bluuebunny/crossref_metadata_2025 huggingface dataset:
Trade Union Responses to Ageing Workplaces: Lessons from the UK
Authors: Ball Chris , Flynn Matt
Published: December 2020

In 2017, European-level unions and business associations agreed a framework for national and workplace level employers and union representatives to take collaborative action to design workforce responses to demographic ageing. This article discusses how unions are responding to pressures to extend working life in the UK. Drawing on industrial relations and social movement literature, it argues that unions pursue the twin strategies of working in partnership with like-minded employers to reorient workplaces towards an age friendly model while organizing and campaigning with members to secure conditions consistent with active and healthy ageing. Resisting an erosion of pension and retirement rights and extending employment protection are examples of this approach, but numerous lower profile initiatives by workplace representatives are also reflective of their having an age friendly agenda. Using qualitative data from focus group discussions with union representatives in two sectors, the article shows that union responses are rooted in both of the dominant models of British unionism—the organizing and partnership models—and argues that literature on social movements helps to understand how union representatives reconcile the competing pressures.
Radiation‐induced endothelial dysfunction markers are differentially modulated by simulated microgravity
Authors: Chowdhury Parimal , Bachri Abdel , Hauer‐Jensen Martin , Pathak Rupak
Published: December 2020

Exposure to ionizing radiation (IR) and microgravity induce greater risks to human space mission. Ground‐based studies on animals and cells have shown that both IR and microgravity cause numerous adverse effects on endothelial cells, which may lead to endothelial dysfunction. However, no systematic studies have been undertaken to investigate whether microgravity differentially modulates the expression of endothelial cell dysfunction markers when exposed either alone or in combination with irradiation. This study was conducted to gain insight into human endothelial cells when subjected to simulated microgravity followed by exposure to IR.

Methods

Endothelial cells were grown on micro‐carrier beads to simulate a low shear microgravity environment and subsequently subjected to a rotary culture systems, called high aspect ratio vessels (HARVs) at 10 rpm. The expression of endothelial dysfunction markers were measured by quantitative real‐time PCR.

Results

Exposure to microgravity environment induced morphological changes in endothelial cells and enhanced radiation‐induced endothelial cell killing. In addition, IR plus microgravity caused differential expression of E‐selectin, Pecam1, Vcam1, Vegf, and Icam1 as compared to IR exposure alone.

Conclusions

These results suggest that microgravity modifies the effect of IR on endothelial cells.

Support or Funding Information

Supported by NASA sponsored Arkansas Space Grant Consortium

This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Eat, Sleep, Console and Adjunctive Buprenorphine Improved Outcomes in Neonatal Opioid Withdrawal Syndrome
Authors: Hein Sarrah , Clouser Barbara , Tamim Mohammed M. , Lockett Diane , Brauer Kathleen , Cooper Linda
Published: December 2020

Background:

The worsening opioid crisis has increased the number of infants exposed to maternal opioids. Standard treatment of newborns exposed to opioids prenatally often requires prolonged hospitalization and separation of the mother–infant dyad. These practices can potentially increase severity of withdrawal symptoms, interrupt breastfeeding, and disturb mother–infant bonding. Use of the Eat, Sleep, Console (ESC) model may ameliorate symptoms, decrease mother–infant separation, and decrease hospital length of stay.

Purpose:

To manage opioid exposed infants in a more holistic manner to decrease neonatal intensive care unit (NICU) admissions, reduce the need for pharmacotherapy, and evaluate response and total length of treatment after a unit protocol change from morphine to buprenorphine.

Methods:

Implemented ESC model, optimized nonpharmacologic bundle, and prescribed buprenorphine therapy instead of morphine as needed for adjunctive therapy.

Results:

Admissions of opioid-exposed infants from the Mother–Baby Unit (MBU) to the NICU decreased by 22%, and the number of infants who required pharmacotherapy was reduced by 50%. The average length of pharmacotherapy fell from 14 to 6.5 days.

Implications for Practice:

The successful implementation of the ESC model helped keep the mother–infant dyad together, reduced admissions to the NICU, and lessened the need for pharmacotherapy. The change to buprenorphine further reduced our average length of treatment.

Implications for Research:

Investigation of monotherapy with buprenorphine needs to be evaluated as a valid treatment option. The buprenorphine dosing and weaning chart will need to be revised and modified if indicated.
Cell-based immunotherapy in gynecologic malignancies
Authors: Kamat Kalika , Krishnan Venkatesh , Berek Jonathan S. , Dorigo Oliver
Published: December 2020

Purpose of review

To provide an update on cell-based immunotherapies in solid tumors particularly in gynecological cancers.

Recent findings

Recent clinical trial results demonstrate safety and tolerability of different cell therapies in gynecological cancers. Novel approaches, such as harnessing the cells of the innate immune system are also under investigation in a phase I trial.

Cell-based therapies are gaining widespread attention as evidenced by the increasing number of clinical trials encompassing both, innate and adaptive cells to target gynecological cancers. A majority of these therapeutic approaches are well tolerated and show promising results in early trials.
Identification of a New Genetic Mutation Associated With Peters Anomaly
Authors: Faber Hanna , Puk Oliver , Holz Anja , Biskup Saskia , Voykov Bogomil
Published: December 2020

Purpose:

To report a new genetic mutation in the COL4A1 gene, which was identified in a baby girl with Peters anomaly (PA), a rare anterior segment mesenchymal dysgenesis, which is characterized by unilateral or bilateral corneal opacities often accompanied by glaucoma, cataract, and systemic malformations and associated with various genetic mutations.

