bluuebunny/crossref_metadata_2025 huggingface dataset:
Kidney transplantation in the extremely elderly from extremely aged deceased donors: a kidney for each age
Authors: Cabrera Jimena , Fernández-Ruiz Mario , Trujillo Hernando , González Esther , Molina María , Polanco Natalia , Hernández Eduardo , Morales Enrique , Gutiérrez Eduardo , Rodríguez Mori Juan , Canon Alejandra , Rodríguez-Antolín Alfredo , Praga Manuel , Andrés Amado
Published: December 2019

Background

Advances in life expectancy have led to an increase in the number of elderly people with end-stage renal disease (ESRD). Scarce information is available on the outcomes of kidney transplantation (KT) in extremely elderly patients based on an allocation policy prioritizing donor–recipient age matching.

Methods

We included recipients ≥75 years that underwent KT from similarly aged deceased donors at our institution between 2002 and 2015. Determinants of death-censored graft and patient survival were assessed by Cox regression.

Results

We included 138 recipients with a median follow-up of 38.8 months. Median (interquartile range) age of recipients and donors was 77.5 (76.3–79.7) and 77.0 years (74.7–79.0), with 22.5% of donors ≥80 years. Primary graft non-function occurred in 8.0% (11/138) of patients. Cumulative incidence rates for post-transplant infection and biopsy-proven acute rejection (BPAR) were 70.3% (97/138) and 15.2% (21/138), respectively. One- and 5-year patient survival were 82.1 and 60.1%, respectively, whereas the corresponding rates for death-censored graft survival were 95.6 and 93.1%. Infection was the leading cause of death (46.0% of fatal cases). The occurrence of BPAR was associated with lower 1-year patient survival [hazard ratio (HR) = 4.21, 95% confidence interval (CI) 1.64–10.82; P = 0.003]. Diabetic nephropathy was the only factor predicting 5-year death-censored graft survival (HR = 4.82, 95% CI 1.08–21.56; P = 0.040).

Conclusions

ESRD patients ≥75 years can access KT and remain dialysis free for their remaining lifespan by using grafts from extremely aged deceased donors, yielding encouraging results in terms of recipient and graft survival.
Lumbar 4-5 Laminoplasty for Ligation of Dural Fistula: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: December 2019

The goal of treatment for spinal dural arteriovenous fistulas is disconnection of the fistulous point to eliminate venous congestion-associated hypoperfusion and mass effect. The nidus can be surgically excised or disconnected from the arterial feeder just proximal to the dilated venous plexus. This patient had a filus terminale dural arteriovenous fistula. The patient had multiple findings of myelopathy, which prompted the imaging evaluation that revealed prominent flow voids and significant caudal thoracic spinal cord edema. Preoperative digital subtraction angiography demonstrated a fistulous point at the lumbar 4 level. A lumbar 4 and lumbar 5 laminoplasty was performed for spinal canal access. Following achievement of intradural access, exploration was performed, augmented by indocyanine green fluoroscopy. The filum terminale was then transected, and the fistula was then completely excised to achieve surgical cure. Following the procedure, the patient's myelopathy improved, and she regained ambulatory status. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Regulation of Photosynthetic Carbohydrate Metabolism by a Raf-Like Kinase in the Liverwort Marchantia polymorpha
Authors: Koide Eri , Suetsugu Noriyuki , Iwano Megumi , Gotoh Eiji , Nomura Yuko , Stolze Sara Christina , Nakagami Hirofumi , Kohchi Takayuki , Nishihama Ryuichi
Published: December 2019

To optimize growth and development, plants monitor photosynthetic activities and appropriately regulate various cellular processes. However, signaling mechanisms that coordinate plant growth with photosynthesis remain poorly understood. To identify factors that are involved in signaling related to photosynthetic stimuli, we performed a phosphoproteomic analysis with Marchantia polymorpha, an extant bryophyte species in the basal lineage of land plants. Among proteins whose phosphorylation status changed differentially between dark-treated plants and those after light irradiation but failed to do so in the presence of a photosynthesis inhibitor, we identified a B4-group Raf-like kinase, named PHOTOSYNTHESIS-RELATED RAF (MpPRAF). Biochemical analyses confirmed photosynthesis-activity-dependent changes in the phosphorylation status of MpPRAF. Mutations in the MpPRAF gene resulted in growth retardation. Measurement of carbohydrates demonstrated both hyper-accumulation of starch and reduction of sucrose in Mppraf mutants. Neither inhibition of starch synthesis nor exogenous supply of sucrose alleviated the growth defect, suggesting serious impairment of Mppraf mutants in both the synthesis of sucrose and the repression of its catabolism. As a result of the compromised photosynthate metabolism, photosynthetic electron transport was downregulated in Mppraf mutants. A mutated MpPRAF with a common amino acid substitution for inactivating kinase activity was unable to rescue the Mppraf mutant defects. Our results provide evidence that MpPRAF is a photosynthesis signaling kinase that regulates sucrose metabolism.
Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes
Authors: De la Cámara Miguel Á , Higueras-Fresnillo Sara , Sadarangani Kabir P , Esteban-Cornejo Irene , Martinez-Gomez David , Veiga Óscar L
Published: December 2019

Background

Although clinical gait speed may indicate health and well-being in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes.

