bluuebunny/crossref_metadata_2025 huggingface dataset:
DNA nanotechnology assisted nanopore-based analysis
Authors: Ding Taoli , Yang Jing , Pan Victor , Zhao Nan , Lu Zuhong , Ke Yonggang , Zhang Cheng
Published: February 2020

Nanopore technology is a promising label-free detection method. However, challenges exist for its further application in sequencing, clinical diagnostics and ultra-sensitive single molecule detection. The development of DNA nanotechnology nonetheless provides possible solutions to current obstacles hindering nanopore sensing technologies. In this review, we summarize recent relevant research contributing to efforts for developing nanopore methods associated with DNA nanotechnology. For example, DNA carriers can capture specific targets at pre-designed sites and escort them from nanopores at suitable speeds, thereby greatly enhancing capability and resolution for the detection of specific target molecules. In addition, DNA origami structures can be constructed to fulfill various design specifications and one-pot assembly reactions, thus serving as functional nanopores. Moreover, based on DNA strand displacement, nanopores can also be utilized to characterize the outputs of DNA computing and to develop programmable smart diagnostic nanodevices. In summary, DNA assembly-based nanopore research can pave the way for the realization of impactful biological detection and diagnostic platforms via single-biomolecule analysis.
Convergent adaptation of the genomes of woody plants at the land–sea interface
Authors: He Ziwen , Xu Shaohua , Zhang Zhang , Guo Wuxia , Lyu Haomin , Zhong Cairong , Boufford David E , Duke Norman C ,   The International Mangrove Consortium, Shi Suhua
Published: February 2020

Sequencing multiple species that share the same ecological niche may be a new frontier for genomic studies. While such studies should shed light on molecular convergence, genomic-level analyses have been unsuccessful, due mainly to the absence of empirical controls. Woody plant species that colonized the global tropical coasts, collectively referred to as mangroves, are ideal for convergence studies. Here, we sequenced the genomes/transcriptomes of 16 species belonging in three major mangrove clades. To detect convergence in a large phylogeny, a CCS+ model is implemented, extending the more limited CCS method (convergence at conservative sites). Using the empirical control for reference, the CCS+ model reduces the noises drastically, thus permitting the identification of 73 convergent genes with Ptrue (probability of true convergence) > 0.9. Products of the convergent genes tend to be on the plasma membrane associated with salinity tolerance. Importantly, convergence is more often manifested at a higher level than at amino-acid (AA) sites. Relative to >50 plant species, mangroves strongly prefer 4 AAs and avoid 5 others across the genome. AA substitutions between mangrove species strongly reflect these tendencies. In conclusion, the selection of taxa, the number of species and, in particular, the empirical control are all crucial for detecting genome-wide convergence. We believe this large study of mangroves is the first successful attempt at detecting genome-wide site convergence.
Processing of Laser-Evoked Potentials in Patients with Chronic Whiplash-Associated Disorders, Chronic Fatigue Syndrome, and Healthy Controls: A Case–Control Study
Authors: Goudman Lisa , Daenen Liesbeth , Mouraux Andre , Nijs Jo , Cras Patrick , Roussel Nathalie , Moens Maarten , Coppieters Iris , Huysmans Eva , De Kooning Margot
Published: February 2020

Objective

Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to investigate patients with neuropathic pain, as they can provide an objective account of the functional status of thermo-nociceptive pathways. The goal of this study was to explore the functioning of the nociceptive afferent pathways by examining LEPs in patients with chronic whiplash-associated disorders (cWAD), patients with chronic fatigue syndrome (CFS), and healthy controls (HCs).

Design

Case–control study.

Setting

A single medical center in Belgium.

Subjects

The LEPs of 21 patients with cWAD, 19 patients with CFS, and 18 HCs were analyzed in this study.

Methods

All participants received brief nociceptive CO2 laser stimuli applied to the dorsum of the left hand and left foot while brain activity was recorded with a 32-channel electroencephalogram (EEG). LEP signals and transient power modulations were compared between patient groups and HCs.

Results

No between-group differences were found for stimulus intensity, which was supraliminal for Aδ fibers. The amplitudes and latencies of LEP wave components N1, N2, and P2 in patients with cWAD and CFS were statistically similar to those of HCs. There were no significant differences between the time–frequency maps of EEG oscillation amplitude between HCs and both patient populations.

Conclusions

EEG responses of heat-sensitive Aδ fibers in patients with cWAD and CFS revealed no significant differences from the responses of HCs. These findings thus do not support a state of generalized central nervous system hyperexcitability in those patients.
The Impact of Music on Nociceptive Processing
Authors: Chai Peter R , Gale Jasmine Y , Patton Megan E , Schwartz Emily , Jambaulikar Guruprasad D , Wade Taylor S , Edwards Robert R , Boyer Edward W , Schreiber Kristin L
Published: February 2020

