bluuebunny/crossref_metadata_2025 huggingface dataset:
Circadian disruption by shifting the light‐dark cycle negatively affects bone health in mice
Authors: Schilperoort Maaike , Bravenboer Nathalie , Lim Joann , Mletzko Kathrin , Busse Björn , van Ruijven Leo , Kroon Jan , Rensen Patrick C. N. , Kooijman Sander , Winter Elizabeth M.
Published: November 2019

The past decade, it has become evident that circadian rhythms within metabolically active tissues are very important for physical health. However, although shift work has also been associated with an increased risk of fractures, circadian rhythmicity has not yet been extensively studied in bone. Here, we investigated which genes are rhythmically expressed in bone, and whether circadian disruption by shifts in light‐dark cycle affects bone turnover and structure in mice. Our results demonstrate diurnal expression patterns of clock genes (Rev‐erbα, Bmal1, Per1, Per2, Cry1, Clock), as well as genes involved in osteoclastogenesis, osteoclast proliferation and function (Rankl, Opg, Ctsk), and osteocyte function (c‐Fos) in bone. Weekly alternating light‐dark cycles disrupted rhythmic clock gene expression in bone and caused a reduction in plasma levels of procollagen type 1 amino‐terminal propeptide (P1NP) and tartrate‐resistant acidic phosphatase (TRAP), suggestive of a reduced bone turnover. These effects coincided with an altered trabecular bone structure and increased cortical mineralization after 15 weeks of light‐dark cycles, which may negatively affect bone strength in the long term. Collectively, these results show that a physiological circadian rhythm is important to maintain bone health, which stresses the importance of further investigating the association between shift work and skeletal disorders.
Regulation of allergic inflammation by dendritic cells
Authors: Chow Timothy G. , Gill Michelle A.
Published: November 2019

Purpose of review

Dendritic cells are critical in directing inflammatory versus tolerogenic responses. As the burden of allergic disease rises worldwide, increased understanding of mechanisms underlying these diseases is needed. This review highlights research demonstrating how dendritic cells influence allergic disease development, providing important mechanistic insights into current clinical management strategies as well as potential areas of focus for future development of novel therapeutic strategies.

Recent findings

Recent studies continue to elucidate dendritic cell-associated pathways which can either promote or prevent allergic inflammation. Mechanisms involved include various aspects of dendritic cell activity, from antigen sampling and dendritic cell migration to complex dendritic cell interactions with other immune cells, infectious agents and allergens. A deeper understanding of these mechanisms and how dendritic cells promote tolerance provides insight into potential strategies to therapeutically target dendritic cells in the management of allergic disease.

Recent discoveries illustrate crucial roles of dendritic cells as regulators of inflammatory versus tolerant cascades. Building on lessons from oncologic strategies for harnessing dendritic cells to promote antitumor responses, several novel pathways could also be targeted to promote dendritic cell-mediated tolerogenesis in the context of allergy. Additional studies are needed to further define the roles and potential effects of dendritic cells in these potential strategies to reduce allergic inflammation.
Antifungal use in the surgical ICU patient
Authors: Póvoa Pedro , Coelho Luís , Nora David , Martin-Loeches Ignacio
Published: November 2019

Purpose of review

The successful treatment of surgical fungal infections depends of a timely and adequate source control alongside with the use of prompt systemic antifungals. The main challenge of antifungal use in critically ill surgical patients is to find a balance between rational versus indiscriminate use in order to accomplish an antifungal stewardship program.

Recent findings

Surgical fungal infections represent an important burden in the daily clinical activity in many ICUs. The efficacy of the available antifungal drugs has not been adequately assessed in randomized controlled trials with surgical fungal infections in ICU patients. Most clinical experience is limited to case reports or uncontrolled case series. Due to the lack of adequate scientific evidence to assess the role of the different antifungals in surgical ICU patients, it is usually suggested to follow the recommendations for invasive candidiasis and candidemia.

Antifungal use in the surgical patients admitted to an ICU is a complex matter and there are several elements to consider like the presence of septic shock and multiorgan failure, local epidemiology and antifungal resistance, among others. The proper use of antifungals alongside early recognition and prompt source control, are critical factors for improved outcomes.
Biplanar Fluoroscopy in Pediatric Orthopaedics
Authors: Young Porter , Rhea Evan , Rasmussen Luke , Loveless Eric
Published: November 2019

Biplanar fluoroscopy allows for the simultaneous acquisition of x-ray images in 2 planes without needing to move the extremity or C-arm. It is advantageous in cases such as pinning supracondylar humerus fractures or slipped capital femoral epiphyses where frequently alternating between 2 planes under fluoroscopic imaging is required. However, literature describing the technique is lacking. Therefore, the purpose of our article is to discuss room setup, advantages, and disadvantages of using biplanar fluoroscopy in cases involving the elbow, shoulder, hip, and knee.
All-Inclusive Central Line Dressing Kits
Authors: Yaglowski Jason “Jake”
Published: November 2019

A team of the frontline nursing staff was assembled to work on central line–associated bloodstream infections (CLABSIs). This team used Lean methodology to identify issues related to central line care and maintenance and then developed countermeasures to systematically eliminate these issues. Since supplies was noted as the number one concern, the team worked to create all-inclusive central line dressing kits. These kits created a standard for dressing changes, leading to a significant decrease in CLABSI rates at a level 1 trauma center.
Validation of a Head-mounted Virtual Reality Visual Field Screening Device
Authors: Mees Lukas , Upadhyaya Swati , Kumar Pavan , Kotawala Sandal , Haran Shankar , Rajasekar Shruthi , Friedman David S. , Venkatesh Rengaraj
Published: November 2019

Précis:

The C3 fields analyzer (CFA) is a moderately reliable perimeter preferred by patients to standard perimetry. While it does not approximate the gold standard, it was sensitive and specific for clinically defined glaucoma (area under the receiving operator characteristic curve=0.77 to 0.86).

