bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic Disintegration? Political, Economic, and Legal Drivers and the Need for ‘Greening Embedded Trade Liberalism’
Authors: Petersmann Ernst-Ulrich
Published: March 2020

This contribution uses the examples of Great Britain’s withdrawal from the EU (Brexit) and US withdrawal from multilateral trade and environmental agreements for exploring political, economic, environmental, social, and legal reasons driving the backlash against economic integration agreements. In both examples, populist battle-cries for ‘taking back control’ and for lowering regulatory standards were followed by governmental attempts at evading parliamentary control over executive foreign policy powers to violate, or withdraw from, multilateral agreements. Anglo-Saxon neo-liberalism, President Trump’s mercantilist power politics, authoritarian state-capitalism (e.g. in China), and European ordo-liberalism reflect systemic divergences that may justify broad interpretations of WTO ‘exceptions’ (e.g. for WTO trade remedies and climate change mitigation). Europe’s multilevel, democratic constitutionalism protecting ‘social market economies’ was comparatively more effective in limiting protectionism and carbon emissions inside Europe’s common market. The EU’s ‘new green deal’ for a carbon-neutral ‘green economy’ was made possible by stronger, social, and democratic support based on ‘constitutional interpretations’ of Europe’s ordo-liberalism assisting adversely affected workers, producers, traders, investors, and other citizens to adjust economic and environmental activities to climate change mitigation. EU leadership for WTO-consistent climate change rules requires ‘greening embedded liberalism’ by interpreting the WTO ‘sustainable development’ objectives in conformity with the 2015 Paris Agreement, the UN ‘sustainable development goals’, and human rights (e.g. as legal basis for climate change litigation in Europe).
Potential Vectors of Leishmania Parasites in a Recent Focus of Visceral Leishmaniasis in Neighborhoods of Porto Alegre, State of Rio Grande do Sul, Brazil
Authors: Rêgo Felipe Dutra , Souza Getúlio Dornelles , Miranda Júlia Bahia , Peixoto Lais Vieira , Andrade-Filho José Dilermando
Published: February 2020

In view of recent cases of human and canine visceral leishmaniasis reported in Porto Alegre, Rio Grande do Sul, Brazil, we investigated the sand fly fauna inhabiting the neighborhoods of Morro Santana and Jardim Carvalho, Brazil, continuing a series of entomological surveys aimed to identify potential vectors of Leishmania (Ross, 1903) parasites. Sand flies were collected monthly from October 2016 to October 2017 using CDC light traps in the intradomiciliary and peridomiciliary environments of seven residences. Sand fly abundance was correlated to climatic variables. Females were pooled by species, location, and date for Leishmania DNA molecular screening using ITS1 and kDNA polymerase chain reaction. In total, 501 sand flies from five species were collected in which Lutzomyia gaminarai (Cordero, Vogelsang & Cossio, 1928) (Diptera: Psychodidae) (78%) was the most abundant species in the intradomiciliary sites while Migonemyia migonei (Franca, 1920) (Diptera: Psychodidae) (43.3%) was the most abundant in the peridomiciliary sites. A higher number of sand flies were collected during the warmest months, from December to March (Mann–Whitney statistical test – P < 0.001). Leishmania infantum DNA was detected in Lu. gaminarai (2), Pintomyia fischeri (Pinto, 1926) (1) and Mg. migonei (1). Leishmania braziliensis DNA was detected in Lu. gaminarai (1) and Pi. fischeri (1). Our results add support to the possible vector role of Pi. fischeri in the epidemiological cycle of Le. infantum in Brazil. Furthermore, the first documented detection of Leishmania DNA in Lu. gaminarai may be indicative of multiple vectors being involved in the Leishmania cycle within Porto Alegre.
MNELLS: the MUSE nearby early-type galaxy lens locator survey
Authors: Collier William P , Smith Russell J , Lucey John R
Published: March 2020

Low-redshift strong-lensing galaxies can provide robust measurements of the stellar mass-to-light ratios in early-type galaxies (ETGs), and hence constrain variations in the stellar initial mass function (IMF). At present, only a few such systems are known. Here, we report the first results from a blind search for gravitationally lensed emission-line sources behind 52 massive z < 0.07 ETGs with Multi-Unit Spectroscopic Explorer (MUSE) integral field spectroscopy. For 16 galaxies, new observations were acquired, whilst the other 36 were analysed from archival data. This project has previously yielded one confirmed galaxy-scale strong lens (J0403−0239) that we report in an earlier paper. J0403−0239 has since received follow-up observations, presented here, which indicate support for our earlier IMF results. Three cluster-scale, and hence dark-matter-dominated, lensing systems were also discovered (central galaxies of A4059, A2052, and AS555). For nine further galaxies, we detect a singly imaged but closely projected source within 6 arcsec (including one candidate with sources at three different redshifts); such cases can be exploited to derive upper limits on the IMF mass-excess factor, α. Combining the new lens and new upper limits, with the previously discovered systems, we infer an average 〈α〉 = 1.06 ± 0.08 (marginalized over the intrinsic scatter), which is inconsistent with a Salpeter-like IMF (α = 1.55) at the 6σ level. We test the detection threshold in these short-exposure MUSE observations with the injection and recovery of simulated sources, and predict that one in 25 observations is expected to yield a new strong-lens system. Our observational results are consistent with this expected yield.
Early Experience With Eravacycline for Complicated Infections
Authors: Alosaimy Sara , Molina Kyle C , Claeys Kimberly C , Andrade Justin , Truong James , King Madeline A , Pullinger Benjamin M , Huang Glen , Morrisette Taylor , Lagnf Abdalhamid M , Davis Susan L , Rybak Michael J
Published: March 2020

