bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiation‐induced endothelial dysfunction markers are differentially modulated by simulated microgravity
Authors: Chowdhury Parimal , Bachri Abdel , Hauer‐Jensen Martin , Pathak Rupak 
Published: December 2020

Exposure to ionizing radiation (IR) and microgravity induce greater risks to human space mission. Ground‐based studies on animals and cells have shown that both IR and microgravity cause numerous adverse effects on endothelial cells, which may lead to endothelial dysfunction. However, no systematic studies have been undertaken to investigate whether microgravity differentially modulates the expression of endothelial cell dysfunction markers when exposed either alone or in combination with irradiation. This study was conducted to gain insight into human endothelial cells when subjected to simulated microgravity followed by exposure to IR.MethodsEndothelial cells were grown on micro‐carrier beads to simulate a low shear microgravity environment and subsequently subjected to a rotary culture systems, called high aspect ratio vessels (HARVs) at 10 rpm. The expression of endothelial dysfunction markers were measured by quantitative real‐time PCR.ResultsExposure to microgravity environment induced morphological changes in endothelial cells and enhanced radiation‐induced endothelial cell killing. In addition, IR plus microgravity caused differential expression of E‐selectin, Pecam1, Vcam1, Vegf, and Icam1 as compared to IR exposure alone.ConclusionsThese results suggest that microgravity modifies the effect of IR on endothelial cells.Support or Funding InformationSupported by NASA sponsored Arkansas Space Grant ConsortiumThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Eat, Sleep, Console and Adjunctive Buprenorphine Improved Outcomes in Neonatal Opioid Withdrawal Syndrome
Authors: Hein Sarrah , Clouser Barbara , Tamim Mohammed M. , Lockett Diane , Brauer Kathleen , Cooper Linda 
Published: December 2020

Background:
The worsening opioid crisis has increased the number of infants exposed to maternal opioids. Standard treatment of newborns exposed to opioids prenatally often requires prolonged hospitalization and separation of the mother–infant dyad. These practices can potentially increase severity of withdrawal symptoms, interrupt breastfeeding, and disturb mother–infant bonding. Use of the Eat, Sleep, Console (ESC) model may ameliorate symptoms, decrease mother–infant separation, and decrease hospital length of stay.

Purpose:
To manage opioid exposed infants in a more holistic manner to decrease neonatal intensive care unit (NICU) admissions, reduce the need for pharmacotherapy, and evaluate response and total length of treatment after a unit protocol change from morphine to buprenorphine.

Methods:
Implemented ESC model, optimized nonpharmacologic bundle, and prescribed buprenorphine therapy instead of morphine as needed for adjunctive therapy.

Results:
Admissions of opioid-exposed infants from the Mother–Baby Unit (MBU) to the NICU decreased by 22%, and the number of infants who required pharmacotherapy was reduced by 50%. The average length of pharmacotherapy fell from 14 to 6.5 days.

Implications for Practice:
The successful implementation of the ESC model helped keep the mother–infant dyad together, reduced admissions to the NICU, and lessened the need for pharmacotherapy. The change to buprenorphine further reduced our average length of treatment.

Implications for Research:
Investigation of monotherapy with buprenorphine needs to be evaluated as a valid treatment option. The buprenorphine dosing and weaning chart will need to be revised and modified if indicated.
Cell-based immunotherapy in gynecologic malignancies
Authors: Kamat Kalika , Krishnan Venkatesh , Berek Jonathan S. , Dorigo Oliver 
Published: December 2020

Purpose of review
To provide an update on cell-based immunotherapies in solid tumors particularly in gynecological cancers.

Recent findings
Recent clinical trial results demonstrate safety and tolerability of different cell therapies in gynecological cancers. Novel approaches, such as harnessing the cells of the innate immune system are also under investigation in a phase I trial.

Summary
Cell-based therapies are gaining widespread attention as evidenced by the increasing number of clinical trials encompassing both, innate and adaptive cells to target gynecological cancers. A majority of these therapeutic approaches are well tolerated and show promising results in early trials.
Identification of a New Genetic Mutation Associated With Peters Anomaly
Authors: Faber Hanna , Puk Oliver , Holz Anja , Biskup Saskia , Voykov Bogomil 
Published: December 2020

Purpose:
To report a new genetic mutation in the COL4A1 gene, which was identified in a baby girl with Peters anomaly (PA), a rare anterior segment mesenchymal dysgenesis, which is characterized by unilateral or bilateral corneal opacities often accompanied by glaucoma, cataract, and systemic malformations and associated with various genetic mutations.