Purpose:

Testing the visual field is a vital sign for diagnosing and managing glaucoma. The current gold standard, the Humphrey visual field analyzer (HFA), is large, expensive and can be uncomfortable for some patients. The current study investigated the CFA, a virtual reality head-mounted visual field testing device, as a possible subjective field test for glaucoma screening and eventually glaucoma monitoring.

Patients and Methods:

The CFA presented stimuli in the same 54 positions as the HFA 24-2 SITA Standard test using a suprathreshold algorithm approximating an 18 dB deficit. A total of 157 patients (both controls and glaucoma patients) at the Aravind Eye Hospital, Pondicherry, India, were tested with both devices.

Results:

The number of stimuli missed on the CFA correlated with HFA mean deviation (r=0.62, P<0.001), and with pattern standard deviation (r=0.36, P<0.001). The area under the receiving operator characteristic curve was 0.77±0.06 for mild glaucoma (HFA mean deviation ≥−6 dB) and 0.86±0.04 for moderate-advanced glaucoma (HFA mean deviation <−6 dB). Patients with an 18 dB or worse deficit at a point in the visual field on the HFA failed to see the CFA stimulus at the same position 38% of the time.

Conclusions:

While the CFA did not reliably identify deficits that matched the HFA, it was moderately effective at identifying glaucoma subjects. Further refinements to the device will be required to improve point by point testing performance and screening performance.
Differences in Health-Related Quality of Life Predictors in People Living With HIV With and Without Diabetes
Authors: Zuñiga Julie Ann , Jang Dong Eun , Walker Gregory , Ohueri Chelsi West , A. García Alexandra
Published: November 2019

Diabetes is one of the most common comorbid conditions in people living with HIV (PLWH). Diabetes may affect health-related quality of life (HRQoL) for PLWH because they experience more symptoms, are prescribed more medications, and are required to do self-care activities. The purpose of our study was to compare predictors of the HRQoL for PLWH with and without diabetes. The study was a secondary analysis of data from the Center for AIDS Research Network of Integrated Clinical Systems cohort using multiple regression. Significant differences were found between PLWH with and without diabetes. The significant predictors of HRQoL for PLWH-alone were depression, anxiety, medication adherence, physical activity, smoking, and age. For PLWH with diabetes, the only significant predictors of HRQoL were anxiety and depression.
Occupational Differences in C-Reactive Protein Among Working-Age Adults in South Korea
Authors: Kim Yongjoo , Zaitsu Masayoshi , Tsuno Kanami , Li Xiaoyu , Lee Sunmin , Jang Soong-nang , Kawachi Ichiro
Published: November 2019

Objective:

To examine the association between occupational class and high-sensitivity C-reactive protein (hsCRP) in Korean workers.

Methods:

We used a nationally representative sample of Koreans (n = 2591) aged 19 to 65 years from the 2015 Korea National Health and Nutrition Examination Survey. The concentration of hsCRP (mg/L) was assessed by a high sensitivity immunoturbidimetric assay. Current occupation was categorized as: white-collar (managers/professionals), pink-collar (clerks/service/sales), blue-collar (craft/equipment/machine-assembling, agricultural/forestry/fishery, and elementary-level labor), or unemployed. Cross-sectional linear regression models adjusted for sociodemographic/work-related/health conditions and behaviors.

Results:

Compared with blue-collar workers, white-collar workers showed significantly higher levels of hsCRP (β = 0.16, 95% CI: 0.02, 0.30) after adjusting for all covariates, whereby the pattern was more pronounced among professionals. However, the association was not significant for unemployed and pink-collar workers.

Conclusions:

Findings suggest that Korean white-collar workers, particularly professionals, have elevated levels of inflammation.
Pregnancy Does Not Increase the Risk of Bell's Palsy: A National Cohort Study
Authors: Choi Hyo Geun , Hong Sung Kwang , Park Su-Kyoung , Kim Hyung-Jong , Chang Jiwon
Published: November 2019

Objectives:

The objective of this study was to compare the incidence of Bell's palsy between women during pregnancy or postpartum periods and non-pregnant/non-postpartum women (controls).

Methods:

Using the national cohort from the Korean Health Insurance Review and Assessment Service, pregnant/postpartum participants (63,264) and control participants (126,528) were matched in a 1:2 ratio based on age, income, region of residence, and medical history. The incidence of Bell's palsy in both groups was measured from pregnancy to 1 year postpartum.

