bluuebunny/crossref_metadata_2025 huggingface dataset:
Confounding effect of therapeutic protamine and heparin levels on routine and special coagulation testing
Authors: Khandelwal Aditi , Phua Chai W. , Chaudhry Hina R. , Tsui Hubert , Rivard Georges E. , Teitel Jerome M. , Sholzberg Michelle
Published: January 2020

The management of a patient with hemophilia undergoing cardiovascular surgery relies on accurate coagulation test results. Both unfractionated heparin (UFH) and protamine sulfate used during cardiac surgery can interfere with factor and inhibitor assays. Here we describe the effects of UFH and protamine sulfate on routine coagulation, factor activity, and inhibitor assays. Pooled normal plasma (PNP) with UFH, PNP with protamine sulfate, PNP with both protamine sulfate and UFH were tested for the activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), UFH anti-Xa, one-stage factor VIII (FVIII) activity, one-stage factor IX (FIX) activity, and Bethesda inhibitor assays for FVIII and FIX. UFH had a dose-dependent effect with TT, aPTT, and PT. On Bethesda inhibitor testing, FIX inhibition was detected at 1 U/ml UFH and 3 U/ml UFH for FVIII. Increasing protamine sulfate concentration in PNP prolonged the PT and aPTT in a dose-dependent manner, decreased FVIII and FIX activity and did not affect TT or UFH anti-Xa. At protamine sulfate doses of at least 200 μg/ml there was weak FVIII and FIX inhibition detected. At lower ratios of protamine sulfate to UFH (0.6 : 1–0.8 : 1), the aPTT decreased, suggesting reversal of UFH. However, at protamine sulfate to UFH ratios of 1.0 : 1 and higher, aPTT prolongation was observed. Inhibition of FVIII and FIX was detected at low ratios of protamine sulfate to UFH (below 0.4 : 1) and disappeared at higher ratios. UFH and protamine sulfate, alone or in combination, impact factor activity and inhibitor testing for both FVIII and FIX. Hence, factor activity and inhibitor assay results should be interpreted with caution when UFH or protamine sulfate are present.
A novel missense mutation in F9 gene causes hemophilia B in a family with clinical variability
Authors: Yi Sheng , Yang Qi , Zuo Yangjin , Li Mengting , Luo Jingsi , Qin Zailong , Zhang Qinle , Li Meng , Huang Limei , Lu Yingchi , Feng Shihan , Fan Xin
Published: January 2020

Hemophilia B is an X-linked recessive bleeding disorder caused by diverse mutations throughout the F9 gene. The same F9 mutation may result in different degrees of clotting factor deficiency. The aim of this study was to investigate the pathogenesis of two hemophilia B patients with different severity in a family. A family with two hemophilia B patients was recruited in this study. Coagulation assays, activities of FVIII (FVIII:C) and FIX (FIX:C) were evaluated. All of the exons and intron exon boundaries of the F9 gene were amplified by PCR and analyzed by direct sequencing. The proband, 12-year-old boy with moderate bleeding history, had manifest prolonged activated partial thromboplastin time (98.1 s) and markedly decreased FIX activity (1%). His maternal uncle presented slightly prolonged activated partial thromboplastin time (48.2 s) and mildly decreased FIX activity (15.2%). Molecular genetic analysis of F9 revealed that they were hemizygous for a novel missense mutation, c.157G>C (p.Glu53Gln). Our study widens the mutation spectrum of the FIX gene. In addition, this report provides a specific case associated with genotype and phenotype heterogeneity of hemophilia B.
Water Exchange (WE) and Quality Improvement—Enhanced Advanced Adenoma Detection
Authors: Leung Felix W. , Koo Malcolm , Jia Hui , Leung Joseph W. , Cadoni Sergio , Falt Premysl , Hsieh Yu-Hsi , Hu Chi-Tan , Pan Yanglin , Radaelli Franco
Published: January 2020

Introduction:

Advanced adenomas (≥10 mm in diameter, >25% villous, or high-grade dysplasia), a marker of colorectal cancer risk, are used to stratify patients for closer surveillance. Modern accessories, endoscopes, and age-adjusted evaluation have variable impacts on the advanced adenoma detection rate (AADR). In 1 randomized controlled trial (RCT) comparing air insufflation (AI) with water exchange (WE), the right colon AADR was significantly increased by WE. Four network meta-analyses reported that WE significantly increased overall adenoma detection rate (ADR), but the impact on AADR was not addressed.

Aim:

The aim of this study was to test the hypothesis that WE significantly increased AADR compared with AI.

Method:

Six Clinicaltrial.gov-registered RCTs were reported by a group of WE investigators. Data including AADR (primary outcome) and overall ADR (secondary outcome) were pooled.

Results:

A total of 5407 patients were randomized to AI (2699) and WE (2708). Compared with AI, WE significantly increased AADR (5.7% vs. 8.3%, P=0.001) and overall ADR (20.9% vs. 27.4%, P=0.001).

Conclusions:

In contrast to published reports, which showed variable impacts on AADR, WE was consistent in increasing AADR in 6 reported RCTs. The pooled data confirm that the impact of WE in increasing AADR was significant. The significantly enhanced overall ADR indicated that WE provided a higher quality outcome than AI. The significant improvement in AADR confirmed WE to be clinically relevant and has finally arrived as a timely addition to colorectal cancer prevention programs.
Metabolic aspects of muscle wasting during critical illness
Authors: van Gassel Robert J.J. , Baggerman Michelle R. , van de Poll Marcel C.G.
Published: January 2020

Purpose of review

Skeletal muscle wasting during critical illness is the result of disturbed metabolism. No proven effective interventions targeting skeletal muscle mass and function during critical illness currently exist. This review summarizes recent advances regarding the complexity of metabolic factors involved and the challenge of establishing the clinical effects of metabolic interventions targeting the muscle.

