The Role of the Neonatal Registered Dietitian Nutritionist: Past, Present, and Future.

Neonatal registered dietitian nutritionists (RDNs) are critical members of the neonatal intensive care unit (NICU) team due to their unique skillset of growth assessment, nutrition evaluation, and implementation of nutrition best practices. There is a paucity of data on appropriate staffing of neonatal RDNs in NICUs to promote improved patient outcomes. Here, the authors describe current neonatal RDN staffing and responsibilities in the US NICUs.

Examining Associations Between Women's Mental Health and Obesity.

Obesity is a common comorbidity associated with mental illness. It is important to understand the many ways weight gain and obesity can impact the cause and course of mental illness in women, with a special focus on vulnerable life stages. Women seem disproportionally impacted by the weight gain side effects of medications, and issues such as weight gain are more likely to impact symptoms of mental illness, impacting self-esteem.

Inducible generalized activation of hSTING-N154S expression in mice leads to lethal hypercytokinemia: a model for "cytokine storm".

Excessive levels of circulating proinflammatory mediators, known as "hypercytokinemia," that are generated by overwhelming immune system activation can lead to death due to critical organ failure and thrombotic events. Hypercytokinemia has been frequently associated with a variety of infectious and autoimmune diseases, with severe acute respiratory syndrome coronavirus 2 infection currently being the commonest cause, of what has been termed the cytokine storm. Among its various functions within the host, STING (stimulator of interferon genes) is critical in the defense against certain viruses and other pathogens.

Nutrition in the Management of Inflammatory Bowel Diseases.

With the increasing global prevalence of inflammatory bowel diseases, research in this field is expanding to better understand the multifactorial etiologies of this complex disease. Nutrition and diet, as modifiable risk factors, have been shown to play an important role in disease activity and prognosis. This article reviews the role of nutrition in inflammatory bowel disease, including appropriate nutrition screening in this at-risk population, and associated micronutrient deficiencies.

Alternative Care Pathways for Obstructive Sleep Apnea and the Impact on Positive Airway Pressure Adherence: Unraveling the Puzzle of Adherence.

The high burden of obstructive sleep apnea (OSA), combined with inadequate supply of sleep specialists and constraints on polysomnography resources, has prompted interest in alternative models of care to improve access and treatment effectiveness. In appropriately selected patients, ambulatory clinical pathways and use of nonphysicians or primary care providers to manage OSA can improve timely access and costs without compromising adherence or other clinical outcomes. Although initial studies show promising results, there are several potential barriers that must be considered before broad implementation, and further implementation research and economic evaluation studies are required.

Benchmarking veterinary librarians' participation in systematic reviews and scoping reviews.

Objectives: The objectives of this study were to benchmark roles that veterinary librarians at universities and colleges play in systematic reviews (SRs) and scoping reviews that are conducted by faculty and students at their institutions, to benchmark the level of training that veterinary librarians have in conducting SRs, to identify barriers to their participation in SRs, and to identify other types of literature reviews that veterinary librarians participate in.

Methods: Sixty veterinary librarians in universities and colleges in Canada, the United States, England, Scotland, Ireland, Australia, and New Zealand were surveyed online about their roles and training in conducting SRs, barriers to participation in SRs, and participation in other types of literature reviews.

Results: Veterinary librarians' highest participation was at an advising level in traditional librarian roles as question formulator, database selector, search strategy developer, and reference manager.

Clinical Usefulness of Therapeutic Neuromodulation for Major Depression: A Systematic Meta-Review of Recent Meta-Analyses.

The authors conducted a meta-review of meta-analyses published in the past decade on therapeutic neuromodulation (ie, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation and deep brain stimulation) for major depression. Active repetitive transcranial magnetic stimulation and transcranial direct current stimulation have been generally associated with small to moderate effect sizes vis-à-vis their efficacy and with similar acceptability compared with sham. Vagus nerve stimulation and deep brain stimulation (although more challenging to investigate) have demonstrated preliminary effectiveness, particularly during longer-term follow-up.

