bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring chemical homogeneity in dwarf galaxies: a VLT-MUSE study of JKB 18
Authors: James Bethan L , Kumari Nimisha , Emerick Andrew , Koposov Sergey E , McQuinn Kristen B W , Stark Daniel P , Belokurov Vasily , Maiolino Roberto
Published: May 2020

Deciphering the distribution of metals throughout galaxies is fundamental in our understanding of galaxy evolution. Nearby, low-metallicity, star-forming dwarf galaxies, in particular, can offer detailed insight into the metal-dependent processes that may have occurred within galaxies in the early Universe. Here, we present VLT/MUSE observations of one such system, JKB 18, a blue diffuse dwarf galaxy with a metallicity of only 12 + log(O/H)=7.6 ± 0.2 (∼0.08 Z⊙). Using high spatial resolution integral-field spectroscopy of the entire system, we calculate chemical abundances for individual H ii regions using the direct method and derive oxygen abundance maps using strong-line metallicity diagnostics. With large-scale dispersions in O/H, N/H, and N/O of ∼0.5–0.6 dex and regions harbouring chemical abundances outside this 1σ distribution, we deem JKB 18 to be chemically inhomogeneous. We explore this finding in the context of other chemically inhomogeneous dwarf galaxies and conclude that neither the accretion of metal-poor gas, short mixing time-scales or self-enrichment from Wolf–Rayet stars are accountable. Using a galaxy-scale, multiphase, hydrodynamical simulation of a low-mass dwarf galaxy, we find that chemical inhomogeneities of this level may be attributable to the removal of gas via supernovae and the specific timing of the observations with respect to star formation activity. This study not only draws attention to the fact that dwarf galaxies can be chemically inhomogeneous, but also that the methods used in the assessment of this characteristic can be subject to bias.
Biosignature surveys to exoplanet yields and beyond
Authors: Sandora McCullen , Silk Joseph
Published: May 2020

Upcoming biosignature searches focus on indirect indicators to infer the presence of life on other worlds. Aside from just signalling the presence of life, however, some biosignatures can contain information about the state that a planet’s biosphere has achieved. This additional information can be used to measure what fractions of planets achieve certain key stages, corresponding to the advent of life, photosynthesis, multicellularity, and technological civilization. We forecast the uncertainties of each measurement for upcoming surveys, and outline the key factors that determine these uncertainties. Our approach is probabilistic and relies on large numbers of candidates rather than detailed examination of individual exoplanet spectra. The dependence on survey size, likeliness of the transition, and several measures of degrees of confidence are discussed, including discussion of geological false positives in biosignatures as well as how combining data from different missions can affect the inference. Our analysis should influence policy recommendations for future mission design and strategy to minimize the impact of measurement uncertainties.
MEIOK21: a new component of meiotic recombination bridges required for spermatogenesis
Authors: Shang Yongliang , Huang Tao , Liu Hongbin , Liu Yanlei , Liang Heng , Yu Xiaoxia , Li Mengjing , Zhai Binyuan , Yang Xiao , Wei Yudong , Wang Guoqiang , Chen Zijiang , Wang Shunxin , Zhang Liangran
Published: May 2020

Repair of DNA double-strand breaks (DSBs) with homologous chromosomes is a hallmark of meiosis that is mediated by recombination ‘bridges’ between homolog axes. This process requires cooperation of DMC1 and RAD51 to promote homology search and strand exchange. The mechanism(s) regulating DMC1/RAD51-ssDNA nucleoprotein filament and the components of ‘bridges’ remain to be investigated. Here we show that MEIOK21 is a newly identified component of meiotic recombination bridges and is required for efficient formation of DMC1/RAD51 foci. MEIOK21 dynamically localizes on chromosomes from on-axis foci to ‘hanging foci’, then to ‘bridges’, and finally to ‘fused foci’ between homolog axes. Its chromosome localization depends on DSBs. Knockout of Meiok21 decreases the numbers of HSF2BP and DMC1/RAD51 foci, disrupting DSB repair, synapsis and crossover recombination and finally causing male infertility. Therefore, MEIOK21 is a novel recombination factor and probably mediates DMC1/RAD51 recruitment to ssDNA or their stability on chromosomes through physical interaction with HSF2BP.
FUS ALS-causative mutations impair FUS autoregulation and splicing factor networks through intron retention
Authors: Humphrey Jack , Birsa Nicol , Milioto Carmelo , McLaughlin Martha , Ule Agnieszka M , Robaldo David , Eberle Andrea B , Kräuchi Rahel , Bentham Matthew , Brown Anna-Leigh , Jarvis Seth , Bodo Cristian , Garone Maria G , Devoy Anny , Soraru Gianni , Rosa Alessandro , Bozzoni Irene , Fisher Elizabeth M C , Mühlemann Oliver , Schiavo Giampietro , Ruepp Marc-David , Isaacs Adrian M , Plagnol Vincent , Fratta Pietro
Published: May 2020