Results:

Among the 63,264 pregnant/postpartum participants, 20 were diagnosed with or treated for Bell's palsy during pregnancy, and 38 during postpartum periods. The annual incidence of Bell's palsy per 100,000 women during pregnancy was 43.4 in the patient group and 80.2 in the control group (p < 0.05), and that during postpartum periods was 60.1 the patient group and 50.6 in the control group (p > 0.05).

Conclusion:

The annual incidence of Bell's palsy was not increased in pregnant women relative to that in the control.
Intratympanic Treatment in Menière's Disease, Efficacy of Aminoglycosides Versus Corticosteroids in Comparison Studies
Authors: Yaz Furkan , Ziylan Fuat , Smeeing Diederik P. J. , Thomeer Hans G. X. M.
Published: November 2019

Objective:

To compare the functional outcomes and complications of intratympanic gentamicin (ITG) versus intratympanic corticosteroids (ITC) in Menière's disease.

Data Sources:

An electronic search was conducted in the Cochrane Library, PubMed, and Embase databases on February 3, 2019. Articles written in English, Dutch, German, French, or Turkish language were included.

Study Selection:

Study inclusion criteria were: 1) patients diagnosed with definite Menière's disease according to the criteria of the American Academy of Otolaryngology-Head and Neck Surgery, 2) treated with ITG or ITC in a comparison study, and 3) reported subjective and objective outcomes concerning Menière's disease.

Data Extraction:

The quality of eligible studies was assessed according to an adjusted version of the Cochrane Risk of Bias tool. The extracted data were study characteristics (study design, publication year, and number of relevant patients), patient's characteristics (sex and age), disease characteristics (uni or bilateral and duration of Menière's disease), treatment protocol, and different therapeutic outcomes (vertigo, tinnitus, aural fullness, and hearing loss).

Data Synthesis:

A total of eight articles were included for data extraction and analysis. For subjective outcomes, ITG was slightly favored compared to intratympanic corticosteroids. This was significant only in three studies (p < 0.05). For objective outcomes and complications, no significant differences were seen.

Conclusions:

The result of this systematic review shows some benefit of ITG over ITC for subjective outcomes and no difference regarding objective outcomes or complication rate. However, this superiority of ITG is rather weak. Both interventions can be effectively and safely used in controlling Menière's disease in acute situations.
Is Longer Surgery More Dangerous? Operative Duration Not Associated With Complications After Vestibular Schwannoma Resection
Authors: Raghavan Arun M. , Lipschitz Noga , Kohlberg Gavriel D. , Samy Ravi N. , Zuccarello Mario , Pensak Myles L. , Breen Joseph T.
Published: November 2019

Objective:

To examine the association between operative duration and complications after vestibular schwannoma (VS) surgery.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

One hundred forty-eight patients undergoing vestibular schwannoma resection in a single institution.

Intervention:

Vestibular schwannoma resection.

Main Outcome Measures:

Operative duration, surgical approach, tumor size, and postoperative complications.

Results:

Forty-one patients underwent middle cranial fossa (MCF) approach, 46 underwent translabyrinthine (TL) approach, and 61 underwent retrosigmoid (RS) approach. The mean operative duration overall was 407 minutes (MCF—339 min, TL—450 min, RS 420 min). When controlling for tumor size, there was no difference in procedure duration by approach (OR 0.92, CI 0.82–1.02, p=0.11).

When controlling for approach, there was a significant increase in procedure duration by tumor size (OR 1.36, CI 1.23–1.50, p < 0.0001). Increased procedure duration was not associated with 30-day readmission (p = 0.82), cerebrospinal fluid leak (CSF) (p = 0.84), return to the operating room (p = 0.75), postoperative deep vein thrombosis (p = 1.0), postoperative stroke (p = 0.23), or postoperative wound complications (p = 0.70). Longer operative time was associated with increased hospital length of stay (p = 0.04). However, when controlling for tumor size and surgical approach, hospital length of stay was no longer associated with increased procedure duration (OR 1.15, CI 0.98–1.33, p = 0.3).

Conclusion:

Increased operative duration was associated with larger tumor size; however contrary to previous reports, increased operative duration was not associated with postoperative complications.
Replicating Skull Base Anatomy With 3D Technologies: A Comparative Study Using 3D-scanned and 3D-printed Models of the Temporal Bone
Authors: Chae Ricky , Sharon Jeffrey D. , Kournoutas Ioannis , Ovunc Sinem S. , Wang Minghao , Abla Adib A. , El-Sayed Ivan H. , Rubio Roberto Rodriguez
Published: November 2019

Hypothesis:

3D technologies, including structured light scanning (SLS), microcomputed tomography (micro-CT), and 3D printing, are valuable tools for reconstructing temporal bone (TB) models with high anatomical fidelity and cost-efficiency.

Background:

Operations involving TB require intimate knowledge of neuroanatomical structures—a demand that is currently met through dissection of limited cadaveric resources. We aimed to document the volumetric reconstruction of TB models using 3D technologies and quantitatively assess their anatomical fidelity.

Methods:

In the primary analysis, 14 anatomical characteristics of right-side TB from 10 dry skulls were measured. Each skull was 3D-scanned using SLS to generate virtual models, which were measured using mesh processing software. Metrics were analyzed using mean absolute differences and one-samplettests with Bonferroni correction. In the secondary analysis, an individualized right-side TB specimen (TBi) was 3D-scanned using SLS and micro-CT, and 3D-printed on a stereolithography printer. Measurements of each virtual and 3D-printed model were compared to measurements of TBi.

