bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral Fluid to Blood Concentration Ratios of Different Psychoactive Drugs in Samples from Suspected Drugged Drivers
Authors: Bakke Eirin , Høiseth Gudrun , Furuhaugen Håvard , Berg Thomas , Arnestad Marianne , Gjerde Hallvard
Published: April 2020

Background:

The ratio between the concentrations of drugs in the oral fluid and blood (OF/B ratio) reflects the transfer of drugs from blood to oral fluid, which is influenced by several factors such as oral fluid contamination. OF/B drug concentration ratios for psychoactive drugs, including interindividual variation, were investigated in this study. For a portion of the material, oral fluid concentrations in both sides of the mouth were compared.

Methods:

Samples of whole blood and oral fluid collected using the Intercept device were obtained from 489 suspected drugged drivers. Concentrations of amphetamine, methamphetamine, THC, diazepam, N-desmethyldiazepam, clonazepam, alprazolam, oxazepam, nitrazepam, morphine, buprenorphine, and methadone were determined in blood and oral fluid samples using liquid chromatography–tandem mass spectrometry.

Results:

Median OF/B ratios were 18.6 for amphetamine, 13.8 for methamphetamine, 3.8 for morphine, 24.8 for buprenorphine, 3.7 for methadone, 0.026 for diazepam, 0.031 for N-desmethyldiazepam, 0.28 for alprazolam, 0.16 for clonazepam, 0.12 for oxazepam, 0.099 for nitrazepam, and 4.3 for THC. Large interindividual variations in OF/B ratios were observed. The median difference in concentrations in oral fluid from both sides of the mouth was less than 20% for all drugs, except THC and buprenorphine, which had median differences of 32%–34%.

Conclusions:

High OF/B ratios were found for amphetamines and opioids, reflecting a high degree of drug transfer from blood to oral fluid and a longer detection window in oral fluid than in blood. For benzodiazepines, low OF/B ratios were found. Results of the concentration measurements in oral fluid from both sides of the mouth could indicate that some remnants of THC and buprenorphine were present in the oral cavity. The large variations among individuals and between the 2 sides of the mouth suggest that drug concentrations in oral fluid do not accurately reflect drug concentrations in the blood.
Determining diagnostic criteria and cause of recurrent implantation failure
Authors: Cakiroglu Yigit , Tiras Bulent
Published: April 2020

Purpose of review

Recurrent implantation failure (RIF) refers to the absence of implantation after repeated transfer of good embryos into a normal uterus. This review discusses the diagnostic criteria and cause of RIF.

Recent findings

Regardless of the advancements in IVF practice, RIF is still a challenge that has to be solved. Exact definition of RIF is lacking today. For the initial evaluation, a rigorous algorithmic evaluation should be compromised with an individualized principle. Factors that might affect the number and quality of the oocyte and sperm cells should be investigated in order to obtain a good-quality embryo. Embryo assessment should be performed under ideal laboratory circumstances. The uterine environment should be carefully evaluated and the embryo should be transferred into the uterus at the most receptive time. Some of the newly introduced diseases and empirical treatment strategies, such as chronic endometritis, vaginal microbiota, immunologic profile and immunomodulator treatments, can be discussed with the couple under the light of adequate evidence-based information.

New diagnostic and treatment modalities are needed to be introduced, which would be safe, efficient and efficacious after well-designed randomized controlled trials.
Impact of underlying stress in infertility
Authors: Santa-Cruz Diana C. , Agudo David
Published: April 2020

Purpose of review

To review the latest findings about the impact of women's physiological stress on fertility treatment outcomes and the main biomarkers used.

Recent findings

Women with infertility report high levels of distress that can impact their treatment outcome. The combination of multiple methodologies in psychological stress evaluation result in higher validity, precision and richness in the data. Hair cortisol levels seem to be a promising biomarker to be associated to treatment outcomes.

The impact of distress on treatment outcome can be assessed with the help of biomarkers. Decreasing burden of treatment may lead to relevant improvements in assisted reproductive technology outcome.
REDUCED VASCULAR DENSITY IN THE CHOROID AFTER TREATMENT WITH PHOTODYNAMIC THERAPY COMBINED WITH AFLIBERCEPT IN PATIENTS WITH POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Mukai Ryo , Matsumoto Hidetaka , Miyakubo Tomoko , Akiyama Hideo
Published: April 2020

Purpose:

To investigate changes of vascular density in the choroid of patients with polypoidal choroidal vasculopathy treated with photodynamic therapy (PDT) combined with intravitreal aflibercept.

Methods:

This study examined 12 eyes of 12 patients, who were diagnosed as polypoidal choroidal vasculopathy. All patents underwent optical coherence tomography before and at 3 months after PDT combined with intravitreal aflibercept treatment. Using en face optical coherence tomography images, we analyzed vascular density of the area outside the polypoidal choroidal vasculopathy lesion and within the PDT exposure area at the level of the choriocapillaris and middle layer of the choroid. In the outer layer of the choroid, the thickest vessel was selected in the area exposed to PDT, with the diameter of the vessel analyzed.

Results:

The vascular density in the choriocapillaris and middle layer of the choroid significantly decreased from 0.54 ± 0.09 before treatment to 0.44 ± 0.07 after PDT treatment in the choriocapillaris and from 0.53 ± 0.10 to 0.47 ± 0.08 in the middle layer of the choroid, respectively. There was also a significant reduction in the diameter of the largest vessel from 309 ± 85 µm at baseline to 220 ± 52 µm.