BioMedtrix Total Hip Replacement Systems: An Overview.

Total hip replacement for canine and feline patients affected by degenerative, traumatic, and vascular injury of the coxofemoral joint has become a highly successful orthopedic procedure. The highly effective BioMedtrix total hip replacement systems use cemented and cementless implants with unique design features to address a variety of bone conditions and surgeon expertise and preferences. There are pros and cons for both systems with common and unique complications that can occur in either system.

Diagnostic yield of small histological cores obtained with a new EUS-guided fine needle biopsy system.

Background: As endoscopic ultrasound-guided tissue acquisition techniques evolve, there is increasing interest in obtaining optimal histological samples to improve diagnostic accuracy. In this study, we aimed to assess the tissue acquisition success rate and test performance characteristics of a novel endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) system.

Methods: We performed a retrospective review of consecutive patients undergoing EUS-guided tissue sampling of solid lesions using the SharkCore fine needle system in a tertiary referral facility.

Guidelines for Potassium Channel Blocker Use.

This article summarizes recommendations for the clinical use of antiarrhythmic drugs for the treatment and prevention of atrial and ventricular arrhythmias based on current guideline and consensus documents. The choice of antiarrhythmic drug is based on the efficacy and safety profile and influenced by the presence or absence of structural heart disease. Because of its adverse side-effect profile, amiodarone is recommended for the management of atrial fibrillation only when other agents have failed or are contraindicated.

The role of vedolizumab in patients with moderate-to-severe Crohn's disease and ulcerative colitis.

Vedolizumab, an α4β7-integrin antagonist, is the first gut-selective monoclonal antibody that has been approved for the treatment of moderate-to-severe ulcerative colitis and Crohn's disease in many countries in the world. However, questions still remain regarding its appropriate use and placement in current treatment algorithms. Therefore, we sought out to evaluate the existing literature on the use of vedolizumab in inflammatory bowel disease.

Screening for Depression and Anxiety in Epilepsy.

Depression and anxiety are common comorbidities of epilepsy and have far-reaching effects on patients, family, and the health care system. Although the burden of these conditions is high, a majority of cases are undetected and untreated. Screening tools can be a fast way to establish the presence of clinically relevant symptoms of depression and anxiety in epilepsy.

What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review.

Introduction: Immigrants are among the most vulnerable population groups in North America; they face multidimensional hurdles to obtain proper healthcare. Such barriers result in increased risk of developing acute and chronic conditions. Subsequently a great deal of burden is placed on the healthcare system.

The Gut-Liver Axis in Primary Sclerosing Cholangitis.

Dysregulation of the key genetic, immunologic, and microbiome compounds of the gut-liver axis is the basis for inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC). This creates opportunities to accelerate therapies that have been traditionally developed for IBD to be used in PSC to the benefit of both diseases. Shared genetic susceptibility loci has yielded important clues into the pathogenesis of PSC-IBD.

Vedolizumab for the treatment of ulcerative colitis.

Introduction: With a need for a larger armamentarium of therapeutic options for those suffering from moderate-to-severe ulcerative colitis, vedolizumab, an α4β7-integrin biologic therapy, has recently received approval in the United States, Canada and Europe. However, it is unclear where it should be positioned in relation to current therapies for moderate-to-severe ulcerative colitis.

Areas Covered: We systematically reviewed the literature for phase 1, phase 2 and phase 3 randomized controlled trials assessing the role of vedolizumab in ulcerative colitis.

Inflammatory mediators in intra-abdominal sepsis or injury - a scoping review.

Introduction: Inflammatory and protein mediators (cytokine, chemokine, acute phase proteins) play an important, but still not completely understood, role in the morbidity and mortality of intra-abdominal sepsis/injury. We therefore systematically reviewed preclinical and clinical studies of mediators in intra-abdominal sepsis/injury in order to evaluate their ability to: (1) function as diagnostic/prognostic biomarkers; (2) serve as therapeutic targets; and (3) illuminate the pathogenesis mechanisms of sepsis or injury-related organ dysfunction.

