bluuebunny/crossref_metadata_2025_split huggingface dataset:
SPARC ‐ The Functional Anatomy of Murine Myelinated Renal Afferents
Authors: Schramm Lawrence P. , Tyshynsky Roman S. , Van Helden Dusty A. , Osborn John W. 
Published: April 2020

Perhaps because they are a small minority of the total population of renal afferents, myelinated renal afferents (MRA ) have been the least studied. Yet, they are promising targets for neuromodulation because of their low thresholds for electrical stimulation. We are studying the calibers, branching patterns, terminal morphologies, and intrarenal targets of MRA. We identify the myelin sheaths and axons of MRA using antibodies to myelin protein zero and heavy‐chain neurofilament, respectively. The diameters of a majority of MRA range between 1 and 4 u. The diameters of a small minority range between 6 and 10u. Thus, the diameters of MRA are distinctly bimodal. Unmyelinated terminal segments of MRA arise from the myelinated segments of axons at two sites. First, an unmyelinated segment of axon projects from the end of each MRA. Second, unmyelinated segments arise as axon collaterals at nodes of Ranvier along the course of the myelinated axon. Most unmyelinated segments end without any terminal specialization. However, some terminate in small “bulbs, that are approximately twice the diameter of the axon. We have not observed receptor‐related, connective tissue specializations surrounding either type of termination. The distal myelinated portions of MRA are frequently tortuous, sometimes forming hairpin turns and loops. These complex features result in spatial concentrations of nodes of Ranvier, concentrations of unmyelinated collaterals, and concentrations of receptors. A marked narrowing at the origin of each unmyelinated segment suggests the presence of a spike‐initiation zone. The majority of MRA terminate deep in the renal cortex, most often in the extracellular space and frequently within bundles of connective tissue. Some terminations closely appose, but never penetrate, the renal tubular system. However, a small number of MRA appear to penetrate the walls of small arteries and venules. Terminations of MRA show no consistent relationship to glomeruli. The functions of MRA are, thus far, uncertain. Their terminations in the extracellular space would permit them to respond to changes in the composition of the extracellular fluid. However, their associations with connective tissue in the extracellular space could also provide them with mechanoreceptor properties. Their presence in the walls of the vasculature could mediate either chemoreceptor or mechanoreceptor functions. The distinctly bimodal distribution of the diameters of MRA suggests that they may participate in more than one physiological function. From a clinical perspective, the differences in stimulation thresholds afforded by those differences in axon caliber could facilitate selective neuromodulation of multiple physiological processes.Support or Funding InformationSupported by SPARC Award 1U01DK116320‐02, JW Osborn, Jr., PI
Cerebrovascular Function is Impaired in Offspring from a Pre‐Clinical Rat Model of Preeclampsia that Exhibits Sex‐Dependent Changes in Blood Pressure
Authors: Cunningham Mark W , Pabbidi Mallikarjuna R , Williams Jan , Duncan Jeremy W 
Published: April 2020