Eravacycline (ERV) was used in 35 patients for various infections. The most common pathogen was Klebsiella pneumoniae, and 30-day survival was 74%. Absence of 30-day recurrence and resolution of signs and symptoms of infection were 91% and 57%, respectively. ERV was well-tolerated, with adverse events leading to drug discontinuation in one patient.
Clinical Management of Respiratory Adverse Events Associated With Amikacin Liposome Inhalation Suspension: Results From a Patient Survey
Authors: Swenson Colin , Lapinel Nicole C , Ali Juzar
Published: March 2020

Patients with Mycobacterium avium complex lung disease treated with amikacin liposome inhalation suspension (ALIS) at 2 clinics in the United States were surveyed to assess the frequency and management of ALIS-associated respiratory adverse events. Most respondents experienced these events, but management through physician-guided measures (eg, bronchodilator use, oral rinses, and/or temporary dosing adjustments) resulted in symptomatic improvement.
Incidence of Unintentional Flow of Contrast into the Facet Joints During Fluoroscopy-Guided Cervical Interlaminar Epidural Injections: A Retrospective Cohort Study
Authors: Park Yoo Jung , Jung Joon-Yong , Choe Gyuho , Lee Yu Jung , Lee Jiyoung , Kim Young Hoon
Published: March 2020

Objective

We sometimes encounter unintentional flow of contrast into the facet joints during cervical interlaminar epidural injection, which leads to false-positive epidural injection. The purposes of this study were to evaluate the rate of facet flow of contrast and to investigate various factors associated with injection into the space of Okada during fluoroscopy-guided cervical interlaminar epidural injection.

Setting and Subjects

Images from consecutive cases of fluoroscopy-guided cervical interlaminar epidural injection performed at a single institution between July 2015 and July 2018 were obtained and reviewed.

Methods

Cases of epidural injection were classified as either facet flow or no facet flow. Multivariate logistic regression was used to identify the predictive factors of unintended injection into the Okada space.

Results

A total of 2,006 cases were included. Intra-articular flow was identified in 6.0% of cases (121/2,006). All cases of flow of contrast into the facet joints were recognized, and appropriate epidurograms were obtained during the procedures. The highest rate of unintended facet flow of the contrast (10.1%, 44/436) occurred at C5–6. Cervical interlaminar epidural injection at C5–6 and above (adjusted odds ratio [aOR] = 1.929, P = 0.001) and the paramidline approach for epidural injection (aOR = 2.427, P < 0.001) were associated with injection into the space of Okada.

Conclusions

We detected injection into the space of Okada during fluoroscopy-guided cervical interlaminar epidural injection in 6.0% of procedures. Cervical interlaminar epidural injection at C5–6 and above and the paramidline approach for epidural injection were positive predictors of unintentional facet flow of the contrast.
News Consumption across Media Platforms and Content
Authors: Geers Sabine
Published: March 2020

In a changing information environment in which people increasingly select a combination of media platforms to consume news, scholars have taken a more comprehensive approach in measuring news consumption by examining news media repertoires. This study specifically (1) examines news repertoires of young people, based on their combined usage of media platforms and news content preferences; and (2) examines their variation due to social background characteristics. Results from a survey of Dutch adolescents (N = 1,084; age 16 to 21) reveal four distinct news repertoires: labeled minimalists, omnivores, traditionalists, and online news users. Findings further suggest that platform-based news repertoires are related to preferences for specific news content. Finally, this study contributes to the digital divide literature by demonstrating that inequalities in news media usage related to education do not seem to apply to younger citizens.
Per-protocol repeat kidney biopsy portends relapse and long-term outcome in incident cases of proliferative lupus nephritis
Authors: Parodis Ioannis , Adamichou Christina , Aydin Selda , Gomez Alvaro , Demoulin Nathalie , Weinmann-Menke Julia , Houssiau Frédéric A , Tamirou Farah
Published: March 2020

Objectives

In patients with LN, clinical and histological responses to treatment have been shown to be discordant. We investigated whether per-protocol repeat kidney biopsies are predictive of LN relapses and long-term renal function impairment.

Methods

Forty-two patients with incident biopsy-proven active proliferative (class III/IV±V) LN from the database of the UCLouvain were included in this retrospective study. Per-protocol repeat biopsies were performed after a median [interquartile range (IQR)] time of 24.3 (21.3–26.2) months. The National Institutes of Health activity index (AI) and chronicity index (CI) scores were assessed in all biopsies.

Results

Despite a moderate correlation between urinary protein/creatinine ratios (UPCR) and AI scores at repeat biopsy (r = 0.48; P = 0.001), 10 patients (23.8%) with UPCR < 1.0 g/g still had a high degree of histological activity (AI > 3). High AI scores (continuous) in repeat biopsies were associated with an increased probability and/or shorter time to renal relapse (n = 11) following the repeat biopsy [hazard ratio (HR) = 1.2, 95% CI: 1.1, 1.3; P = 0.007], independently of proteinuria levels. High CI scores (continuous) in repeat biopsies were associated with a sustained increase in serum creatinine levels corresponding to ≥120% of the baseline value (HR = 1.8, 95% CI: 1.1, 2.9; P = 0.016) through a median (IQR) follow-up time of 131.5 (73.8–178.2) months, being also the case for acute tubulointerstitial inflammation and interstitial fibrosis/tubular atrophy in repeat but not baseline biopsies.