Results:

Significant differences between the physical skulls and virtual models were observed for 11 of 14 parameters (p < 0.0036), with the greatest mean difference in the length of petrous ridge (2.85 mm) and smallest difference in the diameter of stylomastoid foramen (0.67 mm). In the secondary analysis, greater mean differences were observed between TBi and virtual models than between TBi and 3D-printed models.

Conclusion:

For the first time, our study provides quantitative measurements of TB anatomy to demonstrate that 3D technologies can facilitate individualized and highly accurate reconstructions of TB, which may benefit anatomy education, clinical training, and preoperative planning.
Cannabinoids
Authors: Unal Ece , Anderson Brigitte , Helber Andrew , Marks John H.
Published: November 2019

Cannabinoids have been known as the primary component of cannabis for decades, but the characterization of the endocannabinoid system (ECS) in the 1990s opened the doors for cannabis’ use in modern medicine. The 2 main receptors of this system, cannabinoid receptors 1 and 2, are found on cells of various tissues, with significant expression in the gastrointestinal (GI) tract. The characterization of the ECS also heralded the understanding of endocannabinoids, naturally occurring compounds synthesized in the human body. Via secondary signaling pathways acting on vagal nerves, nociceptors, and immune cells, cannabinoids have been shown to have both palliative and detrimental effects on the pathophysiology of GI disorders. Although research on the effects of both endogenous and exogenous cannabinoids has been slow due to the complicated legal history of cannabis, discoveries of cannabinoids’ treatment potential have been found in various fields of medicine, including the GI world. Medical cannabis has since been offered as a treatment for a myriad of conditions and malignancies, including cancer, human immunodeficiency virus/acquired immunodeficiency syndrome, multiple sclerosis, chronic pain, nausea, posttraumatic stress disorder, amyotrophic lateral sclerosis, cachexia, glaucoma, and epilepsy. This article hopes to create an overview of current research on cannabinoids and the ECS, detail the potential advantages and pitfalls of their use in GI diseases, and explore possible future developments in this field.
Recent developments in fetal alcohol spectrum disorder
Authors: Baker Joshua J. , Stoler Joan M.
Published: November 2019

Purpose of review

To highlight research, publications, and medical advancements in fetal alcohol spectrum disorder (FASD) over the past 18 months.

Recent findings

Prevalence numbers have been updated, allowing for a more accurate account of the societal impact. Further work on diagnostic techniques and the underlying mechanisms will allow us to better understand the pathophysiology of FASD and could translate into treatments for the condition. Continued research on new treatments and interventions is needed to improve the affected individual's health care and quality of life. Measurable outcomes allow us to tangibly measure improvements for individuals and families affected by FASD.

The current review highlights recent publications from January 2018 to August 2019 showing continued medical advancement in improving the care for children and families affected by FASD.
Vitamin D-related immunomodulation in patients with liver cirrhosis
Authors: Triantos Christos , Kalafateli Maria , Aggeletopoulou Ioanna , Diamantopoulou Georgia , Spantidea Panagiota I. , Michalaki Marina , Vourli Georgia , Konstantakis Christos , Assimakopoulos Stelios F. , Manolakopoulos Spilios , Gogos Charalambos , Kyriazopoulou Venetsana , Mouzaki Athanasia , Thomopoulos Konstantinos
Published: November 2019

Objective(s)

Increasing evidence indicates that vitamin D status is linked to severity of liver cirrhosis and patients’ survival. However, the potential role of vitamin D-related immunomodulation in hepatic decompensation and patients’ mortality in relation to vitamin D deficiency remains unknown. The aim of the current study is to evaluate the association between vitamin D status and vitamin D binding protein (VDBP) levels with serum cytokine and lipopolysaccharide binding protein (LBP) and to examine their role on disease severity and cirrhotics’ mortality.

Methods

One hundred consecutive Caucasian patients with liver cirrhosis were enrolled in the study. 25(OH)D, VDBP, and LBP concentrations were assessed by ELISA. Cytokine tumor necrosis factor-a (TNF-a), interleukin 6 (IL-6), IL-1β, IL-8, IL-10, and IL-12 levels were determined by Cytometric Bead Array.

Results

25(OH)D levels were inversely correlated with CP score, MELD, IL-6, and CP stage and VDBP levels with CP score, MELD, IL-6, IL-8, LBP, and CP stage. Cirrhotics with 25(OH)D deficiency and severe deficiency had significantly higher CP score, increased IL-6 levels and lower VDBP levels. In the multivariate analysis, the independent prognostic factors associated with patients’ survival were CP stage B [hazard ratio = 6.75; 95% confidence interval (CI) 1.32, 34.43; P = 0.022], CP stage C (hazard ratio = 7.39; 95% CI 1.41, 38.81; P = 0.018), the presence of hepatocellular carcinoma (hazard ratio = 4.50; 95% CI 1.54, 13.13; P = 0.006) and 25(OH)D levels (hazard ratio = 0.87; 95% CI 0.80, 0.95; P = 0.002).