Objective

The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44-m walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults.

Design

A cross-sectional design was used.

Methods

The study population comprised 432 high-functioning, community-dwelling older adults (287 women) aged between 65 and 92 years. Clinical and ambulatory gait speeds were measured using the 2.44-m walk test and a portable gait analysis device, respectively. Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (body mass index, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper- and lower-body strength, physical and mental health status, cognitive status, and self-rated cognitive status).

Results

The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared. Clinical gait speed was associated with 7 health outcomes, and the ambulatory gait speed was associated with 6 health outcomes. The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied; however, the strength of associations was singly different between measures.

Limitations

The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study.

Conclusion

The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed. Both measures have construct validity because they have been associated with physical and health outcomes; however, they may have different predictive validity. Further research should be conducted to compare their predictive validity in longitudinal designs.
Elevated Extracellular Free-Water in a Multicentric First-Episode Psychosis Sample, Decrease During the First 2 Years of Illness
Authors: Bergé Daniel , Mané Anna , Lesh Tyler A , Bioque Miquel , Barcones Fe , Gonzalez-Pinto Ana Maria , Parellada Mara , Vieta Eduard , Castro-Fornieles Josefina , Rodriguez-Jimenez Roberto , García-Portilla Maria Paz , Usall Judith , Carter Cameron S , Cabrera Bibiana , Bernardo Miguel , Janssen Joost ,   PEPs group (collaborators), Mezquida Gisela , Amoretti Silvia , Pina-Camacho Laura , Arango Celso , González-Ortega I , García S , De-la-Cámara C , Fayed N , Sanjuan Julio , Aguilar E J , Guo Joyce Y , Salgado Purificación , Raduà Joquim , Sánchez-Moreno J , de la Serna Elena , Baeza Ima , Contreras-Fernández Fernando , Saiz-Masvidal C , González-Blanco L , Jiménez-Treviño L , Dompablo M , Torío I , Butjosa A , Rubio-Abadel E , Sarró S , Pomarol-Clotet E
Published: December 2019

Recent diffusion imaging studies using free-water (FW) elimination have shown increased FW in gray matter (GM) and white matter (WM) in first-episode psychosis (FEP) and lower corrected fractional anisotropy (FAt) in WM in chronic schizophrenia. However, little is known about the longitudinal stability and clinical significance of these findings.

To determine tissue-specific FW and FAt abnormalities in FEP, as part of a multicenter Spanish study, 132 FEP and 108 healthy controls (HC) were clinically characterized and underwent structural and diffusion-weighted MRI scanning. FEP subjects were classified as schizophrenia spectrum disorder (SSD) or non-SSD. Of these subjects, 45 FEP and 41 HC were longitudinally assessed and rescanned after 2 years. FA and FW tissue-specific measurements were cross-sectional and longitudinally compared between groups using voxel-wise analyses in the skeletonized WM and vertex-wise analyses in the GM surface.

SSD and non-SSD subjects showed (a) higher baseline FW in temporal regions and in whole GM average (P.adj(SSD vs HC) = .003, P.adj(Non-SSD vs HC) = .040) and (b) lower baseline FAt in several WM tracts. SSD, but not non-SSD, showed (a) higher FW in several WM tracts and in whole WM (P.adj(SSD vs HC)= .049) and (b) a significant FW decrease over time in temporal cortical regions and in whole GM average (P.adj = .011). Increased extracellular FW in the brain is a reliable finding in FEP, and in SSD appears to decrease over the early course of the illness. FAt abnormalities are stable during the first years of psychosis.
Sharing Stories, Sharing Bias: How Descriptions of Context Shape Negative Stereotype Use in Response to Accounts of Economic Adversity
Authors: Hunzaker M B Fallin , Mann Marcus
Published: December 2019

Research shows that observers use negative stereotypes to construe victims of misfortune as responsible for their own fate. In two experiments, we test three situational characteristics’ (injustice, scale, and control) effects on observers’ tendency to use negative stereotypes when communicating stories about others’ economic hardship. Study 1 examines predictions, based on social psychological theories of equity and justice, that stereotype use should increase in response to accounts of misfortune that are the result of unjust under-reward. Contrary to predictions, Study 1 found that participants used more stereotypes when retelling accounts in which the protagonist’s misfortune was not the result of unjust rewards. Study 2 investigates competing predictions to Study 1, based on research regarding how portrayals of scale (whether the misfortune affects one vs. many) and control (whether another actor has control over the misfortune of another) affect perceptions of misfortune. Study 2 results indicate that stereotype use increases in response to accounts of large-scale, uncontrollable misfortune. Together, these studies suggest that qualities of portrayals (such as scale and control) are crucial in understanding stereotype transmission processes above and beyond the role of perceptions of injustice (i.e., the unequal distribution of rewards).
Ultrasound-guided blocks for cardiovascular surgery: which block for which patient?
Authors: Smith Lauren M. , Barrington Michael J.
Published: December 2019

Purpose of review

Regional anesthesia blocks may benefit patients undergoing cardiovascular surgery. This review coincides with the evolution of ultrasound-guided fascial plane blocks, societal concerns regarding opioid misuse and changing expectations regarding surgical recovery.