Recent findings

Although the catabolic state is limited to the acute phase of critical illness, its subsequent impact on muscle mass and function persists long after ICU discharge. Immobilization, inflammation and disturbed muscle energy and nutrient metabolism are key drivers of muscle protein loss. Current research focuses on the effects of enhanced protein provision, specific substrate delivery and physical exercise. Whilst some interventions have been successful at improving muscle mass, these effects do not always carry over into muscle function or strength.

Increased understanding of metabolic derangements during critical illness provides new potential targets for treatment. The potential of dietary protein to attenuate the muscle protein catabolic state has yet to be established in clinical trials. Basic research should focus on ways to further improve the anabolic potential of nutrition by unravelling mechanisms that regulate anabolic and catabolic pathways and energy metabolism.
Eosinophils in chronic obstructive pulmonary disease: are they just another biomarker?
Authors: McDonald Christine F.
Published: January 2020

Purpose of review

Interest in blood eosinophils as a biomarker of responsiveness to therapy in chronic obstructive pulmonary disease (COPD) continues to grow, with recommendations regarding their adjunctive use incorporated into the GOLD 2019 treatment algorithm. The present review summarizes some key recent papers referencing differential treatment effects based on blood eosinophil counts.

Recent findings

Post-hoc analyses of trials of inhaled corticosteroids in COPD have shown greater treatment responses in patients with higher blood eosinophil levels, with some exceptions. Eosinophil-directed treatment with oral corticosteroids showed equivalent benefits to noneosinophil-directed therapy, with reduced corticosteroid exposure. Prespecified analyses of recent prospective trials of therapies incorporating inhaled corticosteroids were generally supportive of previous findings, so evidence for the use of blood eosinophils as biomarkers is gathering. Nonetheless, the anti-interleukin (IL)-5 receptor antagonist benralizumab, which depletes blood eosinophils, showed no treatment benefit in patients with COPD selected for eosinophilic phenotype and treatment of COPD with the IL-5 antagonist, mepolizumab showed inconsistent results.

The 2019 GOLD COPD Strategy document embraced the use of the blood eosinophil to guide ICS therapy in management of patients with stable COPD and frequent exacerbations. Although post-hoc and several prospective studies with prespecified subgroup analyses have supported this approach, questions still remain about how to incorporate this new assessment tool into real-life management of COPD and more research is required to validate its adoption into clinical practice. There is an absence of data to support the use of biologic therapy in patients with an eosinophilic COPD phenotype at this stage.
Epigenetic alterations of testicular germ cell tumours
Authors: Ilijazi Dafina , Shariat Shahrok F. , Hassler Melanie R. , Lemberger Ursula , Ertl Iris E.
Published: January 2020

Purpose of review

Testicular germ cell tumours (TGCTs) exhibit, in contrast to other cancer types, a relatively low mutational burden. However, numerous epigenetic alterations have been shown to impact TGCT. In this review, we summarize the most relevant findings of the past 2 years.

Recent findings

Recent studies focused on the functions of microRNAs and the impact of aberrant DNA methylation. Moreover, several epigenetic drugs with antineoplastic effects in TGCTs were identified.

Aberrant DNA methylation and differentially expressed microRNAs have an important effect on TGCT pathogenesis. Moreover, differential DNA methylation patterns were found to be specific for different TGCT subtypes. Various microRNAs, such as miR-371a-3p, were found to be highly sensitive and specific biomarkers for TGCT. The epigenetic drugs guadecitabine, animacroxam, and JQ1 showed promising effects on TGCT in preclinical in-vivo and in-vitro studies.
Complications after active stone removal
Authors: Mourmouris Panagiotis , Tzelves Lazaros , Skolarikos Andreas
Published: January 2020

Purpose of review

Active stone removal has been entirely revolutionized in the past decades. Smaller instruments, scope and laser technology advancements and novel lithotripter modalities have entirely changed the way urological surgeons treat stones. Nevertheless novel technologies may lead to different and difficult to manage complications. Accurate knowledge of indications, limitations and technical details of these novel modalities can significantly decrease complication rates. The purpose of this review is to provide the most recently acquired knowledge to decrease patient's morbidity after active stone removal.

Recent findings

Complications of active stone removal are well known for many years, nevertheless novel technologies in stone management can substantially differentiate their rates. Minimal invasive techniques are becoming even more minimal which reflects on the complications.