Methods:

Ophthalmologic examination of one baby girl and whole exome sequencing and Sanger sequencing of blood samples of the child and her biological parents were performed.

Results:

Ophthalmologic examination led to the diagnosis of PA type I in the baby girl. Whole exome sequencing and Sanger sequencing identified the de novo mutation c.181_189delinsAGGTTTCCG; p.Gly61Arg in the COL4A1 gene in the child, whereas no other putatively causative variants in established genes associated with anterior segment dysgenesis were present.

Conclusions:

PA might be associated with the mutation c.181_189delinsAGGTTTCCG; p.Gly61Arg in the COL4A1 gene. The COL4A1 gene encodes for collagen IVα1, an essential component of basal membranes, and mutations are associated with an increased risk for renal and cerebrovascular disorders and stroke. This should be considered when advising and monitoring patients.
Persistence of Hepatitis B Immune Memory Until 6 Years of Age Following Hexavalent DTaP-IPV-HB-PRP~T Vaccination in a 3-, 5- and 11- to 12-month Schedule and Response to a Subsequent Hepatitis B Challenge Vaccination
Authors: Virta Miia , Soininen Anu , Patel Dhaval M. , Petit Céline , Tabar Cynthia , Lyabis Olga
Published: December 2020

Anti-hepatitis B (HBs) antibody persistence and hepatitis B challenge were evaluated at 6 years of age following vaccination of fully liquid DTaP-IPV-HB-PRP~T or reconstituted DTaP-IPV-HB//PRP~T at 3, 5, 11–12 months of age. At 6 years, 53.8% and 73.5% had seroprotective anti-HBs antibodies (≥10 mIU/mL), increasing to 96.7% and 95.9% postchallenge, confirming a strong anamnestic response in primed vaccinees.
Diagnostic assays for COVID-19: a narrative review
Authors: Zhang Liding , Liang Xiaohan , Li Yanqing , Zheng Hua , Qu Wensheng , Wang Baofeng , Luo Haiming
Published: December 2020

Coronavirus disease 2019 (COVID-19) is a newly emerged infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of COVID-19 cases is continuously increasing and no effective drugs or vaccines are currently available. Accurate and efficient diagnostic testing methods are desperately needed for the detection of SARS-CoV-2 and antiviral antibodies in infected individuals. Various assay techniques, including nucleic acid tests [eg, polymerase chain reaction (PCR), reverse transcription-PCR, real-time loop-mediated isothermal amplification, and CRISPR-Cas-based detection], serological tests [eg, immunoglobulin (Ig)A, IgM/G], imaging tests (eg, computed tomography and positron-emission tomography), and nanoparticle-based detections have been reported for COVID-19 diagnosis. This review aims to present the current diagnostic tools for SARS-CoV-2 and their performance characteristics to inform the appropriate selection of diagnostic and surveillance technologies at optimal testing times. We also describe the advantages of detection using combined nucleic acid and imaging tests, or serological testing and point-of-care diagnostics. Developing reliable protein biomarkers targeting the conserved proteins of SARS-CoV-2 rather than IgA, IgM, or IgG would be useful to manage SARS-CoV-2.
Early or delayed parenteral nutrition for infants: what evidence is available?
Authors: Moon Kwi , Rao Shripada C.
Published: December 2020

Purpose of review

To review the current evidence evaluating early versus delayed commencement of parenteral nutrition in infants.

Recent findings

Recent studies in very premature infants (<32 weeks gestation) have shown that early commencement of parenteral nutrition immediately after birth improves physical growth. However, there are concerns that early use of very high dose of amino-acids (>3.5 g/kg/day immediately after birth) may cause metabolic acidosis, elevated blood urea, slower head growth and refeeding-hypophosphatemia syndrome. A recent multicentre randomized controlled trial found that commencement of parenteral nutrition within 24-h of admission increases the risk of infections and prolongs the duration of ventilation and ICU stay in full-term neonates, older infants and children. The study also found that delaying to day 8 of admission increased the risk of hypoglycaemia.

Benefits of commencing parenteral nutrition on the first day of life appear to outweigh risks in very premature infants; however, it is prudent to avoid early very high doses of amino acids (>3.5 g/kg/day) in the first few days of life. In moderate to late preterm infants, if enteral feeds are not tolerated by 72 h, it is reasonable to commence parenteral nutrition. In full-term and older infants, it is preferable to avoid parenteral nutrition within 24 h of admission and consider delaying by further few days. Diligent monitoring of blood glucose, serum phosphate and other parameters is essential while on parenteral nutrition.
Best practice for treating dyslipidaemia in patients with diabetes based on current international guidelines
Authors: Lan Nick S.R. , Burns Kharis , Bell Damon A. , Watts Gerald F.
Published: December 2020

Purpose of review

Dyslipidaemia is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD) in type 2 diabetes. We provide an in-context overview of recent trials of lipid-lowering pharmacotherapies and of recommendations from international guidelines for managing dyslipidaemia in patients with diabetes.