Methods: We searched MEDLINE, PubMed, EMBASE and the Cochrane Library.

How to Differentiate Syncope from Seizure.

Convulsive syncope is a common cause of misdiagnosis in patients who present with a transient loss of consciousness. This misdiagnosis contributes significantly to the numbers of patients with a questionable diagnosis of epilepsy, and to those with apparently drug-resistant epilepsy. The most important step to an accurate diagnosis is a fastidious history.

Integration of metabolic and inflammatory mediator profiles as a potential prognostic approach for septic shock in the intensive care unit.

Introduction: Septic shock is a major life-threatening condition in critically ill patients and it is well known that early recognition of septic shock and expedient initiation of appropriate treatment improves patient outcome. Unfortunately, to date no single compound has shown sufficient sensitivity and specificity to be used as a routine biomarker for early diagnosis and prognosis of septic shock in the intensive care unit (ICU). Therefore, the identification of new diagnostic tools remains a priority for increasing the survival rate of ICU patients.

Cholesterol balance in prion diseases and Alzheimer's disease.

Prion diseases are transmissible and fatal neurodegenerative disorders of humans and animals. They are characterized by the accumulation of PrPSc, an aberrantly folded isoform of the cellular prion protein PrPC, in the brains of affected individuals. PrPC is a cell surface glycoprotein attached to the outer leaflet of the plasma membrane by a glycosyl-phosphatidyl-inositol (GPI) anchor.

Update on ustekinumab for the treatment of Crohn's disease.

Despite the success of antitumor necrosis factor (TNF) therapy in Crohn's disease, there remains a need for biologic therapy that targets other immune pathways of disease. Ustekinumab is a fully human monoclonal immunoglobulin antibody that targets the interleukin (IL)-12 and IL-23 shared P40 subunit. It has been studied in 2 phase 2 randomized, double-blind, placebo-controlled trials in Crohn's disease.

How phosphodiesterase 4 inhibitors work in patients with chronic obstructive pulmonary disease of the severe, bronchitic, frequent exacerbator phenotype.

Current international guidelines recommend that roflumilast be added on to an inhaled corticosteroid/long-acting β2-adrenoceptor agonist (LABA) combination therapy in high-risk patients with severe, bronchitic chronic obstructive pulmonary disease who have frequent acute exacerbations. This article presents evidence that a glucocorticoid, LABA, and phosphodiesterase (PDE) 4 inhibitor in combination can interact in a complex manner to induce a panel of genes that could act collectively to suppress inflammation and improve lung function. The possibility that multivalent ligands may deliver superior efficacy is also being explored.

The use of ultrasound for dogs and cats in the emergency room: AFAST and TFAST.

Internal injuries are common and often life-threatening conditions that can be challenging to detect based on physical examination, radiographs, and centesis. Recently, ultrasound has been introduced and evaluated in human and veterinary emergency medicine as a point-of-care test for a variety of emergent conditions. This article discusses the indications for point-of-care emergency ultrasound of dogs and cats in the emergency and critical care setting.

Syncope 2020: five grand challenges.

The articles in this issue provide a comprehensive overview of the recent advances in the management of syncope by masters in the field. There are now solid approaches to most facets of diagnosis, risk stratification, prognostication, treatment, and health services delivery. However, 5 important challenges remain, including syncope etiology, treatment, health services delivery, and an individualized approach to syncope.

Tilt table testing and implantable loop recorders for syncope.

This article summarizes the major contributions of tilt table tests and implantable loop recorders to the diagnosis of syncope and provides simple recommendations for these tests. Tilt table tests have provided important benefits in the field of neurally mediated syncope. However, they have significant limitations.

Validation of coding algorithms for the identification of patients with primary biliary cirrhosis using administrative data.

Background: Large-scale epidemiological studies of primary biliary cirrhosis (PBC) have been hindered by difficulties in case ascertainment.

Objective: To develop coding algorithms for identifying PBC patients using administrative data--a widely available data source.

Methods: Population-based administrative databases were used to identify patients with a diagnosis code for PBC from 1994 to 2002.