bluuebunny/crossref_metadata_2025 huggingface dataset:
The activating transcription factor 2: an influencer of cancer progression
Authors: Huebner Kerstin , Procházka Jan , Monteiro Ana C , Mahadevan Vijayalakshmi , Schneider-Stock Regine
Published: November 2019

In contrast to the continuous increase in survival rates for many cancer entities, colorectal cancer (CRC) and pancreatic cancer are predicted to be ranked among the top 3 cancer-related deaths in the European Union by 2025. Especially, fighting metastasis still constitutes an obstacle to be overcome in CRC and pancreatic cancer. As described by Fearon and Vogelstein, the development of CRC is based on sequential mutations leading to the activation of proto-oncogenes and the inactivation of tumour suppressor genes. In pancreatic cancer, genetic alterations also attribute to tumour development and progression. Recent findings have identified new potentially important transcription factors in CRC, among those the activating transcription factor 2 (ATF2). ATF2 is a basic leucine zipper protein and is involved in physiological and developmental processes, as well as in tumorigenesis. The mutation burden of ATF2 in CRC and pancreatic cancer is rather negligible; however, previous studies in other tumours indicated that ATF2 expression level and subcellular localisation impact tumour progression and patient prognosis. In a tissue- and stimulus-dependent manner, ATF2 is activated by upstream kinases, dimerises and induces target gene expression. Dependent on its dimerisation partner, ATF2 homodimers or heterodimers bind to cAMP-response elements or activator protein 1 consensus motifs. Pioneering work has been performed in melanoma in which the dual role of ATF2 is best understood. Even though there is increasing interest in ATF2 recently, only little is known about its involvement in CRC and pancreatic cancer. In this review, we summarise the current understanding of the underestimated ‘cancer gene chameleon’ ATF2 in apoptosis, epithelial-to-mesenchymal transition and microRNA regulation and highlight its functions in CRC and pancreatic cancer. We further provide a novel ATF2 3D structure with key phosphorylation sites and an updated overview of all so-far available mouse models to study ATF2 in vivo.
Global H-NS counter-silencing by LuxR activates quorum sensing gene expression
Authors: Chaparian Ryan R , Tran Minh L N , Miller Conrad Laura C , Rusch Douglas B , van Kessel Julia C
Published: November 2019

Bacteria coordinate cellular behaviors using a cell–cell communication system termed quorum sensing. In Vibrio harveyi, the master quorum sensing transcription factor LuxR directly regulates >100 genes in response to changes in population density. Here, we show that LuxR derepresses quorum sensing loci by competing with H-NS, a global transcriptional repressor that oligomerizes on DNA to form filaments and bridges. We first identified H-NS as a repressor of bioluminescence gene expression, for which LuxR is a required activator. In an hns deletion strain, LuxR is no longer necessary for transcription activation of the bioluminescence genes, suggesting that the primary role of LuxR is to displace H-NS to derepress gene expression. Using RNA-seq and ChIP-seq, we determined that H-NS and LuxR co-regulate and co-occupy 28 promoters driving expression of 63 genes across the genome. ChIP-PCR assays show that as autoinducer concentration increases, LuxR protein accumulates at co-occupied promoters while H-NS protein disperses. LuxR is sufficient to evict H-NS from promoter DNA in vitro, which is dependent on LuxR DNA binding activity. From these findings, we propose a model in which LuxR serves as a counter-silencer at H-NS-repressed quorum sensing loci by disrupting H-NS nucleoprotein complexes that block transcription.
Phylogenetic debugging of a complete human biosynthetic pathway transplanted into yeast
Authors: Agmon Neta , Temple Jasmine , Tang Zuojian , Schraink Tobias , Baron Maayan , Chen Jun , Mita Paolo , Martin James A , Tu Benjamin P , Yanai Itai , Fenyö David , Boeke Jef D
Published: November 2019

Cross-species pathway transplantation enables insight into a biological process not possible through traditional approaches. We replaced the enzymes catalyzing the entire Saccharomyces cerevisiae adenine de novo biosynthesis pathway with the human pathway. While the ‘humanized’ yeast grew in the absence of adenine, it did so poorly. Dissection of the phenotype revealed that PPAT, the human ortholog of ADE4, showed only partial function whereas all other genes complemented fully. Suppressor analysis revealed other pathways that play a role in adenine de-novo pathway regulation. Phylogenetic analysis pointed to adaptations of enzyme regulation to endogenous metabolite level ‘setpoints’ in diverse organisms. Using DNA shuffling, we isolated specific amino acids combinations that stabilize the human protein in yeast. Thus, using adenine de novo biosynthesis as a proof of concept, we suggest that the engineering methods used in this study as well as the debugging strategies can be utilized to transplant metabolic pathway from any origin into yeast.
mitoXplorer, a visual data mining platform to systematically analyze and visualize mitochondrial expression dynamics and mutations
Authors: Yim Annie , Koti Prasanna , Bonnard Adrien , Marchiano Fabio , Dürrbaum Milena , Garcia-Perez Cecilia , Villaveces Jose , Gamal Salma , Cardone Giovanni , Perocchi Fabiana , Storchova Zuzana , Habermann Bianca H
Published: November 2019

