bluuebunny/crossref_metadata_2025 huggingface dataset:
Bradycardia Without Hypertension
Authors: Marmor Itay , Carbell Gary , Koplowitz Jake , Roth Jonathan , Shimoni Nir , Constantini Shlomo , Rimon Ayelet , Glatstein Miguel Marcelo
Published: February 2020

Background

Mechanical shunting of cerebrospinal fluid is an effective treatment for hydrocephalus. Some studies suggest that bradycardia without hypertension may also be observed in ventriculoperitoneal (VP) shunt malfunction; however, in our experience, this is not a common presenting sign.

Objective

The aim of this study was to evaluate whether bradycardia without hypertension was a common sign in patients presenting to the pediatric emergency department (ED) with a VP shunt malfunction.

Methods

A retrospective observational study, from May 2006 to April 2015, which included a random sample of children admitted to the ED with clinical features suggestive of possible VP shunt malfunction. Control patients were defined as those who arrived at our ED with suspected VP shunt malfunction that was later ruled out on further workup.

Results

A total of 65 patients were included in this study. A significantly greater number of patients with a confirmed shunt pathology presented with vomiting (P = 0.01) and lethargy/apathy (P = 0.01). In the control group, a significantly greater number of patients presented with fever (P = 0.004) and seizures (P = 0.02). The number of patients presenting with bradycardia was not significantly different between the shunt pathology and control groups (P > 0.05).

Conclusions

Bradycardia is not a common presentation in patients with VP shunt malfunction. Bradycardia is often recognized as a significant sign; however, it is one of the last presenting signs. Educating patients about the early signs must be considered as part of the treatment for VP shunt malfunction.
Characteristics and Behaviors Among a Representative Sample of New Jersey Adults Practicing Environmental Risk-Reduction Behaviors
Authors: Gleason Jessie A. , Taggert Elizabeth , Goun Barbara
Published: February 2020

Context:

Environmental exposure to groundwater contamination from agricultural runoff, chemical pollution, or geology and indoor air hazards from misuse of consumer products or naturally occurring radon contributes to adverse health outcomes. Individuals can reduce exposure to environmental hazards by practicing risk-reduction behaviors.

Objective:

To characterize the demographic and behavioral characteristics of the population practicing environmental risk-reduction behaviors in order to identify gaps in current prevention outreach efforts.

Design:

The New Jersey Behavioral Risk Factor Survey captures data on self-reported environmental risk-reduction behaviors and health-promoting behaviors (cancer screenings, vaccinations, smoking). To account for complex survey data, weighted analyses were performed in SAS v9.4.

Setting:

New Jersey, 2014-2015.

Participants:

The New Jersey Behavioral Risk Factor Survey is an ongoing telephone health survey of NJ residents. About 1000 NJ residents are selected randomly each month to derive statewide representative prevalence estimates.

Main Outcome Measures:

Self-reported private well testing, radon screening, and carbon monoxide (CO) detector ownership.

Results:

Statewide prevalence of the practice of environmental risk-reduction practices includes 56.6% for private well testing, 44.3% for radon screening, and 86.1% for CO detector ownership. A larger percentage of individuals who are white or Asian, college-educated, earn more than $50 000, and own their homes reported CO detector ownership and radon screening. Age was the only demographic factor associated with private well testing. Screening for radon and CO detector ownership was positively associated with receiving an influenza shot, colonoscopy, aerobic exercise, and positive self-reported health and not smoking.

Conclusions:

There is a need to improve rates of environmental risk-reduction behaviors and reduce disparities in the practice of these behaviors through efforts to increase awareness. Public health officials should target outreach to specific populations that do not practice risk-reduction behaviors.
An Analysis of After Action Reports From Texas Hurricanes in 2005 and 2017
Authors: Barnett Daniel J. , Strauss-Riggs Kandra , Klimczak Victoria L. , Rosenblum Andrew J. , Kirsch Thomas D.
Published: February 2020

Objective:

To review and analyze After Action Reports from jurisdictions in Texas following Hurricanes Katrina and Rita in 2005 and Hurricane Harvey in 2017 in order to assess the utility of AARs as a quality improvement measurement tool.

Methods:

The authors searched the Homeland Security Digital Library, the Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange, and Google Scholar for any AARs that covered the response phase of at least one of the 3 hurricanes, mentioned the state of Texas, and suggested solutions to problems. The authors applied public health emergency management (PHEM) domains, as outlined by Rose et al, to frame the AAR analysis. AARs were coded by 2 reviewers independently, with a third acting as adjudicator. As an example, the problem statements in 2005 and 2017 AARs from 1 statewide agency were compared.

Results:

Sixteen AARs met the inclusion criteria. There were 500 identified problem-solution sets mapped to a PHEM domain. The content was unevenly distributed, with most issues coming under PHEM 2: Policies, Plans, Procedures, and Partnerships at 45.2% in the 2005 hurricanes and 39.9% in 2017. AARs lacked consistent format and were often prepared by the response agencies themselves. Five consistent issues were raised in 2005 and again in 2017. These were volunteer management and credential verification, donations management, information sharing, appropriately identifying those requiring a medical needs shelter, and inadequate transportation to support evacuation.