Conclusion

Our results highlight the usefulness of per-protocol repeat biopsies, herein performed after a median time of 24 months from baseline, as an integral part of the treatment evaluation, also in patients showing adequate clinical response.
Insomnia, hypnotic use, and road collisions: a population-based, 5-year cohort study
Authors: Morin Charles M , Altena Ellemarije , Ivers Hans , Mérette Chantal , LeBlanc Mélanie , Savard Josée , Philip Pierre
Published: February 2020

Study Objectives

The study objectives were to examine accidental risks associated with insomnia or hypnotic medications, and how these risk factors interact with sex and age.

Methods

A population-based sample of 3,413 adults (Mage = 49.0 years old; 61.5% female), with or without insomnia, were surveyed annually for five consecutive years about their sleep patterns, sleep medication usage, and road collisions.

Results

There was a significant risk of reporting road collisions associated with insomnia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.00–1.45) and daytime fatigue (HR = 1.21; 95% CI = 1.01–1.47). Insomnia and its daytime consequences were perceived to have played some contributory role in 40% of the reported collisions. Both chronic (HR = 1.50; 95% CI = 1.17–1.91) and regular use of sleep medications (HR = 1.58; 95% CI = 1.16–2.14) were associated with higher accidental risks, as well as being young female with insomnia and reporting excessive daytime sleepiness.

Conclusions

Both insomnia and use of sleep medications are associated with significant risks of road collisions, possibly because of or in association with some of their residual daytime consequences (i.e. fatigue and poor concentration). The findings also highlight a new group of at-risk patients, i.e. young women reporting insomnia and excessive daytime sleepiness.
FusariumfujikuroiSpecies Complex Associated With Rice, Maize, and Soybean From Jiangsu Province, China: Phylogenetic, Pathogenic, and Toxigenic Analysis
Authors: Qiu Jianbo , Lu Yunan , He Dan , Lee Yin-Won , Ji Fang , Xu Jianhong , Shi Jianrong
Published: March 2020

Species belonging to the Fusarium fujikuroi species complex (FFSC) are of vital importance and are a major concern for food quantity and quality worldwide, as they not only cause serious diseases in crops but also produce various mycotoxins. To characterize the population structure and evaluate the risk of poisonous secondary metabolites, a total of 237 candidate strains were isolated from rice, maize, and soybean samples in Jiangsu Province, China. Species identification of the individual strain was accomplished by sequencing the translation elongation factor 1α gene (TEF-1α) and the fumonisin (FB) synthetic gene (FUM1). The distribution of Fusarium species among the different crops was observed. The maize seeds were dominated by F. proliferatum (teleomorph, Gibberella intermedia) and F. verticillioides (teleomorph, G. moniliformis), whereas F. fujikuroi (teleomorph, G. fujikuroi) was the most frequently isolated species from rice and soybean samples. In addition, phylogenetic analyses of these strains were performed, and the results suggested clear groups showing no obvious relationship with the origin source. FFSC species pathogenicity and toxigenicity were studied. All of the species reduced the rice seed germination rate, with no significant differences. F. fujikuroi showed two distinct patterns of influencing the length of rice seedlings, which were correlated with FBs and gibberellic acid synthesis. FBs were mainly produced by F. verticillioides and F. proliferatum. F. proliferatum and F. fujikuroi also produced moniliformin and beauvericin. The toxigenicity of F. andiyazi (teleomorph, G. andiyazi) was extremely low. Further analysis indicated that the sequence variations in TEF-1α and the differences in the expression levels of the toxin synthesis genes were associated with the diversity of secondary metabolites in F. fujikuroi strains. These findings provide insight into the population-level characterization of the FFSC and might be helpful in the development of strategies for the management of diseases and mycotoxins.
Estimates of Preterm Infants' Breastfeeding Transfer Volumes Are Not Reliably Accurate
Authors: Perrella Sharon L. , Nancarrow Kathryn , Rea Alethea , Murray Kevin , Geddes Donna T. , Simmer Karen N.
Published: March 2020

Background:

Adequate human milk nutrition is critical for infant growth and neurodevelopment; however, low milk transfer volumes are common when establishing preterm breastfeeding. Despite clinical assessments of milk transfer volumes at the breast being inaccurate, measurement of feed volume via test weighing is rarely carried out either routinely or in cases where infant weight gain is inadequate.

Purpose:

To assess the accuracy of the Preterm Breastfeeding Assessment Tool (PBAT) in determining transfer volumes and examine factors associated with PBAT accuracy.

Methods:

Pre/postfeed weights were performed using electronic scales and PBAT scores recorded for 1186 breastfeeds in 60 preterm infants born less than 33/40 and 33 to 39/40 postmenstrual age. Measured milk intake volumes were converted to percent prescribed feed volume and compared with PBAT estimates of milk transfer.

Results:

The PBAT is accurate in identifying when no milk is transferred at the breast but not in estimating transfer of half or the full prescribed volume (accuracy 26% and 47%, respectively). Wide ranges of transfer volumes (11-75 mL) were observed within and between infants, and for 20% of breastfeeds, no milk was transferred. Preterm Breastfeeding Assessment Tool accuracy decreased with each 1-week increase in birth gestation (odds ratio = 0.82; 95% confidence interval, 0.71-0.94; P = .004).

Implications for Practice:

When establishing breastfeeding, test weighing facilitates adequate nutrition by guiding appropriate complementary feeding. For mothers breastfeeding several times per day in preparation for discharge home, test weighing may offer a useful tool for developing maternal confidence in assessing milk transfer. Preterm Breastfeeding Assessment Tool is inaccurate in assessing preterm infants' milk transfer volumes when breastfeeding.

