bluuebunny/crossref_metadata_2025 huggingface dataset:
In loving memory of ‘us’: facing grief during the time of COVID-19 through redirecting perception of life’s realities
Authors: Cordero Dalmacito A
Published: January 2021

Recent correspondence highlighted the complicated process of grief in the time of COVID-19 where some family members and the dying person too are undergoing distress. New rituals can lighten the process of coping with grief or death, one may find it difficult to hurdle such situation and move on without first redirecting one’s perception on the different realities of life. There are things that we can control but at the same time, things that are beyond our reach. With these realities, acceptance plays a key role to handle the situation. Acceptance is a person’s assent to life’s realities. Creativity in accepting grief or death is finding ways to lighten the heavy emotion of the ‘ones left and the one leaving’ through a preservation of memory. This is done through safeguarding and reliving the memories of the dead with various programs and advocacies.
Does the Phenomenology of Auditory Hallucinations Differ Across Patients Having Severe Mental Illness With and Without Hearing Impairment?
Authors: Sadh Kamaldeep , Mehta Urvakhsh M , Muralidharan Kesavan , Shivashankar N , Jain Sanjeev
Published: January 2021

We compared the experience of auditory hallucinations, in persons who have normal (HN; N = 20), or impaired hearing (HI; N = 20), while experiencing psychoses. We assessed this experience across 42 domains and observed that irrespective of the hearing status, patients most often heard voices mainly in the language that they had learnt first (χ2 = 5.584; P = .018). However, a few experienced hallucinations in languages they “did not know” (3/20; 15%). The voices were most often attributed to both males and females (35/40; 87.5%). Those with hearing impairment heard voices closer to their ears, a hubbub of voices of crowds talking to them, and “as if” stuck or repetitive; often in the hearing-impaired ear. The hearing-impaired subjects also reported hearing nonverbal auditory hallucinations more frequently (χ2 = 17.625; P = .001), and the voices lacked emotional salience (χ2 = 4.055; P = .044). In contrast, the hallucinations were experienced in elaborate detail by the HN (20/20), while those with HI often heard only simple sentences (14/20, P = 0.05). The intensity of the hallucinatory voices remained the same on closing the affected ear or both of the ears in the HI group as compared to the HN group. Interestingly, the use of hearing aids attenuated the intensity of the hallucinations (6/7; 85%) in those with HI.
Adaptive Tree Proposals for Bayesian Phylogenetic Inference
Authors: Meyer X
Published: January 2021

Bayesian inference of phylogeny with Markov chain Monte Carlo plays a key role in the study of evolution. Yet, this method still suffers from a practical challenge identified more than two decades ago: designing tree topology proposals that efficiently sample tree spaces. In this article, I introduce the concept of adaptive tree proposals for unrooted topologies, that is, tree proposals adapting to the posterior distribution as it is estimated. I use this concept to elaborate two adaptive variants of existing proposals and an adaptive proposal based on a novel design philosophy in which the structure of the proposal is informed by the posterior distribution of trees. I investigate the performance of these proposals by first presenting a metric that captures the performance of each proposal within a mixture of proposals. Using this metric, I compare the performance of the adaptive proposals to the performance of standard and parsimony-guided proposals on 11 empirical data sets. Using adaptive proposals led to consistent performance gains and resulted in up to 18-fold increases in mixing efficiency and 6-fold increases in convergence rate without increasing the computational cost of these analyses. [Bayesian phylogenetic inference; Markov chain Monte Carlo; posterior probability distribution; tree proposals.]
In UteroMaternal Benzene Exposure Predisposes to the Metabolic Imbalance in the Offspring
Authors: Koshko Lisa , Debarba Lucas K , Sacla Mikaela , de Lima Juliana B M , Didyuk Olesya , Fakhoury Patrick , Sadagurski Marianna
Published: January 2021

Environmental chemicals play a significant role in the development of metabolic disorders, especially when exposure occurs early in life. We have recently demonstrated that benzene exposure, at concentrations relevant to cigarette smoke, induces a severe metabolic imbalance in a sex-specific manner affecting male but not female mice. However, the roles of benzene in the development of aberrant metabolic outcomes following gestational exposure, remain largely unexplored. In this study, we exposed pregnant C57BL/6JB dams to benzene at 50 ppm or filtered air for 6 h/day from gestational day 0.5 (GD0.5) through GD21 and studied male and female offspring metabolic phenotypes in their adult life. While no changes in body weight or body composition were observed between groups, 4-month-old male and female offspring exhibited reduced parameters of energy homeostasis (VO2, VCO2, and heat production). However, only male offspring from benzene-exposed dams were glucose intolerant and insulin resistant at this age. By 6 months of age, both male and female offspring exhibited marked glucose intolerance however, only male offspring developed severe insulin resistance. This effect was accompanied by elevated insulin secretion and increased beta-cell mass only in male offspring. In support, Homeostatic Model Assessment for Insulin Resistance, the index of insulin resistance was elevated only in male but not in female offspring. Regardless, both male and female offspring exhibited a considerable increase in hepatic gene expression associated with inflammation and endoplasmic reticulum stress. Thus, gestational benzene exposure can predispose offspring to increased susceptibility to the metabolic imbalance in adulthood with differential sensitivity between sexes.
Phylogeny and generic classification of the Anthidiini bees from the Neotropical region (Hymenoptera: Apidae)
Authors: Parizotto Daniele R , Urban Danúncia , Melo Gabriel Ar
Published: January 2021