Conclusion:

Because of the lack of objective data, inconsistent format, unevenly distributed content, and lack of adherence to any framework, AARs are fraught with shortcomings as a tool for PHEM. Inclusion of more objective reporting measures is urgently needed.
Combating Stigma Through HIV Self-Testing: New York State's HIV Home Test Giveaway Program for Sexual Minorities
Authors: Johnson Megan C. , Chung Rakkoo , Leung Shu-Yin J. , Edelstein Zoe , Yuan Yingchao , Flavin Susan M.
Published: February 2020

Context:

Gay, bisexual, and men who have sex with men (MSM) are disproportionately affected by the HIV/AIDS epidemic more than any other group. In New York State (NYS) outside of New York City (NYC), MSM accounted for 57% of new HIV/AIDS diagnoses in 2017. HIV/AIDS home testing initiatives have been effective at getting priority populations tested for HIV.

Objectives:

The NYS Department of Health (NYSDOH) administered the HIV Home Test Giveaway (HHTG) program through social media and mobile applications popular among the priority populations to (1) promote HIV screening among gay and bisexual men, MSM, transgender (TG), and gender queer/gender nonconforming (GNC) individuals who have sex with men, and (2) identify individuals with undiagnosed HIV infection.

Design/Setting:

The NYSDOH recruited participants from NYS (excluding NYC) through social media campaigns between November 2016 and January 2018. Interested individuals were directed to an online eligibility survey. Eligible participants received a coupon via e-mail for a free HIV self-test (HIVST) kit through the manufacturer's Web site. Eligible participants received a $20 to $25 Amazon online gift card if they completed a voluntary online follow-up survey regarding their test results, experiences with the HHTG, and HIV/AIDS risk behaviors. Participants were also able to request assistance from the NYSDOH with further testing and various prevention and supportive services.

Participants:

In total, 6190 individuals participated and 3197 (52%) were eligible and received a coupon. Of the eligible, 2022 (63%) redeemed coupons for HIVST.

Results:

Among eligible participants, 976 (31%) reported having never been tested for HIV. On the follow-up survey, 922 (29%) participants reported having used the HIVST kit for themselves; 203 (22%) were first-time testers; and 7 (0.8%) tested HIV reactive. Of the follow-up survey participants, 761 (59%) requested assistance with various services.

Conclusions:

Media campaigns were effective in promoting HIV testing among priority populations and reaching individuals who have never been tested for HIV.
Prospective Comparison of Donor-Site Morbidity following Radial Forearm and Ulnar Artery Perforator Flap Harvest
Authors: Chang Edward I. , Liu Jun
Published: February 2020

Background:

The forearm is a common donor site, providing thin, pliable workhorse flaps for head and neck reconstruction. There are no prospective studies comparing the donor-site morbidity of the radial forearm flap to the ulnar artery perforator flap.

Methods:

All patients undergoing forearm free flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation, and wound healing were assessed.

Results:

A total of 98 patients were enrolled (radial forearm flap, n = 50; ulnar artery perforator flap, n = 48). There were three osteocutaneous radial forearm flaps performed. The donor site was closed primarily in one radial forearm flap patient and four ulnar artery perforator flap patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial forearm flap, n = 40; ulnar artery perforator flap, n = 44), and the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, and 12 months after surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial forearm flap, n = 5; ulnar artery perforator flap, n = 2); all of them healed secondarily with local wound care. There were no flap losses in the study.

Conclusions:

The radial forearm and ulnar artery perforator flaps are equivalent in terms of success and donor-site morbidity. Selection of flap should be based on need for pedicle length, flap bulk, concerns with radial or ulnar dominance, and surgeon comfort.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
A Practical Guide for Building Collaborations Between Clinical Researchers and Engineers: Lessons Learned From a Multidisciplinary Patient Safety Project
Authors: Sankaran Roshun R. , Ameling Jessica M. , Cohn Amy E.M. , Grum Cyril M. , Meddings Jennifer
Published: February 2020

Objectives

Engineering and operations research have much to contribute to improve patient safety, especially within complex, highly regulated, and constantly evolving hospital environments. Despite new technologies, clinical checklists, and alarm systems, basic challenges persist that impact patient safety, such as how to improve communication between healthcare providers to prevent hospital-acquired complications. Because these collaborations are often new territory for both clinical researchers and engineers, the aim of the study was to prepare research teams that are embarking on similar collaborations regarding common challenges and training needs to anticipate while developing multidisciplinary teams.

Methods

Using a specific patient safety project as a case study, we share lessons learned and research training tools developed in our experience from recent multidisciplinary collaborations between clinical and engineering teams, which included many nonclinical undergraduate and graduate students.

Results

We developed a practical guide to describe anticipated challenges and solutions to consider for developing successful partnerships between engineering and clinical researchers. To address the extensive clinical, regulatory, data collection, and laboratory education needed for orienting multidisciplinary team members to join research projects, we also developed and shared a checklist for project managers as well as the training materials as adaptable resources to facilitate other teams’ initiation into these types of collaborations. These resources are appropriate and tailorable for orienting both clinical and nonclinical team members, including faculty and staff as well as undergraduate and graduate students.