Implications for Research:

While studies have typically focused on medically stable infants, test weighing offers a useful tool to examine breastfeeding efficacy and inform nutritional management of preterm infants with complications such as chronic lung and cardiac disease.
Association Between Radiographic Spinopelvic Parameters and Health-related Quality of Life in De Novo Degenerative Lumbar Scoliosis and Concomitant Lumbar Spinal Stenosis
Authors: Gao Ang , Wang Yongqiang , Yu Miao , Wei Feng , Jiang Liang , Liu Zhongjun , Liu Xiaoguang
Published: March 2020

Study Design...

A retrospective clinical study of patients who were treated from January 2011 to December 2018 and met our criteria.

Objective...

The aim of this study is to investigate the relationship between radiographic spinopelvic parameters and the health-related quality of life (HRQOL) in pretreatment de novo degenerative lumbar scoliosis (DNDLS) patients with concomitant lumbar spinal stenosis (LSS).

Summary of Background Data...

DNDLS has garnered attention because of the increasing aged population. Unlike other types of spine deformities, DNDLS may occur with concomitant LSS. Radiographic spinopelvic parameters are important for evaluating spine alignment in these patients; however, the association between these parameters and the HRQOL is unknown.

Methods...

Data from 204 patients diagnosed with DNDLS and concomitant LSS were reviewed. HRQOL was assessed using the visual analog scale (VAS) scores (for the back and leg), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and Scoliosis Research Society (SRS)-22 questionnaire (SRS-22). Radiographic spinopelvic parameters were obtained from anteroposterior and lateral x-rays. The relationship between spinopelvic parameters and HRQOL was analyzed by correlation analysis in the overall population.

Results...

Lumbar lordosis (LL) showed clinical relevance to JOA (r = 0.290), ODI (r = –0.269), SRS-22 pain domain (r = 0.134), SRS-22 function domain (r = 0.257), and VAS for back pain (r = −0.196). There was clinical relevance between T1 pelvic angle (T1PA) and JOA (r = −0.212) and ODI (r = 0.251), sagittal vertical axis (SVA) and JOA (r = −0.211) and SRS-22 function domain (r = −0.229) and ODI (r = 0.215), and L1 pelvic angle (L1PA) and ODI (r = 0.200). HRQOL differences were validated in the SVA and PI-LL groups by SRS-Schwab classification. A significant difference was validated by setting a sagittal balance threshold for SVA, T1PA, T1 sagittal tilt, and L1PA.

Conclusion...

The sagittal radiographic parameters showed a weak correlation with preoperative HRQOL in patients with concomitant DNDLS and LSS. T1PA, T1ST, and L1PA can effectively assess pretreatment HRQOL.

Level of Evidence: 4
The Journal of Cardiopulmonary Rehabilitation and Prevention at 40 Years and Its Role in the Evolution of Pulmonary Rehabilitation
Authors: Carlin Brian W.
Published: March 2020

While the roots of pulmonary rehabilitation (PR) date back to the 1950s, the advent of modern-day PR began in the early 1970s. This commentary describes the important role the Journal of Cardiopulmonary Rehabilitation and Prevention (JCRP) had in the development of PR. Originally, launched as the Journal of Cardiac Rehabilitation in 1981, with the formation of the American Association of Cardiovascular and Pulmonary Rehabilitation, the journal's name was changed to the Journal of Cardiopulmonary Rehabilitation in 1986. This commentary summarizes key publications reported in the journal broken down into 3 time periods, as well as the impact of those publications. It also includes summaries of important scientific statements and reviews including those in collaboration with the American College of Chest Physicians. The development of successful PR programs has been based on the many publications that have been published in JCRP. Further advances in the field will likely be based on the future publications contained within JCRP.
Fallout from Nuclear Weapons Tests: Environmental, Health, Political, and Sociological Considerations
Authors: Bouville André
Published: March 2020

The process of nuclear fission, which was discovered in 1938, opened the door to the production of nuclear weapons, which were used in 1945 by the United States against Japan in World War II, and to the detonation of >500 nuclear weapons tests in the atmosphere by the United States, the former Soviet Union, the United Kingdom, China, and France from 1946–1980. Hundreds of radionuclides, most of them short-lived, were produced in the atmospheric tests. The radioactive clouds produced by the explosions were usually partitioned between the troposphere and the stratosphere: the activity that remained in the troposphere resulted in local and regional fallout, consisting mainly of short-lived radionuclides and in relatively high doses for the populations residing in the vicinity of the test site, whereas the activity that reached the stratosphere returned to the ground with a half-life of ~1 y and was composed of long-lived radionuclides that contaminated all uncovered materials on Earth to a small extent and led to low-level irradiation of the world population for decades or more. The health effects resulting from exposure to radioactive fallout constitute, in most cases, small excesses over baseline rates for thyroid cancer and leukemia. An extra 49,000 cases of thyroid cancer would be expected to occur among the US population from exposure to radioactive fallout from the atmospheric nuclear weapons tests that were conducted at the Nevada Test Site in the 1950s. In addition, there could be as many as 11,000 deaths from non-thyroid cancers related to fallout from all atmospheric tests that were conducted at all sites in the world, with leukemia making up 10% of the total. Public concern arose in part from the secrecy that surrounded the nuclear testing programs and, for a long time, the poor communication regarding the consequences of the tests, both in terms of radiation doses and of health effects. Sociological and political pressures contributed to the establishment of programs of compensation for radiation exposures and evidence of radiation-induced diseases in countries that incurred significant fallout from nuclear weapons testing.
Systemic Infection Caused by Malassezia pachydermatis in Infants: Case Series and Review of the Literature
Authors: Huang Ching-Ying , Peng Chun-Chih , Hsu Chyong-Hsin , Chang Jui-Hsing , Chiu Nan-Chang , Chi Hsin
Published: March 2020

Background:

Malassezia pachydermatis is a rare cause of systemic infection in infants.