BackgroundAdult offspring (AOS) born from hypertensive mothers have an increased risk of developing hypertension, stroke, and neurological complications later in life. Women with preeclampsia (PE) and the pre‐clinical RUPP (reduced uterine perfusion pressure) rat model of PE have an increase in blood pressure, impaired cerebral blood flow (CBF) autoregulation, and cerebrovascular dysfunction during pregnancy. Studies have shown that blood pressure is elevated early in male AOS and later in female AOS born from RUPP dams. However, no study has examined the cerebrovascular function in AOS from RUPP dams.HypothesisWe hypothesize that AOS from RUPP dams will exhibit impaired cerebral vascular myogenic responses and CBF autoregulation.MethodsMale and female Sprague Dawley rats were born from normal pregnant (NP) and RUPP dams. After 3 weeks of weening, OS rats were separated by sex and groups determined by their mother. OS rats were aged to 17 weeks and mean arterial pressure (MAP) and body weight (BW) was recorded. At 22–23 weeks of age, myogenic responses were determined by changes in vascular diameter of the middle cerebral artery in response to increases in intraluminal pressure. At 29–30 weeks, CBF autoregulation was measured by laser doppler flowmetry through a 4 mm x 4 mm cranial window under anesthesia. MAP was elevated step‐wise from 100–190 mmHg by infusion of phenylephrine to determine changes in CBF.ResultsAt 17 weeks, BW was smaller in male AOS born from RUPP vs NP (381±10 vs 414±3g, p<0.05). No change was observed in female AOS BWs. MAP was elevated in male AOS RUPP vs NP (143±2 vs 133±3 mmHg, p<0.05) at 17 weeks, with no change in female AOS. At 22–23 weeks, the myogenic response was impaired and tone was increased in male AOS RUPP vs NP (p<0.05). At 29–30 weeks, CBF autoregulation was impaired in male OS RUPP vs NP rats at 120 mmHg (129±12% vs 103±4), at 140 mmHg (149±21 vs 107±12%), and at 160 mmHg (172±31 vs 108±15%) respectively. Interestingly, CBF autoregulation was also impaired in female AOS RUPP vs NP rats at 140 mmHg (130±14 vs 110±18%) and 160 mmHg (175±2 vs 99±8%, p<0.05) in the absence of hypertension.ConclusionA decrease in BW, increase in blood pressure, and impairments of CBF autoregulation was observed in male RUPP AOS. In contrast, female RUPP AOS exhibited no changes in body weight or blood pressure, but showed a marked impairment in CBF autoregulation, suggesting that elevated MAP is not a prerequisite or required for impaired CBF autoregulation in females. Future studies are warranted to examine the mechanisms underlying CBF autoregulation impairment and their associated sex differences in AOS born from hypertensive pregnancies associated with placental ischemia.Support or Funding InformationSupported: AHA18CDA34110264
Topical Analgesic and Local Anesthetic Agents for Pain Associated with Chronic Leg Ulcers: A Systematic Review
Authors: Purcell Anne , Buckley Thomas , King Jennie , Moyle Wendy , Marshall Andrea P. 
Published: April 2020

ABSTRACT

GENERAL PURPOSE
To provide information about the effectiveness of topical analgesic and local anesthetic agents for reducing pain associated with chronic leg ulcers.

TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will:
1. Distinguish adverse reactions to topical analgesics and local anesthetic agents.
2. Evaluate the effectiveness of topical analgesics and local anesthetic agents for pain associated with chronic leg ulcers.
3. Identify substances used as topical analgesics and local anesthetic agents and the application of those agents.

OBJECTIVE
To examine the evidence related to the effectiveness of topical analgesic and topical local anesthetic agents for reducing pain associated with chronic leg ulcers.

METHODS
A systematic search and review of the literature were undertaken using key search terms such as leg ulcers, topical anesthetics, topical analgesics, and pain. Six databases were electronically searched for articles published between January 1990 and August 2019.

RESULTS
A total of 23 articles were identified that met the inclusion criteria. Data were extracted using content analysis. Most of the included studies were randomized controlled trials; however, the reported methodology for most of studies was poor, so the validity and reliability of the evidence are uncertain. Lidocaine/prilocaine cream, ibuprofen foam, and morphine gel were the most examined topical agents. Lidocaine/prilocaine cream significantly improved wound-related pain compared with all other studied agents. For topical analgesic agents, ibuprofen foam reduced chronic leg ulcer pain significantly, whereas morphine gel was ineffective.

CONCLUSIONS
Lidocaine/prilocaine cream and ibuprofen foam are effective agents for reducing wound-related pain associated with chronic leg ulcers. Effective use of topical agents could reduce the need for systemic pain relief agents, mitigating potential adverse effects, while giving clinicians another treatment option to manage wound-related pain associated with chronic leg ulcers.
Evaluating the Impact of an Innovative Educational Program for Skin Care Champions Using the Pieper-Zulkowski Pressure Ulcer Knowledge Test
Authors: Delmore Barbara , Smith Daniel J. , Savage Elizabeth , Ayello Elizabeth A. 
Published: April 2020

ABSTRACT

OBJECTIVE
To assess pressure injury knowledge of Skin Care Council nursing members using the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT), to design an educational intervention informed by the results of the baseline assessment, and to evaluate the effect of the intervention.

METHODS
This was a single-group pretest-posttest project conducted in an urban, academic, tertiary medical center from January to August 2017. Participants were measured on the pretest, received the intervention, and then were reevaluated on the posttest 3 months later. Pretest results informed the design of the intervention, which was a 1-day interactive, targeted educational program referred to as the “Skin Care Council Boot Camp.” Paired-samples t tests were conducted to examine differences between pretest and posttest scores on the PZ-PUKT overall and in each test section.

