged as part of this work. The 12 competencies the authors describe span 3 categories—individual, teamwork, and system related—and address ideal diagnostic practice for all health professionals. In addition, the authors identify strategies for improving diagnosis education, including the use of theory-based pedagogy and interprofessional approaches, the recognition of the role of the health care system to enhance or inhibit the diagnostic process, and the need to focus on the individual attributes necessary for high-quality diagnosis, such as humility and curiosity. The authors conclude by advocating for increasing and improving the assessment of individual and team-based diagnostic performance in health professions education programs.
Transition From Methadone to Buprenorphine Using a Short-acting Agonist Bridge in the Inpatient Setting: A Case Study
Authors: Callan Jonathan , Pytell Jarratt , Ross Julia , Rastegar Darius A.
Published: January 2020

Methadone and buprenorphine are the most common medications for opioid use disorder. Buprenorphine is often the preferred medication because of fewer drug-drug interactions and fewer regulatory barriers. For these reasons, patients often desire to transition from methadone to buprenorphine, but this can be difficult because of the risk of precipitated withdrawal. There are protocols designed to minimize withdrawal; however, these can be time-consuming or infeasible due to formulation and dosage availability of buprenorphine. We describe an inpatient transition from methadone to buprenorphine using a hydromorphone bridge over a 7-day period. This method used commonly available dosages and formulations of buprenorphine. To our knowledge, this is the first time a method has been described that transitions a patient from methadone to buprenorphine using a short-acting opioid agonist bridge and readily available opioid dosages and formulations. This case provides a viable alternative for rapidly transitioning a patient from methadone to buprenorphine that can be used as a template for an alternative method to transitions between these medications.
Factors Associated With Minimum Effective Volume of Lidocaine 1.5% for Sciatic Nerve Blocks
Authors: Chen Xiaorui , Ling Dandan , Cao Jianfang , Lin Xiaoyan , Cao Xiaodan , Wang Mengying , Luo Junjie , Xie Shuqi , Yu Bin
Published: January 2020

Objectives:

The objectives of this study were to investigate the correlations between the minimum effective volume (MEV) of lidocaine 1.5% for an ultrasound-guided popliteal sciatic nerve block and individual factors including the cross-sectional nerve area, sex, age, body mass index, and the depth of the sciatic nerve and to evaluate the safety of combined femoral and sciatic nerve blocks by monitoring the plasma concentration of local anesthetics.

Methods:

Forty patients received combined single-shot femoral and continuous sciatic nerve blocks. The femoral nerve block was performed with an in-plane technique and 15 mL of lidocaine 1.5%. A continuous peripheral nerve block annular tube was positioned between the tibial and peroneal nerves inside the paraneural sheath. Thirty minutes after the femoral nerve block, a loading dose of 5 mL of lidocaine 1.5% was given to block the sciatic nerve after obtaining the maximum compound muscle action potential (CMAP) amplitude using nerve conduction studies. Additional lidocaine 1.5% was pumped at a rate of 30 mL/h through the indwelling annular tube if, after 8 minutes, the CMAP amplitude was still present. The CMAP amplitude monitored by the nerve conduction studies and pinprick tests were recorded every 2 minutes after the administration of lidocaine 1.5%. When the CMAP amplitude decreased to nearly 0 mV, this MEV was recorded. The influences of the cross-sectional area of the sciatic nerve, sex, age, body mass index, and the depth of the sciatic nerve on the MEV were analyzed using stepwise multiple linear regression. Blood samples were collected from 10 patients to evaluate the safety of combined femoral and sciatic nerve blocks by ultra-performance liquid chromatography-tandem mass spectrometry. Blood was drawn at 0 minutes before femoral nerve injection; 0 minutes before sciatic nerve injection; 8 minutes after sciatic nerve injection; and 0, 10, 20, 30, 45, 60, 75, 90, and 120 minutes after the pumping of lidocaine 1.5% stopped.

Results:

A significant correlation was found between the MEV of lidocaine 1.5% and the cross-sectional area of the sciatic nerve (r=0.459), with a regression equation of the MEV (mL)=5.969+0.095×(the cross-sectional area of the sciatic nerve). The coefficient of determination was 0.211 (P<0.05). The MEV of lidocaine 1.5% for complete sciatic nerve blocks ranged from 7 to 15 mL. The maximum concentrations of lidocaine, monoethylglycinexylidide, and glycinexylidide were 1672.9 (227.6), 265.7 (32.7), and 42.2 (22.4) ng/mL, respectively.