The Anthidiini is a highly diverse tribe of bees with approximately 700 described species worldwide, of which about 350 occur in the Neotropical region. However, the phylogenetic relationships within the Neotropical lineage are poorly understood and the generic limits of these clades are still controversial, with different proposals of classification. Therefore, we carried out a phylogenetic study to investigate the monophyly of Neotropical taxa, to understand the relationships among Neotropical genera, and to propose a classification congruent with the evolution of the group. We performed parsimony-based morphological analyses using a matrix of 204 characters from adults of 83 species (79 terminal taxa of Anthidiini and four outgroup taxa). The results provide strong support for the monophyly of the tribe, despite a representation biased towards the Neotropical taxa. The monophyly of a large group containing only species from Neotropical genera is also supported. The latter group is divided into six main clades, one of them composed of only cleptoparasitic taxa (Austrostelis, Hoplostelis, Melostelis and Rhynostelis). The morphological characters assembled here allowed scrutiny of the genus-level classification of the Neotropical clade and may be useful for future phylogenetic studies involving the Anthidiini from other biogeographic regions.
Transcriptome Analysis of Pear Leaves in Response to Calcium Treatment During Botryosphaeria dothidea Infection
Authors: Sun Xun , Wang Yun , Pan Bisheng , Xu Wenyu , Zhang Shaoling
Published: January 2021

Pear (Pyrus bretschneideri), one of the most widely planted fruit trees in the world, is infected by pear ring rot disease, which is triggered by Botryosphaeria dothidea. Previous research has shown that exogenous calcium enhanced pear resistance to B. dothidea. To explore the molecular mechanism of calcium in pear pathogen resistance, we searched the differentially expressed genes (DEGs) between calcium and H2O treatment with B. dothidea inoculation in pear by using RNA-seq data. On the basis of the standard of a proportion of calcium/H2O fold change >2, and the false discovery rate (FDR) <0.05, 2,812 and 572 genes with significant differential expression were identified between the H2O and calcium treatments under B. dothidea inoculation at 2 days postinoculation (dpi) (D2) and 8 dpi (D8), respectively, indicating that significantly more genes in D2 responded to calcium treatment. Results of the gene annotation showed that DEGs were focused on plant−pathogen interactions, hormone signal transduction, and phenylpropanoid biosynthesis in D2. Moreover, transient silencing of PbrCML30 (pear calmodulin-like proteins 30), which had significantly higher expression in response to calcium than H2O treatments, conferred compromised resistance to B. dothidea. Exogenous calcium treatment slightly alleviated the symptoms of TRV2-PbrCML30 leaves compared with TRV2 leaves under inoculation, supporting its key role in pear resistance to B. dothidea. Overall, the information obtained in this study provides a possible mechanism of calcium in regulating pear resistance to B. dothidea.
Brain metastasis in a patient with multiple malignancies
Authors: Robinson Kevlin , Zerfoss Cindy , Nicholas Joyce , Rolfs Jenna
Published: January 2021

Brain metastases originate from other primary cancers within the body, most commonly lung, breast, and melanoma. Because patients with brain metastasis, stroke, or intracranial hemorrhage may present with similar acute neurologic symptoms, clinicians must have a high suspicion for brain metastasis and perform an immediate workup to rule out life-threatening conditions. This case report focuses on the clinical symptoms, diagnostics, and treatment options for brain metastasis in a patient with multiple malignancies.
Managing obesity in adults as a chronic condition
Authors: Jrolf Cheri Wilder
Published: January 2021

Despite extensive evidence-based guidelines, clinicians still face many barriers to reducing the incidence of obesity. Recognizing that obesity is a chronic disease will allow clinicians to properly treat patients and bill for reimbursement. With enhanced education, knowledge of reimbursement, and a push for legislation, physician assistants can pave the way to reducing rates of obesity in adults.
Original Research: Concussions at School: The Experiences and Knowledge of School Nurses
Authors: Pietz Katy , Graves Janessa , Weybright Elizabeth , Pinkleton Bruce , Klein Tracy
Published: January 2021

Background:

School nurses' knowledge about and confidence in managing concussions are important to ensure continuity of care between a student's school and home environments. This mixed-methods study explored concussion-related knowledge, confidence, and management experiences among urban and rural school nurses in Washington State.

Methods:

Public school nurses, identified via state educational service district websites and recruited by e-mail, completed an online survey assessing their concussion knowledge and confidence levels. Following the survey, a subset of respondents participated in semistructured interviews aimed at exploring their confidence in managing concussions.

Results:

Of the 945 school nurses to whom the survey was sent, 315 responded (33% response rate). Most survey respondents held an RN license (89.6%) and were from urban areas (90.8%). Overall, the respondents exhibited accurate concussion knowledge; only one significant difference was noted based on rural–urban status. Correct responses were given for most questions (67.4% to 98.7% correct responses). In interviews with a subset of six school nurses, emergent themes pertained to communication, assessment, and monitoring, and the nurse's role in postconcussion management. Barriers can include a lack of relevant school policies, low concussion awareness among teachers and parents, and limited resources.

