bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of urinary renalase on early-stage renal damage in Chinese adults with primary hypertension
Authors: You Na-Na , Jiang Wei-Hong , Lin Ming-Yuan , Li Xiao-Gang , Wu Yu-Yan , Li Jia-Ying , Zhou Xiao-Yu , Ding Ze-Wen , Wang Jun-Wen , Zhao Xie-Xiong , Chen Hui-Ling , Tang Hui-Ting
Published: February 2020

It would be of great clinical value to find an indicator that can accurately evaluate the early-stage renal injury in primary hypertension. Previous findings have shown renalase not only plays an important role in hypertension but also closely correlates with kidney function. The purpose of this study is to investigate whether urinary renalase could be used as a predictive index of early-stage renal damage in patients with primary hypertension. Urinary albumin to creatinine ratio (UACR) was used to divide subjects with primary hypertension into two groups: a no renal damage (NRD) group (UACR <30 mg/g) and an early-stage renal damage (RD) group (UACR >30 mg/g). Subjects with normal examination results were randomly included in a healthy control (HC) group. Urinary renalase was determined through an enzyme-linked immunosorbent assay (ELISA). Urinary renalase continued to reduce among the HC (n = 81), NRD (n = 84) and RD group (n = 80), while systolic blood pressure (SBP) increased. Urinary renalase was negatively correlated with SBP in all the groups. Among the subjects with stage 1 primary hypertension, urinary renalase in the RD group was lower than the NRD group, while the UACR was higher, and urinary renalase was negatively correlated with the UACR. A multiple linear stepwise regression analysis showed that there was a linear regression relationship between the increase of the UACR and urinary renalase, heart rate (HR), SBP and serum creatinine. In addition, the standardized partial regression coefficient of urinary renalase was the highest. The performance of urinary renalase as a marker for the diagnosis of early-stage renal damage in patients with primary hypertension was 0.968 with a cut off value of 2.01 µg/ml. Taken together, urinary renalase was further decreased in patients with early-stage renal damage and primary hypertension, and consequently, it could be used as a predictive index.

Impact statement

In patients with early-stage kidney damage of primary hypertension, there are no obvious structural or functional changes, which leads to a high level of diagnostic omissions. Therefore, it would be of great clinical value to find an indicator that can accurately evaluate the early-stage renal injury in primary hypertension. Urinary albumin to creatinine ratio (UACR) is a classic indicator used in early-stage renal damage, but it is affected by many factors. Renalase, a protein discovered by Xu in 2005, not only plays an important role in hypertension but also closely correlates with kidney function. In our study, we found that urinary renalase was further decreased in patients with early-stage renal damage in primary hypertension, and it could be used as a predictive index. This finding could help to diagnose the early-stage renal damage in primary hypertension much earlier and improve the prognosis of these patients.
An enhanced media ciphertext-policy attribute-based encryption algorithm on media cloud
Authors: Li Hao , Deng Lianbing , Yang Cheng , Liu Jianbo
Published: February 2020

With the development of cloud computing, more and more video services are moving to the cloud. How to realize fine-grained access control of those data on cloud becomes an urgent problem. Attribute-based encryption provides a solution. However, heavy computation is still a bottleneck restricting the wider application of attribute-based encryption in cloud computing. In addition, we find that expression of the access control structure on media cloud can be further improved. To solve these problems, we propose an enhanced media ciphertext-policy attribute-based encryption algorithm and introduce its two key components, the multiple access tree and the key chain. To increase the scalability of the proposed algorithm, we discussed the issues of multi-authorization, user revocation, and 1 − n multiple access tree. Security analysis shows that enhanced media ciphertext-policy attribute-based encryption can successfully resist chosen-plaintext attacks under the decisional bilinear Diffie–Hellman assumption. Performance analysis proves both theoretically and practically that the proposed algorithm incurs less computational cost than the traditional ciphertext-policy attribute-based encryption, multi-message ciphertext-policy attribute-based encryption, and scalable ciphertext-policy attribute-based encryption by optimizing the access control structure. Our proposed algorithm has strong practical significance in media cloud.
Comment on the Proposed Institutional Review Board Retrospective Review of Research
Authors: Tsan Min-Fu
Published: February 2020