Mutations in the RNA-binding protein FUS cause amyotrophic lateral sclerosis (ALS), a devastating neurodegenerative disease. FUS plays a role in numerous aspects of RNA metabolism, including mRNA splicing. However, the impact of ALS-causative mutations on splicing has not been fully characterized, as most disease models have been based on overexpressing mutant FUS, which will alter RNA processing due to FUS autoregulation. We and others have recently created knockin models that overcome the overexpression problem, and have generated high depth RNA-sequencing on FUS mutants in parallel to FUS knockout, allowing us to compare mutation-induced changes to genuine loss of function. We find that FUS-ALS mutations induce a widespread loss of function on expression and splicing. Specifically, we find that mutant FUS directly alters intron retention levels in RNA-binding proteins. Moreover, we identify an intron retention event in FUS itself that is associated with its autoregulation. Altered FUS levels have been linked to disease, and we show here that this novel autoregulation mechanism is altered by FUS mutations. Crucially, we also observe this phenomenon in other genetic forms of ALS, including those caused by TDP-43, VCP and SOD1 mutations, supporting the concept that multiple ALS genes interact in a regulatory network.
Smoking Is Associated With COVID-19 Progression: A Meta-analysis
Authors: Patanavanich Roengrudee , Glantz Stanton A
Published: May 2020

Introduction

Smoking depresses pulmonary immune function and is a risk factor contracting other infectious diseases and more serious outcomes among people who become infected. This paper presents a meta-analysis of the association between smoking and progression of the infectious disease COVID-19.

Methods

PubMed was searched on April 28, 2020, with search terms “smoking”, “smoker*”, “characteristics”, “risk factors”, “outcomes”, and “COVID-19”, “COVID”, “coronavirus”, “sar cov-2”, “sar cov 2”. Studies reporting smoking behavior of COVID-19 patients and progression of disease were selected for the final analysis. The study outcome was progression of COVID-19 among people who already had the disease. A random effects meta-analysis was applied.

Results

We identified 19 peer-reviewed papers with a total of 11,590 COVID-19 patients, 2,133 (18.4%) with severe disease and 731 (6.3%) with a history of smoking. A total of 218 patients with a history of smoking (29.8%) experienced disease progression, compared with 17.6% of non-smoking patients. The meta-analysis showed a significant association between smoking and progression of COVID-19 (OR 1.91, 95% confidence interval [CI] 1.42-2.59, p = 0.001). Limitations in the 19 papers suggest that the actual risk of smoking may be higher.

Conclusions

Smoking is a risk factor for progression of COVID-19, with smokers having higher odds of COVID-19 progression than never smokers.

Implications

Physicians and public health professionals should collect data on smoking as part of clinical management and add smoking cessation to the list of practices to blunt the COVID-19 pandemic.
Partial Melts of Intermediate–Felsic Sources in a Wedged Thickened Crust: Insights from Granites in the Sulu Orogen
Authors: Wu Hongjie , He Yongsheng , Li Shuguang , Zhu Chuanwei , Hou Zhenhui
Published: May 2020

High-pressure (>15 kbar) melts of intermediate–felsic materials have been well studied by experiments, whereas their existence in nature, especially in orogenic belts, is rarely examined. With the aim of identifying and characterizing high-pressure partial melts of intermediate–felsic continental crusts, this study presents comprehensive geochemical and geochronological data for 47 Jurassic granites (166∼157 Ma) from the Sulu orogen. These Sulu Jurassic granites (SJG) consist of quartz, K-feldspar and plagioclase with minor mineral assemblages of biotite ± muscovite ± garnet ± epidote ± allanite. Their low mafic mineral abundance, high SiO2 and Al2O3, and low FeOt + MgO contents show leucogranite-like affinities. They have low Mg#, low Rb/Sr, and mildly peraluminous features, collectively suggesting an intermediate–felsic orthogneissic source. Whole-rock Zr saturation thermometry and Ti-in-zircon thermometry together suggest initial magma temperatures between 695 ± 32 °C and 751 ± 27 °C (1 standard deviation), indicating derivation from water-present melting. The SJG notably feature high Sr contents (average 792 ppm), high Sr/CaO ratios (average 476) as well as inter-correlated low REE concentrations (average ΣREE 87 ppm), low Th concentrations (average 5·1 ppm) and positive Eu anomalies (Eu/Eu* up to 2·94). These characteristics are best explained by partial melting of intermediate–felsic sources under high pressure (>15 kbar), leaving residuum where feldspar is sparse or absent and allanite is present. Inherited zircon age spectra and Sr–Nd–Pb isotopic compositions suggest that their source components could be mainly the Triassic orthogneisses whose protoliths are from the northern margin of the South China Block, probably in a wedge structure where the exhumed felsic slabs were wedged into the crust of the North China Block in the middle–late Jurassic and formed a stacked thickened crust. The wedge structure was most probably driven by synchronous large-scale strike-slip of the Tanlu fault, as a far-field effect of the oblique subduction of the paleo-Pacific plate. The characteristic chemical features observed in this study may be applied to identifying partial melts with similar petrogenesis elsewhere.
Factors Impacting Physical Therapy Utilization for Patients With Nonspecific Low Back Pain: Retrospective Analysis of a Clinical Data Set
Authors: Dolot Janet , Hyland Matthew , Shi Qiuhu , Kim Hae-Young , Viola Deborah , Hoekstra Christopher
Published: May 2020

Objective

Factors predicting physical therapy utilization for lower back pain (LBP) remain unclear, limiting the development of value-based initiatives. The purpose of this study was to identify important factors that impact the number of physical therapist visits per episode of care for US adults with nonspecific LBP.

Methods

This study was a retrospective observational cohort study of a clinical dataset derived from 80 clinics of a single physical therapy provider organization. Research variables were categorized at the individual (patient) level and the organization (therapist, clinic) level. A hierarchical regression model was designed to identify factors influencing the number of physical therapist visits per episode of care.