Mitochondria participate in metabolism and signaling. They adapt to the requirements of various cell types. Publicly available expression data permit to study expression dynamics of genes with mitochondrial function (mito-genes) in various cell types, conditions and organisms. Yet, we lack an easy way of extracting these data for mito-genes. Here, we introduce the visual data mining platform mitoXplorer, which integrates expression and mutation data of mito-genes with a manually curated mitochondrial interactome containing ∼1200 genes grouped in 38 mitochondrial processes. User-friendly analysis and visualization tools allow to mine mitochondrial expression dynamics and mutations across various datasets from four model species including human. To test the predictive power of mitoXplorer, we quantify mito-gene expression dynamics in trisomy 21 cells, as mitochondrial defects are frequent in trisomy 21. We uncover remarkable differences in the regulation of the mitochondrial transcriptome and proteome in one of the trisomy 21 cell lines, caused by dysregulation of the mitochondrial ribosome and resulting in severe defects in oxidative phosphorylation. With the newly developed Fiji plugin mitoMorph, we identify mild changes in mitochondrial morphology in trisomy 21. Taken together, mitoXplorer (http://mitoxplorer.ibdm.univ-mrs.fr) is a user-friendly, web-based and freely accessible software, aiding experimental scientists to quantify mitochondrial expression dynamics.
The neural bases of vitality forms
Authors: Di Cesare Giuseppe , Gerbella Marzio , Rizzolatti Giacomo
Published: November 2019

Unlike emotions, which are short-lasting events accompanied by viscero-motor responses, vitality forms are continuous internal states that modulate the motor behaviors of individuals and are devoid of the autonomic modifications that characterize real emotions. Despite the importance of vitality forms in social life, only recently have neurophysiological studies been devoted to this issue. The first part of this review describes fMRI experiments, showing that the dorso-central insula is activated during the execution, the perception and the imagination of arm actions endowed with different vitality forms as well as during the hearing and the production of speech conveying vitality forms. In the second part, we address the means by which the dorso-central insula modulates the networks for controlling action execution and how the sensory and interoceptive information is conveyed to this insular sector. Finally, we present behavioral data showing the importance of vitality forms in social interactions.
Financial Constraints, Monetary Policy Shocks, and the Cross-Section of Equity Returns
Authors: Chava Sudheer , Hsu Alex
Published: November 2019

We analyze the impact ofa unanticipated monetary policy changes on the cross-section of U.S. equity returns. Financially constrained firms earn a significantly lower (higher) return following surprise interest rate increases (decreases) as compared to unconstrained firms. This differential return response between constrained and unconstrained firms appears after a delay of 3 to 4 days. Further, unanticipated Federal funds rate increases are associated with a larger decrease in expected cash flow news, but not discount rate news, for constrained firms relative to unconstrained firms.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
A Randomized, Double-blind, Placebo-Controlled Trial of Onabotulinumtoxin A Trigger Point Injections for Myofascial Pelvic Pain
Authors: Dessie Sybil G. , Von Bargen Emily , Hacker Michele R. , Haviland Miriam J. , Elkadry Eman
Published: November 2019

(Abstracted from Am J Obstet Gynecol 2019; doi: 10.1016/j.ajog.2019.06.044)

Approximately 15% of women have chronic pelvic pain (CPP), which has a significant impact on quality of life and affects more than just the pelvis. Frequently, CPP is associated with irritable bowel syndrome, fibromyalgia, painful bladder syndrome, myofascial pain, and vulvodynia.
Prophylactic Antibiotics in the Prevention of Infection After Operative Vaginal Delivery (ANODE): A Multicenter Randomized Controlled Trial
Authors: Knight Marian , Chiocchia Virginia , Partlett Christopher , Rivero-Arias Oliver , Hua Xinyang , Hinshaw Kim , Tuffnell Derek , Linsell Louise , Juszczak Edmund
Published: November 2019

(Abstracted from Lancet 2019;393:2395–2403)

Sepsis causes 11% of maternal deaths globally; in 2016, an estimated 19,500 women died because of pregnancy-related infections. The risk factors for maternal sepsis are easily recognized, including cesarean delivery and operative vaginal birth (forceps or vacuum extraction).
Induction of Labor at 39 Weeks of Gestation Versus Expectant Management for Low-Risk Nulliparous Women: A Cost-Effectiveness Analysis
Authors: Hersh Alyssa R. , Skeith Ashley E. , Sargent James A. , Caughey Aaron B.
Published: November 2019

(Abstracted from Am J Obstest Gynecol 2019;220(6):590.e1–590.e10)

Inducing labor is commonly used to initiate labor before the spontaneous onset of labor for many indications. One of the major concerns about elective induction of labor (performed when there is no medical indication) is that it will increase risk of cesarean delivery.
Cerclage for Women With Twin Pregnancies: A Systematic Review and Meta-analysis
Authors: Li Chunbo , Shen Jie , Hua Keqin
Published: November 2019

(Abstracted from Am J Obstet Gynecol 2019;220(6):543–557)

The use of assisted-reproductive technique has led to an increase in the twin birth rate over the last 30 years, and these pregnancies are at an increased risk for preterm birth (PTB). Reportedly, approximately 50% of twin pregnancies deliver at <37 weeks of gestation and 14% are delivered at <33 weeks.
Inaccuracies in the Use of the Majeed Pelvic Outcome Score: A Systematic Literature Review
Authors: Kleweno Conor , Vallier Heather , Agel Julie
Published: November 2019

Objectives:

To evaluate the accuracy with which the Majeed Pelvic Score has been reported in the English literature.

