bluuebunny/crossref_metadata_2025 huggingface dataset:
Teaching Health Advocacy: A Systematic Review of Educational Interventions for Postgraduate Medical Trainees
Authors: Scott Michael D. , McQueen Sydney , Richardson Lisa
Published: November 2019

Purpose

A systematic review was undertaken to characterize the training approaches that are currently being implemented in postgraduate medical education to teach residents advocacy skills.

Method

An initial search was conducted in MEDLINE, PubMed, Embase, ERIC, and PsycINFO in November 2016 (updated in December 2017) for articles discussing postgraduate medical education interventions covering advocacy. Articles published between 1995 and 2017 were included. Two authors independently reviewed titles and abstracts (and, if needed, the full text) for inclusion; disagreements were resolved by consensus. Data were extracted from studies to characterize the content and pedagogy of the interventions by mapping them to the CanMEDS health advocate core competencies and key concepts.

Results

A total of 3,027 unique abstracts were retrieved; 2,864 were excluded upon title and abstract review, and another 85 were excluded upon full-text review. Seventy-eight total articles were included. More studies involved residents from pediatrics, psychiatry, primary care or preventative medicine, or internal medicine than from emergency medicine, surgery, obstetrics and gynecology, or neurology. Published interventions varied widely by pedagogical approach and assessment method.

Conclusions

Using the CanMEDS framework, this review maps the breadth and nature of postgraduate medical education interventions in health advocacy, with applicability to community organizations, program directors, educators, and administrators working to develop advocacy training interventions. Areas of focus included adapting practice to respond to the needs of or advocacy in partnership with patients, communities, or populations served; determinants of health; health promotion; mobilizing resources as needed; and social accountability.
A Study of the Validity of the New MCAT Exam
Authors: Violato Claudio , Gauer Jacqueline L. , Violato Efrem M. , Patel Dimple
Published: November 2019

Purpose

To conduct a study of the validity of the new Medical College Admission Test (MCAT).

Method

Deidentified data for first- and second-year medical students (185 women, 54.3%; 156 men, 45.7%) who matriculated in 2016 and 2017 to the University of Minnesota Medical School–Twin Cities were included. Of those students, 220 (64.5%) had taken the new MCAT exam and 182 (53.4%) had taken the old MCAT exam (61 [17.9%] had taken both). The authors calculated descriptive statistics and Pearson product moment correlations (r) between new and old MCAT section scores. They conducteda regression analysis of MCAT section scores with Step 1 scores and with preclerkship course performance. They also conducted an exploratory factor analysis (principal component analysis with varimax rotation) of MCAT scores, undergraduate grade point average, Step 1 scores, and course performance.

Results

The new MCAT exam section mean score percentiles ranged from 72 to 78 (mean composite score percentile of 80). The old MCAT exam section mean score percentiles ranged from 84 to 88 (mean composite score percentile of 83). The pattern of correlations among and between new and old MCAT exam section scores (range of r: 0.03–0.67; P < .01) provided evidence of both divergent and convergent validities. Backward multiple regression of new MCAT exam section scores and Step 1 scores resulted in a multiple R of .440; the same analysis with Human Behavior course performance as the dependent variable provided a similar solution with the expected sections of the new MCAT exam (multiple R = .502). The factor analysis resulted in 4 cohesive, theoretically meaningful factors: biomedical knowledge, basic science concepts, cognitive reasoning, and general achievement.

Conclusions

This study provided empirical evidence of multiple types of validity for the new MCAT exam.
Enhanced neuroinflammation and oxidative stress are associated with altered hippocampal neurogenesis in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine treated mice
Authors: Singh Sonu , Mishra Akanksha , Tiwari Virendra , Shukla Shubha
Published: November 2019

Loss of midbrain dopaminergic neurons in Parkinson’s disease not only induces motor impairments but also leads to the development of non-motor symptoms such as memory impairment, anxiety and depression. Dopaminergic axons directly innervate hippocampus and release dopamine in the local environment of hippocampus, and hence are directly involved in the modulation of hippocampal-dependent functions. Studies have explored the potential effect of dopamine on adult hippocampal neurogenesis. However, it is not well defined whether oxidative damage and inflammation could be associated with alteration in adult hippocampal neurogenesis. In the present study, we analyzed the effect of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine on adult hippocampal neurogenesis and how it is associated with inflammatory conditions in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced mouse model of Parkinson’s disease-like phenotypes. 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-treated mice exhibited significantly reduced dopaminergic neurons and dopamine content that resulted in impairment of motor functions. Interestingly, the formation of endogenous neuronal precursor cells and the number of neuroblasts in the hippocampus were significantly increased following 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine treatment. Net hippocampal neurogenesis was also reduced in the hippocampus after 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine treatment. These effects in the hippocampus were associated with increased oxidative stress markers and a massive reactive gliosis. Taken together, our results suggest that degeneration of midbrain dopaminergic neurons directly affects the local hippocampal microenvironment by enhancing inflammatory influences. The 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced inflammatory reaction in the hippocampus may alter the endogenous regenerative capacity of the brain. Therefore, anti-inflammatory agents could be a potential therapy for the improvement of the endogenous regenerative capacity of the aging or neurodegenerative brain.
Impact of Rectus Muscle Injury during Perforator Dissection on Functional Donor Morbidity after Deep Inferior Epigastric Perforator Flap Breast Reconstruction
Authors: Lee Kyeong-Tae , Park Jin-Woo , Mun Goo-Hyun
Published: November 2019

Background:

This study aimed to assess the extent of rectus muscle damage in deep inferior epigastric perforator (DIEP) flap harvest and to evaluate its association with functional donor morbidity.