Recent findings

Paravertebral block and thoracic epidural analgesia have comparable postoperative analgesic profiles following thoracotomy; however, the former has a more favorable complication profile. Limited trials have compared these modalities in cardiac surgery. The mechanism of action of continuous paravertebral blockade may be systemic. Bilateral continuous paravertebral (and other continuous peripheral nerve blocks) should be used with caution in adult patients having cardiac surgery because of the risk of systemic local anesthetic toxicity and bleeding. Novel ultrasound-guided blocks: erector spinae, serratus anterior, pectoral, transversus thoracic muscle and pecto-intercostal fascial plane blocks potentially reduce postoperative opioid requirements; however, they require further investigation before their routine use can be recommended in adult cardiovascular surgical practice. The mechanism of action of erector spinae block is not fully elucidated.

Ultrasound-guided fascial plane blocks may reduce postoperative opioid requirements. Investigation into the safety and efficacy of bilateral continuous ultrasound-guided blockade for cardiac surgery is required. Trial protocols should be embedded into enhanced recovery after surgery programs. Patient-reported and long-term outcomes are recommended.
A narrative review of electroencephalogram-based monitoring during cardiovascular surgery
Authors: Kaiser Heiko A. , Hight Darren , Avidan Michael S.
Published: December 2019

Purpose of review

The current narrative review focuses on depth of hypnosis monitoring with electroencephalography (EEG) during cardiovascular surgery. There have been important findings in recent years regarding the challenges and limitations of EEG-based monitoring during general anesthesia. The purpose of this review is to summarize key EEG-related concepts, as well as to highlight some of the advantages and disadvantages of processed and unprocessed EEG monitoring, especially for older patients with comorbidities undergoing cardiovascular surgery.

Recent findings

The brain is the target organ of anesthesia. Using the EEG or processed EEG to guide anesthetic administration during cardiovascular surgery conceptually allows precision patient-centered anesthesia. It is suggested that inadequate anesthesia, with the possibility of traumatic intraoperative awareness, can potentially be avoided. Furthermore, excessive anesthesia, with hemodynamic compromise and theoretical risk of delirium, can be minimized. Frail, older patients undergoing major surgery with preexisting neurocognitive disorders might be especially vulnerable to perioperative neurological and other complications. Tailoring anesthetic administration, based on individual patient needs partly guided by certain EEG features, might yield improved perioperative outcomes.

Ability to interpret the EEG during surgery might help anesthesia clinicians to individualize anesthetic administration to prevent adverse events, and optimize postoperative recovery.
Anesthetic considerations for tracheobronchial resection in oncologic surgery
Authors: Stoica Radu T. , Cordos Ioan , Popescu Wanda M.
Published: December 2019

Purpose of review

Anesthesia for the resection and reconstruction of the tracheobronchial tree for neoplastic disease is challenging, both from surgical as well as anesthetic points of view. There are no published recommendations or guidelines addressing anesthetic and airway management dilemmas that arise during these surgical interventions. This review presents key aspects of preoperative imaging evaluation, surgical planning, as well as anesthesia and airway management during these complex cases.

Recent findings

Newly published articles highlight both the surgical and anesthetic challenges encountered during tracheobronchial resections and emphasize the importance of creating specialized, high-volume centers for good patient outcomes. Of great importance is the development of a preoperative joint anesthetic-surgical plan which includes a patient-specific airway management strategy. This review presents newer and less commonly employed anesthetic management strategies which have been recently described in the literature to allow expansion of care to patients who were previously deemed too high risk for surgery.

With advances in technology, the use of classical ventilation methods in conjunction with newer alternatives, such as extracorporeal membrane oxygenation, creates the premise for a more individualized, safer and controlled approach to tracheobronchial resections for oncologic purposes.
Safety and Efficacy of Mohs Micrographic Surgery in Children and Adolescents: A Systematic Review
Authors: Wang Sophie , Ezaldein Harib H. , Delost Gregory R. , Tripathi Raghav , Stamey Christopher , Neudecker Mandy , Scott Jeffrey F.
Published: December 2019

BACKGROUND

Although there is a large body of evidence demonstrating the safety and efficacy of Mohs micrographic surgery (MMS) in adults, little is known regarding the safety and efficacy of MMS in children and adolescents.

METHODS

The authors searched all publications from 1993 to 2018 reporting on the use of MMS for the treatment of cutaneous neoplasms in patients aged 0 to 18 years. Patient demographics, surgical characteristics, outcomes, and complications were extracted from each report.

RESULTS

Forty-one publications describing 58 patients were included in the final analysis. The mean age was 8.3 years, and the most commonly treated tumor was dermatofibrosarcoma protuberans. There were no recurrences noted at a mean follow-up of 2 years. Two (3.4%) patients experienced complications after MMS.

CONCLUSION

In this systematic review, the authors present aggregate data demonstrating high safety and efficacy of MMS in children and adolescents. Further research is necessary to develop guidelines for the use of MMS in children and adolescents.
Studying Geographic Inequalities in Mortality in Contexts with Deficient Data Sources: Lessons from Ecuador
Authors: Peralta Andrés , Benach Joan , Espinel-Flores Verónica , Gotsens Mercè , Borrell Carme , Marí-Dell’Olmo Marc
Published: December 2019

Background:

In Ecuador, there are inequalities in the completeness and quality of the mortality registry between men and women and among geographical areas. Consequently, using cause of death statistics leads to several difficulties. Our aim was to analyze geographical inequalities in mortality due to some of the main specific causes of death in the provinces of Ecuador (2001–2016) after correction for the deficiencies found in the mortality registry.