Conclusions:

The study findings suggest that school nurses possess high levels of concussion knowledge and confidence in managing concussions. Continuing education remains important to ensure that current research and evidence inform practice regarding ongoing concussion management among school-age children.
Accuracy of Bladder Scanner for the Assessment of Postvoid Residual Volumes in Women With Pelvic Organ Prolapse
Authors: Taylor Danielle Lynn , Sierra Tania , Duenas-Garcia Omar Felipe , Kim Youngwu , Leung Katherine , Hall Cynthia , Flynn Michael K.
Published: January 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2020;26:640–643)

There is an increased risk of developing voiding dysfunction in patients with advanced pelvic organ prolapse (POP). An important component of evaluating these patients is assessment of postvoid residual (PVR) volumes.
Application of exhaled nitric oxide (FeNO) in pediatric asthma
Authors: Di Cicco Maria , Peroni Diego Giampietro , Ragazzo Vincenzo , Comberiati Pasquale
Published: January 2021

Purpose of review

Fractional concentration of Nitric Oxide in the exhaled air (FeNO) is a moderately good biomarker of type-2 airway inflammation, and its measurement is feasible also in children. The available evidence is still not enough to support the routine use of FeNO to diagnose or manage asthma in every patient in clinical practice. However, its role in identifying asthma with eosinophilic inflammation is of particular interest in the management of severe asthma.

Recent findings

In healthy subjects, FeNO levels increase with age and height, particularly in males, and are also influenced by ethnicity. FeNO measurement can support asthma diagnosis and help in predicting asthma development later in life in young children with recurrent wheezing. FeNO-guided asthma management is effective in reducing asthma exacerbations but may result in a higher daily dose of inhaled corticosteroids. FeNO can also be used as a marker to evaluate adherence to asthma treatment and predict response to different biologicals, especially Omalizumab and Dupilumab.

This review outlines recent data on the application of FeNO in childhood-onset asthma diagnosis and management, as well as in phenotyping subjects with severe asthma who may benefit from monoclonal antibodies administration.
Small-airway dysfunction in paediatric asthma
Authors: Cottini Marcello , Lombardi Carlo , Berti Alvise , Comberiati Pasquale
Published: January 2021

Purpose of review

Asthma is a chronic inflammatory airway disorder that can involve the entire bronchial tree. Increasing evidence shows that ventilation heterogeneity and small airway dysfunction are relevant factors in the pathogenesis of asthma and represent a hallmark in adults with persistent asthma. Little is known about the contribution of peripheral airway impairment in paediatric asthma, mainly due to the inaccessibility to evaluation by noninvasive techniques, which have only been widely available in recent years.

Recent findings

Emerging evidence suggests that small airways are affected from the early stages of the disease in childhood-onset asthma. Conventional lung function measurement, using spirometry, is unable to sensitively evaluate small airway function and may become abnormal only once there is a significant burden of disease. Recent studies suggest that chronic inflammation and dysfunction in the small airways, as detected with new advanced techniques, are risk factors for asthma persistence, asthma severity, worse asthma control and loss of pulmonary function with age, both in adults and children. Knowing the extent of central and peripheral airway involvement is clinically relevant to achieve asthma control, reduce bronchial hyper-responsiveness and monitor response to asthma treatment.

This review outlines the recent evidence on the role of small airway dysfunction in paediatric asthma development and control, and addresses how the use of new diagnostic techniques available in outpatient clinical settings, namely impulse oscillometry and multiple breath washout, could help in the early detection of small airway impairment in children with preschool wheezing and school-age asthma and potentially guide asthma treatment.
Gelatin–Poly (γ-Glutamic Acid) Hydrogel as a Potential Adhesive for Repair of Intervertebral Disc Annulus Fibrosus
Authors: Yang Jui-Jung , Lin Yu-Yang , Chao Kuo-Hua , Wang Jaw-Lin
Published: January 2021

Study Design.

An in vitro experimental study testing a Gelatin–poly (γ-glutamic acid) hydrogel for disc repair.

Objective.

To evaluate the cytocompatibility and degradability of the above mentioned hydrogel for intervertebral disc annular fibrosis (AF) repair.

Summary of Background Data.

No repair strategies for correcting annular defects in lumbar discectomy have been clinically well recognized. Exogenous supplementation of regenerative materials to fill defects is a minimally invasive way to restore compromised mechanical properties. The injected materials, most commonly gelatin-based materials with cross-linking agents, serve as sealants and as a scaffold for incorporating biomaterials for augmentation. However, cytotoxicity of hydrogel crosslinking agents is of concern in developing viable materials.

Methods.

This in vitro experimental study evaluated a newly developed gelatin-based hydrogel for intervertebral disc AF repair. Mechanical strength was augmented by γ-PGA, and 1-(3-dimethylaminopropyl)-3-ethyl-carbodiimide hydrochloride (EDC) was used for material crosslinking. Isolated bovine tail intervertebral discs (IVDs) were used to test the hydrogel, and hydrogel surface monolayer AF cell culture was used to investigate efficacy in hydrogel constructs of different EDC concentrations. Cell metabolic activity was evaluated with Alamar blue assay, cell viability assay with live/dead stain, and sulfated glycosaminoglycan (GAG) and double strain DNA were quantified to evaluate proliferation of implanted cells and synthesis of extracellular matrix (ECM) proteins.

