Experimental Studies of Latissimus Dorsi Detrusor Myoplasty for Bladder Acontractility: A Systematic Review.

Current therapies that allow patients with bladder acontractility to void are limited. The standard therapy is clean intermittent catheterization. Latissimus dorsi detrusor myoplasty (LDDM) has been shown to provide functional contraction and allow patients with bladder acontractility to void voluntarily. Our goal was to summarize experimental studies of LDDM. We hypothesized that experimental studies would show that latissimus dorsi muscle (LDM) flaps for detrusor myoplasty have superior outcomes when compared with other types of flaps. On January 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, and EMBASE databases, without time frame limitations, to identify articles on the use of LDDM. We excluded studies that investigated other treatments. Of 54 articles identified by the search, three fulfilled the eligibility criteria. A total of 24 dogs underwent procedures and were evaluated with a maximum follow-up of 9 months. Three types of procedures were performed: LDM in situ reconfiguration, LDM myoplasty, and augmentation cystoplasty after supratrigonal cystectomy. Electrical stimulation, cystography, urodynamic and hydrodynamic measurements, and microscopic examinations were performed. Innervated LDM flaps transferred to the bladder were able to contract and promote voiding in response to electrical stimulation. Experimental studies have shown the feasibility of LDDM in canine models. Although no comparison groups were included, innervated LDM flap transferred to the bladder showed promising results regarding contraction capable of voiding.

Using Facial Recognition Tools for Health Assessment.

The number of applications for facial recognition technology is increasing due to the improvement in image quality, artificial intelligence, and computer processing power that has occurred during the last decades. Algorithms can be used to convert facial anthropometric landmarks into a computer representation, which can be used to help identify nonverbal information about an individual's health status. This article discusses the potential ways a facial recognition tool can perform a health assessment. Because facial attributes may be considered biometric data, clinicians should be informed about the clinical, ethical, and legal issues associated with its use.

Using Facial Recognition Tools for Health Assessment.

The number of applications for facial recognition technology is increasing due to the improvement in image quality, artificial intelligence, and computer processing power that has occurred during the last decades. Algorithms can be used to convert facial anthropometric landmarks into a computer representation, which can be used to help identify nonverbal information about an individual's health status. This article discusses the potential ways a facial recognition tool can perform a health assessment. Because facial attributes may be considered biometric data, clinicians should be informed about the clinical, ethical, and legal issues associated with its use.

Bioimpedance Spectroscopy for Assessment of Breast Cancer-Related Lymphedema: A Systematic Review.

Bioimpedance spectroscopy is currently used to evaluate patients with breast cancer-related lymphedema (BCRL). We aimed to describe published studies on the use of bioimpedance spectroscopy for assessment for BCRL. We queried the PubMed, Ovid Medline, and Embase databases to identify studies that evaluated the use of bioimpedance spectroscopy as an assessment tool. We searched for the keywords "bioimpedance" AND ("lymphedema" OR "lymphoedema"). We included English-language studies that reported the use of bioimpedance spectroscopy for assessment of BCRL. Out of 152, 116, and 235 articles identified in each database, respectively, only a total of 11 articles were included. Bioimpedance spectroscopy was studied as a method to assess and predict response to BCRL treatment, assess volume changes, and calibrate L-Dex scores for conversion to units of volume. All studies reported that bioimpedance spectroscopy is a promising tool for predicting response to BCRL treatment and measuring volume changes. Bioimpedance spectroscopy can be used for assessment of BCRL. However, the accuracy of bioimpedance spectroscopy for BCRL assessment has not been determined, and consequently further studies are needed.

Exploratory Analysis on Herbicide Metabolism and Very-Long-Chain Fatty Acid Production in Metolachlor-Resistant Palmer Amaranth (Amaranthus palmeri S. Wats.).