Recent findings

Clinical trials have demonstrated that patients with diabetes derive greater benefits from ezetimibe and proprotein convertase subtilisin–kexin type 9 inhibitors owing to the higher absolute ASCVD risk compared with patients without diabetes. Pure eicosapentaenoic acid ethyl ester therapy should be considered in high risk patients with diabetes and hypertriglyceridaemia who have well controlled low-density lipoprotein cholesterol on statin therapy. International guidelines from USA, Canada and Europe have been updated to support a more intensive approach to treating dyslipidaemia in diabetes.

Dyslipidaemia should be identified and treated intensively as part of overall diabetes management to reduce ASCVD risk. Although lifestyle modifications and statin therapy remain the cornerstone of management, add-on therapies should be strongly considered depending on the absolute risk of ASCVD and the degree of dyslipidaemia.
Coronavirus disease 2019 and type 1 diabetes mellitus
Authors: Chang Diana J. , Moin Tannaz
Published: December 2020

Purpose of review

Type 2 diabetes (T2DM) is a major comorbidity of coronavirus disease 2019 (COVID-19) but less is known about COVID-19 and type 1 diabetes (T1DM). Thus, our goal was to review the literature on COVID and T1DM.

Recent findings

We identified 21 reports focusing on COVID-19 infections among patients with preexisting T1DM (n = 7), incident T1DM presentations during the COVID-19 quarantine (n = 6), and outpatient management of T1DM during the COVID-19 quarantine (n = 8). These studies showed that patients with preexisting T1DM and COVID-19 infection often present with hyperglycemia and/or diabetic ketoacidosis (DKA). Although the risk of in-hospital mortality may be increased, hospitalization rates among patients with T1DM mirror that of the general population. The numbers of patients presenting with incident T1DM during COVID-19 quarantine have remained stable, but cases with severe DKA may have increased. COVID-19 quarantine has also impacted outpatient T1DM management and studies examining changes in glycemic control have shown mixed results.

COVID-19 has important implications for patients with type 1 diabetes, but additional studies with larger numbers of patients and longer term follow-up are needed to confirm the early findings highlighted in this review.
Is there still a role for cranialization in modern sinus surgery?
Authors: Morse Justin C. , Chandra Rakesh K.
Published: December 2020

Purpose of review

To give an overview of recently published literature on the indications and use of cranialization of the frontal sinuses.

Recent findings

Recent studies on cranialization have evaluated its role in frontal sinus fractures, inflammatory disease, and tumors involving both the frontal sinus and anterior cranial fossa. Currently, a more conservative approach is favored with traumatic injury to the frontal sinus outflow tract, with multiple studies demonstrating outflow recanalization with observation alone. Similarly, advancements in endoscopic sinus surgical approaches allow the many posterior table fractures to be managed without cranialization. Severe inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression have successfully been managed without cranialization in multiple studies suggesting an endoscopic surgical approach can be favored in these settings. Both benign and malignant tumors of the frontal sinus are managed without cranialization with select cases favoring an open approach with cranialization depending on tumor location. Malignant tumors of the frontal sinus are more likely to require cranialization as oncologic resection including margins can lead to large dural defects with significant tissue loss, which is unfavorable for more conservative reconstructive options.

Cranialization remains a necessary and indicated procedure in the appropriate clinical circumstances. A more conservative approach to frontal sinus fractures is warranted, with recent literature supporting similar outcomes and less morbidity. Inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression can be managed without cranialization. Although most benign tumors can be resected via endoscopic approaches, cranialization remains a mainstay as part of the reconstructive plan after oncologic resection of malignant tumors involving the frontal sinus.
Eucalyptus camaldulensis efficiency for application against microbial infections
Authors: Talha Mustafa H. , Alnomani Yaqdhan , Mirforughi Seyede A.
Published: December 2020

On account of the continuing increase in antimicrobial resistance among infectious agents which are mostly life-threatening, seeking novel and alternative therapeutic approaches seems essential. Eucalyptus camaldulensis, generally known as eucalyptus, contains various healing traits such as antimicrobial characteristics. These herbs generally grow alongside the rivers with both continuous and seasonal water. The antimicrobial applications of this herb, particularly against pandrug and multidrug resistant microorganisms mostly attributed to phenolic, polar terpene compounds and spathulenol. Major bioactive antimicrobial fractions include flavonoids, alkaloids, pigments, terpenes, phenolics, starches, steroids and essential oils. E. camaldulensis has antimicrobial features against various bacterial (both Gram-positive and Gram-negative species), fungal, parasitic and viral infections. Regarding molecular mechanisms, the discharge of Gram-negative outer membrane lipopolysaccharide and increase the permeability of the cytoplasmic membrane have been proposed. Leaf extracts might be a good source of antibacterial and antifungal materials that might be useful in pharmaceutical industry. Interactions with various conventional antimicrobial agents providing synergistic effects suppose a variety of antimicrobial mechanisms by fractions remaining to be entirely elucidated.
Bacteriological profile and antibiotic sensitivity pattern in chronic obstructive pulmonary disease patients
Authors: Nayak Bhavya , Kharvi Sowmya , Varghese Aneena , MB Arya
Published: December 2020

Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease, which is characterized by obstinate obstruction of airflow with an enhanced chronic inflammatory response in the airways and the lung to toxic elements or gases. COPD is a major etiology of morbidity and one among the primary causes of the death globally. The objective of this study is to analyze the bacteriological profile of the patients with COPD and also to study their antimicrobial sensitivity pattern, which may help to scheme a proper antibiotic treatment to the COPD patients, which will have a beneficial effect in preventing the morbidity and mortality of the disease. A narrative review of the literature was carried out after a bibliographical search on the database PubMed, Science Direct and Scopus and active search lists of bibliographical references of articles selected up to November 2019. According to various studies addressed, the causative agents in COPD from both sputum and bronchoscopic samples are found to be Haemophilus influenza, Streptococcus pneumoniae, and Moraxella catarrhalis. However, to conclude, the bacterial flora in COPD varies with disease severity as Gram-negative organisms, such as Pseudomonas aeruginosa are more commonly detected in patients with more severe airflow obstruction in both stable COPD and in exacerbations.
Secondary Traumatic Stress Among Labor and Delivery Nurses
Authors: Nicholls Erika M. , Hermann Robin M. , Giordano Nicholas A. , Trotta Rebecca L.
Published: December 2020

Purpose:

To describe the prevalence and severity of secondary traumatic stress (STS) among labor and delivery nurses within a Northeastern United States academic health system.

Study Design and Methods:

Using a cross-sectional, descriptive correlational design, a convenience sample of labor and delivery nurses (288 nurses) were invited to complete Secondary Traumatic Stress Scale (STSS), a 17-item Likert-type instrument, that measures intrusion, avoidance, and the arousal symptoms associated with indirect exposure to traumatic events. Five additional questions about potential consequences of STS were also asked.

Results:

N = 144 completed the survey (50% response rate). Average STSS score was 33.74 (SD, 11.8), with 35% of respondents meeting symptom severity scores associated with STS. STSS Scores ≥ 38 were significantly correlated with nurses considering leaving their jobs, calling out sick, or requesting an assignment change after witnessing a traumatic birth (p < 0.001). The majority of respondents (84.7%) reported witnessing a traumatic birth. After witnessing a traumatic birth, respondents used co-workers, family, and friends as sources of support.

Clinical Implications:

This study offers insight into the frequency and severity of STS among labor and delivery nurses, as well as the potential workforce-related consequences and provides a foundation for future work aimed at developing interventions to prevent or alleviate STS.
Maternity Nurses' Responses to Maternal Early Warning Criteria
Authors: Gillespie Kate H. , Chibuk Amber , Doering Jennifer , Nelson Ken
Published: December 2020

Objective:

The purpose of this study was to assess the influence of nursing care on implementing perinatal risk-appropriate care in the context of maternal early warning criteria.

Design:

Medical record review and survey of maternity nurses in a three-hospital system in Wisconsin with two level I hospitals and 1 level III hospital.

Participants:

Seven maternity nurses from the level III hospital conducted the medical record reviews and all maternity staff nurses from two level I hospitals were invited to complete the survey.

Measurements:

All medical records in 2017 that met these inclusion criteria: hypertension, sepsis, preeclampsia, hemorrhage, low Apgar scores, and transport were reviewed to assess identification and response time for maternal early warning signs using the Nurses Contribution to Maternal Mortality Worksheet. The survey included questions about influences on the nurses' confidence when interpreting early warning indicators.

Results:

Thirty-two medical records met inclusion criteria and were reviewed. The number of maternal early warning signs recorded ranged from one to four, with a mean of 1.75 indicators. Eighty percent of records documented increased evaluation as a nursing response to the maternal early warning signs. Time-lapse between notifying a provider and bedside evaluation was less than 15 minutes in 54% of cases. Of the 31 eligible nurses, 18 completed the survey (58% response rate). Personal knowledge (90%) was reported by nurses as being the greatest influence on nursing confidence. Sixty-nine percent of nurses reported not receiving patient information from team members at the transporting hospital.

Conclusion:

A systematic record review by frontline nurses can monitor identification and response to maternal early warning signs. Feedback on patient transports can reinforce nurses' decision-making that has the potential to improve responsiveness to clinical warning signs.
Altered Expression of GJD2 Messenger RNA and the Coded Protein Connexin 36 in Negative Lens–induced Myopia of Guinea Pigs
Authors: Zhu Qiurong , Yang Guoyuan , Chen Bingjie , Liu Fengyang , Li Xia , Liu Longqian
Published: December 2020

SIGNIFICANCE

Decreased expression of the retinalGJD2gene messenger RNA (mRNA) and connexin 36 (Cx36) protein in the guinea pig negative lens–induced myopia (LIM) model suggests their involvement in local retinal circuits regulating eye growth.

PURPOSE

Previous studies suggest that theGJD2gene and Cx36 protein encoded by theGJD2gene play important roles in retinal signaling pathways and eye development. The aim of this study was to investigate the changes inGJD2mRNA and Cx36 protein expression in the guinea pig lens-induced myopia model.

METHODS

Four-week-old guinea pigs were randomly divided into two groups. Animals in the experimental group were fitted with monocular −10 D lenses; and animals in the control group, with monocular plano lenses. Biometric measurements, including the spherical equivalent refractive error and axial length, were monitored. Animals were killed after 0, 1, 2, and 3 weeks of treatment, and their retinas were isolated. RetinalGJD2mRNA and Cx36 protein expression levels were assessed by quantitative real-time polymerase chain reaction and Western blot analysis, respectively.