Results.

EDC concentrations from 10 to 40 mM resulted in significant decreases in AF cell proliferation without obvious influence on cell viability. Higher EDC concentrations resulted in decreased percentage of Alamar blue reduction and GAG and DNA concentration, but did not affect GAG/DNA and live–dead ratios. Degradation tests revealed that higher EDC concentrations decreased the hydrogel degradation rate.

Conclusion.

The developed gelatin–poly (γ-PGA) hydrogel with 20 mM EDC concentration provides an effective gap-filling biomaterial with good cytocompatibility, suggesting substantial promise for use as a sealant for small AF defects.

Level of Evidence: N/A
Unilateral Biportal Endoscopy Versus Tubular Microendoscopy in Management of Single Level Degenerative Lumbar Canal Stenosis
Authors: Aygun Hayati , Abdulshafi Khaled
Published: January 2021

Study Design:

Prospective clinical study.

Summary of Background Data:

To the authors knowledge, there are no previous prospective studies to test the feasibility of the unilateral biportal endoscopic (UBE) technique in management of lumbar canal stenosis.

Purpose:

The study was conducted to compare clinical results of the UBE technique with the tubular microendoscopic (TME) surgery for management of degenerative lumbar canal stenosis.

Methods:

One hundred fifty-four cases of single level degenerative lumbar canal stenosis were randomly divided into 2 groups. Each group consisted of 77 cases: one group underwent UBE and the other TME. Clinical outcome was assessed periodically: early postoperative, at 1, 3, and every 6 months for 2 years. Clinical outcome assessment operatives included the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and patient satisfaction using Modified Macnab Criteria (MMC). In addition, the admission period, operative time, and estimated blood loss were compared.

Results:

In UBE cases, ODI and ZCQ were statistically superior to TME for all periods (P<0.05). For both approaches, values presented progressive improvement until the 24th month. Regarding ODI, UBE and TME had an 84% and 79% success rate, respectively. In ZCQ, UBE and TME had a 79% and 73% success rate, respectively, at the end of the 24th month. Regarding the MMC, UBE and TME had 63% and 29% excellent results, respectively. UBE also has shorter admission period (days: 1.11 vs. 1.28), operative time (minutes: 57.74 vs. 65.31), and less estimated blood loss (mL: 49.47 vs. 53.57).

Conclusions:

Given its demanding learning curve, UBE is considered an effective alternative to TME with a higher clinical success rate.
A Novel Percutaneous Modified Brostrom-Gould Technique for Lateral Ankle Instability Using the Lasso Technique
Authors: Tay Guan Tzu , Ng Julia Poh Hwee , Hap Daniel Xing Fu , Foo Gen Lin , Wee James
Published: January 2021

We describe a percutaneous modification of the Brostrom-Gould procedure for lateral ankle instability. Our surgical technique involves making a stab incision at the anterior aspect of the distal fibula. Dissection is made down to bone and a double-loaded suture anchor is placed at the anterior talofibular ligament (ATFL) origin. The sutures are loaded individually onto a trocar needle and passed underneath the remnant ATFL and inferior extensor retinaculum at its distal extent. Percutaneous stab incisions are made to allow retrieval of the sutures which are passed subcutaneously back to the ATFL origin. The 2 sets of sutures, positioned to reconstruct the ATFL and calcaneofibular fibular ligament, are then secured with the ankle in eversion and plantigrade position. Patients are placed on a short walker boot and 2 to 3 weeks of non–weight-bearing postoperatively.

Level of Evidence: Level V—Expert opinion. See Instructions for Authors for a complete description of levels of evidence.
Achilles Tendon Rupture Treatment: Operative Versus Nonoperative
Authors: Jildeh Toufic R. , Eller Erik B.
Published: January 2021

Acute Achilles tendon ruptures are common injuries with increasing incidence. Management of acute ruptures is controversial. Early evidence suggested that nonoperative treatment led to a significantly higher rerupture rate; however, operative modalities have also been shown to have a higher risk of wound complications. Advances in therapeutic protocols have normalized the rerupture rate between operative and nonoperative modalities, and many have recommended nonoperative treatment becuase of the mitigated complication profile. The purpose of this review is to report contemporary management of Achilles tendon ruptures and provide our preferred technique of management.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Controversies in Limb Salvage in Patients With Diabetes Mellitus
Authors: Louis-Ugbo John
Published: January 2021

Diabetic foot ulcers are the most feared complications among patients with diabetes mellitus because these are frequently a harbinger to major lower extremity amputation after failed attempts at treatment or limb salvage. Though most of these ulcers go on to heal, there is a sizeable proportion that goes on to develop gangrene, deep infections, osteomyelitis, and unstable deformities. These cohorts of patients often require repeated, costly, and controversial attempts at limb salvage surgery. Considering the growing cost of care of these patients worldwide, controversies abound in the literature regarding the best approach for limb salvage that will provide the best possible outcomes. There are no clear guidelines regarding what limbs with diabetic ulcers to salvage and those that require immediate major amputation in the orthopedic literature. However, many reports have shown that aggressive efforts at salvage with partial foot amputations should be entertained before higher-level amputations because of the increased morbidity and mortality associated with major amputation.