Investigators of nonexempt human subjects research conducted without prior institutional review board (IRB) approval often have difficulties in publishing data obtained from such research. Retrospective review and approval of such research has been suggested as a potential pathway for an IRB to help these investigators to publish those data. However, under the Common Rule, an IRB has no authority to retrospectively review and approve human subjects research. Prevention remains the best strategy to ensure that no nonexempt human subjects research is initiated prior to IRB approval.
Media resonance and conflicting memories: Historical event movies as conflict zone
Authors: Ebbrecht-Hartmann Tobias
Published: February 2020

The three-part German television drama Generation War (2013) created a national and subsequently international debate about the past and present of wartime memories. While these discussions were framed nationally as intergenerational dialogue, in the context of a unified Europe that is still struggling with its own self-perception and identity, the framework of international disputes about interpretation of the war was marked by conflicting memories. As a result, and within the increasingly interdependent network of popular television, transnational media and conflicting European memories, Generation War became a televised conflict zone. This article analyses the film as a historical event movie that borrows central aspects from the docudrama genre. It argues that the extra-textual dimension of such programmes is gaining more and more importance for creating resonance effects and thereby also delineates a model of media resonance that reflects the mainly overlooked role that resonance plays with regard to memory processes.
Functional and radiological results of partial capitate shortening osteotomy in the treatment of Kienböck’s disease
Authors: Yıldırım Abdurrahman Murat , Piskin Ahmet , Karaismailoglu Bedri , Sener Muhittin
Published: February 2020

This study assessed the functional and radiological results of partial capitate shortening osteotomy in the treatment of Lichtman stage 2 and 3A Kienböck's disease. Nineteen patients who underwent partial capitate shortening osteotomy between 2014 and 2017 were included. Functional and radiological parameters were assessed both pre- and postoperatively. The mean age was 35 years and the mean follow-up was 16 months. Pain scores, wrist range of motion, hand and finger strength, carpal height ratio and lunate height were significantly improved compared with their preoperative values. Sixteen patients were able to return to work. Ten of them had complete and six had partial revascularization. The mean time taken to return to work was 62 days. No vascularity was achieved in three patients who were unable to return to work. Partial capitate shortening osteotomy is effective in the treatment of stage 2 and 3A Kienböck's disease with successful results both functionally and radiologically.

Level of evidence: IV
Optimizing lifestyle interventions in adult patients with comorbid asthma and obesity
Authors: Kuder Margaret M. , Nyenhuis Sharmilee M.
Published: February 2020

The prevalence of obesity and asthma are both increasing at alarming rates. The link between obesity and asthma suggests that obesity contributes to both risk of new onset asthma and increased asthma severity. The emerging evidence demonstrating the role of obesity and other lifestyle factors, such as diet and physical activity, on asthma outcomes warrants lifestyle interventions that can address these components of asthma care. This review examines the current literature on the pathophysiology of obesity’s role in asthma, as well as the role of diet and physical activity in weight loss and in asthma outcomes. We discuss recent studies that employ lifestyle interventions to target improved asthma outcomes. Finally, we discuss the future direction of research in this area.

The reviews of this paper are available via the supplemental material section.
Total Temporomandibular Joint Replacement: Stick to Stock or Optimization by Customization?
Authors: De Meurechy Nikolas K. G. , Zaror Carlos E. , Mommaerts Maurice Y.
Published: February 2020

Purpose:

This article aims to compare the difference in postoperative results in patients treated with either a patient-specific (PSI) or a stock temporomandibular total joint replacement system.

Materials and Methods:

The investigators performed a systematic review concerning postoperative results after placement of either a stock total joint replacement system or a PSI. PubMed Central, Web of Science, Cochrane Library Plus, Wiley Online Library, and EMBASE were used to conduct this search. All articles up to August 15, 2018, were scrutinized. All included articles were nonrandomized cohort studies. Maximal mouth opening (MMO) and Visual Analog Scale (VAS) scores for pain and diet before and after surgery were evaluated. The Methodological Index for NonRandomized Studies scale was used for quality assessment. Weighted mean difference was calculated and pooled by meta-analysis using random-effect models.