Methods:

This ecologic study used mortality data from 2001 to 2016 for the 22 provinces of Ecuador at the beginning of the study period. We assessed completeness using death distribution methods for the intercensal period 2001–2010. We assessed quality by estimating the percentage of garbage codes for the entire study period. We corrected mortality using completeness as a correction factor and applying a garbage code redistribution protocol. We estimated age-standardized mortality ratios in the provinces of Ecuador for men and women, before and after applying the correction methods.

Results:

We found substantial changes in the number of deaths due to the selected causes after garbage code redistribution and correction for completeness. These changes corresponded to the deficiencies in completeness and quality found in the study areas and the manner in which garbage codes were redistributed to each of the studied causes. We observed changes in the geographical patterns of mortality due to specific causes.

Conclusions:

Correcting deficiencies in the mortality registry resulted not only in changes in the number of deaths but also in the geographical patterns of mortality in Ecuador.
Prenatal caffeine exposure induces down-regulation of the protein kinase A/ryanodine receptor/large-conductance Ca2+-activated K+ pathway in the cerebral arteries of old offspring rats
Authors: Li Na , Shi Ruixiu , Tang Jiaqi , Zhang Wenna , Liu Bailin , Chen Xueyi , Gao Qinqin , Li Xiang , Sun Miao , Xu Zhice
Published: December 2019

Background/aims:

The current study investigated the long-term effects of prenatal caffeine (Caf) exposure on cerebral vessels of old offspring rats.

Methods:

Pregnant rats were treated with Caf (20 mg/kg, twice daily) or 0.9% normal saline during gestational days 3.5–19.5, and offspring were tested at 24 months old. Vascular functions of middle cerebral arteries and ion channel activities in smooth muscle cells were examined using myograph system and patch-clamp.

Results:

Prenatal Caf exposure decreased isoprenaline (β-adrenergic agonist)-induced dilatation of the middle cerebral artery in the offspring. Treatment with protein kinase A (PKA) inhibitor reduced isoprenaline-mediated vasodilatation to a greater extent in the control. Forskolin-mediated vasodilatation and membrane hyperpolarization were reduced in the Caf group. Large-conductance Ca2+-activated K+ (BKCa) channel inhibitor iberiotoxin significantly attenuated forskolin-induced vasodilatation and reduced depolarization in the control, not in the Caf group. The PKA agonist-activated cell-attached single BKCa currents to a greater extent in the control. The mRNA and protein expression levels of PKA-Cα were decreased. The sensitivity of ryanodine receptors to the PKA agonist was blunted in the Caf group, whereas the mRNA expression of ryanodine receptor 2 subunit was reduced. Voltage/Ca2+ sensitivity of BKCa was decreased accompanied by reduced mRNA and protein expression of BKCa-β1 subunits in the Caf group. PKA agonist-stimulated inside-out BKCa currents were weaker in the Caf group.

Conclusion:

Prenatal exposure to Caf-affected isoprenaline/forskolin-mediated vascular functions in aged cerebral arteries, related to dysfunction of the PKA/ryanodine receptors/BKCa signaling pathway.
Association of visit-to-visit variability in blood pressure and first stroke risk in hypertensive patients with chronic kidney disease
Authors: Li Youbao , Zhou Huamin , Liu Mengyi , Liang Min , Wang Guobao , Wang Binyan , Li Jianping , Cui Yimin , Song Yun , Zhang Yan , Xu Xin , Tian Jianwei , Yang Manqiu , Huo Yong , Xu Xiping , Qin Xianhui
Published: December 2019

Objective:

Data on the association between visit-to-visit variability (VVV) in blood pressure (BP) and the risk of stroke among hypertensive patients with chronic kidney disease (CKD) is limited. We aimed to evaluate the relation of VVV in BP with the risk of stroke, and examine any possible effect modifiers in hypertensive patients with mild-to-moderate CKD.

Methods:

This is a post-hoc analysis of the China Stroke Primary Prevention Trial. A total of 3091 patients with estimated glomerular filtration rate 30–60 ml/min per 1.73 m2 and/or proteinuria at baseline, without occurring stroke and with BP measurements of at least two visits from randomization to the 12-month visit were included. The main VVV in BP was expressed as SD. The primary outcome was first stroke.

Results:

The median subsequent treatment duration was 3.7 years. After multivariable adjustment, including baseline SBP and mean SBP during the first 12-month follow-up, there was a significantly positive relationship of SD SBP with the risk of subsequent first stroke (per SD increment; odds ratio, 1.41; 95% confidence interval: 1.17–1.69) and first ischemic stroke (odds ratio, 1.55; 95% confidence interval: 1.26–1.90). Results were consistent across various subgroups, including age, sex, baseline SBP, treatment compliance, and mean SBP, concomitant usage of calcium channel blocker during the first 12-month follow-up period. Similar trends were also found for coefficient of variation SBP, and SD or coefficient of variation DBP. However, there was no significant association between BP variability and first hemorrhagic stroke.