Objective. Music has been shown to modulate pain, although the impact of music on specific aspects of nociceptive processing is less well understood. Using quantitative sensory testing (QST), we assessed the impact of a novel music app on specific aspects of nociceptive processing. Design. Within-subjects paired comparison of pain processing in control vs music condition. Setting. Human psychophysical laboratory. Subjects. Sixty healthy adult volunteers. Methods. Subjects were assessed for baseline anxiety, depression, and catastrophizing using validated questionnaires. QSTs measured included 1) pain threshold and tolerance to deep muscle pressure, 2) pain with mechanical pinprick, 3) temporal summation of pain (TSP) with a repeated pain stimulus, and 4) conditioned pain modulation (CPM) with a second painful stimulus. QSTs were performed in the absence and presence of music delivered through a music app. Results. We found an increase in pressure pain thresholds in both the forearm (P = 0.007) and trapezius (P = 0.002) with music, as well as a decrease in the amount of pinprick pain (P < 0.001) and TSP (P = 0.01) with music. Interestingly, CPM was also significantly diminished (P < 0.001) in the music condition. No significant difference in cold pain, anxiety, or situational catastrophizing was observed with music. Higher baseline pain catastrophizing scores were associated with less music-induced pressure pain reduction. Conclusions. Several measures of mechanical pain sensitivity were reduced with music. TSP, a measure of central sensitization, also decreased with music, but CPM, a measure of descending modulation of pain, was not further augmented by music.
A disconnect between classroom and professional writing: we are not teaching public health students to write effective titles
Authors: Anderson Olivia , August Ella
Published: February 2020

Titles are considered a crucial element of grant applications, journal articles, reports and other public health documents, but they are often overlooked in student writing assignments. In this article, we argue that public health instructors should teach students how to write compelling document titles. Our argument about titles is part of a broader assertion that public health students should be asked to write in professional formats such as grant applications, reports and journal articles. Requiring students to engage with important writing conventions like titles that are used in the professional workplace helps them make connections between the content they are writing about and the activities, roles, values and context of public health practice. We recommend that instructors explicitly incorporate titles into their assigned writing in three ways: first, instructors should require titles; second, instructors should provide criteria for a good title that are appropriate to the document type and finally, instructors should award points for a good title.
Vaping-Associated Respiratory Distress Syndrome: Case Classification and Clinical Guidance
Authors: Lilly Craig M. , Khan Shahzad , Waksmundzki-Silva Kathryn , Irwin Richard S.
Published: February 2020

Objectives:

Exposure to vaping is associated with a growing list of respiratory syndromes including an acute progressive form with life-threatening hypoxemic respiratory failure and pathologic changes of lung injury termed vaping-associated respiratory distress syndrome.

Data Sources:

Center from Disease Control, Departments of Public Health, MEDLINE (via PubMed), and the Cochrane Library.

Study Selection, Data Extraction and Data Synthesis:

Cases, series, and public health reports of cases that met the Centers for Disease Control and Prevention case definition of vaping-associated respiratory disease were extracted by an author with perfect verification by a second. Cases were classified on the basis of toxin exposure, symptoms, oxygen saturation, progression to respiratory failure, and pathologic features, and a clinically actionable system of classification was based on expert opinion.

Conclusions:

The reported spectrum of vaping-associated respiratory diseases allows clinical classification of cases into groups with distinct evaluation, management, and recommendations for prevention and follow-up. Clinical stratification also identifies a small proportion of vaping-exposed patients who are at risk for progression to hypoxemic respiratory failure and an acute respiratory distress syndrome–like illness.
Implementation of a Multidisciplinary Care Pathway via an Emergency Department-ICU to Improve Care of Emergency Department Patients Presenting With Leukostasis
Authors: Haas Nathan L. , Nafday Abhinav , Cranford James A. , Yentz Sarah E. , Bixby Dale L. , Bassin Benjamin S.
Published: February 2020

Objectives:

Leukostasis is a life-threatening complication of acute hyperleukocytic leukemia, and is associated with substantial mortality. Management of leukostasis requires time-sensitive diagnostics and therapeutics, and leukapheresis remains a mainstay of treatment in select patients. Leukapheresis requires coordination of multi-disciplinary resources, which can prove challenging in the emergency department setting, and delays in treatment due to the complexity and coordination required are common. The objective of this study was to assess the effect of utilization of an emergency department-ICU and a multidisciplinary care pathway on outcomes of critically ill leukostasis patients presenting to the emergency department.

Design:

Retrospective cohort study.

Setting:

Single large academic medical center in the United States.

Patients:

Adult emergency department patients with signs and symptoms of leukostasis requiring emergent leukapheresis from 2012-2019.

Interventions:

Implementation of a hybrid emergency department-ICU setting (emergency critical care center) and a multidisciplinary care pathway with members from Emergency Medicine, Hematology, Blood Bank, and Clinical Pathology.

Measurements and Main Results:

A total of 70 patients were identified and included for analysis: 14 preemergency critical care center; 32 postemergency critical care center, premultidisciplinary care pathway; and 24 postemergency critical care center, postmultidisciplinary care pathway. A statistically significant reduction in the time from emergency department presentation to initiation of leukapheresis was observed from preemergency critical care center to postemergency critical care center, premultidisciplinary care pathway and postemergency critical care center, postmultidisciplinary care pathway (11.5 vs 7.9 vs 7.7 hr; p = 0.004). Statistically significant reductions in in-hospital mortality were observed from preemergency critical care center to postemergency critical care center, premultidisciplinary care pathway and postemergency critical care center, postmultidisciplinary care pathway (64.3% vs 21.9% vs 25.0%; p = 0.01). A trend toward decreased inpatient ICU utilization was observed, although was not statistically significant (35.7% vs 12.5% vs 25.0%; p = 0.14.)

