bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Histopathologic Features of Myocarditis in Multisystem Inflammatory Syndrome (Adult)–Associated COVID-19
Authors: Aldeghaither Saud , Qutob Rayan , Assanangkornchai Nawaporn , Issa-Chergui Badia , Tam May , Larotondo Rita , Samoukovic Gordan
Published: February 2022

Background:

Multisystem inflammatory syndrome (MIS) associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is a life-threatening condition first described in children (MIS-C). It is characterized by a hyperinflammatory state that involves the cardiovascular, gastrointestinal, dermatologic, and neurologic systems without severe respiratory system involvement. Myocarditis is one of the cardiovascular presentations of MIS that might be complicated with cardiogenic shock. There are few case reports describing SARS-CoV-2-related MIS in adults (MIS-A).

Case Summary:

Three cases of healthy young adults diagnosed with severe acute respiratory syndrome-CoV-2 related (MIS-A). The main presentation was cardiogenic shock secondary to histologically proven myocarditis, which resolved rapidly after initiation of medical therapy including anti-inflammatory and immunosuppressive drugs. All the cases, however, required mechanical circulatory support (MCS) as a bridge to recovery.

CONCLUSIONS:

It appears reasonable to treat the patient with fulminant myocarditis in SARS-CoV-2-associated MIS-A with high-dose corticosteroid “pulse” therapy in order to suppress the inflammatory response and MCS to correct initial metabolic derangement and reestablish/maintain vital organ perfusion. Addition of IV immunoglobulin and other immunomodulators should be assessed in a case-by-case basis especially considering the associated cost resource allocation.
Proning in COVID-19 Acute Respiratory Distress Syndrome: Role of Paralytics
Authors: Cotton Shannon A. , McGuire W. Cameron , Hussain Abdur , Pearce Alex K. , Zawaydeh Qais , Meehan Melissa D. , Malhotra Atul
Published: February 2022

OBJECTIVES:

Although proning is beneficial to acute respiratory distress syndrome, impressions vary about its efficacy. Some providers believe that paralysis is required to facilitate proning. We studied impact of paralysis on prone-induced gas exchange improvements and provider attitudes regarding paralytics.

DESIGN:

Observational.

SETTING:

University of California San Diego.

PATIENTS:

Intubated COVID acute respiratory distress syndrome patients.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

1) Changes in Pao
2:Fio
2 and Spo
2:Fio
2 ratios before and after proning with and without paralytics, 2) adverse events during proning with and without paralytics, and 3) nurse and physician attitudes about efficacy/safety of proning with and without paralytics. Gas-exchange improvement with proning was similar with and without paralytics (with no serious adverse events). Survey results showed similar attitudes between nurses and physicians about proning efficacy but differing attitudes about the need for paralytics with proning.

CONCLUSIONS:

Findings support use of proning and may help in design of randomized trials to assess paralytics in acute respiratory distress syndrome management.
Supporting Midcareer Women Faculty in Academic Medicine Through Mentorship and Sponsorship
Authors: Keating Julie A. , Jasper Annie , Musuuza Jackson , Templeton Kim , Safdar Nasia
Published: February 2022

Midcareer women faculty face unique career challenges that may benefit from mentorship and sponsorship, yet such programs focused on the needs of this career phase are scarce in academic medicine. Many midcareer faculty require intentional and individual career planning to choose a path from the broad array of options in academic medicine. Ambiguous promotion criteria, increased workloads because of service or citizenship tasks, and a lack of sponsorship are among the barriers that inhibit midcareer faculty's growth into the high-visibility roles needed for career advancement. In addition, issues faced by women midcareer faculty members may be further exacerbated by barriers such as biases, a disproportionate share of family responsibilities, and inequities in recognition and sponsorship. These barriers contribute to slower career growth and higher attrition among women midcareer faculty and ultimately an underrepresentation of women among senior leadership in academic medicine. Here, we describe how a mentoring program involving individuals (eg, mentors, mentees, and sponsors) and departments/institutions (eg, deans and career development offices) can be used to support midcareer faculty. We also provide recommendations for building a mentoring program with complementary support from sponsors targeted toward the specific needs of women midcareer faculty. A robust midcareer mentoring program can support the career growth and engagement of individual faculty members and as a result improve the diversity of academic medicine's highest ranks.
Case Study of an Elderly Patient With New Onset Weakness
Authors: Mirman Igal , Bertorini Tulio
Published: February 2022

We present a patient presented with new onset progressive proximal weakness. On examination noted to have proximal weakness on upper and lower limbs, with preserved reflexes, without sensory involvement. Blood work revealed to have elevated creatine kinase. On electromyography testing shows myopathic features and also noted to have myotonic discharges. Muscle biopsy was obtained next which showed many vacuolization, marked increase in all fat content noted. These findings led us to checking carnitine levels which were noted to be significantly reduced with elevated carnitine palmitoyltransferase levels. These findings highly suggestive of systemic carnitine deficiency. Secondary causes of systemic Carnitine deficiency not identified in this patient and presumed to have primary systemic carnitine deficiency. Patient improved on oral supplementation of L- Carnitine.
A Social-Ecological Perspective of the Perceived Barriers and Facilitators to Virtual Education in Cardiac Rehabilitation
Authors: Cotie Lisa M. , Ghisi Gabriela L. M. , Vanzella Lais M. , Aultman Crystal , Oh Paul , Colella Tracey J. F.
Published: February 2022

Purpose:

This study explored the perceived barriers and facilitators to participation in patients who did and did not attend virtual cardiac rehabilitation (CR) education sessions.

