bluuebunny/crossref_metadata_2025_split huggingface dataset:
Syntaxin1A Neomorphic Mutations Promote Rapid Recovery from Isoflurane Anesthesia in Drosophila melanogaster
Authors: Troup Michael , Zalucki Oressia H. , Kottler Benjamin D. , Karunanithi Shanker , Anggono Victor , van Swinderen Bruno 
Published: July 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Mutations in the presynaptic protein syntaxin1A modulate general anesthetic effects in vitro and in vivo. Coexpression of a truncated syntaxin1A protein confers resistance to volatile and intravenous anesthetics, suggesting a target mechanism distinct from postsynaptic inhibitory receptor processes. Hypothesizing that recovery from anesthesia may involve a presynaptic component, the authors tested whether syntaxin1A mutations facilitated recovery from isoflurane anesthesia in Drosophila melanogaster.

Methods
A truncated syntaxin1A construct was expressed in Drosophila neurons. The authors compared effects on isoflurane induction versus recovery in syntaxin1A mutant animals by probing behavioral responses to mechanical stimuli. The authors also measured synaptic responses from the larval neuromuscular junction using sharp intracellular recordings, and performed Western blots to determine whether the truncated syntaxin1A is associated with presynaptic core complexes.

Results

Drosophila expressing a truncated syntaxin1A (syx227, n = 40) were resistant to isoflurane induction for a behavioral responsiveness endpoint (ED50 0.30 ± 0.01% isoflurane, P < 0.001) compared with control (0.240 ± 0.002% isoflurane, n = 40). Recovery from isoflurane anesthesia was also faster, with syx227-expressing flies showing greater levels of responsiveness earlier in recovery (reaction proportion 0.66 ± 0.48, P < 0.001, n = 68) than controls (0.22 ± 0.42, n = 68 and 0.33 ± 0.48, n = 66). Measuring excitatory junction potentials of larvae coexpressing the truncated syntaxin1A protein showed a greater recovery of synaptic function, compared with controls (17.39 ± 3.19 mV and 10.29 ± 4.88 mV, P = 0.014, n = 8 for both). The resistance-promoting truncated syntaxin1A was not associated with presynaptic core complexes, in the presence or absence of isoflurane anesthesia.

Conclusions
The same neomorphic syntaxin1A mutation that confers isoflurane resistance in cell culture and nematodes also produces isoflurane resistance in Drosophila. Resistance in Drosophila is, however, most evident at the level of recovery from anesthesia, suggesting that the syntaxin1A target affects anesthesia maintenance and recovery processes rather than induction. The absence of truncated syntaxin1A from the presynaptic complex suggests that the resistance-promoting effect of this molecule occurs before core complex formation.
Peripheral Nerve Blocks for Ambulatory Shoulder Surgery
Authors: Hamilton Gavin M. , Ramlogan Reva , Lui Anne , McCartney Colin J. L. , Abdallah Faraj , McVicar Jason , McIsaac Daniel I. 
Published: July 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Nerve blocks improve early pain after ambulatory shoulder surgery; impact on postdischarge outcomes is poorly described. Our objective was to measure the association between nerve blocks and health system outcomes after ambulatory shoulder surgery.

Methods
We conducted a population-based cohort study using linked administrative data from 118 hospitals in Ontario, Canada. Adults having elective ambulatory shoulder surgery (open or arthroscopic) from April 1, 2009, to December 31, 2016, were included. After validation of physician billing codes to identify nerve blocks, we used multilevel, multivariable regression to estimate the association of nerve blocks with a composite of unplanned admissions, emergency department visits, readmissions or death within 7 days of surgery (primary outcome) and healthcare costs (secondary outcome). Neurology consultations and nerve conduction studies were measured as safety indicators.

Results
We included 59,644 patients; blocks were placed in 31,073 (52.1%). Billing codes accurately identified blocks (positive likelihood ratio 16.83, negative likelihood ratio 0.03). The composite outcome was not significantly different in patients with a block compared with those without (2,808 [9.0%] vs. 3,424 [12.0%]; adjusted odds ratio 0.96; 95% CI 0.89 to 1.03; P = 0.243). Healthcare costs were greater with a block (adjusted ratio of means 1.06; 95% CI 1.02 to 1.10; absolute increase $325; 95% CI $316 to $333; P = 0.005). Prespecified sensitivity analyses supported these results. Safety indicators were not different between groups.