Conclusion:

In hypertensive adults with mild-to-moderate CKD, visit-to-visit variability in BP was significantly associated with the risk of subsequent first stroke.
Microalbuminuria mediates the association between serum uric acid and elevation of blood pressure: a longitudinal analysis in the Gusu cohort
Authors: Jiang Yanbo , Yu Jia , Zhang Qiu , Ren Liyun , He Yan , Li Jing , Ma Shengqi , Zhang Mingzhi , Peng Hao
Published: December 2019

Objectives:

Although hyperuricemia, microalbuminuria, and hypertension are highly correlated, their temporal relationship is largely unknown. We aimed to examine whether microalbuminuria mediated the association between hyperuricemia and hypertension.

Methods:

Leveraging a longitudinal cohort including 1981 Chinese adults who had blood pressures, urinary albumin to creatinine ratio (UACR), and uric acid measured twice 4 years apart, we examined the temporal relationships among hyperuricemia, microalbuminuria, and hypertension by cross-lagged panel analysis followed by a causal mediation analysis to confirm the temporal consequence. Age, sex, education level, cigarette smoking, alcohol consumption, obesity, blood glucose, and lipids were adjusted.

Results:

The cross-lagged panel analysis demonstrated that the relationship from baseline UACR to follow-up uric acid was significantly smaller than that from baseline uric acid to follow-up UACR (β: 0.010 vs. 0.054, P < 0.001). The relationships from baseline blood pressures to follow-up UACR were also significantly smaller than that from baseline UACR to follow-up blood pressures (β: 0.031 vs. 0.092, P < 0.001 for systolic and β: 0.015 vs. 0.096, P < 0.001 for diastolic). The causal mediation analysis found that UACR partially mediated the association of baseline uric acid with follow-up SBP (mediate proportion: 9.14%, 95% CI: 1.58–23.00%) and DBP (mediate proportion: 7.38%, 95% CI: 1.05–19.00%).

Conclusion:

Microalbuminuria may follow elevated uric acid and partially mediate its effect on future risk of hypertension in Chinese adults.
Comparison of three office blood pressure measurement techniques and their effect on hypertension prevalence in the general population
Authors: Wohlfahrt Peter , Cífková Renata , Krajčoviechová Alena , Šulc Pavel , Bruthans Jan , Linhart Aleš , Filipovský Jan , Mayer Otto , Widimský Jiří
Published: December 2019

Objectives:

There is an ongoing controversy about the magnitude of the difference between unattended automated office blood pressure (AOBP) and conventional office blood pressure (BP). The aim of our study was to compare unattended AOBP with both auscultatory BP and oscillometric attended AOBP in an epidemiological setting.

Methods:

In 2588 participants of the Czech post-MoNItoring of CArdiovascular Disease study (a randomly selected 1% representative population sample aged 25–64 years, mean age 48 ± 11 years, 47.5% males), BP was measured using an AOBP device unattended, auscultatory mercury sphygmomanometer and an oscillometric attended AOBP device.

Results:

On average, auscultatory BP was 10.6/5.6 mmHg higher than unattended AOBP. Similarly, oscillometric attended AOBP was 9.9/3.4 mmHg higher than unattended AOBP, while the mean difference between attended oscillometric AOBP and auscultatory BP was 0.8/2.1 mmHg. Unattended systolic AOBP of 127 mmHg corresponded to SBP of 140 mmHg measured by a conventional sphygmomanometer. The prevalence of hypertension varied depending on the measurement technique and ranged from 31.5 to 40.1%. Reasonable agreement in hypertension diagnosis was observed with unattended AOBP cut-off at least 130/85 mmHg when compared with both auscultatory (McNemar P = 0.07, kappa 0.819) and attended oscillometric AOBP (McNemar P = 0.46, kappa 0.852) thresholds of at least 140/90 mmHg.

Conclusion:

Unattended automated office SBP is on average 10 mmHg lower than the office auscultatory or attended AOBP values. In epidemiological settings, a threshold of unattended AOBP at least 130/85 mmHg should make comparison of hypertension prevalence possible with studies using auscultatory techniques and cut-off values of 140/90 mmHg.
Chelation Modeling: The Use of Ad Hoc Models and Approaches to Overcome a Dose Assessment Challenge
Authors: Dumit Sara , Bertelli Luiz , Klumpp John A. , Poudel Deepesh , Waters Tom L
Published: December 2019

Chelating agents are administered to treat significant intakes of radioactive elements such as plutonium, americium, and curium. These drugs may be used as a medical countermeasure after radiological accidents and terrorist acts. The administration of a chelating agent, such as Ca-DTPA or Zn-DTPA, affects the actinide's normal biokinetics. It enhances the actinide's rate of excretion, posing a dose assessment challenge. Thus, the standard biokinetic models cannot be directly applied to the chelation-affected bioassay data in order to assess the radiation dose. The present study reviews the scientific literature, from the early 1970s until the present, on the different studies that focused on developing new chelation models and/or modeling of bioassay data affected by chelation treatment. Although scientific progress has been achieved, there is currently no consensus chelation model available, even after almost 50 y of research. This review acknowledges the efforts made by different research groups, highlighting the different methodology used in some of these studies. Finally, this study puts into perspective where we were, where we are, and where we are heading in regards to chelation modeling.
Immunotherapy orchestrates radiotherapy in composing abscopal effects: A strategic review in metastatic head and neck cancer
Authors: Akbor Mohammady , Hung Kai-Feng , Yang Yi-Ping , Chou Shih-Jie , Tsai Ping-Hsing , Chien Chian-Shiu , Lin Liang-Ting
Published: December 2019