Methods:

A mixed-methods approach was used. Virtual patient education was delivered during the coronavirus-19 pandemic. Phase 1 included a cross-sectional online survey completed by individuals who did and did not participate in these sessions. For phase 2, six virtual focus group sessions were conducted using the social-ecological framework to guide thematic analysis and interpretation of findings.

Results:

Overall, 106 online surveys were completed; 60 (57%) attended Cardiac College Learn Online (CCLO) sessions only, one (1%) Women with Heart Online (WwHO) only, 21 (20%) attended both, and 24 (22%) did not attend virtual sessions. Half of the participants who attended virtual sessions viewed between one and four sessions. Most participants were from Canada (95%) and included the Toronto Rehabilitation Institute/Toronto Western Hospital centers (76%). Focus group findings revealed six overarching themes: Intrapersonal (mixed emotions/feelings; personal learning preferences); Interpersonal (desire for warmth of human contact and interaction); Institutional (the importance of external endorsement of sessions); and Environmental (technology; perceived facilitators and barriers).

Conclusion:

These findings highlight the unprecedented situation that patients and CR programs are facing during the pandemic. Virtual patient education may be more accessible, convenient, and responsive to the complex needs of these CR participants.
Application of the 2017 American college of cardiology/American Heart Association Blood Pressure Guidelines for cardiovascular outcomes among Tehranian residents
Authors: Zadeh Seyed Saeed Tamehri , Moazzeni Seyyed Saeed , Matsushita Kunihiro , Hasheminia Mitra , Azizi Fereidoun , Hadaegh Farzad
Published: February 2022

Objective(s):

To evaluate the associations of cardiovascular disease (CVD) outcomes with elevated blood pressure (BP), stage I of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH), defined by 2017 ACC/AHA guidelines among the Tehranian adult population.

Method:

We enrolled 7068 residents of Tehran (district No. 13) aged at least 30 years, who were free of CVD and not taking antihypertensive medications at baseline. Participants were categorized into eight categories: normal BP (reference group), elevated BP, stage I IDH, stage I ISH, stage I SDH, and all stage II phenotypes. Significant interactions were found between age groups (<60 versus ≥60 years) and BP categories (P value: 0.017); hence, the analysis was performed in each age group, separately. We used multivariable Cox proportional regression analysis to evaluate the association of different BP categories with incident CVD.

Results:

During 18years of follow-up, 1053 CVD events occurred. In the younger group, stage I of IDH and SDH were associated with increased CVD risk with hazard ratios (HRs) of 1.23 (95% confidence interval: 0.99–1.52) and 1.42 (1.04–1.94), respectively. In the older group, stage I of IDH had a lower risk for coronary heart disease (CHD) [HR 0.53 (0.29–0.96)]. As a sensitivity analysis, among high CVD risk individuals (10-year risk ≥10%), we found a higher risk for CVD among those with elevated BP and stage I of SDH. For individuals with 10-year risk less than 10%, all BP parameters, except stage I of IDH, were associated with increased CVD risk. Although there was no significant interaction between sex and BP categories, elevated BP and stage I of SDH significantly increased the risk of CVD only among men.

Conclusion:

Age is an important potential modifier in the association between stage I of hypertension and CVD/CHD risk. Stage I of IDH was not an alarming status for CVD development, whether the participants had a high CVD risk or not.
Intermediate-term Visual Outcomes and Complications of Type 1 Boston Keratoprosthesis With and Without Glaucoma Surgery
Authors: AlHilali Sara , Martinez-Osorio Hernan , AlObaida Ibrahim , Jomar Deema , AlZendi Nouf , AlJassar Faisal , AlShahwan Sami , Ahmad Abeer , Malik Rizwan , Vargas Jose
Published: February 2022

Purpose:

Glaucoma is a cause of comorbidity in patients receiving the Boston keratoprosthesis (KPro). The aim of this study was to report the outcomes of the Boston KPro with or without glaucoma surgery.

Methods:

This was a retrospective single-center cohort study. Patients who underwent Boston KPro from March 2009 to February 2019 were included. One eye per patient (the first surgery) was included in this study. Patients were classified into 2 groups: KPro only (group 1) and KPro with any form of glaucoma procedure (group 2). Main outcome measures were Best-corrected visual acuity (BCVA), functional success (BCVA 20/200 or better), anatomical success (retention of KPro at the last follow-up), and complications.

Results:

Seventy-one eyes were included: 27 eyes (38%) in group 1 and 44 (62%) in group 2. There was no statistically significant difference in BCVA between groups 1 and 2 at each time point. Of the eyes in group 1, 11% lost light perception vision and 4.5% in group 2 (P = 0.293). There was no difference in anatomical success with 70% in group 1 and 77% in group 2 (P = 0.703) at the last follow-up, with a median failure time of 18 months. The functional success was 48% for group 1 and 50% for group 2 (P = 0.541).

Conclusions:

Eyes undergoing KPro with glaucoma surgery before or at the same time carry a similar functional and anatomical success to eyes without glaucoma surgery.
Socioeconomic Correlates of Keratoconus Severity and Progression
Authors: Ahmad Tessnim R. , Kong Alan W. , Turner Marcus L. , Barnett Jackson , Kaur Gurbani , O'Brien Kieran S. , Pasricha Neel D. , Indaram Maanasa
Published: February 2022

Purpose:

The purpose of this study was to investigate the social determinants of health for keratoconus.

