bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term enhancements in antidepressant efficacy and neurogenesis: Effects of intranasal co‐administration of neuropeptide Y 1 receptor (NPY1R) and galanin receptor 2 (GALR2) agonists in the ventral hippocampus
Authors: Beltran‐casanueva Rasiel , Hernández‐García Aracelis , Serrano‐Castro Pedro Jesús , Sánchez‐Pérez Jose Andrés , Barbancho‐Fernández Miguel Angel , García‐Casares Natalia , Fuxe Kjell , Borroto‐Escuela Dasiel O. , Narváez Manuel
Published: April 2024

This study evaluates the sustained antidepressant‐like effects and neurogenic potential of a 3‐day intranasal co‐administration regimen of galanin receptor 2 (GALR2) agonist M1145 and neuropeptide Y Y1 receptor (NPY1R) agonist [Leu31, Pro34]NPY in the ventral hippocampus of adult rats, with outcomes analyzed 3 weeks post‐treatment. Utilizing the forced swimming test (FST), we found that this co‐administration significantly enhances antidepressant‐like behaviors, an effect neutralized by the GALR2 antagonist M871, highlighting the synergistic potential of these neuropeptides in modulating mood‐related behaviors. In situ proximity ligation assay (PLA) indicated a significant increase in GALR2/NPYY1R heteroreceptor complexes in the ventral hippocampal dentate gyrus, suggesting a molecular basis for the behavioral outcomes observed. Moreover, proliferating cell nuclear antigen (PCNA) immunolabeling revealed increased cell proliferation in the subgranular zone of the dentate gyrus, specifically in neuroblasts as evidenced by co‐labeling with doublecortin (DCX), without affecting quiescent neural progenitors or astrocytes. The study also noted a significant uptick in the number of DCX‐positive cells and alterations in dendritic morphology in the ventral hippocampus, indicative of enhanced neuronal differentiation and maturation. These morphological changes highlight the potential of these agonists to facilitate the functional integration of new neurons into existing neural circuits. By demonstrating the long‐lasting effects of a brief, 3‐day intranasal administration of GALR2 and NPY1R agonists, our findings contribute significantly to the understanding of neuropeptide‐mediated neuroplasticity and herald novel therapeutic strategies for the treatment of depression and related mood disorders, emphasizing the therapeutic promise of targeting neurogenesis and neuronal maturation processes.
Should Transport Ventilators Be Used in Times of Crisis? The Use of Emergency Authorized Nonconventional Ventilators Is Associated With Mortality Among Patients With COVID-19 Acute Respiratory Distress Syndrome*
Authors: Gondhalekar Vikram B. , Gandomi Amir , Gilman Sarah L. , Hajizadeh Negin , Hasan Zubair M. , Bank Matthew A. , Rolston Daniel M. , Cohen Allison , Li Timmy , Nishikimi Mitsuaki , Narasimhan Mangala , Becker Lance , Jafari Daniel
Published: April 2024

OBJECTIVES:

Nonconventional ventilators (NCVs), defined here as transport ventilators and certain noninvasive positive pressure devices, were used extensively as crisis-time ventilators for intubated patients with COVID-19. We assessed whether there was an association between the use of NCV and higher mortality, independent of other factors.

DESIGN:

This is a multicenter retrospective observational study.

SETTING:

The sample was recruited from a single healthcare system in New York. The recruitment period spanned from March 1, 2020, to April 30, 2020.

PATIENTS:

The sample includes patients who were intubated for COVID-19 acute respiratory distress syndrome (ARDS).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was 28-day in-hospital mortality. Multivariable logistic regression was used to derive the odds of mortality among patients managed exclusively with NCV throughout their ventilation period compared with the remainder of the sample while adjusting for other factors. A secondary analysis was also done, in which the mortality of a subset of the sample exclusively ventilated with NCV was compared with that of a propensity score-matched subset of the control group. Exclusive use of NCV was associated with a higher 28-day in-hospital mortality while adjusting for confounders in the regression analysis (odds ratio, 1.41; 95% CI [1.07–1.86]). In the propensity score matching analysis, the mortality of patients exclusively ventilated with NCV was 68.9%, and that of the control was 60.7% (p = 0.02).

CONCLUSIONS:

Use of NCV was associated with increased mortality among patients with COVID-19 ARDS. More lives may be saved during future ventilator shortages if more full-feature ICU ventilators, rather than NCVs, are reserved in national and local stockpiles.
Spiny Keratoderma: Clinical and Histopathological Findings in a Series of 3 Cases
Authors: Hanly Ailish , Turner Noel , Ko Christine J. , Panse Gauri
Published: April 2024

Spiny keratoderma is a rare entity presenting with minute keratotic spines on the palms and soles. Spiny keratoderma can be inherited or acquired, and the acquired form may be associated with underlying malignancy or systemic disease. Clinically, the differential diagnosis includes other digitate keratoses on acral sites, most notably arsenical keratosis, filiform verruca, and punctate porokeratosis. Biopsy findings typically include a column of parakeratosis overlying a diminished granular cell layer. In this article, we present 3 cases of acquired spiny keratoderma in patients with various systemic diseases, but no underlying malignancy.
Demographic and Clinical Features and Factors Affecting the Quality of Life of Patients With Hidradenitis Suppurativa: A Cross-sectional Study
Authors: Erol Mart Handan Merve , Bostanci Seher , Caliskan Odabas Deniz
Published: April 2024

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with well-known adverse effects on quality of life (QoL). Improving patients' QoL has become an important objective of treatment.