Conclusions
In ambulatory shoulder surgery, nerve blocks were not associated with a significant difference in adverse postoperative outcomes. Costs were statistically higher with a block, but this increase is not likely clinically relevant.
The role of Epstein–Barr virus infection in primary Sjögren's syndrome
Authors: Maślińska Maria 
Published: July 2019

Purpose of review
The purpose of this article is to draw attention to the role of Epstein–Barr virus (EBV) virus in the pathogenesis of the primary Sjögren's syndrome. The article introduces the problem of consequences of EBV acute infection, and its reactivation, in association with the immune response modulation by the virus and with an increased risk of developing systemic autoimmune diseases and EBV-associated cancers.

Recent findings
The knowledge about the mechanisms by which the virus may stay for years in a latent phase, unrecognized by the host response immune cells is constantly expanding. There are several mechanisms and theories about EBV influence on the autoimmune process in Sjogren's syndrome (pSS), including the similarity (molecular mimicry) between viral EBNA-2 protein and Ro-60 antigen or EBER-1 and EBER-2 viral proteins and La antigen.

Summary
The influence of EBV infection on the development and course of pSS has been proven. It has also been established that both EBV and pSS result in the increased risk of tumor (especially lymphoma) development. In the light of these findings, new ways to manage EBV infections are being sought. Optimal methods for assessing EBV infection status are being devised. Research also aims at finding therapies, which target EBV through the inhibition of the autoimmune process and of viral activity. The present article is an attempt to discuss the most important phenomena and elements linking EBV infection to the primary Sjögren's syndrome.
The association between hepatitis B, hepatitis C and systemic sclerosis: a cross-sectional study
Authors: Tiosano Shmuel , Cohen Arnon D. , Amital Howard 
Published: July 2019

Purpose of review
To investigate the association between systemic sclerosis (SSc) to chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) carriage. We utilized the database of Clalit Health Services, the largest healthcare organization in Israel and performed a cross-sectional study.

Recent findings
The study included 2431 SSc patients and 12 710 age-and-sex matched controls, HBV was found in 38 SSc patients (1.56%) and 64 controls (0.5%). HCV was found in 30 SSc patients (1.23%) and 83 controls (0.65%). In multivariable logistic regression model, HBV was found to be associated with smoking, dialysis treatment and SSc [odds ratio (OR) 2.97, 95% confidence interval (CI) 1.92–4.53]. HCV was found to be associated with dialysis treatment and SSc (OR 1.73, 95% CI 1.1–2.66). A trend was found between both HBV and HCV toward low socioeconomic status. SSc patients with HBV had demonstrated higher rates of end-stage renal disease requiring dialysis treatment.

Summary
In our study, HBV and HCV were found to be associated with SSc. Common immune mechanisms or therapeutic modalities may serve as mediators of this association.
Osteoarticular manifestations of Mayaro virus infection
Authors: Arenívar Carlos , Rodríguez Yhojan , Rodríguez-Morales Alfonso J. , Anaya Juan-Manuel 
Published: July 2019

Purpose of review
To carry out an update on the state of the art of the Mayaro virus (MAYV) infection and its osteoarticular implications.

Recent findings
There is a wide distribution of MAYV in Latin America and documented exported cases to the United States and Europe. Although osteoarticular involvement is not the most frequent, it is one the most associated with disability. The main mechanisms related to arthropathy involves cellular infiltrates (i.e. macrophages, natural killer cells, lymphocytes) together with production of cytokines, such as IL-6, IL-7, IL8, IL-12p70.

Summary
MAYV infection is an emerging disease, which has been reported in many and increasing number of countries of Latin America. There is a high risk of epidemic outbreaks, given the inadequate vector control (Aedes mosquitoes). Its main symptoms, like other arbovirus infections, involve the presence of headache, rash, conjunctivitis, and arthralgias. MAYV arthropathy is usually severe, can last in time, and is associated with severe disability. There is currently no treatment for MAYV. Prevention of MAYV as a public health burden will be achieved by integrating vector control with vaccines (still under development).
Osteomyelitis Risk Factors Related to Combat Trauma Open Upper Extremity Fractures: A Case–Control Analysis
Authors: Warkentien Tyler E. , Lewandowski Louis R. , Potter Benjamin K. , Petfield Joseph L. , Stinner Daniel J. , Krauss Margot , Murray Clinton K. , Tribble David R. ,   the Trauma Infectious Disease Outcomes Study Group
Published: July 2019

Objective:
To determine risk factors for osteomyelitis in US military personnel with combat-related, extremity long bone (humerus, radius, and ulna) open fractures.