A Palmer amaranth (Amaranthus palmeri S. Wats.) biotype resistant to S-metolachlor was confirmed from crop fields in Arkansas, USA. This study investigated the metabolic effects of malathion (cytochrome P450 inhibitor) and 4-chloro-7-nitrobenzofurazan [NBD-Cl; glutathione S-transferase inhibitor] on the S-metolachlor-resistant A. palmeri biotype. Root elongation of the resistant biotype was 20% more inhibited by treatment of NBD-Cl (50 nM) and S-metolachlor (2 µM) in mixture than by treatment of S-metolachlor alone. Metabolites of S-metolachlor were 1.4-12.1 times greater produced in the resistant biotype for 7 d than in the susceptible standard. Production of cerotic acid, one of the very-long-chain fatty acids containing 26 carbons, was more reduced in the susceptible standard (3.8-fold) than in the resistant biotype (1.8-fold) by S-metolachlor treatment. Conclusively, evolution of S-metolachlor resistance observed in this study was likely associated with improved activity of glutathione S-transferases. Further studies are needed to genetically evaluate plant endogenous enzymes involving cerotic acid production.

Reconsidering Community-Engaged Research Through a Syndemic Theoretical Framework: Lessons from COVID-19.

BACKGROUND: Community-engaged research is a well-established approach to tackling health disparities in communities of color. However, the devastation caused by coronavirus disease 2019 (COVID-19) calls for a reexamination of the practice of community-engaged research. Syndemic framework characterizes the clustering and synergistic interactions between two or more diseases amid an underlay of social and environmental threats. This framework has been used to explain the disproportionately higher rates of COVID-19 in communities of color and may have utility in guiding future community-engaged research. OBJECTIVES: This article describes the process by which a syndemic framework was used to generate discussions on lessons learned from COVID-19 and describes the ensuing collaborative writing process that emerged from this discourse. METHODS: This article was developed by the Community Engagement Working Group (CEWG) of the Jackson Heart Study, a community-based epidemiologic study focused on cardiovascular disease among African Americans in the Jackson, Mississippi Metropolitan Area. By drawing upon a syndemic framework and lessons from COVID-19, the CEWG identified gaps and opportunities to enhance community-engaged research. CONCLUSIONS: Using syndemic framework as a starting point, the CEWG identified the following as aspects of community-engaged research that may warrant further consideration: 1) the need to examine multiple dimensions and assets of a community, 2) the need to view communities through an intersectionality lens, 3) the need to acknowledge the impact of historical and current trauma on the community, and 4) the need to provide support to community-engaged researchers who may be members of minoritized groups themselves and therefore, experience similar trauma.

Field-Evolved ΔG210-ppo2 from Palmer Amaranth Confers Pre-emergence Tolerance to PPO-Inhibitors in Rice and Arabidopsis.

Resistance to protoporphyrinogen IX oxidase (PPO)-inhibitors in Amaranthus palmeri and Amaranthus tuberculatus is mainly contributed by mutations in the PPO enzyme, which renders herbicide molecules ineffective. The deletion of glycine210 (ΔG210) is the most predominant PPO mutation. ΔG210-ppo2 is overexpressed in rice (Oryza sativa c. 'Nipponbare') and Arabidopsis thaliana (Col-0). A foliar assay was conducted on transgenic T1 rice plants with 2× dose of fomesafen (780 g ha−1), showing less injury than the non-transgenic (WT) plants. A soil-based assay conducted with T2 rice seeds confirmed tolerance to fomesafen applied pre-emergence. In agar medium, root growth of WT rice seedlings was inhibited >90% at 5 µM fomesafen, while root growth of T2 seedlings was inhibited by 50% at 45 µM fomesafen. The presence and expression of the transgene were confirmed in the T2 rice survivors of soil-applied fomesafen. A soil-based assay was also conducted with transgenic A. thaliana expressing ΔG210-ppo2 which confirmed tolerance to the pre-emergence application of fomesafen and saflufenacil. The expression of A. palmeri ΔG210-ppo2 successfully conferred tolerance to soil-applied fomesafen in rice and Arabidopsis. This mutant also confers cross-tolerance to saflufenacil in Arabidopsis. This trait could be introduced into high-value crops that lack chemical options for weed management.