Mastering the novel techniques in active stone removal and knowing their inherent limitations, in association with the recognition of predisposing factors and preventing measures have led to a highly acceptable low complication rate. Further refinements and technical improvement will reduce even more the complication incidence in the future.
Beware of Discharge
Authors: Castro Aimee R. , Tsimicalis Argerie
Published: January 2020

As the population ages and medical therapies advance, more individuals are living in the community with complex health conditions. These individuals, as well as their clinicians, often assume their family members and friends will be capable of, and willing to, provide the caregiving work necessary to continue living at home. There is an ethical problem in this assumption that unpaid community care will be provided by family or friends. Using the Hunt and Ells Patient-Centered Care Ethics Analysis Model for Rehabilitation (2013), this article explores the ethical considerations involved in the hospital discharge planning of a fictional case involving a middle-aged, male stroke patient who is in a strained marriage. We discuss the ethical merits and concerns of the various discharge options. We conclude with recommendations to avoid assumptions that family or friends will provide unpaid care after a hospital discharge. We share advocacy suggestions for improving community supports for caregivers and those with long-term care needs.
Efficacy of a Short Psychoeducational Group Intervention for the Prevention of Cardiovascular Risk in Patients With Severe Mental Disorder
Authors: Torralbas-Ortega Jordi , Paños-Martínez Montserrat , Patró-Moncunill Ester , Santiago-Barragán Angel Maria , Cobo Jesus , Escayola-Maranges Ana María , Granero-Lázaro Albert , Marti-Mestre Marc
Published: January 2020

Psychoeducational interventions to improve healthy habits regarding cardiovascular risk (CVR) in people with a severe mental disorder showed scarce results in the literature. In this article, we showed the results of a randomized clinical trial including 80 adult outpatients (mainly psychosis spectrum) with moderate to very high CVR. A short-term psychoeducational group intervention to improve healthy habits regarding CVR was added to their as-usual individual psychoeducational schedule. With an intention-to-treat analysis, we expected improvements in the different parameters. Baseline and 1-year follow-up included CVR factors and indexes (REGICOR, SCORE, and DORICA). Basal characteristics did not show statistically significant differences between the groups. No significant improvements in any of the variables studied were observed in the intervention enriched group compared with the control individual group. Compliance with the sessions was scarce. The satisfaction with the intervention and the acquisition of knowledge were adequate. Moreover, the benefits of both interventions were weak.
Use of Chest Computed Tomography for Blunt Pediatric Chest Trauma
Authors: Holl Elizabeth M. , Marek Ashley P. , Nygaard Rachel M. , Richardson Chad J. , Hess Donavon J.
Published: January 2020

Introduction

Given the concern for radiation-induced malignancy in children and the fact that risk of severe chest injury in children is low, the risk/benefit ratio must be considered in each child when ordering a computed tomography (CT) scan after blunt chest trauma.

Methods

The study included pediatric blunt trauma patients (age, <15 years) with chest radiograph (CR) before chest CT on admission to our adult and pediatric level I trauma center. Surgeons were asked to view the blinded images and reads and indicate if they felt CT was warranted based on CR findings, if their clinical management change based on additional findings on chest CT, and how they might change management.

Results

Of the 127 patients identified, 64.6% had no discrepancy between their initial CR and chest CT and 35.4% of the children's imaging contained a discrepancy. The majority of the pediatric and general trauma surgeons felt CT was indicated in 6 of 45 patients based on CR. In 87% of patients with a discrepancy in findings on CR and CT, the majority of surgeons agreed that their management would not change based on the additional information. In the 6 patients in which the CT was considered indicated, 4 of the 6 would have triggered a management change.

Conclusions

Our study suggests that chest CT scans frequently serve as confirmatory diagnostic tools and in the pediatric blunt chest trauma patient and can be withheld in many cases without hindering the management of an injured child.
Frequency and Predictors of HIV-Related Cognitive Impairment in East Africa: The Africa Cohort Study (AFRICOS)
Authors: Milanini Benedetta , Allen Isabel , Paul Robert , Bahemana Emmanuel , Kiweewa Francis , Nambuya Alice , Maswai Jonah , Langat Rither , Owuoth John , Martin Shayanne , Possin Katherine , Esber Allahna , Polyak Christina , Ake Julie A. , Valcour Victor ,   on behalf of the AFRICOS study Team
Published: January 2020

Background:

Medication adherence is a critical issue in achieving viral suppression targets, particularly in resource-limited countries. As HIV-related cognitive impairment (CI) impacts adherence, we examined frequency and predictors of CI in the African Cohort Study.

Setting:

Cross-sectional examination of enrollment data from President's Emergency Plan for AIDS Relief supported clinic sites.

Methods:

In a 30-minute cognitive assessment, CI was defined as -1SD on 2 tests or -2SD on one, as compared with 429 controls. We performed univariable and multivariable logistic and linear models examining clinical and demographic factors associated with CI and global neuropsychological performance (NP-6).

Results:

Two thousand four hundred seventy-two HIV+ participants from Kenya (n = 1503), Tanzania (n = 469), and Uganda (n = 500). The mean (SD) age was 39.7 (10.7) years, and 1452 (59%) were women. The majority reported completing or partially completing primary school (n = 1584, 64%). Mean (SD) current and nadir CD4 count were 463 (249) and 204 (221) cells/mm3, respectively; 1689 (68%) were on combination antiretroviral therapy. Nine hundred thirty-nine (38%) HIV+ versus 113 (26%) HIV− individuals showed CI: (P < 0.001). We found significant effects of literacy [odds ratio (OR): 0.3; 95% CI: 0.2 to 0.4; P < 0.001] and World Health Organization stage 4 (OR: 1.5; 95% CI: 1.0 to 2.q; P = 0.046) on CI. Tanzanians (OR: 3.2; 95% CI: 2.4 to 4.3; P < 0.001) and Kenyans (OR: 2.0; 95% CI: 1.6 to 2.6; P < 0.001) had higher risk of CI compared with Ugandans. Results were relatively unchanged in predictive models of NP-6, with the only difference being an additional significant effect of current CD4 cell count (coeff: 0.0; 95% CI: 0.0 to 0.0; P = 0.005).

