bluuebunny/crossref_metadata_2025 huggingface dataset:
Pubic Symphysis Septic Arthritis Caused by Pasteurella multocida
Authors: French Brianna , Myers Joseph P.
Published: November 2019

Pubic symphysis septic arthritis is rare. To our knowledge, pubic symphysis septic arthritis caused by Pasteurella multocida has not been previously reported. A 79-year-old woman presented to the emergency department with a 3-day history of progressively severe left groin pain and swelling with unintentional 20-lb weight loss. Physical examination was negative except for the presence of a tender, fluctuant mass approximately 6 × 2-cm dimensions extending from the midpubic symphysis area to the left femoral crease. Computed tomography scan of the abdomen/pelvis confirmed a multiloculated mass in the area of the pubic symphysis measuring 7.6 × 2.1 × 5.5 cm with fluid extending posteriorly behind the pubic symphysis and erosion of bone in the pubic symphysis. Ultrasound-guided aspiration of the mass yielded 6 mL of purulent fluid with many Gram-negative bacilli on Gram-stained smear and a pure growth P. multocida on culture. Intravenous piperacillin/tazobactam was begun. The patient underwent operative drainage of the mass, and operative cultures revealed pure growth of P. multocida. Subsequently obtained history revealed that the patient has 1 pet cat with only 1 remaining tooth and the patient has not been bitten, scratched, or licked by the cat. Patient was treated with parenteral piperacillin/tazobactam and then ampicillin/sulbactam followed by oral amoxicillin/clavulanate. She rapidly returned to normal activities with no recurrence at 3 months' follow-up.
Wnt signaling contributes to withdrawal symptoms from opioid receptor activation induced by morphine exposure or chronic inflammation
Authors: Wu Mingzheng , Li Zehua , Liang Lei , Ma Pingchuan , Cui Dong , Chen Peng , Wu Genhao , Song Xue-Jun
Published: November 2019

Preventing and treating opioid dependence and withdrawal is a major clinical challenge, and the underlying mechanisms of opioid dependence and withdrawal remain elusive. We hypothesized that prolonged morphine exposure or chronic inflammation-induced μ-opioid receptor activity serves as a severe stress that elicits neuronal alterations and recapitulates events during development. Here, we report that Wnt signaling, which is important in developmental processes of the nervous system, plays a critical role in withdrawal symptoms from opioid receptor activation in mice. Repeated exposures of morphine or peripheral inflammation produced by intraplantar injection of complete Freund's adjuvant significantly increase the expression of Wnt5b in the primary sensory neurons in dorsal root ganglion (DRG). Accumulated Wnt5b in DRG neurons quickly transmits to the spinal cord dorsal horn (DH) after naloxone treatment. In the DH, Wnt5b, acts through the atypical Wnt-Ryk receptor and alternative Wnt-YAP/TAZ signaling pathways, contributing to the naloxone-precipitated opioid withdrawal-like behavioral symptoms and hyperalgesia. Inhibition of Wnt synthesis and blockage of Wnt signaling pathways greatly suppress the behavioral and neurochemical alterations after naloxone-precipitated withdrawal. These findings reveal a critical mechanism underlying naloxone-precipitated opioid withdrawal, suggesting that targeting Wnt5b synthesis in DRG neurons and Wnt signaling in DH may be an effective approach for prevention and treatment of opioid withdrawal syndromes, as well as the transition from acute to chronic pain.
What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments
Authors: Kamper Steven J. , Logan Gabrielle , Copsey Bethan , Thompson Jacqueline , Machado Gustavo C. , Abdel-Shaheed Christina , Williams Christopher M. , Maher Christopher G. , Hall Amanda M.
Published: November 2019

International clinical practice guidelines for low back pain (LBP) contain consistent recommendations including universal provision of information and advice to remain active, discouraging routine referral for imaging, and limited prescription of opioids. This systematic review describes usual care provided by first-contact physicians to patients with LBP. Studies that reported the assessments and care provided to people with LBP in family practice and emergency departments (EDs) from January 2000 to May 2019 were identified by searches of PubMed, EMBASE, and CINAHL. Study quality was assessed with reference to representativeness of samples, potential misclassification of patients, potential misclassification of outcomes, inconsistent data and precision of the estimate, and the findings of high-quality studies were prioritized in the data synthesis. We included 26 studies that reported data from almost 195,000 patients: 18 from family practice, and 8 from EDs. Less than 20% of patients with LBP received evidence-based information and advice from their family practitioner. Around 1 in 4 patients with LBP received referral for imaging in family practice and 1 in 3 in EDs. Up to 30% of patients with LBP were prescribed opioids in family practice and up to 60% in EDs. Large numbers of patients who saw a physician for LBP received care that is inconsistent with evidence-based clinical practice guidelines. Usual care included overuse of imaging and opioid prescription and underuse of advice and information. Suboptimal care may contribute to the massive burden of the condition worldwide.
Patient, Caregiver, and Clinician Perceptions of Ventricular Assist Device Self-care Education Inform the Development of a Simulation-based Mastery Learning Curriculum
Authors: Barsuk Jeffrey H. , Cohen Elaine R. , Harap Rebecca S. , Grady Kathleen L. , Wilcox Jane E. , Shanklin Kerry B. , Wayne Diane B. , Cameron Kenzie A.
Published: November 2019

Background

Patients who undergo ventricular assist device (VAD) implantation and their caregivers must rapidly learn a significant amount of self-care skills and knowledge.

