bluuebunny/crossref_metadata_2025 huggingface dataset:
The neonatal ketone body is important for primordial follicle pool formation and regulates ovarian ageing in mice
Authors: Wang Xin-Ying , Zhang Xin-Ge , Sang Yong-Juan , Chong Dan-Yang , Sheng Xiao-Qiang , Wang Hai-Quan , Yang Chao-Fan , Yan GuiJun , Sun Hai-Xiang , Li Chao-Jun
Published: August 2022

Adverse nutritional conditions during the perinatal stage are related to early menopause in adulthood; however, the underlying mechanism is still unclear. Herein, we revealed that colostrum-activated ketone body elevation during the postnatal stage regulated primordial follicle reservoir size and then affected ovarian ageing. We found that the expression of the ketogenesis rate-limiting enzyme 3-hydroxy-3-methylglutaryl-CoA synthase 2 (Hmgcs2) was largely enhanced during primordial follicle pool formation after birth and might be activated in the ovaries by colostrum. Reactive oxygen species (ROS) elevation in the ovaries leads to follicle apoptosis to deplete damaged follicles, while Hmgcs2 deficiency enhances follicle apoptosis and thus decreases the size of the primordial follicle pool and leads to premature ovarian ageing (POA), which might be related to the activation of cellular endogenous antioxidant system. All these defects could be rescued by ketone body administration, which suppressed ROS-activated follicle apoptosis. Our results suggest that the internal metabolic homeostasis of newborn mice is critical for the primordial reservoir and that any intrauterine and perinatal undernutrition could result in POA.
Appearance of anti-MDA5 antibody-positive dermatomyositis after COVID-19 vaccination
Authors: Sugimoto Tomohiro , Yorishima Ai , Oka Naoya , Masuda Sho , Nakamoto Naoki , Kidoguchi Genki , Watanabe Hirofumi , Yoshida Yusuke , Mokuda Sho , Hirata Shintaro
Published: August 2022

The direct causes of dermatomyositis, a common autoimmune disease, have not yet been accurately identified, but several studies have linked this condition to various patient-associated and environmental factors, such as viral infections and area of residence. In the present report, we describe our experience with a patient presenting with anti-melanoma differentiation–associated gene 5 (MDA5) antibody-positive dermatomyositis, which developed after vaccination against coronavirus disease 2019 (COVID-19). This patient was simultaneously diagnosed with anti-glutamic acid decarboxylase antibody-positive slowly progressive insulin-dependent diabetes (SPIDDM); her human leucocyte antigen test revealed that she expressed the DRB1*04:05 allele. This is important as this genotype is known to increase susceptibility to both anti-MDA5 antibody-positive dermatomyositis and type I diabetes. To the best of our knowledge, this is the first case of dermatomyositis complicated by SPIDDM identified after COVID-19 vaccination against COVID-19 and presenting with an underlying susceptible genotype. The patient’s genetic predisposition may also be important for the development of autoimmune disease after COVID-19 vaccination.
Blastomycosis Presenting With Acute Airway Obstruction From a Retropharyngeal Abscess and Complicated by Severe Hypokalemia During Posaconazole Therapy: A Case Report and Review of Literature
Authors: Hanna John J , Guastadisegni Jessica M , Kouma Marcus A , Knez Emily B , Arasaratnam Reuben J , Storey Donald F
Published: August 2022

We report a case of cervical blastomycosis with associated paravertebral involvement and severe spinal canal stenosis in a 48-year-old patient presenting with acute airway obstruction from a retropharyngeal abscess. Our case was also complicated by severe hypokalemia that developed during the blastomycosis treatment course with posaconazole and which improved after discontinuation and replacement therapy. After 12 months of blastomycosis-targeted therapy, our patient had complete resolution of clinical, laboratory, and radiological findings of blastomycosis.
Predictive factors for enhanced community mental health vulnerability in this COVID-19 pandemic era
Authors: Li S M , Guo B B , Yang Q P , Yin J Y , Tian L , Ji Y Y , Jiang Y , Zhu H H
Published: August 2022

Objective

Explore the mental health status and its influencing factors of local community residents under the post-epidemic era of coronavirus disease 2019 (COVID-19) in China.

Methods

The basic information scale, self-rating depression scale and self-rating anxiety scale were used to carry out an online questionnaire survey among community residents in Jiangsu Province, China, and the influencing factors of depression and anxiety were analyzed by multivariate logistic regression.

Results

A total of 993 residents completed the mental health survey. It was found that the incidence of depressive and anxiety symptoms was 37.06% and 22.86%. Multivariate logistic regression analysis showed that women [odds ratio (OR) 95% confidence interval (95% CI) = 26.239 (14.743–46.698)], college degree and above [OR (95% CI) = 1.843 (1.085–3.130)] and ordinary residents [OR (95% CI) = 2.222 (1.441–3.425)] were risk factors for depressive symptoms, urban residents had lower risk [OR (95% CI) = 0.655 (0.394–0.829)]. Women [OR (95% CI) = 33.595 (15.812–71.381)] and ordinary residents [OR (95% CI) = 3.017 (1.602–5.680)] were risk factors for anxiety symptoms while the incidence was reduced in professional and technical personnel [OR (95% CI) = 0.271 (0.123–0.597)], workers [OR (95% CI) = 0.383 (0.168–0.876)], soldiers or policemen [OR (95% CI) = 0.200 (0.042–0.961)], married residents [OR (95% CI) = 0.463 (0.230–0.931)] and urban residents [OR (95% CI) = 0.531 (0.251–0.824)].