Methods:
Ophthalmologic examination of one baby girl and whole exome sequencing and Sanger sequencing of blood samples of the child and her biological parents were performed.

Results:
Ophthalmologic examination led to the diagnosis of PA type I in the baby girl. Whole exome sequencing and Sanger sequencing identified the de novo mutation c.181_189delinsAGGTTTCCG; p.Gly61Arg in the COL4A1 gene in the child, whereas no other putatively causative variants in established genes associated with anterior segment dysgenesis were present.

Conclusions:
PA might be associated with the mutation c.181_189delinsAGGTTTCCG; p.Gly61Arg in the COL4A1 gene. The COL4A1 gene encodes for collagen IVα1, an essential component of basal membranes, and mutations are associated with an increased risk for renal and cerebrovascular disorders and stroke. This should be considered when advising and monitoring patients.
Early or delayed parenteral nutrition for infants: what evidence is available?
Authors: Moon Kwi , Rao Shripada C. 
Published: December 2020

Purpose of review
To review the current evidence evaluating early versus delayed commencement of parenteral nutrition in infants.

Recent findings
Recent studies in very premature infants (<32 weeks gestation) have shown that early commencement of parenteral nutrition immediately after birth improves physical growth. However, there are concerns that early use of very high dose of amino-acids (>3.5 g/kg/day immediately after birth) may cause metabolic acidosis, elevated blood urea, slower head growth and refeeding-hypophosphatemia syndrome. A recent multicentre randomized controlled trial found that commencement of parenteral nutrition within 24-h of admission increases the risk of infections and prolongs the duration of ventilation and ICU stay in full-term neonates, older infants and children. The study also found that delaying to day 8 of admission increased the risk of hypoglycaemia.

Summary
Benefits of commencing parenteral nutrition on the first day of life appear to outweigh risks in very premature infants; however, it is prudent to avoid early very high doses of amino acids (>3.5 g/kg/day) in the first few days of life. In moderate to late preterm infants, if enteral feeds are not tolerated by 72 h, it is reasonable to commence parenteral nutrition. In full-term and older infants, it is preferable to avoid parenteral nutrition within 24 h of admission and consider delaying by further few days. Diligent monitoring of blood glucose, serum phosphate and other parameters is essential while on parenteral nutrition.
Best practice for treating dyslipidaemia in patients with diabetes based on current international guidelines
Authors: Lan Nick S.R. , Burns Kharis , Bell Damon A. , Watts Gerald F. 
Published: December 2020

Purpose of review
Dyslipidaemia is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD) in type 2 diabetes. We provide an in-context overview of recent trials of lipid-lowering pharmacotherapies and of recommendations from international guidelines for managing dyslipidaemia in patients with diabetes.

Recent findings
Clinical trials have demonstrated that patients with diabetes derive greater benefits from ezetimibe and proprotein convertase subtilisin–kexin type 9 inhibitors owing to the higher absolute ASCVD risk compared with patients without diabetes. Pure eicosapentaenoic acid ethyl ester therapy should be considered in high risk patients with diabetes and hypertriglyceridaemia who have well controlled low-density lipoprotein cholesterol on statin therapy. International guidelines from USA, Canada and Europe have been updated to support a more intensive approach to treating dyslipidaemia in diabetes.

Summary
Dyslipidaemia should be identified and treated intensively as part of overall diabetes management to reduce ASCVD risk. Although lifestyle modifications and statin therapy remain the cornerstone of management, add-on therapies should be strongly considered depending on the absolute risk of ASCVD and the degree of dyslipidaemia.
Coronavirus disease 2019 and type 1 diabetes mellitus
Authors: Chang Diana J. , Moin Tannaz 
Published: December 2020

Purpose of review
Type 2 diabetes (T2DM) is a major comorbidity of coronavirus disease 2019 (COVID-19) but less is known about COVID-19 and type 1 diabetes (T1DM). Thus, our goal was to review the literature on COVID and T1DM.