RESULTS

Spherical equivalent refractive error values indicated that negative lens–treated eyes became significantly more myopic than plano lens–treated eyes (P= .001), consistent with their longer axial lengths compared with those of control eyes. BothGJD2mRNA and Cx36 protein expression levels were decreased in the retinas of negative lens–treated eyes compared with levels in the retinas of plano lens–treated eyes, although there were differences in the timing;GJD2mRNA, levels were significantly decreased after 1 and 2 weeks of treatment (P= .01 andP= .004, respectively), whereas Cx36 protein expression was significantly decreased after only 1 week (P= .01).

CONCLUSIONS

That both retinalGJD2mRNA and Cx36 protein expression levels were decreased after induction of myopia with negative lenses points to retinal circuits involving Cx36 in myopia development in the guinea pig.
The Physiatry Workforce in 2019 and Beyond, Part 2
Authors: Dall Timothy M. , Reynolds Ryan L. , Chakrabarti Ritashree , Forte Gaetano J. , Langelier Margaret , Wang Shen , Whyte John , Sridhara Ankam Nethra , Annaswamy Thiru M. , Fredericson Michael , Jain Nitin B. , Perret Karimi Danielle , Morgenroth David C. , Slocum Chloe , Wisotzky Eric
Published: December 2020

Objective

The aim of this study was to assess the current and future adequacy of physiatrist supply in the United States.

Design

A 2019 online survey of board-certified physiatrists (n = 616 completed, 30.1% response) collected information about demographics, practice characteristics, hours worked, and retirement intentions. Microsimulation models projected future physiatrist supply and demand using data from the American Board of Physical Medicine and Rehabilitation, national and state population projections, American Community Survey, Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and other sources.

Results

Approximately 37% of 8853 active physiatrists indicate that their workload exceeds capacity, 59% indicate that workload is at capacity, and 4% indicate under capacity. These findings suggest a national shortfall of 940 (10.6%) physiatrists in 2017, with substantial geographic variation in supply adequacy. Projected growth in physiatrist supply from 2017 to 2030 approximately equals demand growth (2250 vs. 2390), suggesting that without changes in care delivery, the shortfall of physiatrists will persist, with a 1080 (9.7%) physiatrist shortfall in 2030.

Conclusion

Without an increase in physiatry residency positions, the current national shortfall of physiatrists is projected to persist. Although a projected increase in physiatrists’ use of advanced practice providers may help preserve access to comprehensive physiatry care, it is not expected to eliminate the shortfall.
Emergence of a novel urogenital-tropic Neisseria meningitidis
Authors: Bazan Jose A. , Stephens David S. , Turner Abigail Norris
Published: December 2020

Purpose of review

Neisseria meningitidis (Nm) is primarily associated with asymptomatic nasopharyngeal carriage and invasive meningococcal disease (sepsis and meningitis), but like N. gonorrhoea (Ng), Nm can colonize urogenital and rectal mucosal surfaces and cause disease. First noted in 2015, but with origins in 2011, male urethritis clusters caused by a novel Nm clade were reported in the USA (the US_NmUC). This review describes research developments that characterize this urogenital-tropic Nm.

Recent findings

The US_NmUC evolved from encapsulated Nm serogroup C strains. Loss of capsule expression, lipooligosaccharide (LOS) sialylation, genetic acquisition of gonococcal alleles (including the gonococcal anaerobic growth aniA/norB cassette), antimicrobial peptide heteroresistance and high surface expression of a unique factor-H-binding protein, can contribute to the urethra-tropic phenotype. Loss-of-function mutations in mtrC are overrepresented in clade isolates. Similar to Ng, repeat US_NmUC urethritis episodes can occur. The US_NmUC is now circulating in the UK and Southeast Asia. Genomic sequencing has defined the clade and rapid diagnostic tests are being developed for surveillance.

The US_NmUC emerged as a cause of urethritis due to acquisition of gonococcal genetic determinants and phenotypic traits that facilitate urogenital tract infection. The epidemiology and pathogenesis of this urogenital-tropic pathogen continues to be defined.
Application of Sandwich Shape Double Bilobed Flap in Auricular Defects
Authors: Evin Nuh , Tosun Zekeriya , Akdag Osman
Published: December 2020

Background

Reconstruction of auricular defects is a challenging surgical procedure because of its complex 3-dimensional structure. Various surgical techniques have been used for the reconstruction of the auricle. However, most of these techniques are not applicable to the reconstruction of marginal and central defects, and the texture and color harmony of the reconstructed parts were not evaluated in detail. Thus, the aim of this study is to present a novel technique, sandwich shape double bilobed flap, which can be used for correcting, both, central and marginal defects of the auricle and to evaluate esthetic outcomes with objective and quantitative parameters.

Methods

In this study, 24 patients with partial thickness auricular defects were treated with a bilobed flap, and excess tissue in the postauricular sulcus region was transferred to the defective region on the anterior surface. Color compatibility between the flap and surrounding tissues, patient's satisfaction on the final shape and auricular symmetry, as well as anterior scar formation on the auricle were evaluated.