Methods:

A prospective cohort of 76 patients who underwent DIEP flap breast reconstruction was evaluated preoperatively and followed up for 1 year. Abdominal wall strength was assessed using the upper and lower rectus abdominis manual muscle function tests. Functional weakness was defined as a postoperative decrease in function by at least 2 scores. The effects of patient- and operation-related characteristics on adverse outcomes were also assessed.

Results:

The mean width of the transected rectus muscle was 2.2 cm (partial thickness, 1.8 cm; full thickness, 0.4 cm). The mean width ratio of the overall injured muscle to the entire bilateral muscle was 0.18. Muscle injury was more severe in the cases with bipedicled flap elevation and in those with 4 or more perforators harvested. Functional weakness was detected in 13 patients (17.1%). Multivariate analyses demonstrated that the width ratio of the muscle injury was an independent predictor of functional weakness. The width ratio achieved maximal discrimination regarding the rate of functional weakness at a threshold value of 0.12, indicating that functional weakness did not develop in all 19 cases with a width ratio of <0.12.

Conclusions:

The extent of rectus muscle injury during perforator dissection may be associated with functional donor morbidity after DIEP flap harvest. This may be beneficial in achieving proper balance between securing flap perfusion and preserving donor functions.
Use of Routine Environmental Monitoring Data to Establish a Dose-based Compliance System for a Low-level Radioactive Waste Disposal Site
Authors: Rood Arthur S. , Grogan Helen A. , Mohler H. Justin , Rocco James R. , Caffrey Emily A. , Mangini Colby , Cartwright Jay , Matthews Travis , Shaw Chris , Packard Mark E. , Till John E.
Published: November 2019

A dose-based compliance methodology was developed for Waste Control Specialists, LLC, low-level radioactive waste facility in Andrews, Texas, that allows routine environmental measurement data to be evaluated not only at the end of a year to determine regulatory compliance, but also throughout the year as new data become available, providing a continuous assessment of the facility. The first step in the methodology is a screening step to determine the potential presence of site emissions in the environment, and screening levels are established for each environmental media sampled. The screening accounts for spatial variations observed in background for soil and temporal fluctuations observed in background for air. For groundwater, the natural activity concentrations in groundwater wells at the facility are highly variable, and therefore the methodology uses ratios for screening levels. The methodology compares the ratio of gross alpha to 234U + 238U to identify potentially abnormal alpha activity and the ratio of 235U to 238U to identify the potential presence of depleted uranium. Compliance evaluation is conducted for any samples that fail the screening step. Compliance evaluation uses the radionuclide-specific measurements to first determine (1) if the dose exceeds the background dose and if so, (2) the dose consequences, so that the appropriate investigation or action occurs. The compliance evaluation is applied to all environmental samples throughout the year and on an annual basis to determine regulatory compliance. The methodology is implemented in a cloud-based software application that is also made accessible to the regulator. The benefits of the methodology over the existing system are presented.
Advances in identifying coding variants of common complex diseases
Authors: Cai Minglong , Ran Delin , Zhang Xuejun
Published: November 2019

Many common diseases are characterized by polygenic architectures in which a single variant has only a small effect on phenotype. Genome-wide association studies and next generation sequencing have identified thousands of genetic variants of disease susceptibility. Recently, non-coding variants identified by genome-wide association studies have been systematically reviewed. Here, we review disease-causing coding variants and their relevance to clinical medicine.
Health Information Technology Adoption and Clinical Performance in Federally Qualified Health Centers
Authors: Davlyatov Ganisher , Borkowski Nancy , Feldman Sue , Qu Haiyan , Burke Darrell , Bronstein Janet , Brickman Andrew
Published: November 2019

A national sample (N = 982) of federally qualified health centers (FQHCs) for the period 2011–2016 was examined regarding the relationship between the age and extent of health information technology (HIT) use and clinical performance. We found that each additional year of HIT use was associated with an approximate 4 percent increase in both process and outcome measures of clinical performance. Furthermore, FQHCs that fully adopted HIT had 7 percent higher clinical performance on hypertension control than those that did not adopt HIT. This study's findings can assist stakeholders to make informed decisions for improving care and sustaining a competitive advantage.
Efficacy of microsurgery for dural arteriovenous fistula
Authors: Song Guang-fu , Wang He , Li Xin , He Chuan , Mao Ming-li
Published: November 2019

Background:

Microsurgery is a treatment option for dural arteriovenous fistula (DAF), but its efficacy is still unclear. This study aims to assess the efficacy and safety of microsurgery for the treatment of patients with DAF.

Methods:

We will carry out this study assessing the use of microsurgery in patients with DAF from the following electronic databases: PUBMED, EMBASE, Cochrane Library, CINAHL, PsycINFO, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All those databases will be searched from inception to the present without language limitations. Two independent authors will perform study selection, data extraction, and methodological quality assessment. RevMan 5.3 Software will be applied for statistical analysis.

Results:

This study will assess the efficacy and safety of microsurgery for the treatment of patients with DAF through measuring initial treatment failure, late recurrence, neurological improvement, quality of life, and complications.

Conclusion:

This study will provide most recent evidence of microsurgery for the treatment of patients with DAF.