Conclusions:

Literacy, country, World Health Organization stage, and current CD4 cell count were associated with increased risk of cognitive dysfunction. Our findings help optimize care practices in Africa, illustrating the importance of strategies for early and effective viral-immunological control.
Variations in HIV Risk by Young Women's Age and Partner Age Disparity in Rural South Africa (HPTN 068)
Authors: Topazian Hillary M. , Stoner Marie C. D. , Edwards Jessie K. , Kahn Kathleen , Gómez-Olivé Francesc Xavier , Twine Rhian , Hughes James P. , Cohen Myron S. , Pettifor Audrey
Published: January 2020

Background:

Nearly all population-level research showing positive associations between age-disparate partnerships and HIV acquisition among adolescent girls and young women (AGYW) has classified age disparity as ≥5 or ≥10 years. We describe variations in 1-year risk of HIV infection after exposure to sexual partner(s) of continuous age disparities.

Methods:

Longitudinal data from the HPTN 068 randomized trial in South Africa were used to estimate 1-year risk of HIV infection at various age pairings. The parametric g-formula was used to estimate risk at up to 5 annual time points, stratified by maximum partner age difference, maximum partner age, and AGYW age.

Results:

AGYW reported an older partner in 86% of 5351 age pairings. The 1-year risk of HIV infection rapidly increased with maximum partner age difference among girls ages 13–14 years, from 0·01 with a same-age partner, to 0·21 with a partner 10 years older, and 0·24 with a partner 15 years older. A gradual increase occurred among AGYW ages 15–16 years, up to 0·13 with a partner 15 years older, and 0·09 among AGYW 17–18 years with partners 8–11 years older. Risk of HIV infection among AGYW ages 19–21 years remained relatively constant across maximum partner age differences.

Conclusions:

Age differences between AGYW and their sexual partners have a greater effect on HIV-risk infection in younger compared with older AGYW. Considering both the age of an AGYW and her sexual partners provides granular insight into identifying key groups for HIV transmission prevention efforts.
Brief Report: HIV-Associated Hodgkin Lymphoma Involving the Bone Marrow Identifies a Very High-Risk Subpopulation in the Era of Widescale Antiretroviral Therapy Use in Johannesburg, South Africa
Authors: Vaughan Jenifer , Perner Yvonne , McAlpine Ewen , Wiggill Tracey
Published: January 2020

Background:

The incidence of HIV-associated Hodgkin lymphoma (HIV-HL) has not dropped in the era of widespread antiretroviral therapy (ART), and there have reportedly been shifts in the most prevalent variants encountered. In this study, factors of interest in cases of HIV-HL diagnosed before and after the widespread availability of ART in Johannesburg, South Africa, were compared.

Methods:

All cases of HIV-HL diagnosed in 2007 and 2017 were extracted from the laboratory information system, and pertinent factors compared.

Results:

The number of cases of HL increased significantly over the period assessed, but without a clear increase in the incidence of HIV-HL. As has been reported previously, the proportion of HIV-HL subclassified as the Nodular Sclerosis and Mixed Cellularity subtypes increased and decreased respectively over the period. The number of unclassifiable cases also increased significantly largely because of more frequent diagnosis in bone marrow (BM). BM involvement was highly prevalent at both timepoints (51.7% in 2007 vs 66.2% in 2017; P = 0.18), but was more frequently associated with multiple cytopenias in 2017. Despite significant ART upscaling, the median CD4 count was significantly lower in 2017 (242.5 cells/μL in 2007 vs 85.5 in 2017; P = 0.002). This particularly affected patients with BM involvement, and the median survival time was significantly shorter among BM+ patients diagnosed in 2017 as compared to those diagnosed in 2007. Notably, 40.8% of the patients with BM involvement diagnosed in 2017 died before the diagnosis was established.

Conclusion:

HIV-HL with BM involvement identifies a very high-risk subpopulation in the post-ART era.
Brief Report: Racial and Ethnic Disparities in Sustained Viral Suppression and Transmission Risk Potential Among Persons Aged 13–29 Years Living With Diagnosed HIV Infection, United States, 2016
Authors: Crepaz Nicole , Dong Xueyuan , Hess Kristen L. , Bosh Karin
Published: January 2020

Background:

In 2016, persons aged 13–29 years represented 23.1% of the US population, yet accounted for 41.7% of HIV diagnoses. Racial/ethnic minorities are disproportionally affected by HIV. Sustaining viral suppression helps persons living with diagnosed HIV infection (PLWDH) stay healthy and reduces the risk of transmitting HIV. We examined racial/ethnic disparities in sustained viral suppression and transmission risk potential among PLWDH aged 13–29 years.

Methods:

We analyzed data from the National HIV Surveillance System reported through December 2018 from 42 jurisdictions with complete laboratory reporting. We included persons aged 13–29 years who received an HIV diagnosis by December 31, 2015, most recently resided in one of the 42 jurisdictions, and were alive at the end of 2016. Sustained viral suppression was defined as viral load <200 copies/mL for all tests in 2016. Transmission risk potential was estimated using the number of days with viral loads >1500 copies/mL.

Results:

Of the 90,812 PLWDH aged 13–29 years included in the analysis, 41.5% had sustained viral suppression in 2016. Across age, sex, and most transmission categories, blacks had the lowest prevalence of sustained viral suppression. Among the 28,154 who were in care but without sustained viral suppression, the average number of days with viral load >1500 copies/mL was 206 days (56.4% of the 12-month period).