Methods:

In this retrospective cohort study of patients with keratoconus, the electronic health record was reviewed for keratometry, treatments received, clinical comorbidities, and social characteristics. Outcomes included severe keratoconus at presentation (steep keratometry ≥52 diopters), disease progression (≥0.75 diopters increase from the first to the most recent clinical visit), and corneal transplantation. Logistic regression was used to evaluate factors associated with severity at presentation and corneal transplantation. Cox proportional hazards modeling was used to evaluate progression.

Results:

A total of 1038 patients with keratoconus were identified, 725 (70%) of whom had baseline imaging. Compared with commercially insured patients, Medicaid recipients were more likely to have severe keratoconus, independent of social and clinical confounders [odds ratio (OR) 1.94, 95% confidence interval (CI), 1.12–3.35, P = 0.017]. Male sex was independently associated with progression (hazard ratio = 1.38, 95% CI, 1.03–1.84, P = 0.030). Medicare and Medicaid recipients were more likely to require transplantation compared with commercially insured patients (OR 2.71, 95% CI, 1.65–4.46, P < 0.001 and OR 1.74, 95% CI, 1.08–2.80, P = 0.022, respectively). Other social determinants of health, including non-White race/ethnicity, limited English proficiency, and unemployment, were associated with the outcomes only in univariate analysis. Obstructive sleep apnea, atopy, body mass index, and tobacco use were not associated with any outcome.

Conclusions:

Socioeconomic factors were more consistent predictors of keratoconus severity and corneal transplantation compared with clinical factors that have received relatively greater attention in the keratoconus literature.
Psychometric Properties of the Korean Version of the Nursing Profession Self-Efficacy Scale
Authors: KIM Seon Mi , KIM Ju Hee , KWAK Jung Min
Published: February 2022

Background

Self-efficacy in the nursing profession has been reported to have a positive effect on personal performance in terms of clinical performance and decision-making abilities, nursing performance, professional intuition, organizational commitment, and turnover intention.

Purpose

The purpose of this study was to verify the validity and reliability of the Korean version of the Nursing Profession Self-Efficacy Scale (K-NPSES).

Methods

This methodological study used questionnaires collected from 307 nurses at medical institutions in South Korea. The content validity of the questionnaire was verified using the averaging method, whereas the criterion-related validity was evaluated by calculating the correlation with the Sherer General Self-Efficacy Scale. The construct validity was determined by analyzing the explanatory and confirmatory factors. Reliability was verified using Cronbach's α and test–retest by calculating intraclass correlation coefficients.

Results

The content validity index of the K-NPSES was found to be greater than .95, and the criterion-related validity was satisfactory (coefficient = .57, p < .001). The original Nursing Profession Self-Efficacy Scale has two subfactors, and the K-NPSES analyzed in this study has four subfactors. The data were appropriate for factor analysis using Kaiser–Meyer–Olkin (.87) and Bartlett's sphericity test (χ2 = 1236.01, df = 137, p < .001). The model fit was acceptable (normed chi-square [χ2/df] = 2.22, root mean square residual = .05, root mean square error of approximation = .09, comparative fit index = .88, Tucker–Lewis index = .86, goodness-of-fit index = .83). Regarding reliability, Cronbach's α was .91 and the intraclass correlation coefficient was .78 (p < .001).

Conclusions/Implications for Practice

The findings of this study confirmed the K-NPSES as having acceptable validity. In addition to predicting nursing clinical performance, a well-established nursing profession self-efficacy scale may be used to improve the quality of clinical nursing.
Rehabilitation of the Postpartum Runner: A 4-Phase Approach
Authors: Christopher Shefali Mathur , Gallagher Sandra , Olson Amanda , Cichowski Sara , Deering Rita E.
Published: February 2022

Running after childbirth, specifically how or when to return, is a hot topic in the field of physical therapy and on social media; however, there are significant gaps in the literature supporting when and how to safely initiate running postpartum. During pregnancy and following childbirth (both vaginal and cesarean), the body undergoes changes that may impact strength, neuromuscular control, endurance, and the ability to withstand the high-impact forces and repetitive nature of running. Many mothers experience new or worsened symptoms of musculoskeletal or pelvic floor dysfunction following pregnancy and childbirth and require physical therapy to normalize function. After most major injuries, it is common to participate in formalized rehabilitation; however, this is not the norm for athletes returning to running postchildbirth. Because of lack of evidence, many runners and clinicians struggle to develop appropriate rehabilitation progressions for return to running after childbirth. Pelvic and sports physical therapists must understand biomechanical features of running gait and safely progress strength, endurance, and neuromuscular control of the kinetic chain when guiding a runner back to running. This clinical commentary builds on existing guidelines, research, and expert opinion to propose a 4-phase rehabilitation framework to help runners initiate and progress running after childbirth. The result is an in-depth exercise prescription (intensity, frequency, type), examples of exercises (hip, abdominal, pelvic floor, and foot), running progression, and progression goals to prepare runners for symptom-free running after childbirth (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JWHPT/A58, where authors provide more insight on this return to running framework).
Effects of Ginseng on Cancer-Related Fatigue
Authors: Luo Wun-Ting , Huang Tsai-Wei
Published: February 2022

Background

Cancer-related fatigue (CRF) is a common yet troublesome adverse effect that compromises patient quality of life (QoL). Ginseng is often used to boost energy.