Dissemination and ethics:

The findings of this systematic review will be published in peer-reviewed journals. This systematic review dose not needs ethic approval, because it just analyzes the published data without individual information involvement.

Systematic review registration:

PROSPERO CRD42019144851.
Measurement of proximal tibial morphology in northeast Chinese population based on three-dimensional reconstruction computer tomography
Authors: Zhang Kesong , Han Qing , Wang Hecheng , Yang Kerong , Chen Bingpeng , Zhang Yong , Zhang Shiruo , Wang Jincheng , Chu Haichen
Published: November 2019

Tibial component of total knee arthroplasty (TKA) is designed according to morphology of proximal tibia to a large extent. Owing to racial difference, current design of tibial component based on Caucasian may not be suitable for Chinese patients. Meanwhile, data of proximal tibial morphology in Chinese population is lacking. The objective of this research was to investigate proximal tibial morphology of northeast Chinese population.

Computer tomography (CT) image of 164 northeast Chinese participants was collected. After three-dimensional (3D) reconstruction, size of tibia plateau and TKA resected surface were gauged to guide the design of TKA tibia prothesis in northeast Chinese population. Measurement of tibial size mainly includes tibial mediolateral length (tML), tibial medial/lateral anteroposterior length (tMAP and tLAP). Afterwards, tML/tAP ratio of tibia plateau and TKA resected surface were calculated as feature point of tibia prothesis. tMAP/tLAP ratio of TKA resected surface was calculated to represent tibial asymmetry degree. Medial and lateral posterior tibial slope (MPTS and LPTS) were also measured to give reference to posterior angle of tibia prothesis and angle of tibia osteotomy in TKA. Independent samplettest was performed to conduct statistical analysis,P < .05 was regarded as statistically significance.

Northeast Chinese male has larger knee size than female. Significant difference of tML/tAP ratio was also observed between male and female on tibia plateau (1.71 ± 0.07 vs 1.77 ± 0.09) but not on TKA resected surface (1.60 ± 0.05 versus 1.61 ± 0.06). Significant difference of tMAP/tLAP ratio between male and female was also found and they were 1.31 ± 1.03 and 1.11 ± 0.05 respectively. Northeast Chinese female has higher PTS than male (MPTS: 9.56 ± 2.96° vs 8.81 ± 2.87° and LPTS: 8.57 ± 3.19° vs 8.44 ± 2.76°).

Significant gender-difference of tibial size and asymmetry degree of tibial resected surface were found between northeast Chinese male and female. Meanwhile, northeast Chinese population has smaller knee size, larger PTS and tML/tAP ratio than that of Caucasian population. Therefore, Chinese-specific and gender-specific tibial prostheses were strongly recommended to be designed.
A comparison of clinical features between idiopathic membranous nephropathy patients with and without serum antibody against phospholipase A2 receptor
Authors: Zhang Qiuhua , Liu Xiaobin , Zhang Zhijian , Wu Mian , Huang Biao , Zhang Yi , Liu Bin , Qi Zhen , Shan Weiwei , Wang Liang , Hu Zhigang , Sun Zhuxing
Published: November 2019

Patients with idiopathic membranous nephropathy (IMN) can be categorized into phospholipase A2 receptor (PLA2R)-associated and non-PLA2R-associated cases, according to serum PLA2R antibody status. The present study aimed to determine whether clinical features differed between these.

A total of 89 patients with IMN were retrospectively recruited for the present study. Serum PLA2R-Ab levels were determined by time-resolved fluoroimmunoassay. Furthermore, the relationship between serum PLA2R antibody levels and their responses to immunosuppressants among patients with a complete follow-up period, which was defined as at least 1 year, was analyzed.

Among these enrollees, 71 (80.0%) patients were positive for serum PLA2R antibody. Furthermore, patients with PLA2R-associated IMN had significantly higher age (with vs without, 54.31 ± 14.03 vs 46.67 ± 13.30 years old; P = .04), proteinuria (4.32 ± 1.84 vs 3.29 ± 1.90 g/d, P = .039), and serum albumin (25.33 ± 9.60 vs 31.38 ± 9.52 g/L, P = .019), but had lower serum immunoglobulin G (6.83 ± 2.89 vs 8.72 ± 2.95 g/L, P = .016) and erythrocyte sedimentation rate (47.31 ± 32.11 vs 26.33 ± 27.94, P = .013), when compared to IMN patients without PLA2R. Furthermore, IMN patients without PLA2R exhibited a better response to immunosuppressants, when compared to patients with PLA2R-associated IMN (without vs with, 66.7% vs 62.5% at 6 months and 100% vs 87.5% at 12 months), but the difference was not statistically significant.

Patients with PLA2R-associated IMN had higher disease severity than IMN patients without PLA2R. Furthermore, PLA2R negative patients had a better response to immunosuppressive therapies than PLA2R-positive patients, but the difference was not statistically significant.
Using electroacupuncture with optimized acupoint positioning to predict the efficacy of sacral neuromodulation of refractory overactive bladder
Authors: Shen Jianwu , Luo Ran , Zhang Lu , Li Yujin , Ke Liupan , Gao Zhan
Published: November 2019

Rationale:

Overactive bladder (OAB) is a common disease in the female urinary system. Refractory OAB is an indication for sacral neuromodulation (SNM) therapy, which was approved by the Food and Drug Administration (FDA) of the United States. However, SNM does not alleviate the clinical symptoms in all refractory OAB cases. Patients are required to undergo an SNM stage 1 operation, a traumatic and costly procedure, to evaluate the clinical efficacy of the treatment. If the procedure is predicted to likely be ineffective, the patient has to bear the physical and economic losses. Here, we report a patient with a 3-year course of refractory urge urinary incontinence who was treated with electroacupuncture according to traditional Chinese medicine (TCM).