Results

The color, texture, and thickness of the flap matched well with the adjacent auricular tissue and there was no perceptible color difference. The original size, projection, and subunits of auricles were maintained. All patients were mostly very satisfied with surgical outcomes (mean satisfaction score, 4.75 ± 0.4). There was only inconspicuous scar on the visible anterior surface of the auricle (mean patients' scores, 2.22 ± 0.3; mean observers' scores, 2.6 ± 0.4).

Conclusions

The sandwich shape double bilobed flap technique preserved size and subunits of the auricle. Additionally, this procedure also resulted in inconspicuous scarring as well as similar color, texture, and thickness of the flap with the surrounding tissue, thereby achieving satisfying esthetic outcomes.
Perceived Barriers to Comprehensive Cleft Care Delivery
Authors: Kantar Rami S. , Breugem Corstiaan C. , Alfonso Allyson R. , Keith Kristen , Kassam Serena , Annan Beyhan , Chahine Elsa M. , Wasicek Philip J. , Patel Krishna G. , Flores Roberto L. , Hamdan Usama S.
Published: December 2020

Introduction

We analyzed the perceptions of participants and faculty members in simulation-based comprehensive cleft care workshops regarding comprehensive cleft care delivery in developing countries.

Methods

Data were collected from participants and faculty members in 2 simulation-based comprehensive cleft care workshops organized by Global Smile Foundation. We collected demographic data and surveyed what they believed was the most significant barrier to comprehensive cleft care delivery and the most important intervention to deliver comprehensive cleft care in developing countries. We also compared participant and faculty responses.

Results

The total number of participants and faculty members was 313 from 44 countries. The response rate was 57.8%. The majority reported that the most significant barrier facing the delivery of comprehensive cleft care in developing countries was financial (35.0%), followed by the absence of multidisciplinary cleft teams (30.8%). The majority reported that the most important intervention to deliver comprehensive cleft care was creating multidisciplinary cleft teams (32.2%), followed by providing cleft training (22.6%). We found no significant differences in what participants and faculty perceived as the greatest barrier to comprehensive cleft care delivery (P = 0.46), or most important intervention to deliver comprehensive cleft care in developing countries (P = 0.38).

Conclusions

Our study provides an appraisal of barriers facing comprehensive cleft care delivery and interventions required to overcome these barriers in developing countries. Future studies will be critical to validate or refute our findings, as well as determine country-specific roadmaps for delivering comprehensive cleft care to those who need it the most.
Updates on ophthalmic imaging features of optic disc drusen, papilledema, and optic disc edema
Authors: Yan Yan , Liao Yaping Joyce
Published: December 2020

Purpose of review

Optic nerve head elevation can be associated with vision loss. This review provides an update regarding key features of optic disc drusen (ODD) compared with papilledema from increased intracranial pressure and optic disc edema from other causes.

Recent findings

Clinical history and funduscopic examination are not sufficient to correctly diagnose different causes of optic nerve head elevation. Multimodal ophthalmic imaging is noninvasive and should be used as first-line diagnostic testing to distinguish optic disc edema or papilledema from pseudoedema. Advanced ophthalmic imaging, including enhanced depth imaging optical coherence tomography (EDI-OCT) and autofluorescence imaging, can visualize ODD at high resolution and determine whether there is optic disc edema. OCT angiography does not require contrast and can rapidly visualize papillary, peripapillary, and macular microvasculature and identify important vascular biomarker of ischemia and, potentially, visual prognosis.

Multimodal ophthalmic imaging can help in the diagnosis of ODD and optic disc edema and identify patients at high risk of vision loss and neurological issues in order to ensure appropriate diagnosis and treatment.
Retinal disease in the neurology clinic
Authors: Tauscher Robert G. , Simon Shira S. , Volpe Nicholas J.
Published: December 2020

Purpose of review

Retinal disease can manifest with visual symptoms similar to those which result from central nervous system disorders. We provide a framework for considering retinal causes of common visual complaints presenting to a neurology clinic.

Recent findings

Technological advances have afforded quicker detection and a more thorough understanding of these retinal entities and are crucial to consider when evaluating visual complaints in the neurology clinic.

It is essential to maintain a working knowledge of common retinal conditions that symptomatically overlap with common neurologic conditions. Furthermore, the ophthalmoscopic exam and retinal imaging modalities can both aid in the diagnosis and workup of visual complaints and neurologic disease.
Digital health in stroke medicine: what are the opportunities for stroke patients?
Authors: Antonenko Kateryna , Paciaroni Maurizio , Sokolova Larysa , Pezzella Francesca R.
Published: December 2020

Purpose of review

The European Stroke Organisation published a European Stroke Action Plan (SAP-E) for the years 2018–2030. The SAP-E addresses the entire chain of care from primary prevention through to life after stroke. Within this document digital health tools are suggested for their potential to facilitate greater access to stroke care. In this review, we searched for digital health solutions for every domain of the SAP-E.

Recent findings

Currently available digital health solutions for the cerebrovascular disease have been designed to support professionals and patients in healthcare settings at all stages. Telemedicine in acute settings has notably increased the access to tissue plasminogen activator and thrombectomy whereas in poststroke settings it has improved access to rehabilitation. Moreover, numerous applications aim to monitor vital signs and prescribed treatment adherence.