Objective

The aim of this study was to explore patient, caregiver, VAD coordinator, and physician perspectives and perceptions of existing VAD self-care training to inform development of a simulation-based mastery learning (SBML) curriculum to teach patients and caregivers VAD self-care skills and knowledge.

Methods

We conducted semistructured, in-person interviews with patients with a VAD, their caregivers, VAD coordinators, and physicians (cardiac surgeons, an infectious disease physician, and advanced heart failure cardiologists). We used a 2-cycle team-based iterative inductive approach to coding and analysis.

Results

We interviewed 16 patients, 12 caregivers, 7 VAD coordinators, and 11 physicians. Seven major themes were derived from the interviews including (1) identification of critical curricular content, (2) need for standardization and assessment, (3) training modalities, (4) benefits of repetition, (5) piercing it all together, (6) need for refresher training, and (7) provision of training before implant.

Conclusions

Findings from this study suggest that SBML is a natural fit for the high-risk tasks needed to save VAD self-care. The 7 unique training-related themes derived from the qualitative data informed the design and development of a VAD SBML self-care curriculum.
The nurse practitioner workforce: One rural state's experience of comparing state data with national trends
Authors: Owens Rhoda A. , Zwilling Jana G.
Published: November 2019

Background:

There is a great need for primary care across the country especially in rural and underserved areas. Nurse practitioners (NPs) are filling these access gaps by providing high-quality, cost-effective primary care. However, one rural midwestern state does not address NP workforce data separately from other types of nursing data. In addition, these data are not included in the state's overall primary care workforce. Therefore, the data cannot be compared to the state's needs or national workforce trends.

Purpose:

The purpose of this investigation was to describe North Dakota's (NDs) NP workforce and compare this with national data.

Methods:

A cross-sectional descriptive design was used to collect and analyze NP workforce data from several sources. State Board of Nursing licensure data were used for description of the NDs current NP workforce. Six other data sources or reports were used to complete the data picture. State information was then compared with national NP survey results.

Results:

Both ND and national data sources reported the largest percentage of NPs certified in either primary care or adult care and practice primary care at either an outpatient or inpatient setting. North Dakota has a higher percentage of NPs working in primary care as compared with the national numbers. However, inconsistent categories are used in ND's NP workforce data and national surveys making comparisons difficult.

Implications for practice:

Accurate inclusion of NP workforce data in the overall health care workforce data will better guide state and national policy makers on necessary changes to decrease provider shortages and promote increased access to rural primary care services.
Persistent Soiling Affects Quality of Life in Children With Hirschsprung's Disease
Authors: Espeso Lucile , Coutable Audrey , Flaum Valérie , Rebeuh Julie , Lavrand Frédéric , Podevin Guillaume , Lamireau Thierry , Enaud Raphaël , Talon Isabelle
Published: November 2019

Objective:

This multicentric study aimed to evaluate the quality of life (QOL) in children with Hirschsprung's disease (HD).

Methods:

HD patients aged from 6 to 18 years and followed‐up in 2 French pediatric surgery centers were included in this study. QOL was assessed using the HAQL questionnaires according to age (6–11 and 12–18), filled by patients and their parents (proxy reports) and correlated with initial disease characteristics, nutritional status, and functional score of Krickenbeck.

Results:

Sixty‐three patients were included. The acquisition of satisfactory voluntary bowel movements was found in only 50% of the 6 to 11 years old and 68% of the teenagers. Seventy percentage of the children and 55% of teenagers had soiling issues. The overall HAQLproxy6‐‐11 score was 528/700; best scores were found for “fecal continence” (94/100), “social functioning” (94/100), and “urinary continence” (92/100) whereas the worst scores were for “general well‐being” (64/100) and “diurnal fecal continence” (58/100). The overall HAQLproxy12‐‐16 score was 607/700; best scores were for “urinary continence” (96/100) and “social functioning” (93/100). In a multivariate analysis, soiling was the only factor significantly associated with low QOL (P = 0.03).

Conclusions:

Soiling remains frequent in children operated on for HD and negatively affects their QOL. Assessment and treatment of soiling should be the priority for medical teams in the follow‐up of these children.
Cardiometabolic Risk Factors and Benign Gynecologic Disorders
Authors: AlAshqar Abdelrahman , Patzkowsky Kristin , Afrin Sadia , Wild Robert , Taylor Hugh S. , Borahay Mostafa A.
Published: November 2019

Importance

While it has long been known that polycystic ovarian syndrome is associated with cardiometabolic risk factors (CMRFs), there is emerging evidence that other benign gynecologic conditions, such as uterine leiomyomas, endometriosis, and even hysterectomy without oophorectomy, can be associated with CMRFs. Understanding the evidence and mechanisms of these associations can lead to novel preventive and therapeutic interventions.

Objective

This article discusses the evidence and the potential mechanisms mediating the association between CMRFs and benign gynecologic disorders.

Evidence Acquisition

We reviewed PubMed, EMBASE, Scopus, and Google Scholar databases to obtain plausible clinical and biological evidence, including hormonal, immunologic, inflammatory, growth factor–related, genetic, epigenetic, atherogenic, vitamin D–related, and dietary factors.