OBJECTIVE

The purpose of this study was to evaluate the demographic and clinical characteristics and factors affecting the QoL of patients with HS.

MATERIALS AND METHODS

One hundred seventy-six patients with HS aged between 18 and 65 years were included in the study. The patients' demographic and clinical characteristics, treatments, and comorbidities were recorded. The disease stage was determined based on the Hurley staging system. The Dermatology Life Quality Index (DLQI) was used to evaluate QoL.

RESULTS

Mean DLQI scores were significantly higher in patients with advanced Hurley stages, lesions in the gluteal region and legs, and with more than 2 affected areas (p < .001). Correlations between patient-reported treatment outcomes and clinical characteristics of the patients were assessed. Findings of this study indicate the existence of a potential “window of opportunity” for laser epilation and wide local surgical excision, similar to anti–tumor necrosis factor therapy.

CONCLUSION

Timely and appropriate treatment can only be provided for patients with HS by evaluating objective disease severity measures and subjective patient data in combination.
Longitudinal associations between ambient PM2.5 exposure and lipid levels in two Indian cities
Authors: Anand Kritika , Walia Gagandeep Kaur , Mandal Siddhartha , Menon Jyothi S. , Gupta Ruby , Tandon Nikhil , Narayan K. M. Venkat , Ali Mohammed K. , Mohan Viswanathan , Schwartz Joel D. , Prabhakaran Dorairaj
Published: April 2024

Background:

Exposure to ambient PM2.5 is known to affect lipid metabolism through systemic inflammation and oxidative stress. Evidence from developing countries, such as India with high levels of ambient PM2.5 and distinct lipid profiles, is sparse.

Methods:

Longitudinal nonlinear mixed-effects analysis was conducted on >10,000 participants of Centre for cArdiometabolic Risk Reduction in South Asia (CARRS) cohort in Chennai and Delhi, India. We examined associations between 1-month and 1-year average ambient PM2.5 exposure derived from the spatiotemporal model and lipid levels (total cholesterol [TC], triglycerides [TRIG], high-density lipoprotein cholesterol [HDL-C], and low-density lipoprotein cholesterol [LDL-C]) measured longitudinally, adjusting for residential and neighborhood-level confounders.

Results:

The mean annual exposure in Chennai and Delhi was 40 and 102 μg/m3 respectively. Elevated ambient PM2.5 levels were associated with an increase in LDL-C and TC at levels up to 100 µg/m3 in both cities and beyond 125 µg/m3 in Delhi. TRIG levels in Chennai increased until 40 µg/m3 for both short- and long-term exposures, then stabilized or declined, while in Delhi, there was a consistent rise with increasing annual exposures. HDL-C showed an increase in both cities against monthly average exposure. HDL-C decreased slightly in Chennai with an increase in long-term exposure, whereas it decreased beyond 130 µg/m3 in Delhi.

Conclusion:

These findings demonstrate diverse associations between a wide range of ambient PM2.5 and lipid levels in an understudied South Asian population. Further research is needed to establish causality and develop targeted interventions to mitigate the impact of air pollution on lipid metabolism and cardiovascular health.
Complementary and alternative medicines and liver disease
Authors: Philips Cyriac Abby , Theruvath Arif Hussain , Ravindran Resmi , Augustine Philip
Published: April 2024

Complementary and alternative medicines (CAM) include conventional medical treatments. Patients worldwide use CAM at alarming rates; thus, reports of CAM-related DILI have been on the rise. The clinical presentations include asymptomatic liver test abnormalities, acute hepatitis with or without jaundice, acute cholestatic liver disease (bland or with hepatitis), acute liver failure, severe hepatitis with features of portal hypertension, and acute decompensation of known or unknown cirrhosis that can lead to acute-on-chronic liver failure. Acute hepatitis with or without necrosis, hepatocellular and canalicular cholestasis, herb-induced or CAM-triggered autoimmune hepatitis, granulomatous hepatitis, severe steatohepatitis, and vanishing bile duct syndrome are common liver biopsy findings in CAM-DILI. The presence of preexisting liver disease predicts severe liver injury, risk of progression to liver failure, and decreased transplant-free survival in patients with CAM-DILI. This review discusses global epidemiology and trends in CAM-DILI, clinical presentation, assessment and outcomes, commonly emerging threats in the context of hepatotoxic herbs, pragmatic assessment of “liver beneficial” herbs and health care myths, patient communication, regulatory framework, and future directions on research in CAM.
Brief alcohol interventions are underutilized in persons with nonalcohol-associated chronic liver diseases
Authors: Louissaint Jeremy , Melendez-Torres Jonathan , Zhang Wei , Kozlitina Julia , Anouti Ahmad , Patel Mausam J. , Zhang Bill Y. , Singal Amit G. , Mitchell Mack C. , Cotter Thomas G.
Published: April 2024

Background:

Brief alcohol interventions use patient-provider communication to promote alcohol cessation. We characterized the receipt of this intervention in chronic liver disease (CLD).

Methods:

We surveyed patients with CLD for weekly drinking patterns and examined associations with patient-provider communication receipt.

Results:

Among 840 participants, 82.1% and 56.5% reported ≥1 standard drink weekly and excessive alcohol consumption, respectively. Patient-provider communication was lower in noncirrhotic (adjusted odds ratio:0.34, 95% CI: 0.22–0.54) and nonalcohol-associated CLD (adjusted odds ratio: 0.22, 95% CI: 0.15–0.34) among individuals drinking ≥1 standard drink weekly, and similarly in noncirrhotic CLD (adjusted odds ratio: 0.45, 95% CI: 0.21–0.95) among those with excessive drinking.