Results:

The search identified 1581 articles, of which 15 were included. The average risk of bias was low. Both systems achieved significant increases in MMO and decreased VAS pain scores at 1, 2, and 3 years after surgery. No significant difference was found between the system types. Both achieved significant improvements in dietary VAS scores, with a more significant improvement for stock implants.

Conclusions:

Due to the lack of detailed diagnostic evaluation tools allowing proper start-point categorization, there is a significant risk for selection bias in the pooled data. The PSI is more frequently chosen for cases with more significant joint degeneration, skewing postoperative results. A patient-fitted implant can provide significant operative and patient-centered advantages over a stock implant, which will likely be confirmed when observational cohort studies have included indications like the ones for stock prostheses. Furthermore, while current US Food and Drug Administration-approved stock implants contain cobalt -chromium -molybdenum, the newly manufactured PSI are made of titanium alloy, diminishing the risks of morbidity and implant failure.
Cardiac rehabilitation of elderly patients in eight rehabilitation units in western Europe: Outcome data from the EU-CaRE multi-centre observational study
Authors: Prescott Eva , Eser Prisca , Mikkelsen Nicolai , Holdgaard Annette , Marcin Thimo , Wilhelm Matthias , Gil Carlos Peña , González-Juanatey José R , Moatemri Feriel , Iliou Marie Christine , Schneider Steffen , Schromm Eike , Zeymer Uwe , Meindersma Esther P , Crocamo Antonio , Ardissino Diego , Kolkman Evelien K , Prins Leonie F , van der Velde Astrid E , Van’t Hof Arnoud WJ , de Kluiver Ed P
Published: February 2020

Aims

The European Cardiac Rehabilitation in the Elderly (EU-CaRE) HORIZON 2020 project compares the sustainable effects of cardiac rehabilitation (CR) in elderly patients.

Methods and results

A total of 1633 patients with coronary artery disease (CAD) or heart valve replacement (HVR), with or without revascularization, aged 65 or above, who participated in CR were included. Peak oxygen uptake (VO2peak), smoking, body mass index, diet, physical activity, serum lipids, psychological distress and medication were assessed before and after CR (T0 and T1) and after 12 months (T2). Patients undergoing coronary artery bypass surgery or surgical HVR had lower VO2peak at T0 and a greater increase to T1 and T2 (2.8 and 4.4 ml/kg/min, respectively) than CAD patients undergoing percutaneous or no revascularization (1.6 and 1.4 ml/kg/min, respectively). After multivariable adjustment, earlier CR uptake was associated with greater improvements in VO2peak. The proportion of CAD patients with three or more uncontrolled risk factors declined from 58.4% at T0 to 40.1% at T2 ( p < 0.0001). Psychological distress scores all improved and adherence to medication was overall good at all sites. There were significant differences in risk factor burden across sites, but no CR program was superior to others.

Conclusions

The outcomes of VO2peak in CR programs across Europe seemed mainly determined by timing of uptake and were maintained or even further improved at 1-year follow-up. Despite significant improvements, 40.1% of CAD patients still had three or more risk factors not at target after 1 year. Differences across sites could not be ascribed to characteristics of the CR programs offered.
“Ramp lesions” of the posterior segment of the medial meniscus: what is repaired? An anatomical and histological study
Authors: Nicolas Quentin , Francia Rémi Di , Le Henaff Goulven , Quintin-Roue Isabelle , Gunepin François-Xavier , Dubrana Frédéric
Published: February 2020

Background:

Lesions of the posterior segment of the medial meniscus are the most common intra-articular lesions associated with anterior cruciate ligament injury. “Ramp lesions” have been defined as a tear in the peripheral attachment of the posterior horn of the medial meniscus (PHMM). These injuries are difficult to detect on preoperative MRI, whereas their prevalence with arthroscopy can be as high as 24%. The management of “Ramp lesions” isn’t collegiale. There are only two publications in PUBMED concerning anatomic and histological description posterior menisco-tibial ligament ( PMTL). The objective of this histological study was to analyze the posterior segment of the medial meniscus and its meniscosynovial junction, in order to identify the PMTL.