Patient concerns:

The patient was 73 years old and had frequent urination and urge urinary incontinence for 3 years; she had 24 to 30 counts of urination per day and 7 to 9 counts of urge incontinence. The patient was treated with multiple TCM and Western medicines and therapies. The TCM treatment consisted of several patented Chinese medicines and TCM decoctions. The Western medication comprised mainly antibiotics, alpha receptor antagonists, and muscarinic receptor antagonists. The treatment effect was unsatisfactory, and there was no apparent alleviation of symptoms; therefore, she underwent electroacupuncture.

Diagnosis:

Refractory OAB.

Interventions:

The patient received 30 days of TCM-based electroacupuncture with optimized acupoint positioning, which comprised a total of 10 sessions (1 electroacupuncture session every 2 days) targeting the bilateral Zhongliao and Sanyinjiao acupoints. After treatment, the patient experienced a good therapeutic outcome.

Outcomes:

After 30 days of electroacupuncture treatment, the average daily count of urination in 5 days decreased from 29.3 per day before treatment to 19.8 after treatment, and the average count of urge incontinence decreased from 9.3 before treatment to 5.8 after treatment. However, good prognosis was not stable. After careful consideration, the patient accepted SNM treatment, which greatly alleviated the symptoms of frequent urination and urge incontinence. The patient received follow-up visits for 2 years, during which she manifested stable curative effects.

Lessons:

The optimized positioning at the Zhongliao acupoint improves the accuracy of acupuncture. Accurate electroacupuncture alleviates the symptoms of refractory OAB by stimulating the Zhongliao and Sanyinjiao acupoints, as the underlying mechanisms are similar to those of SNM. Therefore, it is possible to use electroacupuncture to estimate the therapeutic effect of SNM, thereby providing a reference for patients and clinicians to determine whether SNM treatment will be effective.
The LMP2 CfoI polymorphism is associated with ankylosing spondylitis (AS) risk but not with acute anterior uveitis (AAU)
Authors: Qian Yufeng , Chen Bingqian , Sheng Xiaowen , Peng Yuqin
Published: November 2019

Background:

Ankylosing spondylitis (AS) is one of the most common chronic inflammatory disorders affecting the sacroiliac joints, spine, and peripheral joints. Apart from HLA-B27, the LMP2 gene has been shown to play a role in the pathogenesis of AS as well as AAU in AS. However, genetic associations between LMP2 CfoI polymorphism and AS and AAU were inconclusive. We aimed to investigate the correlation of LMP2 CfoI polymorphism and AS and AAU using meta-analysis.

Methods:

An exhaustive search was conducted using the PubMed, Embase, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI) electronic databases. The strength association was assessed by crude ORs with 95% CI.

Results:

Eight eligible records with 449 AS patients and 317 healthy controls were included in the present study. The allelic model of the LMP2 CfoI polymorphism is associated with AS risk (OR = 0.60, 95%CI = [0.32, 1.11], P = .003). A stratified analysis based on ethnicity has shown that the allelic model of LMP2 CfoI was associated with AS in the Caucasian population (OR = 0.72, 95%CI = [0.55, 0.93], P = .01) but not in the Asian population (P > .05). Furthermore, no association was detected between LMP2 CfoI polymorphism and AS complication (AAU).

Conclusion:

Our combined results revealed that the allelic model of LMP2 CfoI might be a protective factor for AS in the Caucasian population. Nevertheless, future studies on different ethnicities with larger sample sizes are needed to obtain a more convincing result.
Metabolic profiling of dialysate at sensitized acupoints in knee osteoarthritis patients
Authors: Li Sheng , Chai Xiao Ning , Zuo Chuan Yi , Lv Peng , Tang Yong , Tan Hui Juan , Liu Li Zhou , Yin Hai Yan , Yu Shu Guang
Published: November 2019

Background:

Acupuncture therapy is frequently used to treat Knee Osteoarthritis (KOA) in clinic, and usually used local acupoints near the diseased knees as therapeutic targets. Some local acupoints appeared sensitization phenomenon which was called sensitized acupoints, which were regarded as important therapeutic targets to get better therapeutic effect on clinic. Therefore, it is necessary to explore the biological basis of acupoint sensitization. Meanwhile, there is a lack of an analysis of the metabolism for sensitized acupoints in KOA patients. Considering that acupuncture effect could be multi-targeted, omics (such as metabolomics) may be a useful method to reveal the relationship between sensitized acupoints and clinical efficacy of acupuncture.

Methods and analysis:

This study is a parallel design trial. Thirty KOA patients and 30 healthy volunteers will be recruited in this study. Mechanical pain threshold will be measured by Electron Von frey in order to confirm the highest sensitized acupoints. Then collect tissue fluid from the highest sensitized acupoints by micro dialysis technical, then apply electro-acupuncture method on the highest sensitized acupoints to treat KOA patients, after 20 sessions treatments, measure and collect again. Liquid chromatography-tandem mass spectrometry method will be used to analyze the metabonomics of dialysate.

Results:

This study will provide a high-quality evidence to reveal the local molecular mechanism of acupuncture sensitized acupoints for patient with KOA.