Results

Cardiometabolic risk factors appear to contribute to uterine leiomyoma pathogenesis. For example, obesity can modulate leiomyomatous cellular proliferation and extracellular matrix deposition through hyperestrogenic states, chronic inflammation, insulin resistance, and adipokines. On the other hand, endometriosis has been shown to induce systemic inflammation, thereby increasing cardiometabolic risks, for example, through inducing atherosclerotic changes.

Conclusion and Relevance

Clinical implications of these associations are 2-fold. First, screening and early modification of CMRFs can be part of a preventive strategy for uterine leiomyomas and hysterectomy. Second, patients diagnosed with uterine leiomyomas or endometriosis can be screened and closely followed for CMRFs and cardiovascular disease.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this activity, the learner should be better able to identify the association between cardiometabolic risk factors and benign gynecologic disorders; explain the potential underlying mechanisms of such association; and discuss their clinical implications on health and health care.
Physical Activity: Impact on Survival in Gynecologic Cancer
Authors: Tucker Katherine , Staley Stuart-Allison , Clark Leslie H. , Soper John T.
Published: November 2019

Importance

Physical activity has many important health benefits. There is also growing evidence that physical activity plays a role in the prevention and prognosis of multiple cancers, including gynecologic malignancies. Despite the many benefits of physical activity, the number of individuals meeting physical activity recommendations remains low.

Objective

To examine the role that physical activity plays in the prevention, treatment, and prognosis of gynecologic malignancies and to review the feasibility of physical activity interventions among gynecologic cancer survivors.

Evidence Acquisition

A PubMed search was performed using relevant terms to identify journal articles related to the proposed subject. The websites of multiple national and international organizations were also used to obtain up-to-date guidelines and recommendations.

Results

Physical activity appears to decrease the risk of ovarian, endometrial, and cervical cancer, with the strongest evidence of this association seen in endometrial cancer. Although the literature is scarce, participation in physical activity is feasible during active treatment for gynecologic cancers and may decrease symptom burden and increase chemotherapy completion rates. Gynecologic cancer survivors are motivated to increase physical activity, and lifestyle intervention programs are feasible and well received among this population.

Conclusions and Relevance

Health care providers caring for women with gynecologic malignancies must counsel patients regarding the importance of physical activity. This should include a discussion of the health benefits and, specifically, the cancer-related benefits. A personalized approach to physical activity intervention is essential.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to summarize the physical activity recommendations for adults; describe health benefits of physical activity and review the hypotheses for its role in cancer; assess the general conclusions for the role of physical activity in the setting of gynecologic cancer; and propose considerations or modifications to physical activity in patients who may have treatment or disease-related adverse effects.
Bell’s Palsy in Pregnancy
Authors: Evangelista Victor , Gooding Megan S. , Pereira Leonardo
Published: November 2019

Importance

The incidence and severity of Bell's palsy are increased in pregnancy, with most cases arising in the third trimester or postpartum period. It has been indicated that pregnancy-related Bell's palsy has worse long-term outcomes, such as complete facial paralysis, compared with nonpregnant women and males.

Objective

This article outlines the existing literature diagnosis, treatment, and prognosis of Bell's palsy, specifically looking at the implications during pregnancy. The aim is to provide a reference for physicians treating Bell's palsy in pregnant patients.

Evidence Acquisition

Existing literature on neuropathies during pregnancy, clinical presentation, and treatment of Bell's palsy was reviewed through a MEDLINE and PubMed search. Referenced articles were reviewed and used as primary source materials as appropriate.

Results

Multiple clinical tests of motor function are used to establish the diagnosis of Bell's palsy including Wartenberg's lid vibration test, an abnormal eyelash occlusion test, and asymmetry with voluntary and spontaneous smiling. Optimal treatment for Bell's palsy remains controversial. While early treatment with corticosteroids for 10 days is highly recommended, the simultaneous use of antiviral therapy is frequently performed but has less supporting evidence. Pregnancy itself and delay in treatment initiation are associated with persistent nerve palsy, whereas treatment started within 3 days of symptom onset is usually associated with full recovery. Recurrence of Bell's palsy in pregnancy is rare.

Conclusions and Relevance

To date, there is limited literature in the diagnosis and treatment of Bell's palsy during pregnancy. The prognosis of Bell's palsy in pregnancy is worse than in nonpregnant individuals. Early treatment with steroids is recommended, but not without risk.

Target Audience

Obstetricians and gynecologists, family physician.

Learning Objectives

After completing this activity, the learner should be better able to identify clinical features and presentations of Bell's palsy; differentiate between the treatment and prognosis of Bell's palsy during pregnancy versus nonpregnancy; and assess the risks and benefits of treatment of Bell's palsy with corticosteroids and antivirals in pregnant women.
Short-term Health-Related Quality of Life After Hysterectomy Compared With Myomectomy for Symptomatic Leiomyomas
Authors: Nicholson Wanda K. , Wegienka Ganesa , Zhang Shuaiqi , Wallace Kedra , Stewart Elizabeth , Laughlin-Tommaso Shannon , Thomas Laine , Jacoby Vanessa L. , Marsh Erica E. , Wise Lauren , Borah Bijan J. , Spies James , Venable Sateria , Anchan Raymond M. , Maxwell G. Larry , Diamond Michael , Lytle Barbara , Myers Evan R.
Published: November 2019

(Abstracted from Obstet Gynecol 2019;134:261–269)