Conclusion

The incidence of symptoms of depression and anxiety among residents was relatively high under the post-epidemic era of COVID-19, which could be affected by various factors.
Exploring the educational needs of patients with systemic vasculitis using the educational needs assessment tool
Authors: Brolin Sara , Welin Elisabet , Lövström Björn , Bruchfeld Annette , Gunnarsson Iva , Pettersson Susanne
Published: August 2022

Objectives

Knowledge and health literacy enable patients to monitor symptoms and disease impact. Educational needs have previously been explored in rheumatology, but scarcely for patients with ANCA-associated vasculitis (AAV). The aim of the study was to assess the educational needs among patients with AAV using the educational needs assessment tool (ENAT).

Methods

This was a cross-sectional observational study including adults with AAV. Educational needs were captured by ENAT. Total ENAT (0–117 points, with higher numbers indicating higher educational need) and the seven domains (managing pain, movement, feelings, disease process, treatment, self-management and support systems) were explored regarding sex, age, education, diagnosis, disease duration and disease activity. To compare domains, a percentage response (0–100%) was calculated.

Results

One hundred and seventy-eight individuals (50% men; 34% with disease duration ≤2 years) were included. The total ENAT mean was 66.5 (s.d. 26.6; 57%), with domains as follows: disease process, 78%; self-management, 69%; treatments, 64%; feelings, 56%; managing pain, 48%; support systems, 47%; and movement, 41%. Higher educational needs were found among women in the domains movement, feelings and disease process and in total ENAT (all P < 0.04) compared with men. Higher educational needs were also seen in patients with disease duration ≤2 years regarding disease process, self-management and support systems and in total ENAT compared with patients with longer disease duration (all P < 0.03).

Conclusion

This study revealed great educational needs among AAV patients. Some groups expressed higher needs (women and those with shorter disease duration). Increased education for patients with AAV might lead to improved self-care and treatment adherence.
Addition of collagen type I in agarose created a dose-dependent effect on matrix production in engineered cartilage
Authors: López-Marcial Gabriel R , Elango Keerthana , O’Connell Grace D
Published: August 2022

Extracellular-matrix composition impacts mechanical performance in native and engineered tissues. Previous studies showed collagen type I-agarose blends increased cell-matrix interactions and extracellular matrix production. However, long-term impacts on protein production and mechanical properties of engineered cartilage are unknown. Our objective was to characterize the effect of collagen type I on the matrix production of chondrocytes embedded in agarose hydrogels. We hypothesized that the addition of collagen would improve long-term mechanical properties and matrix production (e.g. collagen and glycosaminoglycans) through increased bioactivity. Agarose hydrogels (2% w/v) were mixed with varying concentrations of collagen type I (0, 2 and 5 mg/ml). Juvenile bovine chondrocytes were added to the hydrogels to assess matrix production over 4 weeks through biochemical assays, and mechanical properties were assessed through unconfined compression. We observed a dose-dependent effect on cell bioactivity, where 2 mg/ml of collagen improved bioactivity, but 5 mg/ml had a negative impact on bioactivity. This resulted in a higher modulus for scaffolds supplemented with lower collagen concentration as compared to the higher collagen concentration, but not when compared to the control. In conclusion, the addition of collagen to agarose constructs provided a dose-dependent impact on improving glycosaminoglycan production but did not improve collagen production or compressive mechanics.
The association of polysomnographic sleep on posttraumatic stress disorder symptom clusters in trauma-exposed civilians and veterans
Authors: Brownlow Janeese A , Miller Katherine E , Ross Richard J , Barilla Holly , Kling Mitchel A , Bhatnagar Seema , Mellman Thomas A , Gehrman Philip R
Published: August 2022

Study Objectives

Self-reported sleep disturbance has been established as a risk factor and predictor for posttraumatic stress disorder (PTSD); however, less is known about the relationship between objective sleep and PTSD symptom clusters, and the specific role of hyperarousal. The present study examined the relationships between sleep continuity and architecture on PTSD symptom clusters.

Methods

Participants underwent two in-laboratory sleep studies to assess sleep continuity and architecture. They also completed the Clinician-Administered PTSD-IV scale and the Structured Clinical Interview for the DSM-IV to assess for PTSD diagnosis and other psychiatric disorders.

Results

Sleep continuity (i.e. total sleep time, sleep efficiency percent, wake after sleep onset, sleep latency) was significantly related to PTSD Cluster B (reexperiencing) symptom severity (R2 = .27, p < .001). Sleep architecture, specifically Stage N1 sleep, was significantly associated with PTSD Cluster B (t = 2.98, p = .004), C (Avoidance; t = 3.11, p = .003), and D (Hyperarosual; t = 3.79, p < .001) symptom severity independently of Stages N2, N3, and REM sleep. REM sleep variables (i.e. REM latency, number of REM periods) significantly predicted Cluster D symptoms (R2 = .17, p = .002).

Conclusions

These data provide evidence for a relationship between objective sleep and PTSD clusters, showing that processes active during Stage N1 sleep may contribute to PTSD symptomatology in civilians and veterans. Further, these data suggest that arousal mechanisms active during REM sleep may also contribute to PTSD hyperarousal symptoms.