Cytogenetic evaluation of malathion-induced toxicity in Sprague-Dawley rats.

Malathion is a well known pesticide and is commonly used in many agricultural and non-agricultural settings. Its toxicity has been attributed primarily to the accumulation of acetylcholine (Ach) at nerve junctions, due to the inhibition of acetylcholinesterase (AChE), and consequently overstimulation of the nicotinic and muscarinic receptors. However, the genotoxicity of malathion has not been adequately studied; published studies suggest a weak interaction with the genetic material. In the present study, we investigated the genotoxic potential of malathion in bone marrow cells and peripheral blood obtained from Sprague-Dawley rats using chromosomal aberrations (CAs), mitotic index (MI), and DNA damage as toxicological endpoints. Four groups of four male rats, each weighing approximately 60 ± 2g, were injected intraperitoneally (i.p.) once a day for five days with doses of 2.5, 5, 10, and 20mg/kg body weight (BW) of malathion dissolved in 1% DMSO. The control group was made up of four animals injected with 1% DMSO. All the animals were sacrificed 24h after the fifth day treatment. Chromosome preparations were obtained from bone marrow cells following standard protocols. DNA damage in peripheral blood leukocytes was determined using alkaline single-cell gel electrophoresis (comet assay). Malathion exposure significantly increased the number of structural chromosomal aberrations (CAs) and the percentages of DNA damage, and decreased the mitotic index (MI) in treated groups when compared with the control group. Our results demonstrate that malathion has a clastogenic/genotoxic potential as measured by the bone marrow CA and comet assay in Sprague-Dawley rats.

The effects of cytochrome P450 2D6 inhibitors on a high-dose tramadol taper for medically supervised opioid withdrawal: a retrospective chart review.

Background: Tramadol is used off-label for medically supervised opioid withdrawal. Tramadol is metabolized by CYP2D6 to an active metabolite with significantly more pharmacologic activity compared to the parent compound.Objectives: The objective of this study is to evaluate the effects of CYP2D6 inhibitors on patient response to a tramadol taper for medically supervised opioid withdrawal.Methods: A retrospective chart review of patients who received a tramadol taper for medically supervised opioid withdrawal was conducted comparing patients who received concomitant moderate-to-strong CYP2D6 inhibitors to patients without concomitant therapy. The primary outcome was the change in Clinical Institute Narcotic Assessment (CINA) scores from baseline to discharge. Secondary outcomes included area under the curve of CINA scores over time, additional CINA outcomes, length of stay, and readmissions.Results: Of 100 charts reviewed, 30 patients received a concomitant moderate-to-strong CYP2D6 inhibitor. There were no statistically significant differences between the baseline demographics of the two groups. Change from baseline CINA to discharge did not differ significantly between the Non-2D6 group and the 2D6 group (-4.0 ± 3.83 and -4.5 ± 4.48 respectively; p = 0.606). The average CINA score for nausea and vomiting was significantly higher in the Non-2D6 group compared to the 2D6 group (0.34 ± 0.35 and 0.18 ± 0.33 respectively; p = 0.019). Otherwise there were no significant differences found in any secondary outcomes.Conclusions: Based on these results, moderate-to-strong CYP2D6 inhibitors do not appear to have a significant impact on the withdrawal course for patients treated with a high-dose tramadol taper.

A Quality Improvement Pilot of Pharmacist-Led Identification of an Inpatient Population for Opioid Stewardship and Pain Management.

The Joint Commission standards now include identification and monitoring patients at high-risk for adverse outcomes of opioid use. Our institution does not have a method to identify at-risk patients. This pilot aimed to assess feasibility of pharmacist-led identification of a population for pain management and opioid stewardship. All patients admitted to the hospital were screened; electronic health record reports identified all opioid, antidepressant, and benzodiazepine administrations within the previous 24 hours, and pertinent family and social history risk factors for Opioid Use Disorder (OUD) and opioid-induced respiratory depression (OIRD). Data were exported to spreadsheets and calculated risk scores for OUD and OIRD, and opioid utilization and morphine milligram equivalents (MME) were tabulated. Chart reviews were completed on patients identified as high risk for OUD or OIRD, if MME was 90 or greater, or those receiving four or more "as needed" opioid doses in the previous 24 hours. Potential regimen adjustments based on the primary investigator's judgment were categorized. Mean number of patients identified per day to receive stewardship was 13, and 18.6 potential interventions per day were identified. Based on results of this pilot, pharmacist-led identification of inpatients warranting pain and opioid stewardship is feasible at our institution.