Conclusions:

There is a positive correlation between the cross-sectional area of the sciatic nerve and the MEV. The regression equation can help to predict the MEV of lidocaine 1.5% for popliteal sciatic nerve blocks. The maximum concentrations of lidocaine and its metabolites did not approach toxic threshold limits in this study.
“Aural Patching” After Bilateral Cochlear Implantation Is Challenging for Children With Prior Long-Term Unilateral Implant Experience
Authors: Abbasalipour Parvaneh , Papsin Blake C. , Gordon Karen A.
Published: January 2020

Objectives:

To assess the use of “aural patching” as a strategy to potentially reduce the known persistence of aural preference in children receiving bilateral cochlear implants (CIs) with long inter-implant delays by removing the first device to increase stimulation to the second implanted side.

Design:

Children/adolescents who received a second CI at 12.8 ± 3.5 years of age after 9.4 ± 2.9 years of unilateral CI use were asked to remove their first CI for regular periods daily (aural patching). Their compliance was monitored, and asymmetries in speech perception were measured at the end of the study period.

Results:

Partial adherence to aural patching over the first few months of bilateral hearing use markedly declined with time. As expected, the group demonstrated asymmetries in speech perception that were not significantly affected by the limited aural patching.

Conclusions:

The aural patching protocol was a challenge to maintain for most children and families studied, reflecting both the expected aural preference for the first implanted ear and their challenges to reverse it.
The Incremental Cost of Inpatient Venous Thromboembolism After Hip Fracture Surgery
Authors: Trivedi Nikunj N. , Abola Matthew V. , Kim Chang Y. , Sivasundaram Lakshmanan , Smith Eric J. , Ochenjele George
Published: January 2020

Objectives:

To (1) identify trends in the rates of deep venous thrombosis (DVT) and pulmonary embolism (PE) and (2) calculate the additional incremental inpatient cost and length of stay associated with venous thromboembolism (VTE) after hip fracture surgery.

Design:

Retrospective database analysis.

Setting:

Hospital discharge data.

Patients/Participants:

A total of 838,054 patients undergoing operative treatment of hip fractures in the National Inpatient Sample from 2003 to 2014.

Intervention:

Internal fixation or partial/total hip replacement.

Main Outcome Measures:

The length of stay and cost of hospitalization were compared between patients with VTE and those without using a Student t-test. A logistic regression model was performed to evaluate the trends in VTE rates, and a multivariable linear regression model was performed to evaluate inpatient hospital costs.

Results:

The overall rates of DVT and PE were 0.3% and 0.53%, respectively. VTE was associated with an increased length of stay (9 days vs. 5 days) and increased inpatient cost ($103,860.83 vs. $51,576.00). The rate of DVT over the study period decreased, whereas the rate of PE increased.

Conclusions:

Each episode of VTE after hip fracture is a significant source of additional inpatient cost. Patients who sustain a VTE have approximately twice the length of stay and total inpatient cost compared with those who do not. The rates of DVT after hip fracture surgery are decreasing, whereas the rates of PE are increasing.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Comparison of Wide Margin and Inadequate Margin for Recurrence in Sacral Chordoma
Authors: Yu Xiao , Kou Changgui , Bai Wei , Yu Weiying , Zhu Bo , Zhang Min , Hua Wanqing , Li Yuanyuan , Duan Ruixin , Yin Fei
Published: January 2020

Study Design..

A meta-analysis.

Objective..

The goal of this study was to accurately evaluate the risk ratio (RR) of recurrence in chordoma patients with wide margin after removing the tumors using surgery, compared with inadequate margin (intralesional or marginal).

Summary of Background Data..

As a rare malignant bone cancer, the more effective treatment for sacral chordoma is still surgical resection. However, there is no convincing evidence and risk ratio about sacral chordoma patients would be benefit from which kind of surgical margin.

Methods..

We searched the PubMed, Cochrane Library, Web of Science, and EMBASE from inception to December 2018. The heterogeneity analysis and calculation of the pooled risk ratio were performed using RevMan 5.3 software. The assessment of publication bias and sensitivity analysis was conducted using StataSE 15.1 software. The protocol for this meta-analysis was registered on International prospective register of systematic reviews (PROSPERO, CRD42019127441).