Conclusion:

Photodynamic therapy may cause occlusion of the choriocapillaris and middle vessels in the choroid, as well as stenosis of the large vessels.
Outcomes of Ahmed Glaucoma Drainage Implant in Eyes With Glaucoma Secondary to Iridocorneal Endothelial Syndrome
Authors: Gebremichael Bayu G. , Mohamed Ashik , Chaurasia Sunita , Senthil Sirisha
Published: April 2020

Aim:

To evaluate the success of Ahmed glaucoma valve (AGV) implantation in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome.

Materials and Methods:

This retrospective study included 18 eyes of 18 patients with ICE syndrome and glaucoma who had undergone AGV implantation at our institute between January 2008 and April 2019. The primary outcome was the success of AGV, defined as intraocular pressure (IOP) ≥6 and ≤21 mm Hg with or without topical antiglaucoma medication (AGM). Failure was defined as IOP <6 or >21 mm Hg/need for oral AGM/need for additional glaucoma surgery or loss of light perception because of a surgical complication. Corneal clarity and graft survival in these eyes post-AGV were the secondary outcome measure.

Results:

The median (interquartile range) follow-up was at 20.61 (3.9 to 57) months. Of the 18 eyes, 14 (77.8%) had adequate IOP control with or without AGMs. Postoperatively, the mean (±standard deviation) IOP significantly reduced from 29.7(±10) mm Hg to 16(±3.8) mm Hg and the number of AGMs reduced significantly from a mean of 3.6 (±1) to 1.7 (±0.9). The probability of AGV success was 92.3±7.4%, 66.1±11.0%, and 50.5%±17.3% at 1, 3, and 4 years, respectively. All 4 failures were because of uncontrolled IOP and needed either oral AGM or additional surgery for IOP control. At the last follow-up visit, 16 eyes had clear cornea and 2 eyes had pre-existing corneal scar (eccentric) that persisted after AGV implantation.

Conclusion:

AGV implant was reasonably successful for IOP control in glaucoma secondary to ICE syndrome with a few common but manageable corneal complications.
Repair of Tube Erosion by Modifying the Tube Extender
Authors: Liu Wendy W. , Werner Astrid , Chen Teresa C.
Published: April 2020

We describe here a case report of a novel technique for tube erosion repair, which modifies and utilizes the commercially available tube extender (Model TE). The modification of the tube extender makes the commercially available tube extender more compact and is useful in cases where conjunctival mobility and space are limited. This debulking of the tube extender may reduce the risk of future tube exposure and dellen formation.
Subperiosteal Masqueraders as Compared to Subperiosteal Abscess: Contrasting Clinical Presentation and Radiographic Densities
Authors: Dohlman Jenny C. , Habib Larissa A. , Cunnane Mary E. , Yoon Michael K.
Published: April 2020

Purpose:

Subperiosteal orbital lesions are most commonly abscesses secondary to sinusitis but, in rare cases, may represent other processes. Here, the authors compare the clinical and radiographic presentation of subperiosteal abscesses and alternate subperiosteal processes (“masqueraders”) in an effort to establish distinguishing preoperative diagnostic criteria.

Methods:

A retrospective chart review of cases of subperiosteal orbital lesions that underwent surgical intervention over a 3-year period was performed. The medical records of 6 cases of subperiosteal masqueraders and 6 cases of abscesses were reviewed for the clinical course, imaging (including radiographic density of lesions), and pathology. Clinical and radiographic features of the 2 groups were compared.

Results:

All cases presented with orbital signs on exam. Fever and leukocytosis were absent in the masquerader group and present in 3 patients from the abscess group. Common radiographic findings in both groups included a rim-enhancing convex mass along the orbital wall and adjacent sinus opacification, often with bony dehiscence. Of the masqueraders, the final diagnosis was hematoma in 3 cases, mucocele in 1, and malignancy in 2. The difference between the mean radiodensity of the subperiosteal abscesses, 38 ± 5 Hounsfield units (95% CI, 34–42), as compared with the average radiodensity of the masqueraders, 71 ± 5 Hounsfield units (95% CI, 67–75), was significant (p = 0.042). Comparing radiodensity of the orbital lesion to adjacent sinus lesions and metastatic lesions elsewhere was also informative in establishing the diagnosis.

Conclusions:

Radiographic features, particularly radiodensity, may help distinguish subperiosteal abscesses from other lesions and aid in preoperative diagnosis and management.
Patients' experience with and perspectives on neuromodulation for pain: a systematic review of the qualitative research literature
Authors: McCarron Tamara L. , MacKean Gail , Dowsett Laura E. , Saini Manik , Clement Fiona
Published: April 2020

Chronic pain has far-reaching impacts on a person's life and on society more broadly. After failure or intolerance of conservative treatments, neuromodulation may be an option for a subgroup of patients. However, little is known about the patient experience of neuromodulation. We conducted a systematic review of published qualitative research on patient experience with neuromodulation for chronic pain. Four databases were searched: MEDLINE, EMBASE, Psych INFO, and all EMB reviews, from inception to December 4, 2019. We used narrative synthesis to identify key findings from the included studies. The data were qualitatively analyzed using a modified constant comparative analysis to identify key themes across the studies. Seven thousand five hundred forty-two unique citations were retrieved. Sixty-four abstracts were selected by the reviewers and continued to full-text review. After full-text review, 57 studies were excluded with 7 studies included in this systematic review. The included studies were of high quality. Four broad themes emerged: (1) living with chronic pain, (2) expectations, (3) managing challenges, and (4) regaining normalcy. Neuromodulation should be part of an overall pain management plan that may include the need for ongoing emotional and psychosocial support. A deeper knowledge of the patient experience with neuromodulation will assist care teams in providing meaningful support to patients. The results of this study suggest that further research is needed to support neuromodulation as an option for patients living with chronic pain.
Stroke Survivors' Feelings and Perceptions of Their Recovery After a Tai Chi Exercise Intervention
Authors: Taylor-Piliae Ruth E. , Zeimantz Melinda A. , Dolan Hanne , Rosenfeld Anne G.
Published: April 2020

Background

Most tai chi studies conducted among stroke survivors have focused on physical functioning, whereas inclusion of stroke survivors' feelings and perceptions of participating in tai chi is lacking.