Objectives

The aim of this study was to systematically appraise evidence whether ginseng could alleviate CRF and improve QoL.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials on the effectiveness of ginseng for relieving CRF. The primary outcome was fatigue. The secondary outcomes included QoL, anxiety, adverse events, depression, and laboratory markers.

Results

The final sample comprised seven trials. The pooled results showed that ginseng consumption led to significant reductions in CRF levels (standard mean difference [SMD], −0.21; 95% confidence interval [CI], −0.42 to 0.00). Furthermore, improvements in physical well-being (SMD, 0.25; 95% CI, 0.09–0.41) and emotional well-being (SMD, 0.20; 95% CI, 0.01–0.40) were observed, as were nonsignificant trends toward improvement in vigor (SMD, 0.18; 95% CI, −0.02 to 0.38), mitigated nausea (SMD, 0.38; 95% CI, −0.09 to 0.85), dyspnea (SMD, 0.27; 95% CI, −0.04 to 0.59), and anxiety (mean difference, −0.97; 95% CI, −2.12 to 0.18).

Conclusions

Ginseng consumption alleviates CRF and may have certain benefits in improving QoL especially physical well-being.

Implications for Practice

Ginseng may be used as an energy or nutrient supplement to alleviate CRF. However, the concentration of ginseng’s functional components is affected by the production methods and thus probably its effects. Oncology nurses are encouraged to have a better understanding of the benefits and functional limitations of ginseng as an energy or nutrient supplement for CRF.
Point-of-Care Ultrasound–Guided Serratus Anterior Plane Block for Chest Tube Placement in a Spontaneous Pneumothorax
Authors: Khalil Paul A. , Becker Emily
Published: February 2022

Chest tube placement is a common procedure in the pediatric emergency department. There is general emergency medicine literature as well as pediatric cardiac surgery literature supporting the use of an ultrasound-guided serratus anterior plane block for regional anesthesia with no prior pediatric emergency medicine studies to our knowledge. This case describes a pediatric patient who required chest tube placement twice for a pneumothorax and describes his preference for the nerve block over the more commonly used procedural sedation.
Using Telehealth to Conduct Family-Centered, Movement Intervention Research in Children With Autism Spectrum Disorder During the COVID-19 Pandemic
Authors: Cleffi Corina , Su Wan-Chun , Srinivasan Sudha , Bhat Anjana
Published: February 2022

Purpose:

After the COVID-19 pandemic, several randomized controlled trials came to a halt; however, we chose to reinvent our study and shifted to a home-based, telehealth intervention delivery format to support children with autism spectrum disorder and their families. Children with autism spectrum disorder have social communication impairments as well as perceptuomotor and cognitive comorbidities. Continued access to care is crucial for their long-term development.

Methods:

We created a general movement intervention to target strength, endurance, executive functioning, and social skills through goal-directed games and activities delivered using a telehealth intervention model.

Findings:

Our family-centered approach allowed for collaboration between trainers and caregivers and made it easy for families to replicate training activities at home.

Conclusions:

While more studies comparing telehealth and face-to-face interventions are needed, we encourage researchers and clinicians to consider family-centered telehealth as a valid and feasible intervention delivery method, to increase the likelihood of carryover of skills into the daily lives of children and ultimately enhance their long-term development.
Effect of Contingency Paradigm–Based Interventions on Developmental Outcomes in Young Infants: A Systematic Review
Authors: Inamdar Ketaki , Khurana Sonia , Dusing Stacey C.
Published: February 2022

Purpose:

The purpose of this systematic review was to identify controlled trials evaluating the efficacy of contingency paradigm–based interventions to improve feeding, motor, or cognitive outcomes during the first year of life.

Summary of Key Points:

Seventeen studies, including 10 randomized controlled trials, incorporating contingency paradigm–based interventions were identified. Three of 3 trials reported improvements in nutritive sucking using pacifier-activated lullaby in preterm infants before term age. Seven of 12 trials reported improvements in reaching, manual exploration, and kicking behaviors in term and preterm infants; and 6 of 10 trials reported gains in early cognition using sticky mittens and contingent toys.

Conclusion and Recommendations for Clinical Practice:

Contingency paradigm–based interventions can improve feeding outcomes in the neonatal intensive care unit in very preterm infants, and increase reaching, and perceptual-cognitive behaviors in term infants. Future research is needed to establish contingency paradigms as an effective early intervention strategy.

What This Adds to the Evidence:

This review synthesizes a body of literature on contingency paradigm-based interventions and highlights its potential paradigm–based interventions to improve developmental outcomes in infants.
Medication-Related Osteonecrosis of the Jaw Associated in a Patient Treated With Etanercept
Authors: Nisi Marco , Izzetti Rossana , Graziani Filippo
Published: February 2022

Medication-related osteonecrosis of the jaws (MRONJ) is defined as a pathologic condition affecting the maxillary and mandibular bones arising subsequently to pharmacological treatment with antiresorptive and antiangiogenic drugs.

