bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of a prolonged COVID-19 lockdown on patterns of admission, mortality and performance indicators in a cardiovascular intensive care unit
Authors: Szarfer Jorge Luis , Puente Luciana , Bono Leandro , Estrella María Laura , Doppler Eugenia , Napoli Llobera Mariano , Arce María Patricia , Borri Karina Alejandra , Fiandesio Mariana Elisa , Ferraris Marta Josefina , Gagliardi Juan
Published: February 2021

Background

The effects of an early and prolonged lockdown during the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular intensive care units (CICUs) are not well established.

Objectives

This study analyses patterns of admission, mortality and performance indicators in a CICU before and during the Argentine lockdown in the COVID-19 pandemic.

Methods

This is a retrospective observational cross-sectional study of all consecutive patients aged 18 years or more admitted to the cardiac intensive care unit at a high-volume reference hospital in Buenos Aires, Argentina, comparing hospitalization rates, primary causes of admission, inpatient utilization indicators, pharmacy supplies’ expenditures and in-hospital mortality between 5 March and 31 July 2020, with two corresponding control periods in 2019 and 2018.

Results

We included 722 female patients [mean age of 61.6 (SD 15.5) years; 237 (32.8%)]. Overall hospitalizations dropped 53.2% (95%CI: 45.3, 61.0%), from 295.5 patients/year over the periods 2018/2019 to 137 patients in 2020. Cardiovascular disease–related admissions dropped 59.9%, while admission for non-cardiac causes doubled its prevalence from 9.6% over the periods 2018/2019 to 22.6% in the study period (P < 0.001).

In the period 2020, the bed occupancy rate fell from 82.2% to 77.4%, and the bed turnover rate dropped 50% from 7.88 to 3.91 monthly discharges/bed. The average length of stay doubled from 3.26 to 6.75 days, and the turnover interval increased from 3.8 to 8.39 days in 2020.

Pharmacy supplies’ expenditures per discharge increased 134% along with a rise in antibiotics usage from 6.5 to 11.4 vials/ampoules per discharge (P < 0.02).

Overall mortality increased from 7% (n = 41) to 13.9% (n = 19) (P = 0.008) at the expense of non-cardiac-related admissions (3.6–19.4%, P = 0.01).

Conclusions

This study found a significant reduction in overall and cardiovascular disease–related causes of admission to the cardiac intensive care unit, worse performance indicators and increased in-hospital mortality along the first 5 months of the early and long-lasting COVID-19 lockdown in Argentina. These results highlight the need to foster public awareness concerning the risks of avoiding hospital attendance. Moreover, health systems should follow strict screening protocols to prevent potential biases in the admission of patients with critical conditions unrelated to the COVID-19 pandemic.
Uniform criteria for total hip replacement surgery in patients with hip osteoarthritis: a decision tool to guide treatment decisions
Authors: Atsma Femke , Molenkamp Olivier , Bouma Heinse , Bolder Stefan B , Groenewoud A Stef , Westert Gert P
Published: February 2021

Background

Uniform criteria for performing hip replacement surgery in hip osteoarthritis patients are currently lacking. As a result, variation in surgery and inappropriateness of care may occur. The aim of this study was to develop a consensus-based decision tool to support the decision-making process for hip replacement surgery.

Methods

Patients with a diagnosis of unilateral or bilateral osteoarthritis were included. Consensus rounds with orthopedic surgeons were organized to blindly reassess medical files and to decide whether surgery is indicated or not, based on all available pre-treatment information. We compared the outcomes obtained from the blind reassessment by the consensus group with the actual treatment. Furthermore, prediction models were fitted on the reassessment outcome to identify which set of clinical parameters would be most predictive and uniformly shared in the decision to operate.

Two prediction models were fitted, one model without radiologic outcomes and one model where radiologic outcomes were included.

Results

In total, 364 medical files of osteoarthritis patients were included and reassessed in the analyses. Key predictors in the prediction model without radiology were age, flexion, internal rotation and the Hip disability and Osteoarthritis Outcome Score–quality of life. The discriminative power was high (Area Under Receiver Operating Curve (AUC) = 0.86). Key predictors in the prediction model with radiology were age, internal rotation and Kellgren and Lawrence severity score (AUC = 0.94).

Conclusion

The study yielded a decision tool with uniform criteria for hip replacement surgery in osteoarthritis patients. The tool will guide the clinical decision-making process of physicians on whether to perform hip surgery and should be used together with information about patient preferences and social context.
In vitro antiviral activity of the anti-HCV drugs daclatasvir and sofosbuvir against SARS-CoV-2, the aetiological agent of COVID-19
Authors: Sacramento Carolina Q , Fintelman-Rodrigues Natalia , Temerozo Jairo R , Da Silva Aline de Paula Dias , Dias Suelen da Silva Gomes , da Silva Carine dos Santos , Ferreira André C , Mattos Mayara , Pão Camila R R , de Freitas Caroline S , Soares Vinicius Cardoso , Hoelz Lucas Villas Bôas , Fernandes Tácio Vinício Amorim , Branco Frederico Silva Castelo , Bastos Mônica Macedo , Boechat Núbia , Saraiva Felipe B , Ferreira Marcelo Alves , Jockusch Steffen , Wang Xuanting , Tao Chuanjuan , Chien Minchen , Xie Wei , Patel Dinshaw , Garzia Aitor , Tuschl Thomas , Russo James J , Rajoli Rajith K R , Pedrosa Carolina S G , Vitória Gabriela , Souza Letícia R Q , Goto-Silva Livia , Guimarães Marilia Zaluar , Rehen Stevens K , Owen Andrew , Bozza Fernando A , Bou-Habib Dumith Chequer , Ju Jingyue , Bozza Patrícia T , Souza Thiago Moreno L
Published: February 2021