Objective

The aim of this study was to identify stroke survivors' feelings and perceptions of participating in a tai chi intervention during their poststroke recovery.

Methods

This qualitative descriptive study examined stories from community-dwelling stroke survivors, collected as part of a larger randomized clinical trial. To examine these stories, an inductive content analysis approach was used with a priori theoretical codes (and subcodes): (1) Feelings (confidence, enjoy, hopeful, helpful, other) and (2) Perceptions of Impact (physical abilities, mental/cognitive abilities, challenges, other). Lincoln and Guba's criteria were followed to ensure trustworthiness of the study findings.

Results

Participants (n = 17) were on average 71 years old (range, 54–87 years), mainly men (65%), and had the option of writing their own story or having someone write it for them. Stories from these stroke survivors revealed feelings of confidence (n = 4), enjoyment (n = 7), hope (n = 1), and helpfulness (n = 15). Perceptions of the impact of tai chi on their poststroke recovery process identified improved physical abilities (n = 23), better mental/cognitive abilities (n = 12), moving forward (n = 7), and developing friendships (n = 4), with few challenges (n = 1).

Conclusions

Using storytelling, healthcare providers can discuss the benefits of tai chi and then relate the feelings and perceptions of other stroke survivors' experiences to encourage engagement in regular physical activity to aid in the poststroke recovery process.
Factors influencing the implementation of falls prevention practice in primary care
Authors: McConville Alexandra , Hooven Katie
Published: April 2020

Background:

Patient falls in the primary care setting are a complex problem and are detrimental to the independence and quality of life of older adults.

Objectives:

The purpose of this integrative review is to identify what factors influence the implementation of fall prevention practice in the primary care setting. This review explores qualitative and quantitative research published between 2004 and 2018 on barriers to fall prevention management in primary care.

Data sources:

The authors conducted a systematic search of the evidence and identified 18 articles which met the inclusion criteria.

Conclusions:

Five themes were identified that described barriers in fall risk management in the primary care setting. These included provider beliefs and practice, lack of provider knowledge, time constraints, patient engagement, and financial issues.

Implications for practice:

The lack of screening and assessment regarding fall risk identification demonstrates a gap in the management of older adults in primary care. Using the evidence- and theory-based Stopping Elderly Accidents, Deaths, and Injuries toolkit and algorithm is an effective method to assist practitioners with fall assessment and preventative measures.
The nurse practitioner role in treating the homeless and rough-sleeper population
Authors: Kirkland-Kyhn Holly
Published: April 2020

Homelessness has always existed worldwide and it presents challenges to society. Delivering health care can be challenging but relationships can be built by starting with wound care, a common problem. Often, the homeless and rough-sleepers need expert attention from caring individuals. However, this population does not have access to expert care, advice, or supplies. This column presents techniques for assessment, treatment, and engagement for better health outcomes in a low resource setting.
Low Uptake of Direct-acting Antiviral Therapy Among Hepatitis C Patients With Advanced Liver Disease and Access to Care, 2014-2017
Authors: Spradling Philip R. , Xing Jian , Rupp Loralee B. , Moorman Anne C. , Gordon Stuart C. , Lu Mei , Teshale Eyasu H. , Boscarino Joseph A. , Schmidt Mark A. , Daida Yihe G. , Holmberg Scott D.
Published: April 2020

Goals:

To determine the proportion and characteristics of adults with hepatitis C at health care organizations in 4 US states who initiated direct-acting antivirals (DAAs).

Background:

There are almost no data to assess the penetrance of treatment of the hepatitis C population in general US health care settings.

Study:

We conducted a prospective observational study using electronic clinical, pharmacy, and mortality data to determine the fraction of patients who initiated DAAs between January 2014 and December 2017, by start date and regimen. We used stepwise multivariate logistic regression analysis to identify sociodemographic and clinical characteristics associated with receipt of DAAs.

Results:

Of 8823 patients, 2887 (32.7%) received DAAs. Quarterly (Q) uptake ranged from 1.1% in Q3 2014 to a high of 5.6% in Q2 2015. Characteristics associated with receipt of DAAs included age 51 to 70 years, higher income, pre-2014 treatment failure, and higher noninvasive fibrosis score (FIB4); however, over one half of patients with FIB4 scores >3.25, consistent with severe liver disease, were not treated. A lower likelihood of initiation was associated with Medicaid coverage. Of 5936 patients who did not initiate treatment, 911 (15.3%) had died and 2774 (46.7%) had not had a clinical encounter in ≥12 months by the end of the study. Fewer than 1% of DAA prescriptions originated from nonspecialty providers.