Methods:

A total of 4 cases of M. pachydermatis fungemia that occurred in our neonatal intensive care unit over a 21-month period were reviewed, as well as 27 cases reported in the literature since 1988.

Results:

The patients were preterm with multiple complications and had birth weights ranging from 490 to 810 g and gestational age between 23 and 26 weeks. All patients had received prophylactic fluconazole, broad-spectrum antibiotics and parenteral lipid supplements before fungemia onset, which occurred between the age of 7 and 28 days. Symptoms were nonspecific and thrombocytopenia was the primary laboratory finding. All patients received intravenous antifungal treatment and recovered from their infection. The 27 cases from review of the literature also indicated that the infected infants were extremely low birth weight (77.8%), with multiple underlying diseases (94.7%), receiving lipid-supplementation (100%) from a central vascular catheter. Most infants received antifungal treatment (73.1%) and catheter removal (73.1%) as the management.

Conclusions:

M. pachydermatis is a pathogenic agent that causes late onset sepsis in critically ill low birth weight infants with generally good outcomes. Targeted antifungal treatment as well as catheter removal appear to be key factors for infection management.
Subconjunctival Lipid Leakage From Deep Orbital Dermoid Cysts
Authors: Vahdani Kaveh , Godfrey Kyle J. , Patel Payal , Rose Geoffrey E.
Published: March 2020

Orbital dermoid cysts are fairly common and arise by sequestration of surface ectoderm along skeletal suture lines during embryologic development. Although anterior dermoid cysts are generally evident in infancy, deeper cysts typically present with inflammatory symptoms in adulthood. The authors report the clinical and imaging features for 6 cases of deep orbital dermoid cysts that were identified by the presence of subconjunctival lipid droplets; to the authors’ knowledge, this case report represents the largest series of dermoids with such a presentation. In the absence of prior vitreoretinal surgery, subconjunctival lipid droplets are an important clinical sign suggesting the presence of a deep orbital dermoid cyst.
Multidrug-Resistant Escherichia coli Canaliculitis
Authors: Bansal Oshin , Bothra Nandini , Sharma Savitri , Ali Mohammad Javed
Published: March 2020

Escherichia coli canaliculitis is an exceptionally rare organism to cause primary canaliculitis. The present case describes unilateral canaliculitis refractory to conventional therapy with a significant history of recurrent culture proven E. coli urinary tract infection. Microbiological analysis revealed E. coli bacilli and histological examination showed goblet cell metaplasia, subepithelial edema with acute and chronic inflammatory infiltrate. The possibility of an endogenous infection or autoinoculation secondary to urinary tract infection cannot be ruled out.
Home blood pressure monitoring and e-Health: investigation of patients’ experience with the Hy-Result system
Authors: Postel-Vinay Nicolas , Steichen Olivier , Pébelier Emmanuelle , Persu Alexandre , Berra Elena , Bobrie Guillaume , Savard Sébastien , Nogueria José , Azizi Michel
Published: March 2020

Background:

Hy-Result is a validated system designed to help patients complying with the home blood pressure monitoring (HBPM) protocol and understanding their blood pressure (BP) readings. It is available as a standalone web application or within a wireless BP monitor app.

Objective:

The aim of the study was to explore patients’ experience with Hy-Result.

Methods:

Online survey completed by 512 users of the Hy-Result web application or monitor app, and three focus groups with 24 hypertensive patients who monitor their BP at home and use the Hy-Result web application to record their data. We assessed the experience of patients with the functionalities and medical content of Hy-Result, their feelings and expectations, and the impact of Hy-Result on the physician–patient relationship.

Results:

(1) Functionalities: Over 90% of survey respondents and all focus group participants found Hy-Result easy to use. The main drawback of the web application is the need to manually enter all BP values at once. (2) Medical content: Hy-Result offers information on arterial hypertension and HBPM that most patients found useful. Users found that Hy-Result triggers appropriate reactions to BP readings, including adequately timed general practitioner visits. (3) Feelings and expectations: Over 90% of survey respondents trust Hy-Result and focus group participants understood that text messages are suggestions, not diagnoses. Hy-Result did not cause anxiety or excessive BP measurements. (4) Physician–patient relationship: Three-quarter of survey respondents agreed that Hy-Result may help when talking with their doctor about their BP values but only one-third of those have shown the report to their physician. For focus group participants, using Hy-Result should ideally be a physician prescription. They were aware that Hy-Result does not replace clinical judgment and that physicians still have a decisive role in BP management.

Conclusion:

Most of the users described Hy-Result as an easy-to-use and useful tool. Patients are willing to use it on physician request.
Is the blood pressure of right arm measured with synchronous four-limb method is equal to that with single arm method?
Authors: Yang Tao , Wu Qinghua , Hu Weitong , Su Hai
Published: March 2020

Objective:

Synchronous four-limb blood pressure (BP) measurement (four-limb method) is widely used for diagnosing peripheral artery diseases in clinical practise, but it is unclear whether the BP of right arm measured with this method is similar to that measured with single arm method.