Conclusion:

This study will provide up-date evidence of whether acupuncture sensitized acupoints have local molecular mechanism for KOA.
Trial registration number: NCT03599180 (24 Jul. 2018)
Interventions for cancer-related pain
Authors: Xu Tao , Lei Hanzhou , Zhang Yutong , Huang Siying , Wang Ziwen , Zhou Siyuan , Yang Jiao , Zheng Qianhua , Chen Jiao , Zhao Ling
Published: November 2019

Background:

Several treatments are beneficial for patients with cancer-related pain (CRP), and there are numbers of systematic reviews evaluating the effectiveness and safety of these treatments. However, the overall quality of the evidence has not been quantitatively assessed. The aim of this study is to overcome the inconclusive evidence about the interventions of CRP.

Methods:

We will perform an umbrella systematic review to identify eligible randomised controlled trials (RCTs). A comprehensive literature search will be conducted in MEDLINE, EMBASE, and the Cochrane library for systematic reviews, meta-analyses and RCTs. We will describe the general information of the RCTs for participants, interventions, outcome measurements, comparisons, and results. Network meta-analysis will be developed to determine the comparative effectiveness of the treatments.

Results:

The result of this network meta-analysis will provide direct and indirect evidence of treatments for CRP.

Conclusion:

The conclusion of our study will help clinicians and CRP patients to choose suitable treatment options.

Ethics and dissemination:

Formal ethical approval is not required, as the data are not individualized. The findings of this systematic review will be disseminated in a peer-reviewed publication and/or presented at relevant conferences.

PROSPERO registration number:

CRD42019131721.
Development and validation of a novel and robust blood small nuclear RNA signature in diagnosing autism spectrum disorder
Authors: Zhou Jinxia , Hu Qian , Wang Xijia , Cheng Wei , Pan Chunlian , Xing Xiaobin
Published: November 2019

Reliable molecular signatures are needed to improve the early and accurate diagnosis of autism spectrum disorder (ASD), and indicate physicians to provide timely intervention. This study aimed to identify a robust blood small nuclear RNA (snRNA) signature in diagnosing ASD. 186 blood samples in the microarray dataset were randomly divided into the training set (n = 112) and validation set (n = 72). Then, the microarray probe expression profiles were re-annotated into the expression profiles of 1253 snRNAs though probe sequence mapping. In the training set, least absolute shrinkage and selection operator (LASSO) penalized generalized linear model was adopted to identify the 9-snRNA signature (RNU1-16P, RNU6-1031P, RNU6-258P, RNU6-335P, RNU6-485P, RNU6-549P, RNU6-98P, RNU6ATAC26P, and RNVU1-15), and a diagnostic score was calculated for each sample according to the snRNA expression levels and the model coefficients. The score demonstrated a good diagnostic ability for ASD in the training set (area under receiver operating characteristic curve (AUC) = 0.90), validation set (AUC = 0.87), and the overall (AUC = 0.88). Moreover, the blood samples of 23 ASD patients and 23 age- and gender-matched controls were collected as the external validation set, in which the signature also showed a good diagnostic ability for ASD (AUC = 0.88). In subgroup analysis, the signature was robust when considering the confounders of gender, age, and disease subtypes, and displayed a significantly better performance among the female and younger cases (P = .039; P = .002). In comparison with a 55-gene signature deriving from the same dataset, the snRNA signature showed a better diagnostic ability (AUC: 0.88 vs 0.80, P = .049). In conclusion, this study identified a novel and robust blood snRNA signature in diagnosing ASD, which might help improve the diagnostic accuracy for ASD in clinical practice. Nevertheless, a large-scale prospective study was needed to validate our results.
Bevacizumab-induced immunoglobulin A vasculitis with nephritis
Authors: Endo Yoko , Negishi Kousuke , Hirayama Kento , Suzuki Hitoshi , Shimizu Akira
Published: November 2019

Rationale:

Bevacizumab—an inhibitor of vascular endothelial growth factor—is effective against various advanced cancers. However, it is associated with the development of hypertension and high-grade proteinuria during thrombotic microangiopathy of the kidney. In addition, there are several reports of immunoglobulin A deposition in the glomeruli, but the etiology is unclear.

Patient concerns:

A 67-year-old Japanese man with metastatic rectal cancer underwent low anterior rectal resection, followed by treatment with bevacizumab and SOX (S-1 plus oxaliplatin). Six months later, the patient developed hematuria, nephrotic syndrome, and purpura.

Diagnoses:

Renal biopsy revealed endocapillary proliferative glomerulonephritis. Immunofluorescence analyses showed granular mesangial deposition of galactose-deficient immunoglobulin A1. Skin biopsy revealed leukocytoclastic vasculitis.

Interventions:

We ceased bevacizumab treatment, while continuing the remaining chemotherapy regimen, as we suspected bevacizumab-induced nephropathy.

Outcomes:

Proteinuria and purpura improved immediately after cessation of bevacizumab. We identified this as a case of bevacizumab-induced immunoglobulin A vasculitis with nephritis.