Conclusions:

Sustained viral suppression was suboptimal and transmission risk potential was high for PLWDH aged 13–29 years. Racial/ethnic disparities were apparent, calling for strengthening tailored interventions to improve care outcomes.
Reverse-Flow Versus Perforator Propeller Lateral Arm Flap for Elbow Reconstruction
Authors: di Summa Pietro Giovanni , Sapino Gianluca , Guillier David , Dash Jeremy , Hart Andrew , Raffoul Wassim
Published: January 2020

Background

The lateral arm flap (LAF) represents an attractive option for elbow reconstruction, due to low donor site morbidity and a consistent surgical anatomy. It has been described as reverse-flow and as perforator propeller flap (radial collateral artery perforator [RCAP]). We compared the 2 techniques in terms of immediate- and long-term outcomes, together with functional and aesthetic evaluation.

Methods

We retrospectively reviewed 15 patients, 9 males and 6 females, according to the department prospectively maintained database. Ethiology of the defects and patient comorbidities were listed together with flap and clinical data (operative time, time to healing, hospital stay, etc). Functional outcomes were measured according to Quick Disability of Arm Shoulder and Hand score at the time of the last follow-up.

Results

Seven LAF flaps were raised in a reverse-flow fashion, whereas 8 were RCAP flaps. No patients described any major elbow functional limitations, and they were generally satisfied with the aesthetic appearance. When comparing the 2 groups of reconstruction, harvest of RCAP flap resulted significantly faster and patients needed less hospitalization days (*P < 0.05). Aesthetic scores were lower where a cutaneous bridge was left intact during rotation (leading to a dogear), which was always the case in reverse-flow flap. Among complications, a partial RCAP flap necrosis occurred in a highly comorbid patient and required a skin graft coverage, whereas 4 reverse-flow flaps presented distal venous congestion which, in 1 patient, led to a secondary flap procedure.

Conclusions

In our practice, elbow reconstruction using the RCAP flap required less hospital stay and operative time. Being less prone to venous congestion, in presence of sizeable perforators, it should be preferred to the reverse-flow LAF flap.
Neurolysis of the Dorsal Nerve to the Penis to Restore Function After Trauma
Authors: Klifto Kevin M. , Dellon A. Lee
Published: January 2020

Background

Loss of penile sensation or development of a painful penis and erectile dysfunction can occur after injury to the dorsal branch of the pudendal nerve. Although recovery of genital sensibility has been discussed frequently in transmen, this subject has been reported rarely in cismen. The purpose of this report is to review our experience with recovery of sensation in men after decompression of the dorsal branch of the pudendal nerve after trauma.

Methods

A retrospective chart review of men who have had decompression of the dorsal branch of the pudendal nerve was carried out from 2014 to 2018. Patients were included in the cohort if they had a loss of penile sensation or the development of a painful penis after trauma. Primary outcomes measured were the change in penile symptoms, including erection, ejaculation, ejaculatory pain, erogenous sensation, numbness, and penile pain.

Results

For the 7 men included in this study, the mean follow-up time was 57 weeks (range, 28–85 weeks). Bilateral surgery was done in 71% (5/7). Of the 6 patients with loss of penile sensation, complete recovery of erogenous sensibility occurred in 5 (83%) patients, with partial relief in 1 (17%) patient. Of the 3 men who had erectile dysfunction, normal erections were restored in 2 (67%) patients. Of the 2 patients unable to ejaculate, 1 (50%) patient regained ejaculatory function. Of the 4 patients with ejaculatory pain, complete relief of pain occurred in 2 (50%) patients, with partial relief in 2 (50%) patients. Of the 6 patients with penile pain in the absence of ejaculation, complete relief of pain occurred in 3 (50%) patients, with partial relief in 3 (50%) patients.

Conclusion

Neurolysis of the dorsal nerve to the penis at the inferior pubic ramus canal can be successful in relieving pain, and restoring sensation and erectile function in men who sustained an injury along the inferior pubic ramus.
Quality Improvement Initiative
Authors: Mills Katie , Odiaga Janice , Karjoo Sara , McClenathan Daniel , Wilsey Michael
Published: January 2020

It is common practice for providers to wait up to 24 hours to begin enteral feedings using a newly placed gastrostomy tube in children. As a quality improvement initiative, guidelines were developed to begin early enteral nutrition 4 hours following gastrostomy tube placement. These patient care guidelines standardized electronic ordering, dosing, and feeding administration instructions. Healthcare professionals from the departments of gastroenterology, case management, and nutrition were asked to evaluate the new process by completing a questionnaire. Changes were made to the quality improvement initiative on the basis of the feedback received from the questionnaires. The early feeding initiative aimed to improve patient outcomes and enhance the quality of care received following the child's gastrostomy procedure. These guidelines will then be used in a prospective clinical trial to evaluate the validity of the quality improvement initiative.
Evaluation of the Impact of the Wound Treatment Associate (WTA) Education Program on Practice and Quality Patient Outcomes
Authors: Ramundo Janet , Coverstone Sara , Crumbley David R. , Geiger Donna , Jankowski Irene , Ritter Deborah , Smith Shannon , Sutton Angel
Published: January 2020

PURPOSE:

The Wound Treatment Associate (WTA) program is an education offering of the WOCN Society. This evidence-based continuing education program prepares nurses to serve as a unit-based resource for nursing staff. The WTA program is approved by the American Nurses Credentialing Association (ANCC) for 32.25 contact hours and aimed at licensed health care personnel. This article focuses on the impact of this education program, in particular a reduction in hospital-acquired pressure injury (HAPI) in acute care and decrease in visits per episode (VPE) and supply costs in home health.