Results

Higher out-of-pocket payments per visit, receipt of “active” physical therapy, longer average visit length, earlier use of physical therapy, and sex of the therapist (male) were found to predict fewer visits per episode of care. Percent change of function, prior receipt of physical therapy by the same provider organization, self-discharge from physical therapy, level of starting function, and therapist certification were found to predict more visits. Of the variance in number of visits, 8.0% was attributable to the health care organization.

Conclusions

Individual factors, such as higher out-of-pocket payment, have a significant impact on reducing visits per episode of care and should be considered when developing value-based initiatives to optimize clinical and utilization outcomes.

Impact

Payers use consumer-directed healthcare to reduce costs by discouraging utilization of low value services and encouraging use of low-cost providers. LBP is a costly condition for which physical therapy is a high-value treatment. This study shows that non-need factors predict the number of physical therapy visits per episode of care for patients with nonspecific LBP. Insurance benefit plans with lower out-of-pocket payments for physical therapy and higher reimbursement for active physical therapist interventions may facilitate appropriate utilization of high-value treatment for LBP.
Quantitative Trait Loci Associated withRotylenchulusreniformisHost Suitability in Soybean
Authors: Wilkes Juliet , Saski Christopher , Klepadlo Mariola , Fallen Benjamin , Agudelo Paula
Published: May 2020

Reniform nematode (Rotylenchulus reniformis) is a yield-limiting pathogen of soybean (Glycine max) in the southeastern region of the United States. A population of 250 recombinant inbred lines (RIL) (F2:8) developed from a cross between reniform nematode resistant soybean cultivar Forrest and susceptible cultivar Williams 82 was utilized to identify regions associated with host suitability. A genetic linkage map was constructed using single-nucleotide polymorphism markers generated by genotyping-by-sequencing. The phenotype was measured in the RIL population and resistance was characterized using normalized and transformed nematode reproduction indices in an optimal univariate cluster analysis. Quantitative trait loci (QTL) analysis using normalized phenotype scores identified two QTLs on each arm of chromosome 18 (rrn-1 and rrn-2). The same QTL analysis performed with log10(x) transformed phenotype data also identified two QTLs: one on chromosome 18 overlapping the same region in the other analysis (rrn-1), and one on chromosome 11 (rrn-3). While rrn-1 and rrn-3 have been reported associated with reduced reproduction of reniform nematode, this is the first report of the rrn-2 region associated with host suitability to reniform nematode. The resistant parent allele at rrn-2 showed an inverse relationship with the resistance phenotype, correlating with an increase in nematode reproduction or host suitability. Several candidate genes within these regions corresponded with host plant defense systems. Interestingly, a characteristic pathogen resistance gene with a leucine-rich repeat was discovered within rrn-2. These genetic markers can be used by soybean breeders in marker-assisted selection to develop lines with resistance to reniform nematode.
Congenital heart disease in adults (when kids grow up) pediatric geriatric anesthesia
Authors: Motta Pablo , Manrique Ana M. , Partington Sara L. , Ullah Sana , Zabala Luis M.
Published: May 2020

Purpose of review

The current review focuses on the new development of adult congenital heart disease (ACHD) patients in the areas of imaging, percutaneous interventions, ventricular assist devices and transplantation.

Recent findings

Since the last ACHD publication in the journal, several advances have been made in the evaluation and treatment of these patients. As CHD patients’ longevity increases pregnancy, comorbities and acquired heart disease become a concern. Recent data show that the incidence of complications in low-risk CHD is not higher that the regular population. In addition, breakthrough research in percutaneous valve implantation has been published showing good outcomes but needing intensive care recovery in a significant number of patients. In the ACHD heart failure population, assist device and transplant fields mounting evidence shows that these therapies should not be the last resort since low-risk ACHD patient may have similar outcomes to those with acquired heart disease. Finally risk stratification is important in ACHD to define better ways to recover from surgery and anesthesia.

The field of anesthesia for ACHD is growing with new indications for diagnostic, interventional and surgical procedures. Tailoring cardiac and noncardiac care to the different risk profile in ACHD patients will be defined in the next few years.

Video abstract

Motta summary clip: http://links.lww.com/COAN/A65.
Prehabilitation: the anesthesiologist's role and what is the evidence?
Authors: Minnella Enrico Maria , Coca-Martinez Miquel , Carli Francesco
Published: May 2020

Purpose of review

Surgery poses major threats to functional independence. Prehabilitation is a preoperative conditioning intervention that aims to prevent or attenuate surgery-related functional decline and its consequences. The present review is to summarize most recent evidence on the effectiveness of prehabilitation on key topics in cancer care, such as perioperative functional capacity, surgical and oncologic outcomes.

Recent findings

Recent studies predominantly focus on functional outcomes, demonstrating a positive effect of prehabilitation on perioperative physical fitness.

Prehabilitation prevents functional decline associated with major cancer surgery. Evidence is still needed to support its effectiveness in relation to postoperative complication, length of hospital stay, tumor progression, response to medical treatment, and survival. Ongoing and future research is essential to prompt the role of perioperative medicine in cancer care.
Perioperative Precision Medicine: Where Are We in 2020?
Authors: Pal Nirvik , Kertai Miklos D.
Published: May 2020

Purpose of review

The present review examines how targeted approaches to care, based on individual variability in patient characteristics, could be applied in the perioperative setting. Such an approach would enhance individualized risk assessment and allow for targeted preventive and therapeutic decision-making in patients at increased risk for adverse perioperative events.