RESULTS
Seventy-seven participants enrolled in the project and completed the pretest. Of those, 58 (75.3%) were retained through the intervention and the posttest evaluation. Participants had a mean pretest score of 78.9 and a mean posttest score of 85.3. There were significant mean differences among pretest and posttest PZ-PUKT scores: 6.4 (t = 9.419, P < .001) overall; 4.6 (t = 5.356, P < .001) in the Prevention/Risk category; 4.1 (t = 3.668, P < .001) in the Staging category; and 10.5 (t = 7.938, P < .001) in the Wound Description category.

CONCLUSIONS
By testing pressure injury knowledge before developing a program, investigators created a tailored, education program that addressed knowledge gaps. Posttest results provided insight into the program’s success and opportunities for future improvement.
Nonspatial Features Reduce the Reliance on Sustained Spatial Auditory Attention
Authors: Bonacci Lia M. , Bressler Scott , Shinn-Cunningham Barbara G. 
Published: April 2020

Objective:
Top-down spatial attention is effective at selecting a target sound from a mixture. However, nonspatial features often distinguish sources in addition to location. This study explores whether redundant nonspatial features are used to maintain selective auditory attention for a spatially defined target.

Design:
We recorded electroencephalography while subjects focused attention on one of three simultaneous melodies. In one experiment, subjects (n = 17) were given an auditory cue indicating both the location and pitch of the target melody. In a second experiment (n = 17 subjects), the cue only indicated target location, and we compared two conditions: one in which the pitch separation of competing melodies was large, and one in which this separation was small.

Results:
In both experiments, responses evoked by onsets of events in sound streams were modulated by attention, and we found no significant difference in this modulation between small and large pitch separation conditions. Therefore, the evoked response reflected that target stimuli were the focus of attention, and distractors were suppressed successfully for all experimental conditions. In all cases, parietal alpha was lateralized following the cue, but before melody onset, indicating that subjects initially focused attention in space. During the stimulus presentation, this lateralization disappeared when pitch cues were strong but remained significant when pitch cues were weak, suggesting that strong pitch cues reduced reliance on sustained spatial attention.

Conclusions:
These results demonstrate that once a well-defined target stream at a known location is selected, top-down spatial attention plays a weak role in filtering out a segregated competing stream.
A Prospective Study About Trastuzumab-induced Cardiotoxicity in HER2-positive Breast Cancer
Authors: Ben Kridis Wala , Sghaier Syrine , Charfeddine Salma , Toumi Nabil , Daoud Jamel , Kammoun Samir , Khanfir Afef 
Published: April 2020

Background:
Trastuzumab improves therapeutic outcomes among patients with human epidermal growth factor receptor 2–positive breast cancer (BC). However, it is associated with a risk of treatment-induced cardiotoxicity. The aims of this study were to determine the frequency of trastuzumab-induced cardiotoxicity (TIC) in Tunisian patients, to study the effects of trastuzumab on cardiac biomarkers and echocardiographic parameters using the speckle tracking technique and to identify risk factors of occurrence of TIC.

Patients and Methods:
Fifty women with newly diagnosed human epidermal growth factor receptor 2–positive BC treated with or without anthracycline followed by taxane and trastuzumab were enrolled, from November 2016 to December 2018, to be evaluated every 3 months during trastuzumab treatment (total of 15 mo) using echocardiograms and blood samples. Left ventricular ejection fraction (LVEF) and peak systolic left ventricular longitudinal myocardial strain were calculated. Ultrasensitive troponin I (TNI) and N-terminal pro–B-type natriuretic peptide (NT pro-BNP) were also measured.

Results:
LVEF decreased from 62±3.12% to 59±3.3% (P=0.005) over 15 months. Seven patients (14%) developed cardiotoxicity, as defined by the European Society of Cardiology; of these patients, 2 (4%) had symptoms of heart failure. Hypertension, left ventricular longitudinal myocardial strain, Log TNI, and NT pro-BNP measured at the completion of anthracyclines were significantly correlated to TIC occurrence. At multivariate analysis, the degree of LVEF decline was the only independent factor correlated to TIC (hazard ratio=2.4; 95% confidence interval=1.2-6.03; P=0.049). This TIC was reversible in 86% of cases.