Design:
Retrospective observational case–control study.

Setting:
US military regional hospital in Germany and tertiary care military hospitals in the United States (2003–2009).

Patients/Participants:
Sixty-four patients with open upper extremity fractures who met diagnostic osteomyelitis criteria (medical record review verification) were classified as cases. Ninety-six patients with open upper extremity fractures who did not meet osteomyelitis diagnostic criteria were included as controls.

Intervention:
Not applicable.

Main Outcome Measurements:
Multivariable odds ratios (ORs; 95% confidence interval [CI]).

Results:
Among patients with surgical implants, osteomyelitis cases had longer time to definitive orthopaedic surgery compared with controls (median: 26 vs. 11 days; P < 0.001); however, there was no significant difference with timing of radiographic union. Being injured between 2003 and 2006, use of antibiotic beads, Gustilo–Anderson [GA] fracture classification (highest with GA-IIIb: [OR: 22.20; CI: 3.60–136.95]), and Orthopaedic Trauma Association Open Fracture Classification skin variable (highest with extensive degloving [OR: 15.61; CI: 3.25–74.86]) were independently associated with osteomyelitis risk. Initial stabilization occurring outside of the combat zone was associated with reduced risk of osteomyelitis.

Conclusions:
Open upper extremity fractures with severe soft-tissue damage have the highest risk of developing osteomyelitis. The associations with injuries sustained 2003–2006 and location of initial stabilization are likely from evolving trauma system recommendations and practice patterns during the timeframe.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Impact of Point-of-Care Ultrasound in the Emergency Department on Care Processes and Outcomes in Critically Ill Nontraumatic Patients
Authors: Mosier Jarrod M. , Stolz Uwe , Milligan Rebecca , Roy-Chaudhury Akshay , Lutrick Karen , Hypes Cameron D. , Billheimer Dean , Cairns Charles B. 
Published: July 2019

Objectives:
Outcomes data on point-of-care ultrasound (POCUS) in critically ill patients are lacking. This study examines the association between POCUS in the emergency department and outcomes in critically ill patients.

Design:
Retrospective cohort study of critically ill emergency department patients in two academic emergency departments. All emergency department patients admitted to the intensive care unit or that die in the emergency department were entered prospectively into a registry.

Setting:
Two academic emergency departments.

Patients:
All adult (> 18 years old) non-trauma patients with hemodynamic instability [shock index (heart rate/systolic blood pressure) > 0.6] between November 1, 2013-October 31, 2016, were included.

Interventions:
Cohorts were assigned as follows: no POCUS (cohort 1), POCUS prior to a key intervention (cohort 2), and POCUS after a key intervention (cohort 3). A key intervention was either a fluid bolus or vasoactive drug initiation.

Measurements and Main Results:
Multivariable logistic regression was used to evaluate the association between POCUS use and the primary outcome of in-hospital mortality. We conducted several sensitivity analyses including propensity score matching and inverse-probability-weighted regression-adjustment along with multiple imputation to account for non-random assignment of POCUS as well as bias due to missing data. Of the 7,734 eligible patients, 2,293 patients were excluded. The remaining 5,441 patients were included in the analysis: 4165 in Cohort 1, 614 in Cohort 2, and 662 in Cohort 3. Mortality was 22%, 29%, and 26%, respectively (p < 0.001). POCUS prior to an intervention was associated with an adjusted odds ratio for death of 1.41 (95% CI, 1.12-1.76) compared to no POCUS. The sensitivity analyses showed an absolute increased mortality of +0.05 (95% CI, 0.02-0.09) for cohort 2 compared to 1.