Conclusions

We shared a practical guide to prepare teams for new multidisciplinary collaborations between clinicians and engineers.
Early antiretroviral therapy-treated perinatally HIV-infected seronegative children demonstrate distinct long-term persistence of HIV-specific T-cell and B-cell memory
Authors: Cotugno Nicola , Morrocchi Elena , Rinaldi Stefano , Rocca Salvatore , Pepponi Ilaria , di Cesare Silvia , Bernardi Stefania , Zangari Paola , Pallikkuth Suresh , de Armas Lesley , Levy Ofer , Rossi Paolo , Pahwa Savita , Palma Paolo
Published: February 2020

Objective:

To investigate long-term persistence of HIV-specific lymphocyte immunity in perinatally HIV-infected children treated within the first year of life.

Design:

Twenty perinatally HIV-infected children who received ART therapy within the first year of life (early treated) and with stable viral control (>5 years) were grouped according to their serological response to HIV.

Methods:

Western blot analysis and ELISA defined 14 HIV-seropositive and six seronegative patients. Frequencies of gp140-specific T-cell and B-cell, and T-cell cytokine production were quantified by flow cytometry in both seronegatives and seropositives. Transcriptional signatures in purified gp140-specific B-cell subsets, in response to in-vitro stimulation with HIV peptides was evaluated by multiplex RT-PCR.

Results:

Gp140-specific T cells and B cells persist at similar levels in both groups. A higher production of IL-21 in gp140-specific T cells was found in seropositives vs. seronegatives (P = 0.003). Gene expression in switched IgM−IgD− gp140-specific memory B cells after stimulation with HIV peptides in vitro demonstrated a differential expression of genes involved in signal transduction and activation after BCR/TLR triggering and B-cell activation. Genes relating to antibody production (PRDM1) and T–B cognate stimulation (CXCR4, IL21R) were differentially induced after in-vitro stimulation in seronegatives vs. seropositives suggesting a truncated process of B-cell maturation.

Conclusion:

HIV-specific memory B and T cells persist in early treated regardless their serological status. Seronegatives and seropositives are distinguished by gp140-specific T-cell function and by distinct transcriptional signatures of gp140-specific B cells after in-vitro stimulation, presumably because of a different antigen exposure. Such qualitative insights may inform future immunotherapeutic interventions.
The same lesson over and over: drugs alone will not get us to 90--90--90
Authors: Cohen Jennifer , Pepperrell Toby , Venter Willem Daniel Francois
Published: February 2020

Addressing social determinants of health (SDH) has far greater potential to improve the real-world effectiveness of HIV treatment than expensive, incremental changes in antiretroviral therapy. The ADVANCE study demonstrates that SDH is more impactful than medication regimen on health outcomes. Younger patients and unemployed patients experience heightened precarity, which can have pervasive effects on adherence and suppression. Enhanced adherence counselling can help socioeconomically precarious patients maintain suppression, but in order to improve treatment effectiveness and population health, we should move beyond the short-term solution of helping patients ‘cope’ with insecurity toward tackling the underlying factors that lead to precarity. Data on intention-to-treat populations are critical to this effort, yet medical researchers and publications continue to obscure the influence of SDH by focusing on per-protocol populations.
Subregion Radiomics Analysis to Display Necrosis After Hepatic Microwave Ablation—A Proof of Concept Study
Authors: Bressem Keno K. , Adams Lisa C. , Vahldiek Janis L. , Erxleben Christoph , Poch Franz , Lehmann Kai S. , Hamm Bernd , Niehues Stefan M.
Published: February 2020

Objectives

The aim of this study was to improve the visualization of coagulation necrosis after computed tomography (CT)–guided microwave ablation (MWA) in routine postablational imaging.

Materials and Methods

Ten MWAs were performed in 8 pigs under CT guidance. After each ablation, we obtained contrast-enhanced CT scans in venous phase. Ablations were then resected as a whole, and histologic slices were obtained orthogonally through the ablation center. Subsequently, a vital stain was applied to the sections for visualization of coagulation necrosis. Computed tomography images were reformatted to match the histologic slices. Afterwards, quantitative imaging features were extracted from the subregions of all images, and binary classifiers were used to predict the presence of coagulation necrosis for each subregion. From this, heatmaps could be created, which visually represented the extent of necrosis in each CT image. Two independent observers evaluated the extent of coagulative necrosis between the heat maps and histological sections.

Results

We applied 4 different classifiers, including a generalized linear mixed model (GLMM), a stochastic gradient boosting classifier, a random forest classifier, and a k-nearest neighbor classifier, out of which the GLMM showed the best performance to display coagulation necrosis. The GLMM resulted in an area under the curve of 0.84 and a Jaccard index of 0.6 between the generated heat map and the histologic reference standard as well as a good interobserver agreement with a Jaccard index of 0.9.

Conclusions

Subregion radiomics analysis may improve visualization of coagulation necrosis after hepatic MWA in an in vivo porcine model.
Preoperative Evaluation of the Superficial Fascial System Can Predict Wound Complications in Body Contouring Surgery
Authors: Straughan David M. , McCarthy Michelle E. , Guidry Richard F. , Chaffin Abigail E. , St. Hilaire Hugo , Dancisak Michael , Lindsey John T.
Published: February 2020

Background

The demand for body contouring surgery continues to rise. The inclusion of the superficial fascial system (SFS) during closure of such procedures has been shown to improve outcomes; however, currently reported wound complication rates remain high. The authors assess whether decreased quantities of SFS are associated with wound complications in these patients.