The treatment of metastatic head and neck squamous cell carcinoma (HNSCC) with a combination of radiotherapy (RT) and immunotherapy can augment treatment response and symptomatic relief. Combination therapy can also trigger a non-targeted tumor control event called the abscopal effect. This effect can be demonstrated by treatment with anti-programmed death 1/programmed death ligand 1 (PD-L1) and anti-cytotoxic T-lymphocyte–associated antigen 4 antibodies in combination with hypofractionated RT. Individual studies and clinical trials have revealed that combination radio-immunotherapy improves overall treatment response by successful initiation of the abscopal effect, which extends the treatment effects to non-targeted lesions. Growing attention to the abscopal effect may inspire innovations in current RT toward more effective and less toxic radiobiological treatment modalities for advanced HNSCC. We review the latest findings on the abscopal effect with emphases on therapeutic modalities and potential applications for treating metastatic HNSCC.
Needs Assessment for a Comprehensive Reemployment Program Among Residents of a Work Rehabilitation Program for Individuals With Unstable or Lack of Housing
Authors: Madigan Dana , Johnson Timothy P. , Forst Linda , Cambron Jerrilyn A. , Zanoni Joseph , Patil Crystal L. , Conroy Lorraine M. , Friedman Lee S.
Published: December 2019

Objective:

Individuals in transitional housing programs often have a goal of reaching stable employment, but the unique needs and barriers for achieving this warrants further study.

Methods:

A structured interview guide was administered orally and descriptive data analysis was done for this exploratory mixed-methods study.

Results:

Commonly reported reemployment challenges included legal barriers and unmet transportation, housing, and financial needs. More than two-thirds of residents reported no place to live after the program regardless of if they had previous precarious housing. Emerging themes included challenges regarding sufficient time for the transition to being employed, fear of relapse, and lack of long-term goals and planning.

Conclusions:

Findings suggest that residential rehabilitation programs are an important resource. While these programs tend to focus on reemployment, their services could be enhanced by assessing individual needs and allowing for variation in reemployment preparation.
Pregnancy-related thrombosis risk in patients with protein C deficiency and comparison with pregnant women with heterozygous factor V Leiden mutation
Authors: Rugeri Lucia , Desage Stephanie , Khouatra Linda , Battie Catherine , Doret-Dion Muriel , Trzeciak Christine , Dargaud Yesim
Published: December 2019

The risk of pregnancy-related venous thromboembolism is high in patients with inherited thrombophilia. The aim of this study was to compare the risk of pregnancy related-venous thromboembolism of women with protein C (PC) deficiency to patients with heterozygous factor V Leiden mutation. 145 consecutive pregnant women with confirmed PC deficiency or heterozygous factor V Leiden mutation were prospectively enrolled in the study. Lyon venous thromboembolism-risk score was used to individually tailor antithrombotic prophylaxis. The use of a validated clinical score presents the advantage to have a homogenous management of the venous thromboembolism risk in patients having similar risk factors. 53 pregnancies with PC deficiency were compared with 190 pregnancies in heterozygous factor V Leiden mutation carriers. 50% of the patients with PC deficiency and 64% of the heterozygous factor V Leiden mutation carriers were asymptomatic. According to the Lyon-venous thromboembolism risk score, 50% of patients with PC deficiency and 51% of heterozygous factor V Leiden carriers did not received any antepartum heparin prophylaxis. 34 and 37% of patients respectively received heparin prophylaxis during the third trimester only. No venous thromboembolism was observed in patients with PC deficiency and one postpartum venous thromboembolism occurred in a patient with heterozygous factor V Leiden. In the absence of randomized controlled clinical studies, we report here a large prospective series of pregnant women with PC deficiency. In our cohort, no difference of outcome, in terms of venous thromboembolism, was observed between pregnant women with PC deficiency and those with heterozygous factor V Leiden. Based on our results, low-molecular-weight heparin prophylaxis should not be mandatory in all pregnant women with PC deficiency. Similar prophylaxis strategies may be applied to women with factor V Leiden mutation or PC deficiency.
Bivalirudin anticoagulation to overcome heparin resistance in a neonate with cerebral sinovenus thrombosis
Authors: Bertamino Marta , Severino Mariasavina , Parodi Alessandro , Andreato Chiara , Malova Mariya , Svahn Johanna , Tortora Domenico , Moretti Paolo , Molinari Angelo C. , Ramenghi Luca A.
Published: December 2019

Anticoagulation in a neonate is a challenge and the availability of anticoagulant options is extremely limited. Here we describe the use of a direct thrombin inhibitor, bivalirudin, in a full-term neonate with symptomatic cerebral sinovenous thrombosis complicated by bilateral thalamic hemorrhagic stroke and intraventricular hemorrhage, who could not be effectively treated with sodium heparin due to heparin resistance (HR) and showed thrombosis regression after start of bivalirudin treatment, without worsening of the hemorrhage. While the use of bivalirudin in neonates has been previously described, the indication of cerebral sinovenous thrombosis and the setting of HR are unique.
What is the evidence for macrolide therapy in chronic rhinosinusitis?
Authors: Cavada Marina N. , Grayson Jessica W. , Sacks Raymond
Published: December 2019

Purpose of review

To assess the most recent evidence for macrolide therapy in chronic rhinosinusitis (CRS).