Lessons:

To our knowledge, this is the first case of bevacizumab-related immunoglobulin A vasculitis with nephritis, as evidenced by galactose-deficient immunoglobulin A1. When a patient's urine tests are abnormal during bevacizumab treatment, clinicians should consider not only thrombotic microangiopathy but also vasculitis.
Immediate effects of kinesiology tape on the pain and gait function in older adults with knee osteoarthritis
Authors: Park Ji-Su , Yoon Taehyung , Lee Sang-Hoon , Hwang Na-Kyung , Lee Jung-Hoon , Jung Young-Jin , Lee Gihyoun
Published: November 2019

Background:

Osteoarthritis (OA) is a degenerative disease that not only causes knee pain in older adults, but also has an adverse effect on walking. Therefore, intervention for older patients with OA is important. To investigate the immediate effects of kinesiology taping (KT) on the pain and gait function of the older adults with knee OA.

Methods:

This study enrolled 10 older adults individuals living in the community who were diagnosed with knee OA. All participants were assessed for knee pain, walking ability, and balance before and after application of knee KT. Knee pain was assessed in resting and walking conditions using the visual analog scale. Walking and balance were assessed using a 10-m walking test and a timed up and go test.

Results:

In the present study, KT significantly improved gait and balance with reduction in knee pain during walking than non-KT (P < .05).

Conclusions:

This study demonstrated that knee KT has a positive effect on pain reduction and walking and balance ability of the older adults with OA. Therefore, this study suggests that KT can be used as an intervention to relieve knee pain and aid walking and balance ability in the older adult.
Short-term exposure to particulate matters is associated with septic emboli in infective endocarditis
Authors: Hsieh Fu-Chien , Huang Chun-Yen , Lin Sheng-Feng , Sun Jen-Tang , Yen Tzung-Hai , Chang Chih-Chun
Published: November 2019

This survey was to investigate the short-term effect of particulate matters (PMs) exposure on clinical and microbiological variables, especially septic emboli, in infective endocarditis (IE). The study analyzed 138 IE patients in Far Eastern Memorial Hospital from 2005 to 2015 and clinical variables were retrospectively requested. The data of air quality were recorded and collected by a network of 26 monitoring stations spreading in Northern part of Taiwan. We found that IE patients with septic emboli were found to be exposed to a significantly higher level of PM2.5 (32.01 ± 15.89 vs. 21.70 ± 13.05 μg/m3, P < .001) and PM10 (54.57 ± 24.43 vs 40.98 ± 24.81 μg/m3, P = .002) on lag 0 day when compared to those without. Furthermore, multivariate regression analysis revealed that that ambient exposure to PM2.5 (odds ratio: 3.87, 95% confidence interval: 1.31–8.31; P = .001) and PM10 (odds ratio: 4.58, 95% confidence interval: 2.03–10.32; P < .001) significantly increased risk of septic emboli in IE patients. To our knowledge, this is the first study demonstrating that short-term exposure to PMs was associated with septic emboli in IE.
Increased risk of eczema after joint replacement
Authors: Wu Po-Yuan , Muo Chih-Hsin , Tsai Chun-Hao
Published: November 2019

There are very few reports of eczema and other prosthetic-related allergic skin complications following arthroplasty. We aimed to assess the risk of eczema after joint replacement.

We performed a retrospective population-based cohort study in 2024 joint replacement patients using the Longitudinal Health Insurance Database. For comparison, 8096 controls were selected, with 4 control subjects for each joint replacement patient matched for age, sex, and index year, to assess eczema risk. We examined 14-year cumulative eczema incidence associated with age, sex, immunity, disease history, and joint replacement location.

Eczema rates in the joint replacement patients were 38% higher than in the control group (57.90 vs 41.84 per 1000 person-years, respectively). Compared with the control group, joint replacement patients showed a 1.35-fold increased risk of eczema according to the multivariable Cox model (95% Confidence interval [CI] = 1.23–1.49). Knee replacement patients had higher eczema risk compared with the control group (Hazard ratio [HR] = 1.45, 95% CI = 1.33–1.70). Stratified by study period, the joint replacement cohort had a higher eczema risk after the 3-month follow-up.

Our study revealed that joint arthroplasty increased risk of eczema in this 14-year follow-up study, and this was not related to personal atopic history or gender.
Surgical versus trans-catheter aortic valve replacement (SAVR vs TAVR) in patients with aortic stenosis
Authors: Ziv-Baran Tomer , Zelman Richard B. , Dombrowski Philip , Schaub Amber E. , Mohr Rephael , Loberman Dan
Published: November 2019

Trans-catheter aortic valve replacement (TAVR) has become an alternative to surgical aortic valve replacement (SAVR) in high and intermediate risk patients with aortic stenosis. TAVR programs are spreading from large referral centers and being established in community based institutions. The purpose of this study was to compare the outcomes of TAVR to those of SAVR in a community hospital.

A historical cohort study of patients with aortic stenosis and pre-post procedure echocardiography data who underwent SAVR or TAVR in Cape Cod Hospital between January 2014 and December 2016. Patient characteristics and procedure outcomes were compared between the two procedures.

The study included 230 patients, of them 111 underwent SAVR and 119 underwent TAVR. None of the patients died during the 30 days after the procedure. TAVR patients had higher rates of postoperative mild+ aortic regurgitation (AR) (29.4% vs 12.6%, P = .002), postoperative atrial ventricular blocks (11.8% vs 0.9%, P = .001), and more often need an implantation of pacemaker (16.8% vs 0.9%, P < .001). Postoperative mean gradient of SAVR patients was higher (median 14 vs 11 mm Hg, P = .001) and atrial fibrillation postoperatively was more frequent (18.9% vs 2.5%, P < .001). Length of stay after procedure was shorter in TAVR patients (median 2 vs 4 days, P < .001).