Level of Evidence:Level IV.
Deltoid Ligament Insufficiency
Authors: Hynes Kelly
Published: January 2021

Deltoid ligament insufficiency can be present after an ankle sprain or fracture and in the setting of adult acquired flatfoot. If symptoms of medial ankle instability persist after nonoperative treatment for an ankle sprain, deltoid ligament repair or reconstruction may be indicated. More commonly, deltoid ligament injuries occur at the time of rotational ankle fractures. The indications for acute deltoid ligament repair in the setting of fracture are of great interest and debate. This chapter will review the conditions of deltoid ligament insufficiency in the setting of sprains and fractures including the current state of evidence and technique for operative repair.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Persistent Nerve Injury and CRPS After Ankle Sprains
Authors: Pina Matthew , Messina James , Geaney Lauren E.
Published: January 2021

A number of patients continue to experience prolonged pain, swelling, instability, and disability after a lateral ankle sprain, which is sufficient to limit their activity. There are several conditions that are misdiagnosed as chronic lateral ligament injury. In this review, we highlight common nerve conditions, with specific attention to the peroneal nerve, and chronic regional pain syndrome that can mimic chronic lateral ligament injury and can cause persistent ankle pain after lateral ankle sprain. We also offer advice for effective diagnosis and treatment of these associated pathologies. Sprained ankle syndrome, as it has been referred to, continues to be an unsolved problem in many, but we hope to better elucidate the diagnostic and treatment dilemma in most of these patients.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Recurrent Syndesmotic Diastasis Treated With Revision Tightrope Fixation
Authors: Lin Sheldon , Genovese Nicholas
Published: January 2021

Recurrent syndesmotic diastasis following screw fixation for pronation-external rotation (Weber C) fractures is a known complication, however, the ideal management for revision reduction and fixation of the syndesmosis remains controversial. This article reviews the background of syndesmotic injuries, as well as recent aspects of management that have generated controversy. Particular emphasis is placed on syndesmotic stability, assessment of reduction, and various methods of fixation.

Level of Evidence: Diagnostic Level V—review article, expert opinion. See Instructions for Authors for a complete description of levels of evidence.
Major and durable response to second-line pembrolizumab-carboplatin-paclitaxel in an oral cavity cancer patient
Authors: Cabezas-Camarero Santiago , Cabrera-Martin Maria Nieves , Saiz-Pardo Sanz Melchor , Perez-Segura Pedro
Published: January 2021

Many patients with recurrent/metastatic squamous cell cancer of the head and neck (SCCHN) are old or fragile and, despite deserving rapid and deep responses due to symptoms or a high tumor burden, they are not candidates for the current standard in the first-line setting of pembrolizumab plus platinum-5-FU. Other chemoimmunotherapy combinations substituting the 5-FU infusion by a taxane, may allow for less toxic effects without the need for a central venous catheter placement while maintaining efficacy. We present the case of an oral cavity cancer progressing with bulky disease to first-line cetuximab-paclitaxel in a frail and malnourished patient, where second-line treatment with pembrolizumab and reduced-dose 3-weekly carboplatin-paclitaxel achieved a deep and durable response. This is, to our knowledge, the first reported case of such combination being used in the R/M setting of SCCHN. Clinical trials should try to investigate the feasibility of this potentially less toxic and convenient combination in patients with SCCHN.
Association of aspirin and nonaspirin NSAIDs therapy with the incidence risk of hepatocellular carcinoma: a systematic review and meta-analysis on cohort studies
Authors: Liu Yuwei , Ren Tianqi , Xu Xiaotong , Jin Jinglan
Published: January 2021

According to the current research evidence, the therapy of nonsteroidal anti-inflammatory drugs (NSAIDs) might effectively decrease the risk of hepatocellular carcinoma (HCC) incidence. Investigations have been conducted on the relationship between NSAIDs (aspirin and nonaspirin NSAIDs) and the risk of HCC incidence. We searched the PubMed, Web of Science, Embase and Cochrane Library databases for cohort studies published prior to 15 March 2020 and screened eligible studies. There were a total of 12 eligible studies (published between 2012 and 2020). We observed a lower risk of HCC among aspirin users [hazard ratio 0.53; 95% confidence interval (CI), 0.43–0.65]. However, there were no statistically significant associations discovered between nonaspirin NSAID use and the risk of HCC incidence (hazard ratio 0.95; 95% CI, 0.79–1.15). Furthermore, aspirin use has also been found to reduce the risk of HCC in patients with cirrhosis or viral hepatitis compared to that in the general population (hazard ratio 0.15; 95% CI, 0.10–0.23; hazard ratio 0.65; 95% CI, 0.56–0.76, respectively). Moreover, no statistical associations were found between aspirin use and a higher risk of bleeding risk, with a hazard ratio value of 0.76 (95% CI, 0.51–1.13). In summary, the conducted meta-analysis reveals that aspirin, rather than nonaspirin NSAIDs, can significantly decrease the risk of HCC, particularly in patients with cirrhosis or viral hepatitis.
Respite Care for Families of Children with Disabilities
Authors: Bigham Amy , Cunningham Jill , Johnston Kristen
Published: January 2021