Recent findings

Prior and current studies highlight valuable lessons on how future investigations attempting to link specific patient-related characteristics or treatment modalities with outcomes and adverse drug responses might be designed in the perioperative setting.

Our review highlights the past, present, and future directions of perioperative precision medicine. Current evidence provides important lessons on how a specific patient and disease tailored approach can help perioperative physicians in delivering the most appropriate and safest perioperative care.
The opioid epidemic in pediatrics: a 2020 update
Authors: Yaster Myron , McNaull Peggy P. , Davis Peter J.
Published: May 2020

Purpose of review

Over the last 3 years and for the first time in 60 years, life expectancy in the United States has declined across all racial groups primarily because of drug overdoses, alcohol abuse, and suicide. A public health response to the opioid crisis must expand its focus to more broadly include children, adolescents, and young adults while increasing efforts toward preventing new cases of opioid addiction, early identification of individuals with opioid-abuse disorder, and ensuring access to effective opioid addiction treatment, while simultaneously continuing to safely meet the needs of patients experiencing pain.

Recent findings

Although a multimodal approach to pain management is fundamental in current practice, opioids remain an essential building block in the management of acute and chronic pain and have been for over 5000 years as they work. Left over, unconsumed opioids that were appropriately prescribed for pain have become the gateway for the development of opioid use disorder, particularly in the vulnerable adolescents and young adult patient populations. How to reduce the amount of opioids dispensed, improve methods of disposal in an environmentally safe way, and proactively make naloxone, particularly nasal spray, readily available to patients (and their families) receiving prescription opioids or who are at risk of opioid use disorder are highlighted in this review.

We describe the historical use of opioids and the scope of the current opioid crisis, review the differences between dependence and addiction, and the private and public sectors response to pain management and highlight the issue of adolescent vulnerability. We conclude with a proposal for future directions that address both public and patient health needs.
Updates in periprocedural management of direct oral anticoagulants
Authors: Tao Jing , Oprea Adriana D.
Published: May 2020

Purpose of review

As the prevalence of patients on antithrombotics is increasing, anesthesiologists must have a firm understanding of these medications and considerations for their periprocedural management. This review details up-to-date periprocedural management of direct oral anticoagulants (DOACs).

Recent findings

DOACs have favorable pharmacokinetics including quick onset of action and short half-lives. Periprocedural management of DOACs relies heavily on drug half-life as well as procedural risk of bleeding. Other than a few exceptions, the American College of Cardiologists generally recommends complete clearance of oral anticoagulants prior to high-risk bleeding procedures and partial clearance prior to low-risk bleeding procedures. Procedures with little to no clinical risk of bleeding can be performed without any drug interruption or during trough levels. Exceptions to periprocedural DOAC management pertain to electrophysiology procedures.

With the exception of no clinically relevant bleeding risk or certain electrophysiology procedures, DOACs should be discontinued periprocedurally in accordance with bleeding risks and drug's half-life. Bridging is generally not recommended for DOACs.
Perioperative management of antiplatelet therapy in noncardiac surgery
Authors: Filipescu Daniela C. , Stefan Mihai G. , Valeanu Liana , Popescu Wanda M.
Published: May 2020

Purpose of review

Perioperative management of antiplatelet agents (APAs) in the setting of noncardiac surgery is a controversial topic of balancing bleeding versus thrombotic risks.

Recent findings

Recent data do not support a clear association between continuation or discontinuation of APAs and rates of ischemic events, bleeding complications, and mortality up to 6 months after surgery. Clinical factors, such as indication and urgency of the operation, time since stent placement, invasiveness of the procedure, preoperative cardiac optimization, underlying functional status, as well as perioperative control of supply–demand mismatch and bleeding may be more responsible for adverse outcome than antiplatelet management.

Perioperative management of antiplatelet therapy (APT) should be individually tailored based on consensus among the anesthesiologist, cardiologist, surgeon, and patient to minimize both ischemic/thrombotic and bleeding risks. Where possible, surgery should be delayed for a minimum of 1 month but ideally for 3–6 months from the index cardiac event. If bleeding risk is acceptable, dual APT (DAPT) should be continued perioperatively; otherwise P2Y12 inhibitor therapy should be discontinued for the minimum amount of time possible and aspirin monotherapy continued. If bleeding risk is prohibitive, both aspirin and P2Y12 inhibitor therapy should be interrupted and bridging therapy may be considered in patients with high thrombotic risk.
Changing practice patterns: the impact of a cost analysis project on surgeons’ preference for treatment of pediatric displaced humeral lateral condyle fractures
Authors: Cohen Lara L. , Glotzbecker Michael P. , Miller Patricia E. , Waters Peter M. , Bae Donald S. , Shore Benjamin J.
Published: May 2020