Conclusions:

Brief alcohol interventions are underutilized in noncirrhotic and nonalcohol-associated CLD.
Microforceps-Assisted Transscleral Fixation of Intraocular Lens
Authors: Li Wei , Tsai Ching-Yao , Tsai I-Lun , Su Yu-Ting , Chen Yen-Ta , Fang I-Mo , Tzu-Yi Chen Zoe , Woung Lin-Chung , Chang Yen-Jui
Published: April 2024

Purpose:

This study presents a novel technique for intraocular lens (IOL) fixation. The technique can be used on single-piece acrylic IOLs and can manage patients who are either with aphakia or with a dislocated IOL.

Methods:

One end of the Gore-Tex suture is tied into the optic–haptic junction of the IOL. Another end is fixated on the scleral wall. The single-sclerotomy and double-sclerotomy settings can be applied to different situations.

Results:

Twelve eyes received this procedure. After a follow-up period of up to 20 months, the IOLs were well centered.

Conclusion:

The technique is a reliable method for scleral fixation of IOLs, which can be applied to the widely used single-piece acrylic IOLs. In the authors’ experience, it is reproducible and rarely causes complications.
Topical Losartan for Treating Corneal Haze After Ultraviolet-A/Riboflavin Collagen Cross-Linking
Authors: Rodgers Emily Grace , Al-Mohtaseb Zaina , Chen Allison J.
Published: April 2024

Purpose:

The purpose of this study was to report our first clinical experience using topical losartan for the treatment of severe corneal haze after epithelium-off corneal cross-linking (CXL).

Methods:

A 20-year-old man presented with clinically significant corneal haze in the right eye 1 month following Ultraviolet-A/Riboflavin Epithelium-off Collagen CXL. Haze progressed to a deep stromal scar, and vision was 20/150 with no improvement on refraction, 60 days after CXL. After unsuccessful treatment with topical corticosteroids, the patient elected to start off-label treatment with topical losartan 0.8 mg/mL, administered 6 times per day.

Results:

After 3 months of initiating topical losartan, the right eye vision improved to preoperative vision of 20/40-1. Corneal haze was significantly reduced as observed on slitlamp examination and on Scheimpflug corneal tomography (Pentacam; OCULUS, Inc. Arlington, WA).

Conclusions:

Topical losartan, a transforming growth factor-β inhibitor, is a potential treatment in clinically significant corneal haze following epithelium-off corneal CXL. This clinical experience highlights the potential efficacy of topical losartan as a novel therapeutic option in such cases, but further clinical studies are needed.
Changes in Posterior Cornea and Posterior-To-Anterior Curvature Radii Ratio 1 Year After LASIK, PRK, and SMILE Treatment of Myopia
Authors: Moshirfar Majid , Cha David S. , Santos Jordan M. , Herron Michael S. , Hoopes Phillip C.
Published: April 2024

Purpose:

The purpose of this study was to compare changes in the posterior curvature and the posterior–anterior radii ratio of the cornea, 1 year postoperatively in laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE).

Methods:

This retrospective study was performed at a single surgical center. 199 eyes were included in the study from 119 patients with manifest refraction spherical equivalents from −7.61 to −2.54 D. 67 eyes underwent LASIK, 89 underwent PRK, and 43 underwent SMILE. Both preoperative and 1-year postoperative front and back sagittal keratometry were measured at 4- to 6-mm zones around the corneal vertex. Corneal asphericity (Q-value) was measured at an 8-mm zone around the corneal vertex.

Results:

The average change in the posterior–anterior radii ratio after LASIK, PRK, and SMILE did not differ between surgery groups at 4 mm (LASIK: −0.075, PRK: −0.073, SMILE: −0.072, P = 0.720), 5 mm (LASIK: −0.072, PRK: −0.068, SMILE: −0.068, P = 0.531), or 6 mm (LASIK: −0.075, PRK: −0.071, SMILE: −0.072, P = 0.456) zones. Anterior Q-value significantly positively increased after all 3 surgeries (P < 0.001). The posterior Q-value also significantly positively increased after LASIK (P < 0.001) and SMILE (P < 0.001), but not after PRK (P = 0.227). Both anterior and posterior keratometric power decreased significantly after LASIK, PRK, and SMILE for all diameters.

Conclusions:

The change in the posterior–anterior radii ratio was not influenced by the type of refractive surgery performed, as indicated by statistically identical preoperative, postoperative, and delta values. In addition, the posterior cornea exhibited paracentral flattening after LASIK, SMILE, and PRK and increased oblateness after LASIK and SMILE.
Hospital Outcomes Among Children With Congenital Heart Disease and Adenovirus Pneumonia
Authors: Crawford Richard , Akmyradov Chary , Dachepally Rashmitha , Prodhan Parthak
Published: April 2024

Background:

The aim of the study is to evaluate the mortality risk factors and hospitalization outcomes of adenovirus pneumonia in pediatric patients with congenital heart disease.

Methods:

In this retrospective multicenter cohort study utilizing the Pediatric Health Information System database, we analyzed congenital heart disease patients with adenovirus pneumonia from January 2004 to September 2018, categorizing them into shunts, obstructive lesions, cyanotic lesions and mixing lesions. Multivariate logistic regression analysis was employed to identify mortality risk factors with 2 distinct models to mitigate collinearity issues and the Mann–Whitney U test was used to compare the hospital length of stay between survivors and nonsurvivors across these variables.