Conclusion

The results show that vitamin D status and VDBP levels are associated with liver cirrhosis severity and patients’ mortality, possibly through a proinflammatory immune response.
Dietary fructose and dyslipidemia: new mechanisms involving apolipoprotein CIII
Authors: Hieronimus Bettina , Stanhope Kimber L.
Published: November 2019

Purpose of review

Chronic consumption of fructose and fructose-containing sugars leads to dyslipidemia. Apolipoprotein (apo) CIII is strongly associated with elevated levels of triglycerides and cardiovascular disease risk. We reviewed the effects of fructose consumption on apoCIII levels and the role of apoCIII in fructose-induced dyslipidemia.

Recent findings

Consumption of fructose increases circulating apoCIII levels compared with glucose. The more marked effects of fructose compared with glucose on apoCIII concentrations may involve the failure of fructose consumption to stimulate insulin secretion. The increase in apoCIII levels after fructose consumption correlates with increased postprandial serum triglyceride. Further, RNA interference of apoCIII prevents fructose-induced dyslipidemia in nonhuman primates. Increases in postprandial apoCIII after fructose, but not glucose consumption, are positively associated with elevated triglycerides in large triglyceride-rich lipoproteins and increased small dense LDL levels.

ApoCIII might be causal in the lipid dysregulation observed after consumption of fructose and fructose-containing sugars. Decreased consumption of fructose and fructose-containing sugars could be an effective strategy for reducing circulating apoCIII and subsequently lowering triglyceride levels.
Inherited conditions resulting in nephrolithiasis
Authors: Hoppe Bernd , Martin-Higueras Cristina
Published: November 2019

Purpose of review

Prevalence of pediatric urolithiasis is increasing, which is definitively visible in increasing numbers of presentations in emergency or outpatient clinics. In pediatric patients, a genetic or metabolic disease has to be excluded, so that adequate treatment can be installed as early as possible. Only then either recurrent stone events and chronic or even end-stage kidney disease can be prevented.

Recent findings

The genetic background of mostly monogenic kidney stone diseases was unravelled recently. In hypercalcuria, for example, the commonly used definition of idiopathic hypercalciuria was adopted to the genetic background, here three autosomal recessive hereditary forms of CYP24A1, SLC34A1 and SLC34A3 associated nephrocalcinosis/urolithiasis with elevated 1.25-dihydroxy-vitamin D3 (1.25-dihydroxy-vitamin D3) (calcitriol) levels. In addition either activating or inactivating mutations of the calcium-sensing receptor gene lead either to hypocalcemic hypercalciuria or hypercalcemic hypocalciuria. In primary hyperoxaluria, a third gene defect was unravelled explaining most of the so far unclassified patients. In addition, these findings lead to new treatment options, which are currently evaluated in phase III studies.

Kidney stones are not the disease itself, but only its first symptom. The underlying disease has to be diagnosed in every pediatric patient with the first stone event.
New approaches to therapeutic drug development for childhood cancers
Authors: Campbell Kevin , Ma Clement , DuBois Steven G.
Published: November 2019

Purpose of review

We provide an overview of the current landscape of drug development relevant to childhood cancers. We present recent and ongoing efforts to identify therapeutic targets in pediatric cancers. We describe efforts to improve the approach to clinical trials and highlight the role regulatory changes and multistakeholder platforms play in advancing pediatric cancer drug development.

Recent findings

Expanding knowledge of the genetic landscape of pediatric malignancies through clinical genomics studies has yielded an increasing number of potential targets for intervention. In parallel, new therapies for children with cancer have shifted from cytotoxic agents to targeted therapy, with examples of striking activity in patients with tumors driven by oncogenic kinase fusions. Innovative trial designs and recent governmental policies provide opportunities for accelerating development of targeted therapies in pediatric oncology.

Novel treatment strategies in pediatric oncology increasingly utilize molecularly targeted agents either as monotherapy or in combination with conventional cytotoxic agents. The interplay between new target identification, efforts to improve clinical trial design and new government regulations relevant to pediatric cancer drug development has the potential to advance novel agents into frontline care of children with cancer.
Treatment Decision Making and Regret in Parents of Children With Incurable Cancer
Authors: Ye Zeng Jie , Cheng Meng Hui , Zhang Xiao Ying , Tang Ying , Liang Jian , Sun Zhe , Liang Mu Zi , Yu Yuan Liang
Published: November 2019

Background

The treatment-related decision-making process is a highly emotional time for parents of children with incurable cancer, and they tend to continue the cancer-directed treatment even when they realize that there is no cure for their child.

Objective

To evaluate whether parents involved in different treatment decisions regretted their treatment decision after their child’s death.

Methods

We collected prospective data from 418 parents of children who died of incurable cancer after receiving cancer care at 1 of 4 hospitals. We assessed parent decisional regret and its association with the type of treatment decision made (non–cancer-directed vs cancer-directed). Propensity score–matched analysis (at a ratio of 1:1) was performed.

Results

One hundred forty-eight parents (35.4%) reported heightened regret. Two isonumerical arms with 103 (non–cancer-directed) and 103 (cancer-directed) resulted after propensity score matching. Parents with a cancer-directed treatment decision (relative risk, 1.53; 95% confidence interval, 1.24–1.90; P = .002) were more likely to report decisional regret compared with those with a non–cancer-directed decision.

Conclusion

Bereaved parents with a cancer-directed treatment decision are more likely to experience increased regret for their decision than bereaved parents involved in a non–cancer-directed treatment decision.