In this case report, the occurrence of MRONJ is described in a 66-year-old female patient affected by rheumatoid arthritis and treated with Etanercept, a Tumor Necrosis Factor (TNF)-a inhibitor. The patient developed a mandibular MRONJ following the extraction of teeth 3.4 and 3.5. The patient was then treated with conservative surgery of the necrotic bone. At 12-month follow-up complete resolution was observed. According to the data presented, the evaluation of the effects of new immunosuppressive biological therapies on the oral cavity appears of utmost importance in preventing the development of MRONJ. Although the risk related to TNF-a inhibitors has not been quantified yet, the clinician should be aware of the potential adverse effects on the oral cavity.
Vein Bypass Versus Nitinol Stent in Long Femoropopliteal Lesions
Authors: Enzmann Florian K. , Nierlich Patrick , Hölzenbein Thomas , Aspalter Manuela , Kluckner Michaela , Hitzl Wolfgang , Opperer Mathias , Linni Klaus
Published: February 2022

Objectives:

The aim of this study was to compare technical success, patency rates and clinical outcomes of vein bypass (VBP) with angioplasty and nitinol stents (NS) in femoropopliteal Trans-Atlantic Intersociety Consensus (TASC) II C and D lesions.

Summary Background Data:

Guidelines widely recommend an endovas-cular-first strategy for long femoropopliteal lesions without sufficient data comparing it with vein bypass surgery.

Methods:

A single-center prospective, randomized controlled trial (RCT) was performed, after approval of the local ethics committee, with technical success, primary and secondary patency as primary endpoints. Secondary endpoints were limb salvage, survival, complications, and clinical improvement.

Results:

Between 2016 and 2020, 218 limbs (109 per group) in 209 patients were included. Baseline and lesion characteristics were similar in both groups with a mean lesion length of 268 mm. The indication for treatment was chronic limb threatening ischemia in 53% of limbs in both groups. Technical success was feasible in 88% in the stent group. During a 4-year follow-up, primary patency, freedom from target lesion revascularizations, limb salvage, survival and complications showed no significant differences between the groups. At 48 months secondary patency for the bypass group was 73% versus 50% in the stent group (P = 0.021). Clinical improvement was significantly superior in the bypass group with 52% versus 19% reaching a Rutherford 0 category (P < 0.001).

Conclusions:

This is the largest RCT comparing angioplasty with NS and vein bypass in femoropopliteal TASC II C and D lesions and the first to report 4-year results. The data underline the feasibility of endovascular treatment in long lesions but also emphasize the advantages of VBP.
Working Definitions of “Critical Portions”
Authors: Langerman Alexander , Brelsford Kathleen , Hammack-Aviran Catherine
Published: February 2022

Objective:

Identify the considerations academic surgeons use when determining which portions of a procedure are “critical” and necessitate their presence.

Background:

Teaching physicians are required to be present for the “critical portion” of surgical procedures, but the definition of what constitutes a critical portion remains elusive. Current guidelines defer to surgeons' expert judgment in identifying critical portion(s) of a procedure; little is known about what concepts surgeons apply when deciding what parts of a procedure are critical.

Methods:

Qualitative analysis of interviews with 51 practicing surgeons from a range of specialties regarding their working definition of critical portions.

Results:

Surgeons identified 4 common themes that they use in practice to define the critical portions of procedures: portions that require their first-hand observation of events, those involving challenging anatomy or structures that cannot be repaired if injured, and portions where an error would result in severe consequences for the patient. Surgeons also recognized contextual factors regarding the patient, trainee, surgeon, and team that might alter determinations for individual cases.

Conclusions:

Although critical portion definitions are largely treated as subjective, surgeons across multiple specialties identified consistent themes defining “critical portions'', suggesting that setting a minimum standard for criticality is feasible for specific procedures. Surgeons also recognized contextual factors that support the need for case-specific judgement beyond minimum standard. This framework of procedure features and contextual factors may be used as a guide for surgeons making day-to-day decisions and in future work to formally define critical portions for a given procedure.
“The Triptan's Hangover”
Authors: Rueda Vega Mónica , Martínez-Fernández Alicia , Quintas Sonia , Díaz de Terán Javier , Latorre González Germán , Trabajos García Olga , Vivancos Mora Jose , Gago-Veiga Ana Beatriz
Published: February 2022

The emergence of triptans represented a breakthrough in the treatment of migraine, but in clinical practice, patients describe symptoms that resemble those of a hangover after taking them. We propose the use of the Hangover Symptoms Scale (HSS) to evaluate this syndrome in patients that take triptans, which may help identify patients at higher risk of presenting these adverse effects that may interfere with therapeutic compliance.

A cross-sectional observational pilot study with prospective data collection through a clinical-demographic questionnaire and the HSS was carried out on patients with migraine treated in headache units in 3 tertiary hospitals in Madrid.

Sixty-six patients were included in the study. The median HSS was 4 and all symptoms were present in at least 15% of the patients, with difficulty to concentrate being the most frequent (57.6%). No significant differences were found between the presence of a higher HSS score and the sociodemographic characteristics of the patient or his migraine. The presence of aura was associated with a higher percentage of trembling (P = 0.029) and fatigue (nonvisual, polymodal auras; P = 0.017).