Data Sources:

Databases used to search for literature were PubMed, Embase, and Ovid, restricted to English language from inception to October 2, 2018.

Study Selection:

Search words used were: Majeed, pelvis, and outcome.

Data Extraction:

Articles were assessed for descriptions of scoring and proper reporting of Majeed Pelvic Outcome Score.

Data Synthesis:

Descriptive statistics were used to report the outcome of our findings.

Conclusions:

Ninty-two English articles were identified. Twenty-four (26%) articles were identified as including methodology related to the use and scoring of the Majeed Pelvic score. The remaining 68 presented mean Majeed scores with no methodological information. None (0/92) discussed how the range of possible scores for the most severe function was applied. Six (7%) reported adjusted scores for patients not working. Three (3%) included a discussion of the scores as adjusted for patients working before injury compared with those not working. Ten (11%) addressed the categorization of scores by excellent to poor describing what raw scores defined those categories. We observed poor accuracy and notable inconsistency in the use and reporting of the Majeed Pelvic Outcome Score in the literature. These data demonstrate that interpretation and comparison of research reporting this score should be done cautiously. Future studies should include specific information as to how the Majeed instrument calculated to allow for verification of the presented scores and subsequent conclusions.
The Incidence and Risk Factors Associated With the Need for Fasciotomy in Tibia and Forearm Fractures: An Analysis of the National Trauma Data Bank
Authors: Saiz Augustine M. , Wellman Alexandria C. , Stwalley Dustin , Wolinsky Philip , Miller Anna N.
Published: November 2019

Objective:

The aims of this study were to analyze a large national trauma database to determine the incidence of, risk factors for, and outcomes after a fasciotomy of the lower leg or forearm after fracture.

Methods:

Data from the National Trauma Data Bank for the years 2004–2016 were analyzed, and we identified 301,351 patients with forearm fractures and 369,237 patients with tibial fractures. Risk factors, length of stay (LOS), and mortality were assessed to determine associations with an injury that required a fasciotomy.

Results:

A total of 1.22% of the forearm fractures and 3.79% of the tibial fractures had a fasciotomy. Patients with a fasciotomy were more likely to have invasive procedures (P < 0.0001); have injuries resulting from machinery, motor vehicle collisions, and firearms (P < 0.0001); and smoke, use drugs, and/or alcohol (P < 0.05) compared with patients who did not undergo fasciotomies. Fasciotomy procedures were associated with longer LOS and higher mortality rate (P < 0.05).

Conclusions:

The incidence of a fasciotomy is less than 5% in tibia or forearm fractures. Patients who underwent fasciotomy have higher energy injuries, increased alcohol or drug use, higher rates of surgical interventions, and increased LOS. Furthermore, having a fasciotomy is associated with increased mortality rate. When counseling patients and evaluating surgeon/hospital performance, fasciotomies can serve as an indicator and modifier for a more complex trauma pathology.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Semisupine Positioning for Proximal Humerus ORIF Using Arthroscopic Shoulder Distractor
Authors: Hightower Cody , Mobley Kyle , Jones Thomas
Published: November 2019

Advances in implant technology have improved the orthopaedic surgeon's ability to successfully treat proximal humerus fractures. However, obtaining and maintaining anatomic reduction throughout surgery remains difficult. Failure to do so can compromise surgical outcomes leading to poor clinical results. Here, we describe a novel surgical method using upper-extremity traction that allows control and positioning of the operative extremity. This technique facilitates achieving and maintaining fracture reduction and decreases operative time.
Association between flavonoids, flavonoid subclasses intake and breast cancer risk: a case-control study in China
Authors: Feng Xiao-Li , Ho Suzanne C. , Mo Xiong-Fei , Lin Fang-Yu , Zhang Nai-Qi , Luo Hong , Zhang Xin , Zhang Cai-Xia
Published: November 2019

Anti-tumor effect of dietary flavonoids has been sustained by laboratory experiments, but epidemiological studies with breast cancer risk remained inconsistent and insufficient. This study aimed to investigate the associations between total and subclasses of flavonoid and breast cancer risk among Chinese population. This case-control study recruited 1522 eligible breast cancer cases and 1547 frequency-matched control subjects from June 2007 to July 2018 in Guangdong, China. Dietary intake was obtained by face-to-face interview using a validated food frequency questionnaire. Odds ratios and 95% confidence intervals were calculated by multivariable logistic regression models. After adjusting for potential confounders, inverse associations were observed between total flavonoids, anthocyanidins, proanthocyanidins, flavanones, flavones, flavonols and isoflavones and overall breast cancer risk. Comparing the highest versus the lowest quartile, odds ratio (95% confidence interval) was 0.66 (0.54–0.82) for total flavonoids, 0.61 (0.49–0.75) for anthocyanidins, 0.67 (0.54–0.83) for proanthocyanidins, 0.71 (0.57–0.88) for flavanones, 0.48 (0.39–0.60) for flavones, 0.51 (0.41–0.63) for flavonols and 0.67 (0.54–0.83) for isoflavones, respectively. No significant association was found between flavanols, flavan-3-ol monomers, theaflavins and breast cancer risk. Stratified analysis by menopausal status and estrogen receptor/progesterone receptor status showed that the associations of total flavonoids, most flavonoid subclasses with breast cancer risk were generally not modified by menopausal or estrogen receptor/progesterone receptor status. This study indicates that total flavonoids and most flavonoid subclasses intakes were inversely associated with breast cancer risk.
Female sexuality and vaginal health across the menopausal age
Authors: Cagnacci Angelo , Venier Martina , Xholli Anjeza , Paglietti Chiara , Caruso Salvatore
Published: November 2019

Objective:

The primary aim was to evaluate changes in female sexuality across the menopausal period, and the secondary objective was to test the associations of female sexuality domains with vaginal atrophy and its symptoms.