Recent findings

Macrolides play a significant role in a select group of patients with CRS. Low-serum and tissue eosinophilia in patients who do not respond to corticosteroid therapy appeared to be an effective predictor of a CRS phenotype suitable for a trial of long-term macrolide therapy. Therapies using half a dose for longer than 12 weeks have noted good outcomes.

The anti-inflammatory and immunomodulatory effects of macrolides have been demonstrated in several studies. Macrolides have shown an important role in patients who are nonresponsive to corticosteroid therapies, therefore patient selection is key. Previous inconsistencies in results may be due to poor patient selection.
Donor pretreatment and machine perfusion: current views
Authors: O’Neill Stephen , Oniscu Gabriel C.
Published: December 2019

Purpose of review

To summarise recently published studies of donor pretreatment and machine perfusion strategies in kidney transplantation.

Recent findings

The sparsity of donor pretreatment trials has resulted in the re-analysis of already existing data, and RCTs are urgently needed to reinvigorate this aspect of donor research. Uncontrolled donation after circulatory death kidney transplantation has the highest risk of delayed graft function and graft failure, and recent studies have reported that normothermic regional perfusion improves graft function and survival in this setting. Hypothermic machine perfusion reduces delayed graft function following deceased donor kidney transplantation across donor types but unanswered questions still remain regarding its use. The use of oxygenated hypothermic machine perfusion appears to improve graft function in controlled donation after circulatory death mediated by a reduction in acute rejection. Ex-situ normothermic perfusion is emerging and while technically challenging it may facilitate the delivery of pretreatments.

RCTs are urgently needed to reinvigorate research into donor pretreatment and to establish the place of specific preservation techniques in deceased donor kidney transplantation.
Should living donor liver transplant selection be subject to the same restrictions as deceased donor transplant?
Authors: Kwon Yong K. , Etesami Kambiz , Genyk Yuri
Published: December 2019

Purpose of review

In the United States, most of the liver allografts come from deceased donors, and our current liver recipient selection process is heavily centered on the ethical principle of utility to maximize the net benefit to the liver recipient community as a group rather than individuals due to the organ scarcity. Although living donor liver transplantation contributes less than 5% of total liver transplant in the United States, these living donor recipients are being subjected to the same selection process designed to benefit the group as a whole rather than the individuals. We would like to examine if these recipients who have living donors should be subjected to the same selection process.

Recent findings

There are several disease processes where liver transplantation is the only curative option, and recent studies have shown clear survival benefits with liver transplantation.

For those who have living donors, different selection criteria based on their specific disease, not based on the principle of utilization should be used to evaluate their candidacy.
Health Impacts of Early Complementary Food Introduction Between Formula‐fed and Breastfed Infants
Authors: Rippey Phyllis L.F. , Aravena Fabiola , Nyonator John Paul
Published: December 2019

Background:

Global health agencies agree that infants should not be fed complementary foods before 4 to 6 months of age. However, given the World Health Organization (WHO) definition of complementary food as “anything other than breast milk,” little is known about the relative risks of formula compared with other complementary foods on infant health. This article aims to fill this gap in the literature, by assessing how differences in the timing of the introduction of nonformula complementary food between breastfed and formula‐fed infants impacts infant health.

Methods:

Eight health outcomes by complementary food introduction, breast‐feeding, formula feeding, and mixed feeding (breastfed and formula‐fed) were predicted using logistic regression with generalized estimating equations on the newborn through 6‐month waves of the Infant Feeding Practices Study II (IFPS‐II).

Results:

Complementary foods increased the likelihood for all health risks measured. Given greater prevalence of early complementary food introduction among formula‐fed infants, most health differences between breast‐feeding groups shift to nonsignificance in full models, with the exception of higher rates of hard stool and cough/wheeze among formula‐fed and mixed‐fed infants but lower rates of diarrhea (LO = −0.577; 95% confidence interval [CI] = −1.074 to 0.080) and runny nose or cold (LO = −3.19; 95% CI = −0.552 to −0.086) for mixed‐fed than breastfed infants.

Conclusions:

Our results confirm health benefits of exclusive breast‐feeding and that the introduction of complementary foods before 4 to 6 months poses a greater risk to infant health than does formula. Greater attention to the early introduction of complementary foods is needed in research and clinical practice.
Effect of Definitions of Acute Gastroenteritis Episodes Using Symptom Diaries in Paediatric Cohorts
Authors: Mihala Gabor , Grimwood Keith , Morley Carla , Lambert Stephen B. , Ware Robert S.
Published: December 2019