Methods:

We dissected ten cadaveric knees. A posterior approach to the posteromedial capsule was used. Therefore, we were able to access the posterior segment of the medial meniscus and its meniscosynovial junction. The proximal capsule, the posterior segment of the medial meniscus, the entire meniscal capsular-tibial junction, and a fragment of the tibia were removed together. For each part, three section slices were prepared for the histological study.

Results:

Macroscopically, the meniscotibial attachments was pellucid, homogeneous. The meniscocapsular attachments was pellucid, homogeneous but appeared to be strengthened at both the anterior and posterior portions of the capsule. The microscopic study of meniscosynovial jonction revealed loose collagen fibers, oriented but not organized parallel, network with rare fibroblasts and and adipocytes, several capillaries were seen. No histological differences were observed, and the 2 attachments merged at a common attachment site on PHMM.

Conclusion:

For us, “Ramp lesion” is a tear of common attachment of menicocapsular and meniscotibial junctions of PHMM. This attachment is vascularized, an outfit is possible and biomechanical role is increasingly identified.
The Literary Exception: Reflections on Agamben's “Liberal Democratic” Political Theology and the Religious Destabilisation of the Political in our Time
Authors: Van Der Walt Johan
Published: February 2020

The concern with stabilising the political and avoiding the excessive deployments of coercive force by totalitarian political imaginations is usually associated with political liberalism and liberal political theory. It is rarely associated with political theology and conceptions of sovereignty that are based on political theology. The unique contribution of the Italian philosopher Giorgio Agamben to contemporary political theory is the opportunity it offers to contemplate the stabilisation of the political in terms of political theology and not in terms of typical rule of law arguments that one would associate with political liberalism. The aim of this article is to trace and question some of the essential thoughts on the basis of which Agamben puts forward the idea of the called existence of the Christian community. It does so in order to put forward, in response, an argument for a literary community that has much in common with Agamben's conception of the Christian ekklesia, but ultimately also differs from it in certain important respects. The argument for a literary community that is developed ultimately has more in common with Nancy's conception of an “inoperative community”. The article also offers a close scrutiny of Agamben's engagement with the work of Carl Schmitt. This scrutiny of Agamben's engagement with Schmitt is crucial for the argument that the article forwards, considering the way in which Schmitt's work is with good reason historically linked to exactly the kind of political theology that destabilises rather than stabilises the political.
Party Politics Triumph over Substantive Scrutiny and Principled Policy: Examining Czech MPs’ Voting Behaviour in Regard to EU Affairs
Authors: Kuta Martin
Published: February 2020

The paper deals with the European dimension of the competition and contention between Czech political parties and argues that domestic party interests undermine the formal oversight of EU politics by the Czech national parliament. Within the current institutional arrangements, national political parties assume stances – which are expressed through voting – towards the European Union (and European integration as such) as they act in the arena of national parliaments that are supposed to make the EU more accountable in its activities. Based on an analysis of roll-calls, the paper focuses on the ways the political parties assume their stances towards the EU and how the parties check this act by voting on EU affairs. The paper examines factors that should shape parties’ behaviour (programmes, positions in the party system, and public importance of EU/European integration issues). It also focuses on party expertise in EU/European issues and asserts that EU/European integration issues are of greater importance in extra-parliamentary party competition than inside the parliament, suggesting a democratic disconnect between voters and parliamentary behaviour. The study's empirical analysis of the voting behaviour of Czech MPs also shows that the parliamentary scrutiny introduced by the Lisbon Treaty is undermined by party interests within the system.
Deter and Engage: Making the Case for Harmel 2.0 as NATO's New Strategy
Authors: Kühn Ulrich
Published: February 2020