METHODS:

Surveys were sent to all course participants to date to fulfill the summative evaluation requirement for ANCC approval to determine the perception of improvement in knowledge, skills, and practice. An additional survey was developed and reviewed by members to send to WTA program course coordinators.

RESULTS:

Participants (n = 153) reported an increase in confidence in knowledge and skills about wound care and use in nursing practice. The number of respondents to the course coordinator survey was lower (n = 48). Coordinators did report a reduction in pressure injuries in acute care. Home health respondents noted a decrease in VPE and reduction in the cost of supplies. Data reported on abstracts and posters suggested positive impacts of pressure injury prevention programs in acute and home health care.

CONCLUSIONS:

Although there are limitations to the aforementioned reporting, incorporating the WTA program into pressure injury prevention programs and wound treatment programs showed a reduction in HAPIs in acute care and decreased VPE and supply costs in home health.
Pathway-specific deregulation of striatal excitatory synapses in LRRK2 mutations
Authors: Chen Chuyu , Soto Giulia , Bannon Nicholas , Kang Shuo , Kozorovitskiy Yevgenia , Parisiadou Loukia
Published: January 2020

LRRK2 is a kinase expressed in striatal spiny projection neurons (SPNs), cells which lose dopaminergic input in Parkinson’s disease (PD). R1441C and G2019S are the most common pathogenic mutations of LRRK2. How these mutations alter the structure and function of individual synapses on direct and indirect pathway SPNs is unknown and may reveal pre-clinical changes in dopamine-recipient neurons that predispose towards disease. Here, R1441C and G2019S knock-in mice enabled thorough evaluation of dendritic spines and synapses on pathway-identified SPNs. Biochemical synaptic preparations and super-resolution imaging revealed increased levels and altered organization of glutamatergic AMPA receptors in LRRK2 mutants. Relatedly, decreased frequency of excitatory post-synaptic currents accompanied changes in dendritic spine nano-architecture, and single-synapse currents, evaluated using 2-photon glutamate uncaging. Overall, LRRK2 mutations reshaped synaptic structure and function, an effect exaggerated in R1441C dSPNs. These data open the possibility of new neuroprotective therapies aimed at SPN synapse function, prior to disease onset.
Insulin signaling mediates neurodegeneration in glioma
Authors: Jarabo Patricia , de Pablo Carmen , Herranz Héctor , Martín Francisco Antonio , Casas-Tintó Sergio
Published: January 2020

Cell to cell communication facilitates tissue development and physiology. Under pathological conditions, brain tumors disrupt glia-neuron communication signals that in consequence, promote tumor expansion at the expense of surrounding healthy tissue. The glioblastoma is the most aggressive and frequent brain tumor. This type of glioma expands and infiltrates into the brain, causing neuronal degeneration and neurological decay, among other symptoms. Here we describe how the glioblastoma produce ImpL2, an antagonist of the insulin pathway, which is regulated by the microRNAmiR-8. ImpL2 targets neighboring neurons and causes mitochondrial disruption as well as synapse loss, both early symptoms of neurodegeneration. Furthermore, glioblastoma progression requires insulin pathway attenuation in neurons. Restoration of neuronal insulin activity is sufficient to rescue the synapse loss and to delay the premature death caused by glioma. Therefore, signals from GB to neuron emerge as a potential field of study to prevent neurodegeneration and to develop anti-tumoral strategies.

Significance Statement

Glioblastoma (GB) is the most aggressive type of brain tumour and currently there is no cure or effective treatment. Patients course with neurological decay and previous data in animal models indicate that GB cause a neurodegenerative process. We describe here a molecule named ImpL2 that is produced by GB cells and impact on neighbouring neurons. ImpL2 is an antagonist of the insulin pathway and signaling reduction in neurons causes mitochondrial defects and synapse loss. These mechanisms underlying GB-induced neurodegeneration plays a central role in the premature death caused by this tumour. Restoration of insulin signaling in neurons prevents tumour progression and rescues the lethality caused by GB inDrosophilamodels.
Role of Acetate in Sporogenesis of
Bacillus cereus
Authors: Nakata H. M.
Published: January 2020

Nakata, H. M.
(Washington State University, Pullman). Role of acetate in sporogenesis of
Bacillus cereus
. J. Bacteriol.
91:
784–788. 1966.—The distribution of radioactivity associated initially with acetate-
2-C
14
was followed during sporogenesis of
Bacillus cereus
strain T. This was accomplished by replacing cells committed to sporulation into a chemically defined sporulation medium. It was observed that 65 to 70% of the initial radioactivity was incorporated into poly-β-hydroxybutyrate, whereas 20 to 25% was found in other cellular constituents. Virtually no radioactivity was lost as C
14
O
2
during the first 5 to 6 hr after replacement. Then, a gradual evolution of C
14
O
2
coincident with poly-β-hydroxybutyrate degradation, was observed until about the ninth hour. By this time, the polymer was essentially depleted, and the first spore structures were observed in stained preparations. The total amount of radioactivity lost as C
14
O
2
was 20 to 25%. The major portion of products derived from poly-β-hydroxybutyrate was incorporated into the spores. As much as 17% of the radioactivity associated with the spores was found in dipicolinic acid. More than 50% was located in spore proteins, 20 to 25% in the hot 5% trichloroacetic acid-soluble fraction, 4 to 5% in the lipid fraction, and 15 to 20% in the cold 5% trichloroacetic acid-soluble fraction. These data, accounting for 70 to 75% of the initial radioactivity, confirmed the hypothesis that the major role of acetate, and subsequently of poly-β-hydroxybutyrate, in sporulation of
B. cereus
T is to provide carbon precursors and energy for sporogenesis.
Effect of Hydroxyurea on Virus Development I. Electron Microscopic Study of the Effect on the Development of Bacteriophage T4
Authors: Margaretten William , Morgan Councilman , Rosenkranz Herbert S. , Rose Harry M.
Published: January 2020