Methods

A retrospective study of patients undergoing body contouring surgery was performed. Preoperatively, ultrasound images were obtained of the SFS. Using Cellprofiler, the mean gray values (MGVs) of the SFS were calculated to quantify this structure. Chart review was performed to identify postoperative wound complications.

Results

Thirty-six patients were included: 30 abdominoplasties, 3 bilateral medial thigh lifts, and 3 bilateral brachioplasties. The overall wound complication rate was 22.5%. There were no significant differences in body mass index, age, smoking status, weight of resected specimen, or diabetes when comparing the complication and noncomplication groups. However, the MGV was significantly greater in the noncomplication group compared with the complication group (0.135 ± 0.008 vs 0.099 ± 0.005, respectively, P = 0.03). The average MGV for the entire cohort was 0.127. Patients with an MGV of greater than 0.127 had a wound complication rate of 0% compared with that of 39% for patients with an MGV of 0.127 or less (P = 0.005).

Conclusions

Poor quantities of SFS identified by ultrasound were associated with increased wound complications in patients undergoing body contouring surgery. Furthermore, patients with better than average SFS seem to be protected from such complications.
Portable Color-Flow Ultrasound Facilitates Precision Flap Planning and Perforator Selection in Reconstructive Plastic Surgery
Authors: Homsy Christopher , McCarthy Michelle E. , Lim Soobin , Lindsey John T. , Sands Thomas T. , Lindsey John T.
Published: February 2020

Background

Precise flap planning and perforator selection are paramount for successful perforator flap surgery. Portable color-flow ultrasound (PCFU) is a convenient, low-cost, easily accessible imaging modality that is pivotal in the planning of perforator flaps where anatomic variability is the rule.

Methods

Perforator mapping was performed using an L12–4 linear-array ultrasound probe connected to an Android tablet. Images were obtained with the Lumify app (Philips Lumify, usa.philips.com). Perforator characteristics were recorded (arterial diameter, emergence points from fascia, subcutaneous course, and projection onto the skin surface) using still images and real-time videos.

Results

Thirty consecutive patients had 40 perforator or musculocutaneous flap reconstructions over a 2-year period. For the 15 flaps that had preoperative computed tomographic angiography (CTA) imaging, the preoperative sonographic measurements correlated with CTA and intraoperative findings. Portable color-flow ultrasound allowed perforator flap design and selection based on the largest available perforator, the most appropriate flap thickness, and comparison of multiple donor sites including left versus right. Two deep inferior epigastric perforator patients required take-back to the operating room for debridement of devitalized nonflap tissue. The superior gluteal artery perforator flap was abandoned intraoperatively due to proximal vascular anomalies. Overall flap success rate was 98% (39/40 flaps).

Conclusions

Our experience with PCFU has rapidly improved, allowing individualized perforator flap selection and design based on each patient's unique perforator anatomy, reconstructive requirements, and donor site characteristics. In our practice, PCFU has supplemented CTA and in many cases has supplanted CTA as the primary imaging modality of choice in the planning of perforator flap reconstruction.
Clinical Research of the Remanent Diplopia Correction Operation After Orbital Fracture Repair
Authors: Liu Shaorui , Shen Qin , Shi Wodong , He Jie , Fan Xianqun
Published: February 2020

Objective:

To investigate the occasion, method and effectiveness of the diplopic correction after the orbital fracture repair in Chinese patients with orbital fracture.

Methods:

This was a retrospective observational study of 64 patients with remanent diplopia after the reconstructions of orbital fracture were studied between January 2014 and June 2017. The different cause, operational occasions, and surgical techniques analyzed. All patients were followed for 6 months after the surgeries.

Results:

After treatment, 64 patients with III degree diplopia were all performed the operations on extraocular muscles. Different operation was selected to different patients according to the examinational results of the extraocular muscles and passive drawer test, including rectos retropulsion, suspension, excise, Jensen's connection, and fixation to periorbital membrane. During the surgery, 25 patients had no diplopia in mainly functional visual fields, while 15 patients still had III degree diplopia. After 6 months, 27 patients had no diplopia in mainly functional visual fields, while 13 patients still had II degree diplopia. Among these 13 patients with III degree diplopia, 7 patients had no the diplopia of primary position of eye, and 6 patients had the diplopia of primary position. These 6 patients were suggested to wear the triangular prisms for improvement of the diplopia.

Conclusion:

The operations should be selected according to the examining results about eye movements and diplopia before and during the surgeries. Reasonable operations could correct diplopia and improve the eye movements effectually.
Usage of Epinephrine Mixed With Lidocaine in Plastic Surgery
Authors: Kim Hun , Hwang Kun , Yun Seon Mi , Kim Dae Joong
Published: February 2020

Plastic surgeons commonly administer subcutaneous epinephrine to reduce intraoperative blood loss. The authors hypothesized that there are safe and effective concentration of epinephrine for vasoconstriction and their durations. The aim of this study is to summarize the existing literatures for the usage of epinephrine mixed with lidocaine in plastic surgical field.