Methods:

A cross-sectional multicenter study was performed involving 518 women, 40 to 55 years of age, consulting outpatient gynecological services at 30 centers across Italy. Vaginal atrophy was identified by the contemporaneous presence of a pH >5, subjective vaginal dryness, and an objective sign. The relationships between vaginal atrophy and its main symptoms (vaginal dryness and dyspareunia), and Female Sexual Function Index (FSFI) score and its domains (desire, arousal, orgasm, dyspareunia, lubrication, and sexual satisfaction) were analyzed.

Results:

The prevalence of sexual dysfunction, as defined by a FSFI score <26.55, was 70.6%, increasing from 55% in the years 40 to 45, to 82.8% (P < 0.01) in the years 52 to 55 of age. Mean FSFI score decreased from 40 to 45, to 46 to 48 years of age (23.13 ± 9.76 vs 19.49 ± 9.88; P < 0.05), and from 48 to 51, to 52 to 55 years of age (21.3 ± 8.06 to 17.59 ± 9.11; P < 0.01). Independent determinants of FSFI were age, vaginal atrophy, and the presence of vaginal dryness and dyspareunia (R2 0.208; P = 0.011). FSFI score was independently correlated (R2 0.116) with weight (CR −0.067; 95% confidence interval [CI] −0.126, −0.006; P < 0.032), menopausal status (CR −2.406; 95% CI −4.180, −0.63; P < 0.008), and vaginal dryness (CR −5.647; 95% CI −7.677, −3.618; P < 0.0001). Vaginal dryness was the only variable correlated independently with each FSFI domain, including desire (also correlated with menopausal status), arousal (with age and menopausal status), lubrication (with age), orgasm (with age), satisfaction (with vaginal atrophy and being an ex-smoker), and dyspareunia (with age and spontaneously referred dyspareunia).

Conclusions:

In the perimenopausal years, FSFI score decreases and sexual dysfunction increases by about 30%. Vaginal dryness is the symptom of vaginal atrophy most closely related to all domains of female sexuality.
Impact of evening primrose oil consumption on psychological symptoms of postmenopausal women: a randomized double-blinded placebo-controlled clinical trial
Authors: Sharif Seyedeh Nazanin , Darsareh Fatemeh
Published: November 2019

Objective:

The purpose of this study was to determine the efficacy and safety of evening primrose oil on women's psychological symptoms during menopause.

Methods:

A double-blinded randomized placebo-controlled trial carried out from September 2018 to February 2019 in Bandar Abbas, Iran. Eligible women randomly received either 1,000 mg of evening primrose oil capsules daily or matching placebo for 8 weeks. The Main outcome measures were psychological symptoms based on the psychological subscale of the Menopause Rating Scale. Independent samplesttest was used for intergroup comparisons and paired samplesttest for pre- and post-treatment comparisons.P ≤ 0.05 was considered statistically significant.

Results:

The 8-week treatment was completed by 189 women. The mean baseline psychological score did not differ among the two groups. After intervention, the psychological score, however, differed significantly among groups (P < 0.01). To distinguish the effect of evening primrose oil, we compared the reduction in the psychological score in each group. Regarding mean differences of the psychological score in both groups, there was a prominent alleviation in the intervention group mean difference: −3.44 (95% confidence interval of difference: −4.01 to −1.20) (P < 0.01). In addition, only one patient reported gastric upset in the intervention group.

Conclusions:

This study could provide evidence regarding the potential benefits of evening primrose oil for the psychological symptoms of postmenopausal women. Longer trials are necessary to make more reliable decisions about the use of evening primrose oil and its safety in clinical practice.
Spontaneous Generation and an Eighteenth Century Italian Rabbi-Physician
Authors: Katz Ben Z.
Published: November 2019

Spontaneous generation is usually stated to have been laid to rest by Louis Pasteur with his swan-necked flask experiments. However, a century and a half earlier an Italian physician-Rabbi, Isaac Lampronti, was so convinced of the falsity of spontaneous generation that he was willing to overturn Jewish legal precedent.
Route of Oseltamivir Administration Affects Metabolite Concentrations in Critically Ill Children
Authors: Tang Girdwood Sonya C. , Mizuno Tomoyuki , Krallman Kelli A. , Benken Laura A. , Stoneman Erin M. , Yunger Toni M. , Wong Hector R. , Vinks Alexander A. , Kaplan Jennifer M.
Published: November 2019

We performed a prospective cohort study to investigate oseltamivir administration in critically ill children. We found that enteric tube administration of oseltamivir resulted in lower concentrations of its active metabolite compared with oral delivery. These findings could have significant clinical implications, and more studies are required to better understand the effects of administration route on potential lower systemic metabolite exposure.
Microbiology of Osteoarticular Infections in Patients with Sickle Hemoglobinopathies at Texas Children’s Hospital, 2000–2018
Authors: Kaplan Julika , Ikeda Saki , McNeil J. Chase , Kaplan Sheldon L. , Vallejo Jesus G.
Published: November 2019