Results:

Among 381 patients with a mean age of 3.2 years (range: 0–4 years), we observed an overall mortality rate of 12.1%, with the highest mortality of 15.1% noted in patients with shunts. Model 1 identified independent factors associated with increased mortality, including age 0–30 days (OR: 8.13, 95% CI: 2.57–25.67, P < 0.005), sepsis/shock (OR: 3.34, 95% CI: 1.42–7.83, P = 0.006), acute kidney failure (OR: 4.25, 95% CI: 2.05–13.43, P = 0.0005), shunts (OR: 2.95, 95% CI: 1.14–7.67, P = 0.03) and cardiac catheterization (OR: 6.04, 95% CI: 1.46–24.94, P = 0.01), and Model 2, extracorporeal membrane oxygenation (OR: 3.26, 95% CI: 1.35–7.87, P = 0.008). Nonsurvivors had a median hospital stay of 47 days compared to 15 days for survivors.

Conclusion:

The study revealed a 12.1% mortality rate in adenoviral pneumonia among children with congenital heart disease, attributed to risk factors such as neonates, sepsis, acute kidney failure, shunts, cardiac catheterization, extracorporeal membrane oxygenation use and a 3-fold longer hospital stay for nonsurvivors compared to survivors.
Skin and Soft Tissue Actinomycosis in Children and Adolescents
Authors: Demirhan Salih , Orner Erika , Szymczak Wendy , Lee Philip J. , Aldrich Margaret
Published: April 2024

Background:

Pediatric actinomycosis studies are limited to case reports or small case series. In this retrospective cohort study, we aimed to describe characteristics of skin and soft tissue actinomycosis in adolescents and children.

Methods:

We conducted the study from January 2019 to December 2022, including patients ≤21 years of age with at least 1-year follow-up data. All clinical cultures obtained under sterile conditions with Actinomyces growth were included.

Results:

One hundred four patients met inclusion criteria; median age 19 (interquartile range: 17–20) years, 68.3% female, 46.2% Black and 47.1% Hispanic. The median antibiotic treatment duration was 10 (7–10) days, and majority of patients received treatment with non-first-line Actinomyces antibiotics. Infectious disease consultation was requested for only 7 patients during their initial skin and soft tissue actinomycosis treatment. One-third of the patients with skin and soft tissue actinomycosis had documented recurrence within a median of 10 (interquartile range: 6–16) months of the initial episode. Monobacterial culture growth (85.7% vs. 63.8%, P = 0.02), patients with body mass index >25 (75% vs. 52.6%, P = 0.04) and patients with prior abscess in the same area (18.8% vs. 51.4%, P = 0.001) were significantly higher in patients with recurrent actinomycosis compared to the nonrecurrent group. In a univariate logistic regression model, they were found to be significantly associated with recurrence; monobacterial growth [odds ratio (OR): 3.4; 95% confidence interval (CI): 1.2–9.9], body mass index >25 (OR: 2.7; 95% CI, 1.1–7.0) and prior abscess (OR: 4.6; 95% CI: 1.9–11.2).

Conclusions:

Our study results highlight the importance of considering Actinomyces species in skin and soft tissue infections, especially in recurrent ones, and risk factors for recurrence. Suboptimal antibiotic utilization, very low numbers of consultations with infectious diseases and high recurrence rate suggest that providers should be informed and updated regarding this rare but hard-to-treat infection.
Use of Cefiderocol in the Management of Children With Infection or Colonization With Multi-drug Resistant Gram-negative Bacteria: A Retrospective, Single-center Case Series
Authors: Schmid Hanna , Brown Li-An K. , Indrakumar Bairavi , McGarrity Orlagh , Hatcher James , Bamford Alasdair
Published: April 2024

Cefiderocol, a novel siderophore cephalosporin, represents a treatment option for infections with multidrug-resistant Gram-negative bacteria, of which rates are rising worldwide. Clinical data on its use in children is limited. In our pediatric case series, the largest reported to date, cefiderocol seems safe and well tolerated, with more favorable clinical outcomes when compared to the literature reviewing adult cases.
Subgroups of pelvic pain are differentially associated with endometriosis and inflammatory comorbidities: a latent class analysis
Authors: Ghiasi Marzieh , Chang Chi , Shafrir Amy L. , Vitonis Allison F. , Sasamoto Naoko , Vazquez Ana I. , DiVasta Amy D. , Upson Kristen , Sieberg Christine B. , Terry Kathryn L. , Holzman Claudia B. , Missmer Stacey A.
Published: April 2024