In 1903, Braun reported that adrenaline prolonged the local anesthetic effects of cocaine. The Parke-Davis Company began selling cocaine with adrenaline, as well as combining adrenaline with new synthetic local anesthetics.

Based on a review of the literature, concentrations between 1:50,000 and 1:400,000 are equally effective and provide superior vasoconstriction compared with more dilute solutions. If epinephrine is further diluted, its onset and time to peak serum concentration are delayed, and its duration of action is shortened. When lidocaine is used without epinephrine, duration of anesthesia is shortened reverse proportionally to the lidocaine concentration. When lidocaine is used with epinephrine, duration of anesthesia is prolonged proportionally to the lidocaine concentration. With slow injection rate in the soft tissue, the maximum safe dose of lidocaine is approximately 3 mg/kg plain and 7 mg/kg when mixed with epinephrine. Lidocaine may protect the myocardium because of its antiarrhythmic activity, which is the rationale for infiltrating lidocaine mixed with epinephrine in general anesthesia.

In plastic surgery, subcutaneous infiltration of epinephrine-lidocaine solution is performed to reduce intraoperative blood loss. Even in general anesthesia, infiltrating lidocaine mixed with epinephrine may protect the myocardium because of its antiarrhythmic activity.
Disastrous Complications Following Rhinoplasty: Soft Tissue Defects
Authors: Bilgen Fatma , Ince Bilsev , Ural Alper , Bekerecioğlu Mehmet
Published: February 2020

Background:

Rhinoplasty has become one of the most frequently performed worldwide aesthetic procedures thanks to the successful results obtained by plastic surgeons. In this study, soft tissue defects, encountered as an undesirable and fearsome complication following rhinoplasty, its causes and precautions are presented by authors.

Materials and Methods:

Eight patients operated between December 2015 and December 2018 were enrolled in this study. According to the causes of soft tissue defects observed following rhinoplasty; patients were examined in 5 groups consisting of excessive subcutaneous adipose tissue defatting, improper dissection plane, compression of cast, splint and strip materials, pressure applied to skin by cartilage grafts, and overresection.

Results:

Herein, while subcutaneous excessive defatting and intense cigarette smoking was responsible of the necrosis in the first patient we defined, high pressure on skin due to tight bandaging or external splint materials lead to skin necrosis in our patients 2, 3, and 4. The 5th and 6th patients were candidates of a revision rhinoplasty; however, both resulted with necrosis probably by reason of inaccurate dissection and/or possible diminished vascularity by previous rhinoplasty operations. In the 8th patient, necrosis was observed due to the compression of the bulky autologous cartilage graft used in the skin.

Conclusion:

In conclusion, skin necrosis is a rare but bothersome complication of rhinoplasty. The importance of atraumatic techniques and appropriate dissection plane during the rhinoplasty operation as well as the importance of the effect and control of the postoperative applied splint and bandage materials is so obviously seen.
Is There an Increasing Interest in Facial Feminization Surgery? A Search Trends Analysis
Authors: Teixeira Jeffrey C. , Morrison Shane D. , Brandstetter Kathleyn A. , Nuara Michael J.
Published: February 2020

Facial feminization surgery (FFS) has increased in prevalence and recent studies show that transgender women are just as likely to want facial feminization surgery compared to genital affirmation surgery. While previous research has demonstrated an increase in individuals seeking gender affirmation surgery, little is known on the prevalence of facial feminization surgery. Categorizing the number of facial feminization surgeries performed is difficult given lack of reimbursement rates and paucity of centers of excellence which publish data on their case numbers. Research has also shown a general increase in the information that patients seek on the internet with respect to gender affirmation surgery as procedures have become more prevalent. However, to date, there have been no studies looking at the overall interest in individuals seeking information on facial feminization surgery on the internet. Therefore, this study looks for the first time at an analysis of Google Trends data with respect to global interest in facial feminization surgery.
Consensus Recommendations for the Use of Simulation in Therapeutic Patient Education
Authors: Penneçot Christelle , Gagnayre Remi , Ammirati Christine , Bertin Éric , Capelle Delphine , Cheraitia Elisabeth , Chiniara Gilles , David Valérie , De La Tribonnière Xavier , Decelle Béatrice , Derambure Philippe , Gignon Maxime , Greffier Catherine , Gross Olivia , Lalande Anne , Lartiguet Patrick , Letallec Claire , Mahé Claude , Mero Yannette , Mohammed Roland , Pétré Benoit , Picchiottino Patricia , Pougheon-Bertrand Dominique , Secheresse Thierry , Vaillant Geneviève , Van der Schueren-Etévé Marie , Verdier Jocelyne , Benhaberou-Brun Dalila , Bardou Marc , Marchand Claire
Published: February 2020

Introduction

Simulation is rarely used to help individuals with chronic diseases develop skills. The aim of the study was to provide recommendations for the use of simulation in therapeutic patient education (S-TPE).