The association between Salmonella spp. and osteoarticular infections in pediatric patients with major sickle hemoglobinopathies has been well established. However, the contemporary microbiology of these infections in such patients is unknown. We conducted a retrospective review of medical records at Texas Children’s Hospital in Houston from 2000 to 2018 to investigate this question. Fifty cases were identified. In 23 (46%) cases, a pathogen was identified. Salmonella was the most common pathogen isolated, accounting for 61% of culture-positive cases followed by Staphylococcus aureus (21.7%).
Identifying Children With Measles for Isolation in a High-volume Pediatric Emergency Department in Singapore
Authors: Teng Sung Shin , Chua Cheng Rong , Chan Yiong Huak , Ong Gene Yong-Kwang
Published: November 2019

Background:

Viral exanthems in the pediatric age group are common. The worldwide increase in the incidence of highly infectious measles and other vaccine-preventable diseases and its impact in emergency departments (EDs) of a cosmopolitan city-state like Singapore are unknown. Our aims were to investigate and describe recent epidemiologic trends of proven measles infection seen in our ED and elucidate risk factors that can potentially impact our ED isolation practice.

Methods:

This is a retrospective observational cohort study on laboratory-confirmed measles infection in patients admitted through our pediatric ED from January 2010 to December 2016.

Results:

A total of 277 patients were hospitalized for measles infection during the study period. Of these, 177 patients (63.9%) were not isolated initially at the ED triage and 92 patients (33.2%) were not admitted to isolation wards on admission. Seventy-five patients (27.1%) with microbiologically proven measles had no rash at initial ED presentation. They presented earlier in their illness (3.1 days) compared with an average of 4.8 days for those who had a rash at presentation (P < 0.001). These patients without rash were younger, and most were admitted for poor feeding.

Conclusions:

Our study found that most pediatric patients who required hospitalization presented with nonspecific symptoms at an early phase of illness, making it challenging to adequately isolate patients despite strict isolation policies. This calls for the importance of universal push for global vaccination to increase herd immunity to prevent measles infection.
Growth Patterns in Children With Congenital Cytomegalovirus Infection
Authors: Tagarro Alfredo , Del Valle Ruth , Dominguez-Rodríguez Sara , Baquero-Artigao Fernando , Noguera-Julian Antoni , Vives-Oñós Isabel , Santos Mar , Hawkins María M. , Pérez-Seoane Beatriz , Medina Gema , Rojo Pablo , Frick M. Antoniette , Alonso-Ojembarrena Almudena , Rives María T. , Sota Itziar , Moliner Elisenda , Colino Elena , Cilleruelo María J. , Ramos José Tomás , Bustamante Jorge , Fortuny Claudia , Cañete Alfonso , Donoso Irene , Piñeiro María , Suárez Sergio , Blázquez-Gamero Daniel
Published: November 2019

Background:

Congenital cytomegalovirus infection (CMVc) affects 0.7%–6% of recent births. Among its clinical manifestations are low weight and length at birth.

Objective:

Describe the growth patterns of children with CMVc in their early years.

Methods:

Observational, multicenter study of patients with CMVc. Anthropometric data were collected during the first 2 years of life and compared with World Health Organization standards.

Results:

Anthropometric characteristics of 383 children with CMVc were studied, of which 198 (51%) were symptomatic at birth. At birth, 9% were small for gestational age (SGA) in terms of their weight and length and 17% had microcephaly. At 24 ± 3 months, 10% had a weight and length ≤2 SD, and 13% a head circumference ≤2 SD. Of those who were SGA at birth, at 24 ± 3 months >20% remained at ≤2 SD of their weight and length. Conversely, 75% of children with low weight or length at 24 ± 3 had not been SGA at birth. 20% of infants with microcephaly at birth remained with microcephaly, and 10% of those without microcephaly developed it at 24 ± 3 months. The average growth rate in length and weight was normal. Patients who were symptomatic at birth, premature and with motor and neurocognitive impairment had a significantly higher risk of low weight and length at 24 ± 3 months.

Conclusion:

Around 10% of children with CMVc are at ≤2 SD in weight, length and head circumference at 24 ± 3 months. The lack of adequate growth is associated with symptoms at birth, prematurity and motor and neurocognitive impairment. Growth impairment could be incorporated into the symptomatic spectrum of CMVc.
Enteropathogens and Rotavirus Vaccine Immunogenicity in a Cluster Randomized Trial of Improved Water, Sanitation and Hygiene in Rural Zimbabwe
Authors: Church James A. , Rogawski McQuade Elizabeth T. , Mutasa Kuda , Taniuchi Mami , Rukobo Sandra , Govha Margaret , Lee Benjamin , Carmolli Marya P. , Chasekwa Bernard , Ntozini Robert , McNeal Monica M. , Moulton Lawrence H. , Kirkpatrick Beth D. , Liu Jie , Houpt Eric R. , Humphrey Jean H. , Platts-Mills James A. , Prendergast Andrew J.
Published: November 2019

Background:

Oral rotavirus vaccines (RVVs) are less efficacious in low-income versus high-income settings, plausibly due to more enteropathogen exposure through poor water, sanitation and hygiene (WASH). We explored associations between enteropathogens and RVV immunogenicity and evaluated the effect of improved WASH on enteropathogen carriage.