Conclusions and Relevance:

Implementation of a multidisciplinary care pathway via use of an emergency department-ICU for critically ill patients with leukostasis was associated with statistically significant reductions in time to leukapheresis and in-hospital mortality. These findings suggest an emergency department-ICU model may allow for maximal resource and care coordination at the point of contact with critically ill patients and improved clinical outcomes.
Genomic profiling proves metastasis of cutaneous melanoma to vitreal fluid
Authors: Padrnos Leslie J. , Houghton Odette M. , Iacob Codrin E. , Kurli Madhavi , Ocal Idris T. , Bryce Alan H.
Published: February 2020

Cutaneous melanoma metastases can contribute to visual disturbances through a variety of factors, including metastasis to the vitreal fluid. The optimum management of metastatic cutaneous melanoma to the vitreal fluid is unknown, but can include radiation therapy or systemic therapy including immunotherapy. A high degree of suspicion is necessary to consider this complication while working with patients with cutaneous melanoma.
New approaches to congenital diaphragmatic hernia
Authors: Blumenfeld Yair J. , Belfort Michael A.
Published: February 2020

Purpose of review

Congenital diaphragmatic hernia (CDH) is a structural birth defect that results in significant neonatal morbidity and mortality. CDH occurs in 2–4 per 10 000 pregnancies, and despite meaningful advances in neonatal intensive care, the mortality rate in infants with isolated CDH is still 25–30%. In this review, we will present data on the molecular underpinnings of pathological lung development in CDH, prenatal diagnosis, and prognostication in CDH cases, existing fetal therapy modalities, and future directions.

Recent findings

Developments in the prenatal assessment and in-utero therapy of pregnancies complicated by congenital diaphragmatic hernia are rapidly evolving. Although ultrasound has been the mainstay of prenatal diagnosis, fetal MRI appears to be an increasingly important modality for severity classification. While fetal endoscopic tracheal occlusion (FETO) may have a role in the prenatal management of severe CDH cases, it is possible that future therapeutic paradigms will incorporate adjunct medical interventions with either stem cells or sildenafil in order to address the vascular effects of CDH on the developing lung.

Both animal and human data have shown that the pathophysiological underpinnings of CDH are multifactorial, and it appears that future prenatal assessments and therapies will likely be as well.
IDIOPATHIC FOVEAL HYPOPLASIA
Authors: Le Hoang Mai , Souied Eric H. , Pedinielli Alexandre , Zambrowski Olivia , Miere Alexandra
Published: February 2020

Purpose:

To evaluate vascular density (VD), fractal dimension, and skeletal density on optical coherence tomography angiography in eyes with idiopathic foveal hypoplasia (IFH).

Methods:

Patients presenting with IFH to Creteil University Eye Clinic between January 2015 and October 2018 and age-matched healthy controls were retrospectively evaluated. Vascular density, skeletal density, and fractal dimension analyses were computed on optical coherence tomography angiography superficial capillary plexa (SCP) and deep capillary plexa (DCP) images on the whole image using a custom algorithm. Vascular density on the central 1 mm2and the peripheral 8 mm2for the two groups was performed.

Results:

Thirty-six eyes of 21 patients (18 eyes with IFH and 18 control eyes) were included. A decrease of VD at the level of the SCP and DCP was found in eyes with IFH compared with healthy control eyes (P= 0.005 for VD at the level of the SCP andP= 0.003 for VD at the level of the DCP, respectively). On the central 1 mm2, VD was decreased in healthy eyes (32.3% ± 4.8) at the level of the SCP compared to IFH eyes (55.6% ± 46.3) (P< 0.001). Skeletal density was decreased in IFH eyes in both SCP and DCP (P=< 0.001). Fractal dimension was lower in IFH eyes in both SCP and DCP (P< 0.001).

Conclusion:

Vascular density, skeletal density, and fractal dimension are reduced at the level of SCP and DCP in patients with IFH compared with controls, reflecting a particular anatomical and vascular organization. Quantitative analysis using optical coherence tomography angiography could help to evaluate the severity of IFH.
Treatment of Cytomegalovirus Anterior Uveitis at a North American Tertiary Center With Oral Valganciclovir
Authors: Bhoopat Taniya , Takhar Jaskirat S. , Oldenburg Catherine E. , Keenan Jeremy D. , Gonzales John A. , Margolis Todd P.
Published: February 2020

Purpose:

Cytomegalovirus is an increasingly recognized cause of anterior uveitis. We present clinical features of cytomegalovirus anterior uveitis (CMVAU) and outcomes of oral valganciclovir treatment at a tertiary referral center in North America.

Methods:

This is a retrospective case series review (2002–2014) of immunocompetent patients with CMVAU treated with valganciclovir 900 mg BID and subsequent maintenance dosing of ≤450 mg BID. Most patients were prescribed topical corticosteroids concurrently. Diagnostic evaluations and clinical features at baseline and follow-up were reviewed. Resolution time, maintenance of quiescence, and adverse events were assessed.