Methods

Expert consensus was achieved with the participation of the following 3 groups of experts: (a) expert patients and caregivers; (b) health professionals specialized in therapeutic patient education (TPE); and (c) simulation experts. Each expert received a list of questions by e-mail in 3 iterations. The synthesis of the 2 first questionnaires resulted in 34 first recommendations voted during the consensus conference meeting. Each recommendation was subject to an extensive literature review. The quality of the evidence and the strength of the recommendations were assessed through the evaluation, development, and evaluation criteria categories (GRADE criteria). The third questionnaire selected and illustrated recommendations more specific to the use of S-TPE.

Results

At the end of the process, the experts identified 26 recommendations specific to the use of S-TPE. They proposed examples of skills in different diseases and stressed the importance of adapting the conditions of use (location, equipment, time of the care) to the circumstances of the patient learner and skills to be developed. Experts should exercise great caution as this technique presents ethical considerations related to patient care.

Conclusions

These recommendations underline the fact that simulation could bring added value to TPE. They provide a framework and examples for the experimental use of simulation in TPE. Research into feasibility and acceptability is needed.
Estimated Glomerular Filtration Rate at Transplant Listing and Other Predictors of Post-Heart Transplant Mortality and the Development of ESRD
Authors: Kumar Abhishek , Howard Alan , Thomas Christie P.
Published: February 2020

Background.

Elevated serum creatinine at the time of heart transplant is an independent predictor of posttransplant end-stage renal disease (ESRD) and mortality. Patients who are at risk of ESRD should be identified before transplantation. We looked at the severity of CKD at the time of waitlisting on posttransplant ESRD and mortality.

Methods.

We analyzed the United Network of Organ Sharing transplant database from 2000 to 2017. Adults receiving their first heart transplant, and not on dialysis, were included in study. We divided our cohort into 4 groups based on their listing estimated glomerular filtration (eGFR) as well as based on their eGFR at the time of transplant. Primary outcome was all cause mortality and secondary outcome was ESRD.

Results.

Compared with the patients on waitlist eGFR ≥60 mL/min/1.73 m2, the adjusted subdistribution hazard for ESRD was 1.41 (confidence interval [CI], 1.2-1.5), 2.15 (CI, 1.9-2.4), and 2.91 (CI, 2.4-3.5) in the patient groups with eGFR of 45–59, 30–44, and <30 mL/min/1.73 m2, respectively. Despite the highest risk of ESRD with the lowest baseline eGFR group, there was a substantial increase in eGFR seen during follow-up with a mean gain of 11 mL/min by year 15 compared with a mean loss of 10 mL/min in the highest eGFR group. Compared with the patients on waitlist eGFR ≥60 mL/min/1.73m2, the adjusted hazard ratio for mortality was 1.04 (0.98–1.11), 1.07 (1.00–1.15), and 1.04 (0.91–1.19) in the patient groups with eGFR of 45–59, 30–44, and <30 mL/min/1.73m2, respectively.

Conclusions.

Our findings show that risk of ESRD post-heart transplant increases with worsening eGFR at waitlisting even after adjusting for multiple confounders.
Seizure Occurrences: Patient Report, Scalp EEG, and RNS Electrocorticography Findings
Authors: Chen Hai , Koubeissi Mohamad
Published: February 2020

Eliminating or reducing seizures is a main goal of epilepsy treatment, and clinicians rely mainly on patient self-report regarding seizure frequency. Here, we compare seizure frequency by patient report with responsive neurostimulation (RNS) recordings in two patients, one of whom also had prolonged scalp EEG recording. RNS being more sensitive in detecting seizures than scalp EEG, our cases illustrate that patients may strikingly underreport seizure frequency. In addition, patients may also overreport seizures. Although a negative scalp EEG study does not exclude the possibility of focal aware seizures, RNS can reliably differentiate between nonepileptic events and focal aware seizures if electrodes are properly placed in the seizure-onset zone. Besides its therapeutic benefit, RNS can also play an important role in identifying seizure frequency. Improving seizure monitoring using the device could help to optimize therapy and outcome.
Cognitive profile partly mediates allergy-associated decrease in mental health
Authors: Dalmaijer Edwin S. , Nord Camilla L. , Bignardi Giacomo , Anwyl-Irvine Alexander L. , Siugzdaite Roma , Smith Tess A. , Uh Stepheni , Billing Addison , Astle Duncan E.
Published: February 2020

Background

There is a well-established link between allergies and mental health. While both atopic and food allergies are associated with increased levels of depression and anxiety, it is unclear what the mechanism behind this relationship is. Several theories touch upon potential psychological mechanisms, but until now putative cognitive mechanisms of the link between mental health and allergies have been unexplored.

Methods

We employed tablet-based deep cognitive phenotyping, and also recorded mental health, socio-economic status, and allergies in 533 children aged 7-9 years. We then employed mediation analyses to test whether cognitive mechanisms mediated the association between allergies and mental health.

Findings

In line with previous research, we found children with allergies reported higher levels of anxiety and depression. Furthermore, compared to children without allergies, they showed faster processing speed, equal verbal short-term memory, and worse performance on tests of fluid reasoning, number sense, search organisation, and spatial short-term memory. We confirmed that these variables predicted allergic state using logistic regression. Most importantly, we found that cognition partially mediated the relationship between allergy and both anxiety and depression.