One or more leiomyomas will be detected by abdominal or pelvic imaging by age 50 years in 70% of white women and more than 80% of African American women. Most leiomyomas are asymptomatic, but 25% to 30% of affected women will experience pelvic pain, heavy or prolonged menstrual bleeding, bulk symptoms (ie, pelvic pressure or genitourinary symptoms), and/or reproductive dysfunction.
Universal Endometrial Cancer Tumor Typing: How Much Has Immunohistochemistry, Microsatellite Instability, and MLH1 Methylation Improved the Diagnosis of Lynch Syndrome Across the Population?
Authors: Kahn Ryan M. , Gordhandas Sushmita , Maddy Brandon Paul , Nelson Becky Baltich , Askin Gulce , Christos Paul J. , Caputo Thomas A. , Chapman-Davis Eloise , Holcomb Kevin , Frey Melissa K.
Published: November 2019

(Abstracted from Cancer 2019;125(18):3172–3183)

Lynch syndrome caused by germline mutations in several DNA mismatch repair (MMR) proteins is the most common cause of hereditary and endometrial cancers. Lynch syndrome accounts for approximately 2% to 3% of all endometrial cancers, although the lifetime risk of endometrial cancer for patients with Lynch syndrome varies depending on the specific mutation.
Delayed Recognition of Lower Urinary Tract Injuries Following Hysterectomy for Benign Indications: A NSQIP-Based Study
Authors: Bretschneider C. Emi , Casas-Puig Viviana , Sheyn David , Hijaz Adonis , Ferrando Cecile A.
Published: November 2019

(Abstracted from Am J Obstet Gynecol 2019;221:132.e1–132.e13)

The occurrence of lower urinary tract (LUT) injury at the time of hysterectomy for benign indications is rare. Reported rates range from 0.3% to 1.3%.
Routine HIV Test Results in 6 US Clinical Laboratories Using the Recommended Laboratory HIV Testing Algorithm With Geenius HIV 1/2 Supplemental Assay
Authors: Wesolowski Laura G. , Chavez Pollyanna R. , Cárdenas Ana María , Katayev Alex , Slev Patricia , Valsamakis Alexandra , Wang Yun F. , Yao Joseph D. , Dougherty Caitlin , Gillim-Ross Laura , Harmon Christopher , Delaney Kevin P.
Published: November 2019

Background

Geenius HIV 1/2 Supplemental Assay (Geenius; Bio-Rad Laboratories) is the only Food and Drug Administration–approved HIV-1/HIV-2 antibody differentiation test for the second step in the HIV laboratory testing algorithm. We characterized the occurrence of true HIV-1 and HIV-2 infections as well as false results in 6 US clinical laboratories using Geenius.

Methods

We examined routine HIV testing outcome data from the time the laboratories began using the algorithm with Geenius until September 30, 2017. We calculated the positive predictive value for Geenius HIV-1 and HIV-2 reactivity separately.

Results

Of 5,046,684 specimens tested, 41,791 had reactive antigen/antibody test results. Most specimens with reactive antigen/antibody results were HIV-1 antibody–positive established infections (n = 32,421), 1,865 of which also had indeterminate HIV-2 bands present. Ninety-three specimens were HIV-2 antibody positive or untypable for HIV-1/HIV-2 antibody. Acute HIV-1 infections were found in 528 specimens; 881 specimens lacked the nucleic acid test to determine the possibility of acute HIV-1 infection. False-positive antigen/antibody test results were present in 7505 specimens. Few specimens (n = 363) had false-positive antigen/antibody results with indeterminate Geenius and negative HIV-1 nucleic acid test results. The positive predictive values of Geenius reactivity were 99.4% for HIV-1 and 4.3% for HIV-2.

Conclusions

Routine testing using the laboratory testing algorithm with Geenius resulted in most specimens resolving as HIV negative or HIV-1 positive. The occurrence of indeterminate HIV-2 bands with a Geenius final assay interpretation of HIV-1 positive was more common than true HIV-2 infections. Reporting indeterminate HIV-2 results in this situation may cause confusion with interpreting HIV infection status.
Effect of Dextrose Prolotherapy on Pain Intensity, Disability, and Plantar Fascia Thickness in Unilateral Plantar Fasciitis
Authors: Mansiz-Kaplan Basak , Nacir Baris , Pervane-Vural Secil , Duyur-Cakit Burcu , Genc Hakan
Published: November 2019

Objective

The aim of the study was to evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis through comparison with a control group.

Design

In this double-blind, randomized, controlled study, the patients were divided into two groups. The prolotherapy group (n = 30) was administered 5 ml of 30% dextrose, 4 ml of saline, and 1 ml of 2% lidocaine mixture (15% dextrose solution) and the control group was given 9 ml of saline and 1 ml of 2% lidocaine mixture twice at a 3-wk interval. During the 15-wk follow-up period, pain intensity was measured using the visual analog scale during activity and at rest. The foot function index was used to measure pain and disability. The plantar fascia thickness was measured by ultrasonography. The measurements were undertaken before treatment and at posttreatment weeks 7 and 15.

Results

Improvements in visual analog scale during activity, at rest, foot function index (all subgroups), and plantar fascia thickness measured at the 7th and 15th weeks were significantly higher in the prolotherapy group compared with the control group (P < 0.001).