This intervention argues that NATO needs a new strategy towards Russia. The current strategy is imbalanced because it over-emphasizes power and risks negatively affecting the European security order. A new strategy should recall the 1967 Harmel Report, which successfully combined the security elements of power, order, and liberal values. Today, such a balanced strategy is again needed. A new Harmel strategy (Harmel 2.0) should, like its predecessor, rely on a combination of deterrence and engagement. This intervention thus argues that in the realm of power, NATO needs to respond to Russia's hybrid warfare threats with conventional reassurance and societal soft power measures and that securing the Allies’ economic vulnerabilities while leaving NATO's current nuclear posture untouched will also be crucial. In the realm of order, NATO needs to re-engage on cooperative security and the instruments of arms control, and it is argued that a pause to further NATO enlargement would be helpful. Finally, in the realm of liberal values, the Allies should lower their expectations as a gesture of recognition that they cannot change the domestic situation in Russia in the short term, but they should address the attitudes of certain member states in that realm. In order to succeed with such a multi-pronged strategy, the Allies need to better coordinate their policies in the OSCE and amongst EU countries.
An Unending Quest for Russia's Place in the World: The Discursive Co-evolution of the Study and Practice of International Relations in Russia
Authors: Omelicheva Mariya Y. , Zubytska Lidiya
Published: February 2020

The idea of ‘Global IR’ generated a growing interest in ‘national schools’ of IR and their contribution to understanding the diversity of international relations. As a part of this discussion, the current study is set to explore what has been presented as Russian IR theory and its utility for understanding Russian foreign policy and international relations. Our contention is that there is still not a Russian ‘national school’ of IR with a distinct set of concepts and theories, research methods, and standards for assessing its legitimate contributions to global knowledge. Strongly influenced by the theoretical developments in the West, Russian IR has produced a number of conceptual innovations for the study of IR, but its highly ideological and relativist character limits its global appeal. The dominant Russian IR perspectives resonate with the world imagery and foreign policy agenda of the Kremlin administration not because they offer a novel and productive way of studying Russian foreign policy, but because Russian theoretical perspectives have been shaped, by and large, by political rather than academic considerations. To map out the complex theoretical landscape of Russian IR and how it relates to perspectives of Russian foreign policy-makers, this study employs discourse theory to analyse the co-evolution of the study and practice of Russian IR.
Prague at the End of History
Authors: Sayer Derek
Published: February 2020

The Prague Address, for the European International Studies Association (EISA) 12th Pan-European Conference on International Relations, Prague, September 12, 2018.

What we call “progress” is confined to each particular world, and vanishes with it. Always and everywhere in the terrestrial arena, the same drama, the same setting, on the same narrow stage – a noisy humanity infatuated with its own grandeur, believing itself to be the universe and living in its prison as though in some immense realm, only to founder at an early date along with its globe, which has borne with deepest disdain the burden of human arrogance.

Auguste Blanqui (1872, as quoted in Benjamin, 1999: 25)
Brexit and EU Legitimation: Unwitting Martyr for the Cause?
Authors: Beaumont* Paul
Published: February 2020

Drawing upon emerging trends across Europe, this essay argues that the painful learning Britain undergoes via Brexit, looks set to become a useful lesson for the rest of the EU. Not unlike how Europe's bloody past once served as shorthand for justifying the EU's existence, should Brexit continue to humiliate Britain and result in recession, it will provide a new and powerful symbolic resource capable of legitimating membership and making up for the EU's democratic deficit. As such, Britain looks set to become an unwitting martyr for the EU cause. Contrary to the prevailing wisdom then, a no-deal Brexit may be the optimum outcome for the EU because it would best illuminate the folly of leaving and therefore publicly crystalize the benefits of membership.
Ethnographic studies in international human resource management: Types and usefulness
Authors: Mahadevan Jasmin
Published: February 2020

This article provides a first conceptual discussion of the usefulness of ethnography for International Human Resource Management. In line with its original anthropological meaning, ethnography is understood as a multi-paradigmatic mindset involving five interrelated strands, all of which have the potential to contribute to International Human Resource Management studies. Structural-functionalist ethnography enables deep comparison and can thus contribute, for instance, to meeting the structural and institutional integration challenges of International Human Resource Management. Interpretive ethnography sheds light onto the hidden realities of International Human Resource Management and can thus help, for example, to acknowledge the diversity of employee and stakeholder experiences. Critical, postmodern, and postcolonial ethnography reveal the power-inequalities associated with diverse frameworks, practices, and work experiences in a global context. They can thus help overcome the inherent power-inequalities of International Human Resource Management and might utilize previously marginalized knowledge for the development of alternative International Human Resource Management strategies and practices. Yet, leveraging the full potential of ethnography for International Human Resource Management studies requires International Human Resource Management scholars not to borrow pre-selected ethnographic approaches, such as interpretive ethnography, from related disciplines, such as International Business and Cross-Cultural Management, because these might not fit the specific needs of International Human Resource Management. For facilitating this goal, this article provides a first multi-paradigmatic discussion of the development and principles of ethnography in anthropology, and its present and potential contributions to International Human Resource Management studies. It is not a guide of how to do ethnography, but a roadmap enabling future International Human Resource Management researchers to choose their ethnographic research strategy consciously, reflexively, and as their research interest demands for.
Management of Revision Reverse Shoulder Arthroplasty
Authors: Goldman Brian H , Halpern Abby L , Deal Matthew J , Richey Bradley P , Mason Eric M , Gupta Hari O , Callegari Jonathan , Bravo Cesar J
Published: February 2020