Results..

Twelve studies with a total of 436 patients who met the inclusion criteria were included. The pooled results indicated that patients in the wide group had lower recurrence rate than those in the inadequate group (RR = 0.42, 95% confidence interval [CI] 0.31–0.57; P < 0.001). And patients in the wide group had lower mortality rate than those in the inadequate group (RR = 0.49, 95% CI 0.26–0.91; P = 0.02). No significant differences in the risk of mortality were found between relapsed patients in the two groups (RR = 0.64, 95% CI 0.35–1.15; P = 0.13).

Conclusion..

In sacral chordoma patients, wide margin is associated with low recurrence risk, when it is feasible, a wide excision should be considered appropriate for sacrum chordoma.

Level of Evidence: 2
Radiographic Fusion Rates Following a Stand-alone Interbody Cage Versus an Anterior Plate Construct for Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion
Authors: Gandhi Sapan D. , Fahs Adam M. , Wahlmeier Steven T. , Louie Philip , Possley Daniel R. , Khalil Jad G. , Park Daniel K.
Published: January 2020

Study Design.

Case–control.

Objectives.

The aim of this study was to evaluate fusion rates and compare a stand-alone cage construct with an anterior-plate construct in the setting revision anterior cervical discectomy and fusion (ACDF) for adjacent segment disease.

Summary of Background Data.

Anterior cervical discectomy and fusion are considered the criterion standard of surgical treatment for cervical myelopathy and radiculopathy. One common consequence is adjacent segment disease. Treatment of adjacent segment disease is complicated by the previous surgical implants, which may make application of an additional anterior cervical plate difficult. Stand-alone cage constructs obviate the need for removal or revision of prior implants in the setting of adjacent segment disease.

Methods.

All patients undergoing surgery for adjacent segment disease in a 2-year period were identified and separated into groups based on implant construct. A control group of patients undergoing primary, single-level ACDF were selected from during the same 2-year period. Demographic variables, fusion rate, and reoperation rate were compared between groups. Continuous variables were compared using Student t test, fusion, and revision rates were compared using Pearson χ
2 test.

Results.

Patients undergoing primary ACDF had lower age and American Society of Anesthesia score as well as shorter operative time. Fusion rate was higher for primary ACDF compared to all patients who underwent ACDF for adjacent segment disease (95% vs. 74%). When compared to primary ACDF, patients with a stand-alone cage construct had significantly lower fusion rate (69% vs. 95%) and higher reoperation rate (14% vs. 0%). There were no significant differences in anterior plate construct versus stand-alone cage construct in terms of fusion and reoperation.

Conclusion.

Symptomatic adjacent segment disease can be managed surgically with either revision anterior plating or a stand-alone cage constructs, although our results raise questions regarding a difference in fusion rates that requires further investigation.

Level of Evidence: 3
Advances in the development of chimeric antigen receptor-T-cell therapy in B-cell acute lymphoblastic leukemia
Authors: Zhang Xian , Li Jing-Jing , Lu Pei-Hua
Published: January 2020

CD19-targeted chimeric antigen receptor T-cell (CAR-T) therapy is effective in refractory/relapsed (R/R) B-cell acute lymphoblastic leukemia (B-ALL). This review focuses on achievements, current obstacles, and future directions in CAR-T research. A high complete remission rate of 68% to 93% could be achieved after anti-CD19 CAR-T treatment for B-ALL. Cytokine release syndrome and CAR-T-related neurotoxicity could be managed. In view of difficulties collecting autologous lymphocytes, universal CAR-T is a direction to explore. Regarding the high relapse rate after anti-CD19 CAR-T therapy, the main solutions have been developing new targets including CD22 CAR-T, or CD19/CD22 dual CAR-T. Additionally, some studies showed that bridging into transplant post-CAR-T could improve leukemia-free survival. Some patients who did not respond to CAR-T therapy were found to have an abnormal conformation of the CD19 exon or trogocytosis. Anti-CD19 CAR-T therapy for R/R B-ALL is effective. From individual to universal CAR-T, from one target to multi-targets, CAR-T-cell has a chance to be off the shelf in the future.