Conclusions

Dextrose prolotherapy has efficacy up to 15 wks and can be used as an alternative method in the treatment of chronic resistant plantar fasciitis.
Knee Buckling (Negative Myoclonus) Associated With Clozapine: Reports on 3 Cases
Authors: Uzun Özcan , Bolu Abdullah , Taşçi Azize Beril , Oğur Begüm
Published: November 2019

Background

Negative myoclonus is rarely seen in the clinical setting. It can be involved in some central nervous system pathologies. It has also been observed after antipsychotic treatment.

Case Reports

In this article, we will present 3 cases diagnosed with negative myoclonus in a 120-bed university-affiliated hospital within the past 7 years. Based on our clinical experience, it was observed that myoclonic jerk was a rare condition that started with suddenly dose changes. Patients showed good improvement in response to dose reduction.

Conclusions

Since the number of reported cases on negative myoclonus is limited, there is still a lack of well-established consensus on the management of this disease. It can be concluded that myoclonic jerk may be dose-dependent, sudden dose changes may be effective, anticonvulsants are not effective in all cases, and treatment can be achieved by reducing the dose.
Systematic Evaluation of Levodopa Effect on Visual Improvement in Amblyopia: A Meta-analysis
Authors: Wang Su-Ping , Li Qiao-Xian , Li Shaomin
Published: November 2019

Purpose

This study aims to evaluate the effectiveness of levodopa as a therapeutic drug in the treatment of children and adults with amblyopia.

Methods

We performed a systematic review and meta-analysis with randomized controlled trials of levodopa and placebo in the treatment of amblyopia. All data were identified and extracted from the PubMed, EMBASE, Cochrane libraries, and the Chinese knowledge resource integration database.

Results

After screening the literature and evaluating the quality, 11 studies met the criteria from 308 studies. The mean difference of LogMAR visual acuity between levodopa and the placebo group was −0.1031 (95% confidence interval, −0.11 to −0.09; P < 0.0001). The improvement of visual acuities of the subgroup of younger patients with amblyopia was significantly higher than that of the placebo group (P < 0.0001). Increasing the dosage of levodopa and prolonging the treatment can significantly improve the curative effect.

Conclusions

Levodopa is effective in the treatment of amblyopia by prolonging the treatment, especially for young patients.
Medical Adhesives-Related Skin Injury in a Pediatric Intensive Care Unit
Authors: Kim Min Ji , Jang Jeong Mi , Kim Hye Kyung , Heo Hyun Ju , Jeong Ihn Sook
Published: November 2019

PURPOSE:

The purpose of this study was to identify the purpose, type, and site of medical adhesives (MAs) used for patient care and to measure the incidence of medical adhesive-related skin injury (MARSI) among patients in a pediatric intensive care unit (PICU).

DESIGN:

A prospective observational study.

SUBJECTS AND SETTING:

The sample comprised 60 children hospitalized at a 13-bed PICU in a university-affiliated tertiary care hospital in Yangsan (southeastern Korea) from August 2 to October 25, 2017. The median age was 2.9 months, and the composition of male and female was 34 (56.7%) and 26 (43.3%), respectively.

METHODS:

The skin of all participants was examined by first-line staff nurses every shift and occurrences of MARSI were confirmed by a wound care specialist. Characteristics of MA use were analyzed with descriptive statistics, and incidence rates of MARSI were calculated using 3 methods: (1) rate per 100 patients, (2) rate per 100 MAs, and (3) rate per 1000 days of MA use. Chi-squared (χ2) tests were conducted to analyze associations between MARSI and sex, age group, and primary service type (medical vs surgical).

RESULTS:

The total number of MAs used was 414 and the total day of use of MAs was 1424.8. Medical adhesives most frequently used were endotracheal tube fixation devices (55/414) and fixation devices for the face (167/414). The number of MARSI occurrences was 35 cases in 23 patients; skin stripping was the most common form of MARSI (26/35). The incidence rate was 58.3 MARSIs per 100 patients, 8.5 MARSIs per 100 MAs, and 24.6 MARSIs per 1000 days of MA use. The MARSI incidence rate was significantly different based on age group (P = .014).

CONCLUSION:

We observed a frequent occurrence of MARSI among patients in the PICU, especially in patients requiring long-term use of MAs such as central line dressings or in MAs placed in high-moisture areas such as near an endotracheal tube. We highlight the importance of regular skin inspection and frequent but gentle replacement of MAs for prolonged use of MAs in critically ill children.
Friction Injury Versus Deep Tissue Injury: Level of Tissue Involvement
Authors: Berke Christine Thies
Published: November 2019

BACKGROUND:

Friction injuries are postulated to be caused by acute or chronic abrasive/friction forces during sliding, scooting, or slouching behaviors prevalent in individuals with impaired mobility and particularly when transferring and repositioning.

CASES:

Patient histories for 2 cases were collected for determination of wound etiology. Outpatient wound clinic visits including photographic documentation for both cases were reviewed, compared, and contrasted for level of tissue involvement with each wound type/etiology. With serial sharp debridement of both wounds, differences were noted in level of tissue involvement/destruction. Healing progression and scarring were also different for both wounds.