Recent findings
We identified 21 reports focusing on COVID-19 infections among patients with preexisting T1DM (n = 7), incident T1DM presentations during the COVID-19 quarantine (n = 6), and outpatient management of T1DM during the COVID-19 quarantine (n = 8). These studies showed that patients with preexisting T1DM and COVID-19 infection often present with hyperglycemia and/or diabetic ketoacidosis (DKA). Although the risk of in-hospital mortality may be increased, hospitalization rates among patients with T1DM mirror that of the general population. The numbers of patients presenting with incident T1DM during COVID-19 quarantine have remained stable, but cases with severe DKA may have increased. COVID-19 quarantine has also impacted outpatient T1DM management and studies examining changes in glycemic control have shown mixed results.

Summary
COVID-19 has important implications for patients with type 1 diabetes, but additional studies with larger numbers of patients and longer term follow-up are needed to confirm the early findings highlighted in this review.
Is there still a role for cranialization in modern sinus surgery?
Authors: Morse Justin C. , Chandra Rakesh K. 
Published: December 2020

Purpose of review
To give an overview of recently published literature on the indications and use of cranialization of the frontal sinuses.

Recent findings
Recent studies on cranialization have evaluated its role in frontal sinus fractures, inflammatory disease, and tumors involving both the frontal sinus and anterior cranial fossa. Currently, a more conservative approach is favored with traumatic injury to the frontal sinus outflow tract, with multiple studies demonstrating outflow recanalization with observation alone. Similarly, advancements in endoscopic sinus surgical approaches allow the many posterior table fractures to be managed without cranialization. Severe inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression have successfully been managed without cranialization in multiple studies suggesting an endoscopic surgical approach can be favored in these settings. Both benign and malignant tumors of the frontal sinus are managed without cranialization with select cases favoring an open approach with cranialization depending on tumor location. Malignant tumors of the frontal sinus are more likely to require cranialization as oncologic resection including margins can lead to large dural defects with significant tissue loss, which is unfavorable for more conservative reconstructive options.

Summary
Cranialization remains a necessary and indicated procedure in the appropriate clinical circumstances. A more conservative approach to frontal sinus fractures is warranted, with recent literature supporting similar outcomes and less morbidity. Inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression can be managed without cranialization. Although most benign tumors can be resected via endoscopic approaches, cranialization remains a mainstay as part of the reconstructive plan after oncologic resection of malignant tumors involving the frontal sinus.
Secondary Traumatic Stress Among Labor and Delivery Nurses
Authors: Nicholls Erika M. , Hermann Robin M. , Giordano Nicholas A. , Trotta Rebecca L. 
Published: December 2020

Abstract

Purpose:
To describe the prevalence and severity of secondary traumatic stress (STS) among labor and delivery nurses within a Northeastern United States academic health system.

Study Design and Methods:
Using a cross-sectional, descriptive correlational design, a convenience sample of labor and delivery nurses (288 nurses) were invited to complete Secondary Traumatic Stress Scale (STSS), a 17-item Likert-type instrument, that measures intrusion, avoidance, and the arousal symptoms associated with indirect exposure to traumatic events. Five additional questions about potential consequences of STS were also asked.

Results:

N = 144 completed the survey (50% response rate). Average STSS score was 33.74 (SD, 11.8), with 35% of respondents meeting symptom severity scores associated with STS. STSS Scores ≥ 38 were significantly correlated with nurses considering leaving their jobs, calling out sick, or requesting an assignment change after witnessing a traumatic birth (p < 0.001). The majority of respondents (84.7%) reported witnessing a traumatic birth. After witnessing a traumatic birth, respondents used co-workers, family, and friends as sources of support.

Clinical Implications:
This study offers insight into the frequency and severity of STS among labor and delivery nurses, as well as the potential workforce-related consequences and provides a foundation for future work aimed at developing interventions to prevent or alleviate STS.
Maternity Nurses' Responses to Maternal Early Warning Criteria
Authors: Gillespie Kate H. , Chibuk Amber , Doering Jennifer , Nelson Ken 
Published: December 2020

Abstract

Objective:
The purpose of this study was to assess the influence of nursing care on implementing perinatal risk-appropriate care in the context of maternal early warning criteria.