Background

The number of reverse total shoulder arthroplasty procedures performed has increased in recent years due to expanding surgical indications. There has been a proportional increase in complications, with reported complication rates for a revision reverse total shoulder arthroplasty as high as 68%. Revising a reverse total shoulder is a complex procedure requiring significant preoperative planning.

Methods

A literature review of revision shoulder arthroplasty techniques was performed. No IRB approval was needed for this study.

Results

Instability is the most common reason for revision reverse total shoulder arthroplasty followed by infection. Revision arthroplasty is also needed in the setting of bone loss, aseptic loosening, and periprosthetic fracture. Each case requires a comprehensive preoperative plan to address each deformity for a successful result.

Conclusions

For this procedure to be successful, it is imperative that the physician understands the risk factors, identifies the cause, and is familiar with current surgical techniques. This study reviews both preoperative and perioperative management of reverse total shoulder arthroplasty in the revision setting.
Heterogeneous water provision in Dar es Salaam: The role of networked infrastructures and alternative systems in informal areas
Authors: Smiley Sarah L
Published: February 2020

Urban waterscapes in developing world cities are notoriously fragmented, resembling archipelagos rather than continuous networks. Graham and Marvin’s concept of splintering urbanism links the collapse of infrastructure networks to this fragmentation. Yet this idea has been criticized for suggesting the absence of these networks is a sign of failed modernity in Southern cities such as Dar es Salaam. Urban political ecology illustrates how social, historical, political, and ecological processes work together to create uneven and unjust landscapes and waterscapes. In Dar es Salaam, the colonial policy of segregation and unequal service provision helped to create the fragmented system seen today. As a result, many residents—especially those in informal and peripheral areas—rely on heterogeneous water provision systems. These systems provide innovative ways to deliver water but do so at a high cost. This paper uses case studies of two informal areas—Buguruni and Vingunguti—to illustrate the divergent trajectories of seemingly similar places. One is more connected to the piped water network while the other relies almost exclusively on informal water delivery providers. In explaining these differences, this paper offers an intra-urban comparison that highlights inequities at a smaller scale. It also acknowledges the role of networked infrastructure in these heterogeneous systems by giving voice to residents who consider the piped water network their ideal source.
Erdheim-Chester disease
Authors: Haroche Julien , Cohen-Aubart Fleur , Amoura Zahir
Published: February 2020

Erdheim-Chester disease (ECD) is characterized by the infiltration of tissues by foamy CD68+CD1a− histiocytes, with 1500 known cases since 1930. Mutations activating the MAPK pathway are found in more than 80% of patients with ECD, mainly the BRAFV600E activating mutation in 57% to 70% of cases, followed by MAP2K1 in close to 20%. The discovery of BRAF mutations and of other MAP kinase pathway alterations, as well as the co-occurrence of ECD with LCH in 15% of patients with ECD, led to the 2016 revision of the classification of histiocytoses in which LCH and ECD belong to the “L” group. Both conditions are considered inflammatory myeloid neoplasms. Ten percent of ECD cases are associated with myeloproliferative neoplasms and/or myelodysplastic syndromes. Some of the most striking signs of ECD are the long bone involvement (80%-95%), as well as the hairy kidney appearance on computed tomography scan (63%), the coated aorta (40%), and the right atrium pseudo-tumoral infiltration (36%). Central nervous system involvement is a strong prognostic factor and independent predictor of death. Interferon-α seems to be the best initial treatment of ECD. Since 2012, more than 200 patients worldwide with multisystem or refractory ECD have benefitted from highly effective therapy with BRAF and MEK inhibitors. Targeted therapies have an overall, robust, and reproducible efficacy in ECD, with no acquired resistance to date, but their use may be best reserved for the most severe manifestations of the disease, as they may be associated with serious adverse effects and as-yet-unknown long-term consequences.
In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone
Authors: Fan Kenneth C. , Lin James , Yannuzzi Nicolas A. , Al-Khersan Hasenin , Patel Nimesh A. , Maestre-Mesa Jorge , Zaidi Mustafa , Miller Darlene , Flynn Harry W.
Published: February 2020