CONCLUSION:

A comparison of 2 cases is presented to compare and contrast level of tissue involvement and destruction in an acute friction injury (top-down) versus a deep tissue injury (bottom-up). The importance of knowing a wound's history is critical for accurate diagnosis and coding.
International Consensus Results
Authors: Colwell Janice C. , Bain Kimberly A. , Hansen Anne Steen , Droste Werner , Vendelbo Grethe , James-Reid Sarah
Published: November 2019

Evidence indicates that a common problem for the person with an ostomy is pouch leakage and the development of peristomal skin irritation, which can negatively affect quality of life. While it is clear that the pouching system seal leakage can cause profound problems for the person with an ostomy, little information is available on interventions that focus on leakage. To address this gap, an international group of ostomy nurse experts was convened to develop consensus-based practice guidelines to assist ostomy nurses in determining the best pouching system for the patient. The outcomes of these guidelines for the person with a stoma are to decrease leakage and increase security and confidence leading to an increased quality of life. A large-scale Modified Delphi Consensus-Building Process was used to identify key factors in assessing body and stoma profiles to determine the best pouching system. The resulting consensus provides practice guidelines on how to assess body and stoma profiles, engage and educate patients, and when to follow up with patients after hospital discharge or product change.
Tsukamurella asaccharolytica sp. nov., Tsukamurella conjunctivitidis sp. nov. and Tsukamurella sputi sp. nov., isolated from patients with bacteraemia, conjunctivitis and respiratory infection in Hong Kong
Authors: Teng Jade L. L. , Fong Jordan Y. H. , Fok Kenny M. N. , Lee Hwei Huih , Chiu Tsz Ho , Tang Ying , Ngan Antonio H. Y. , Wong Samson S. Y. , Que Tak-Lun , Lau Susanna K. P. , Woo Patrick C. Y.
Published: November 2019

Three bacterial strains, HKU70T, HKU71T and HKU72T, were isolated from the conjunctival swab, blood and sputum samples of three patients with conjunctivitis, bacteraemia and respiratory infection, respectively, in Hong Kong. The three strains were aerobic, Gram-stain positive, catalase-positive, non-sporulating and non-motile bacilli and exhibited unique biochemical profiles distinguishable from currently recognized

Tsukamurella

species. 16S rRNA, secA, rpoB and groEL gene sequence analyses revealed that the three strains shared 99.6-99.9, 94.5-96.8, 95.7-97.8 and 97.7-98.9 % nucleotide identities with their corresponding closest

Tsukamurella

species respectively. DNA–DNA hybridization confirmed that they were distinct from other known species of the genus

Tsukamurella

(26.2±2.4 to 36.8±1.2 % DNA–DNA relatedness), in line with results of in silico genome-to-genome comparison (32.2–40.9 % Genome-to-Genome Distance Calculator and 86.3–88.9 % average nucleotide identity values]. Fatty acids, mycolic acids, cell-wall sugars and peptidoglycan analyses showed that they were typical of members of

Tsukamurella

. The G+C content determined based on the genome sequence of strains HKU70T, HKU71T and HKU72T were 69.9, 70.2 and 70.5 mol%, respectively. Taken together, our results supported the proposition and description of three new species, i.e. Tsukamurella sputi HKU70T (=JCM 33387T=DSM 109106T) sp. nov., Tsukamurella asaccharolytica HKU71T (=JCM 33388T=DSM 109107T) sp. nov. and Tsukamurella conjunctivitidis HKU72T (=JCM 33389T=DSM 109108T) sp. nov.
Frequency selectivity of persistent cortical oscillatory responses to auditory rhythmic stimulation
Authors: Lerousseau Jacques Pesnot , Trébuchon Agnès , Morillon Benjamin , Schön Daniele
Published: November 2019

Cortical oscillations have been proposed to play a functional role in speech and music perception, attentional selection and working memory, via the mechanism of neural entrainment. One of the most compelling arguments for neural entrainment is that its modulatory effect on ongoing oscillations outlasts rhythmic stimulation. We tested the existence of this phenomenon by studying cortical neural oscillations during and after presentation of melodic stimuli in a passive perception paradigm. Melodies were composed of ∼60 and ∼80 Hz tones embedded in a 2.5 Hz stream. Using intracranial and surface recordings in humans, we reveal consistent neural response properties throughout the cortex, well beyond the auditory regions. Persistent oscillatory activity in the high-gamma band was observed in response to the tones. By contrast, in response to the 2.5 Hz stream, no persistent activity in any frequency band was observed. We further show that our data are well-captured by a model of damped harmonic oscillator and can be classified into three classes of neural dynamics, with distinct damping properties and eigenfrequencies. This model provides a mechanistic and quantitative explanation of the frequency selectivity of auditory neural entrainment in the human cortex.

Significance statement

It has been proposed that the functional role of cortical oscillations is subtended by a mechanism of entrainment, the synchronisation in phase or amplitude of neural oscillations to a periodic stimulation. We tested whether the modulatory effect on ongoing oscillations outlasts the rhythmic stimulation, a phenomenon considered to be one of the most compelling arguments for entrainment. Using intracranial and surface recordings of human listening to rhythmic auditory stimuli, we reveal consistent oscillatory responses throughout the cortex, with persistent activity of high-gamma oscillations. On the contrary, neural oscillations do not outlast low-frequency acoustic dynamics. We interpret our results as reflecting harmonic oscillator properties - a model ubiquitous in physics but rarely used in neuroscience.
Oral feeding with probioticLactobacillus rhamnosusattenuates cigarette smoke-induced COPD in C57Bl/6 mice: Relevance to inflammatory markers in human bronchial epithelial cells
Authors: Carvalho J.L. , Miranda M. , Fialho A.K. , Castro-Faria-Neto H. , Anatriello E. , Keller A.C. , Aimbire F.
Published: November 2019