This paper is part of the War, Trauma, and Sleep Across the Lifespan Collection. This collection is sponsored by the Sleep Research Society.
Recurrent SARS-CoV-2 mutations in immunodeficient patients
Authors: Wilkinson S A J , Richter Alex , Casey Anna , Osman Husam , Mirza Jeremy D , Stockton Joanne , Quick Josh , Ratcliffe Liz , Sparks Natalie , Cumley Nicola , Poplawski Radoslaw , Nicholls Samuel N , Kele Beatrix , Harris Kathryn , Peacock Thomas P , Loman Nicholas J
Published: August 2022

Long-term severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in immunodeficient patients are an important source of variation for the virus but are understudied. Many case studies have been published which describe one or a small number of long-term infected individuals but no study has combined these sequences into a cohesive dataset. This work aims to rectify this and study the genomics of this patient group through a combination of literature searches as well as identifying new case series directly from the COVID-19 Genomics UK (COG-UK) dataset. The spike gene receptor-binding domain and N-terminal domain (NTD) were identified as mutation hotspots. Numerous mutations associated with variants of concern were observed to emerge recurrently. Additionally a mutation in the envelope gene, T30I was determined to be the second most frequent recurrently occurring mutation arising in persistent infections. A high proportion of recurrent mutations in immunodeficient individuals are associated with ACE2 affinity, immune escape, or viral packaging optimisation.

There is an apparent selective pressure for mutations that aid cell–cell transmission within the host or persistence which are often different from mutations that aid inter-host transmission, although the fact that multiple recurrent de novo mutations are considered defining for variants of concern strongly indicates that this potential source of novel variants should not be discounted.
Prediction of Postoperative Deterioration in Cardiac Surgery Patients Using Electronic Health Record and Physiologic Waveform Data
Authors: Mathis Michael R. , Engoren Milo C. , Williams Aaron M. , Biesterveld Ben E. , Croteau Alfred J. , Cai Lingrui , Kim Renaid B. , Liu Gang , Ward Kevin R. , Najarian Kayvan , Gryak Jonathan ,   BCIL Collaborators Group
Published: August 2022

Background

Postoperative hemodynamic deterioration among cardiac surgical patients can indicate or lead to adverse outcomes. Whereas prediction models for such events using electronic health records or physiologic waveform data are previously described, their combined value remains incompletely defined. The authors hypothesized that models incorporating electronic health record and processed waveform signal data (electrocardiogram lead II, pulse plethysmography, arterial catheter tracing) would yield improved performance versus either modality alone.

Methods

Intensive care unit data were reviewed after elective adult cardiac surgical procedures at an academic center between 2013 and 2020. Model features included electronic health record features and physiologic waveforms. Tensor decomposition was used for waveform feature reduction. Machine learning–based prediction models included a 2013 to 2017 training set and a 2017 to 2020 temporal holdout test set. The primary outcome was a postoperative deterioration event, defined as a composite of low cardiac index of less than 2.0 ml min˗1 m˗2, mean arterial pressure of less than 55 mmHg sustained for 120 min or longer, new or escalated inotrope/vasopressor infusion, epinephrine bolus of 1 mg or more, or intensive care unit mortality. Prediction models analyzed data 8 h before events.

Results

Among 1,555 cases, 185 (12%) experienced 276 deterioration events, most commonly including low cardiac index (7.0% of patients), new inotrope (1.9%), and sustained hypotension (1.4%). The best performing model on the 2013 to 2017 training set yielded a C-statistic of 0.803 (95% CI, 0.799 to 0.807), although performance was substantially lower in the 2017 to 2020 test set (0.709, 0.705 to 0.712). Test set performance of the combined model was greater than corresponding models limited to solely electronic health record features (0.641; 95% CI, 0.637 to 0.646) or waveform features (0.697; 95% CI, 0.693 to 0.701).

Conclusions

Clinical deterioration prediction models combining electronic health record data and waveform data were superior to either modality alone, and performance of combined models was primarily driven by waveform data. Decreased performance of prediction models during temporal validation may be explained by data set shift, a core challenge of healthcare prediction modeling.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
What’s New in Pediatric Orthopaedic Health Care Disparities?
Authors: Arant Kaetlyn R. , Modest Jacob M. , Gil Joseph A. , Cruz Aristides I.
Published: August 2022

Background:

Health care disparities are prevalent within pediatric orthopaedics in the United States. Social determinants of health, such as income, race, social deprivation, place of residence, and parental involvement, all play a role in unequal access to care and disparate outcomes. Although there has been some effort to promote health equity both within pediatric orthopaedics and the US health care system altogether, disparities persist. In this review, we aim to identify major sources of inequality and propose solutions to achieve equitable care in the future.

Methods:

We searched the PubMed database for papers addressing disparities in pediatric orthopaedics published between 2016 and 2021, yielding 283 papers.

Results:

A total of 36 papers were selected for review based upon new findings. Insurance status, race, and social deprivation are directly linked to poorer access to care, often resulting in a delay in presentation, time to diagnostic imaging, and surgery. Although these disparities pervade various conditions within pediatric orthopaedics, they have most frequently been described in anterior cruciate ligament/meniscal repairs, tibial spine fractures, adolescent idiopathic scoliosis, and upper extremity conditions. Treatment outcomes also differ based on insurance status and socioeconomic status. Several studies demonstrated longer hospital stays and higher complication rates in Black patients versus White patients. Patients with public insurance were also found to have worse pain and function scores, longer recoveries, and lower post-treatment follow-up rates. These disparate outcomes are, in part, a response to delayed access to care.