Results:

Eighteen eyes of 16 patients were included. The mean age of diagnosis was 41 years. At diagnosis, mean best-corrected visual acuity was 0.30 LogMAR and mean intraocular pressure (IOP) was 18.4 mm Hg; 14 eyes (78%) had an active anterior chamber (AC) cell, 8 (44%) had circinate keratic precipitates, and 6 (33%) had iris atrophy. The mean follow-up duration was 48 months. Fourteen eyes of 12 patients were available for the 12-month follow-up; patients demonstrated improvement in best-corrected visual acuity (difference: −0.21 LogMAR, 95% CI −0.33 to −0.09; P = 0.003), AC cell (OR = 0.10, 95% CI 0.02–0.41; P = 0.002), and IOP (difference: −4.21 mm Hg, 95% CI −7.98 to −0.44; P = 0.03) compared with baseline. One patient experienced a serious adverse event likely due to valganciclovir. Thirteen eyes experienced recurrence of inflammation: 7 (54%) on prophylactic dose of valganciclovir and 6 (46%) after stopping.

Conclusions:

Valganciclovir appears effective and safe for treating CMVAU in this retrospective case series. Long-term antiviral prophylaxis does not abolish recurrences, although it may possibly reduce their frequency when compared with no prophylaxis.
Fulminant Acanthamoeba Endophthalmitis After Cataract Surgery—A Case Report
Authors: Raghavan Anita , Veerappan Saravanan , Rangarajan Viji , Rajaraman Revathi , Salian Romit , MK Janani , L Dhanurekha , Ganesh VR Ram , Venkatapathy Narendran , Rammohan Ram
Published: February 2020

Purpose:

To report a case of Acanthamoeba endophthalmitis after an uneventful cataract surgery.

Methods:

Description, management, and outcomes of a biopsy-proven case of Acanthamoeba endophthalmitis.

Results:

Two days after a routine cataract surgery elsewhere, the patient presented with acute endophthalmitis diagnosed as a bacterial infection based on timing and severity. When conventional methods of management failed, the patient was referred to us. Only the presence of an atypical ring infiltrate suggested Acanthamoeba as a probable cause. Subsequent diagnostic evaluations confirmed the initial suspicion. Management with topical antiamoebics and intracameral and intravitreal voriconazole was attempted. Systemic voriconazole and metronidazole were also administered. However, because of relentless disease progression, the eye had to be eviscerated. The cornea, aqueous, vitreous, and sclera were positive by culture and/or polymerase chain reaction and histopathology.

Conclusions:

Acanthamoeba usually causes a chronic smoldering keratitis and, very rarely, scleritis. This report, which is the first of its kind, emphasizes the fact that fulminant endophthalmitis with associated scleritis can occur after ocular surgery in an immunocompetent individual, with no significant ophthalmic history.
Health Care for Transgender Men: What Is Missing in OB/GYN Care?
Authors: Haseen Ben , Kahn Abigail , Belton Allyson , Roth Bayer Carey
Published: February 2020

Objective

Transgender men (TGM) are those who identify their sex as male but were assigned female at birth who face marginalization in obstetrics and gynecology (OB/GYN) practices. The following commentary highlights recommendations for creating inclusive OB/GYN spaces and improving outcomes for TGM patients.

Methods

The commentary is written in a call to action style using previously published literature about treatment and guidelines for care of transgender patients to highlight recommendations for creating inclusive OB/GYN spaces for TGM. The GLMA Handbook on LGBT Health and The UCSF Transgender Care Web site were among the resources used to gather information on transgender patient inclusivity in health care settings.

Results

Supporting literature was collected that reinstates the need to include framing questions specific to the TGM population during history-taking, creating inclusive clinic settings, and enhancing health care provider training in TGM care.

Conclusions

It is important for TGM who have a vagina, cervix, and/or uterus to have routine gynecological screenings. However, the lack of gender inclusive care in OB/GYN clinics presents a barrier for many TGM and the recommendations emphasized in this commentary will increase sensitivity for the TGM patient population and decrease their marginalization in health care settings.
Fractionated CO2 Laser as Therapy in Recalcitrant Lichen Sclerosus
Authors: Balchander Divya , Nyirjesy Paul
Published: February 2020

Objectives

The aim of this study was to evaluate the efficacy of the fractionated CO2 laser in treating recalcitrant lichen sclerosus (LS).

Materials and Methods

The study population was 40 women diagnosed with LS who were symptomatic despite medical treatment. Patients had at least 2 or more laser sessions with a 2-month follow-up visit at the Drexel Vaginitis Center. A fractionated CO2 laser was used on affected areas at mild or standard power settings. Analyses were performed of changes in symptom rating scales, verbal reports, and physical examination findings.

Results

In the LS cohort of 40 patients, 22 women (55%) experienced symptoms that had persisted longer than 5 years before treatment. After the appropriate laser sessions, 72.5% of women described their improvement as significant or more than 66% improvement. In addition, there was a statistically significant reduction in vaginal pain, itching, dyspareunia, and dysuria. The presence of white epithelium decreased 20% after treatment. Furthermore, the mean corticosteroid use declined from 4.28 times per week to 2.04 times per week, indicating a resolution of many symptoms.