Margaretten, William
(College of Physicians and Surgeons of Columbia University, New York, N.Y.),
Councilman Morgan, Herbert S. Rosenkranz, and Harry M. Rose
. Effect of hydroxyurea on virus development. I. Electron microscopic study of the effect on the development of bacteriophage T4. J. Bacteriol.
91:
823–833. 1966.—Double fixation in gluteraldehyde and osmium tetroxide and the application of lead staining revealed details of viral structure not previously observed in thin sections. Bacteriophage presumed to have injected its deoxyribonucleic acid (DNA) exhibited a dense, hollow, disc-shaped core. Within the cytoplasm of infected bacteria, the peripheral membrane of the viral heads was clearly visible. Aberrant forms containing the hollow core and believed to be devoid of DNA were encountered in studies of the normal course of development. Hydroxyurea, which is believed to interfere with the production of infective bacteriophage by inhibiting DNA synthesis, resulted in the appearance of viral particles with the hollow disc or with bizarre, distorted cores. However, a significant number of viral heads looked entirely normal and presumably contained a full complement of DNA. Hypotheses are presented to explain these observations.
Ultrastructure of
Escherichia coli
Cells Infected with Bacteriophage R17
Authors: Franklin Richard M. , Granboulan Nicole
Published: January 2020

Franklin, Richard M.
(Institut de Recherches sur le Cancer, Villejuif, Seine, France),
and Nicole Granboulan
. Ultrastructure of
Escherichia coli
cells infected with bacteriophage R17. J. Bacteriol.
91:
834–848. 1966—Ultrastructural changes in
Escherichia coli
cells infected with ribonucleic acid (RNA) bacteriophage R17 were studied under conditions of one-step growth. No morphological alterations were seen during the latent period. During the period of rapid viral synthesis, a fibrillar lesion surrounded by ribonucleoprotein particles was observed in a polar region. Late in infection, paracrystalline arrays of virions were found in over 90% of the cells. When protein synthesis was blocked by in over 90% of the cells. When protein synthesis was blocked by chloramphenicol at 20 min postinfection, allowing continued viral RNA synthesis without production of coat protein, a dense fibrillar area appeared in a paranuclear region. Cytochemical studies were done on cells embedded in hydroxypropyl methacrylate, a water-miscible embedding agent. The paracrystalline arrays of virions were digested after extensive treatment with either pepsin or ribonuclease. Shorter digestion with the pepsin resulted in better definition of the crystal regions. The fibrillar area found in chloramphenicol-treated cells was digested by ribonuclease but not by pepsin, and was also resistant to lead extraction. This region probably represents a pool of virus-specific RNA.
Delayed Dermal Hypersensitivity in Mice to Spherule and Mycelial Extracts ofCoccidioides immitis
Authors: Kong Yi-Chi M. , Savage D. C. , Kong Leighton N. L.
Published: January 2020

Kong, Yi-chiM. (University of California, Berkeley), D. C.Savage, and Leighton N. L. Kong. Delayed dermal hypersensitivity in mice to spherule and mycelial extracts ofCoccidioides immitis. J. Bacteriol.91:876–883. 1966.—A delayed hypersensitivity reaction to spherule and mycelial extracts ofCoccidioides immitiswas elicited in the footpads of mice vaccinated with killed spherules. Emulsification of the spherules with Freund's adjuvants was unnecessary, but a high concentration of antigen was required to elicit the reaction. Injection of the extracts produced, initially, a swelling which subsided within 4 hr, and then induration, which began at 6 to 8 hr and reached a maximum at 24 hr. The time course of the reaction corresponded to that of the tuberculin reaction in BCG-vaccinated mice. The histological response to coccidioidal extracts was characterized by the early infiltration of both polymorphonuclear and mononuclear cells, and the subsequent predominance of mononuclear cells at 24 to 48 hr. By 72 hr, the mononuclear cells comprised >90% of the cellular infiltrate. Animals infected intranasally with arthrospores (1 to 5ld50) reacted negatively before and during the crisis period; thereafter (by 28 to 31 days after infection), up to 50% of the survivors showed a delayed reaction.
Factors Affecting Transformation of
Bacillus licheniformis
Authors: Thorne Curtis B. , Stull Harold B.
Published: January 2020