Conclusions:

Greater attention paid to health care disparities over the past several years has enabled progress toward achieving equitable pediatric orthopaedic care. However, delays in access to pediatric orthopaedic care among uninsured/publicly insured, and/or socially deprived individuals remain and consequently, so do differences in post-treatment outcomes. Reducing barriers to care, such as insurance status, transportation and health literacy, and promoting education among patients and parents, could help health care access become more equitable.

Level of Evidence:

Level IV—narrative review
Neutrophil extracellular traps accelerate vascular smooth muscle cell proliferation via Akt/CDKN1b/TK1 accompanying with the occurrence of hypertension
Authors: Fang Xinhui , Ma Ling , Wang Yanfu , Ren Fang , Yu Yanqiu , Yuan Zhengwei , Wei Hongquan , Zhang Haipeng , Sun Yingxian
Published: August 2022

Objective:

Neutrophil extracellular traps (NETs) can trigger pathological changes in vascular cells or vessel wall components, which are vascular pathological changes of hypertension. Therefore, we hypothesized that NETs would be associated with the occurrence of hypertension.

Methods:

To evaluate the relationship between NETs and hypertension, we evaluated both the NETs formation in spontaneously hypertensive rats (SHRs) and the blood pressure of mice injected phorbol-12-myristate-13-acetate (PMA) via the tail vein to induce NETs formation in arterial wall. Meanwhile, proliferation and cell cycle of vascular smooth muscle cells (VSMCs), which were co-cultured with NETs were assessed. In addition, the role of exosomes from VSMCs co-cultured with NETs on proliferation signaling delivery was assessed.

Results:

Formation of NETs increased in the arteries of SHR. PMA resulted in up-regulation expression of citrullinated Histone H3 (cit Histone H3, a NETs marker) in the arteries of mice accompanied with increasing of blood pressure. NET treatment significantly increased VSMCs count and accelerated G1/S transition in vitro. Cyclin-dependent kinase inhibitor 1b (CDKN1b) was down-regulated and Thymidine kinase 1 (TK1) was up-regulated in VSMCs. Exosomes from VSMCs co-cultured with NETs significantly accelerated the proliferation of VSMCs. TK1 was up-regulated in the exosomes from VSMCs co-cultured with NETs and in both the arterial wall and serum of mice with PMA.

Conclusion:

NETs promote VSMCs proliferation via Akt/CDKN1b/TK1 and is related to hypertension development. Exosomes from VSMCs co-cultured with NETs participate in transferring the proliferation signal. These results support the role of NETs in the development of hypertension.
Platelet-derived extracellular vesicles correlate with therapy-induced nocturnal blood pressure changes
Authors: Lugo-Gavidia Leslie Marisol , Burger Dylan , Nolde Janis M. , Carnagarin Revathy , Chan Justine , Bosio Erika , Matthews Vance B. , Schlaich Markus P.
Published: August 2022

Introduction:

Elevated nocturnal blood pressure (BP) is closely associated with increased risk of cardiovascular (CV) events. Circulating extracellular vesicles (EVs) have been proposed as a potential CV risk biomarker and shown to correlate with BP. The present study aimed to assess whether a reduction in BP is paralleled by respective changes in EVs.

Methods:

Fifty-five hypertensive patients (age: 57.7 ± 14.1 years) were included in the study. EVs and BP were assessed at baseline and at 12 weeks follow-up. Interventions to lower BP included advice on life-style modification only or life-style advice combined with additional pharmacotherapy. EVs were evaluated by flow cytometry (CD41+/Annexin V+) and BP by unobserved automated office BP and ambulatory BP monitoring.

Results:

Nocturnal systolic BP correlated with EV levels at baseline (P = 0.01). Multivariable regression models showed that changes in nocturnal systolic BP (adjusted R
2 = 0.23; P = 0.01) and diastolic BP (adjusted R
2 = 0.18; P = 0.02) were associated with respective changes in EV levels. Furthermore, intervention-induced improvement of systolic dipping was associated with a reduction in EVs in the univariate analysis (adjusted R
2 = 0.06; P = 0.03). In contrast, systolic office, 24 h- and daytime-BP did not show significant associations with EVs. Patients whose medication was up-titrated at baseline showed a trend towards lower EV levels at follow-up (absolute change of −1.7 ± 1.3 EV/μl; P = 0.057)

Conclusions:

Circulating platelet-derived EVs were positively associated with nocturnal BP and therapy-induced changes over a 12-week treatment period. EVs may provide an integrated measure of BP changes achieved with pharmacotherapy.
Inflammatory cytokines induce neutrophil extracellular traps interaction with activated platelets and endothelial cells exacerbate coagulation in moderate and severe essential hypertension
Authors: Li Jihe , Tong Dongxia , Song Bin , Xie Fangyu , Zhang Guixin , Hao Xin , Li Wuwei , Chi Hang , Wang Weiming , Shao Yibing
Published: August 2022

Background:

Essential hypertension (EH) patients suffer from paradoxically thrombotic rather than haemorrhagic, although the exact mechanism remains elusive. Our aim is to explore whether and how neutrophil extracellular traps (NETs) play the procoagulant role in EH patients, as well as evaluated whether the NET releasing were triggered by inflammatory cytokines.