Background

Current approaches of drug repurposing against COVID-19 have not proven overwhelmingly successful and the SARS-CoV-2 pandemic continues to cause major global mortality. SARS-CoV-2 nsp12, its RNA polymerase, shares homology in the nucleotide uptake channel with the HCV orthologue enzyme NS5B. Besides, HCV enzyme NS5A has pleiotropic activities, such as RNA binding, that are shared with various SARS-CoV-2 proteins. Thus, anti-HCV NS5B and NS5A inhibitors, like sofosbuvir and daclatasvir, respectively, could be endowed with anti-SARS-CoV-2 activity.

Methods

SARS-CoV-2-infected Vero cells, HuH-7 cells, Calu-3 cells, neural stem cells and monocytes were used to investigate the effects of daclatasvir and sofosbuvir. In silico and cell-free based assays were performed with SARS-CoV-2 RNA and nsp12 to better comprehend the mechanism of inhibition of the investigated compounds. A physiologically based pharmacokinetic model was generated to estimate daclatasvir’s dose and schedule to maximize the probability of success for COVID-19.

Results

Daclatasvir inhibited SARS-CoV-2 replication in Vero, HuH-7 and Calu-3 cells, with potencies of 0.8, 0.6 and 1.1 μM, respectively. Although less potent than daclatasvir, sofosbuvir alone and combined with daclatasvir inhibited replication in Calu-3 cells. Sofosbuvir and daclatasvir prevented virus-induced neuronal apoptosis and release of cytokine storm-related inflammatory mediators, respectively. Sofosbuvir inhibited RNA synthesis by chain termination and daclatasvir targeted the folding of secondary RNA structures in the SARS-CoV-2 genome. Concentrations required for partial daclatasvir in vitro activity are achieved in plasma at Cmax after administration of the approved dose to humans.

Conclusions

Daclatasvir, alone or in combination with sofosbuvir, at higher doses than used against HCV, may be further fostered as an anti-COVID-19 therapy.
Audio Mining: The Role of Vocal Tone in Persuasion
Authors: Wang Xin (Shane) , Lu Shijie , Li X I , Khamitov Mansur , Bendle Neil
Published: February 2021

Persuasion success is often related to hard-to-measure characteristics, such as the way the persuader speaks. To examine how vocal tones impact persuasion in an online appeal, this research measures persuaders’ vocal tones in Kickstarter video pitches using novel audio mining technology. Connecting vocal tone dimensions with real-world funding outcomes offers insight into the impact of vocal tones on receivers’ actions. The core hypothesis of this paper is that a successful persuasion attempt is associated with vocal tones denoting (1) focus, (2) low stress, and (3) stable emotions. These three vocal tone dimensions—which are in line with the stereotype content model—matter because they allow receivers to make inferences about a persuader’s competence. The hypotheses are tested with a large-scale empirical study using Kickstarter data, which is then replicated in a different category. In addition, two controlled experiments provide evidence that perceptions of competence mediate the impact of the three vocal tones on persuasion attempt success. The results identify key indicators of persuasion attempt success and suggest a greater role for audio mining in academic consumer research.
Association of Obesity With Breast Cancer Outcome in Relation to Cancer Subtypes: A Meta-Analysis
Authors: Lohmann Ana Elisa , Soldera Sara V , Pimentel Isabel , Ribnikar Domen , Ennis Marguerite , Amir Eitan , Goodwin Pamela J
Published: February 2021

Background

Obesity at breast cancer (BC) diagnosis has been associated with poor outcome, although the magnitude of effect in different BC subtypes is uncertain. We report on the association of obesity or overweight at diagnosis of nonmetastatic BC with disease-free (DFS) and overall survival (OS) in the following defined subtypes: hormone receptor positive/HER2 negative (HR+HER2−), HER2 positive (HER2+), and triple negative (TNBC).

Methods

We searched MEDLINE, EMBASE, and COCHRANE databases up to January 1, 2019. Study eligibility was performed independently by 2 authors. Studies reporting hazard ratios (HRs) of OS and/or DFS for obesity or overweight in BC subtypes were included. The pooled hazard ratio was computed and weighted using generic inverse variance and random effects models.

Results

Twenty-seven studies were included. Obese compared with nonobese women had worse DFS in all subtypes: the hazard ratios were 1.26 (95% confidence interval [CI] = 1.13 to 1.41, P < .001) for HR+HER2− BC, 1.16 (95% CI = 1.06 to 1.26, P < .001) for HER2+ BC, and 1.17 (95% CI = 1.06 to 1.29, P = .001) for TNBC. OS was also worse in obese vs nonobese women (HR+HER2− BC HR = 1.39, 95% CI = 1.20 to 1.62, P < .001; HER2+ BC HR = 1.18, 95% CI = 1.05 to 1.33, P = .006; and TNBC HR = 1.32, 95% CI = 1.13 to 1.53, P < .001). As opposed to obesity, overweight was not associated with either DFS or OS in HER2+ BC (HR = 1.02, 95% CI = 0.81 to 1.28, P = .85; and HR = 0.96, 95% CI = 0.76 to 1.21, P = .99, respectively) or TNBC (HR = 1.04, 95% CI = 0.93 to 1.18, P = .49; and HR = 1.08, 95% CI = 0.81 to 1.44, P = .17), respectively. In HR+HER2− BC, being overweight was associated with worse OS (HR = 1.14, 95% CI = 1.07 to 1.22, P < .001).