Design:
Medical record review and survey of maternity nurses in a three-hospital system in Wisconsin with two level I hospitals and 1 level III hospital.

Participants:
Seven maternity nurses from the level III hospital conducted the medical record reviews and all maternity staff nurses from two level I hospitals were invited to complete the survey.

Measurements:
All medical records in 2017 that met these inclusion criteria: hypertension, sepsis, preeclampsia, hemorrhage, low Apgar scores, and transport were reviewed to assess identification and response time for maternal early warning signs using the Nurses Contribution to Maternal Mortality Worksheet. The survey included questions about influences on the nurses' confidence when interpreting early warning indicators.

Results:
Thirty-two medical records met inclusion criteria and were reviewed. The number of maternal early warning signs recorded ranged from one to four, with a mean of 1.75 indicators. Eighty percent of records documented increased evaluation as a nursing response to the maternal early warning signs. Time-lapse between notifying a provider and bedside evaluation was less than 15 minutes in 54% of cases. Of the 31 eligible nurses, 18 completed the survey (58% response rate). Personal knowledge (90%) was reported by nurses as being the greatest influence on nursing confidence. Sixty-nine percent of nurses reported not receiving patient information from team members at the transporting hospital.

Conclusion:
A systematic record review by frontline nurses can monitor identification and response to maternal early warning signs. Feedback on patient transports can reinforce nurses' decision-making that has the potential to improve responsiveness to clinical warning signs.
Altered Expression of GJD2 Messenger RNA and the Coded Protein Connexin 36 in Negative Lens–induced Myopia of Guinea Pigs
Authors: Zhu Qiurong , Yang Guoyuan , Chen Bingjie , Liu Fengyang , Li Xia , Liu Longqian 
Published: December 2020

SIGNIFICANCEDecreased expression of the retinalGJD2gene messenger RNA (mRNA) and connexin 36 (Cx36) protein in the guinea pig negative lens–induced myopia (LIM) model suggests their involvement in local retinal circuits regulating eye growth.PURPOSEPrevious studies suggest that theGJD2gene and Cx36 protein encoded by theGJD2gene play important roles in retinal signaling pathways and eye development. The aim of this study was to investigate the changes inGJD2mRNA and Cx36 protein expression in the guinea pig lens-induced myopia model.METHODSFour-week-old guinea pigs were randomly divided into two groups. Animals in the experimental group were fitted with monocular −10 D lenses; and animals in the control group, with monocular plano lenses. Biometric measurements, including the spherical equivalent refractive error and axial length, were monitored. Animals were killed after 0, 1, 2, and 3 weeks of treatment, and their retinas were isolated. RetinalGJD2mRNA and Cx36 protein expression levels were assessed by quantitative real-time polymerase chain reaction and Western blot analysis, respectively.RESULTSSpherical equivalent refractive error values indicated that negative lens–treated eyes became significantly more myopic than plano lens–treated eyes (P= .001), consistent with their longer axial lengths compared with those of control eyes. BothGJD2mRNA and Cx36 protein expression levels were decreased in the retinas of negative lens–treated eyes compared with levels in the retinas of plano lens–treated eyes, although there were differences in the timing;GJD2mRNA, levels were significantly decreased after 1 and 2 weeks of treatment (P= .01 andP= .004, respectively), whereas Cx36 protein expression was significantly decreased after only 1 week (P= .01).CONCLUSIONSThat both retinalGJD2mRNA and Cx36 protein expression levels were decreased after induction of myopia with negative lenses points to retinal circuits involving Cx36 in myopia development in the guinea pig.
The Physiatry Workforce in 2019 and Beyond, Part 2
Authors: Dall Timothy M. , Reynolds Ryan L. , Chakrabarti Ritashree , Forte Gaetano J. , Langelier Margaret , Wang Shen , Whyte John , Sridhara Ankam Nethra , Annaswamy Thiru M. , Fredericson Michael , Jain Nitin B. , Perret Karimi Danielle , Morgenroth David C. , Slocum Chloe , Wisotzky Eric 
Published: December 2020

Objective
The aim of this study was to assess the current and future adequacy of physiatrist supply in the United States.

Design
A 2019 online survey of board-certified physiatrists (n = 616 completed, 30.1% response) collected information about demographics, practice characteristics, hours worked, and retirement intentions. Microsimulation models projected future physiatrist supply and demand using data from the American Board of Physical Medicine and Rehabilitation, national and state population projections, American Community Survey, Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and other sources.