Use of bioimpedance spectroscopy for prospective surveillance and early diagnosis of breast cancer-related lymphedema.

BACKGROUND: Bioimpedance spectroscopy has been suggested as a useful tool for early diagnosis of breast cancer-related lymphedema (BCRL). We aimed to describe the outcomes of published studies that evaluated bioimpedance analysis as a method for prospective surveillance and early diagnosis of BCRL. METHODS: We queried the PubMed, Ovid Medline, and EMBASE databases to identify studies that evaluated use of bioimpedance spectroscopy as a diagnostic tool. We used the keywords "bioimpedance" AND ("lymphedema" OR "lymphoedema") in the search. Only English-language studies that reported quantitative outcomes for patients with BCRL were included. RESULTS: Of 152, 235 and 116 identified articles in PubMed, Ovid Medline and EMBASE databases, only 22 were included. Use of bioimpedance analysis for prospective surveillance has been shown to prevent chronic BCRL. All the cross-sectional and retrospective studies that evaluated bioimpedance for diagnosis of BCRL reported significantly different L-Dex scores between lymphedema patients and healthy participants; in addition, bioimpedance scores were positively correlated with volume of lymphedema. CONCLUSION: Bioimpedance analysis is a potential tool with demonstrated benefits for prevention of chronic BCRL and may be an economic and great alternative for early diagnosis of BCRL.

Malathion-induced oxidative stress, cytotoxicity, and genotoxicity in human liver carcinoma (HepG2) cells.

Malathion is an organophosphate pesticide that is known for its high toxicity to insects and low to moderate potency to humans and other mammals. Its toxicity has been associated with the inhibition of acetylcholinesterase activity, leading to the interference with the transmission of nerve impulse, accumulation of acetylcholine at synaptic junctions, and subsequent induction of adverse health effects including headache, dizziness, nausea, vomiting, bradycardia, and miosis. Oxidative stress (OS) has been reported as a possible mechanism of malathion toxicity in humans. Hence, the aim of this study was to examine the role of OS in malathion-induced cytotoxicity and genotoxicity. To achieve this goal, MTT, lipid peroxidation, and single cell gel electrophoresis (Comet) assays were performed, respectively, to evaluate the levels of cell viability, malondialdehyde (MDA) production, and DNA damage in human liver carcinoma (HepG(2)) cells. Study results indicated that malathion is mitogenic at lower levels of exposure, and cytotoxic at higher levels of exposure. Upon 48 h of exposure, the average percentages of cell viability were 100% +/- 11%, 117% +/- 15%, 86% +/- 15%, 35% +/- 9%, and 27% +/- 7% for 0, 6, 12, 18, and 24 mM, respectively. In the lipid peroxidation assay, the concentrations of MDA produced were 12.55 +/- 0.16, 20.65 +/- 0.27, 31.1 +/- 0.40, 34.75 +/- 0.45, and 15.1 +/- 0.20 muM in 0, 6, 12, 18, and 24 mM malathion, respectively. The Comet assay showed a significant increase in DNA damage at the 24 mM malathion exposure. Taken together, our results indicate that malathion exposure at higher concentrations induces cytotoxic and genotoxic effects in HepG(2) cells, and its toxicity may be mediated through OS as evidenced by a significant production of MDA, an end product of lipid peroxidation.

The professional association and practice excellence.

Nursing practice in occupational settings is different from nursing practice in acute care settings. Due to the sparse professional practice resources available to most occupational health nurses at the worksite, belonging to the professional association is important for support and knowledge enhancement needed to maintain practice excellence and credibility.