Conclusions:

During 4 calendar years of follow-up, one third of patients initiated DAAs. Large fractions of untreated patients had advanced liver disease, died, or were lost to follow-up. Even among patients in integrated health care systems, receipt of DAAs was limited.
Approach to patients with bilateral adrenal incidentalomas
Authors: Vassiliadi Dimitra A. , Partsalaki Eirini , Tsagarakis Stylianos
Published: April 2020

Purpose of review

The current review provides a summary on the most recent developments regarding the cause, work-up and management of bilateral adrenal incidentalomas (BAI).

Recent findings

The recent ENS@T/ESE guidelines provide comprehensive directions on the evaluation and management of patients with adrenal incidentalomas with special focus on those with bilateral tumours. Intraadrenal ACTH synthesis that may locally stimulate cortisol secretion challenging the traditionally used term ‘ACTH-independent’. Inactivating mutations of a new tumour suppressor gene, armadillo repeat containing 5 (ARMC5), are implicated in a number of patients, especially those with multiple macronodules (bilateral macronodular hyperplasia) and evidence of hypercortisolism. Loss-of-function mutations of the glucocorticoid receptor gene (NR3C1) consist a new possible genetic cause of BAIs. Regarding management an increasing number of studies provide data on the benefits and safety of unilateral rather than bilateral adrenalectomy. There is also emerging data on the beneficial use of steroidogenesis inhibitors in a dosing schedule that aims to mimic the normal cortisol rhythm with promising short-term results, but the long-term clinical benefits of this approach remain to be demonstrated.

The diagnostic approach consists of imaging and hormonal evaluation. Imaging characterization should be done separately for each lesion. Hormonal evaluation includes testing for primary aldosteronism, pheochromocytoma and evaluation for autonomous cortisol secretion, using the 1-mg overnight dexamethasone suppression test. Midnight cortisol or 24-h urinary-free cortisol may aid in establishing the degree of cortisol excess. In patients with hypercortisolism ACTH levels should be measured to establish ACTH-independency. The appropriate management of BAI associated with cortisol excess remains controversial. Bilateral adrenalectomy results in lifetime steroid dependency and is better reserved only for patients with overt and severe hypercortisolism. Unilateral adrenalectomy might be considered in selected patients. Medical therapy is not an established approach yet but it may be considered when control of hypercortisolism is desired, but surgery is not an option.
Glucose metabolism in Cushing's syndrome
Authors: Sharma Anu , Vella Adrian
Published: April 2020

Purpose of review

Impairment of glucose metabolism is commonly encountered in Cushing's syndrome. It is the source of significant morbidity and mortality even after successful treatment of Cushing's. This review is to understand the recent advances in understanding the pathophysiology of diabetes mellitus from excess cortisol.

Recent findings

In-vitro studies have led to significant advancement in understanding the molecular effects of cortisol on glucose metabolism. Some of these findings have been translated with human data. There is marked reduction in insulin action and glucose disposal with a concomitant, insufficient increase in insulin secretion. Cortisol has a varied effect on adipose tissue, with increased lipolysis in subcutaneous adipose tissue in the extremities, and increased lipogenesis in visceral and subcutaneous truncal adipose tissue.

Cushing's syndrome results in marked impairment in insulin action and glucose disposal resulting in hyperglycemia. Further studies are required to understand the effect on incretin secretion and action, gastric emptying, and its varied effect on adipose tissue.
Usefulness of monitoring antitumor necrosis factor serum levels during the induction phase in patients with Crohn’s disease
Authors: Chaparro María , Guerra Iván , Iborra Marisa , Cabriada José Luis , Bujanda Luis , Taxonera Carlos , García-Sánchez Valle , Marín-Jiménez Ignacio , Barreiro-de Acosta Manuel , Vera Isabel , Martín-Arranz María Dolores , Hernández-Breijo Borja , Mesonero Francisco , Sempere Laura , Gomollón Fernando , Hinojosa Joaquín , Bermejo Fernando , Beltrán Belén , Rodríguez Pescador Ainhoa , Banales Jesús María , Olivares David , Aguilar-Melero Patricia , Menchén Luis , Ferreiro-Iglesias Rocío , Blazquez Gomez Isabel , Benítez García Belén , Guijarro Luis González , Marin Alicia , Bernardo David , Gisbert Javier P.
Published: April 2020

Aims

The aims of this study were (a) to know the kinetics of antitumor necrosis factor (TNF) drug serum levels during the induction phase in patients with Crohn’s disease; (b) to identify variables associated with these levels; and (c) to assess the relation between these levels and short-term effectiveness in Crohn’s disease patients.

Methods

Patients with Crohn’s disease naïve to anti-TNF treatment were prospectively included. Remission was defined as a Crohn’s disease activity index (CDAI) score <150 after 14 weeks of treatment. Blood samples were obtained at baseline and at weeks 4, 8, and 14. Adalimumab and infliximab levels were measured, receiver operating characteristic (ROC) curves were constructed, and the area under the ROC curve was calculated.

Results

One-hundred fifty patients with Crohn’s disease were included, 79 (53%) received infliximab and 71 (47%) had CDAI > 150 at study entry. At week 14, 52 out of 71 patients with CDAI > 150 at baseline (73%) had clinical remission. There were no differences in infliximab levels between patients with and without remission (8 vs. 9.1 μg/mL, P > 0.05) or with and without response (7 vs. 11 μg/mL, P > 0.05) at week 14. There was a trend to higher levels of adalimumab concentration in responders in comparison with nonresponders (13 vs. 6.7 μg/mL, P = 0.05) and in patients who achieved remission in comparison with nonremitters (13.5 vs. 8.4 μg/mL, P = 0.06). In the multivariate analysis, no variable was predictive of short-term remission, including infliximab and adalimumab serum levels.