SAP-E with its seven domains covers the whole continuum of stroke care, where digital health solutions have been considered to provide utility at a low cost. These technologies are progressively being used in all phases of stroke care, allowing them to overcome geographical and organizational barriers. The commercially available applications may also be used by patients and their careers in various context to facilitate accessibility to health improvement strategies.
Neuroimaging in attention-deficit/hyperactivity disorder
Authors: Pereira-Sanchez Victor , Castellanos Francisco X.
Published: December 2020

Purpose of review

Neuroimaging research on attention-deficit/hyperactivity disorder (ADHD) continues growing in extent and complexity, although it has yet to become clinically meaningful. We review recent MRI research on ADHD, to identify robust findings, current trends and challenges.

Recent findings

We identified 40 publications between January 2019 and September 2020 reporting or reviewing MRI research on ADHD. Four meta-analyses have presented conflicting results regarding across-study convergence of functional and resting-state functional (fMRI and R-fMRI) studies on ADHD. On the other hand, the Enhancing NeuroImaging Genetics Through Meta-Analysis international consortium has identified statistically robust albeit small differences in structural brain cortical and subcortical indices in children with ADHD versus typically developing controls. Other international consortia are harnessing open-science efforts and multimodal data (imaging, genetics, phenotypic) to shed light on the complex interplay of genetics, environment, and development in the pathophysiology of ADHD. We note growing research in ‘prediction’ science, which applies machine-learning analysis to identify biomarkers of disease based on big data.

Neuroimaging in ADHD is still far from informing clinical practice. Current large-scale, multimodal, and open-science initiatives represent promising paths toward untangling the neurobiology of ADHD.
Genome-wide transcriptomic analysis of intestinal mucosa in celiac disease patients on a gluten-free diet and post gluten challenge
Authors: Dotsenko Valeriia , Oittinen Mikko , Taavela Juha , Popp Alina , Peräaho Markku , Staff Synnöve , Sarin Jani , Leon Francisco , Isola Jorma , Mäki Markku , Viiri Keijo
Published: December 2020

Background & Aims

Gluten challenge studies are instrumental in understanding the pathophysiology of celiac disease. Our aims in this study were to reveal early gluten-induced transcriptomic changes in duodenal biopsies and to find tools for clinics.

Methods

Duodenal biopsies were collected from 15 celiac disease patients on a strict long-term gluten-free diet (GFD) prior to and post a gluten challenge (PGC) and from 6 healthy control individuals (DC). Biopsy RNA was subjected to genome-wide 3’ RNA-Seq. Sequencing data was used to determine the differences between the three groups and was compared to sequencing data from the public repositories. The biopsies underwent morphometric analyses.

Results

In DC vs. GFD group comparisons, 167 differentially expressed genes were identified with 117 genes downregulated and 50 genes upregulated. In PGC vs. GFD group comparisons, 417 differentially expressed genes were identified with 195 genes downregulated and 222 genes upregulated. Celiac disease patients on a GFD were not “healthy”. In particular, genes encoding proteins for transporting small molecules were expressed less. In addition to the activation of immune response genes, a gluten challenge induced hyperactive intestinal wnt-signaling and consequent immature crypt gene expression resulting in less differentiated epithelium. Biopsy gene expression in response to a gluten challenge correlated with the extent of the histological damage. Regression models using only four gene transcripts described 97.2% of the mucosal morphology and 98.0% of the inflammatory changes observed.

Conclusions

Our gluten challenge trial design provided an opportunity to study the transition from health to disease. The results show that even on a strict GFD, despite being deemed healthy, patients reveal patterns of ongoing disease. Here, a transcriptomic regression model estimating the extent of gluten-induced duodenal mucosal injury is presented.
Post-infectious inflammatory disease in MIS-C features elevated cytotoxicity signatures and autoreactivity that correlates with severity
Authors: Ramaswamy Anjali , Brodsky Nina N. , Sumida Tomokazu S. , Comi Michela , Asashima Hiromitsu , Hoehn Kenneth B. , Li Ningshan , Liu Yunqing , Shah Aagam , Ravindra Neal G. , Bishai Jason , Khan Alamzeb , Lau William , Sellers Brian , Bansal Neha , Guerrerio Pamela , Unterman Avraham , Habet Victoria , Rice Andrew J. , Catanzaro Jason , Chandnani Harsha , Lopez Merrick , Kaminski Naftali , Dela Cruz Charles S. , Tsang John S. , Wang Zuoheng , Yan Xiting , Kleinstein Steven H. , van Dijk David , Pierce Richard W. , Hafler David A. , Lucas Carrie L.
Published: December 2020

Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening post-infectious complication occurring unpredictably weeks after mild or asymptomatic SARS-CoV2 infection in otherwise healthy children. Here, we define immune abnormalities in MIS-C compared to adult COVID-19 and pediatric/adult healthy controls using single-cell RNA sequencing, antigen receptor repertoire analysis, unbiased serum proteomics, andin vitroassays. Despite no evidence of active infection, we uncover elevated S100A-family alarmins in myeloid cells and marked enrichment of serum proteins that map to myeloid cells and pathways including cytokines, complement/coagulation, and fluid shear stress in MIS-C patients. Moreover, NK and CD8 T cell cytotoxicity genes are elevated, and plasmablasts harboring IgG1 and IgG3 are expanded. Consistently, we detect elevated binding of serum IgG from severe MIS-C patients to activated human cardiac microvascular endothelial cells in culture. Thus, we define immunopathology features of MIS-C with implications for predicting and managing this SARS-CoV2-induced critical illness in children.
Predictive modeling of morbidity and mortality in COVID-19 hospitalized patients and its clinical implications
Authors: Wang Joshua M. , Liu Wenke , Chen Xiaoshan , McRae Michael P. , McDevitt John T. , Fenyö David
Published: December 2020