A 2012 publication regarding the surgical management of pediatric lateral humeral condyle fractures (PLHCF) found that leaving pins exposed produced an average savings of $3442 per patient compared to burying pins, with fewer complications. The primary objective of this present study was to determine the impact of this cost analysis on surgeons’ treatment preferences at the same hospital. The secondary aim was to verify that leaving pins exposed continued to be a cost-effective and safe treatment strategy. We reviewed all PLHCF treated with open reduction and internal fixation at our institution between 2004 and 2017. The Clavien–Dindo Classification was used to grade complications. Variations in treatment course were evaluated using a chi-squared test to compare the proportions of buried and exposed pins, pre- and postcost analysis report publication. Two hundred forty-eight patients were included. The mean age was 5.9 years (range 1–12 years). In 174 (70%) cases, the pins were buried and in the remaining 30% the pins were exposed. Between 2004 and 2012, the majority of pins were buried (90%) compared to between 2013 and 2017, when the majority of pins were exposed (62%) (P < 0.001). There was no difference detected in complication rate (P = 0.75) or complication severity (P = 0.61) across groups. The demonstrated cost-effectiveness of exposing the pins in the treatment of PLHCF has had a statistically significant impact on surgeon behavior at our institution. Publishing cost analysis research can change physician practice to improve quality, safety and value of care delivery.
Lateral Brain Displacement and Cerebral Autoregulation in Acutely Comatose Patients
Authors: Adatia Krishma , Geocadin Romergryko G. , Healy Ryan , Ziai Wendy , Ponce-Mejia Luciano , Anderson-White Mirinda , Shah Dhaval , Radzik Batya R. , Palmisano Caitlin , Hogue Charles W. , Brown Charles , Suarez Jose I. , Rivera-Lara Lucia
Published: May 2020

Objectives:

Lateral displacement and impaired cerebral autoregulation are associated with worse outcomes following acute brain injury, but their effect on long-term clinical outcomes remains unclear. We assessed the relationship between lateral displacement, disturbances to cerebral autoregulation, and clinical outcomes in acutely comatose patients.

Design:

Retrospective analysis of prospectively collected data.

Setting:

Neurocritical care unit of the Johns Hopkins Hospital.

Patients:

Acutely comatose patients (Glasgow Coma Score ≤ 8).

Interventions:

None.

Measurements and Main Results:

Cerebral oximetry index, derived from near-infrared spectroscopy multimodal monitoring, was used to evaluate cerebral autoregulation. Associations between lateral brain displacement, global cerebral autoregulation, and interhemispheric cerebral autoregulation asymmetry were assessed using mixed random effects models with random intercept. Patients were grouped by functional outcome, determined by the modified Rankin Scale. Associations between outcome group, lateral displacement, and cerebral oximetry index were assessed using multivariate linear regression. Increasing lateral brain displacement was associated with worsening global cerebral autoregulation (p = 0.01 septum; p = 0.05 pineal) and cerebral autoregulation asymmetry (both p < 0.001). Maximum lateral displacement during the first 3 days of coma was significantly different between functional outcome groups at hospital discharge (p = 0.019 pineal; p = 0.008 septum), 3 months (p = 0.026; p = 0.007), 6 months (p = 0.018; p = 0.010), and 12 months (p = 0.022; p = 0.012). Global cerebral oximetry index was associated with functional outcomes at 3 months (p = 0.019) and 6 months (p = 0.013).

Conclusions:

During the first 3 days of acute coma, increasing lateral brain displacement is associated with worsening global cerebral autoregulation and cerebral autoregulation asymmetry, and poor long-term clinical outcomes in acutely comatose patients. The impact of acute interventions on outcome needs to be explored.
Financial Toxicity After Acute Respiratory Distress Syndrome: A National Qualitative Cohort Study*
Authors: Hauschildt Katrina E. , Seigworth Claire , Kamphuis Lee A. , Hough Catherine L. , Moss Marc , McPeake Joanne M. , Iwashyna Theodore J. ,   for the National Heart, Lung, and Blood Institute (NHLBI) Prevention and Early Treatment of Acute Lung Injury (PETAL) Network
Published: May 2020

Objectives:

The financial burdens and subsequent related distress of medical care, referred to as financial toxicity, may limit access to beneficial treatments. However, financial toxicity after acute care is less described—and may be an important but underexplored mechanism preventing full recovery after critical illnesses such as acute respiratory distress syndrome. We sought to identify the mechanisms by which financial toxicity manifested in patients with acute respiratory distress syndrome, protective factors against such toxicity, and the consequences of financial toxicity to survivors’ lives following acute respiratory distress syndrome.

Design:

We conducted semistructured interviews following patients’ hospitalization and during recovery as an ancillary study to a multicenter randomized clinical trial in acute respiratory distress syndrome. Patients were 9–16 months post randomization at the time of interview.

Setting and Participants:

The Reevaluation Of Systemic Early Neuromuscular Blockade trial examined the use of early neuromuscular blockade in mechanically ventilated patients with moderate/severe acute respiratory distress syndrome. We recruited consecutive surviving patients who were English speaking, consented to follow-up, and were randomized between December 11, 2017, and May 4, 2018 (n = 79) from 29 U.S. sites.

Measurements and Main Results:

We asked about patients’ perceptions of financial burden(s) that they associated with their acute respiratory distress syndrome hospitalization. Forty-six of 79 eligible acute respiratory distress syndrome survivors (58%) participated (from 22 sites); their median age was 56 (interquartile range 47–62). Thirty-one of 46 reported at least one acute respiratory distress syndrome-related financial impact. Financial toxicity manifested via medical bills, changes in insurance coverage, and loss of employment income. Respondents reported not working prior to acute respiratory distress syndrome, using Medicaid or Medicare, or, conversely, generous work benefits as factors which may have limited financial burdens. Patients reported multiple consequences of acute respiratory distress syndrome–related financial toxicity, including harms to their mental and physical health, increased reliance on others, and specific material hardships.