Conclusions

Obesity was associated with modestly worse DFS and OS in all BC subtypes.
“Society-Ready” and “Fire-Ready” Forestry Education in the United States: Interdisciplinary Discussion in Forestry Course Textbooks
Authors: De’Arman Kindra Jesse , York Richard F
Published: February 2021

Changing environmental and social forestry contexts present new challenges for forestry graduates. In contrast with previous generations, forestry students today must be prepared to handle the impacts of climate change and increasing fire severity and frequency, as well as critical human dimensions, including the need to collaborate with Native American nations. To explore the extent to which social and fire science is taught in forestry programs and how it has changed over time, we conducted a content analysis of prominent forestry course textbooks used in graduate programs in the United States. We found little change between texts published before and after 2000, except for an increase in discussion of climate change. Of the currently used textbooks, we found a significant variation in whether they included discussion of traditional ecological knowledge, prescribed burning, combined economic factors, logging, and whether they recommended prescribed burning and logging. Given that not all programs offer or require courses that specialize in these topics, many forestry students may be missing relevant interdisciplinary social-fire education that is necessary to handle contemporary and changing forestry issues.
Torsional vibration of irregular single-walled carbon nanotube incorporating compressive initial stress effects
Authors: Selim Mahmoud M
Published: February 2021

This study is an attempt to show the impacts of surface irregularity and compressive initial stresses on the torsional vibration of a single-walled carbon nanotube (SWCNT). The governing equation and corresponding closed-form solutions were derived with the aid of Hamilton's principle. Then, the natural frequencies were obtained analytically and the influences of surface irregularity and compressive initial stresses on the torsional vibration were studied in detail. Numerical results analyzing the torsional vibration incorporating compressive initial stress effects were discussed and presented graphically. The effects of surface irregularity on the natural frequency of torsional vibrations of nanomaterials, especially for SWCNTs, have not been investigated before, and most of the previous research works have been carried for a regular carbon nanotube. Therefore, it must be emphasized that the torsional vibrations of irregular SWCNTs are novel and applicable for the design of nano-oscillators and nanodevices, in which SWCNTs act as the most prevalent nanocomposite structural element. The analytical solutions and numerical results revealed that the surface irregularity and compressive initial stress have notable effects on the natural frequency of torsional vibrations. It has been observed that, as the surface irregularity and compressive initial stress parameters increase, the torsional natural frequency of vibrations of SWCNTs also increases. Since SWCNTs have very small size, they are always subject to initial stresses from different resources; therefore, understanding the influences of compressive initial stresses on the torsional frequency of nanotubes helps the engineers and researchers to design proper nanodevices for different applications with irregular shapes.
Two sides of the same story in grapevine–pathogen interactions
Authors: Santos Rita B , Figueiredo Andreia
Published: February 2021

Proteases are an integral part of plant defence systems, and their role in plant–pathogen interactions is unequivocal. Emerging evidence suggests that different protease families contribute to the establishment not only of hypersensitive response, priming, and signalling, but also of recognition events through complex proteolytic cascades. Moreover, they play a crucial role in pathogen/microbe-associated molecular pattern (PAMP/MAMP)-triggered immunity as well as in effector-triggered immunity. However, despite important advances in our understanding of the role of proteases in plant defence, the contribution of proteases to pathogen defence in grapevine remains poorly understood. In this review, we summarize current knowledge of the main grapevine pathosystems and explore the role of serine, cysteine, and aspartic proteases from both the host and pathogen point of views.
The radical ideation of peasants, the ‘pseudo-radicalism’ of international human rights law, and the revolutionary lawyer
Authors: Salomon Margot E
Published: February 2021

This article questions the use of international human rights law in realising social transformation. It studies the new United Nations Declaration on the Rights of Peasants and Other People Working in Rural Areas, drawing on the commodity-form theory of law. Through this lens, foregrounding the relationship between capitalism and law and their shared constituent form, the contradiction in what is at times a radical normative project in international human rights law is revealed. With the unintended consequences of human rights lawyering made visible, this work turns to the means through which the advocate can launch a potentially transformative ‘legal’ strategy. An exploration of two seminal modes of reconciliation follows: reconciling the use of international human rights law with a commitment to social transformation and reconciling the post-capitalist politics of progressive lawyers with their use of the law.
Sufficiency of a Gaussian power spectrum likelihood for accurate cosmology from upcoming weak lensing surveys
Authors: Upham Robin E , Brown Michael L , Whittaker Lee
Published: February 2021

We investigate whether a Gaussian likelihood is sufficient to obtain accurate parameter constraints from a Euclid-like combined tomographic power spectrum analysis of weak lensing, galaxy clustering, and their cross-correlation. Testing its performance on the full sky against the Wishart distribution, which is the exact likelihood under the assumption of Gaussian fields, we find that the Gaussian likelihood returns accurate parameter constraints. This accuracy is robust to the choices made in the likelihood analysis, including the choice of fiducial cosmology, the range of scales included, and the random noise level. We extend our results to the cut sky by evaluating the additional non-Gaussianity of the joint cut-sky likelihood in both its marginal distributions and dependence structure. We find that the cut-sky likelihood is more non-Gaussian than the full-sky likelihood, but at a level insufficient to introduce significant inaccuracy into parameter constraints obtained using the Gaussian likelihood. Our results should not be affected by the assumption of Gaussian fields, as this approximation only becomes inaccurate on small scales, which in turn corresponds to the limit in which any non-Gaussianity of the likelihood becomes negligible. We nevertheless compare against N-body weak lensing simulations and find no evidence of significant additional non-Gaussianity in the likelihood. Our results indicate that a Gaussian likelihood will be sufficient for robust parameter constraints with power spectra from stage IV weak lensing surveys.
Did Sgr cause the vertical waves in the solar neighbourhood?
Authors: Bennett Morgan , Bovy Jo
Published: February 2021