Chronic pelvic pain is heterogeneous with potentially clinically informative subgroups. We aimed to identify subgroups of pelvic pain based on symptom patterns and investigate their associations with inflammatory and chronic pain-related comorbidities. Latent class analysis (LCA) identified subgroups of participants (n = 1255) from the Adolescence to Adulthood (A2A) cohort. Six participant characteristics were included in the LCA: severity, frequency, and impact on daily activities of both menstruation-associated (cyclic) and non–menstruation-associated (acyclic) pelvic pain. Three-step LCA quantified associations between LC subgroups, demographic and clinical variables, and 18 comorbidities (10 with prevalence ≥10%). Five subgroups were identified: none or minimal (23%), moderate cyclic only (28%), severe cyclic only (20%), moderate or severe acyclic plus moderate cyclic (9%), and severe acyclic plus severe cyclic (21%). Endometriosis prevalence within these 5 LCA-pelvic pain–defined subgroups ranged in size from 4% in “none or minimal pelvic pain” to 24%, 72%, 70%, and 94%, respectively, in the 4 pain subgroups, with statistically significant odds of membership only for the latter 3 subgroups. Migraines were associated with significant odds of membership in all 4 pelvic pain subgroups relative to those with no pelvic pain (adjusted odds ratios = 2.92-7.78), whereas back, joint, or leg pain each had significantly greater odds of membership in the latter 3 subgroups. Asthma or allergies had three times the odds of membership in the most severe pain group. Subgroups with elevated levels of cyclic or acyclic pain are associated with greater frequency of chronic overlapping pain conditions, suggesting an important role for central inflammatory and immunological mechanisms.
Uncovering moderators of pain perception by women with endometriosis from Latin America and Spain: the roles of sociodemographics, racial self–identity, and pain catastrophizing
Authors: Flores Idhaliz , Torres-Reverón Annelyn , Navarro Eduardo , Nieves-Vázquez Cristina I. , Cotto-Vázquez Ariana C. , Alonso-Díaz Joanne M. , Bracero Nabal J. , Vincent Katy
Published: April 2024

A cross-sectional multinational collaborative study on women with endometriosis from Latin America and Spain uncovered high levels of painful symptomatology and high pain catastrophizing scores. Associations between pain perception/catastrophizing and race/ethnicity have been documented. This study was conducted to uncover factors moderating pelvic pain severity, including socioeconomic variables, self-identified race, and pain catastrophizing in women with endometriosis from Latin America and Spain, a population encompassing diverse racial and sociocultural contexts. Self-reported data on demographics, clinical history, Ob-Gyn history, pelvic pain intensity, and pain catastrophizing were collected with the Spanish World Endometriosis Research Foundation (WERF) Endometriosis Phenome Project (EPhect) Clinical Questionnaire (ECQ). Multiple logistic regression was conducted to analyze effects of self-identified race, demographic clusters (defined as countries with similar racial population distribution), socioeconomic factors, and pain catastrophizing on reporting severe vs moderate–mild levels of dysmenorrhea, dyspareunia, and pelvic pain. Self-identified race did not affect the likelihood of reporting severe pelvic pain; however, there were significant differences in reporting severe dysmenorrhea at worst among demographic clusters. Older age was associated with severe dyspareunia at worst and recent pelvic pain. Pain catastrophizing score was highly predictive of reporting most types of severe pelvic pain, regardless of race and demographic cluster. These results negate a role of racial categories as moderator of pain in women from Latin America and Spain and support integration of pain catastrophizing assessments and psychological interventions into the pain management plan to enhance therapeutic outcomes and QoL for patients with endometriosis.
HIV Inequities, the Therapeutic Alliance, Moral Injury, and Burnout: A Call for Nurse Workforce Participation and Action
Authors: Sprague Courtenay
Published: April 2024

Health inequities for those living with HIV have persisted for key populations in the United States and globally. To address these inequities, in accordance with Goals 2 and 3 of the National HIV/AIDS Strategy for the United States, the evidence indicates that the therapeutic alliance could be effective in addressing impediments that undermine HIV outcomes. Nonetheless, the therapeutic alliance relies on health care providers, particularly nurses, reporting burnout and moral injury, further exacerbated by COVID-19. Burnout and moral injury have forced the systemic undervaluing of nurses as a social–cultural norm to the fore—in part a legacy of the economic model that underpins the health care system. Given a looming health workforce shortage and negative effects for key populations with HIV already experiencing health inequities, historic opportunities now exist to advance national institutional reforms to support nurses and other health professionals. This opportunity calls for concerted attention, multisectoral dialogue, and action, with nurses participating in and leading policy and interventions.
Melanoma Patient with Normal PSA and DRE with Suspicious Prostate FDG PET/CT Uptake Significant for Prostate Adenocarcinoma
Authors: Schwieters Kurt L. , Santa-Cruz Robert W.
Published: April 2024

A patient with a history of melanoma finds prostate adenocarcinoma after unexpected fluorodeoxyglucose (FDG) uptake on routine screening positron emission tomography (PET)/CT, despite having a normal prostate-specific antigen and digital rectal examination, underscoring the necessity of secondary imaging studies to adequately screen for prostate cancer in cases of prostatic uptake on FDG PET/CT.
Nurturing a Nursing Workforce
Authors: Hoyt Erica E. , Díaz Desiree A. , Anderson Mindi
Published: April 2024

Nurses' demands and challenges can sometimes lead to burnout, compassion fatigue, and a lack of focus on self-care. Implementing innovative strategies, such as role-play, may be instrumental in nurturing and rejuvenating the health care workforce. Role-play simulations offer a promising method to support essential skills and practices for health care workers. Using health care simulation is a widely accepted method to enhance critical thinking and decision-making among health care professionals. The International Nursing Association for Clinical Simulation and Learning (INACSL) Standards Committee in 2021 released the Healthcare Simulation Standards of Best Practice (HSSOBP), providing a structured framework to build and implement quality simulation-based education. These standards guide simulation scenarios' development, implementation, and evaluation, ensuring they align with educational objectives and promote experiential learning. This article describes role-play and how to develop and implement role-play scenarios built upon the HSSOBP.
Bereavement Care Team
Authors: Farrow Kerry-Ann , Felber Neff Donna
Published: April 2024