You're a published author!

Once a nurse author writes a quality manuscript, the article is submitted to an appropriate journal, reviewed by the editor, and sent to review panel members with expertise consistent with the topic of the article or the methodology of research articles. After review, panel members recommend the article be published, accepted for publication after revision, revised without promise of publication, or rejected. Nurse authors have options as to how they handle the recommendation. To successfully publish in a peer-reviewed journal, nurse authors should communicate with the editor and realize that the editor and author have the same goals.

It starts with an idea!

Writing for publication is a responsibility of all a profession's members; however, nurses may not have had the opportunity to learn the process of writing and publishing manuscripts in professional journals. The process of writing for publication begins with an idea that is focused on and slanted toward a particular audience. Nurse authors must then create space in their fast-paced day for writing in an environment that supports their concentration and creativity. Several strategies can be used, including reading well-written manuscripts, to assist nurses in writing quality manuscripts that are likely to be published.

Updating the UK competence framework for orthopaedic and trauma nurses 2019.

The updated RCN Competence Framework for orthopaedic and trauma practitioners was published in 2019 following completion of a 2 year project undertaken by a working group of representatives from England, Northern Ireland, Scotland and Wales. Expert musculoskeletal practitioners, including an allied health professional and working across the lifespan in varying domains of orthopaedic and trauma practice, collaborated to produce a working document applicable to trauma and orthopaedic (T&O) practitioners from all NHS (UK) pay bands. The 2019 document builds on the original and subsequent versions (2005 and 2012), importing new evidence and reformatting it so that it is contemporary and easily cross referenced with the NMC Code (2018). The restructure includes an example of a learning contract demonstrating how the framework can be applied in practice, whether for self-learning, or in conjunction with the revalidation process. This paper reflects on and describes the process undertaken by the working group in the development and restructuring of the 2019 framework, including its evaluation to date and planned in the future.

Global-World HIV/AIDS Alliance (GHAA): charting healthy pathways for vulnerable populations.

The Global-World HIV/AIDS Alliance (GHAA) is a collaboration of representatives from civil society, faith-based organizations, institutions of higher education, and government agencies who are pooling resources specific to their respective organizations' missions to assist with enhancing education and early treatment for HIV/AIDS in marginalized and medically underserved communities worldwide. The Alliances' partnerships are divided into five geographically oriented operational groups (called clusters), which are the Africa Regional Cluster, Asia Regional Cluster, Europe Regional Cluster, Latin-Caribbean Cluster, and United States Cluster. The purpose of this collaborative effort, which relies on the expertise and services of agencies and institutions from 26 countries, is to mobilize experts from various fields to share lessons learned about effective (and ineffective) strategies for reaching those most neglected, to ultimately realize a decline in HIV/AIDS infection and death rates. It is hoped the sharing of culturally sensitive educational materials and prevention strategies will decrease new HIV cases, increase participation in clinical trials, and mobilize grassroots efforts to affect health policy. Emerging from GHAA is the Charting Healthy Pathways for Vulnerable Populations, a 15-year initiative scheduled for 2006 through 2020. The inaugural launching took place in Hyderabad, India, in February 2006, and the first biennial global conference was held in October 2007 in Richard's Bay, South Africa. Several regional cluster meetings are scheduled in various countries before the second global conference in China in October 2009. In the meantime, cluster countries' representatives will be engaging in various forms of dialogue to promote innovative prevention/awareness strategies, identification of resources and services to be rendered, potential research collaborations, and networking to engage others in the cause of GHAA as we move to become the "global voice for vulnerable HIV populations".

Higher dietary intake of vitamin D may influence total cholesterol and carbohydrate profile independent of body composition in men with Chronic Spinal Cord Injury.