Implications

Shared-decision aids should be prepared for young parents with low education to improve disease-related knowledge, accurate risk perceptions, and options congruent with parents’ values.
Applying the Medications at Transitions and Clinical Handoffs Toolkit in a Rural Primary Care Clinic
Authors: Jarrett Traci , Cochran Jill , Baus Adam
Published: November 2019

Background:

Adequate medication reconciliation is related to patients' safety. Rural populations are at increased risk of adverse drug events due to errors in medication reconciliation and often receiving medical care across multiple health care entities and across long distances with separate electronic medical records.

Methods:

This study examined the implementation of Medications at Transitions and Clinical Handoffs Toolkit (MATCH) in a rural primary care clinic and assessed the acceptability and feasibility of implementation.

Intervention:

MATCH was developed as a workflow process intervention to improve medication reconciliation.

Results:

Findings from MATCH implementation indicate that the process improved medication reconciliation workflow. A shared definition of current medications across providers and patients was essential.

Conclusions:

Empowering patients and caregivers with tools and language to work with providers, particularly nurses, to conduct medication reconciliation during primary care clinic visits is key to improving patient medication reconciliation in rural settings.
Filling the Gap for Obsessive-Compulsive Disorder Services in Canada
Authors: Taube-Schiff Marlene , Rector Neil A. , Young Rebecca , Larkin Persephone , Richter Margaret A.
Published: November 2019

Obsessive-compulsive disorder (OCD) is a significant psychiatric illness that can impact an individual in terms of their quality of life, functional abilities, and interpersonal relationships. Until recently, services for individuals with severe symptoms of OCD were limited within Canada. The Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook Health Sciences Centre in Toronto, Canada, recently launched an intensive services program for individuals with severe symptoms of OCD. This article provides an overview of the steps that were taken to develop this program. Methods involved incorporation of information gathered from both service users and service providers of these models of treatment within North America and beyond. This article provides a potential treatment model for residential psychiatric treatment that can be applied to OCD and possibly other severe treatment refractory psychiatric illnesses in terms of methods used and generalizable key ingredients.
An Innovative Dietary Supplement Scorecard for Assessing Risk
Authors: Rittenhouse Melissa , Kegel Jessica , Attipoe Selasi , Deuster Patricia
Published: November 2019

Individuals often use dietary supplements (DSs) to enhance performance without knowing the potential dangers. Therefore, Operation Supplement Safety developed a safety rating scorecard to help individuals independently assess DS, by using 7 simple criteria. Dietary supplements that met at least 4 of the 7 criteria were classified as “less risky” compared with those scoring less than 4. We assessed the accuracy and reliability of a DS safety rating scorecard, when coupled with a DS educational session. Adults with a mean age of 46 years attended two sessions. Session I included a general overview of DS, education on DS safety, and instructions on how to use the DS scorecard. Participants then independently scored 12 DSs. During session II, participants rescored the same 12 DSs and participated in a focus group. Completed DS scorecards were analyzed for accuracy and reliability both between participants and across sessions. More than 86% of participants correctly classified the DSs using the scorecard. When provided a brief session on DS education, participants could reliably use the scorecard to correctly classify DSs as “risky” or “less risky.” Education is key for assisting individuals to make more informed decisions about DSs.
The Clinicopathologic Characteristics and Complement Activation of Antineutrophil Cytoplasmic Antibody-associated Vasculitides With Glomerular IgA Deposition
Authors: Ma Yanhong , Chen Liangliang , Xu Ying , Han Quan , Yu Binfeng , Zhao Jie , Hua Zhou , Yang Yi , Chen Jianghua , Han Fei
Published: November 2019

The renal injury caused by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are characterized by few or no immune deposits in glomerulus. A growing number of AAV patients with glomerular immunoglobulin (Ig)A deposits have been reported. We retrospectively investigated all AAV patients with glomerular IgA deposits diagnosed in our center. Serum galactose-deficient IgA1 (Gd-IgA1) level and glomerular Gd-IgA1 and IgA staining were measured. Moreover, we detected complement pathway components in their sera. A total of 168 AAV patients were enrolled, including 26 patients with glomerular IgA deposition and 142 patients with pauci-immune-complex deposition. The AAV patients with IgA deposition had a tendency of lower systemic disease activity, presenting with lower erythrocyte sedimentation rate, lower myeloperoxidase-ANCA, and tendency of lower C reactive protein and Birmingham Vasculitis Activity Score. For renal injury, there were no significant differences in clinical data, pathologic parameters, or renal outcome between groups. The serum level of Gd-IgA1 and intensity of glomerular Gd-IgA1 staining in IgA deposition AAV patients were similar to IgA nephropathy patients. All patients in the IgA nephropathy group and AAV groups with or without IgA deposition had the activation of the alternative complement pathway, whereas AAV patients with IgA deposition also had the activation of the classic complement pathway. Correlation analysis showed serum C1q level correlated directly with serum globulin and IgA levels. In conclusion, AAV patients with IgA deposition had the basis of IgA nephropathy and may present lower systemic disease activity. But it differs from pauci-immune AAV or IgA nephropathy by the possible activation of the classic complement pathway.
Utilizing the Cholecystagogue, Ensure Plus, Results in Similar Hepatobiliary Scintigraphy Study Results and Patient Outcomes Status Post Cholecystectomy, in Comparison With Sincalide
Authors: Peacock Justin G. , Katchen Jared M. , Christensen Chad T. , Banks Kevin P.
Published: November 2019