After controlling for confounders, the use of TAVR was associated with an increased risk for postoperative pacemaker implantation (OR = 16.3, 95%CI 1.91–138.7, P = .011), lower mean gradient (−4.327, 95%CI −7.68 to −0.98, P = .011), and lower risk for atrial fibrillation (OR = 0.11, 95%CI 0.03–0.38, P = .001), but not with postoperative AR (OR = 0.84, 95%CI 0.22–3.13, P = .789).

In conclusion, short-term mortality was not reported in SAVR or TAVR patients. However, TAVR was associated with an increased risk for postoperative pacemaker implantation but with a lower risk for atrial fibrillation. Aortic valves implanted through a trans-catheter approach are also associated with a better hemodynamic performance.
Probiotics supplement in children with severe hand, foot, and mouth disease
Authors: Zhang Haibo , Zhang Lei , Xie Jiadong , Wen Wenting , Wei Luxia , Nie Bo
Published: November 2019

Background:

Severe hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by infection with serotypes of Enterovirus A, most commonly by enterovirus A71 and coxsackievirus A16. Clinical symptoms usually include fever, malaise, rashes on hands and feet, and oral vesicles. Of note, severe and even life-threatening complications can develop rapidly in young children, such as acute pulmonary edema, cardiopulmonary failure, aseptic meningitis, encephalitis and acute flaccid paralysis. Probiotics supplement have been demonstrated play a positive role as a therapeutic approaches for modulation of gut microbiota. This study aims to systematically investigate the efficacy and safety of probiotics for children with severe HFMD.

Methods:

All randomized controlled trials related to probiotics and severe HFMD will be searched in 9 electronic databases (PubMed, Cochrane Library, Embase, ClinicalTrails, China National Knowledge Infrastructure, Sino Med, ScienceDirect, VIP, and Wanfang Data databases) from their inception to November 2019. The primary outcome is total effective rate, fever clearance time, rash regression time, remission time of neurological symptoms, and clinical cure time. Two researchers will perform the study selection, data extraction, and assessment of risk of bias independently. RevMan software (version 5.3) will be used for data synthesis.

Results:

The findings of this study will be published in a peer-reviewed journal.

Conclusion:

The study will provide evidence to judge whether probiotics is an effective therapeutic intervention for severe HFMD.

PROSPERO registration number:

PROSPERO CRD42019152946.
Handgrip Strength Is Associated With Hippocampal Volume and White Matter Hyperintensities in Major Depression and Healthy Controls: A UK Biobank Study
Authors: Firth Josh A. , Smith Lee , Sarris Jerome , Vancampfort Davy , Schuch Felipe , Carvalho Andre F. , Solmi Marco , Yung Alison R. , Stubbs Brendon , Firth Joseph
Published: November 2019

Objective

Emerging evidence suggests that handgrip strength (a proxy for muscular fitness) is associated with better cognitive performance in people with major depressive disorder (MDD). The underlying processes are unclear, although hippocampal volume (HCV) reductions and white matter hyperintensities (WMHs) have been implicated. Therefore, we investigated the associations between handgrip strength and various brain region volumes and WMHs in MDD and healthy controls (HCs).

Methods

This study is a cross-sectional analysis of handgrip strength and neuroimaging data from the UK Biobank. Generalized linear models were used to assess the relationship between grip strength and gray matter, white matter, total brain volume, left and right hippocampus volume, and WMHs in MDD and HCs, adjusting for age, sex, education, and body weight.

Results

The sample included 527 people with MDD (54.3 ± 7.3 years, 37.2% male) and 1764 HCs (56.6 ± 7.2 years, 53% male). In MDD, stronger handgrip was significantly associated with increased left (coefficient ± SE = 108.1 ± 27.6, t = 3.92) and right (76.8 ± 30.4, t = 2.53) HCV. In HCs, only right HCV related to handgrip strength (44.8 ± 18.1, t = 2.47). Interaction analyses found stronger associations between grip strength and HCV in MDD compared with HCs, for both hippocampal regions. Stronger handgrip was associated with reduced WMHs in people with MDD (−0.24 ± 0.07, t = −3.24) and HCs (−0.11 ± 0.04, t = −2.47). Maximal handgrip strength was not associated with gray matter, white matter, or total brain volumes in either group.

Conclusions

Stronger grip strength is associated with greater left and right HCV and reduced WMHs in MDD. Future research should investigate directionality and consider if interventions targeting strength/muscular fitness can improve brain health and reduce the neurocognitive abnormalities associated with MDD.
Consistency of Visual Evoked Potential in Extraocular Manifestations of Behcet Disease and Impact of Corticosteroid Treatment
Authors: Mahgoub Marwa Yahia , Elmohamady Mohamed Nagy
Published: November 2019

Purpose:

To study the ability of pattern reversal visual evoked potentials (VEPs) to detect subclinical visual pathway pathologic assessment in Behcet disease (BD) and correlate VEP results in BD with disease activity and response to corticosteroid treatment.

Methods:

This study included 18 patients (36 eyes) with BD without recent ocular manifestations and 20 healthy controls (40 eyes). Clinical history was taken, and clinical examinations were done. Visual evoked potential recordings were performed by an electromyographic evoked machine for patients and controls. Corticosteroids were given to patients with extraocular activity, and VEP was repeated after clinical and laboratory improvement of the manifestations.