Methods:

This study included 198 in-patients (aged 18–89, mean age 60.1± 13.9 years old, 109 males). They were divided into four groups on the therapy as renin-angiotensin system inhibitor (46 patients), calcium channel blocker (43 patients), beta receptor blocker (27 patients), and combination (Com, 82 patients) groups. The patients were randomly instructed to follow one of two BP measurement proposals designed to avoid the bias induced by BP measurement order. The result with single arm method was recorded as RA-1 and that with four-limb method as RA-4. The difference between RA-4 and RA-1 was calculated as Dif-RA. The percentage increase (PI) was also calculated on the formula: (RA-4 − RA-1)/RA-1.

Results:

The mean Dif-RA on SBP and DBP were 1.9/1.5 mmHg. Although the levels of SBP, DBP and pulse pressure of RA-1 were different, the PI of these parameters were comparable among four treatment groups. Multivariate regression analyses showed that age and SBP of RA-1 were positive independent factors for Dif-RA on SBP.

Conclusion:

The SBP and DBP of right arm measured with synchronous four-limb method are 1.9/1.5 mmHg higher against the single arm method in treated hypertensives, and the increase extent of BP is not associated with the used drugs.
The prognostic role of Ki-67/MIB-1 in meningioma
Authors: Liu Ning , Song Si-Ying , Jiang Jia-Bao , Wang Ting-Jian , Yan Chang-Xiang
Published: March 2020

Background:

Ki-67 is a typical immunohistochemical marker for cell proliferation. Higher expression of Ki-67 is correlated with poor clinical outcomes in several cancers. However, the prognostic value of Ki-67 on the prognosis of meningiomas is still controversial. The purpose of this meta-analysis was to evaluate the prognostic value of Ki-67 in meningiomas.

Methods and materials:

We searched Medline and EMBASE from inception to December 31, 2018, to identify relevant articles. Using a fixed or random effects model, pooled hazard ratios (HRs) for overall survival (OS) and disease/progression/recurrence-free survival (D/P/RFS) were estimated.

Results:

A total of 43 studies, comprising 5012 patients, were included in this analysis. Higher Ki-67 expression levels were significantly associated with worse OS (HR = 1.565; 95% CI: 1.217–2.013) and D/P/RFS (HR = 2.644; 95% CI: 2.264–3.087) in meningiomas. Subgroup analysis revealed that all the included factors (ethnicity, tumor grade, HR sources, definition of cutoffs, cutoff values) for heterogeneity investigation can affect the pooled results. Among them, the definitions of cutoffs and cutoff values factor are the two main contributors toward heterogeneity. Multivariable meta-regression analysis also showed that methodologies used for cutoff value definition contributed to the high inner-study heterogeneity.

Conclusions:

Higher Ki-67 expression levels negatively influenced survival in meningiomas. A higher cutoff value (>4%) is more appropriate for prognosis prediction. It is highly recommended that Ki-67 expression profile could be assessed in meningiomas treatment for predicting survival. And patients with elevated expression of Ki-67 need to have close follow-ups.
Aspirin and the risk of hepatocellular carcinoma development in patients with alcoholic cirrhosis
Authors: Shin Sangdeok , Lee Sang Hoon , Lee Minjong , Kim Ji Hyun , Lee Wongu , Lee Hyun Woo , Park Min Soo , Park Seungwoo , Kim Tae Suk , Choi Dae Hee
Published: March 2020

Aspirin therapy has shown protective effects against hepatocellular carcinoma (HCC) in preclinical studies. However, it is unclear whether aspirin therapy lowers the risk of HCC in patients with alcoholic cirrhosis.

A retrospective analysis of data from 949 consecutive patients with alcoholic cirrhosis who abstained from alcoholic drinking was performed. The primary and secondary outcomes were development of HCC and gastrointestinal bleeding events, respectively. Risk was compared between patients with aspirin treatment and patients who were not treated (non-aspirin group) using a time-varying Cox proportional hazards model for total population and propensity score-matching analysis.

The aspirin group included 224 patients and the non-aspirin group had 725 patients. During the study period of median duration of 3.1 years, 133 patients (13.6%) developed HCC. In time-varying Cox proportional analyses, the aspirin group showed a significantly lower risk of HCC (adjusted hazard ratio [aHR]: 0.13; 95% confidence interval [CI]: 0.08–0.21; P < .001). In propensity score-matched pairs, aspirin therapy significantly reduced the risk of HCC (aHR: 0.14; 95% CI: 0.09–0.22; P < .001). In bleeding risk, treatment with aspirin alone was not significantly associated with a higher bleeding risk (aHR: 0.81; 95% CI: 0.45–1.44; P = .46).

Aspirin therapy was associated with the lower risk of HCC in patients with alcoholic cirrhosis.
Clinical effects of hemoperfusion combined with pulse high-volume hemofiltration on septic shock
Authors: Chu Laping , Li Guangyao , Yu Yafen , Bao Xiaoyan , Wei Hongyi , Hu Minhong
Published: March 2020

Sepsis can cause septic shock, multiple organ dysfunction and even death. The combination of different blood purification would be the certain trend in the treatment of sepsis.

This study was to evaluate the clinical effects of hemoperfusion (HP) combined with pulse high volume hemofiltration (PHVHF) on septic shock.

Thirty cases were involved in this study and were randomly divided into two groups: HP and PHVHF group (n = 15) and CVVH (continuous veno-venous hemofiltration) group (n = 15). Acute physiology and chronic health evaluation (APACHE) II scores, sequential organ failure assessment (SOFA) scores as well as biochemical changes were measured before and after the treatment. The levels of IL-6, IL-10, and TNF-α in plasma were assessed by ELISA before and after treatment for 2 and 24 h. The norepinephrine doses were also analyzed. The 28-day mortalities in both groups were also compared.