When nurses care for dying patients, their compassion fatigue may increase and lead to burnout and feelings of professional bereavement. However, if a nurse perceives that the patient had a “good death,” it may have a positive impact on them and reduce their emotional distress. The purpose of this project is to reduce nurses’ feelings of professional bereavement by implementing a Bereavement Care Team (BCT) in the intensive care unit (ICU). This study is a pre-post quasi-experimental design. The Chen and Chow bereavement subscales Factor 1 and Factor 2 measured elements of a nurse’s professional bereavement, and 5 items were statistically significant. Nurses felt a reduction in their exhaustion, frustration, and feeling fatigue in their job, reduced feelings about being nervous and worried about potential professional/patient conflicts, and nurses were moved by the patient’s family’s understanding of the patient’s death. Implementing a BCT in the ICU provided an environment that created a “good death” for the patient and their loved ones. These findings supported the need for the BCT as they demonstrated an improvement in the ICU nurses’ feelings of professional bereavement.
Clinical Faculty Orientation Practices in the United States
Authors: Ross Jennifer Gunberg , Dunker Kimberly Silver , Morrell Martina , Duprey Melissa D. , Parson Tracy , Kim Lydia
Published: April 2024

Background:

Due to the nursing faculty shortage, expert clinical nurses are working as novice clinical instructors (CIs). Orientation is needed to prepare these nurses to teach; however, lack of evidence-based guidelines for orientation programs can lead to variability among institutions.

Purpose:

The purpose of this study was to describe clinical nursing faculty orientation practices in the United States

Methods:

A descriptive convergent mixed methods design was used.

Results:

One hundred thirteen CIs participated. Of these, 70.8% were not provided with a formal orientation to their role. Duration, modality, and content varied widely among orientations. Four themes were derived from the qualitative data: Administrative Requirements, Transition to Clinical Educator, Mentorship, and Resilience.

Conclusions:

Clinical faculty orientation practices vary widely in the United States. Evidence-based guidelines are needed to streamline orientations to provide CIs with the requisite knowledge and skills to support clinical students.
Variations in Management and Clinical Outcomes for Children With Diabetic Ketoacidosis in an Academic Pediatric Versus Community Emergency Department Setting
Authors: Freeman John Nathan , Giroux Callie , King Timothy , Marbrey Christina , Maready Matthew , Pasha Simeen , Davis Justin
Published: April 2024

Objectives

Our objectives were to characterize variations from standardized, evidence-based guidelines in the management of pediatric patients with diabetic ketoacidosis (DKA) based on initial presentation to a tertiary pediatric emergency department (PED) versus a community emergency department (OSH) and compare clinical outcomes.

Methods

We conducted a retrospective study on children 18 years and younger with DKA who presented to an OSH or PED over a 3-year period. Treatments monitored for variation included intravenous fluid management, insulin delivery, and sodium bicarbonate administrations. Clinical outcomes included time to anion gap correction and on insulin infusion, hypokalemia, hypoglycemia, rapid serum glucose decline, cerebral edema, mechanical ventilation, mortality, and time from initial presentation to hospital discharge.

Results

Children with DKA who presented to an OSH (n = 250) were more acidotic (pH 7.11 vs. 7.13, P = 0.001) and had larger anion gaps (28.8 vs. 25.5, P < 0.001) compared with children presenting to the PED (n = 237). The OSH patients were more likely to receive larger fluid boluses (>20 cc/kg or >1000 ml, 43% vs. 4%, P < 0.001), sodium bicarbonate (5% vs. 0%, P < 0.001), and intravenous bolus insulin (28% vs. 0%, P < 0.001). The OSH group were less likely to be started on maintenance intravenous fluids (70% vs. 99%, P < 0.001) or receive potassium in maintenance intravenous fluids (14% vs. 42%, P < 0.001). The OSH group had longer anion gap correction times (754 vs. 541 mins, P < 0.001), insulin infusion times (1018 vs. 854 min, P = 0.003), and times to hospital discharge (3358 vs. 3045 mins, P < 0.001). Incidence of hypokalemia, hypoglycemia, rapid glucose decline, cerebral edema, and deaths were similar between the 2 groups.

Conclusions

Our study demonstrated significant variations in the initial management of pediatric DKA patients by OSH facilities that deviated from an evidence-based treatment pathway utilized by a PED. Statewide quality improvement initiatives could help improve the overall clinical care provided to pediatric DKA patients.
Building Blocks—A Block-by-Block Approach to Better Emergency Care in Children
Authors: Katzir Yair , Ganor Lior , Berant Ron , Shahar-Nissan Keren
Published: April 2024

Regional anesthesia has gained prevalence over recent years in the emergency department setting, mainly in adults. Various frameworks have been suggested as toolkits encompassing the common procedures found in the adult setting. To date, no such framework exists for the pediatric emergency setting.

Objective

We describe a case series of regional nerve blocks, which comprise an adapted framework for the pediatric emergency setting and were performed by pediatric emergency medicine physicians.

Methods

A case series of 8 different ultrasound-guided nerve blocks and 1 anatomical block, performed in 11 pediatric patients, aged 7 weeks to 17 years.

Results

All blocks resulted in adequate analgesia. No procedural complications were observed.