According to our study, triptans are responsible for a set of symptoms overlapping with those that occur during a hangover. Therefore, we propose that the HSS could be a useful tool for the evaluation and quantification of these effects in patients receiving triptans. In addition, we found that clinical features could be more frequently associated with the appearance of these adverse effects that, however, are not related to any particular patient profile.
Radiographic Imaging of Power Injectable Medical Access Ports as a Supplemental Identification Tool
Authors: Goyal Nikhil , Do Huy M. , Toscano Alexandra P. , Spear Lillian G. , Hazen Lindsey A. , Folio Les R.
Published: February 2022

Purpose

Our aims were to describe characteristic radiographic features of two power injectable medical access ports (MAPs) on various imaging modalities for rapid and precise identification; and to demonstrate the value of this approach in identifying other types of MAPs via “pictorial atlas”.

Methods

We analyzed two commonly seen MAPs at our clinical center, Smart Port® CT-Injectable Port and PowerPort® M.R.I.® Implantable Port. Photographs of these two MAPs were retrospectively compared with identity-verified MAPs seen on chest X-ray (CXR), computed tomography (CT) and dual energy subtraction radiography (DESR) images from routine patient encounters at our clinical center. Visualized radiographic features were used for MAP differentiation and identification.

Results

Based on selected patient case examples for these two MAPs, physical characteristics seen on imaging were used for MAP identification. These properties included port body and chamber shape; location and number of suture holes; and radiopaque and radiolucent features. Each imaging modality provided a unique set of radiographic features and highlighted specific components of each MAP for rapid and precise identification. CXR offered better visualization of unique MAP features compared to CT.

Conclusions

Radiographic imaging can serve as a tool for medical staff to quickly identify MAPs. Hospital-specific “pictorial atlases” can be developed to display MAPs along with their associated distinctive radiographic and physical features for rapid and precise identification. This may be useful for large referral centers that see a wide array of MAPs by mitigating complications associated with MAP misidentification and usage, thus improving patient care.
Toxic heavy metals in the breast milk of diabetic and non-diabetic postpartum mothers in Yenagoa, Nigeria
Authors: Philip-Slaboh Tuboseiyefah Perekebi , Eleke Chinemerem , Ezejiofor Anthonet Ndidiamaka
Published: February 2022

Background

Breast milk is considered to be the best substance for neonatal nutrition. It is not well known whether diabetes increases the expression of toxic heavy metals in the breast milk of postpartum mothers. This study compared the concentration of toxic heavy metals in breast milk between diabetic and non-diabetic postpartum mothers in Yenagoa.

Material and methods

A cross-sectional design was utilized on a purposive sample of 144 consenting postpartum mothers (72 diabetic and 72 non-diabetic mothers) from one tertiary, one secondary, and one primary medical centre. Breast milk samples were collected at 5-6 weeks postpartum between 1st November 2020 and 30th April 2021. A spectrophotometer was used to analyze the breast milk samples. A pro forma was used for data extraction and data were analyzed at a 5% significance level.

Result

The Diabetes group had levels of Arsenic (63.9%), Lead (95.8%), Mercury (68.1%), and Cadmium (84.7%) above the WHO permissible limits. The mean concentrations were 0.6 ng/ml (Arsenic), 13.2ng/ml (Lead), 2.9ng/ml (Mercury), and 3.3ng/ml (Cadmium). The non-diabetic mothers also had high levels of Arsenic (62.5%), Lead (95.8%), Mercury (72.2%), and Cadmium (86.1%); and the mean concentrations were 0.6ng/ml (Arsenic), 12.2 ng/ml (Lead), 3.0ng/ml (Mercury), and 3.2ng/ml (Cadmium). There was no significant difference in the concentration of toxic heavy metals in breast milk between the diabetic and non-diabetic postpartum mothers (p = > 0.585).

Conclusions

Diabetes did not seem to increase the concentration of toxic heavy metals expressed in breast milk. More rigorous studies are needed to confirm these findings.
IRF4 deficiency vulnerates B cell progeny for leukemogenesis via somatically acquiredJak3mutations conferring IL-7 hypersensitivity
Authors: Gupta Dennis Das , Paul Christoph , Samel Nadine , Bieringer Maria , Staudenraus Daniel , Marini Federico , Raifer Hartmann , Menke Lisa , Hansal Lea , Camara Bärbel , Roth Edith , Daum Patrick , Wanzel Michael , Mernberger Marco , Nist Andrea , Bauer Uta-Maria , Helmprobst Frederik , Buchholz Malte , Roth Katrin , Bastian Lorenz , Hartmann Alina M , Baldus Claudia , Ikuta Koichi , Neubauer Andreas , Burchert Andreas , Jäck Hans-Martin , Klein Matthias , Bopp Tobias , Stiewe Thorsten , Pagenstecher Axel , Lohoff Michael
Published: February 2022

The processes leading from disturbed B cell development to adult B cell progenitor acute lymphoblastic leukemia (BCP-ALL) are poorly understood. Here, we describeIrf4−/−mice as prone to developing BCP-ALL with age.Irf4−/−preB-I cells exhibited impaired differentiation but enhanced proliferation in response to IL-7, along with reduced retention in the IL-7 providing bone marrow niche due to decreased CXCL12 responsiveness. Thus selected, preB-I cells acquiredJak3mutations, probably following irregular AID activity, resulting in malignant transformation. We demonstrate heightened IL-7 sensitivity due toJak3mutants, devise a model to explain it and describe structural and functional similarities toJak2mutations often occurring in human Ph-like ALL. Finally, targeting JAK signaling with Ruxolitinibin vivoprolonged survival of mice bearing establishedIrf4−/−leukemia. Intriguingly, organ infiltration including leukemic meningeosis was selectively reduced without affecting blood blast counts. In this work, we present spontaneous leukemogenesis following IRF4 deficiency with potential implications for high-risk BCP-ALL in adult humans.
Dual-Drug Loaded Biomimetic Chitosan-Collagen Hybrid Nanocomposite Scaffolds for Ameliorating Potential Tissue Regeneration in Diabetic Wounds
Authors: Tallapaneni Vyshnavi , Pamu Divya , Mude Lavanya
Published: February 2022