Conclusion

Determining anti-TNF serum levels during the induction phase is not useful for predicting short-term remission in patients with Crohn’s disease.
Successful Allogeneic Stem Cell Transplant in Pediatric Patients With Diminished Left Ventricular Ejection Fractions
Authors: Lyon Shannon M. , Schamberger Marcus S. , Delgado David C. , Skiles Jodi L. , Goebel William S. , Robertson Kent A. , Parent John J.
Published: April 2020

Chemotherapy-associated cardiotoxicity may delay or impair the ability to administer fully myeloablative chemotherapy for stem cell transplant in those with reduced left ventricular ejection fraction. Studies in adults have been inconsistent regarding the value of ejection fraction in predicting cardiotoxicity in the posttransplant period. Recent publications, however, have demonstrated successful stem cell transplantation in adults despite low ejection fractions. This case series highlights 2 pediatric patients who were successfully treated with stem cell transplantation without posttransplant cardiac complications, despite pretransplant ejection fractions of 38% and 29%.
STAR—Sonographic Thigh Adjustment Ratio
Authors: Kara Murat , Kaymak Bayram , Ata Ayşe Merve , Özkal Özden , Kara Özgür , Baki Aysun , Şengül Ayçiçek Gözde , Topuz Semra , Karahan Sevilay , Soylu Abdullah Ruhi , Çakır Banu , Halil Meltem , Özçakar Levent
Published: April 2020

Objective

The aim of the study was to explore an individualized sonographic muscle thickness ratio and its cutoff values in the diagnosis of sarcopenia.

Design

A total of 326 community-dwelling adults were included in this cross-sectional study. Total skeletal muscle mass was evaluated by bioelectrical impedance analysis, and nine-site muscle thickness measurements using ultrasound. Isometric handgrip and knee extension strengths were assessed. Physical performance was evaluated by usual Gait Speed, Chair Stand Test, and Timed Up and Go Test.

Results

Because the anterior thigh muscle thickness was the most significantly decreasing measurement with aging and the most significantly related value with body mass and height; sonographic thigh adjustment ratio was calculated by dividing it with body mass index. Using the two standard deviation values of our healthy young adults, sonographic thigh adjustment ratio cutoff values were found as 1.4 and 1.0 for male and female subjects, respectively. Sonographic thigh adjustment ratio values were negatively correlated with Chair Stand Test and Timed Up and Go Test in both sexes (all P < 0.05) and positively correlated with gait speed in female subjects and knee extension strength in male subjects (both P < 0.05).

Conclusions

Our results imply that regional (rather than total) muscle mass measurements should be taken into consideration for the diagnosis of sarcopenia.
The Thai Translation of the Pediatric Gait, Arms, Legs, Spine Tool is Useful for Pediatric Residents in Detecting Musculoskeletal Abnormalities in Children
Authors: Sukharomana Maynart , Charuvanij Sirirat
Published: April 2020

Background

The pediatric Gait, Arms, Legs, Spine (pGALS) tool is used to screen musculoskeletal (MSK) abnormalities in children. This study aimed to evaluate the application of the Thai translation of pGALS tool in outpatient clinical settings.

Methods

This cross-sectional study included patients aged 4 to 16 years, recruited from the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Pediatric residents performed the Thai pGALS tool, and a pediatric rheumatologist performed the MSK examination.

Results

One hundred Thai patients were enrolled with a mean age of 9.87 ± 3.01 years. Forty percent of patients had MSK complaints. The median duration of the assessment was 3.96 minutes (interquartile range, 2.07–5.84 minutes). Abnormal pGALS examination by pediatric residents was found in 43 patients, all of which had abnormal MSK examination by a pediatric rheumatologist. Seventeen patients did not have abnormal pGALS examination by pediatric residents, but had abnormal MSK examination confirmed by a pediatric rheumatologist; these patients all had noninflammatory/mechanical conditions. The 3 screening questions of the Thai pGALS tool had a sensitivity and specificity of 71.67% and 77.5%, respectively; the examination had a sensitivity and specificity of 74.14% and 100%, respectively. For acceptability, 99% of parents and 89% of patients reported no discomfort. For practicality, 99% of parents and 89% of patients reported the highest level of practicality.

Conclusions

The Thai pGALS tool is useful for MSK screening in children performed by pediatric residents in outpatient clinical settings. Adding maneuvers to the pGALS examination to detect more common noninflammatory MSK conditions would be beneficial.
What Messages About Osteoporosis Are Offered in Spanish Videos on YouTube?
Authors: Tejada-Llacsa Paul J. , Díaz-Sánchez Paquita Crismalú , Villagaray-Pacheco Nicole Ingrid , Meregildo-Silverio Maxi Ruth , Cabello-León Eduardo
Published: April 2020

Objective

The aim of this study was to determine the appropriateness of messages on osteoporosis in Spanish videos posted on YouTube.

Methods

YouTube Spanish language videos on osteoporosis were evaluated. The main variable was the presence of appropriate messages related to osteoporosis. The content was evaluated through a checklist based on available guidelines and reviewed by an expert (E.C.L.). The evaluation was performed twice independently for each video. A discussion of discordant messages was made with the expert. Other variables included were number of views, comments, “likes,” and “dislikes”; the total duration of the video; and their source (health professionals and non–health professionals). Bivariate analysis between health professionals and non–health professionals were performed using the Mann-Whitney U and the χ2 tests.