Conclusions:
POCUS use prior to interventions appears to be associated with care delays and increased in-hospital mortality compared to critically ill patients with no POCUS. Further explorations of the impact of POCUS in the emergency department appear warranted.
Practice Patterns and Ethical Considerations in the Management of Venovenous Extracorporeal Membrane Oxygenation Patients: An International Survey*
Authors: Abrams Darryl , Pham Tài , Burns Karen E. A. , Combes Alain , Curtis J. Randall , Mueller Thomas , Prager Kenneth M. , Serra Alexis , Slutsky Arthur S. , Brodie Daniel , Schmidt Matthieu 
Published: July 2019

Objectives:
To characterize physicians’ practices and attitudes toward the initiation, limitation, and withdrawal of venovenous extracorporeal membrane oxygenation for severe respiratory failure and evaluate factors associated with these attitudes.

Design:
Electronic, cross-sectional, scenario-based survey.

Setting:
Extracorporeal membrane oxygenation centers affiliated with the Extracorporeal Life Support Organization and the International Extracorporeal Membrane Oxygenation Network.

Subjects:
Attending-level physicians with experience managing adult patients receiving venovenous extracorporeal membrane oxygenation.

Interventions:
None.

Measurements and Main Results:
Five-hundred thirty-nine physicians in 39 countries across six continents completed the survey. Factors that influenced the decision to limit extracorporeal membrane oxygenation initiation included older patient age (46.9%), additional organ failures (37.7%), and prolonged mechanical ventilation (35.1%). Patient comorbidities (70.5%), patient’s wishes (56.0%), and etiology of respiratory failure (37.7%) were factors that influenced the decision to withdraw extracorporeal membrane oxygenation. In multivariable analysis, factors associated with increased odds of withdrawing life-sustaining therapies included pulmonary fibrosis, stroke, surrogate’s desire to withdraw, lack of knowledge regarding patient’s or surrogate’s wishes in the setting of fibrosis, not initiating extracorporeal membrane oxygenation in the baseline scenario, and respondent religiosity. Factors associated with decreased odds of withdrawal included practicing in an environment where it is not legally possible to make decisions against patient or surrogate wishes. Most respondents (90.5%) involved other physicians in treatment decisions for extracorporeal membrane oxygenation patients, whereas only 53.2%, 45.3%, and 29.5% of respondents involved surrogates, awake patients, or bedside nurses, respectively.

Conclusions:
Patient and physician-level factors were associated with decision-making regarding extracorporeal membrane oxygenation initiation and withdrawal, including patient prognosis and knowledge of patient or surrogate wishes. Respondents reported low rates of engaging in shared decision-making when managing patients receiving extracorporeal membrane oxygenation.
Association Between the Use of Sodium Bicarbonate and Mortality in Acute Kidney Injury Using Marginal Structural Cox Model
Authors: Zhang Zhongheng , Mo Lei , Ho Kwok M. , Hong Yucai 
Published: July 2019

Objective:
Acute kidney injury with metabolic acidosis is common in critically ill patients. This study assessed the associations between the use of IV sodium bicarbonate and mortality of patients with acute kidney injury and acidosis.

Design:
The study was conducted by using data from Beth Israel Deaconess Medical Center, which included several ICUs such as coronary care unit, cardiac surgery recovery unit, medical ICU, surgical ICU, and trauma-neuro ICU. Marginal structural Cox model was used to assess the relationship between receipt of sodium bicarbonate and hospital mortality, allowing pH, Paco
2, creatinine, and bicarbonate concentration as time-varying predictors of sodium bicarbonate exposure while adjusting for baseline characteristics of age, gender, Sequential Organ Failure Assessment score, acute kidney injury stage, Elixhauser score, quick Sequential Organ Failure Assessment, and Simplified Acute Physiology Score II.

Setting:
A large U.S.-based critical care database named Medical Information Mart for Intensive Care.

Patients:
Patients with Kidney Disease: Improving Global Outcomes acute kidney injury stage greater than or equal to 1 (> 1.5

JOURNAL/ccme/04.03/00003246-201910000-00016/inline-graphic1/v/2023-10-17T042033Z/r/image-tiff

baseline creatinine) and one measurement of acidosis (pH ≤ 7.2). Baseline creatinine was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation.

Interventions:
None.