Families of children with disabilities or special healthcare needs report respite care as a great need, yet availability of such care is scarce. A partnership developed between a nursing school in the Southeast and a faith community, to provide respite care and summer camps, resulted in a win-win situation for families, children, interprofessional students and educators, the faith community, and volunteers. This article explains the need for respite, how schools of nursing and faith communities can partner, and the benefits to all stakeholders.
CSOG MFM Committee Guideline: Management of Hepatitis B During Pregnancy and Prevention of Mother-to-Child Transmission of Hepatitis B Virus (2020)
Authors: Zhou Yi-Hua , Hu Yali , Liu Xinghui , Yang Huixia
Published: January 2021

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is the main cause of chronic hepatitis B. The prevention of MTCT plays a critical role in control chronic hepatitis B. The main purpose of the present clinical guidelines is to aid healthcare providers in managing pregnant women with positive HBsAg and in preventing MTCT of HBV. We recommend: (1) all pregnant women require prenatal screen for hepatitis B serological markers; (2) newborn infants of mothers with negative hepatitis B surface (HBsAg) require administration of hepatitis B vaccine on a 0, 1, and 6 month-schedule; (3) newborn infants of mothers with positive HBsAg need hepatitis B immunoglobulin (HBIG) and birth dose vaccine within 12 hours (the sooner the better) after birth, followed by injection of the second and third dose of hepatitis B vaccine at the age of one and six months respectively; (4) in preterm neonates or neonates with poor health conditions born to HBsAg-positive mothers, the immunoprophylaxis measures should be appropriately taken; (5) to further reduce MTCT of HBV, pregnant women with HBV DNA levels >2 × 105 IU/mL or positive hepatitis B e antigen may receive oral antivirals, starting from 28 to 32 weeks of gestation and discontinuing the drug on the delivery day; (6) cesarean section is not recommended to reduce MTCT of HBV; (7) breastfeeding is recommended in infants of HBsAg-positive mothers, regardless of maternally positive hepatitis B e antigen, maternal nipple injury or bleeding, oral mucosal injury in neonates or infants; (8) breastfeeding is recommended in infants born to HBsAg-positive mothers who require continuation of antiviral therapy after delivery, and the infants should be followed up to observe whether adverse effects develop; and (9) the infants born to HBsAg-positive mothers should be tested for hepatitis B serological markers at the age of 7–12 months, and those who are negative for HBsAg and anti-HBs should receive three doses of hepatitis B vaccine on the 0, 1, and 6 month-schedule as soon as possible.
ASSOCIATIONS WITH RECURRENCE OF MACULAR EDEMA IN BRANCH RETINAL VEIN OCCLUSION AFTER THE DISCONTINUATION OF ANTI VASCULAR ENDOTHELIAL GROWTH FACTOR
Authors: Lee Geun Woo , Kang Se Woong , Kang Min Chae , Kim Sang Jin , Kim Yoon Young
Published: January 2021

Purpose:

To identify factors predicting the recurrence of macular edema after the discontinuation of intravitreal antivascular endothelial growth factor injection in patients with branch retinal vein occlusion.

Methods:

This retrospective study included only subjects who had discontinued injections at 3 months after the final bevacizumab injection due to fully resolved macular edema. Fifty-two eyes meeting the criteria were included in the study and divided into two groups (recurrence and no recurrence). Clinical features and measurements of retinal thickness at the time of the diagnosis and when the decision to stop injections was made (stopping point) were analyzed.

Results:

At the stopping point, the no recurrence group showed a thinner parafoveal inner retina, better best-corrected visual acuity, and lower incidence of ellipsoid zone disruption in multivariate logistic regression analysis (all P < 0.05). Similarly, parafoveal inner retinal thinning of more than 30 µm, when compared with the corresponding region of the fellow eye or the unaffected region of the affected eye, was significantly related to less recurrence of macular edema.

Conclusion:

Thinning of the parafoveal inner retina as well as better vision and intact outer retinal layers are associated with a lack of recurrence of macular edema. These findings suggest that inner retinal atrophy after branch retinal vein occlusion may result in a reduction in oxygen demand in the affected retinal tissue and less production of vascular endothelial growth factor.
Effect of Body Refrigeration Time on Cornea Donor Tissue
Authors: Munir Wuqaas M. , Brown Clayton H. , Munir Saleha Z. , Hoover Caroline K.
Published: January 2021

Purpose:

To determine how early body refrigeration affects corneal donor transplant suitability and endothelial cell density.

Methods:

Donor information was obtained from the CorneaGen Eye Bank including demographics, time of death to preservation, and body refrigeration status, for donors between 2012 and 2016. The death to preservation interval was classified into 3 categories: 0 to 10, 10 to 20, and 20+ hours. Two primary logistic method models were fit using a main effects model and an interaction model to determine the association of body refrigeration on unsuitability of transplantation and endothelial cell density.

Results:

Analysis was from 42,929 donor eyes, with a mean (standard deviation) endothelial cell count of 2743 (415) cells/mm2. Fifty-nine percent of donor eyes were from male donors in the eye bank data set, and the mean death to preservation interval was 11.0 (5.6) hours for all eyes. Unsuitability for transplantation demonstrated a reduced adjusted odds ratio by 22% (OR = 0.78, P = 0.009) when the body was refrigerated during the death to preservation interval versus when the body was not refrigerated. Eyes that were refrigerated, however, exhibited no statistically significant difference in endothelial cell count from eyes that were not refrigerated (P = 0.12).