Conclusions

The fractionated CO2 laser may be a helpful approach for managing LS that is unresponsive to traditional treatment options.
Brain death: optimizing support of the traumatic brain injury patient awaiting organ procurement
Authors: Souter Michael J. , Kirschen Matthew
Published: February 2020

Purpose of review

Increasing numbers of deaths on the transplant waiting list is associated with an expanding supply–demand deficit in transplantable organs. There is consequent interest in reviewing both donor eligibility after death from traumatic brain injury, and subsequent management, to minimize perimortem insult to donatable organs.

Recent findings

Recipient outcomes are not worsened when transplanting organs from donors who were declared dead after traumatic brain injury. Protocolized donor management improves overall organ procurement rates and subsequent organ function. Longer periods of active management (up to 48 h) are associated with improved outcomes in renal, lung, and heart transplantation. Several empirically derived interventions have been shown to be ineffective, but there are increasing numbers of structured trials being performed, offering the possibility of improving transplant numbers and recipient outcomes.

New studies have questioned previous considerations of donor eligibility, demonstrating the ability to use donated organs from a wider pool of possible donors, with less exclusion for associated injury or comorbid conditions. There are identifiable benefits from improved donor resuscitation and bundled treatment approaches, provoking systematic assessments of effect and new clinical trials in previously overlooked areas of clinical intervention.
New biomarkers for respiratory infections
Authors: Póvoa Pedro , Coelho Luís , Bos Lieuwe D.J.
Published: February 2020

Purpose of review

Although pneumonia, either community or hospital-acquired, is the most frequent severe respiratory infection, it is an infection difficult to diagnose. At present, the diagnosis of pneumonia relies on a combination of clinical, radiologic, and microbiologic criteria. However, these criteria are far from perfect leading to uncertainty in the diagnosis, risk stratification, and choice of antibiotic therapy. Biomarkers have been used to bring additional information in this setting.

Recent findings

The aim of this review is to provide a clear overview of the current evidence for biomarkers to distinguish between patients in several clinical scenarios: to exclude pneumonia in order to withhold antibiotics, to identify the causative pathogen to target antimicrobial treatment, to identify phenotypes of inflammatory response to facilitate adjunctive treatments, to stratify the risk of severe pneumonia and provide the adequate level of care, and to monitor treatment response and de-escalate antibiotic therapy.

In recent years the number of new biomarkers increased markedly in different areas like pathogen identification or host response. Although far from the ideal, there are several promising areas that could represent true evolutions in the management of pneumonia, in the near future.
Validation set analysis to predict postoperative outcomes by technetium-99m galactosyl serum albumin scintigraphy for hepatectomy
Authors: Nanashima Atsushi , Hiyoshi Masahide , Imamura Naoya , Yano Koichi , Hamada Takeomi , Wada Takashi , Nishimuta Masato , Shimizu Ikko , Mizutani Yoichi
Published: February 2020

Background

The indocyanine green retention rate at 15 min (ICGR15) is a gold standard parameter of liver function when deciding on the extent of hepatectomy. However, ICGR15 is influenced by several hepatic conditions. To evaluate auxiliary preoperative liver functional reserve, we examined the clinical significance of modified parameters by blood tests and technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy.

Methods

We measured liver function parameters, including the hepatic uptake ratio (LHL15) and the blood pool clearance index (HH15) of 99mTc-GSA and their modified formulae [LHL/HH15, LHL minus HH15, and converted ICGR15 (cICGR15) from a preliminary study] in 229 patients, including 18 with biliary obstruction.

Results

The mean values of LHL15/HH15, LHL minus HH15, and cICGR15 were 1.646 ± 0.295, 0.347 ± 0.116, and 13.2 ± 5.3%, respectively. These parameters correlated significantly with other liver functions measured by blood tests except for the bilirubin level (P < 0.05) although the actual ICGR15 level correlated positively with the bilirubin level. The difference of ICGR15 (ICGR15 minus cICGR15) in patients with biliary obstruction tended to be higher in comparison with that in patients without biliary obstruction (P = 0.044). Values of LHL/HH15, LHL minus HH15, and the cICGR15 were not significantly associated with postoperative complications.

Conclusion

The modified parameters of 99mTc-GSA were useful for evaluating hepatic function in patients with high bilirubinemia due to biliary obstruction. However, it remains difficult to establish a more reliable parameter as a standard hepatic function test instead of ICGR15.
Novel lecithin:cholesterol acyltransferase-based therapeutic approaches
Authors: Freeman Lita A. , Karathanasis Sotirios K. , Remaley Alan T.
Published: February 2020

Purpose of review

To review recent lecithin:cholesterol acyltransferas (LCAT)-based therapeutic approaches for atherosclerosis, acute coronary syndrome, and LCAT deficiency disorders.