In both groups, body temperature (BT), respiratory rate (RR), white blood cells (WBC), C-reactive protein (CRP), Procalcitonin (PCT), lactic acid, serum creatinine, APACHE II scores and SOFA scores decreased after hemofiltration (P < .05). The HP&PHVHF group was superior to the CVVH group in CRP, APACHE II score (P < .01), and heart rate (HR), WBC, PCT, SOFA (P < .05). The doses of norepinephrine were also decreased after treatment (P < .01), with more reduction in the HP&PHVHF group (P < .05). After 24 h of treatment, the levels of IL-6, IL-10, and TNF-α decreased in both groups (P < .05), and the decrease was more significant in HP&PHVHF group (P < .05). In combined group, after 2 h of hemoperfison, there was a significant reduction in these inflammatory factors (P < .01). Combined therapy group's mortality was 26.7%, while CVVH group's was 40%.

HP combined with PHVHF has a significant effect on septic shock and can be an important therapy for septic shock.
Angiolymphatic invasion and absence of koilocytosis predict lymph node metastasis in penile cancer patients and might justify prophylactic lymphadenectomy
Authors: Nascimento Athienne D. M. T. do , Pinho Jaqueline D. , Júnior Antonio Augusto L. Teixeira , Larges Joyce S. , Soares Fabrício M. , Calixto José Ribamar R. , Coelho Ronald W. P. , Belfort Marta Regina C. , Nogueira Leudivan R. , da Cunha Isabela W. , Silva Gyl E. B.
Published: March 2020

To analyze possible clinical–pathological parameters and predictors of lymph node metastasis and evaluate the impact of lymphadenectomy in the survival of these patients.

A retrospective study of patients diagnosed with penile cancer and submitted to regional lymphadenectomy at two reference hospitals in Maranhão, Northeast, Brazil, an area where the disease has a high incidence. We described here clinical and histopathological characteristics of patients diagnosed between January 2009 and September 2017.

Fifty-five patients with an average age of 55.4 years (range: 25–84 years) were analyzed, with 24.4 months being the average time between the onset of symptoms and start of treatment. Among patients without palpable lymph nodes at the first examination, 51% were affected by inguinal metastasis. In the multivariate analysis, the presence of angiolymphatic invasion (P = .029) and absence of koilocytosis (P = .001) were found to be predictive factors for lymph node metastasis. Patients submitted to prophylactic lymphadenectomy presented with a disease-free period of 25.4 months (±5.81), whereas those who underwent therapeutic lymphadenectomy presented with a disease-free period of 19.9 months (±3.12).

Angiolymphatic invasion and absence of koilocytosis appeared to be predictive factors for lymph node metastasis. Therefore, the submission of patients with metastatic risk to prophylactic lymphadenectomy may improve their survival. Thus, prophylactic lymphadenectomy in patients at risk for inguinal metastasis may create a positive impact in survival rates.
Prognostic value of long non-coding RNA SNHG20 in cancer
Authors: Zeng Jiling , Liu Zhuoyi , Zhang Chao , Hong Tao , Zeng Furong , Guan Jing , Tang Siyuan , Hu Zhiping
Published: March 2020

Background:

Small nucleolar RNA host gene 20 (SNHG20) is a newly identified long non-coding RNA (lncRNA). Accumulative evidence suggest that SNHG20 is highly related to tumorigenesis. However, whether the levels of SNHG20 can be used for prognosis of patients with different cancer types was unclear. The present study aims to explore the role of SNHG20 in tumor prognosis and its clinical significance.

Methods:

Related articles published before March 14, 2019 were searched in PubMed, Excerpta Medica Database (EMBASE), ISI Web of Science, and China National Knowledge Infrastructure (CNKI). Hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were obtained using Stata 11.0 software and used to for determination of the link between the levels of SNHG20 and overall survival (OS). Fixed or random model was chosen depending on the heterogeneity of the studies. A quality assessment of the included studies was performed according to the Newcastle-Ottawa scale. This study was approved by the Medical Ethics Committee of Xiangya Hospital of Central South University.

Results:

After a strict filtering process, a total of 1149 patients from 15 studies were enrolled in this study. Pooled data showed that elevated level of SNHG20 was correlated not only with poor overall survival (HR = 2.49, 95% confidence interval (CI): 2.05–2.98), but also with tumor-node-metastasis stage (TNM) (odds ratio (OR) = 3.32, 95% CI: 2.27–4.86), high histological grade (OR = 2.11, 95% CI: 1.55–2.87), tumor size (OR = 2.92, 95% CI: 2.17–3.91), and lymph node metastasis (OR = 4.48, 95% CI: 2.90–6.92). Of note, there is no significant heterogeneity difference among the studies.

Conclusion:

Up-regulated SNHG20 predicts unfavorable prognosis for multiple kinds of cancers although further studies are in need to verify its clinical applications.
Assessment of biotin interference in thyroid function tests
Authors: Zhang Youjia , Wang Renjie , Dong Ying , Huang Guanning , Ji Bin , Wang Qing
Published: March 2020

The aim of the study was to systematically characterize the interference of biotin on thyroid function tests and biotin washout periods.

Ten healthy adults were recruited with administration of 5 and 10 mg/d biotin for 7 days. Analyte concentrations of thyroid function tests were measured at baseline prior to starting biotin and from 2 hours to 2 days after withdrawal of 5 and 10 mg/d biotin. The outcomes were compared the baseline with the several points after taking biotin at Roche cobas e602, Beckman UniCel DxI 800, and Abbott Architect 2000 immunoassay platforms, respectively.