The vertical distribution of stars in the solar neighbourhood is not in equilibrium but contains a wave signature in both density and velocity space originating from a perturbation. With the discovery of the phase-space spiral in Gaia data release (DR) 2, determining the origin of this perturbation has become even more urgent. We develop and test a fast method for calculating the perturbation from a passing satellite on the vertical component of a part of a disc galaxy. This fast method allows us to test a large variety of possible perturbations to the vertical disc very quickly. We apply our method to the range of possible perturbations to the solar neighbourhood stemming from the recent passage of the Sagittarius dwarf galaxy (Sgr), varying its mass, mass profile, and present-day position within their observational uncertainties, and its orbit within different realistic models for the Milky Way’s gravitational potential. We find that we are unable to reproduce the observed asymmetry in the vertical number counts and its concomitant breathing mode in velocity space for any plausible combination of Sgr and Milky Way properties. In all cases, either the amplitude or the perturbation wavelength of the number-count asymmetry and of the oscillations in the mean vertical velocity produced by the passage of Sgr are in large disagreement with the observations from Gaia DR2. We conclude that Sgr cannot have caused the observed oscillations in the vertical disc or the Gaia phase-space spiral.
Magnetic field amplification in accretion discs around the first stars: implications for the primordial IMF
Authors: Sharda Piyush , Federrath Christoph , Krumholz Mark R , Schleicher Dominik R G
Published: February 2021

Magnetic fields play an important role in the dynamics of present-day molecular clouds. Recent work has shown that magnetic fields are equally important for primordial clouds, which form the first stars in the Universe. While the primordial magnetic field strength on cosmic scales is largely unconstrained, theoretical models strongly suggest that a weak seed field existed in the early Universe. We study how the amplification of such a weak field can influence the evolution of accretion discs around first stars, and thus affect the primordial initial mass function (IMF). We perform a suite of 3D ideal magneto-hydrodynamic simulations with different initial field strengths and numerical resolutions. We find that, in simulations with sufficient spatial resolution to resolve the Jeans scale during the collapse, even initially weak magnetic fields grow exponentially to become dynamically important due to both the so-called small-scale turbulent dynamo and the large-scale mean-field dynamo. Capturing the small-scale dynamo action depends primarily on how well we resolve the Jeans length, while capturing the large-scale dynamo depends on the Jeans resolution as well as the maximum absolute resolution. Provided enough resolution, we find that fragmentation does not depend strongly on the initial field strength, because even weak fields grow to become strong. However, fragmentation in runs with magnetic fields differs significantly from those without magnetic fields. We conclude that the development of dynamically strong magnetic fields during the formation of the first stars is likely inevitable, and that these fields had a significant impact on the primordial IMF.
Dark matter haloes of massive elliptical galaxies at z ∼ 0.2 are well described by the Navarro–Frenk–White profile
Authors: Shajib Anowar J , Treu Tommaso , Birrer Simon , Sonnenfeld Alessandro
Published: February 2021

We investigate the internal structure of elliptical galaxies at z ∼ 0.2 from a joint lensing–dynamics analysis. We model Hubble Space Telescope images of a sample of 23 galaxy–galaxy lenses selected from the Sloan Lens ACS (SLACS) survey. Whereas the original SLACS analysis estimated the logarithmic slopes by combining the kinematics with the imaging data, we estimate the logarithmic slopes only from the imaging data. We find that the distribution of the lensing-only logarithmic slopes has a median 2.08c ± 0.03 and intrinsic scatter 0.13 ± 0.02, consistent with the original SLACS analysis. We combine the lensing constraints with the stellar kinematics and weak lensing measurements, and constrain the amount of adiabatic contraction in the dark matter (DM) haloes. We find that the DM haloes are well described by a standard Navarro–Frenk–White halo with no contraction on average for both of a constant stellar mass-to-light ratio (M/L) model and a stellar M/L gradient model. For the M/L gradient model, we find that most galaxies are consistent with no M/L gradient. Comparison of our inferred stellar masses with those obtained from the stellar population synthesis method supports a heavy initial mass function (IMF) such as the Salpeter IMF. We discuss our results in the context of previous observations and simulations, and argue that our result is consistent with a scenario in which active galactic nucleus feedback counteracts the baryonic-cooling-driven contraction in the DM haloes.
Damped perturbations in stellar systems: genuine modes and Landau-damped waves
Authors: Polyachenko E V , Shukhman I G , Borodina O I
Published: February 2021