Diabetes Mellitus (DM) is one of the most concerning conditions, and its chronic complications are nearly synonymous with inflammation, oxidative stress, and infections. In the acute inflammatory phase of diabetic wound healing (DWH), reducing excessive reactive oxygen species (ROS) and inflammatory response of the wound is a necessary treatment. The current work used a mix of emulsification and lyophilization approaches to investigate the effects of resveratrol microparticles (RES-GMS) loaded chitosan-collagen (CS-CLG) scaffold with doxycycline (DOX) on DWH. Resveratrol (RES) is a powerful antioxidant that promotes cell proliferation in the dermis by improving fibroblast function and enhancing CLG production. DOX can potentially shift the balance away from the chronic wound’s pro-inflammatory, proteolytic status toward an environment that promotes vascular ingrowth and, eventually, epithelial development. Cross-linked scaffolds had optimal porosity, reduced matrix degradation, and prolonged drug release when compared to non-cross-linked scaffolds, according to the results of composite scaffold characterization. Cell proliferation assay employing mouse fibroblasts was used to study the kinetics and bioactivity of growth factors produced from the scaffold. The RES-DOX-CS-CLG scaffold was biocompatible and promoted cell development compared to the control and CS-CLG scaffolds in in vitro experiments. DOX-loaded CS-CLG scaffold loaded with R-GMS delivers a prolonged release of RES, according to in vitro tests.
Athletes’ access to, attitudes towards, and experiences of help-seeking for mental health: A scoping review protocol
Authors: Brown Kirsty R. , Quinton Mary L. , Cumming Jennifer
Published: February 2022

Introduction

Athletes are not immune to mental health issues but are less likely to seek help than nonathletes and experience barriers including lack of access to services, lack of knowledge as to how to access services and negative past experiences for help-seeking. Formal and semi-formal sources of support (e.g. support provided in healthcare, sporting context, and higher education systems) are key places for athletes to seek help for mental health, and there is a need to synthesise the evidence on athletes’ access, attitudes to, and experiences of, these services. This protocol outlines a scoping review that will be used to map the evidence, identify gaps in the literature, and summarise findings on athletes’ access, attitudes to and experiences of help-seeking for their mental health.

Methods and analysis

The methodological frameworks of Arksey and O’Malley (2005), Levac et al. (2010), and the Joanna Briggs Institute (2020 & 2021) were used to inform this scoping review protocol alongside the PRISMA-P checklist and published scoping review protocols within sport and health. This protocol outlines the background evidence, need for this scoping review, and the steps that will be taken.

Dissemination

The evidence will be mapped numerically and thematically to describe studies and highlight key concepts, themes, and gaps in the literature. The published scoping review will be disseminated to relevant stakeholders and policymakers including those in healthcare, the sporting context, and the higher education system. The resulting outputs will be in the form of both peer-reviewed and non-peer reviewed publications (e.g. multimedia in the form of a blog post and at conferences).

Strengths and limitations

Strength: The protocol outlines a novel scoping review that will contribute to a gap in the literature, and impact further research directions.

Strength: Informed by best practice methodological frameworks to ensure rigour.

Limitation: Lack of quality assessment of papers.

Limitation: The review will only focus on formal and semi-formal sources of help-seeking (e.g. healthcare, the sporting context and higher education) and will not include research on informal or self-help sources.
m6A governs length-dependent enrichment of mRNAs in stress granules
Authors: Ries Ryan J. , Pickering Brian F. , Poh Hui Xian , Namkoong Sim , Jaffrey Samie R.
Published: February 2022

Stress granules are biomolecular condensates composed of protein and mRNA. Long mRNAs are enriched in stress granules, which is thought to reflect the ability of long mRNAs to form multiple RNA-RNA interactions with other mRNAs. RNA-RNA interactions are thus thought to be critical for stress granule formation. Stress granule-enriched mRNAs also often contain multipleN6-methyladenosine (m6A) residues. YTHDF proteins bind m6A, creating mRNA-protein complexes that partition into stress granules. Here we determine the basis of length-dependent enrichment of mRNAs in stress granules. We show that depletion of m6A is sufficient to abrogate the length-dependent enrichment of mRNAs in stress granules. We show that the presence of m6A predicts which mRNAs are enriched. m6A formation is triggered by long exons, which are often found in long mRNAs, accounting for the link between m6A, length and stress granule enrichment. Thus, length-dependent enrichment of mRNAs in stress granules is driven by YTHDF-mRNA interactions.
High retention of genomic variation and fitness-related traits in the effective population of reintroduced wolves in Yellowstone National Park
Authors: vonHoldt Bridgett M. , DeCandia Alexandra L. , Cassidy Kira A. , Stahler Erin E. , Sinsheimer Janet S. , Smith Douglas W. , Stahler Daniel R.
Published: February 2022