Objective

To determine if use of the oral cholecystagogue, Ensure Plus (EP), in hepatobiliary scintigraphy (HBS) leads to a similar distribution of normal and abnormal gallbladder ejection fractions (GBEFs) versus other historical secondary findings of chronic biliary disease in a similar patient population compared with the conventional cholecystokinin analog, sincalide. The HBS findings analyzed included the GBEF, small bowel transit time, gallbladder fill time, and reversal of the normal gallbladder versus small bowel transit. The secondary objectives were to determine whether patient outcomes were significantly different for EP and sincalide HBS study patients following cholecystectomy, namely, the surgical pathology and patient-reported biliary-type pain.

Methods

We reviewed all HBS examinations over a retrospective 34-month period. Data from 446 patients who underwent sincalide or EP HBS with GBEF determination for evaluation of chronic symptoms concerning for biliary etiology met the inclusion criteria. The aforementioned HBS findings and postsurgical patient outcomes were obtained for each patient group.

Results

Comparing HBS examinations performed with sincalide or EP, no significant differences were noted in the major HBS findings of similar patient populations. Outcomes for the sincalide and EP groups status post cholecystectomy were assessed to determine their sensitivity, specificity, positive predictive value, and negative predictive value. The outcomes assessed were the histopathology and patient-reported amelioration of biliary-type pain. No significant differences were noted.

Conclusions

The sincalide and EP cholecystagogues did not lead to significantly different HBS findings for similar patient populations or postcholecystectomy outcomes.
Imaging of Prostate Cancer Recurrence in the Vas Deferens With 68Ga-PSMA PET/CT
Authors: Priftakis Dimitrios , Afaq Asim , Bomanji Jamshed
Published: November 2019

Two cases with 68Ga-PSMA–avid prostate cancer recurrence in the vas deferens are presented. These cases highlight the clinical importance of imaging the pattern of local prostate cancer recurrence and the potential difficulties that arise due to the altered anatomy in the prostate bed after prostatectomy or radiotherapy.
Ocular myasthenia gravis: updates on an elusive target
Authors: Melson Andrew T. , McClelland Collin M. , Lee Michael S.
Published: November 2019

Purpose of review

Ocular myasthenia gravis (OMG) is a complex condition with heterogenous phenotypes and ill-defined diagnostic criteria. Understanding concomitant risk factors and autoimmune serology can help inform prognosis for generalization and guide treatment.

Recent findings

Although antibodies to acetylcholine receptors or muscle-specific kinase likely increase risk of generalization, they are less frequent in OMG. Patients without either antibody tend to have a milder disease process and often have variable antibodies to other end-plate proteins such as LRP4, agrin, or cortactin. The treatment of OMG begins with pyridostigmine and is supplemented by oral prednisone if treatment-resistant or high risk for generalization. Variable oral prednisone regimens have been used with success and further immunosuppression may be best achieved with mycophenolate mofetil and azathioprine. Checkpoint inhibitor-induced myasthenia gravis is increasingly recognized and likely has high rates of mortality associated with myocarditis.

Our understanding of OMG and its variable phenotypes continues to evolve. Autoantibody testing increasingly provides valuable diagnostic and prognostic information. Despite these improvements, a lack of quality treatment trials creates significant challenges for evidence-based management guidelines.
Differential diagnosis of acute vascular vertigo
Authors: Lee Seung-Han , Kim Ji-Soo
Published: November 2019

Purpose of review

The current review covers recent advances in vascular vertigo in terms of diagnostic strategies, clinical/laboratory features, pathophysiology, and differential diagnosis.

Recent findings

Acute strokes presenting with isolated dizziness/vertigo without other obvious symptoms or signs of central nervous system involvements may be easily mistaken as peripheral vestibulopathy. For correct diagnosis of vascular vertigo, the importance of clinical history (timing and triggers) and targeted bedside examination cannot be overemphasized. In addition to Head Impulse-Nystagmus-Test of Skew, several differential strategies have been advanced by adopting a combination of clinical history, bedside or laboratory examination, and imaging for diagnosis of vascular vertigo. Circumscribed cerebellar and brainstem lesions may cause isolated central vestibular syndromes with characteristic vestibular and ocular motor manifestations. Recognition of these findings would aid in localizing the lesions and understanding the function of each central vestibular structure. Central positional nystagmus (CPN) may mimic benign paroxysmal positional vertigo (BPPV), but additional oculomotor or neurological findings mostly permit differentiation of CPN from BPPV.

In acute vestibular syndrome, discriminating vascular causes is still challenging especially when other central symptoms and signs are not evident. An integrated approach based on understanding of clinical features, laboratory findings, speculated mechanisms, and limitations of current diagnostic tests will lead to better clinical practice.
Retinal vessel changes in cerebrovascular disease
Authors: Dumitrascu Oana M. , Koronyo-Hamaoui Maya
Published: November 2019

Purpose of review

The retina is growingly recognized as a window into cerebrovascular and systemic vascular conditions. The utility of noninvasive retinal vessel biomarkers in cerebrovascular risk assessment has expanded due to advances in retinal imaging techniques and machine learning-based digital analysis. The purpose of this review is to underscore the latest evidence linking retinal vascular abnormalities with stroke and vascular-related cognitive disorders; to highlight modern developments in retinal vascular imaging modalities and software-based vasculopathy quantification.