Methods:

The concentration of plasma NETs components were detected by ELISA. The morphology of cells and NETs formation were analysed using immunofluorescence. Procoagulant activity was analysed by clotting time, purified coagulation complex and fibrin generation assays. Phosphatidylserine (PS) exposure on endothelial cells (ECs) was analysed with flow cytometry.

Results:

Moderate to severe EH patients plasma NETs levels were significantly higher compared to mild EH patients or controls. Furthermore, inflammatory cytokines can induce NETs generation, depleting these patients plasma inflammatory cytokines led to a reduction in NET releasing. NETs from moderate to severe EH patients neutrophils led to significantly decreased clotting time (CT), increased potency to generate thrombin and fibrin (all P < 0.05). These procoagulant effects were markedly attenuated by approximately 70% using DNase I. Additionally, high concentrations NETs exerted a strong cytotoxic effect on ECs, conferring them a procoagulant phenotype.

Conclusion:

Our study reveals that EH drives a systemic inflammatory environment, which, in turn, drives neutrophils to prime and NET releasing, and found a link between hypercoagulability and NETs levels in moderate to severe EH patients. Therefore, anti-inflammatory combined with block the generation of NETs may represent a new therapeutic target for preventing thrombosis in EH patients.
Mediators of inflammation resolution and vasoactive eicosanoids in gestational diabetes and preeclampsia
Authors: Barden Anne E. , Shinde Sujata , Phillips Michael , Beilin Lawrence J. , Mori Trevor A.
Published: August 2022

Objective:

Women with gestational diabetes (GDM) have an increased risk of preeclampsia and postpartum diabetes. Inflammation associates with both GDM and preeclampsia. This study examined specialized proresolving mediators (SPM) that direct inflammation resolution and eicosanoids that are involved in inflammation, in relation to the development of preeclampsia and ongoing postpartum glucose intolerance in GDM.

Methods:

Participants were selected from a prospective study examining the development of preeclampsia in women with GDM. Four groups of age-matched women were studied: GDM (n = 20), GDM who developed preeclampsia (GDM+PE, n = 21), GDM who remained glucose-intolerant postpartum (GDM+PPIGT, n = 20), or pregnancies with glucose tolerance within the normal range (NGT, n = 21). Measurement of SPM (E-series resolvins and D-series resolvins), SPM pathway intermediates (14-HDHA, 18-HEPE and 17-HDHA), 20-hydroxyeicosatetraenoic acid (20-HETE), and the urinary metabolite of the vasodilator prostacyclin 2,3-dinor-6-Keto-PGF1α, were made at 28, 32 and 36 weeks gestation and at 6 months postpartum.

Results:

Compared with GDM, GDM+PE had elevated levels of 20-HETE and the SPM pathway intermediates 14-HDHA, 18-HEPE, 17-HDHA, at 32 weeks, and the SPM RvE1 at 32 and 36 weeks gestation. Compared with NGT and regardless of whether they developed preeclampsia or PPIGT, GDM had lower levels of 2,3-dinor-6-Keto-PGF1α during pregnancy.

Conclusion:

Reduced levels of the prostacyclin metabolite 2,3-dinor-6-Keto-PGF1α may contribute to the increased risk of preeclampsia in women with GDM. The increase in 20-HETE, a vasoconstrictor and mediator of inflammation, and SPM that contribute to inflammation resolution, prior to the onset of preeclampsia require further investigation to clarify their clinical significance.
Effects of Gum Chewing on Recovery From Postoperative Ileus: A Randomized Clinical Trail
Authors: HSU Ya-Chuan , SZU Shu-Ying
Published: August 2022

Background

Sham feeding with products such as chewing gum has been theorized to decrease the incidence and time to resolution of postoperative ileus. The conflicting findings in the literature on this subject are because in part of the use of mixed study populations, which has led to difficulties in assessing the value of sham feeding in ameliorating this condition.

Purpose

The aim of this study was to evaluate the efficacy of postsurgical gum chewing in restoring normal bowel movement in patients with colorectal cancer who had undergone abdominal surgery for colon resection.

Methods

A randomized controlled trial was used to examine the time to first postoperative flatus and defecation. The intervention group (n = 30) received xylitol chewing gum on the first day after colon resection, one piece of gum for 15 minutes, 3 times daily, until the time to first flatus and defecation. Both the intervention and control groups (n = 30) received standard postoperative care and were encouraged to walk as soon as possible after surgery. The time to first flatus was reported by patients.

Results

The time to first flatus and defecation in the intervention group was significantly shorter than that in the control group (39.13 ± 15.66 vs. 52.92 ± 21.97 hours and 54.55 ± 18.90 vs. 77.98 ± 34.59 hours, respectively). However, after controlling for age and surgical duration, only time to first flatus was significantly shorter in the intervention group. Significantly positive correlations were found between time to first flatus and time to first defecation in both groups.

Conclusions/Implications for Practice

In this study, gum chewing was shown to have a positive effect on the time to first postoperative flatus and defecation. This inexpensive and noninvasive intervention may be recommended to decrease the time to resolution of postsurgical ileus in middle-aged and older patients who have undergone open abdominal surgery for colorectal resection.
Acute mesenteric ischaemia
Authors: Reintam Blaser Annika , Forbes Alastair , Björck Martin
Published: August 2022

Purpose of review

To summarize the recent evidence on acute mesenteric ischaemia (AMI).