Conclusions:

We demonstrate an appreciable effect of early body refrigeration on transplant suitability in this large cohort of eye bank eyes. There was no beneficial effect of body refrigeration on endothelial cell count.
CRISPR-Cas9 System: A Revolutionary Tool in the Fight Against Antimicrobial Resistance: Retracted
Authors: Ekwebelem Osmond C. , Aleke Job , Ofielu Ekenedirichukwu , Nnorom-Dike Obinna
Published: January 2021

The rapidly evolving world of antimicrobial resistance has not only made it difficult to combat infectious diseases, but during the last decades also brought the discovery of novel antimicrobials to a standstill. In recent years, researchers discovered the potential of the clustered regularly interspaced short palindromic repeats (CRISPR)-associated (CRISPR-Cas) system as an alternative therapeutic. Since the unearthing of CRISPR-Cas9 as an “adaptive immune system” of bacteria, the CRISPR-Cas9 system has been improved into a state-of-the-art genetic engineering tool, with an impressive ability to cause specific gene insertions and/or gene deletions, in almost all microorganisms. The emerging picture suggests that the CRISPR-Cas9 system can be exploited in a sequence-specific manner to selectively eliminate individual bacterial strains in a mixed microbial population, and/or re-sensitize bacteria to antibiotics. These findings have not only revolutionized biomedical research, but might also prove to be pivotal in creating novel alternative treatments for multidrug-resistant infections. Here, we discussed the up-to-date findings reported in this area, as well as the approaches involved in the utilization of CRISPR-Cas9 as a novel technology in the fight against antimicrobial resistance. We also highlighted recent studies that have exploited the CRISPR-Cas9 system in the context of targeting pathogenic and drug-resistant bacteria.
Evaluating the Benefits of Early Intensive Rehabilitation for Patients With Sepsis in the Medical Intensive Care Unit: A Retrospective Study
Authors: Uthup Bahitha R. , Myszenski Adele , Saigh Nora , Samuel Preethy S.
Published: January 2021

Purpose:

To evaluate the benefits of early rehabilitation intervention for patients with sepsis in a medical intensive care unit (MICU) and to identify the factors associated with positive outcomes at discharge.

Methods:

A retrospective review of 97 electronic medical records of patients with sepsis admitted to 2 similar-sized MICU pods of an urban tertiary care hospital was conducted. Bivariate analyses were conducted to compare the sociodemographics, length of stay, mobility level, and discharge disposition of 47 patients who received early rehabilitation intervention in MICU pod 1, with 46 patients who received standard rehabilitation intervention in MICU pod 2. In addition, multivariate analysis of the entire sample was conducted to identify the factors associated with positive discharge outcomes.

Results:

Patients in pod 1 had significantly higher level of mobility at discharge (mean difference = 0.80, P = .009) and a better discharge disposition (λ2 = 25.05, df = 7, P < .001) than those in pod 2. The positive outcomes of increased mobility and return to home at discharge were associated with rehabilitation intensity (F
1,91 = 52.30; P < .001, b = 0.82) and rehabilitation initiation (adjusted odds ratio: 0.85, P = .039), respectively.

Conclusion:

These findings provide empirical support for the safety and benefits of providing early intensive rehabilitation for patients in the MICU with sepsis using a therapist-driven model of care.
Acute Care Physical Therapy Practice Analysis Identifies the Need for a Core Outcome Measurement Set
Authors: Mayer Kirby P. , Norris Traci L. , Kumble Sowmya , Morelli Nathan , Gorman Sharon L. , Ohtake Patricia J.
Published: January 2021

Purpose:

This study's primary objective is to determine the current use of outcome measures (OMs) by physical therapists practicing in acute care settings. Secondarily, this study aims to establish whether physical therapists support the development of a core OM set for use in acute care settings.

Methods:

An investigator-developed online survey (Qualtrics) was distributed to acute care physical therapy stakeholders, including practicing clinicians, educators, and administrators. The survey contained 4 sections with 28 questions: (1) acute care physical therapy practice patterns; (2) use of OMs in practice; (3) the development of a core OM set; and (4) demographic, education, and experience in the physical therapy profession. Descriptive statistics were used to assess response frequency and rationale for the use of specific OMs.

Results:

A convenience sample of 170 acute physical therapy stakeholders completed the survey. Respondents represented 38 states, with most respondents (n = 153; 90%) practicing in one or more acute care specialty areas. The majority of respondents (n = 145; 83%) reported using an OM more than 50% of the time in their practice. Physical function was the main construct (n = 163; 96%) respondents assessed with an OM. Acute care physical therapists primarily used OMs to track response to interventions (n = 134; 79%) and develop a care plan (n = 91; 54%). Length of time required to complete an OM and its clinical utility were the most common rationales for selecting an OM (n = 150, 88%; n = 147, 86%, respectively). Strong support was found for developing a core OM set for acute physical therapist practice (n = 147; 86%). The preferred methods for the organization of a core OM set, in rank order, were by diagnosis, International Classification of Functioning, Disability, and Health (ICF) framework, domains of health, and settings/location.