Conclusions:

Financial toxicity related to critical illness is common and may limit patients’ emotional, physical, and social recovery after acute respiratory distress syndrome hospitalization for at least a year.
Effects of intra-operative positive end-expiratory pressure setting guided by oesophageal pressure measurement on oxygenation and respiratory mechanics during laparoscopic gynaecological surgery
Authors: Piriyapatsom Annop , Phetkampang Sanchai
Published: May 2020

BACKGROUND

The creation of pneumoperitoneum during laparoscopic surgery can lead to adverse effects on the respiratory system. Positive end-expiratory pressure (PEEP) plays an important role in mechanical ventilation during laparoscopic surgery.

OBJECTIVE

To evaluate whether PEEP setting guided by oesophageal pressure (P
oeso) measurement would affect oxygenation and respiratory mechanics during laparoscopic gynaecological surgery.

DESIGN

A randomised controlled study.

SETTING

A single-centre trial from March 2018 to June 2018.

PATIENTS

Forty-four adult patients undergoing laparoscopic gynaecological surgery with anticipated duration of surgery more than 2 h.

INTERVENTION

PEEP set according to P
oeso measurement (intervention group) versus PEEP constantly set at 5 cmH2O (control group).

MAIN OUTCOME MEASURES

Gas exchange and respiratory mechanics after induction and intubation (T0) and at 15 and 60 min after initiation of pneumoperitoneum (T1 and T2, respectively).

RESULTS

PEEP during pneumoperitoneum was significantly higher in the intervention group than in the control group (T1, 12.5 ± 1.9 vs. 5.0 ± 0.0 cmH2O and T2, 12.4 ± 1.9 vs. 5.0 ± 0.0 cmH2O, both P < 0.001). Partial pressures of oxygen decreased significantly from baseline during pneumoperitoneum in the control group but not in the intervention group. Nevertheless, the changes in partial pressures of oxygen did not differ between groups. Compliance of the respiratory system (C
RS) significantly decreased and driving pressure significantly increased during pneumoperitoneum in both groups. However, the changes in C
RS and driving pressure were significantly less in the intervention group. Transpulmonary pressure during expiration was maintained in the intervention group while it decreased significantly in the control group.

CONCLUSION

PEEP setting guided by P
oeso measurement showed no beneficial effects in terms of oxygenation but respiratory mechanics were better during laparoscopic gynaecological surgery.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03256396.
Very early changes in serum creatinine are associated with 30-day mortality after cardiac surgery
Authors: Bernardi Martin H. , Ristl Robin , Neugebauer Thomas , Hiesmayr Michael J. , Druml Wilfred , Lassnigg Andrea
Published: May 2020

BACKGROUND

Acute kidney injury predicts adverse outcomes after cardiac surgery.

OBJECTIVES

To determine whether ultra-short-term changes (within 120 min) in serum creatinine (SCrea) levels after cardiac surgery predict clinical outcomes (30-day mortality).

DESIGN

Observational cohort study.

SETTING

Austrian tertiary referral centre.

PATIENTS

A total of 7651 patients scheduled to undergo elective cardiac surgery.

MAIN OUTCOME MEASURES

We analysed SCrea levels measured pre-operatively (baseline) and within 120 min after surgery. We also adjusted the postoperative SCrea levels for fluid balance. Patients were grouped according to the difference between the pre and postoperative SCrea levels (ΔSCreaAdmICU). We performed univariable and multivariable analyses to determine the association between changes in SCrea levels and 30-day mortality.

RESULTS

After cardiac surgery, the SCrea level decreased in 5923 patients and increased in 1728 patients. Increased SCrea levels were associated with a 21% increase in 30-day mortality. Even minimal increases in SCrea (0 to <26.5 μmol l−1) were significantly associated with 30-day mortality [hazard ratio (HR), 1.98; 95% confidence interval (CI), 1.54 to 2.55; P < 0.001]. Adjustments for fluid balance strengthened the above association (increases of 0 to <26.5 μmol l−1: HR, 1.78; 95% CI, 1.40 to 2.26; P < 0.001; increases of at least 26.5 μmol l−1: HR, 2.40; 95% CI, 1.68 to 3.42; P < 0.001).

CONCLUSION

Even minimal, ultra-short-term increases in SCrea levels after cardiac surgery are associated with increased 30-day mortality. Adjustment for fluid balance strengthens this association. The change in SCrea between baseline and after admission to the Intensive Care Unit (ΔSCreaAdmICU) can serve as a simple, cheap and widely available marker for very early risk stratification after cardiac surgery.
Erroneous neuraxial administration of neuromuscular blocking drugs
Authors: Patel Santosh
Published: May 2020

BACKGROUND

Drug errors during neuraxial anaesthesia or analgesia are not well known.

OBJECTIVES

To review the clinical consequences associated with incorrect administration of neuromuscular blocking drugs (NMBDs) during spinal or epidural anaesthesia, and to investigate human factors and strategies available to help prevent such errors.

DESIGN

A review of reports of neuraxial administration of NMBDs in humans.

DATA SOURCES

Published reports of errors involving NMBDs. We searched the period between 1965 and 2019.

ELIGIBILITY CRITERIA

Error reports in any language. Nonneuraxial drug errors were excluded.

RESULTS

We identified 20 reports involving seven different NMBDs inadvertently administered via the epidural or intrathecal routes. All patients developed systemic neuromuscular junction blockade. Fourteen errors occurred while patients were awake. The onset of action was delayed following epidural rocuronium and suxamethonium. The duration of action was prolonged following epidural administration of vecuronium, pancuronium, cisatracrium and suxamethonium. Five patients required emergency airway interventions. Intrethecal gallamine caused convulsions and muscle spasms migrating up the body. Syringe swap was the primary cause for the majority of errors and perceptual errors were the most common. Implementation of recommendations could have prevented the errors.