This research was stimulated by the recent studies of damping solutions in dynamically stable spherical stellar systems. Using the simplest model of the homogeneous stellar medium, we discuss non-trivial features of stellar systems. Taking them into account will make it possible to correctly interpret the results obtained earlier and will help to set up decisive numerical experiments in the future. In particular, we compare the initial value problem versus the eigenvalue problem. It turns out that in the unstable regime, the Landau-damped waves can be represented as a superposition of van Kampen modes plus a discrete damped mode, usually ignored in the stability study. This mode is a solution complex conjugate to the unstable Jeans mode. In contrast, the Landau-damped waves are not genuine modes: in modes, eigenfunctions depend on time as exp (−iωt), while the waves do not have eigenfunctions on the real $v$-axis at all. However, ‘eigenfunctions’ on the complex $v$-contours do exist. Deviations from the Landau damping are common and can be due to singularities or cut-off of the initial perturbation above some fixed value in the velocity space.
Dust transport in protoplanetary discs with wind-driven accretion
Authors: Hu Zitao , Bai Xue-Ning
Published: February 2021

It has recently been shown that the inner region of protoplanetary discs (PPDs) is governed by wind-driven accretion, and the resulting accretion flow showing complex vertical profiles. Such complex flow structures are further enhanced due to the Hall effect, especially when the background magnetic field is aligned with disc rotation. We investigate how such flow structures impact global dust transport via Monte Carlo simulations, focusing on two scenarios. In the first scenario, the toroidal magnetic field is maximized in the mid-plane, leading to accretion and decretion flows above and below. In the second scenario, the toroidal field changes sign across the mid-plane, leading to an accretion flow at the disc mid-plane, with decretion flows above and below. We find that in both cases, the contribution from additional gas flows can still be accurately incorporated into the advection-diffusion framework for vertically integrated dust transport, with enhanced dust radial (pseudo-)diffusion up to an effective αeff ∼ 10−2 for strongly coupled dust, even when background turbulence is weak α < 10−4. Dust radial drift is also modestly enhanced in the second scenario. We provide a general analytical theory that accurately reproduces our simulation results, thus establishing a framework to model global dust transport that realistically incorporates vertical gas flow structures. We also note that the theory is equally applicable to the transport of chemical species.
Utility of lymphocyte phenotype profile to differentiate primary Sjögren’s syndrome from sicca syndrome
Authors: Loureiro-Amigo José , Palacio-García Carlos , Martínez-Gallo Mónica , Martínez-Valle Fernando , Ramentol-Sintas Marc , Soláns-Laqué Roser
Published: February 2021

Objective

To assess the potential diagnostic utility of advanced lymphocyte profiling to differentiate between primary Sjögren’s Syndrome (pSS) and non-Sjögren Sicca syndrome.

Methods

Distribution of peripheral lymphocyte subpopulations was analysed by flow cytometry in 68 patients with pSS, 26 patients with sicca syndrome and 23 healthy controls. The ability to discriminate between pSS and sicca syndrome was analysed using the area under the curve (AUC) of the receiver operating characteristic curve of the different lymphocyte subsets.

Results

The ratio between naïve/memory B cell proportions showed an AUC of 0.742 to differentiate pSS and sicca syndrome, with a sensitivity of 76.6% and a specificity of 72% for a cut-off value of 3.4. The ratio of non-switched memory B cells to activated CD4+ T cells percentage (BNSM/CD4ACT) presented the highest AUC (0.840) with a sensitivity of 83.3% and specificity of 81.7% for a cut-off value <4.1. To differentiate seronegative pSS patients from sicca patients, the BNSM/CD4ACT ratio exhibited an AUC of 0.742 (sensitivity 75%, specificity 66.7%, cut-off value <4.4), and the number of naïve CD4 T cells had an AUC of 0.821 (sensitivity 76.9%, specificity 88.9%, cut-off value <312/mm3).

Conclusion

Patients with pSS show a profound imbalance in the distribution of circulating T and B lymphocyte subsets. The ratio BNSM/CD4ACT is useful to discriminate between pSS and sicca syndrome.
Altered Peripersonal Space and the Bodily Self in Schizophrenia: A Virtual Reality Study
Authors: Lee Hyeon-Seung , Hong Seok-Jin J , Baxter Tatiana , Scott Jason , Shenoy Sunil , Buck Lauren , Bodenheimer Bobby , Park Sohee
Published: February 2021

Self-disturbances such as an anomalous perception of one’s own body boundary are central to the phenomenology of schizophrenia (SZ), but measuring the spatial parameters of the hypothesized self–other boundary has proved to be challenging. Peripersonal space (PPS) refers to the immediate zone surrounding the body where the self interacts physically with the environment; the space that corresponds to hypothesized self–other boundary. PPS is represented by enhanced multisensory integration and faster reaction time (RT) for objects near the body. Thus, multisensory RT tasks can be used to estimate self–other boundary. We aimed to quantify PPS in SZ using an immersive virtual reality visuotactile RT paradigm. Twenty-four participants with SZ and 24 demographically matched controls (CO) were asked to detect tactile vibration while watching a ball approaching them, thrown by either a machine (nonsocial condition) or an avatar (social condition). Parameters of PPS were estimated from the midpoint of the spatial range where the tactile RT decreased most rapidly (size) and the gradient of the RT change at this midpoint (slope). Overall, PPS was smaller in participants with SZ compared with CO. PPS slope for participants with SZ was shallower than CO in the social but not in nonsocial condition, indicating an increased uncertainty of self–other boundary across an extended zone in SZ. Social condition also increased false alarms for tactile detection in SZ. Clinical symptoms were not clearly associated with PPS parameters. These findings suggest the context-dependent nature of weakened body boundary in SZ and underscore the importance of reconciliating objective and subjective aspects of self-disturbances.
Emotional Regulation as a Mediating Factor in Substance Use Disorders
Authors: Okasha Tarek , Abd Elsamie Afaf , Azzam Hanan , Elserafi Doha , Morsy Mahmoud , Shorub Eman
Published: February 2021

Objectives:

Although the relationship between substance use disorders (SUDs) and emotion regulation is a topic of great scientific interest, little is still known about the nature of this association. The aim of this study is to examine emotion regulation among patients with SUDs and assess the different predictors that affect it.