Conclusion:

Most physical therapists participating in this study of practice in acute care reported using OMs in their daily practice. This survey confirms the desire to develop a core OM set with high clinical utility for use in acute care settings.
Once-weekly prophylaxis regimen of nonacog alfa in patients with hemophilia B: an analysis of timing of bleeding event onset
Authors: Tortella Bartholomew J. , Carr Marcus E. , Rendo Pablo , Korth-Bradley Joan , Smith Lynne M. , Kavakli Kaan
Published: January 2021

In a pivotal, multicenter, open-label study, 25 patients aged 12–54 years with moderately severe/severe hemophilia B received on-demand nonacog alfa (6 months; dose at investigator's discretion) followed by once-weekly prophylaxis with nonacog alfa 100 IU/kg (12 months). During prophylaxis, patients had a median spontaneous annualized bleeding rate (sABR) of 1.0 and significant reductions in ABR (P < 0.0001). This post hoc analysis examined the time of onset of spontaneous bleeding events (sBEs) and spontaneous target joint bleeding events (sTJBEs). The postdosing day (D) of onset of sBEs observed during prophylaxis and steady-state FIX activity data (FIX:C) between 144 and 196 h postdose were collected at weeks 26 and 78. Twelve patients (48%) had no sBEs; the remaining 13 (52%) had the following onset of sBEs: less than 1 D (0%), 1 to less than 2D (5%), 2 to less than 3 D (22%), 3 to less than 4 D (9%), 4 to less than 5D (22%), 5 to less than 6D (23%), 6 to less than 7D (11%), and at least 7D (8%). Reductions in sBEs and sTJBEs during on-demand versus prophylaxis treatment were experienced by all 13 patients. Target joint sABR during prophylaxis was 0 for 5/13 patients. ABR reduction ranged from 66.1% (27.2→9.2) to 97.8% (46.2→1.0); sTJBE reductions ranged from 6.2% (2.1→2.0) to 100% (from 40.1, 19.1, 3.9, 9.0, 6.1--0). During prophylaxis, 47% (8/17) of trough FIX activity samples were more than 2%. In sBE patients, ABR and number of TJBEs were reduced with once-weekly nonacog alfa. When sBEs occurred, they followed no apparent pattern for day of occurrence. Clinicaltrials.gov identifier: NCT01335061.
Effective tranexamic acid concentration for 95% inhibition of tissue-type plasminogen activator-induced hyperfibrinolysis in full-term pregnant women: a prospective interventional study
Authors: Lechien Arnaud , Faraoni David , Van der Linden Philippe
Published: January 2021

Postpartum haemorrhage is the leading cause of maternal mortality and morbidity worldwide. Tranexamic acid (TXA) has been shown to reduce blood loss and blood product transfusion requirements. Despite clinical evidence, further studies are needed to better define the pharmacokinetic and pharmacodynamic characteristics of TXA in pregnant women. The objective of our prospective observational ex-vivo study was to define the effective TXA concentration required to inhibit 95% (EC95) of tissue-type plasminogen activator (t-PA)-induced fibrinolysis in full-term pregnant women. Hyperfibrinolysis was induced by adding supraphysiologic concentration of t-PA to blood samples obtained from 30 full-term pregnant women and 10 healthy nonpregnant female volunteers. Increasing TXA concentrations (0--40 μg/ml) were then spiked into the blood samples and inhibition of fibrinolysis was assessed using the lysis index at 30 min of the ROTEM measured on EXTEM and NATEM tests. Effective TXA concentrations required to achieve EC95 were extrapolated using nonlinear regression. EC95 were compared between groups using an extra sum-of-squares F test. EC95 in pregnant women was 14.7 μg/ml (95% CI 12.4--17.5 μg/ml) on EXTEM and 11.2 μg/ml (95% CI 8.3--15.1 μg/ml) on NATEM tests. These values were significantly higher than those obtained in volunteers: 8.7 μg/ml (95% CI 5.5--13.9 μg/ml) and 6.8 μg/ml (95% CI 5.3--8.8 μg/ml), respectively (both P < 0.001). Our results suggest a higher fibrinolytic potential in pregnant women compared with nonpregnant women.
Coronary artery calcium score: pivotal role as a predictor for detecting coronary artery disease in symptomatic patients
Authors: Cherukuri Lavanya , Birudaraju Divya , Budoff Matthew J.
Published: January 2021

Chest pain and dyspnea are common presentations for symptomatic individuals with suspected coronary artery disease (CAD) in the primary care office and cardiology clinics. However, it is imperative to properly diagnose who should undergo further evaluation for cardiac etiologies of chest pain, with either noninvasive or invasive imaging tests. The purpose of this review is to highlight the role of coronary artery calcium (CAC) score as a screening tool for symptomatic patients to detect CAD. The purpose of CAC scoring is to establish the presence and severity of coronary atherosclerosis that can play a vital role in symptomatic patients. The use of CAC testing in symptomatic patients has traditionally been limited due to fundamental concerns, including the occurrence of coronary calcification relatively late in the atherosclerotic process and high prevalence of CAC in the population. Further issue relates to its low specificity for obstructive CAD, as well as demonstration of significant ethnic variability in plaque composition and calcification patterns. CAC testing gained attention as an inexpensive, rapid, reproducible and a well-tolerated alternative to exclude CAD in symptomatic patients and defer further invasive imaging tests. This article will review the available literature in regard to the use of CAC in symptomatic populations.