Results

A total of 148 videos were reviewed. The median appropriate score for all videos was 5 (p25: 3, p75: 9) (maximum possible, 29 points). Seventy-three (49%) videos had a health professional as source, 124 (83.8%) mentioned at least one message in the definition area, 99 (66.9%) in the area of diagnosis, 99 (66.9%) in the area of recommendations, 43 (29.1%) in the area of treatment, and 5 (3.4%) in follow-up. The most frequent message was “risk of fracture” (68.9%).

Conclusions

The content of osteoporosis information found in YouTube was generally incomplete and inaccurate. The content of these videos should include treatment and preventive strategies.
Rosai-Dorfman Disease Presenting as a Pulmonary Artery Mass on FDG PET/CT
Authors: Hou Guozhu , Chen Kailin , Jiang Yuanyuan , Cheng Wuying , Li Fang
Published: April 2020

Rosai-Dorfman disease (RDD) is an uncommon histiocytic disorder typically involving the lymph nodes and occasionally manifests as extranodal disease. Extranodal RDD involving pulmonary artery without lymphadenopathy or other extranodal lesions is very rare. We present the case of a 48-year-old woman complaining of shortness of breath on exertion for 6 months. 18F-FDG PET/CT revealed a pulmonary artery mass with intense FDG avidity. No other abnormal FDG-avid lesion was observed. The pulmonary artery mass was then surgically removed, and the pathological and immunohistochemical results confirmed RDD.
18F-FDG PET/CT Brain in a Case of Agrammatic/Nonfluent Variant of Primary Progressive Aphasia (Broca’s Aphasia)
Authors: Kousik Vankadari , Mittal Bhagwant Rai , Kumar Rajender , Singh Harmandeep , Goyal Manoj
Published: April 2020

Primary progressive aphasia is a neurodegenerative variant of frontotemporal lobe degeneration presenting with isolated selective impairment of language domain, not secondarily due to stroke. We present a case of middle-aged female patient who underwent 18F-FDG PET of the brain for evaluating progressively declining speaking ability associated with altered fluency of speech and occasional mutism. 18F-FDG PET revealed asymmetric hypometabolism involving the left inferior frontal gyrus along with left anterior cingulate gyrus suggestive of Broca's aphasia.
Nursing Management of Hepatic Encephalopathy
Authors: Rodenbaugh Diana , Vo Christina T. , Redulla Rhoda , McCauley Kathleen
Published: April 2020

This article provides a background of hepatic encephalopathy, its relation to liver disease as well as its prevalence in the United States. A literature review provides an overview of HE discussing the pathophysiology, evidence-based diagnosis, and grading of the disease severity as well as treatment options and interventions. A large emphasis of the article is placed on nursing's role of identifying and managing hepatic encephalopathy. The authors hope to provide clinical nurses with the tools and information needed to provide evidence-based care to this patient population. Pharmacologic therapies, as well as nutrition for these patients, are other topics reviewed. Education for nurses on the management of hepatic encephalopathy is important, as well as education needed for patients and families to support them through the treatment and follow-up care needed to manage hepatic encephalopathy. The authors also hope to provide nurses with education tips to provide the patients and families they care for during their hospitalization with HE, as well as on discharge from the hospital to prevent reoccurrence of symptoms.
A Clinical Review of Primary Biliary Cholangitis
Authors: Pullen Richard
Published: April 2020

Primary biliary cholangitis is a slowly progressive immune-mediated cholestatic disease that causes a destruction of the intrahepatic bile ducts and may lead to cirrhosis of the liver, end-stage liver disease, and the need for liver transplantation. The disease is among the most common reasons why adults require liver transplantation. The primary signs of the disease include the presence of antimitochondrial and antinuclear antibodies, elevated alkaline phosphatase, hyperbilirubinemia, hypercholesterolemia, and histologic features, such as intense inflammation with a florid duct lesion and hepatic fibrosis. The patient's quality of life is impacted by fatigue, pruritus, malabsorption syndrome, sicca syndrome, osteoporosis, and challenges coping with chronic illness. Advanced practice registered nurses need to understand the pathophysiology, clinical presentation, diagnostic approaches, disease and symptom management, and priority nursing assessment and care in patients with this rare disease to differentiate it from primary sclerosing cholangitis, autoimmune hepatitis, obstructed bile duct lesions, drug-induced cholestasis, cholestasis in pregnancy, cholangiocarcinoma, hepatic malignancy, and peptic ulcer disease.
Racial inequality in the trauma of women: A disproportionate decade
Authors: Izadi Shawn N. , Patel Niral , Fofana Demba , Paredes Anghela Z. , Snyder Samuel K. , Torres-Reveron Annelyn , Skubic Jeffrey J.
Published: April 2020

BACKGROUND

Historically, women have been largely underrepresented in the body of medical research. Given the paucity of data regarding race and trauma in women, we aimed to evaluate the most common types of traumas incurred by women and analyze temporal racial differences.

METHODS

A 10-year review (2007–2016) of the National Trauma Data Bank was conducted to identify common mechanisms of injuries among women. Trends of race, intent of injury, and firearm-related assaults were assessed using the Cochran-Armitage Trend test. Multivariable multinomial logistic regressions were utilized to examine the association between race and trauma subtypes.