COPD is a prevalent lung disease with significant impacts on public health. Affected airways exhibit pulmonary neutrophilia and consequent secretion of pro-inflammatory cytokines and proteases, which result in lung emphysema. Probiotics act as nonspecific modulators of the innate immune system that improve several inflammatory responses. To investigate the effect ofLactobacillus rhamnosus (Lr)on cigarette smoke (CS)-induced COPD C57Bl/6 mice were treated withLrduring the week before COPD induction and three times/week until euthanasia. Forin vitroassays, murine bronchial epithelial cells as well as human bronchial epithelial cells exposed to cigarette smoke extract during 24 hours were treated withLr1 hour before CSE addition.Lrtreatment attenuated the inflammatory response both in the airways and lung parenchyma, reducing neutrophilic infiltration and the production of pro-inflammatory cytokines and chemokines. Also, Lr-treated mice presented with lower metalloproteases in lung tissue and lung remodeling. In parallel to the reduction in the expression of TLR2, TLR4, TLR9, STAT3, and NF-κB in lung tissue,Lrincreased the levels of IL-10 as well as SOCS3 and TIMP1/2, indicating the induction of an anti-inflammatory environment. Similarly, murine bronchial epithelial cells as well as human bronchial epithelial cells (BEAS) exposed to CSE produced pro-inflammatory cytokines and chemokines, which were inhibited byLrtreatment in association with the production of anti-inflammatory molecules. Moreover, the presence of Lr also modulated the expression of COPD-associated transcription found into BALF of COPD mice group, i.e.,Lrdownregulated expression of NF-κB and STAT3, and inversely upregulated increased expression of SOCS3. Thus, our findings indicate thatLrmodulates the balance between pro- and anti-inflammatory cytokines in human bronchial epithelial cells upon CS exposure and it can be a useful tool to improve the lung inflammatory response associated with COPD.
Counting the paternal founders of Austroasiatic speakers associated with the language dispersal in South Asia
Authors: Singh Prajjval Pratap , Vishwakarma Shani , Sultana Gazi Nurun Nahar , Pilvar Arno , Karmin Monika , Rootsi Siiri , Villems Richard , Metspalu Mait , Behar Doron M , Kivisild Toomas , van Driem George , Chaubey Gyaneshwer
Published: November 2019

The phylogenetic analysis of Y chromosomal haplogroup O2a-M95 was crucial to determine the nested structure of South Asian branches within the larger tree, predominantly present in East and Southeast Asia. However, it had previously been unclear how many founders brought the haplogroup O2a-M95 to South Asia. On the basis of the updated Y chromosomal tree for haplogroup O2a-M95, we analysed 1,437 male samples from South Asia for various downstream markers, carefully selected from the extant phylogenetic tree. With this increased resolution, we were able to identify at least three founders downstream to haplogroup O2a-M95 who are likely to have been associated with the dispersal of Austroasiatic languages to South Asia. The fourth founder was exclusively present amongst Tibeto-Burman speakers of Manipur and Bangladesh. In sum, our new results suggest the arrival of Austroasiatic languages in South Asia during last five thousand years.
Comparative transcriptomics of a monocotyledonous geophyte reveals shared molecular mechanisms of underground storage organ formation
Authors: Tribble Carrie M. , Martínez-Gómez Jesús , Alzate-Guarin Fernando , Rothfels Carl J. , Specht Chelsea D.
Published: November 2019

Many species from across the vascular plant tree-of-life have modified standard plant tissues into tubers, bulbs, corms, and other underground storage organs (USOs), unique innovations which allow these plants to retreat underground. Our ability to understand the developmental and evolutionary forces that shape these morphologies is limited by a lack of studies on certain USOs and plant clades. Bomarea multiflora (Alstroemeriaceae) is a monocot with tuberous roots, filling a key gap in our understanding of USO development. We take a comparative transcriptomics approach to characterizing the molecular mechanisms of tuberous root formation in B. multiflora and compare these mechanisms to those identified in other USOs across diverse plant lineages. We sequenced transcriptomes from the growing tip of four tissue types (aerial shoot, rhizome, fibrous root, and root tuber) of three individuals of B. multiflora. We identify differentially expressed isoforms between tuberous and non-tuberous roots and test the expression of a priori candidate genes implicated in underground storage in other taxa. We identify 271 genes that are differentially expressed in root tubers versus non-tuberous roots, including genes implicated in cell wall modification, defense response, and starch biosynthesis. We also identify a phosphatidylethanolamine-binding protein (PEBP), which has been implicated in tuberization signalling in other taxa and, through gene-tree analysis, place this copy in a phylogenytic context. These findings suggest that some similar molecular processes underlie the formation of underground storage structures across flowering plants despite the long evolutionary distances among taxa and non-homologous morphologies (e.g., bulbs versus tubers).
Transposon-mediated telomere destabilization: a driver of genome evolution in the blast fungus
Authors: Rahnama Mostafa , Novikova Olga , Starnes John , Chen Li , Zhang Shouan , Farman Mark
Published: November 2019