CONCLUSION

Following the epidural injection of NMBDs the effects are delayed and prolonged. There was no serious morbidity reported following neuraxial administration of the NMBDs used in current practice. Perceptual errors resulting in incorrect syringe choice were the commonest cause. Four measures can be introduced to reduce such errors.
Effects of KCNMB2 gene polymorphisms on ritodrine therapy outcomes in women with preterm labor
Authors: Yoon Ha Young , Park Jin Young , Yee Jeong , Hwang Han Sung , Chung Jee Eun , Lee Kyung Eun , Kim Young Ju , Gwak Hye Sun
Published: May 2020

Objective

The present prospective follow-up study aimed to evaluate the effects of KCNMB2 gene polymorphisms on ritodrine efficacy and adverse drug events (ADEs) in patients with preterm labor.

Methods

A total of 163 preterm labor patients were included in this single-center study. Nine single nucleotide polymorphisms (SNPs) in the KCNMB2 gene (rs10936979, rs7624046, rs7429015, rs7625907, rs6443559, rs9839376, rs9637454, rs11918114, and rs1382045) were assessed. The primary endpoint was time to delivery, and the secondary endpoint was ritodrine-induced ADEs.

Results

Patients with variant homozygotes of two SNPs (rs7624046 and rs9839376), which were in linkage disequilibrium, showed 2.06 [95% confidence interval (CI), 1.14–3.73] and 2.68 (95% CI, 1.16–6.20) times the hazard of time to delivery compared to wild-type allele carriers, respectively. Among demographic characteristics, gestational age at start of drug therapy and modified Bishop score were significant factors for time to delivery. Regarding safety outcomes, patients with variant homozygotes of rs7625907 had fewer ADEs compared to those with other genotypes (odds ratio, 0.32; 95% CI, 0.13–0.83).

Conclusion

This pharmacogenomic study suggests that ritodrine efficacy and ADEs are associated with KCNMB2 gene polymorphisms in patients with preterm labor.
Associations between carotid-femoral and heart-femoral pulse wave velocity in older adults: the Atherosclerosis Risk In Communities study
Authors: Stoner Lee , Meyer Michelle L. , Kucharska-Newton Anna , Stone Keeron , Zieff Gabriel , Dave Gaurav , Fryer Simon , Credeur Daniel , Faulkner James , Matsushita Kunihiro , Hughes Timothy M. , Tanaka Hirofumi
Published: May 2020

Background:

Carotid-femoral pulse wave velocity (cfPWV) is widely used in epidemiological studies to assess central arterial stiffness. However, despite being superior to traditional risk factors in predicting cardiovascular outcomes, cfPWV is not routinely used in clinical practice. cfPWV assessments require applanation of the carotid artery, which can be cumbersome, and individual-level factors, including carotid artery plaque, may confound the measurements. Heart-femoral PWV (hfPWV) may be a suitable alternative measure of central arterial stiffness.

Objectives:

The aim of this study was to estimate the strength of the agreement between hfPWV and cfPWV.

Methods:

We evaluated 4133 older-aged [75.2 (5.0) years] African–American and white adults in the community-based Atherosclerosis Risk in Communities (ARIC) Study. cfPWV and hfPWV were measured using an automated cardiovascular screening device. Agreement between the two measurements was determined using Pearson's correlation coefficient (r), standard error of estimate (SEE) and Bland–Altman analysis.

Results:

There was a strong (r > 0.7) agreement between hfPWV and cfPWV (r = 0.83, 95% CI: 0.82–0.84). Although the mean cfPWV [11.5 m/s (SD: 3.0)] and hfPWV [11.5 m/s (SD: 2.3)] were comparable, the SEE was 1.7 m/s. Inspection of the Bland–Altman plot revealed greater variability and bias for higher PWV values, with higher PWV further away from the regression line.

Discussion:

Findings suggest good agreement between hfPWV and cfPWV. hfPWV is a simpler alternative to cfPWV that is less likely to be confounded by individual-level factors. Considering the greater variability for higher PWV values, further work is warranted to determine the importance of local artery mechanics to both measures.
Additional CTA-Subtraction Technique in Detection of Pulmonary Embolism—a Benefit for Patients or Only an Increase in Dose?
Authors: Nestler Kai , Becker Benjamin Valentin , Majewski Matthäus , Veit Daniel Anton , Krull Bastian Felix , Waldeck Stephan
Published: May 2020

Latest advantages in computed tomography (CT) come with enhanced diagnostic imaging and also sophisticated dose reduction techniques. However, overall exposure to ionizing radiation of patients in Germany rises slightly, which is mainly based on the growing number of performed CT scans. Furthermore, new possibilities in modern imaging, including 4D scans or perfusion protocols, offer new medical insights but require additional scans.