Results
Approximately 37% of 8853 active physiatrists indicate that their workload exceeds capacity, 59% indicate that workload is at capacity, and 4% indicate under capacity. These findings suggest a national shortfall of 940 (10.6%) physiatrists in 2017, with substantial geographic variation in supply adequacy. Projected growth in physiatrist supply from 2017 to 2030 approximately equals demand growth (2250 vs. 2390), suggesting that without changes in care delivery, the shortfall of physiatrists will persist, with a 1080 (9.7%) physiatrist shortfall in 2030.

Conclusion
Without an increase in physiatry residency positions, the current national shortfall of physiatrists is projected to persist. Although a projected increase in physiatrists’ use of advanced practice providers may help preserve access to comprehensive physiatry care, it is not expected to eliminate the shortfall.
Emergence of a novel urogenital-tropic Neisseria meningitidis
Authors: Bazan Jose A. , Stephens David S. , Turner Abigail Norris 
Published: December 2020

Purpose of review

Neisseria meningitidis (Nm) is primarily associated with asymptomatic nasopharyngeal carriage and invasive meningococcal disease (sepsis and meningitis), but like N. gonorrhoea (Ng), Nm can colonize urogenital and rectal mucosal surfaces and cause disease. First noted in 2015, but with origins in 2011, male urethritis clusters caused by a novel Nm clade were reported in the USA (the US_NmUC). This review describes research developments that characterize this urogenital-tropic Nm.

Recent findings
The US_NmUC evolved from encapsulated Nm serogroup C strains. Loss of capsule expression, lipooligosaccharide (LOS) sialylation, genetic acquisition of gonococcal alleles (including the gonococcal anaerobic growth aniA/norB cassette), antimicrobial peptide heteroresistance and high surface expression of a unique factor-H-binding protein, can contribute to the urethra-tropic phenotype. Loss-of-function mutations in mtrC are overrepresented in clade isolates. Similar to Ng, repeat US_NmUC urethritis episodes can occur. The US_NmUC is now circulating in the UK and Southeast Asia. Genomic sequencing has defined the clade and rapid diagnostic tests are being developed for surveillance.

Summary
The US_NmUC emerged as a cause of urethritis due to acquisition of gonococcal genetic determinants and phenotypic traits that facilitate urogenital tract infection. The epidemiology and pathogenesis of this urogenital-tropic pathogen continues to be defined.
Application of Sandwich Shape Double Bilobed Flap in Auricular Defects
Authors: Evin Nuh , Tosun Zekeriya , Akdag Osman 
Published: December 2020

Background
Reconstruction of auricular defects is a challenging surgical procedure because of its complex 3-dimensional structure. Various surgical techniques have been used for the reconstruction of the auricle. However, most of these techniques are not applicable to the reconstruction of marginal and central defects, and the texture and color harmony of the reconstructed parts were not evaluated in detail. Thus, the aim of this study is to present a novel technique, sandwich shape double bilobed flap, which can be used for correcting, both, central and marginal defects of the auricle and to evaluate esthetic outcomes with objective and quantitative parameters.

Methods
In this study, 24 patients with partial thickness auricular defects were treated with a bilobed flap, and excess tissue in the postauricular sulcus region was transferred to the defective region on the anterior surface. Color compatibility between the flap and surrounding tissues, patient's satisfaction on the final shape and auricular symmetry, as well as anterior scar formation on the auricle were evaluated.

Results
The color, texture, and thickness of the flap matched well with the adjacent auricular tissue and there was no perceptible color difference. The original size, projection, and subunits of auricles were maintained. All patients were mostly very satisfied with surgical outcomes (mean satisfaction score, 4.75 ± 0.4). There was only inconspicuous scar on the visible anterior surface of the auricle (mean patients' scores, 2.22 ± 0.3; mean observers' scores, 2.6 ± 0.4).

Conclusions
The sandwich shape double bilobed flap technique preserved size and subunits of the auricle. Additionally, this procedure also resulted in inconspicuous scarring as well as similar color, texture, and thickness of the flap with the surrounding tissue, thereby achieving satisfying esthetic outcomes.