Conclusion

We describe a set of nerve blocks performed by emergency medicine physicians in the pediatric population in an ED setting. In suitable settings, this is a safe and effective tool for procedural analgesia or for pain management. In such cases, performing an ultrasound-guided nerve block in the ED is a viable alternative for repeated doses of opiates, deep procedural sedation, or the operating theater. We propose this set of regional anesthesia procedures as a pediatric-adapted toolkit for the emergency physician to be performed in children in the ED setting. Adopting this set of procedures ensures better and safer care for children and provides a training framework for pediatric ED physicians.
Injury and Biological Factors Impact Shoulder Function following Autogenous Grafting of Spinal Nerves for Pan–Brachial Plexus Reconstruction
Authors: Li Neill Y. , Wu Kitty Y. , Loosbrock Michelle F. , Bishop Allen T. , Spinner Robert J. , Shin Alexander Y.
Published: April 2024

Background:

Shoulder function after spinal nerve grafting in pan–brachial plexus injuries (pan-BPI) is not well described. The authors evaluated shoulder abduction (ABD) and external rotation (ER) after spinal nerve grafting to the suprascapular nerve, axillary nerve, or posterior division of the upper trunk and determined patient characteristics, injury severity and characteristics, and nerve graft factors that influenced outcomes.

Methods:

A total of 362 patients undergoing pan-BPI reconstruction and spinal nerve grafting for shoulder reanimation in a single institution between 2001 and 2018 were reviewed. Patient demographics, Injury Severity Score (ISS), graft characteristics, strength, range of motion for shoulder ABD and ER, and patient-reported outcomes were recorded. Patients were divided into 3 groups based on recovery of shoulder function: no return, ABD only, and ABD and ER.

Results:

A total of 110 patients underwent spinal nerve grafting, with 41 meeting inclusion criteria. Seventeen (41.5%) had no return of shoulder function, 14 (34.1%) had ABD alone, and 10 (24.4%) had ABD and ER. Patients with recovery of both ABD and ER were significantly younger (18.6 ± 5.56 years), had lower body mass index (22.4 ± 4.0), and had a lower ISS (10.5 ± 6.24; P = 0.003). Multivariable analysis found that with increasing age (OR, 0.786; 95% CI, 0.576, 0.941) and ISS (OR, 0.820; 95% CI, 0.606, 0.979), odds for return of ABD and ER decreased significantly.

Conclusions:

In pan-BPI, 24.4% of patients demonstrated return of both ABD and ER after spinal nerve grafting to suprascapular nerve and either axillary nerve or posterior division of the upper trunk. Age, body mass index, and ISS were associated with poorer recovery of shoulder function. Careful patient selection and consideration of age, body mass index, and ISS may improve outcomes of spinal nerve grafting for shoulder reanimation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Perioperative Estrogen Hormonal Therapy Does Not Increase Venous Thromboembolism Risk in Facial Feminization Surgery
Authors: Li Alexander Y. , Park Matthew J. , Fick Jennifer , Ousterhout Douglas K. , Deschamps-Braly Jordan C.
Published: April 2024

Background:

Conflicting data exist regarding increased perioperative venous thromboembolism (VTE) risk with feminizing hormone therapy. The effect has been poorly studied within the transgender population. Acute perioperative cessation of feminizing hormone therapy often leads to unpleasant side effects and exacerbates gender dysphoria in the perioperative period. The authors sought to identify VTE incidence in patients undergoing facial feminization surgery while continuing hormone replacement therapy throughout the time of surgery.

Methods:

A 38-year retrospective cohort study within a 2-surgeon practice (D.K.O. and J.C.D.-B.) was designed to evaluate postoperative VTE in patients continuing hormone therapy. The primary outcome variable was postoperative VTE.

Results:

A total of 1715 patients underwent facial feminization surgery within our search window. A total of 953 patients met final inclusion criteria. One patient (0.10%) was diagnosed with a VTE postoperatively, comparable to reported literature rates for similar cosmetic and orthognathic procedures. The average Caprini score of all patients was 3.1 ± 1.0 and the average case length was 491.9 ± 111.0 minutes. Subgroup analysis of patients before and after internal practice changes identified 714 patients (77.7%) continuing full-dose hormonal therapy perioperatively, 197 (20.7%) undergoing hormonal dose reduction to 25% to 50% perioperatively, and 8 who were either not taking hormonal therapy or stopped in the perioperative period. There was no significant difference in VTE incidence among the 3 subgroups (P > 0.99).

Conclusions:

Perioperative use of feminizing hormonal therapy does not increase risk for perioperative VTE in patients undergoing facial feminization surgery. Therefore, it is reasonable to continue these medications through the time of surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Medical Weight Management Considerations in Plastic Surgery
Authors: Paranzino Alisha B. , Vieira Brittany , Apovian Caroline M. , Agarwal Shailesh
Published: April 2024

Obesity is one of the greatest public health concerns in the United States and has reached an epidemic scope over the past few decades. Plastic surgery in patients with obesity has been linked to higher complication rates both before and after weight loss. This article discusses the evolution and landscape of antiobesity medications as they apply to plastic surgery. Although bariatric surgery has been effective in long-term treatment, new pharmacologic advances in glucagon-like peptide-1 agonists, such as semaglutide, have demonstrated promising effectiveness. These medications pose several unique challenges, particularly with regard to perioperative management and risk of weight regain after discontinuation. An understanding of these new pharmacologic agents is crucial for plastic surgeons, who treat patients with obesity.
An Interdisciplinary, Comprehensive Recovery Pathway Improves Microsurgical Breast Reconstruction Delivery
Authors: Clark Robert Craig , Segal Rachel , Kordahi Anthony , Sendek Gabriela , Alving-Trinh Alexandra , Abramson Wendy , Sztain Jacklynn , Swisher Matthew , Gabriel Rodney A. , Gosman Amanda , Said Engy T. , Reid Chris M.
Published: April 2024

Introduction

Free-flap (autologous) breast reconstruction demonstrates superiority over alloplastic approaches but is offered infrequently. Enhanced recovery protocols can address postoperative challenges, but most literature is limited to inpatient interventions and outcomes. This study describes an adoptable, longitudinally comprehensive and multidisciplinary recovery pathway for autologous reconstruction which adds to the current guidelines. The authors aimed to allow perioperative outcomes comparable to alloplastic reconstructions.