Thorne, Curtis
B. (Fort Detrick, Frederick, Md.),
and Harold B. Stull
. Factors affecting transformation of
Bacillus licheniformis
. J. Bacteriol.
91:
1012–1020. 1966.—Transformation systems involving two types of transformable mutants of
Bacillus licheniformis
9945A were compared. Each system required its specific growth medium, but a single transformation medium could be used for both. Cells from a culture of optimal age were not competent, at least to any great extent, but they developed competence during incubation in a transformation medium. With each system, 3 to 5% of the recipient cells were transformed upon exposure to wild-type deoxyribonucleic acid (DNA) for 2 to 3 hr. When competent cells were exposed to DNA for 30 min, 1 to 2% of them were transformed. The data are interpreted to mean that cells were heterogeneous with respect to development of competence, and when properly grown cells were incubated in transformation medium some of them gained competence, whereas others lost it. If DNA was present during the entire period, the cells were transformed as they became competent and the transformants accumulated. However, during any short period of exposure to DNA, only those cells that were competent at the time were potential transformants. The high frequencies of transformation obtained in these studies made it feasible to prepare marked strains by transforming markers into recipient cells. These experiments demonstrated that the characteristics of the two transformation systems could not be attributed to specific nutritional markers. Presumably, each of the two series of highly transformable auxotrophic mutants also carried at least one other mutation that resulted in development of competence under the specific conditions.
Effects of Organic Matter on the Growth of
Thiobacillus intermedius
Authors: London Jack , Rittenberg Sydney C.
Published: January 2020

London, Jack
(University of California, Los Angeles),
and Sydney C. Rittenberg
. Effects of organic matter on the growth of
Thiobacillus intermedius
. J. Bacteriol.
91:
1062–1069. 1966.—Yeast extract, glucose, glutamate, and other organic materials stimulate the rate and extent of growth of
Thiobacillus intermedius
in thiosulfate broth. Growth did not occur in glucose or glutamate mineral salts medium in the absence of thiosulfate, although a stable variant was obtained which grows on yeast extract alone. Cells harvested from media supplemented with organic matter have a reduced rate of thiosulfate oxidation (20 to 30% of autotrophic), oxidize the organic supplement, and have an additive rate of oxidation in the presence of both the organic substrate and thiosulfate. Carboxydismutase synthesis is repressed, and the incorporation of bicarbonate carbon into cell material is almost completely eliminated by the presence of organic matter in the growth medium. It is concluded that the availability of organic matter eliminates the autotrophic assimilatory mechanisms of
T. intermedius
but not its autotrophic energy-generating system. The data are discussed in relation to the existence of “obligate” chemoautotrophic bacteria.
Inoculum-Dependent Division Lag of
Bacillus
Cultures and Its Relation to an Endogenous Factor(s) (“Schizokinen”)
Authors: Lankford C. E. , Walker James R. , Reeves James B. , Nabbut N. H. , Byers B. R. , Jones R. J.
Published: January 2020

Lankford
, C. E. (The University of Texas, Austin),
James R. Walker, James B. Reeves, N. H. Nabbut, B. R. Byers, and R. J. Jones
. Inoculum-dependent division lag of
Bacillus
cultures and its relation to an endogenous factor(s) (“schizokinen”). J. Bacteriol.
91:
1070–1079. 1966.—When cells of
Bacillus megaterium
, grown on Brain Heart Infusion Agar, were inoculated into a chemically defined medium, they exhibited a division lag which was an inverse function of inoculum size. The addition of filtrates of cultures from the same medium eliminated the inoculum-dependent component of lag, but not an inoculum-independent residual lag of constant duration. Culture filtrate of
B. subtilis
var.
niger
not only eliminated its inoculum-dependent lag but also was required to sustain exponential division. Dose-response and “growth time” bioassays, developed to measure lag-reducing activity of filtrates, demonstrated accumulation of active filtrate factor to a “critical” concentration prior to division initiation. Addition of this concentration to cultures eliminated the inoculum-dependent lag. Accumulation of the factor ceased temporarily at onset of division, but excretion was resumed later during exponential growth. Accumulation of a lag-reducing, cell-associated factor followed a similar course. Chromatographic and bioautographic analyses of culture filtrates of
B. megaterium
indicated that a single substance was primarily responsible for their activity. Results of dose-response tests for reciprocal activities of filtrates of different
Bacillus
species and strains suggested production of different factors by some, and of different quantities of similar factors by others. It is proposed that such endogenous factors which are synthesized and accumulate to a population-dependent concentration as a requisite to initiation and maintenance of division be designated as “schizokinens.”
Sterols and the Sensitivity of
Pythium
Species to Filipin
Authors: Schlosser Eckart , Gottlieb David
Published: January 2020

Schlosser, Eckart
(University of Illinois, Urbana),
and David Gottlieb
. Sterols and the sensitivity of
Pythium
species to filipin. J. Bacteriol.
91:
1080–1084. 1966.—The growth of several
Pythium
species was not affected by filipin. No leakage of inorganic phosphate was observed after treatment with the antibiotic. No sterol could be detected in 1 g (dry weight) of mycelium. Thus, the insensitivity of these fungi to the antibiotic may be explained by the lack of sterols, the postulated reaction site for filipin in the cell membrane. Though not capable of synthesizing sterols,
Pythium
species can incorporate exogeneous sterols, which renders them sensitive to filipin; such treatment causes a lag in growth and leakage of inorganic phosphate. The leakage after filipin treatment is indirect evidence that the sterols have been incorporated into the cell membrane. Induced sensitivity to filipin was reversible; it was lost when the sterols were diluted out by one transfer through a medium free from sterols. The hypothesis that the primary site of interaction of filipin is the sterol located in the cell membrane was strengthened by these studies. The experiments further demonstrated a change in sensitivity of a fungus to a toxic agent due to nutritional conditions.