Cooperatively breeding species exhibit numerous strategies to avoid mating with close relatives, inherently reducing effective population size. For species of management concern, accurate estimates of inbreeding and trait depression are crucial for the species’ future. We utilized genomic and pedigree data for Yellowstone National Park gray wolves to investigate the contributions of foundation stock lineages, genetic architecture of the effective population, and putative fitness consequences of inbreeding. Our dataset spans 25 years and seven generations since reintroduction, encompassing 152 nuclear families and 329 litters. We found over 87% of the pedigree foundation genomes persisted and report influxes of allelic diversity from two translocated wolves from a divergent source in Montana. As expected for group-living species, mean kinship significantly increased over time, although we found high retention of genetic variation. Strikingly, the effective population carried a significantly lower level of genome-wide inbreeding coefficients and autozygosity with shorter decays for linkage disequilibrium relative to the non-breeding population. Lifespan and heterozygosity were higher in the effective population, although individuals who had their first litter at an older age also had higher inbreeding coefficients. Our findings highlight genetic contributions to fitness, and the importance of effective population size and gene flow to counteract loss of genetic variation in a wild, free-ranging social carnivore. It is crucial for managers to mitigate factors that significantly reduce effective population size and genetic connectivity, which supports the dispersion of genetic variation that aids in rapid evolutionary responses to environmental challenges.
Weighting by Gene Tree Uncertainty Improves Accuracy of Quartet-based Species Trees
Authors: Zhang Chao , Mirarab Siavash
Published: February 2022

Phylogenomic analyses routinely estimate species trees using methods that account for gene tree discordance. However, the most scalable species tree inference methods, which summarize independently inferred gene trees to obtain a species tree, are sensitive to hard-to-avoid errors introduced in the gene tree estimation step. This dilemma has created much debate on the merits of concatenation versus summary methods and practical obstacles to using summary methods more widely and to the exclusion of concatenation. The most successful attempt at making summary methods resilient to noisy gene trees has been contracting low support branches from the gene trees. Unfortunately, this approach requires arbitrary thresholds and poses new challenges. Here, we introduce threshold-free weighting schemes for the quartet-based species tree inference, the metric used in the popular method ASTRAL. By reducing the impact of quartets with low support or long terminal branches (or both), weighting provides stronger theoretical guarantees and better empirical performance than the original ASTRAL. More consequentially, weighting dramatically improves accuracy in a wide range of simulations and reduces the gap with concatenation in conditions with low gene tree discordance and high noise. On empirical data, weighting improves congruence with concatenation and increases support. Together, our results show that weighting, enabled by a new optimization algorithm we introduce, dramatically improves the utility of summary methods and can reduce the incongruence often observed across analytical pipelines.
Latitudinal cline does not predict variation in the microbiome of wildDrosophila melanogaster
Authors: Henry Lucas P. , Ayroles Julien F.
Published: February 2022

Microbiomes affect many aspects of host biology, but the eco-evolutionary forces that shape their diversity in natural populations remain poorly understood. Geographic gradients, like latitudinal clines, generate predictable patterns in biodiversity at macroecological scales, but whether these macro-scale processes apply to host-microbiome interactions is an open question. To address this question, we sampled the microbiomes of 13 natural populations ofDrosophila melanogasteralong a latitudinal cline in eastern United States. The microbiomes were surprisingly consistent across the cline–latitude did not predict either alpha or beta diversity. Only a narrow taxonomic range of bacteria were present in all microbiomes, indicating that strict taxonomic filtering by the host and neutral ecological dynamics are the primary factors shaping the fly microbiome. Additional temporal sampling across two independent sites revealed significant differences in microbial communities over time, suggesting that local environmental differences that vary at fine spatiotemporal scales are more likely to shape the microbiome. Our findings reveal the complexity of eco-evolutionary interactions shaping microbial variation inD. melanogasterand highlight the need for additional sampling of the microbiomes in natural populations along environmental gradients.
A conditional null allele of Dync1h1 enables targeted analyses of dynein roles in neuronal length sensing and neurological disorders
Authors: Di Pizio Agostina , Marvaldi Letizia , Birling Marie-Christine , Okladnikov Nataliya , Dupuis Luc , Fainzilber Mike , Rishal Ida
Published: February 2022

Size homeostasis is one of the most fundamental aspects of biology and it is particularly important for large cells as neurons. We have previously proposed a motor-dependent length-sensing and growth-regulating mechanism wherein a partial reduction in the levels of microtubule motor proteins should lead to accelerated neuronal growth. This prediction was originally validated in sensory neurons heterozygous for the Loa point mutation in dynein heavy chain 1 (Dync1h1Loa). Here we describe a new mouse model with a conditional allele allowing deletion of exons 24-25 inDync1h1. Homozygous Islet1-Cre deletion ofDync1h1is embryonic lethal, but heterozygous animals (Isl1-Dync1h1+/−) survive to adulthood with approximately 50% dynein expression in targeted cell types.Isl1-Dync1h1+/−adult sensory neurons reveal an accelerated growth phenotype, similar to that previously reported inDync1h1Loaneurons. Moreover,Isl1-Dync1h1+/−mice show mild impairments in gait, proprioception and tactile sensation; and slightly impaired recovery from peripheral nerve injury. Thus, conditional deletion ofDync1h1exons 24-25 enables targeted studies of the role of dynein in neuronal growth and neurological disorders.