Methods

All autologous Comprehensive Recovery Pathway (CRP) subjects from a single surgeon were retrospectively included. A comparator group of equal size was randomly selected from institutional subpectoral and dual-plane tissue expander patients having Enhanced Recovery After Surgery guideline–directed care. All subjects in both cohorts received preoperative paravertebral regional blocks. Operative detail, inpatient recovery, longitudinal morphine equivalents (MEs) required, and complications were compared.

Results

Each cohort included 71 cases (99 breasts). Despite longer operations, intraoperative MEs were fewer in autologous cases (P = 0.02). Morphine equivalents during inpatient stay were similar between cohorts, with both being discharged on median day 2. Multivariate regression demonstrated a 0.8-day increased stay for autologous subjects with additional contribution from bilateral cases, body mass index, and age (P < 0.05). Autologous subjects were regularly discharged postoperative day 1 (17%) and postoperative day 2 (39%), with trend toward earlier discharge (P < 0.01). Outpatient MEs were significantly fewer in autologous subjects, corresponding to a 30- to 150-mg oxycodone difference (P < 0.01). Major complication occurred in 12.7% of autologous and 22.5% of alloplastic subjects (P = 0.11). Flap loss occurred in 1 autologous subject versus 11 alloplastic failures (P < 0.01).

Conclusions

This study details partnership between the plastic surgery service, regional and acute pain anesthesia services, and dedicated nursing with longitudinal optimizations allowing perioperative outcomes improved over current literature. Patients in the CRP used fewer opioids from operation through follow-up with comparable length of stay and significantly fewer reconstructive failures than alloplastic subjects. The pathway may be quickly adopted into academic practice patterns and mitigates traditional barriers, allowing extension of autologous reconstruction offerings.
Regional random mutagenesis driven by multiple sgRNAs and diverse on-target genome editing events to identify functionally important elements in non-coding regions
Authors: Morimoto Kento , Suzuki Hayate , Kuno Akihiro , Daitoku Yoko , Tanimoto Yoko , Kato Kanako , Murata Kazuya , Sugiyama Fumihiro , Mizuno Seiya
Published: April 2024

Functional regions that regulate biological phenomena are interspersed throughout eukaryotic genomes. The most definitive approach for identifying such regions is to confirm the phenotype of cells or organisms in which specific regions have been mutated or removed from the genome. This approach is invaluable for the functional analysis of genes with a defined functional element, the protein-coding sequence. By contrast, no functional analysis platforms have been established for the study of
cis
-elements or microRNA cluster regions consisting of multiple microRNAs with functional overlap. Whole-genome mutagenesis approaches, such as via
N
-ethyl-
N
-nitrosourea and gene trapping, have greatly contributed to elucidating the function of coding genes. These methods almost never induce deletions of genomic regions or multiple mutations within a narrow region. In other words,
cis
-elements and microRNA clusters cannot be effectively targeted in such a manner. Herein, we established a novel region-specific random mutagenesis method named CRISPR- and transposase-based regional mutagenesis (CTRL-mutagenesis). We demonstrate that CTRL-mutagenesis randomly induces diverse mutations within target regions in murine embryonic stem cells. Comparative analysis of mutants harbouring subtly different mutations within the same region would facilitate the further study of
cis
-element and microRNA clusters.
Steklov eigenvalues of nearly hyperspherical domains
Authors: Han Tan Chee , Viator Robert
Published: April 2024

We consider Steklov eigenvalues of nearly hyperspherical domains in

R

d
+
1

with

d
≥
3

. In previous work, treating such domains as perturbations of the ball, we proved that the Steklov eigenvalues are analytic functions of the domain perturbation parameter. Here, we compute the first-order term of the asymptotic expansion and show that the first-order perturbations are eigenvalues of a Hermitian matrix, whose entries can be written explicitly in terms of Pochhammer’s and Wigner

3
j

-symbols. We analyse the asymptotic expansion and show the following isoperimetric results among domains with fixed volume: (i) for an infinite subset of Steklov eigenvalues, the ball is not optimal and (ii) for a different infinite subset of Steklov eigenvalues, the ball is a stationary point.
Olfactory self-recognition in two species of snake
Authors: Freiburger Troy , Miller Noam , Skinner Morgan
Published: April 2024

Mark tests, in which an animal uses a mirror to locate and examine an otherwise unnoticeable mark on its own body, are commonly used to assess self-recognition, which may have implications for self-awareness. Recently, several olfactory-reliant species have appeared to pass odour-based versions of the mark test, though it has never been attempted in reptiles. We conducted an odour-based mark test on two species of snakes, Eastern gartersnakes and ball pythons, with widely divergent ecologies (i.e. terrestrial foragers that communally brumate versus semi-arboreal ambush predators that do not). We find that gartersnakes, but not ball pythons, pass the test, and a range of control tests suggest this is based on self-recognition. Gartersnakes are more social than ball pythons, supporting recent suggestions that social species are more likely to self-recognize. These results open the door to examination of the ecology of self-recognition, and suggest that this ability may evolve in response to species-specific ecological challenges, some of which may align with complexity of social structures.