STUDY DESIGN: A case-control design. OBJECTIVES: To determine the effects of dietary vitamin D intake on insulin sensitivity (Si), glucose effectiveness (Sg), and lipid profile in individuals with spinal cord injury (SCI). METHODS: 20 male, paraplegic (T3-L1) with chronic (> one year) motor complete SCI (AIS A or B) were recruited. Three-day dietary records were analyzed for dietary vitamin D (calciferol), and participants were assigned to one of two groups, a high vitamin D intake group and a low vitamin D intake group based on the mid-point of vitamin D frequency distribution. Individuals in both groups were matched based on age, weight, time since injury and level of injury. Sg, Si and lipid profiles were measured of the two groups. RESULTS: The high vitamin D group had an average intake of 5.33 ± 4.14 mcg compared to low vitamin D group, 0.74 ± 0.24 mcg. None of the 20 participants met the recommended guidelines for daily vitamin D intake. The higher vitamin D group had a significantly lower (P = 0.035) total cholesterol (148.00 ± 14.12 mg/dl) than the lower vitamin D group (171.80 ± 36.22 mg/dl). Vitamin D adjusted to total dietary intake was positively correlated to improvement in Si and Sg (P<0.05). CONCLUSION: The findings suggest that persons with SCI consume much less than the recommended guidelines for daily vitamin D intake. However, a higher dietary intake of vitamin D may influence total cholesterol and carbohydrate profile as demonstrated by a significant decrease in total cholesterol and improvement in glucose homeostasis independent of body composition changes after SCI.

A retrospective chart review of outcomes resulting from a three-day tramadol taper for acute opioid withdrawal.

The purpose of the study was to describe patient outcomes with a 3-day tramadol taper for acute opioid withdrawal on the detoxification unit at Summa Health System. The primary endpoint was the change in Clinical Institute Narcotic Assessment (CINA) score from the start of the taper until completion or discharge. Secondary endpoints were length of stay, use of adjuvant medications, taper completion rates, highest CINA score, adverse events, and 30-day readmission rates. A retrospective, quality improvement, cohort study was performed describing outcomes of opioid dependent patients in acute withdrawal admitted on the detoxification unit between September 2014 and September 2016 receiving the 3-day tramadol taper. All patients ≥18 years of age admitted for opioid dependence were included. Pregnant patients were excluded. Forty-five patients were included in the analysis. Patient ages ranged from 18-67 and 25 (55.6%) were male. The full taper was completed in 67.7% of admissions and 75.8% of patients were discharged by the physician. There was a statistically significant change of the pre-taper score compared to the score at completion or discharge in the per protocol group (-1.58, p = 0.010). There were no reported seizures or falls. The 3-day tramadol taper proved to be safe and effective therapy for treating acute opioid withdrawal. In the Summa Health System detoxification unit, patients treated with a 3-day tramadol taper for acute opioid withdrawal had their pre-taper CINA scores reduced by over 25% at the completion of the taper or discharge.

Body composition changes with testosterone replacement therapy following spinal cord injury and aging: A mini review.

Context Hypogonadism is a male clinical condition in which the body does not produce enough testosterone. Testosterone plays a key role in maintaining body composition, bone mineral density, sexual function, mood, erythropoiesis, cognition and quality of life. Hypogonadism can occur due to several underlying pathologies during aging and in men with physical disabilities, such as spinal cord injury (SCI). This condition is often under diagnosed and as a result, symptoms undertreated. Methods In this mini-review, we propose that testosterone replacement therapy (TRT) may be a viable strategy to improve lean body mass (LBM) and fat mass (FM) in men with SCI. Evidence Synthesis Supplementing the limited data from SCI cohorts with consistent findings from studies in non-disabled aging men, we present evidence that, relative to placebo, transdermal TRT can increase LBM and reduce FM over 3-36 months. The impact of TRT on bone mineral density and metabolism is also discussed, with particular relevance for persons with SCI. Moreover, the risks of TRT remain controversial and pertinent safety considerations related to transdermal administration are outlined. Conclusion Further research is necessary to help develop clinical guidelines for the specific dose and duration of TRT in persons with SCI. Therefore, we call for more high-quality randomized controlled trials to examine the efficacy and safety of TRT in this population, which experiences an increased risk of cardiometabolic diseases as a result of deleterious body composition changes after injury.