Conclusion:
In patients with BC treated with trastuzumab, in addition to the evaluation of the LVEF, systolic longitudinal strain, TNI, and NT pro-BNP measured at the completion of anthracyclines are useful in the prediction of subsequent TIC.
Variability of Care of Infants With Severe Respiratory Syncytial Virus Bronchiolitis
Authors: Kadmon Gili , Feinstein Yael , Lazar Isaac , Nahum Elhanan , Sadot Efraim , Adam Dganit , Zamir Gur , Chodick Gabriel , Schiller Ofer 
Published: April 2020

Background:
Viral bronchiolitis caused by respiratory syncytial virus (RSV) is a common childhood disease accounting for many hospitalizations worldwide. Some infants may clinically deteriorate, requiring admission to an intensive care unit. We aimed to describe diagnostic and therapeutic measures of bronchiolitis in Israeli pediatric intensive care units (PICUs) and evaluate intercenter variability of care.

Methods:
Medical records of all RSV-infected infants admitted to 5 Israeli PICUs over 4 RSV seasons were retrospectively reviewed.

Results:
Data on 276 infants with RSV-positive bronchiolitis, admitted to the participating PICUs were analyzed. Most of the infants were males with a mean admission age of 4.7 months. Approximately half of the infants had pre-existing conditions such as prematurity, cardiac disease or chronic lung disease. Respiratory distress was the most common symptom at presentation followed by hypoxemia and fever. There was significant variation in the methods used for RSV diagnosis, medical management and respiratory support of the infants. Furthermore, utilization of inhalational therapy and transfusion of blood products differed significantly between the centers. Although a bacterial pathogen was isolated in only 13.4% of the infants, 82.6% of the cohort was treated with antibiotics.

Conclusions:
Significant variation was found between the different PICUs regarding RSV bronchiolitis diagnosis, medical management and respiratory support, which may not be accounted for by the differences in baseline and clinical characteristics of the infants. Some of these differences may be explained by uneven resource allocations. This diversity and the documented routine use of medications with weak evidence of efficacy calls for national guidelines for bronchiolitis management.
Geriatric Nutritional Risk Index Score Predicts Clinical Outcome in Patients With Acute ST-Segment Elevation Myocardial Infarction
Authors: Jia Yu , Gao Yongli , Li Dongze , Cao Yu , Cheng Yisong , Li Fanghui , Xiao Lei , Jiang Ying , Wan Zhi , Zeng Zhi , Zeng Rui 
Published: April 2020

Background
The Geriatric Nutritional Risk Index (GNRI), based on serum albumin levels and body index, is a simple nutrition-related risk assessment instrument.

Objective
We aimed to evaluate the prognostic value of GNRI in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.

Methods
We retrospectively analyzed in-hospital and long-term adverse outcomes of 786 patients with STEMI. Patients were divided into 2 groups based on their GNRI score (≤98 vs >98). Kaplan-Meier curves and Cox regression models were used to evaluate the prognostic value of the GNRI score in patients with STEMI.

Results
Of the patients enrolled, 78 (9.9%) died of cardiovascular disease during the median follow-up period of 12.4 (8.3–15.5) months. Patients with a GNRI score of 98 or lower had a higher incidence of bleeding, cardiogenic shock, infection, acute respiratory failure, malignant dysrhythmia, atrial fibrillation, and in-hospital mortality as well as a longer length of hospital stay (P < .05). Kaplan-Meier survival analysis showed that patients with a lower GNRI score had lower cumulative survival (P < .001), regardless of age group (elderly vs middle-aged) or sex. Multivariable Cox regression analysis showed that the adjusted hazard ratio of the GNRI score for cardiovascular death was 0.934 (95% confidence interval, 0.896–0.974; P = .001).