Magnaporthe oryzaeis a filamentous ascomycete fungus that causes devastating diseases of crops that include rice and wheat, and a variety of turf, forage and wild grasses. Strains from ryegrasses possess highly stable chromosome ends that undergo frequent rearrangements during vegetative growth in culture andin planta. Instability is associated with the presence of two related retrotransposons (MagnaportheoryzaeTelomericRetrotransposons - MoTeRs) inserted within the telomere repeat tracts. The objective of the present study was to determine the mechanisms by which MoTeRs promote telomere instability. Targeted cloning, restriction mapping, and sequencing of both parental and novel telomeric restriction fragments, along with MinION sequencing of DNA from three single-spore cultures, allowed us to document the molecular alterations for 109 newly-formed telomeres. Rearrangement events included truncations of subterminal rDNA sequences; acquisition of MoTeR insertions by “plain” telomeres; insertion of the MAGGY retrotransposons into MoTeR arrays; expansion and contraction of subtelomeric tandem repeats; MoTeR truncations; duplication and terminalization of internal sequences; and breakage at long, interstitial telomeres generated during MoTeR insertion. Together, our data show that when MoTeRs invade the telomeres, they can dramatically perturb the integrity of chromosome ends, leading to the generation of unprotected DNA termini whose repair has the potential to generate chromosome alterations that extend well into the genome interior.
Endocrine autoimmune disease as a fragility of immune-surveillance against hypersecreting mutants
Authors: Kohanim Yael Korem , Tendler Avichai , Mayo Avi , Friedman Nir , Alon Uri
Published: November 2019

Many endocrine organs show prevalent autoimmune diseases (AID) such as type-1-diabetes and Hashimoto’s-thyroiditis. The fundamental origins of these diseases is unclear. Here we address AID from the viewpoint of feedback control. Endocrine tissues maintain their mass by feedback-loops that balance cell proliferation and removal according to input signals related to the hormone function. Such feedback is unstable to mutant cells that mis-sense the signal, and therefore hyper-proliferate and hyper-secrete the hormone. We hypothesize that in order to prevent these mutants from expanding, each organ has a dedicated ‘autoimmune surveillance of hyper-secreting mutants’ (ASHM), in which hyper-secreting cells are preferentially eliminated, at the cost of a fragility to AID. ASHM correctly predicts the identity of the self-antigens and the presence of T-cells against these self-antigens in healthy individuals. It offers a predictive theory for which tissues get frequent AID, and which do not and instead show frequent mutant-expansion disease (e.g. hyperparathyroidism).
The immunogenic potential of recurrent cancer drug resistance mutations: anin silicostudy
Authors: Punta Marco , Jennings Victoria , Melcher Alan , Lise Stefano
Published: November 2019

Cancer somatic mutations have been identified as a source of antigens that can be targeted by cancer immunotherapy. In this work, expanding on previous studies, we analyse the immunogenic properties of mutations that are known to drive resistance to cancer targeted-therapies. We survey a large dataset of mutations that confer resistance to different drugs and occur in numerous genes and tumour types. We show that a significant number of these mutations are predictedin silicoto have immunogenic potential across a large proportion of the human population. Two of these mutations had previously been experimentally validated and it was confirmed that some of their associated neopeptides elicit T-cell responsesin vitro. The identification of potent cancer-specific antigens can be instrumental for developing more effective immunotherapies. Resistance mutations, several of which are known to recur in different patients, could be of particular interest in the context of off-the-shelf precision immunotherapies such as therapeutic cancer vaccines.
Genetic buffering and potentiation in metabolism
Authors: Poyatos Juan F.
Published: November 2019

Cells adjust their metabolism in response to mutations, but how this reprogramming depends on the genetic context is not well known. Specifically, the absence of individual enzymes can affect reprogramming and thus the impact of mutations in cell growth. Here, we examine this issue with an in silico model of Saccharomyces cerevisiae’s metabolism. By quantifying the variability in the growth rate of 10000 different mutant metabolisms that accumulated changes in their reaction fluxes, in the presence, or absence, of a specific enzyme, we distinguish a subset of modifier genes serving as buffers or potentiators of variability. We notice that the most potent modifiers refer to the glycolysis pathway and that, more broadly, they show strong pleiotropy and epistasis. Moreover, the evidence that this subset depends on the specific growing condition strengthens its systemic underpinning, a feature only observed before in a simple model of a gene-regulatory network. Some of these enzymes also modulate the effect that biochemical noise and environmental fluctuations produce in growth. Thus, the reorganization of metabolism triggered by mutations has not only direct physiological implications but also changes the influence that other mutations have on growth. This is a general result with implications in the development of cancer therapies based on metabolic inhibitors.
Mutation of kvrA causes OmpK35/36 porin downregulation and reduced meropenem/vaborbactam susceptibility in KPC-producing Klebsiella pneumoniae
Authors: Dulyayangkul Punyawee , Ismah Wan Ahmad Kamil Wan Nur , Douglas Edward J. A. , Avison Matthew B.
Published: November 2019

Meropenem/vaborbactam resistance in Klebsiella pneumoniae is associated with loss of function mutations in the OmpK36 porin. Here we identify two previously unknown loss of function mutations that confer cefuroxime resistance in K. pneumoniae. The proteins lost were NlpD and KvrA; the latter is a transcriptional repressor that controls capsule production. We demonstrate that KvrA loss reduces OmpK35 and OmpK36 porin production, which confers reduced susceptibility to meropenem/vaborbactam in a KPC-3 producing K. pneumoniae clinical isolate.