In this study, we reevaluated data sets from patients undergoing CT examinations because of suspected pulmonary embolism and compared doses and diagnostic results of the standard protocol to the additional modern CT subtraction technique. Two groups of single-blinded radiologists were provided with CT data sets from 50 patients. One group (G1) had access to full datasets including CT subtraction with perfusion map. The other group (G2) only evaluated conventional CT angiography. Results were compared to final clinical diagnosis. Dose length product (DLP) of CT angiography was compared to CT subtraction technique, which consists of an additional non-contrast-enhanced scan and perfusion map. Effective dose was calculated using a Monte Carlo simulation-based software tool (ImpactDose). Inter-rater agreement of both groups was strong in G1 with κ = .896 and minimal in G2 (κ = .307). Agreement to final diagnosis was strong in both groups (G1, κ = .848; G2, κ = .767). Doses applied using the CT subtraction technique were 34.8% higher than for CT angiography alone (G1 DLP 337.6 ± 171.3 mGy x cm; G2 DLP 220.2 ± 192.8 mGy x cm; p < .001). Calculated effective dose was therefore significantly higher for G1 (G1 4.82 ± 2.20 mSv; G2 3.04 ± 1.33 mSv; p < .001). Our results indicate a benefit of the CT subtraction technique for the detection of pulmonary embolisms in clinical routine, accompanied by an increase in the dose administered. Although CT protocols should always be applied carefully to specific clinical indications in order to maximize the potential for dose reduction and keep the administered dose as low as reasonably achievable, one should never lose sight of the diagnostic benefit, especially in vital clinical indications.
Comparison of in-hospital and out-of-hospital cardiac arrest patients receiving targeted temperature management: A matched case-control study
Authors: Chen Chung-Ting , Chen Cheng-Han , Chen Tzu-Yin , Yen David Hung-Tsang , How Chorng-Kuang , Hou Peter Chuanyi
Published: May 2020

Background:

Evidences that support the use of targeted temperature management (TTM) for in-hospital cardiac arrest (IHCA) are lacking. We aimed to investigate the hypothesis that TTM benefits for patients with IHCA are similar to those with out-of-hospital cardiac arrest (OHCA) and to determine the independent predictors of resuscitation outcomes in patients with cardiac arrest receiving subsequent TTM.

Methods:

This is a retrospective, matched, case-control study (ratio 1:1) including 93 patients with IHCA treated with TTM after the return of spontaneous circulation, who were admitted to Partners HealthCare system in Boston from January 2011 to December 2018. Controls were defined as the same number of patients with OHCA, matched for age, Charlson score, and sex. Survival and neurological outcomes upon discharge were the primary outcome measures.

Results:

Patients with IHCA were more likely to have experienced a witnessed arrest and receive bystander cardiopulmonary resuscitation, a larger total dosage of epinephrine, and extracorporeal membrane oxygenation. The time duration for ROSC was shorter in patients with IHCA than in those with OHCA. The IHCA group was more likely associated with mild thrombocytopenia during TTM than the OHCA group. Survival after discharge and favorable neurological outcomes did not differ between the two groups. Among all patients who had cardiac arrest treated with TTM, the initial shockable rhythm, time to ROSC, and medical history of heart failure were independent outcome predictors for survival to hospital discharge. The only factor to predict favorable neurological outcomes at discharge was initial shockable rhythm.

Conclusion:

The beneficial effects of TTM in eligible patients with IHCA were similar with those with OHCA. Initial shockable rhythm was the only independent predictor of both survival and favorable neurological outcomes at discharge in all cardiac arrest survivors receiving TTM.
Trauma Nurses' Experience With Decontamination: Opportunities for Improvement
Authors: Schieman Karen , Cowles Alaina , Hoeve Melanie
Published: May 2020

Trauma patients are unique in their potential for exposure to dangerous chemicals or material, placing staff in the emergency department (ED) or trauma unit at risk for exposure themselves. The purpose of this study was to describe one centers' trauma nursing experience with decontamination and to identify opportunities for improvement. This was a cross-sectional descriptive study of decontamination practices using an anonymous online survey of trauma nurses at a single Midwestern verified Level I trauma center and burn center. A total of 82 nurses completed the survey with a 48% response rate. Overall, 57% reported having had some previous decontamination training, with ED and air transport nurse's training, knowledge, and comfort level reported as the highest and inpatient trauma nurses the lowest. A significant association was found between ED nurses and feeling the surest about their safety when caring for exposed patients (χ2 = 19.908, p = .018) and between hazardous materials training and receiving communication about the patient's decontamination procedures during care (χ2 = 8.879, p = .031). Our results show that trauma nurse decontamination training and communication, as well as confidence in knowledge and safety, vary by nursing unit. The relatively low-volume high-risk scenario of trauma decontaminations likely contributes to inpatient nurses reporting of inadequate preparedness. This requires administrative commitment to ensure that all trauma nurses receive decontamination training in orientation, as well as ongoing continuing education, skill competency checks, and simulation training. Decontaminate communication is an essential requirement of all ED trauma team handoffs and medical record documentation.
Timely Venous Thromboembolism Prophylaxis in Trauma: A Team Approach to Process Improvement
Authors: Farrell Loretta , Romeo Oreste , Johnson Ruth
Published: May 2020

Venous thromboembolism is a significant complication in trauma. Multisystem injury, advancing age, surgery, and blood transfusion all contribute to the risk of venous thromboembolism in trauma patients. Our Level I trauma center was identified as an outlier with compliance in timely venous thromboembolism prophylaxis in the Michigan Trauma Quality Improvement Program, a statewide collaborative for improving trauma care. The purpose of this study was to provide an evaluation of a performance improvement project to increase the timely administration of venous thromboembolism prophylaxis in admitted trauma patients. Using a Plan-Do-Study-Act method of quality improvement, we initiated a focused, goal-directed team approach that emphasized education, tracking, and feedback. This approach resulted in improved and sustained compliance rates. Resolute focus, audit, and feedback moved our center from a low- to high-performing center for timely venous thromboembolism prophylaxis.