Measurements and Main Results:
Of the 3,406 eligible patients, 836 (24.5%) had received sodium bicarbonate treatment. Patients who received sodium bicarbonate treatment had a higher Sequential Organ Failure Assessment (9 vs 7; p < 0.001), lower pH (7.16 vs 7.18; p < 0.001), and bicarbonate concentration (16.51 ± 7.04 vs 20.57 ± 6.29 mmol/L; p < 0.001) compared with those who did not receive sodium bicarbonate. In the marginal structural Cox model by weighing observations with inverse probability of receiving sodium bicarbonate, sodium bicarbonate treatment was not associated with mortality in the overall population (hazard ratio, 1.16; 95% CI, 0.98–1.42; p = 0.132), but it appeared to be beneficial in subgroups of pancreatitis (hazard ratio, 0.53; 95% CI, 0.28–0.98; p = 0.044) and severe acidosis (pH < 7.15; hazard ratio, 0.75; 95% CI, 0.58–0.96; p = 0.024). Furthermore, sodium bicarbonate appeared to be beneficial in patients with severe bicarbonate deficit (< –50 kg·mmol/L).

Conclusions:
In the analysis by adjusting for potential confounders, there is no evidence that IV sodium bicarbonate is beneficial for patients with acute kidney injury and acidosis. Although the study suggested potential beneficial effects in some highly selected subgroups, the results need to be validated in experimental trials.
Reproducibility of Measurements Obtained During Cardiopulmonary Exercise Testing in Individuals With Fatiguing Health Conditions: A Case Series
Authors: Larson Benjamin , Davenport Todd E. , Stevens Staci R. , Stevens Jared , Van Ness J. Mark , Snell Christopher R. 
Published: July 2019

Purpose:
Measurements obtained during maximal cardiopulmonary exercise testing (CPET) demonstrate high test–retest reliability, which indicates low error variance. However, measurements obtained from people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may depart from typically observed high reproducibility, which could represent functionally relevant biological variability that is characteristic of the underlying pathophysiology. The purpose of this case series was to document individual experiences with test–retest variability in CPET measurements in individuals with ME/CFS compared with other fatiguing health conditions.

Methods:
In this case series, 6 women matched for age and body mass index underwent 2 maximal CPETs spaced 24 hours apart. Clients comprised 1 sedentary individual without fatigue, 1 active individual without fatigue, 1 individual with multiple sclerosis (MS), 1 individual diagnosed with HIV, 1 individual with ME/CFS and low maximal volume of oxygen consumed (VO2max), and 1 high-functioning individual with ME/CFS and high VO2max. Percent change in CPET measurements between tests was calculated for each client.

Results:
Nondisabled clients and clients with MS and HIV reproduced or improved in their volume of oxygen consumed (VO2), workload (WL), heart rate (HR), and minute ventilation (VE) at ventilatory anaerobic threshold (VAT) and at peak exercise (except peak WL and VE for the individual with HIV). Neither individual with ME/CFS reproduced VO2, WL, HR, or VE at VAT within literature estimates.

Conclusions:
Measurements during CPET for individual patients may relate to potential condition-specific deficits in cardiac, pulmonary, and metabolic functioning.
Prophylactic Use of Mucosal Protective Agents and Proton Pump Inhibitors in Patients Undergoing Percutaneous Coronary Intervention: Real World Evidences of 36,870 Patients
Authors: Li Yan-Hua , Yang Shan-Shan , Guo Xin-Hong , Chen Yun-Dai 
Published: July 2019

Background:
Prophylactic medications are believed to reduce risks of gastrointestinal (GI) bleeding after percutaneous coronary intervention (PCI). However, their true effectiveness in preventing GI bleeding is still unknown.

Methods:
The clinical data of 36,870 patients treated with PCI from January 2010 to July 2017 were retrospectively analyzed. The trend in the prophylactic use of mucosal protective agents and proton pump inhibitors was analyzed.

Results:
A total of 36,870 patients were included with a mean age of 60 ± 18 years. In patients treated with primary PCI for ST-segment elevation myocardial infarction, prophylactic medications were associated with a significantly lower incidence of postprocedure GI bleeding in comparison with no medication (1.072%, 52/4852 vs. 2.747%, 25/910; P < 0.001). In patients with CRUSADE scores >40, prophylactic medications were associated with a significantly lower incidence of postprocedure GI bleeding in comparison with not using prophylactic medications (0.679%, 21/3093 vs. 1.899%, 20/1053; P = 0.001).

Conclusions:
Prophylactic medications were associated with significantly lower incidence of postprocedure 30-day GI bleeding in patients with primary PCI for ST-segment elevation myocardial infarction or CRUSADE scores >40.