RESULTS

Of the 2,082,768 women identified as a trauma during this study period, the majority presented due to an unintentional intent (94.5%), whereas fewer presented secondary to an assault (4.4%) or self-inflicted injury (1.1%). While racioethnic minority women encompassed a small percentage of total traumas (19%), they accounted for roughly three fifths of assault-related traumas (p < 0.001). Though total assaults decreased by 20.8% during the study period, black and Hispanic women saw a disproportionately smaller decrease of 15.1% and 15.8%, respectively. On regression analysis, compared with white women, black women had more than four times the odds of being an assault-related trauma compared with unintentional trauma (odds ratio, 4.48; 95% confidence interval, 4.41–4.55). On subset analysis, firearm-related assault was 17.3 times more prevalent among black women (white, 0.3% vs. black: 5.2%; p < 0.001). In fact, history of alcohol abuse was found to be an effect modifier of the association of race/ethnicity and firearm-related trauma.

CONCLUSION

Compelling data highlight a disproportionate trend in the assault-related trauma of minority women. Specifically, minority women, especially those with a history of alcohol abuse, were at increased risk of being involved in a firearm assault. Further studies are essential to help mitigate disparities and subsequently develop preventative services for this diverse population.

LEVEL OF EVIDENCE

Epidemiological, Level III.
Amycolatopsis nivea sp. nov., isolated from a Yellow River sample
Authors: Niu Ming-Ming , Ming Hong , Cheng Li-Jiao , Zhao Zhuo-Li , Ji Wei-Li , Li Meng , Yi Bing-Fang , Xia Ting-Ting , Nie Guo-Xing
Published: April 2020

A novel actinobacterium, designated strain CFH S0261T, was isolated from a sediment sample of the Yellow River. The taxonomic position of the strain was investigated by using a polyphasic approach. Cells of strain CFH S0261T were Gram-reaction-positive, aerobic, non-motile. Growth occurs at 15–37 °C, pH 6.0–8.0 and with 0–9.0 % (w/v) NaCl. Phylogenetic analysis based on the 16S rRNA gene sequence revealed that strain CFH S0261T was a member of the genus

Amycolatopsis

. The 16S rRNA gene sequence similarity indicated that strain CFH S0261T is most closely related to the type strains of

Amycolatopsis niigatensis

LC11T (98.95 %),

Amycolatopsis echigonensis

LC2T (98.81 %) and

Amycolatopsis albidoflavus

IMSNU 22139T (98.73 %). The whole-genome of CFH S0261T showed a G+C content of 69.5 mol%. The ANI values and in silico DDH values between CFH S0261T and the other species of the genus

Amycolatopsis

were found to be low (ANIb <90.61 % and DDH <53.40 %). The cell wall diamino acid in the peptidoglycan of strain CFH S0261T was meso-diaminopimelic acid and the whole-cell hydrolysate comprised arabinose, galactose, glucose, rhamnose and ribose. The predominant menaquinone was MK-9(H4). The major cellular fatty acids were C16 : 0, iso-C15 : 0 and iso-C16 : 0. The polar lipid profile contained diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol, phosphatidylinositol mannosides and four unidentified glycolipids. On the basis of phenotypic, genotypic and phylogenetic data, strain CFH S0261T represents a novel species of the genus

Amycolatopsis

, for which the name Amycolatopsis nivea sp. nov. is proposed. The type strain is CFH S0261T (=KCTC 39515T =CCTCC AA 2014028T).
Aequorivita lutea sp. nov., a novel bacterium isolated from the estuarine sediment of the Pearl River in China, and transfer of Vitellibacter todarodis and Vitellibacter aquimaris to the genus Aequorivita as Aequorivita todarodis comb. nov. and Aequorivita aquimaris comb. nov.
Authors: Zhang Shuangfei , Zhou Haixin , Sun Chongran , Hu Zhong , Wang Hui
Published: April 2020

A Gram-negative, aerobic, rod-shaped, non-motile by gliding bacterium was isolated from the estuarine sediment of the Pearl River in PR China and designated as strain q18T. Colonies were circular, smooth and yellow on marine agar after 48 h cultivation. Salinity, temperature and pH for optimal growth were 5 % (NaCl), 30 °C and 7, respectively. The 16S rRNA gene sequence of the strain q18T showed the highest similarity of 97.3 % to the type strain of

Aequorivita echinoideorum

CC-CZW007T. 16S rRNA gene-based phylogenetic analysis indicated that strain q18T grouped into the genus

Aequorivita

in the family

Flavobacteriaceae

of the phylum

Bacteroidetes

, and was distinct from all known species in the genus. Menaquinone (MK-6) was the main respiratory quinone detected in strain q18T. The major fatty acids were iso-C15 : 0 and iso-C17 : 0 3-OH. The polar lipids of strain q18T mainly comprised phosphatidylethanolamine, two unidentified aminolipids, two unidentified phospholipids and one unidentified polar lipid. The G+C content of the genome was ~42.8 mol%. The draft genome size of strain q18T was 3.3 Mbp. The average nucleotide identity values were around 79.0 % between strain q18T and reference

Aequorivita

strains. Based on the polyphasic analysis, strain q18T was confirmed to represent a novel species of the genus

Aequorivita

, for which the name Aequorivita lutea sp. nov., is proposed. The type strain is q18T (=CICC 24821T=KCTC 72764 T). Further, based on the results of phylogenetic, chemotaxonomic and phenotypic analyses, two species previously classified into the genus

Vitellibacter

,

Vitellibacter todarodis

Kim et al. 2018 and

Vitellibacter aquimaris

Thevarajoo et al. 2016, are transferred to the genus

Aequorivita

as Aequorivita todarodis comb. nov. and

Aequorivita aquimaris

comb. nov. respectively.
Multigenic engineering of the chloroplast genome in the green alga Chlamydomonas reinhardtii
Authors: Larrea-Alvarez Marco , Purton Saul
Published: April 2020