Recent findings

A wide variety of approaches to using LCAT as a novel therapeutic target have been proposed. Enzyme replacement therapy with recombinant human LCAT is the most clinically advanced therapy for atherosclerosis and familial LCAT deficiency (FLD), with Phase I and Phase 2A clinical trials recently completed. Liver-directed LCAT gene therapy and engineered cell therapies are also another promising approach. Peptide and small molecule activators have shown efficacy in early-stage preclinical studies. Finally, lifestyle modifications, such as fat-restricted diets, cessation of cigarette smoking, and a diet rich in antioxidants may potentially suppress lipoprotein abnormalities in FLD patients and help preserve LCAT activity and renal function but have not been adequately tested.

Preclinical and early-stage clinical trials demonstrate the promise of novel LCAT therapies as HDL-raising agents that may be used to treat not only FLD but potentially also atherosclerosis and other disorders with low or dysfunctional HDL.
Dietary risk factors for urinary stones in children
Authors: Sas David J.
Published: February 2020

Purpose of review

As the incidence of urinary stone disease in children is increasing, identifying dietary risk factors becomes vitally important, especially in the context of targeting interventions to reduce risk for stone formation. Indiscriminant dietary restrictions are not appropriate for paediatric patients.

Recent findings

Although large, prospective studies are still needed to better quantify dietary risk factors for paediatric stone formers, a number of smaller studies provide data to identify common risk factors to help prevent stone formation, while minimizing inappropriate dietary restrictions.

Interpretation of 24-h urine samples to identify individualized dietary risk factors is crucial for implementing a strategy for prevention of further urinary stone formation in children. Clinicians should avoid generalized dietary restrictions in stone-forming children uninformed by laboratory data.
The evolving role of regulatory reporting on patient and donor selection in organ transplantation
Authors: Schold Jesse D.
Published: February 2020

Purpose of review

To describe the historical and evolving role of quality oversight in the field of transplantation. The review highlights of the prior use and effects of oversight of solid organ transplant centers and discusses potential ramifications of changes for the field.

Recent findings

There have been a number of studies illustrating unintended consequences associated with regulatory oversight. Although the intent of oversight to ensure safety and high quality of care, research highlights the potential deleterious effects of policies that do not consider the complexities and effects on practice, patient selection and utilization of donor organs in this field. Recent amendment of policy by the Center for Medicare and Medicaid Services (CMS) highlight the recognition and prominence of these concerns and potentially expand opportunities for transplantation prospectively.

The historical development and implementation of regulatory reporting in transplantation is unique and the oversight imposed on transplant organizations is particularly high compared with other healthcare contexts. The effects of recent CMS policy changes and any related developments from other regulators and payers will be important to evaluate in the years to come.
Instituting a New Central Line Policy to Decrease Central Line-associated Blood Stream Infection Rates During Induction Therapy in Pediatric Acute Lymphoblastic Leukemia Patients
Authors: Berger Rebecca , Messina Allison F. , Chandler Nicole M. , Amankwah Ernest K. , Shaw Peter H.
Published: February 2020

Background:

Children with acute lymphoblastic leukemia (ALL) require central lines to facilitate their care. Peripherally inserted central catheters (PICCs) may have lower rates of central line-associated bloodstream infections (CLABSIs) versus other central lines.

Objectives:

The objective of this study was to compare the CLABSI rate in the first month of therapy after initiating a policy to place PICCs in new patients with severe neutropenia (SN) and Mediports in those with moderate-to-no neutropenia. We also examined thrombosis rates.

Design/Method:

We prospectively gathered data on new patients for 2.5 years following the policy change and retrospectively for the 2 years prior and compared rates of CLABSIs and thrombosis.

Results:

CLABSIs decreased in SN patients from 7.52/1000 to 3.11/1000 line days (P=0.33). The CLABSI rate for all patients with SN who had a Mediport was 13.39/1000 versus 4.08/1000 line days for those that received PICCs (P=0.15). The thrombosis rate for Mediport patients was 3.13 clots/1000 versus 7.65/1000 line days for PICC patients, but the difference was not significant (P= 0.11).

Conclusion:

The differences observed suggest that placing PICCs versus Mediports in new ALL patients with SN may result in a lower incidence of CLABSIs in the first month of therapy without a significant increase in thrombosis.
Community-dwelling individuals with stroke, who have inspiratory muscle weakness, report greater dyspnea and worse quality of life
Authors: Alvarenga Maria Tereza M. , Menezes Kênia K.P. , Nascimento Lucas R. , Avelino Patrick R. , Almeida Tályta L.S. , Teixeira-Salmela Luci F.
Published: February 2020