Patients and Methods:

In all, 100 male patients with SUDs were selected from Okasha Institute of Psychiatry, Ain Shams University and were compared with 100 healthy controls matched for age, sex, and education. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders I; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders II; Temperament and Character Inventory; Barratt impulsiveness scale (BIS), version 11; Trait Meta Mood Scale; and addiction severity index were used.

Results:

Emotional repair was significantly lower in cases compared with control group specifically cases with personality disorders. Cases had significantly lower scores in harm avoidance and persistence and higher in novelty seeking. In addition, cases showed significantly higher total, motor, attention, and nonplan scores of BIS compared with the control group. Furthermore, there was a negative correlation between attention to feeling, clarity of feeling, and repair of mood, and BIS items. Meanwhile, there was a negative correlation between emotional repair and novelty seeking, harm avoidance, persistence, and self-transcendence. Lastly, there was a significant negative correlation between attention to feeling and duration of substance use.

Conclusion:

The study confirms that emotion regulation is a mediator for SUDs especially with long duration of illness, presence of certain personality traits and disorders, and high impulsivity.
Local Recurrence Rates of Skin Tumors After Resection With Complete Circumferential Peripheral and Deep Margin Assessment—Identification of High-Risk Entities
Authors: Kofler Lukas , Breuninger Helmut , Schulz Claudia , Häfner Hans-Martin , Kofler Katrin
Published: February 2021

BACKGROUND

The local recurrence rates of malignant skin tumors after micrographic controlled surgery using complete circumferential peripheral and deep margin assessment (CCPDMA) are reported to be low. However, in daily practice, tumor entities with a significantly higher recurrence rate are found.

OBJECTIVE

The aim of the investigation was to identify these high-risk tumors to develop approaches for risk stratification.

PATIENTS AND METHODS

We included different malignant tumors that were surgically treated and examined with CCPDMA using paraffin sections and H&E staining. Re-excisions were performed until the tumor was completely removed.

RESULTS

Ninety-nine thousand three hundred seventy-two tumors were included in the study; the follow-up period was 4 years (median). Eight tumor entities were identified as high-risk entities, showing a significantly higher local recurrence rate of over 20%: desmoplastic squamous cell carcinoma, desmoplastic melanoma, Merkel cell carcinoma, microcystic adnexal carcinoma, pleomorphic sarcoma, liposarcoma as well as angiosarcoma, and extramammary Paget's disease.

CONCLUSION

Complete circumferential peripheral and deep margin assessment allows complete control of the resection margins and enables skin-sparing resections with low recurrence rates for basal cell carcinomas, nondesmoplastic squamous cell carcinomas, lentiginous melanomas, and dermatofibrosarcoma protuberans. However, other tumors show significantly higher recurrence rates and therefore need to be classified as high-risk tumors.
What Women Want: Women's Perspectives on Male Cosmetic Procedures
Authors: Kim David , Tu Yingqi Michelle , Chapas Anne
Published: February 2021

BACKGROUND

The rate of growth for male cosmetic treatments has slowed in the past 5 years. There is limited data on why men may not seek cosmetic treatments.

OBJECTIVE

To evaluate women's perspectives on male cosmetic treatments.

METHODS

Heterosexual female patients (single (n = 64); in a relationship/married (IR/M) (n = 136)) completed an online survey.

RESULTS

87.5% of single and 36.03% of IR/M women reported that men are bothered by signs of aging (p < .0001). However, both single and IR/M women reported that men are interested in (single: 77.78%, IR/M: 65.44%) and will benefit (single: 93.55%, IR/M: 67.31%) from cosmetic procedures. Both groups of women (single: 93.75%, IR/M: 83.82%, p < .0530) indicated, however, that men are reluctant to seek cosmetic treatments. Societal stigma/perception of masculinity was the number one cited reason (single: 87.1.75%, IR/M: 73.02%, p < .0264). However, 87.5% of single and 94.86% of IR/M women (p = .0659) reported that male cosmetic treatments will not affect their perceptions of masculinity. Furthermore, 95% of women (single: 95.31%, IR/M: 95.59%, p = .9292) reported that they will support their partners from pursuing cosmetic treatments.

CONCLUSION

Women strongly believe that men can benefit from cosmetic treatments, do not believe cosmetic treatments affect masculinity, and are overwhelmingly supportive of male cosmetic treatments.
A Systematic Review Supporting the American Society for Dermatologic Surgery Guidelines on the Prevention and Treatment of Adverse Events of Injectable Fillers
Authors: Nayfeh Tarek , Shah Sahrish , Malandris Konstantinos , Amin Mustapha , Abd-Rabu Rami , Seisa Mohamed O. , Saadi Samer , Rajjoub Rami , Firwana Mohammed , Prokop Larry J. , Murad Mohammad H.
Published: February 2021

BACKGROUND

As the use of injectable skin fillers increase in popularity, an increase in the reported adverse events is expected.

OBJECTIVE

This systematic review supports the development of American Society for Dermatologic Surgery practice guideline on the management of adverse events of skin fillers.

METHODS AND MATERIALS

Several databases for studies on risk factors or treatments of injection-related visual compromise (IRVC), skin necrosis, inflammatory events, and nodules were searched. Meta-analysis was conducted when feasible.