Estimates of acute gastroenteritis (AGE) burden are difficult to compare between studies because of inconsistent definitions describing this illness. AGE definitions used in prospective, community‐based childhood cohort studies were identified by searching databases for studies that collected daily observations of AGE symptoms. Disease definitions and refractory periods were extracted. Data from the Australian community‐based Observational Research in Childhood Infectious Diseases birth cohort were used to calculate AGE incidence and duration using identified AGE definitions, and the World Health Organization definition for diarrhoea. Eight distinct AGE definitions were identified. All included loose stools and 7 included vomiting as symptoms. The refractory period separating episodes ranged from 1 to 21 days. When applied to the Observational Research in Childhood Infectious Diseases dataset, AGE incidence ranged from 0.8 to 2.6 episodes per child‐year‐at‐risk, a 3‐fold relative difference. Direct comparisons of rates from different cohorts can only be undertaken if a standard definition for AGE is adopted.
Blending Evidence-Based Practice and Lean Six Sigma Methodology to Reduce Hospital-Acquired Pressure Injuries in a Progressive Care Unit
Authors: Gallo Ana-Maria , Doyle Rochelle Anne Catahay , Beckman Jennifer , Lizarraga Cabiria G.
Published: December 2019

Background:

Hospital-acquired pressure injuries (HAPIs) continue to challenge acute care facilities. Best practice to reduce HAPI includes assessment, documentation, positioning, and treatment.

Local Problem:

In spite of using evidence-based practices, the hospital's gastrointestinal/genitourinary progressive care unit had more HAPIs each month than the other units in the hospital.

Methods:

A combination of Lean Six Sigma and evidence-based practice was used to decrease HAPIs.

Interventions:

The T3 program (turn, touch, and tidy) was developed to address the areas of concern identified in the root cause analysis.

Results:

HAPIs were reduced from 22 in the previous 2 quarters to zero for 3 consecutive quarters with a cost avoidance to $379 767.

Conclusions:

The successful implementation of the T3 program was the result of blending Lean Six Sigma and evidence-based practice.
Assessment of the Cost-Effectiveness of a Brief Video Intervention for Sexually Transmitted Disease Prevention
Authors: Williams Austin M. , Gift Thomas L. , O'Donnell Lydia N. , Rietmeijer Cornelis A. , Malotte C. Kevin , Margolis Andrew D. , Warner Lee
Published: December 2019

Background

Cost-effective, scalable interventions are needed to address high rates of sexually transmitted diseases (STDs) in the United States. Safe in the City, a 23-minute video intervention designed for STD clinic waiting rooms, effectively reduced new infections among STD clinic clients. A cost-effectiveness analysis of this type of intervention could inform whether it should be replicated.

Methods

The cost-effectiveness of a brief video intervention was calculated under a baseline scenario in which this type of intervention was expanded to a larger patient population. Alternative scenarios included expanding the intervention over a longer period or to more clinics, including HIV prevention benefits, and operating the intervention part time. Program costs, net costs per STD case averted, and the discounted net cost of the intervention were calculated from a health sector perspective across the scenarios. Monte Carlo simulations were used to calculate 95% confidence intervals surrounding the cost-effectiveness measures.

Results

The net cost per case averted was $75 in the baseline scenario. The net cost of the intervention was $108,015, and most of the alternative scenarios found that the intervention was cost saving compared with usual care.

Conclusions

Single session, video-based interventions can be highly cost effective when implemented at scale. Updated video-based interventions that account for the changing STD landscape in the United States could play an important role in addressing the recent increases in infections.
Facial Asymmetry in Unilateral Duane Retraction Syndrome
Authors: Akbari Mohamad Reza , Khorrami-Nejad Masoud , Aghazadeh Amiri Mohamad , Akbarzadeh Baghban Alireza , Khosravi Bahram , Nourizad Sima
Published: December 2019

SIGNIFICANCE

The overall objective of this study was to evaluate facial asymmetry in patients with unilateral Duane retraction syndrome (DRS). The results showed a high frequency of facial asymmetry parameters of the opposite side of head turn in unilateral DRS patients.

PURPOSE

The purposes of this study were to evaluate the characteristics of facial asymmetry in unilateral exotropic and esotropic DRS and to compare the findings with orthotropic subjects.

METHODS

This cross-sectional comparative case series study was performed in 44 consecutive patients with head turn caused by DRS and 44 orthotropic subjects from 2016 to 2019. Four pictures were taken from the patients' faces. The first and second pictures were taken when patients had head turn and when the head was completely straight for calculating the facial angle and relative facial size, respectively. The third and fourth pictures were taken when the head was positioned downward (to compare the size of the cheek) and upward (to evaluate nose asymmetry).

RESULTS

The mean ± SD age of DRS patients and orthotropic subjects was 16.23 ± 9.92 and 20.68 ± 11.82 years, respectively. The frequency of facial asymmetry and all facial parameters (cheek compression, nasal tip and columella deviation, and compression of one of the nostrils) was significantly higher in DRS patients compared with orthotropic subjects (P< .001). In DRS patients with facial asymmetry, columella and nasal tip deviation (P= .006) and cheek and face compression (P= .03) were significantly more prevalent in the opposite direction of head turn. In the DRS group, the mean ± SD age of the patients with and without facial asymmetry was 17.37 ± 9.76 and 7.40 ± 6.54 years, respectively (P= .02).

CONCLUSIONS

The frequency of facial asymmetry and all facial parameters was significantly higher in DRS patients compared with orthotropic subjects. In unilateral DRS patients, the face was more commonly affected on the opposite side of head turn.