Clinical activity of 3740 de-identified COVID-19 positive patients treated at NYU Langone Health (NYULH) were collected between January and August 2020. XGBoost model trained on clinical data from the final 24 hours excelled at predicting mortality (AUC=0.92, specificity=86% and sensitivity=85%). Respiration rate was the most important feature, followed by SpO2 and age 75+. Performance of this model to predict the deceased outcome extended 5 days prior with AUC=0.81, specificity=70%, sensitivity=75%. When only using clinical data from the first 24 hours, AUCs of 0.79, 0.80, and 0.77 were obtained for deceased, ventilated, or ICU admitted, respectively. Although respiration rate and SpO2 levels offered the highest feature importance, other canonical markers including diabetic history, age and temperature offered minimal gain. When lab values were incorporated, prediction of mortality benefited the most from blood urea nitrogen (BUN) and lactate dehydrogenase (LDH). Features predictive of morbidity included LDH, calcium, glucose, and C-reactive protein (CRP). Together this work summarizes efforts to systematically examine the importance of a wide range of features across different endpoint outcomes and at different hospitalization time points.
Engineering Analysis of Aortic Wall Stress in the Surgery of V-shape Resection of the Noncoronary Sinus
Authors: Dong Hai , Liu Minliang , Qin Tongran , Liang Liang , Ziganshin Bulat , Ellauzi Hesham , Zafar Mohammad , Jang Sophie , Elefteriades John , Sun Wei
Published: December 2020

Ascending aortic aneurysms often include the sinotubular junction (STJ) and extend into the root portion of the aorta. The novel surgery of the V-shape resection of the noncoronary sinus of the aortic root has been shown to be a simpler procedure, comparing with traditional surgeries such as full aortic root replacement, for patients with moderate ascending aortic aneurysm and aortic root ectasia. This novel surgery could reduce the diameter and cross-sectional area of the aortic root. However, the detailed effect on the stress field and the rupture risk of the aortic root and aneurysm has not been fully investigated. In this study, we performed patient-specific finite element (FE) analysis based on the 3D geometries of the aortic root and ascending aortic aneurysm, reconstructed directly from the clinical computed tomographic (CT) images. By comparing the pre- and post-surgery results, we investigated the influence of the V-shape surgery on the stress field and rupture risk of the aortic root, ascending aortic aneurysm and aortic arch. It was found that the surgery could significantly reduce the wall stress of the aortic root, ascending aortic aneurysm, as well the aortic arch, and hence lower the rupture risk.
The impact of population-wide rapid antigen testing on SARS-CoV-2 prevalence in Slovakia
Authors: Pavelka Martin , Van-Zandvoort Kevin , Abbott Sam , Sherratt Katharine , Majdan Marek ,   CMMID COVID-19 working group, Analýz Inštitút Zdravotných , Jarčuška Pavol , Krajčí Marek , Flasche Stefan , Funk Sebastian
Published: December 2020

Slovakia conducted multiple rounds of population-wide rapid antigen testing for SARS-CoV-2 in late 2020, combined with a period of additional contact restrictions. Observed prevalence decreased by 58% (95% CI: 57-58%) within one week in the 45 counties that were subject to two rounds of mass testing, an estimate that remained robust when adjusting for multiple potential confounders. Adjusting for epidemic growth of 4.4% (1.1-6.9%) per day preceding the mass testing campaign, the estimated decrease in prevalence compared to a scenario of unmitigated growth was 70% (67-73%). Modelling suggests that this decrease cannot be explained solely by infection control measures, but requires the additional impact of isolation as well as quarantine of household members of those testing positive.
Targeting multicopy prophage genes for the differential diagnosis of Lyme disease
Authors: Shan Jinyu , Jia Ying , Teulières Louis , Patel Faizal , Clokie Martha R.J.
Published: December 2020

The successful treatment of Lyme disease (LD) requires an accurate diagnostic test; however, most tests are insensitive and unspecific. To overcome these challenges, we developed and validated an internally-controlled quantitative PCR (Ter-qPCR) that targets the multicopy terminase large subunit (terL) gene encoded by prophages that are only found in LD-causing bacteria. TheterLprotein helps phages pack their DNA. Strikingly, the detection limit of the Ter-qPCR was analytically estimated to be 22 copies and one bacterial cell in bacteria spiked blood. Furthermore, significant quantitative differences in terms of the amount ofterLdetected in healthy individuals and patients with either early or late disease. Together, the data suggests that the prophage-targeting PCR has significant power to provide a differential diagnosis for LD. Prophage encoded markers are prevalent in many other pathogenic bacteria rendering this approach highly applicable to bacterial identification in general, potentially revolutionising the detection of disease.