Recent findings

The overall incidence of AMI is below 10/100 000 person years but increases exponentially with age. The overall mortality of AMI remains high, exceeding 50%, despite continuing progress and increasing availability of imaging and endovascular interventions. However, patients with (early) revascularization have significantly better outcomes. The majority of patients surviving the acute event are still alive at 1 year, but evidence on quality of life is scarce.

Clinical suspicion of AMI is the key to timely diagnosis, with biphasic computed tomography-angiography the diagnostic method of choice. Currently, no biomarker has sufficient specificity to diagnose AMI.

Improved awareness and knowledge of AMI are needed to raise the suspicion of AMI in relevant patients and thereby to achieve better outcomes.
COVID-19-associated pulmonary aspergillosis: an underdiagnosed or overtreated infection?
Authors: Rouzé Anahita , Martin-Loeches Ignacio , Nseir Saad
Published: August 2022

Purpose of review

Coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA) may concern up to one third of intensive care unit (ICU) patients. The purpose of this review is to discuss the diagnostic criteria, the pathogenesis, the risk factors, the incidence, the impact on outcome, and the diagnostic and therapeutic management of CAPA in critically ill patients.

Recent findings

The incidence of CAPA ranges 3--28% of critically ill patients, depending on the definition used, study design, and systematic or triggered screening. COVID-19 is associated with direct damage of the respiratory epithelium, immune dysregulation, and common use of immunosuppressive drugs which might promote Aspergillus respiratory tract colonization and invasion. Positive Aspergillus tests among COVID-19 critically patients might reflect colonization rather than invasive disease. CAPA usually appears during the second week after starting invasive mechanical ventilation and is independently associated with ICU mortality.

Further studies are needed to validate CAPA case definitions, to determine the accurate incidence of CAPA in comparison to adequate controls, and its evolution during the pandemic. A pro-active diagnostic strategy, based on risk stratification, clinical assessment, and bronchoalveolar lavage could be recommended to provide early antifungal treatment in patients with high probability of CAPA and clinical deterioration.
Hospital Price Transparency in the United States
Authors: Linde Sebastian , Egede Leonard E.
Published: August 2022

Background:

Effective January 1, 2021, US hospitals were required to upload information on their chargemaster prices (database of list prices), discounted cash prices (commonly charged to self-pay patients), and payer-specific negotiated prices.

Objective:

Examine how prices vary and are associated with hospital characteristics, market competition, and hospital quality.

Design Setting and Participants:

This observational study used data on 14 common medical services across 1599 hospitals in 2021. Descriptive and regression analyses were used to study price variation. Analyses adjust for hospital characteristics, market competition and state fixed effects.

Results:

Ninetieth -to-10th-percentile price markups factors (ratios) range between 3.2 and 11.5 for chargemaster; 6.1 and 19.7 for cash; and 6.6 and 30.0 for negotiated prices. Adjusted regression results indicate that hospitals’ cash prices are on average 60% (P<0.01) higher, and list prices are on average 164% (P<0.01) higher, than negotiated prices. Systematic pricing differences across hospitals were noted, with urban hospitals having 14% (P<0.01) lower prices than rural hospitals, teaching hospitals having 3% (P<0.01) higher prices than nonteaching hospitals, and nonprofit hospitals pricing 9% (P<0.01), and for-profit hospitals 39% (P<0.01), higher than government owned hospitals. In addition, hospitals that contract with more insurance plans have higher prices, hospitals in more competitive markets have lower prices, and higher quality hospitals have on average 5% (P<0.01) lower prices than lower quality hospitals.

Conclusions:

Prices all vary considerably across US hospitals. High quality hospitals are associated with lower pricing across all three sets of prices examined. Hospital price transparency may help consumers better identify hospitals that provide both high quality, and low cost, care.
Mitochondria and ischemia reperfusion injury
Authors: Panconesi Rebecca , Widmer Jeannette , Carvalho Mauricio Flores , Eden Janina , Dondossola Daniele , Dutkowski Philipp , Schlegel Andrea
Published: August 2022

Purpose of review

This review describes the role of mitochondria in ischemia-reperfusion-injury (IRI).

Recent findings

Mitochondria are the power-house of our cells and play a key role for the success of organ transplantation. With their respiratory chain, mitochondria are the main energy producers, to fuel metabolic processes, control cellular signalling and provide electrochemical integrity. The mitochondrial metabolism is however severely disturbed when ischemia occurs. Cellular energy depletes rapidly and various metabolites, including Succinate accumulate. At reperfusion, reactive oxygen species are immediately released from complex-I and initiate the IRI-cascade of inflammation. Prior to the development of novel therapies, the underlying mechanisms should be explored to target the best possible mitochondrial compound. A clinically relevant treatment should recharge energy and reduce Succinate accumulation before organ implantation. While many interventions focus instead on a specific molecule, which may inhibit downstream IRI-inflammation, mitochondrial protection can be directly achieved through hypothermic oxygenated perfusion (HOPE) before transplantation.