Interpretation

Our results suggest that allergies bias children towards particular cognitive profiles, which in turn are risk factors for anxiety and depression. This supports the view that early cognitive interventions could reduce the number of allergic children that develops comorbid psychiatric conditions.

Funding

This study was supported by grant TWCF0159 from the Templeton World Charity Foundation to DEA, and by the UK Medical Research Council.
Lysophosphatidic acid-mediated GPR35 signaling in CX3CR1+macrophages regulates the intestinal cytokine milieu
Authors: Kaya Berna , Cuadra Cristian Doñas , Wuggenig Philipp , Diaz Oscar E. , Morales Rodrigo A. , Melhem Hassan ,   Swiss IBD Cohort Investigators, Hernández Pedro P. , Kaymak Tanay , Das Srustidhar , Hruz Petr , Ayata C. Korcan , Villablanca Eduardo J. , Niess Jan Hendrik
Published: February 2020

Single nucleotide polymorphisms in the gene encoding G protein-coupled receptor 35 (GPR35) are associated with increased risk of inflammatory bowel disease. However, the mechanism(s) by which GPR35 modulates the intestinal milieu remain undefined. Here we demonstrate in zebrafish and mice that expression ofGpr35is microbiota-dependent and is enhanced upon inflammation. We identify a GPR35+colonic macrophage population in mice that is characterized by increased production of pro-inflammatory cytokines, and determine that lysophosphatidic acid (LPA) acts as an endogenous GPR35 ligand to induceTnfexpression. Mice lackingGpr35in CX3CR1+macrophages have aggravated colitis when exposed to dextran sodium sulfate, have decreased transcript levels of the corticosterone-generating geneCyp11b1, and reduced levels of macrophage-derived TNF. Administration of TNF in these mice restoresCyp11b1expression and intestinal corticosterone production, and ameliorates DSS-induced colitis. These findings suggest that LPA signals through GPR35 in CX3CR1+macrophages to control the intestinal cytokine milieu.

Highlights

Inflammatory cues and the microbiota modulateGpr35expression across species

LPA modulates GPR35-dependent functions in zebrafish and mice macrophages

GPR35 expressing macrophages have a protective role during intestinal inflammation

GPR35 control intestinal inflammation by inducing TNF and corticosterone synthesis

eTOC Blurb

GPR35 have been associated with IBD, but how GPR35 may influence macrophage-mediated intestinal homeostasis remains unclear. Using zebrafish and mice genetic tools, Niess, Villablanca, and colleagues have identified that LPA triggers GPR35 activity, and loss of macrophage GPR35 signaling confers intrinsic dysfunctions with effects on cytokine production and intestinal homeostasis.
Making the urban environment around schools healthier, developing an initial programme theory: an early realist process evaluation of the London superzones pilot
Authors: Catt Heather , Senior Steven L
Published: February 2020

BACKGROUND

More than four out of five people in England live in an urban area so the urban environment is an important determinant of health and an important contributor to health inequalities. This is especially true for children, for whom the impacts of their local environment may have lifelong effects. To improve the health effects of the urban environment the London Devolution Partnership piloted multi-agency partnerships focusing on 400m ‘superzones’ around schools in deprived communities. The intention is for local partners to work together to make the environment within the superzone healthier.

METHODS

A realist process evaluation of 13 pilot sites. We used data from programme documents, a rapid literature search, and interviews with lead officers for the 13 local authorities that took part in the programme. Qualitative analysis was used to identify combinations of context, mechanisms, and outcomes (CMOs) that affected the creation of a local partnership and plan.

RESULTS

All but one of the 13 pilot sites established a superzone and multi-agency action plan. We identified 12 CMOs that affect the process of creating a school superzone. We present a logic model that describes how these CMOs combine to make up an initial programme theory of superzones. Key aspects of this programme theory include the importance of local partners’ priorities, leadership and support from across the local authority, and the flexibility of the model itself.

CONCLUSION

The superzones model is an emerging framework for local place-based partnership working to improve the urban environment. However, the success of the model is likely to depend on local context. The evidence presented here could guide the further roll out of the model, and support those local authorities that want to create superzones.
Quantification of positive family history as a risk factor for ischaemic heart disease
Authors: Iqbal Basit
Published: February 2020

Objective

There is very little research regarding quantification of family history as a risk factor for ischaemic heart disease. This is especially so in the South Asian population, which tends to suffer from ischaemic heart disease at a much younger age, even after environmental and dietary factors are accounted for. This indicates a likely genetic basis. The aim of this study was to quantify family history as a risk factor.

Methods

It is a retrospective, cross-sectional study. Patients with family history and hypertension as the only cardiac risk factors were recruited in the study along with control subjects. Myocardial perfusion scintigraphy was used for the detection of myocardial ischemia.

Results

114 patients had hypertension and family history as the only risk factors. 64 of these patients had myocardial ischemia. 102 control patients were also recruited, of whom only 26 suffered from myocardial ischemia. The odds-ratio was thus calculated to be 3.69 (95% CI: 1.54-9.28, p=0.001).