Recent findings

Longitudinal studies undertaken for extended periods indicate that retinal vascular changes can predict cerebrovascular disorders (CVD). Cerebrovascular ties to dementia provoked recent explorations of retinal vessel imaging tools for conceivable early cognitive decline detection. Innovative biomedical engineering technologies and advanced dynamic and functional retinal vascular imaging methods have recently been added to the armamentarium, allowing an unbiased and comprehensive analysis of the retinal vasculature. Improved artificial intelligence-based deep learning algorithms have boosted the application of retinal imaging as a clinical and research tool to screen, risk stratify, and monitor with precision CVD and vascular cognitive impairment.

Mounting evidence supports the use of quantitative retinal vessel analysis in predicting CVD, from clinical stroke to neuroimaging markers of stroke and neurodegeneration.
Novel intermicrobial molecular interaction: Pseudomonas aeruginosa Quinolone Signal (PQS) modulates Aspergillus fumigatus response to iron
Authors: Nazik Hasan , Sass Gabriele , Ansari Shajia R. , Ertekin Reyhan , Haas Hubertus , Déziel Eric , Stevens David A.
Published: November 2019

Pseudomonas aeruginosa

(Pa) and Aspergillus fumigatus (Af), the commonest bacterium and fungus in compromised host airways, compete for iron (Fe). The Pseudomonas quinolone signal (PQS), a Pa quorum sensing molecule, also chelates Fe, and delivers Fe to the Pa cell membrane using Pa siderophores. In models of Af biofilm formation or preformed biofilms, PQS inhibited Af in a low Fe environment. AfΔsidA (mutant unable to produce siderophores) biofilm was more sensitive to PQS inhibition than wild-type (WT), as was planktonic AfΔsidA growth. PQS decreased WT Af growth on agar. All these inhibitory actions were reversed by Fe. The Pa siderophore pyoverdin, or Af siderophore inhibitor celastrol, act cooperatively with PQS in Af inhibition. These findings all indicate PQS inhibition is owing to Fe chelation. Remarkably, in high Fe environments, PQS enhanced Af biofilm at 1/100 to 1/2000 Fe concentration required for Fe alone to enhance. Planktonic Af growth, and on agar, Af conidiation, were also enhanced by PQS+Fe compared to Fe alone. In contrast, neither AfΔsidA biofilm, nor planktonic AfΔsidA, were enhanced by PQS-Fe compared to Fe. When Af siderophore ferricrocin (FC),+PQS, were added to AfΔsidA, Af was then boosted more than by FC alone. Moreover, FC+PQS+Fe boosted AfΔsidA more than Fe, FC, FC+Fe, PQS+FC or PQS+Fe. Thus PQS-Fe maximal stimulation requires Af siderophores. PQS inhibits Af via chelation under low Fe conditions. In a high Fe environment, PQS paradoxically stimulates Af efficiently, and this involves Af siderophores. PQS production by Pa could stimulate Af in cystic fibrosis airways, where Fe homeostasis is altered and Fe levels increase, supporting fungal growth.
Functional Vagotopy in the Cervical Vagus Nerve of the Domestic Pig: Implications for the Study of Vagus Nerve Stimulation
Authors: Settell Megan L. , Knudsen Bruce E. , Dingle Aaron M. , McConico Andrea L. , Nicolai Evan N. , Trevathan James K. , Ross Erika K. , Pelot Nicole A. , Grill Warren M. , Gustafson Kenneth J. , Shoffstall Andrew J. , Williams Justin C. , Zeng Weifeng , Poore Samuel O. , Populin Luis C. , Suminski Aaron J. , Ludwig Kip A.
Published: November 2019

Given current clinical interest in vagus nerve stimulation, there are surprisingly few studies characterizing the anatomy of the vagus nerve in large animal models as it pertains to on-and off-target engagement of local fibers. We sought to address this gap by evaluating vagal anatomy in the domestic pig, whose vagus nerve organization and size approximates the human cervical vagus nerve. We provide data on key features across the cervical vagus nerve including diameter, number and diameter of fascicles, and distance of fascicles from the epineural surface where stimulating electrodes are placed. We also characterized the relative locations of the superior and recurrent laryngeal branches of the vagus nerve that have been implicated in therapy limiting side effects with common electrode placement. We identified key variants across the cohort that may be important for vagus nerve stimulation with respect to changing sympathetic/parasympathetic tone, such as cross-connections to the sympathetic trunk. We discovered that cell bodies of pseudo-unipolar cells aggregate together to form a very distinct grouping within the nodose ganglion. This distinct grouping gives rise to a larger number of smaller fascicles as one moves caudally down the cervical vagus nerve. This often leads to a distinct bimodal organization, or ‘vagotopy’ that may be advantageous to exploit in design of electrodes/stimulation paradigms. Finally, we placed our data in context of historic and recent histology spanning mouse, rat, canine, pig, non-human primate and human models, thus providing a comprehensive resource to understand similarities and differences across species.