Mitochondria are attractive targets for novel molecules to limit IRI-associated inflammation. Although dynamic preservation techniques could serve as delivery tool for new therapeutic interventions, their own inherent mechanism should not only be studied, but considered as key treatment to reduce mitochondrial injury, as seen with the HOPE-approach.
A Protocol to Assess Adult Outcomes at 30 Years Following Preterm Birth
Authors: Sullivan Mary C , D’Agata Amy L. , Stanley Zachary , Brewer Pamela , Kelly Michelle M.
Published: August 2022

Background

Among the most intense adversity experiences for infants is premature birth. Early birth marks the beginning of a life course that broadly affects families, health care, education, social systems, and the survivors themselves. For many, the transition to adulthood is challenging and often hampered by cognitive, physical and mental health, and motor and independence difficulties.

Objectives

To share a comprehensive protocol of a 10th follow-up study of premature infants in their 30s. The protocol accounts for stress during the neonatal period, the cumulative context (risk, protection) of development, biological and epigenetic mechanisms, and individual resilience.

Methods

The prospective 5-group longitudinal design includes 215 term-born and preterm-born individuals with various neonatal morbidities at ages 30–35. Adult outcomes include health, adaptive, executive, and work and social competence. Novel measures are four system indicators of allostatic load (AL) and epigenetics. Contextual measures include socioeconomic risk and individual resilience. All measures were selected based on coherence with constructs of the scientific aims, strong psychometrics, continuity for repeated measures, and minimal subject burden. Objective assessments include body composition imaging, exercise testing, blood and saliva collection, and actigraphy. The 2-phase protocol takes approximately 8 hr.

Discussion

After an 11-month COVID-19 pause, participant response has been strong. As of May 2022, 75 participants have completed the full protocol, and 99 have consented to participate. When socioeconomic risk is controlled, we hypothesize that life course trajectories in physical and psychological health, adaptive function, and executive function will differ between term and preterm neonatal morbidity groups. AL will vary across groups and contribute to outcomes. We expect proximal protection and resilience to mediate the cumulative medical and socioeconomic risk and AL. Epigenome-wide DNA methylation, with estimates of age acceleration, will be examined across groups and explored in longitudinal associations with medical risk, socioeconomic status, and protection. To our knowledge, this is the only U.S. study of premature infants aged 30–35 years. With millions of preterm-born individuals reaching adulthood, the protocol incorporates molecular and genetic biomarkers in a life course developmental examination to inform the timing and content of interventions.
Do Nutrition Students' and Professionals' Whole-Grain Knowledge, Perceptions, and Experiences Differ?
Authors: Hicks-Roof Kristen , Walker Krystal , Marsh Tamara , Reyes-Gonzalez Cristina , LeBlanc Kelly , Xu Jing , Hamadi Hanadi Y.
Published: August 2022

The purpose of this study was to investigate nutrition students' and professionals' knowledge, perceptions, and experiences with whole grains and the differences between the levels of nutrition experts. Participants completed an 18-question online survey from December 2020 to February 2021. Convenience, snowballing, and purposive recruitment strategies were used. Data were analyzed using descriptive statistics, regression, and correlation analysis. Participants (n = 472) included 2 groups: registered dietitians/registered dietitian nutritionists (n = 348) and dietetic intern and nutrition students (NUTRs) (n = 124). Both registered dietitian nutritionists and NUTRs were able to correctly identify whole-grain foods and had had high whole-grain knowledge. Registered dietitian nutritionists had a significantly positive relationship between categorizing whole grains and whole-grain health impacts, which was not seen for NUTRs. Registered dietitian nutritionists personally consumed an average of 13 different grains, whereas NUTRs consumed 11 grains (P < .001). More than 60% of all participants reported never consumed 7 unique grains (triticale, KAMUT, teff, spelt, sorghum, amaranth, and millet). Nutrition students and professionals are knowledgeable on whole-grain choices and their benefits yet are less experienced in their consumption of those grains. In order to inform and promote to the public whole-grain foods, nutrition students and professionals need to continue to boost their familiarity with diverse whole grains.
Nutritional Quality of Kids' Fast-Food Meals
Authors: Arslan Ezgi , Ozlu Tugce , Meral Koc Bilge , Kenger Emre Batuhan
Published: August 2022

Despite the increasing consumption of fast foods, the nutrient quality of such meals has not been systematically evaluated I Turkey. Our study aimed to investigate and compare the nutritional value of the kids' menus of 4 popular fast-food chains and traditional Turkish menus created by specialist dietitians. The nutritional values of the kids' menus were assessed using the recommended daily allowance, dietary guidelines for Turkey, and national food-based dietary recommendations of the Turkish Ministry of Health. All meals were compared in terms of energy, macro food items, and sodium content. The kids' menus from the following 4 most preferred fast-food companies in Turkey were included in the study: McDonald's, Burger King, Popeyes, and Arby's. The menus with the highest energy and fat content were offered by Burger King, those with the highest protein content were offered by Popeyes, and those with the highest sodium content were offered by Arby's. The contribution of fat to the energy content was found to be low in traditional Turkish menus (P < .05), whereas the contribution of protein to the energy content was significantly higher in the Popeyes menus (P < .05). Improving the nutritional quality of kids' fast-food menus may be effective in controlling childhood obesity.
The Cost of Operating Sexual Health Clinics During the Ending the (HIV) Epidemic Initiative in New York City
Authors: Williams Austin M. , Jamison Kelly , Eppink Samuel T. , Pathela Preeti , Blank Susan , Peters Dana , Gift Thomas L. , Berruti Andrés A.
Published: August 2022

Background

As part of New York State's Ending the Epidemic (EtE) initiative, sexual health clinics (SHCs) in New York City invested in clinic enhancements and expanded their HIV-related services to increase access to HIV prevention interventions and treatment. The objective of this study was to estimate and describe the change in SHC operating costs related to clinic enhancements and expanded patient services implemented as part of the EtE initiative.