Methods:

We detected stool enteropathogens using quantitative molecular methods and measured anti–rotavirus immunoglobulin A by enzyme-linked immunosorbent assay in infants enrolled to a cluster randomized 2 × 2 factorial trial of improved WASH and improved infant feeding in Zimbabwe (NCT01824940). We used multivariable regression to explore associations between enteropathogens and RVV seroconversion, seropositivity and geometric mean titer. We evaluated effects of improved WASH on enteropathogen prevalence using linear and binomial regression models with generalized estimating equations.

Results:

Among 224 infants with enteropathogen and immunogenicity data, 107 (47.8%) had ≥1 pathogen and 39 (17.4%) had ≥2 pathogens detected at median age 41 days (interquartile range: 35–54). RVV seroconversion was low (23.7%). After adjusting for Sabin-poliovirus quantity, pan-enterovirus quantity was positively associated with RVV seroconversion (relative risk 1.61 per 10-fold increase in pan-enterovirus; 95% confidence interval: 1.35–1.91); in the same model, Sabin quantity was negatively associated with RVV seroconversion (relative risk: 0.76; 95% confidence interval: 0.60–0.96). There were otherwise no meaningful associations between individual or total pathogens (bacteria, viruses, parasites or all pathogens) and any measure of RVV immunogenicity. Enteropathogen detection did not differ between randomized WASH and non-WASH groups.

Conclusions:

Enteropathogen infections were common around the time of rotavirus vaccination in rural Zimbabwean infants but did not explain poor RVV immunogenicity and were not reduced by a package of household-level WASH interventions.
Comprehensive Detection of Respiratory Bacterial and Viral Pathogens in the Middle Ear Fluid and Nasopharynx of Pediatric Patients With Acute Otitis Media
Authors: Sawada Shoichi , Okutani Fumino , Kobayashi Taisuke
Published: November 2019

Background:

Acute otitis media (AOM) is a common ear infection caused by respiratory viruses and bacteria of the nasopharynx. The present study aimed to detect various respiratory viruses and bacteria in middle ear fluid (MEF) and nasopharyngeal aspirates (NPA) using polymerase chain reaction (PCR).

Methods:

We collected MEF and NPA samples from 122 pediatric patients with AOM. Real-time PCR detected 11 types of respiratory viruses (respiratory syncytial virus A/B, parainfluenza virus 1/2/3, human metapneumovirus, influenza virus A/B, adenovirus, human bocavirus and rhino virus) and 7 types of bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pyogenes, Legionella pneumophila and Moraxella catarrhalis). MEF specimens were also examined using bacterial culture.

Results:

At least 1 respiratory viral or bacterial pathogen was detected in MEF of 120 cases (98%) by viral and bacterial PCR and of 93 cases (76%) by viral PCR and bacterial culture. Respiratory viruses were detected in NPA of 84 cases (69%) and MEF of 67 cases (55%). The most common virus detected in MEF was respiratory syncytial virus (21%), followed by parainfluenza virus (15%). All the viruses present in MEF were also detected in NPA specimens. Bacteria were detected by PCR in MEF of 109 cases (89%); H. influenzae was the most frequently detected (65%).

Conclusions:

In many cases, pediatric AOM was found to constitute a respiratory polymicrobial infection. Multiplex PCR was useful to detect multiple respiratory viruses and bacteria in AOM. To understand intractable AOM, further studies regarding the clinical features of each viral and bacterial coinfection are required.
Early-onset Sepsis Among Preterm Neonates in China, 2015 to 2018
Authors: Jiang Siyuan , Hong Luyang , Gai Jianfang , Shi Jingyun , Yang Yi , Lee Shoo K. , Cao Yun
Published: November 2019

Background:

The epidemiology of early-onset sepsis (EOS) in China is poorly understood because of the paucity of high-quality data. We aimed to examine the epidemiology, pathogen distribution and neonatal outcomes of EOS among a large cohort of preterm infants in China.

Methods:

All infants born at <34 weeks of gestation and admitted to 25 tertiary neonatal intensive care units in China from April 2015 to May 2018 were enrolled. EOS was defined as a culture-confirmed infection that occurred within 72 hours after birth.

Results:

Among 27,532 enrolled infants, 321 (11.7 cases per 1000 admissions) infants developed EOS, and 61 (19.0%) infants died within seven days after EOS onset. The incidence of EOS among inborn infants in 18 perinatal centers was 9.7 cases per 1000 live births <34 weeks’ gestation (186/19,084). The case fatality rate was 22.6% (42/186). Gram-negative bacteria were responsible for 61.7% of EOS and 82.0% of EOS-related deaths. Escherichia coli (20.3%) was the leading pathogen, followed by Coagulase-negative staphylococcus (16.5%), Achromobacter xylosoxidans (9.0%) and Klebsiella pneumoniae (8.1%). Group B streptococci infections were relatively rare (2.5%). EOS was an independent risk factor for all-cause mortality and retinopathy of prematurity.