The objective of the present study was to investigate if different levels of inspiratory muscle strength would be associated with dyspnea, walking capacity, and quality of life after stroke. For this exploratory study, the dependent outcome was strength of the inspiratory muscles, measured by maximal inspiratory pressure. Individuals with maximal inspiratory pressure ≥80 cmH2O were classified as non-weak, those with maximal inspiratory pressure between 45 and 80 cmH2O were classified as weak, and those with maximal inspiratory pressure ≤45 cmH2O were classified as very weak. Related outcomes included dyspnea, measured by the modified Medical Research Council scale; walking capacity, measured by the 6-minute walk test; and quality of life, measured by the Stroke-Specific Quality of Life scale. Fifty-three participants, who had a mean age of 62 years (SD 12) and a mean time since the onset of the stroke of 20 (SD 17) months were included. Significant differences were found only between the weak/very weak and non-weak groups. The mean differences between the non-weak and weak/very weak participants were −1.8 points (95% confidence interval −2.7 to −0.9) for dyspnea and 55 points (95% confidence interval 22–88) for quality of life. Significant correlations were found between measures of inspiratory strength and dyspnea (r = −0.54; P < 0.01) and quality of life (r = 0.56; P < 0.01). There were not found any significant differences or correlations regarding walking capacity. The findings demonstrated that individuals with stroke, who had weakness of the inspiratory muscles, reported greater dyspnea and worse quality of life, compared with those, who did not have weakness. The results regarding walking capacity remain unclear.
Artificial Intelligence and Nursing: The Future Is Now
Authors: Clancy Thomas R.
Published: February 2020

As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on the application of management strategies in health systems. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. Since writing my 1st article for Managing Organizational Complexity in 2004, much has happened to further our understanding of complexity in healthcare systems. The growth of new computational methods in the fields of data science and data analytics has allowed scientists to identify signals or patterns in large complex data sets (big data) that in the past were seemingly hidden. Rather than relying on historical statistical methods to infer outcomes, these advanced methods combined with increased computer processing power allow machines to learn the structure of data and create artificial intelligence (AI). In our ongoing efforts to find solutions for complex healthcare problems, AI is becoming more and more an accepted method. The purpose of this edition of Managing Organizational Complexity is to define AI and machine learning, discuss the recent resurgence of AI, and then provide examples of how AI can provide value to healthcare with an emphasis on nursing.
Beyond the Artificial Intelligence Hype
Authors: van Assen Marly , Banerjee Imon , De Cecco Carlo N.
Published: February 2020

The field of artificial intelligence (AI) is currently experiencing a period of extensive growth in a wide variety of fields, medicine not being the exception. The base of AI is mathematics and computer science, and the current fame of AI in industry and research stands on 3 pillars: big data, high performance computing infrastructure, and algorithms. In the current digital era, increased storage capabilities and data collection systems, lead to a massive influx of data for AI algorithm. The size and quality of data are 2 major factors influencing performance of AI applications. However, it is highly dependent on the type of task at hand and algorithm chosen to perform this task. AI may potentially automate several tedious tasks in radiology, particularly in cardiothoracic imaging, by pre-readings for the detection of abnormalities, accurate quantifications, for example, oncologic volume lesion tracking and cardiac volume and image optimization. Although AI-based applications offer great opportunity to improve radiology workflow, several challenges need to be addressed starting from image standardization, sophisticated algorithm development, and large-scale evaluation. Integration of AI into the clinical workflow also needs to address legal barriers related to security and protection of patient-sensitive data and liability before AI will reach its full potential in cardiothoracic imaging.
Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach
Authors: Crippa Jacopo , Grass Fabian , Dozois Eric J. , Mathis Kellie L. , Merchea Amit , Colibaseanu Dorin T. , Kelley Scott R. , Larson David W.
Published: February 2020

Objective:

To compare short term outcomes of patients undergoing laparoscopic or robotic rectal cancer surgery.

Background:

Significant benefits of robotic rectal cancer surgery over laparoscopy have yet to be demonstrated. Operative time and direct institutional cost seem in favor of the laparoscopic approach.

Methods:

We performed a retrospective review of consecutive patients operated on for rectal cancer with a mini-invasive approach at Mayo Clinic from 2005 to 2018. The primary aim of this study was to investigate the difference in postoperative morbidity between the laparoscopic and robotic approach. Multivariable models for odds to complications and prolonged (≥6 days) length of stay were built.

Results:

A total of 600 patients were included in the analysis. The number of patients undergoing robotic surgery was 317 (52.8%). The 2 groups were similar in respect to age, sex, and body mass index. Laparoscopic surgery was correlated to shorter operative time (214 vs 324 minutes; P < 0.001). Patients undergoing robotic surgery had a lower overall complications rate (37.2% vs 51.2%; P < 0.001). Robotic surgery was found to be the most protective factor [odds ratio (OR) 0.485; P = 0.006] for odds to complications. The event of a complication (OR 9.33; P < 0.001) and conversion to open surgery (OR 3.095; P = 0.002) were identified as risk factors for prolonged length of stay whereas robotic surgery (OR 0.62; P = 0.027) was the only independent protective factor.

Conclusions:

Robotic rectal cancer surgery is strongly associated with better short-term outcomes over laparoscopic surgery.
Antipsychotics and the microbiota
Authors: Chen Anderson , Park Tae Yang , Li Kevin J. , DeLisi Lynn E.
Published: February 2020

Purpose of review

The gut microbiota has been speculated to underpin metabolic changes associated with chronic antipsychotic use. The change in the gut microbiota can also cause abnormal absorbtion from the gut into the blood stream (leaky gut syndrome) that can lead to inflammatory reactions, and thus, secondary damage to the brain and central nervous system. Our article aims to highlight relevant research on antipsychotic's effect on the microbiota and to point out future directions.