Conclusions

These findings suggest a strong genetic basis for ischemic heart disease in the South Asian population. This needs to be taken into consideration when such patients present with non-specific cardiac symptoms.
Constitutive ghrelin receptor activity modulates AMPA receptor traffic and supports memory formation
Authors: Ribeiro Luís F. , Catarino Tatiana , Carvalho Mário , Santos Sandra D. , Cortes Luísa , Opazo Patricio O. , Ribeiro Lyn Rosenbrier , Choquet Daniel , Esteban José A. , Peça João , Luísa Carvalho Ana
Published: February 2020

The ability of animals to store and retrieve food caches in the wild requires the integration of biological signals of hunger, satiety and memory. The role of ghrelin in regulating feeding and memory makes ghrelin receptors an important target to shape the required cellular and molecular responses. We investigated the effects of the high ligand-independent activity of the ghrelin receptor on the physiology of excitatory synapses. Blocking this type of activity produced a decrease in the synaptic content of AMPA receptors in hippocampal neurons and a reduction in GluA1 phosphorylation at Ser845. Impaired constitutive activity from the ghrelin receptor increased surface diffusion of AMPA receptors and impaired AMPA receptor synaptic delivery mediated by chemical long-term potentiation. These observations support a role for the constitutive activity of the ghrelin receptor in regulating AMPA receptor trafficking under basal conditions and synaptic plasticity. Accordingly, we found that blocking the ghrelin receptor constitutive activity impairs spatial and recognition memory.

Impact statement

This work uncovers a role for the constitutive activity of the ghrelin receptor in memory, and in the regulation of the synaptic levels of AMPA receptors, their mobility and synaptic plasticity. Underscoring the importance of deciphering the physiological role of constitutive ghrelin receptor activity, ghrelin receptor inverse agonism is now being considered as a therapy to treat alcohol use disorder.
Learning massive interpretable gene regulatory networks of the human brain by merging Bayesian Networks
Authors: Bernaola Nikolas , Michiels Mario , Larrañaga Pedro , Bielza Concha
Published: February 2020

We present the Fast Greedy Equivalence Search (FGES)-Merge, a new method for learning the structure of gene regulatory networks via merging locally learned Bayesian networks, based on the fast greedy equivalent search algorithm. The method is competitive with the state of the art in terms of the Matthews correlation coefficient, which takes into account both precision and recall, while also improving upon it in terms of speed, scaling up to tens of thousands of variables and being able to use empirical knowledge about the topological structure of gene regulatory networks. We apply this method to learning the gene regulatory network for the full human genome using data from samples of different brain structures (from the Allen Human Brain Atlas). Furthermore, this Bayesian network model should predict interactions between genes in a way that is clear to experts, following the current trends in explainable artificial intelligence. To achieve this, we also present a new open-access visualization tool that facilitates the exploration of massive networks and can aid in finding nodes of interest for experimental tests.
Foxg1Organizes Cephalic Ectoderm to Repress Mandibular Fate, Regulate Apoptosis, Generate Choanae, Elaborate the Auxiliary Eye and Pattern the Upper Jaw
Authors: Compagnucci Claudia , Depew Michael J.
Published: February 2020

Gnathostome jaw patterning involves focal instructive signals from the embryonic surface cephalic ectoderm (SCE) to a fungible population of cranial neural crest. The spatial refinement of these signals, particularly for those patterning the upper jaws, is not fully understood. We demonstrate thatFoxg1, broadly expressed in the SCE overlying the upper jaw primordia, is required for both neurocranial and viscerocranial development, including the sensory capsules, neurocranial base, middle ear, and upper jaws.Foxg1controls upper jaw molecular identity and morphologic development by actively inhibiting the inappropriate acquisition of lower jaw molecular identity within the upper jaw primordia, and is necessary for the appropriate elaboration of the λ-junction, choanae, palate, vibrissae, rhinarium, upper lip and auxiliary eye. It regulates intra-epithelial cellular organization, gene expression, and the topography of apoptosis within the SCE.Foxg1integrates forebrain and skull development and genetically interacts withDlx5to establish a single, rostral cranial midline.
Imputing Single-cell RNA-seq data by combining Graph Convolution and Autoencoder Neural Networks
Authors: Rao Jiahua , Zhou Xiang , Lu Yutong , Zhao Huiying , Yang Yuedong
Published: February 2020

Single-cell RNA sequencing technology promotes the profiling of single-cell transcriptomes at an unprecedented throughput and resolution. However, in scRNA-seq studies, only a low amount of sequenced mRNA in each cell leads to missing detection for a portion of mRNA molecules, i.e. the dropout problem. The dropout event hinders various downstream analysis, such as clustering analysis, differential expression analysis, and inference of gene-to-gene relationships. Therefore, it is necessary to develop robust and effective imputation methods for the increasing scRNA-seq data. In this study, we have developed an imputation method (GraphSCI) to impute the dropout events in scRNA-seq data based on the graph convolution networks. The method takes advantage of low-dimensional representations of similar cells and gene-gene interactions to impute the dropouts. Extensive experiments demonstrated that GraphSCI outperforms other state-of-the-art methods for imputation on both simulated and real scRNA-seq data. Meanwhile, GraphSCI is able to accurately infer gene-to-gene relationships by utilizing the imputed matrix that are concealed by dropout events in raw data.