Conclusions:

There is a high burden of EOS among preterm infants in China with a distinctive pathogen distribution. Longitudinal epidemiologic monitoring, further investigation of causative pathogens and development of targeted strategies for prevention and treatment of EOS are needed.
Characteristics of Delphi Processes in Orthotics and Prosthetics Research
Authors: Falbo Kierra Jean , Brinkmann John
Published: November 2019

Introduction

The implementations of a structured consensus process can facilitate agreement among experts on varied and inconsistent clinical and educational practices. Recommendations exist for use of the Delphi consensus process in health care research. Most Delphi studies in orthotics and prosthetics research occurred after these recommendations were published, and it is unclear how closely these recommendations have been followed when applying this method. The aim of this review is to summarize the characteristics of Delphi processes in orthotics and prosthetics in order to guide future research.

Materials and Methods

A review was undertaken of published reports of Delphi processes used to research some aspect of the orthotics and prosthetics profession. Research methods were evaluated to identify and characterize features of the application of the Delphi process. These features were compared with the recommendations for Delphi processes in health care research.

Results

The application of the Delphi method in the 19 reviewed studies varied significantly in regards to topic, qualifications and number of experts, survey item creation, number of rounds, consensus requirements, outcomes, inclusion of a final conference, dropout rate, and final output. Although some studies closely followed the recommendations for the use of the Delphi method in health care, others deviated greatly.

Conclusions

Although the Delphi method is a common consensus process used in orthotics and prosthetics research, study methods vary and do not always follow recommended guidelines. Guidelines for future Delphi processes in orthotics and prosthetics research can be developed based on the data collected in this review. It is likely that there will be an increase in the number of Delphi studies conducted in this field in the future. Understanding the way this method has been implemented in previous studies can inform the design of future studies and may result in a more consistent application of this valuable research method.
Exploring substance use and mental health for minority transgender youth: Implications for advanced practice nurses
Authors: Raynor Phyllis A. , Nation Austin , Outlaw Freida
Published: November 2019

Background:

Transgender youth, particularly if they are transgender female and of a minority racial or ethnic group (i.e., minority transgender youth [MTY]), are known to have higher incidence of new HIV infections, substance abuse, and suicidality when compared with cisgender youth. Mental health disparities and substance use among MTY, between the ages of 13–24 years, have been underexplored in the United States, although they have serious public health concerns contributing to morbidity and mortality.

Objectives:

To examine the US literature to discover what is known about the intersection of substance use, mental health disorders, and associated health risks for MTY.

Data sources:

An integrative review exploring experimental and nonexperimental research was conducted from 2010 to 2018 using Cumulative Index for Nursing and Allied Health (CINAHL), PsycINFO, and PubMed. Articles were selected if the research identified MTY, mental health and/or substance use risks, data-driven outcomes, or considerations that could potentially influence MTY outcomes. Ten articles were included in the final selection.

Conclusions:

All studies addressed mental health, substance use, and/or health risks, although many of the articles explored all transgender youth outcomes without a particular focus on MTY. Identified factors linked to poor health outcomes included socioeconomic vulnerability, substance use, mood disorders, self-harm, and risky sexual behaviors.

Implications for practice:

The authors have provided recommendations regarding culturally appropriate, compassionate, evidence-informed practices for engaging MTY and their families to promote greater well-being for all youth, regardless of gender identity.
“Now that you've got that coverage”: Promoting use of a regular source of primary care among homeless persons
Authors: Dickins Kirsten , Buchholz Susan W. , Ingram Diana , Hamilton Rebekah J. , Braun Lynne T. , Karnik Niranjan S. , Earle Melinda
Published: November 2019

Background:

The growing number of homeless persons in the United States demonstrates greater morbidity and mortality than the population as a whole. Homeless persons are often without a regular source of primary care. Homeless persons use emergency departments and are hospitalized at higher rates than nonhomeless persons. In 2010, the enactment of the Affordable Care Act expanded access to primary care services. Nurse practitioners were at the forefront of its subsequent implementation.

Purpose:

The purpose of this qualitative study was to explore the factors that influence establishing and maintaining a regular source of primary care among homeless persons.

Methodological orientation:

In 2017, semistructured interviews were conducted in a federally qualified health center that serves predominately homeless persons.

Sample:

A purposive convenience sample included adult health center users (N = 20). The majority of participants were insured (90%), African American (70%), and male (65%).

Conclusions:

Thematic analysis revealed five facilitators: sense of community, mutual patient–provider respect, financial assurance, integrated health services, and patient care teams. To establish and maintain use of a regular primary care source, homeless persons desire to experience a sense of community, feel respected by their provider/staff, and have certainty that costs will not exceed their capacity to pay. Integrated care models that leverage a multidisciplinary team approach support the use of a regular primary care source.