RESULTS

The review included 182 studies. However, IRVC was very rare (1–2/1,000,000 patients) but had poor prognosis with improvement in 19% of cases. Skin necrosis was more common (approximately 5/1,000) with better prognosis (up to 77% of cases showing improvement). Treatments of IRVC and skin necrosis primarily depend on hyaluronidase injections. Risk of skin necrosis, inflammatory events, and nodules may be lower with certain fillers, brands, injection techniques, and volume. Treatment of inflammatory events and nodules with antibiotics, corticosteroids, 5-FU, and hyaluronidase was associated with high response rate (75%–80%). Most of the studies were small and noncomparative, making the evidence certainty very low.

CONCLUSION

Practitioners must have adequate knowledge of anatomy, elicit history of skin filler use, and establish preemptive protocols that prepare the clinical practice to manage complications.
Evaluation of Direct Oral Anticoagulants Versus Warfarin for Intracardiac Thromboses
Authors: Iskaros Olivia , Marsh Kassandra , Papadopoulos John , Manmadhan Arun , Ahuja Tania
Published: February 2021

Intracardiac thrombus (ICT) formation is a common complication of several cardiovascular diseases. Warfarin is recommended for treatment of ICT by guidelines based on observational studies occurring before the advent of nonvitamin K antagonist direct oral anticoagulants (DOACs). We aim to evaluate the current prescribing patterns at our institution and to compare the efficacy and safety profiles of warfarin versus DOACs for ICT. This is a retrospective review of adult patients treated with oral anticoagulation for ICT between May 2013 and December 2019. Our primary end point was complete thrombus resolution. Secondary outcomes included time to resolution of thrombus, treatment failure, and duration of therapy. Safety end points included stroke and systemic embolization (SSE) and bleeding events. A total of 123 patients were included (DOAC n = 61; warfarin n = 62). At baseline, more patients in the DOAC group had anemia [6 (10%) vs. 0 (0%), P = 0.013] and alcohol use disorder [6 (10%) vs. 0 (0%), P = 0.013]. Complete thrombus resolution occurred in 50 (82%) and 46 (74%) patients in the DOAC and warfarin groups, respectively (P = 0.298). There was a shorter time to thrombus resolution in the DOAC group versus the warfarin group {63 days [interquartile range (IQR) 40–138] vs. 123 days [IQR 86–244], P = 0.003}. There were no differences found in SSE or bleeding between the groups [DOAC 11 (19%) vs. warfarin 17 (28%), P = 0.213]. For patients with an ICT, treatment with a DOAC for at least 3 months may be a comparable alternative to warfarin in safety and efficacy.
Carbamylated form of human erythropoietin normalizes cardiorespiratory disorders triggered by intermittent hypoxia mimicking sleep apnea syndrome
Authors: Andrade David C. , Toledo Camilo , Diaz Hugo S. , Pereyra Katherin V. , Schwarz Karla G. , Díaz-Jara Esteban , Melipillan Claudia , Rios-Gallardo Angélica P. , Uribe-Ojeda Atenea , Alcayaga Julio , Quintanilla Rodrigo A. , Iturriaga Rodrigo , Richalet Jean-Paul , Voituron Nicolas , Del Rio Rodrigo
Published: February 2021

Background and objective:

Chronic intermittent hypoxia (CIH), one of the main features of obstructive sleep apnea (OSA), enhances carotid body-mediated chemoreflex and induces hypertension and breathing disorders. The carbamylated form of erythropoietin (cEpo) may have beneficial effects as it retains its antioxidant/anti-inflammatory and neuroprotective profile without increasing red blood cells number. However, no studies have evaluated the potential therapeutic effect of cEpo on CIH-related cardiorespiratory disorders. We aimed to determine whether cEpo normalized the CIH-enhanced carotid body ventilatory chemoreflex, the hypertension and ventilatory disorders in rats.

Methods:

Male Sprague–Dawley rats (250 g) were exposed to CIH (5% O2, 12/h, 8 h/day) for 28 days. cEPO (20 μg/kg, i.p) was administrated from day 21 every other day for one more week. Cardiovascular and respiratory function were assessed in freely moving animals.

Results:

Twenty-one days of CIH increased carotid body-mediated chemoreflex responses as evidenced by a significant increase in the hypoxic ventilatory response (FiO2 10%) and triggered irregular eupneic breathing, active expiration, and produced hypertension. cEpo treatment significantly reduced the carotid body--chemoreflex responses, normalizes breathing patterns and the hypertension in CIH. In addition, cEpo treatment effectively normalized carotid body chemosensory responses evoked by acute hypoxic stimulation in CIH rats.

Conclusion:

Present results strongly support beneficial cardiorespiratory therapeutic effects of cEpo during CIH exposure.
Bilateral detachment of the neurosensory retina in an apparently asymptomatic woman
Authors: Brambati Maria , Borrelli Enrico , Trevisani Francesco , Bruschi Elena , Bandello Francesco , Querques Giuseppe
Published: February 2021

Systemic hypertension is related to a variety of retinal manifestations. Reported herein is a case of malignant hypertension associated with bilateral foveal neurosensory detachment in a middle age woman with stenosis of the left renal artery. The present case outlines the importance of recognizing ocular manifestations as a possible consequence of life-threatening systemic disease.
Active Surveillance of Healthcare-associated Infections in Pediatric Intensive Care Units
Authors: Briassoulis Panagiotis , Briassoulis George , Christakou Eleni , Machaira Maria , Kassimis Athanasios , Barbaressou Chariklia , Nikolaou Filippia , Sdougka Maria , Gikas Achilleas , Ilia Stavroula
Published: February 2021

Background:

Surveillance is essential to all aspects of management of healthcare-associated infections (HAIs) in critically ill children, where data are limited. We conducted an active surveillance study to elucidate epidemiology, resistance, antimicrobial treatment practices and outcomes of pediatric intensive care unit-acquired HAIs in a southern European country.