Conclusion
The GNRI can be used to assess prognosis of patients with STEMI and to identify those who may benefit from further nutritional assessment and intervention.
Study on urinary metabolomics of premenstrual dysphoric disorder patients with liver-qi depression syndrome treated with Xiaoyaosan
Authors: Xu Mengbai , Liu Yanfeng , Guo Yu , Liu Chenyue , Liu Yueyun , Yan Zhiyi , Hou Yajing , Li Xiaojuan , Ma Qingyu , Zhou Xuan , Liu Liuqing , Huang Sheng , Chen Jiaxu 
Published: April 2020

Abstract

Introduction:
Premenstrual dysphoric disorder (PMDD) is a serious form of premenstrual syndrome with mental symptoms as its main manifestation, which seriously affects women's health and daily life. Some basic research and clinical studies have shown that the Chinese herbal medicine of Xiaoyaosan can relieve the symptoms of mental disorders with few side effects. The aim of this study is to evaluate the clinical efficacy of Xiaoyaosan for treating PMDD with liver-qi depression syndrome. In addition, metabonomics and small molecular marker compounds closely related to the pathogenesis of PMDD are expected to be found, and mechanism of Xiaoyaosan is further explored from the metabolic level.

Methods and analysis:
This study is a clinical pilot trial. Thirty PMDD patients with liver-qi depression syndrome and thirty healthy participants will be recruited. Study participants will be assigned in a 1:1 ratio to 2 groups: a normal control group and Xiaoyaosan treatment group. The treatment group will receive the Chinese patent medicine of Xiaoyaosan for 3 menstrual cycles. The primary outcome is the syndrome change in the Daily Record of Severity of Problems (DRSP). The secondary outcome is improvement in TCM syndrome, which will be measured with TCM symptom score scale. Urine metabolism profiles of participants by liquid chromatograph-mass spectrometer (LC-MS) method will be measured to explore the mechanism of PMDD pathogenesis and action of Xiaoyaosan on PMDD.

Discussion:
This trial will evaluate the effectiveness and the therapeutic mechanism from the metabolomics level of Xiaoyaosan in individuals with PMDD. If successful, the outcome of this trial will provide a viable treatment option for PMDD patients and objective evidence on the efficacy of Xiaoyaosan for PMDD.

Ethics and dissemination:
The trial has been approved by the Institutional Ethics Committee of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine (file number: DZMEC-KY-2019-73). Written informed consent will be obtained from all participants. The results of the study will be published in peer-reviewed journals or communicated via yearly reports to funding bodies.

Trial registration:
Chinese Clinical Trial Registry, ChiCTR1900026296.
Evaluation of photobiomodulation in salivary production of patients with xerostomy induced by anti-hypertensive drugs
Authors: Varellis Maria Lucia Zarvos , Gonçalves Marcela Leticia Leal , Pavesi Vanessa Christina Santos , Horliana Anna Carolina Ratto Tempestini , de Fátima Teixeira da Silva Daniela , Motta Lara Jansiski , Barbosa Filho Valdomiro F. , Bezerra Cícero Dayves Silva , Silva Felipe Gonçalves da , Bussadori Sandra Kalil , Deana Alessandro M. 
Published: April 2020

Abstract

Introduction:
Hypertension (systemic arterial hypertension [SAH]) is a systemic condition that affects about 30% of the world population, according to data from the World Health Organization (WHO). Drugs used to control this disease have the potential to induce xerostomia, an oral condition in which the decrease of the salivary flow is observed and whose presence leads to the increase of the index of caries, periodontal disease, loss of the teeth, dysgeusia, difficulty of mastication, dysphagia, bad breath and oral burning and impairment of prothesis installed in the buccal cavity, including retention of removable and total dentures.

Methods:
This is a randomized, placebo-controlled, blind clinical protocol that aims to analyze the impact of phobiomodulation (PBM) on salivary glands of patients with antihypertensive drug induced xerostomia. Patients will be divided into 2 groups: G1: older adults with xerostomia induced by antihypertensive drugs and treatment with PBM (n = 30); G2: placebo PBM (n = 30). The irradiation will be made using a diode laser emitting at 808 nm with 100 mW and 40 seconds of exposure per site at the salivary glands. Twenty sites will be irradiated weekly for 4 weeks. Non-stimulated and stimulated salivary flow will be analyzed before and after the treatment.

Results:
This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of xerostomia in older adults using antihypertensive drugs.

Conclusion:
This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of xerostomia in older adults using antihypertensive drugs.

Trial registration:
Clinicaltrials.gov – NCT03632096