The chloroplast of microalgae such as Chlamydomonas reinhardtii represents an attractive chassis for light-driven production of novel recombinant proteins and metabolites. Methods for the introduction and expression of transgenes in the chloroplast genome (=plastome) of C. reinhardtii are well-established and over 100 different proteins have been successfully produced. However, in almost all reported cases the complexity of the genetic engineering is low, and typically involves introduction into the plastome of just a single transgene together with a selectable marker. In order to exploit fully the potential of the algal chassis it is necessary to establish methods for multigenic engineering in which many transgenes can be stably incorporated into the plastome. This would allow the synthesis of multi-subunit proteins and the introduction into the chloroplast of whole new metabolic pathways. In this short communication we report a proof-of-concept study involving both a combinatorial and serial approach, with the goal of synthesizing five different test proteins in the C. reinhardtii chloroplast. Analysis of the various transgenic lines confirmed the successful integration of the transgenes and accumulation of the gene products. However, the work also highlights an issue of genetic instability when using the same untranslated region for each of the transgenes. Our findings therefore help to define appropriate strategies for robust multigenic engineering of the algal chloroplast.
Aerosol-spread during chest compressions in a cadaver model
Authors: Ott Matthias , Milazzo Alfio , Liebau Stefan , Jaki Christina , Schilling Tobias , Krohn Alexander , Heymer Johannes
Published: April 2020

Objective

To evaluate aerosol-spread in cardiopulmonary resuscitation (CPR) using different methods of airway management. Knowledge about aerosol-spread is vital during the SARS-CoV-2-Pandemic.

Methods

To evaluate feasibility we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a second approach we applied nebulized detergents into human cadavers by an endotracheal tube and detected aerosol-spread during chest compressions the same way. We did recordings with undergoing compression-only-CPR, with a surgical mask and with an inserted laryngeal tube with and without a connected airway filter.

Results

Most aerosol-spread at the direction of the provider was visualized during compression-only-CPR. The use of a surgical mask deflected the spread. Inserting a laryngeal tube connected to an airway filter lead to a remarkable reduction of aerosol-spread.

Conclusion

The early insertion of a laryngeal tube connected to an airway filter before starting chest compression may be good for two things – the treatment of hypoxemia as the likeliest cause of cardiac arrest and for staff protection during CPR.
Indomethacin has a potent antiviral activity against SARS CoV-2 in vitro and canine coronavirus in vivo
Authors: Xu Tianhong , Gao Xuejuan , Wu Zengbin , Selinger Douglas W. , Zhou Zichen
Published: April 2020

Background

The outbreak of SARS CoV-2 has caused ever-increasing attention and public panic all over the world. Currently, there is no specific treatment against the SARS CoV-2. Therefore, identifying effective antiviral agents to combat the disease is urgently needed. Previous studies found that indomethacin has the ability to inhibit the replication of several unrelated DNA and RNA viruses, including SARS-CoV.

Methods

SARS CoV-2 pseudovirus-infected African green monkey kidney VERO E6 cells treated with different concentrations of indomethacin or aspirin at 48 hours post infection (p.i). The level of cell infection was determined by luciferase activity. Anti-coronavirus efficacy in vivo was confirmed by evaluating the time of recovery in canine coronavirus (CCV) infected dogs treated orally with 1mg/kg body weight indomethacin.

Results

We found that indomethacin has a directly and potently antiviral activity against the SARS CoV-2 pseudovirus (reduce relative light unit to zero). In CCV-infected dogs, recovery occurred significantly sooner with symptomatic treatment + oral indomethacin (1 mg/kg body weight) daily treatments than with symptomatic treatment + ribavirin (10-15 mg/kg body weight) daily treatments (P =0.0031), but was not significantly different from that with symptomatic treatment + anti-canine coronavirus serum + canine hemoglobin + canine blood immunoglobulin + interferon treatments (P =0.7784).

Conclusion

The results identify indomethacin as a potent inhibitor of SARS CoV-2.
Mapping the needs and psychological outcomes of Slovenian adolescent and young adult cancer patients: An exploratory mixed-methods study
Authors: Košir Urška , Roškar Sanja , Wild Jennifer , Bowes Lucy
Published: April 2020

Objectives

Baseline data from an ongoing online longitudinal survey were analysed. Three objectives guided our analyses: 1) to describe the self-reported levels of psychological distress among young Slovenian cancer patients and compare it to an international sample, 2) to describe the subjective illness experience of young Slovenian patients, and 3) to highlight areas for improvement in holistic care.

Method

Seventy-nine participants, aged 19 - 39 years, answered questionnaires about anxiety, depression, mental defeat, cancer worry, and their experience of learning the diagnosis and being treated. We used visualizations to demonstrate the relationship between anxiety and depression. The qualitative responses were analysed using an inductive thematic approach.

Results

Twenty-eight (35%) participants scored in the clinical range for anxiety and fifteen (19%) for depression. Cancer-related worry was common (85% reported at least one worry). Mental defeat was positively associated with measures of psychological distress. Those who felt negative about learning their diagnosis emphasized the need for more time, empathy, and dignity. Psychological support during illness was seen as crucial.

Conclusion

Anxiety and depression remain a problem for a subset of patients. Medical professionals working with young people with cancer should encourage a warm atmosphere as they attend to patients’ needs and concerns.