Results:

p100 latency of VEP was prolonged in 8 patients (11 eyes) (44.4% of cases). Mean p100 latency showed statistically significant prolongations in BD group compared with the control group (106.7 ± 8.1 ms vs. 99.6 ± 1.9 ms) with P value < 0.001. There was a positive correlation between p100 latency and the disease activity score (r = 0.8673), whereas there was no correlation between p100 latency and the disease duration (r = 0.00072). Patients treated with corticosteroids showed statistically significant reduction in mean p100 latency after treatment (P < 0.001).

Conclusions:

Visual evoked potential may be a valuable tool for detecting subclinical neurologic affection in BD.
Cortical Spreading Depression Phenomena Are Frequent in Ischemic and Traumatic Penumbra: A Prospective Study in Patients With Traumatic Brain Injury and Large Hemispheric Ischemic Stroke
Authors: Sueiras Maria , Thonon Vanessa , Santamarina Estevo , Sánchez-Guerrero Ángela , Poca Maria A. , Quintana Manuel , Riveiro Marilyn , Sahuquillo Juan
Published: November 2019

Purpose:

Spreading depolarization (SD) phenomena are waves of neuronal depolarization, which propagate slowly at a velocity of 1 to 5 mm/minute and can occur in patients with ischemic or hemorrhagic stroke, traumatic brain injury, and migraine with aura. They form part of secondary injury, occurring after spreading ischemia. The purposes of this study were to describe the frequency and characteristics of SD phenomena and to define whether a correlation existed between SD and outcome in a group of patients with TBI and large hemispheric ischemic stroke.

Methods:

This was a prospective observational study of 39 adult patients, 17 with malignant middle cerebral artery infarction and 22 with moderate or severe traumatic brain injury, who underwent decompressive craniectomy and multimodal neuromonitoring including electrocorticography. Identification, classification, and interpretation of SDs were performed using the published recommendations from the Cooperative Study on Brain Injury Depolarization group. The outcomes assessed were functional disability at 6 and 12 months after injury, according to the extended Glasgow outcome scale, Barthel index, and modified Rankin scale.

Results:

Four hundred eighty-three SDs were detected, in 58.9% of the patients. Spreading depolarizations were more common, particularly the isoelectric SD type, in patients with malignant middle cerebral artery infarction (P < 0.04). In 65.21% of patients with SDs on electrocorticography, the “peak” day of depolarization was day 0 (the first 24 hours of recording). Spreading depolarization convulsions were present in 26.08% of patients with SDs. Patients with more SDs and higher depolarization indices scored worse on extended Glasgow outcome scale (6 months) and Barthel index (6 and 12 months) (P < 0.05).

Conclusions:

Evidence on SD phenomena is important to ensure continued progress in understanding their pathophysiology, in the search for therapeutic targets to avoid additional damage from these secondary injuries.
Using genetic variation to disentangle the complex relationship between food intake and health outcomes
Authors: Pirastu Nicola , McDonnell Ciara , Grzeszkowiak Eryk J. , Mounier Ninon , Imamura Fumiaki , Merino Jordi , Day Felix R. , Zheng Jie , Taba Nele , Concas Maria Pina , Repetto Linda , Kentistou Katherine A. , Robino Antonietta , Esko Tõnu , Joshi Peter K. , Fischer Krista , Ong Ken K. , Gaunt Tom R. , Kutalik Zoltan , Perry John R. B. , Wilson James F.
Published: November 2019

Despite food choices being one of the most important factors influencing health, efforts to identify individual food groups and dietary patterns that cause disease have been challenging, with traditional nutritional epidemiological approaches plagued by biases and confounding. After identifying 302 individual genetic determinants of dietary intake in 445,779 individuals in the UK Biobank study, we develop a statistical genetics framework that enables us, to directly assess the impact of food choices on health outcomes. We show that the biases which affect observational studies extend also to GWAS, genetic correlations and causal inference through genetics, which can be corrected by applying our methods. Finally, by applying Mendelian Randomization approaches to the corrected results we identify some of the first robust causal associations between eating patterns and cancer, heart disease, obesity, and several other health related risk factors, distinguishing between the effects of specific foods or dietary patterns.
Experimentally revealed stochastic preferences for multi-component choice options
Authors: Pastor-Bernier Alexandre , Volkmann Konstantin , Stasiak Arkadiusz , Grabenhorst Fabian , Schultz Wolfram
Published: November 2019

Realistic, everyday rewards contain multiple components. An apple has taste and size. However, we choose in single dimensions, simply preferring some apples to others. How can such single-dimensional preference relationships refer to multi-component choice options? Here, we measured how stochastic choices revealed preferences for two-component milkshakes. The preferences were intuitively graphed as indifference curves that represented the orderly integration of the two components as trade-off: parts of one component were given up for obtaining one additional unit of the other component without a change in preference. The well-ordered, non-overlapping curves satisfied leave-one-out tests, followed predictions by machine learning decoders and correlated with single-dimensional Becker-DeGroot-Marschak (BDM) auction-like bids for the two-component rewards. This accuracy suggests a decision process that integrates multiple reward components into single-dimensional estimates in a systematic fashion. In inter-species comparisons, human performance matched that of highly experienced laboratory monkeys, as measured by accuracy of the critical trade-off between bundle components. These data describe the nature of choices of multi-component choice options and attest to the validity of the rigorous economic concepts and their convenient graphic schemes for explaining choices of human and non-human primates. The results encourage formal behavioral and neural investigations of normal, irrational and pathological economic choices.