Methods:

Four Greek pediatric intensive care unit encounters (153 patients, 2183 patient-days) during a 6-month period participated using the European Centre for Disease Prevention and Control HAI-net ICU (v2.2) protocol. Bloodstream infections and device-associated HAIs were recorded. Clinical severity, isolated pathogens, antimicrobial resistance and antibiotic prescriptions were collected on a daily basis. Mortality and excess length of stay due to HAI were also assessed.

Results:

Overall rate of HAIs was 18.3 per 1000 patient-days. Aggregate rates for device-associated HAI were: catheter-related bloodstream infection 2.32, intubation-associated pneumonia 10.5, and catheter-associated urinary tract infection 4.6 per 1000 device-days. Children with HAI (n = 28, 18.3%) had higher severity of illness (Pediatric Risk Mortality Score 7.5 vs. 4, P < 0.001), longer hospitalization (23 vs. 6 days, P < 0.001), but not higher mortality, compared with those without. Most frequent recovered pathogens were Klebsiella pneumoniae (40%), Pseudomonas aeruginosa (22.5%), Acinetobacter baumannii (12.5%), with respective carbapenem resistance 50%, 44% and 80%, and Staphylococcus aureus (12.5%). Total antibiotic use was 2142 days of treatment per 1000 patient-days.

Conclusions:

Our study, based on the updated ECDC HAI-net ICU (v2.2) protocol, effectively addresses the significant burden of HAIs in critically ill children in Greece. Using a well-standardized system facilitates inter- and intra-countries reliable recordings and comparative assessments of infection control programs.
New Compartmental Reading Method for MRI Enables Accurate Localization of Cholesteatomas With High Sensitivity and Specificity
Authors: Meranger Antoine , Venkatasamy Aïna , Charpiot Anne , Tavernier Laurent , Veillon Françis
Published: February 2021

Objectives:

Cholesteatoma is an inflammatory disease, frequently observed in childrens and young adults, with a risk of relapse or recurrence. The few studies which analyzed cholesteatoma localization on magnetic resonance imaging (MRI) usually merged CT-MR images or relied on their authors’ anatomical knowledge. We propose a compartmental reading method of the compartments of the middle ear cavity for an accurate localization of cholesteatomas on MR images alone.

Material and Methods:

Our method uses easily recognizable anatomical landmarks, seen on both computed tomography (CT) and MRI, to delimit the middle ear compartments (epitympanum, mesotympanum, hypotympanum, retrotympanum, protympanum, antrum-mastoid cavity). We first tested it on 50 patients on non-enhanced temporal bone CT. Then, we evaluated its performances for the localization of cholesteatomas on MRI, compared with surgery on 31 patients (validation cohort).

Results:

The selected anatomical landmarks that delimited the middle ear compartments were applicable in 98 to 100% of the cases. In the validation cohort, we were able to accurately localize the cholesteatoma on MRI in 83% of the cases (n = 26) with high sensitivity (95.7%) and specificity (98.6%).

Conclusion:

With our compartmental reading method, based on the recognition of well-known anatomical landmarks to differentiate the compartments of the middle ear cavity on MRI, we were able to accurately localize the cholesteatoma with high (>90%) sensitivity and specificity. Such landmarks are widely applicable and only require limited learning time based on key images. Accurate localization of the cholesteatoma is useful for the choice of surgical approach.
Lack of association between BDNF rs6265 polymorphism and risk of type 2 diabetes
Authors: Xie Xian-Qiong , Cai Dong-Gui , Yang Quan
Published: February 2021

Background:

Brain-derived neurotrophic factor (BDNF) rs6265 polymorphism has been previously suggested to be associated with the susceptibility of type 2 diabetes mellitus (T2DM), but results remained controversial. We aim to provide a more reliable conclusion about the association between BDNF rs6265 polymorphism and T2DM risk by using a meta-analysis.

Methods:

Electronic databases such as Pubmed, Embase, CNKI, and Wanfang were searched for relevant articles published up to May 06, 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to evaluate the strength of the associations. Subgroup analysis was carried out according to source of controls and quality score of included studies. A trial sequential analysis was conducted to reduce the risk of type I error.

Results:

A total of 8 case-control studies (7 conducted in China) with 1576 T2DM patients and 1866 controls were included. Overall, our results indicated no significant association between BDNF rs6265 polymorphism and T2DM risk with the random-effects model (allele model: pooled OR = 1.14, 95% CI = 0.79–1.65, homozygote model: pooled OR = 1.13, 95% CI = 0.57–2.21, heterozygote model: pooled OR = 1.07, 95% CI = 0.78–1.48, dominant model: pooled OR = 1.14, 95% CI = 0.74–1.75 and recessive model: pooled OR = 1.10, 95% CI = 0.67–1.80). Subgroup analysis by source of controls and quality score also showed no significant association between BDNF rs6265 polymorphism and T2DM risk. Trial sequential analysis results confirmed the null association and further studies were unnecessary.

Conclusion:

This meta-analysis study indicated that no significant association between BDNF rs6265 polymorphism and T2DM risk.