Methods

A comprehensive microcosting approach was used to collect retrospective cost information from SHCs, broken down by category and programmatic activity. Cost information was collected from 8 clinics across New York City during two 6-month time periods before (2015) and during (2018–2019) EtE.

Results

Eight SHCs reported comprehensive cost data. Costs increased by $800,000 on average per clinic during the 6-month EtE period. The cost per visit at an SHC increased by $120 on average to $381 (ranging from $302 to $464) during the EtE period. Personnel costs accounted for 69.9% of EtE costs, and HIV-related medications accounted for 8.9% of costs. Employment of social workers and patient navigators increased costs by approximately $150,000 on average per clinic. Postexposure prophylaxis was the costliest medication with average expenditures of $103,800 per clinic.

Conclusions

This study demonstrates the key drivers of cost increases when offering enhanced HIV services in SHCs. Documenting the changes in resources necessary to implement these services and their costs can inform other health departments on the viability of offering enhanced HIV services within their own clinics.
Observation and Patients’ Perceptions of Incorporating Their Photograph Into the Electronic Health Record
Authors: Reuland Brian D. , Redman Chelsea T. , Kneifati-Hayek Jerard Z. , Fernandes Yelstin , Kosber Rashid , Ortuno-Garcia Claudia , Crossman Daniel J. , Salmasian Hojjat , Chen Allen R. , Barchi Daniel J. , Applebaum Jo R. , Green Robert A. , Adelman Jason S.
Published: August 2022

Objectives

Wrong-patient errors are common and have the potential to cause serious harm. The Office of the National Coordinator for Health Information Technology Patient Identification SAFER Guide recommends displaying patient photographs in electronic health record (EHR) systems to facilitate patient identification and reduce wrong-patient errors. A potential barrier to implementation is patient refusal; however, patients’ perceptions about having their photograph captured during registration and integrated into the EHR are unknown.

Methods

The study was conducted in an emergency department (ED) and primary care outpatient clinic within a large integrated health system in New York City. The study consisted of 2 components: (1) direct observation of the registration process to quantify the frequency of patient refusals and (2) semistructured interviews to elicit patients’ feedback on perceived benefits and barriers to integrating their photograph into the EHR.

Results

Of 172 registrations where patients were asked to take a photograph for patient identification, 0 refusals were observed (ED, 0 of 87; primary care outpatient clinic, 0 of 85). A convenience sample of 30 patients were interviewed (female, 70%; age ≥55 years, 43%; Hispanic/Latino, 67%; Black, 23%). Perceived benefits of integrating patient photographs into the EHR included improved security (40%), improved patient identification (23%), and ease of registration (17%). A small proportion of patients raised privacy concerns.

Conclusions

Patient refusal was not found to be a barrier to implementation of patient photographs in the EHR. Efforts to identify and address other potential barriers would help ensure that the highest proportion of patients has photographs in their medical record.
Interventions Into Reliability-Seeking Health Care Organizations: A Systematic Review of Their Goals and Measuring Methods
Authors: Auschra Carolin , Asaad Eleonora , Sydow Jörg , Hinkelmann Jürgen
Published: August 2022

Objectives

Within the last 2 decades, numerous interventions making use of high-reliability theory have been implemented to increase reliability in healthcare organizations. This systematic literature review first explores the concrete goals on which such interventions focus. Second, the review captures how the achievement of these goals, or alternatively a change, generally an increase in organizational reliability, is measured across different contexts.

Methods

Searches were conducted in PubMed, Academic Search Ultimate, Business SourcePremier, CINAHL, Communication Source, EconLit, ERIC, Medline, Political Science Complete, PsycArticles, APA PsycInfo, PSYNDEX, SocINDEX (via the resource hosterEbscoHost), and Web of Science (through November 22, 2021). Peer-reviewed, English language studies were included, reporting on the implementation of a concrete intervention to increase reliability in a medical context and referring to high-reliability theory.

Results

The search first yielded 8896 references, from which 75 studies were included in the final sample. Important healthcare goals stated by the seminal report “Crossing the Quality Chasm” guided the analysis of the included studies. Most of the studies originated from the United States and report on interventions to increase reliability of either organizational units or whole organizations when aiming for safety (n = 65). Other goals reported on include effectiveness, and much less frequently timeliness, patient centeredness, and efficiency. Fifty-eight studies use quantitative measurement exclusively to account for the achievement of these goals; 7 studies use qualitative measurement exclusively, and 10 studies use a mixed-method approach. The operationalization of goals, including the operationalization of organizational reliability, and measurement methods do not follow a unified approach, despite claiming to be informed by a coherent theory. Instead, such operationalizations strongly depend on the overall objective of the study and the respective context.

Conclusions

Measuring the outcomes of high-reliability interventions into healthcare organizations is challenging for different reasons, including the difficult operationalization of partly overlapping goals, the complex, processual nature of achieving reliability, and the limited ability of organizations striving for more reliability if they are already performing on a high level. This review critically assesses the adoption of the goals stated in the seminal report “Crossing the Quality Chasm” and provides insights for organizations and funding providers that strive to evaluate more reliable service provision.