Implications for practice:

Actualizing achievable strategies that promote the consistent use of a regular primary care source can reduce use of avoidable emergency and hospital-based services, thereby improving health outcomes among homeless persons.
Central Catheter‐related Bloodstream Infection Rates in Children on Home Parenteral Nutrition
Authors: Trivić Ivana , Mišak Zrinjka , Kerman Višnjica , Prlić Hrvoje , Kolaček Sanja , Hojsak Iva
Published: November 2019

Reliable venous access is prerequisite for patients receiving long‐term parenteral nutrition (PN). Central venous catheters are, however, an important risk factor for the development of potentially lethal complications, including catheter‐related bloodstream infection (CRBSI). We have retrospectively assessed the incidence of CRBSIs in children on long‐term PN who were treated at the Children's Hospital Zagreb from January 2011 until January 2019 and the cost effectiveness of the use of taurolidine line locks in children at home PN (HPN). During this period 48 children received long‐term PN and 24 children were discharged to HPN. The rate of CRBSI 1.15/1000 catheter days in total; 2.35/1000 days in the hospital; and 0.48/1000 days at home. If taurolidine line lock was used every day of PN for children on HPN total costs would exceed existing CRBSI treatment costs >5 times.
Normal Gamma Glutamyl Transferase Levels at Presentation Predict Poor Outcome in Biliary Atresia
Authors: Shankar Sahana , Bolia Rishi , Foo Hee Wei , D'Arcy Colleen E , Hardikar Natasha , Wensing Martin , Hardikar Winita
Published: November 2019

Objectives:

Gamma‐glutamyl transferase levels (GGT) are typically elevated in biliary atresia (BA), but normal GGT levels have been observed. This cohort of “normal GGT” BA has neither been described nor has the prognostic value of GGT level on outcomes in BA. We aimed to describe outcomes of a single‐centre Australian cohort of infants with BA and assess the impact of GGT level at presentation on outcomes in BA.

Methods:

Infants diagnosed with BA between 1991 and 2017 were retrospectively analysed. Outcomes were defined as survival with native liver, liver transplantation (LT), and death. Patients were categorized into normal (<200I U/L) or high GGT groups based on a mean of 3 consecutive GGT values done before Kasai portoenterostomy (KPE). Baseline parameters, age at surgery, clearance of jaundice (COJ), and outcomes were compared between the 2 groups.

Results:

One hundred thirteen infants underwent KPE at median 61 (30–149) days. At a median follow‐up of 14.2 (0.9–26.3) years, 35% (39/113) patients were surviving with native liver, 55% (62/113) underwent LT and 11% (12/113) died pretransplant. 12.3% (14/113) patients had normal GGT. Age at KPE and time to COJ were similar between normal and high GGT groups. Normal GGT group had shorter time from KPE to LT (11 vs 18 months, P = 0.02), underwent LT at a younger age (14 vs 20 months, P = 0.04), and had poorer transplant‐free survival (P = 0.04) than high GGT group.

Conclusions:

12.3% of infants with BA had normal GGT levels at diagnosis. Low GGT levels at presentation in BA was associated with a poorer outcome.
Developing a Hospital-Based Postpartum Depression Education Intervention for Perinatal Nurses
Authors: Lewis Nikiya L.
Published: November 2019

Perinatal nurses in the hospital setting have prolonged contact with new mothers and are in a vital position to provide postpartum depression patient education. This study describes the development and implementation of an education intervention that led to nurses’ increased knowledge and provision of postpartum depression patient education. The framework can be utilized by nursing professional development practitioners to develop staff education programs to improve patient education in various clinical settings.
Calling Out MS Fatigue: Feasibility and Preliminary Effects of a Pilot Randomized Telephone-Delivered Exercise Intervention for Multiple Sclerosis Fatigue
Authors: Kratz Anna L. , Atalla Mareena , Whibley Daniel , Myles Abigail , Thurston Taylor , Fritz Nora E.
Published: November 2019

Background and Purpose:

Fatigue is a common and debilitating symptom of multiple sclerosis (MS). Exercise therapy is effective in reducing MS-related fatigue; however, its feasibility, acceptability, and effectiveness when delivered over the telephone remain unknown. This randomized study aimed to determine the feasibility and acceptability of a telephone-delivered exercise intervention for MS-related fatigue. In addition, pre-/postchange in fatigue and secondary outcomes were compared with an otherwise identical in-person delivered exercise intervention.

Methods:

Twenty participants with MS and clinically significant fatigue were randomized to 8 sessions of either telephone (n = 10) or in-person (n = 10) delivered exercise therapy. Primary outcome measures concerned feasibility (number of sessions attended), acceptability (Client Satisfaction Questionnaire), and fatigue (Fatigue Severity Scale and two 11-point numeric rating scales: fatigue intensity and interference). Data on a range of secondary outcome measures were also collected.

Results:

There was no difference in average session attendance by group (telephone group: 7.6 ± 1.3 sessions; in-person 7.8 ± 0.42). Acceptability and reductions in fatigue were observed regardless of group, and improvements in a range of secondary outcomes were comparable.

Discussion and Conclusions:

A telephone-delivered exercise intervention that targets MS-related fatigue is both feasible and acceptable. Primary and secondary outcome measures signaled that telephone-delivered exercise may be an effective mode of delivery that overcomes barriers to care in persons with MS and warrants testing in larger efficacy trials.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A293).
Screening for Trisomies by cfDNA Testing of Maternal Blood in Twin Pregnancy: Update of the Fetal Medicine Foundation Results and Meta-analysis
Authors: Gil M. M. , Galeva S. , Jani J. , Konstantinidou L. , Akolekar R. , Plana M. N. , Nicolaides K. H.
Published: November 2019

(Abstracted from Ultrasound Obstet Gynecol 2019;53:734–742)

Cell-free DNA (cfDNA) analysis of maternal blood is useful and effective when screening for trisomies 21, 18, and 13 in singleton pregnancies. However, in twin pregnancies, data on cfDNA tests are much more limited: in a previous literature review and meta-analysis, there were only 5 prospective studies.