Ingesting 5 or 10 mg/d of biotin for 7 days could produce positive or negative interference among the thyroid function tests at Roche cobas e602 and Beckman UniCel DxI 800 systems, but no interference on Abbott Architect 2000. Interference duration of 5 mg/d biotin for Roche cobas e602 and Beckman UniCel DxI 800 of thyroid function tests lasted for 8 hours, while 10 mg/d biotin interfered with Roche cobas e602 or Beckman UniCel DxI 800 for 1 day or 2 days.

This study provides valuable guidance on biotin washout periods at doses common in over-the-counter supplements necessary to avoid false assay results.

Trial registration: ChiCTR1800020472
Visinin-like protein-1 level is associated with short-term functional outcome of acute ischemic stroke
Authors: Liu Dengjun , Dong Xiaoli , Yang Rui , Guo Hao , Wang Tao , Xu Guodong
Published: March 2020

Stroke is a serious disease that can lead to disability and death in adults, and the prediction of functional outcome is important in the management of acute ischemic stroke (AIS). Blood biomarker is a promising technique, for the measurement is fast, cheap and convenient. Visinin-like protein-1 (VILIP-1) is a classic stroke biomarker, thus we tried to investigate the predictive value of VILIP-1 for early functional outcomes of AIS.

A total of 70 AIS patients were enrolled in our study. Venous blood samples of all patients were taken at day 3 after admission to the stroke unit, and levels of serum VILIP-1 were analyzed by the use of the enzyme-linked immunosorbent assay. All subjects underwent diffusion weighted imaging (DWI) of the brain MRI scanning at 72 hours after stroke onset, and infarct volumes were calculated. Initial neurological status was evaluated by the National Institutes of Health Stroke Scale (NIHSS) on admission. The short-term functional outcome was graded by the modified Rankin Scale (mRS) at discharge from the hospital. Baseline data between the favorable outcome group and poor outcome group were compared, and univariate and multivariable logistic regression analysis were used to identify risk factors of early functional outcome of AIS.

The multivariate logistic regression analysis showed age, initial NIHSS scores and levels of VILIP had a strong association with poor clinical outcomes.

Levels of serum VILIP-1 are associated with short-term functional outcomes in patients with AIS.
No-reflow phenomenon during percutaneous coronary intervention in a patient with polycythemia vera
Authors: Oktaviono Yudi Her , Hutomo Suryo Ardi , Al-Farabi Makhyan Jibril
Published: March 2020

Rationale:

Acute myocardial infarction is the leading cause of mortality and morbidity in a patient with polycythemia vera (PV). However, the benefit of various percutaneous coronary intervention (PCI) technique on the patient with PV is relatively unexplored.

Patient concern:

A 46-year-old woman presented to the primary hospital complained about new-onset typical chest pain. Echocardiography examination showed inferior ST-elevation myocardial infarction (STEMIs) and increased cardiac markers. Complete blood count showed elevated hemoglobin, white blood cell, and platelet.

Diagnosis:

Coronary angiography revealed simultaneous total occlusion at proximal right coronary artery (RCA) and also at proximal left anterior descending (LAD) artery. Elevated hemoglobin and hematocrit with JAK2 mutation establish the diagnosis of PV.

Interventions:

We performed multi-vessel primary PCI by using direct stenting in RCA and aspiration thrombectomy in LAD after failed with balloon dilatation and direct stenting method. This procedure resulted in thrombolysis in myocardial infarction (TIMI)-3 flow in both coronary arteries. However, the no-reflow phenomenon occurred in the LAD, followed by ventricular fibrillation. After several attempts of resuscitation, thrombus aspiration, and low-dose intracoronary thrombolysis, the patient was returned to spontaneous circulation. The patient then received dual antiplatelet and cytoreductive therapy.

Outcomes:

The patient clinical condition and laboratory finding were improved, and the patient was discharged on the 7th day after PCI.

Lessons:

Cardiologist should be aware of the no-reflow phenomenon risk in the patient with PV and STEMI. Direct stenting, intracoronary thrombectomy, and thrombolysis are preferable instead of balloon dilatation for PCI technique in this patient.
Assessment of persistent fifth aortic arch by echocardiography and computed tomography angiography
Authors: Yang Haiyan , Zhu Xu , Wu Chun , Zhao Xiaodong , Ji Xiaojuan
Published: March 2020

To evaluate the utility of echocardiography (echo) in the diagnosis of persistent fifth aortic arch (PFAA), a very rare congenital aortic arch anomaly, and to compare echo and computed tomography angiography (CTA) imaging findings to improve our understanding of this anomaly.

Data on the clinical diagnosis, imaging findings, and clinical management of PFAA were retrospectively analyzed in 10 suspected cases of PFAA admitted to our hospital between January 2012 and February 2017. We compared echo as a first line examination modality, and CTA and surgery results as the gold standard. Weinberg's classification was used to classify the type of PFAA.

All patients (100%) received echo examination, eight patients (80%) received CTA examination, and four patients (40%) received sternotomy surgery; all recovered well after surgery. According to Weinberg's classification, 2, 6, and 2 cases (20%, 60%, and 20%) were classified as Type A, B, and C, respectively. Echo was able to diagnose 5 cases of PFAA (1 Type A case and 4 Type B cases) in the first instance. The diagnostic conformance rate of echo was 62.5% after comparisons with CTA and surgery results.

The clinical manifestation of PFAA was atypical, and its diagnosis depended primarily on medical imaging. Echo has a relatively high diagnostic accuracy for PFAA, which is very valuable for its early detection.