Recent findings

Antipsychtoic use can result in specific microbiota changes, and it is important to differentiate this from the innate microbiota of the patient. It is important to treat these microbiota changes, as they are correlated with obesity, which is a negative contributor to the cardiovascular health of those suffering with schizophrenia. Ways to prevent antipsychotic-induced side-effects include antibiotic treatment, histamine 3 receptor blockade and metformin use.

Given the dearth of current literature, more research is needed, however, to determine, which comes first in people with schizophrenia--an abnormal gut microbiota that elevates one's risk for schizophrenia or psychopharmacologic treatment of schizophrenia leading to secondary microbiota abnormalities or the negative symptoms of schizophrenia leading to obesity and its associated microbiota changes.
The effect of time-dilation on Bell experiments in the retrocausal Brans model
Authors: Sen Indrajit
Published: February 2020

The possibility of using retrocausality to obtain a fundamentally relativistic account of the Bell correlations has gained increasing recognition in recent years. It is not known, however, the extent to which these models can make use of their relativistic properties to account for relativistic effects on entangled systems. We consider here a hypothetical relativistic Bell experiment, where one of the wings experiences time-dilation effects. We show that the retrocausal Brans model (
Found. Phys.
,
49
(2), 2019) can be easily generalized to analyse this experiment, and that it predicts less separation of eigenpackets in the wing experiencing the time-dilation. This causes the particle distribution patterns on the photographic plates to differ between the wings—an experimentally testable prediction of the model. We discuss the difficulties faced by other hidden variable models in describing this experiment, and their natural resolution in our model due to its relativistic properties. In particular, we discuss how a
ψ
-epistemic interpretation may resolve several difficulties encountered in relativistic generalizations of de Broglie–Bohm theory and objective state reduction models. Lastly, we argue that it is not clear at present, due to technical difficulties, if our prediction is reproduced by quantum field theory. We conclude that if it is, then the retrocausal Brans model predicts the same result with great simplicity in comparison. If not, the model can be experimentally tested.
Evaluating the operational resilience of small and medium-sized enterprises to flooding using a computational modelling and simulation approach: a case study of the 2007 flood in Tewkesbury
Authors: Coates Graham , Alharbi Meshal , Li Chunhui , Ahilan Sangaralingam , Wright Nigel
Published: February 2020

The resilience of small and medium-sized enterprises (SMEs) to disruptive events is significant as this highly prevalent category of business forms the economic backbone in developed countries. This article provides an overview of the application of a computational modelling and simulation approach to evaluate SMEs' operational resilience to flooding based on combinations of structural and procedural mitigation measures that may be implemented to improve their premises' resistance to flooding and safeguard their business continuity. The approach integrates flood modelling and simulation with agent-based modelling and simulation (ABMS) within a modelled geographical environment. SMEs are modelled as agents based on findings of semi-structured interviews with SMEs that have experienced flooding or are at risk of flooding. In this paper, the ABMS has been applied to a new case study of the major flood event of 2007 in Tewkesbury. Furthermore, to enable an evaluation of the operational resilience of manufacturing SMEs in terms of the relative effectiveness of flood mitigation measures, a new coefficient based on production loss is introduced. Results indicate structural mitigation measures are more effective than procedural measures. While this result is intuitive, the approach provides a means of evaluating the relative effectiveness of combinations of mitigation measures that SMEs may implement to enhance their operational resilience to flooding.

This article is part of the theme issue ‘Urban flood resilience’.
Characterization of the phylogenetic diversity of two novel species belonging to the genus Bifidobacterium: Bifidobacterium cebidarum sp. nov. and Bifidobacterium leontopitheci sp. nov.
Authors: Duranti Sabrina , Lugli Gabriele Andrea , Viappiani Alice , Mancabelli Leonardo , Alessandri Giulia , Anzalone Rosaria , Longhi Giulia , Milani Christian , Ossiprandi Maria Cristina , Turroni Francesca , Ventura Marco
Published: February 2020

TwoBifidobacteriumstrains, i.e., 2176BTand 2177BT, were isolated from Golden-Headed Lion Tamarin (Leontopithecus chrysomelas) and Goeldi's monkey (Callimico goeldii). Isolates were shown to be Gram-positive, non-motile, non-sporulating, facultative anaerobic andd-fructose 6-phosphate phosphoketolase-positive. Phylogenetic analyses based on 16S rRNA sequences, multilocus sequences (includinghsp60,rpoB,dnaJ,dnaG andclpC genes) and the core genome revealed that bifidobacterial strains 2176BTand 2177BTexhibit close phylogenetic relatedness toBifidobacterium felsineumDSM 103139TandBifidobacterium bifidumLMG 11041T, respectively. Further genotyping based on the genome sequence of the isolated strains combined with phenotypic analyses, clearly show that these strains are distinct from each of the type strains of the so far recognizedBifidobacteriumspecies. Thus,Bifidobacterium cebidarumsp. nov. (2176BT=LMG 31469T=CCUG 73785T) andBifidobacterium leontopithecisp. nov. (2177BT=LMG 31471T=CCUG 73786Tare proposed as novelBifidobacteriumspecies.