Background

To assess the in-vitro efficacy of delafloxacin, a new fourth generation fluoroquinolone, against Staphylococcus vitreous isolates from patients with clinically diagnosed endophthalmitis. This is the first investigation of delafloxacin in ocular tissues.

Methods

Intravitreal isolates of culture-proven S. aureus and S. epidermidis were identified between 2014 and 2018. Minimum inhibitor concentrations (MIC) were determined using ETEST strips. The antibiotic susceptibilities were tested against a panel of drugs including glycopeptides such as vancomycin, as well as traditional and newer fluoroquinolones (levofloxacin, moxifloxacin, and delafloxacin).

Results

Of 45 total isolates identified between 2014 and 2018, 13% (6) were methicillin-resistant S. aureus (MRSA), 9% (4) were methicillin-sensitive S. aureus (MSSA), 53% (24) were methicillin-resistant S. epidermidis (MRSE), and 24% (11) were methicillin-sensitive S. epidermidis (MSSE). Among the fluoroquinolones, resistance rates were 61% for levofloxacin, 50% for moxifloxacin, and 12% for delafloxacin. Inter-class comparisons between delafloxacin and the two other fluoroquinolones demonstrated higher Gram-positive susceptibility to delafloxacin (p < 0.01). MIC90 values were lowest for delafloxacin (1.0 μg/mL) compared to levofloxacin (8.0 μg/mL) and moxifloxacin (8.0 μg/mL). Vancomycin was 100% effective against all isolates with MIC90 value of 0.75 μg/mL.

Conclusion

Compared to levofloxacin and moxifloxacin, the newer fluoroquinolone delafloxacin demonstrated the lowest MICs values and lowest rates of resistance for Gram-positive in-vitro S. epidermidis and S. aureus vitreous isolates.
The hypotensive effect of salt substitutes in stage 2 hypertension: a systematic review and meta-analysis
Authors: Jafarnejad Sadegh , Mirzaei Hamed , Clark Cain C. T. , Taghizadeh Mohsen , Ebrahimzadeh Armin
Published: February 2020

Background

Hypertension (HTN) is a ubiquitous risk factor for numerous non-communicable diseases, including cardiovascular disease and stroke. There are currently no wholly effective pharmacological therapies for subjects with HTN. However, salt substitutes have emerged as a potential therapy for the treatment of HTN. The aim of the present study was to assess the effect of salt substitutes on reducing systolic blood pressure (SBP) and diastolic BP (DBP), following a meta-analysis of randomized controlled trials.

Methods

Studies were found via systematic searches of the Pubmed/Medline, Scopus, Ovid, Google Scholar and Cochrane library. Ten studies, comprised of 11 trials and 1119 participants, were included in the meta-analysis.

Results

Pooled weighted mean differences showed significant reductions of SBP (WMD − 8.87 mmHg; 95% CI − 11.19, − 6.55, p < 0.001) and DBP (WMD − 4.04 mmHg; 95% CI − 5.70, − 2.39) with no statistically significant heterogeneity between the 11 included comparisons of SBPs and DBPs. The stratified analysis of trials based on the mean age of participants showed a significant reduction in the mean difference of SBP in both adults (< 65 years old) and elderly (≥65 years old). However, the DBP-lowering effect of salt substitutes was only observed in adult patients (WMD − 4.22 mmHg; 95% CI − 7.85, − 0.58), but not in the elderly subjects.

Conclusions

These findings suggest that salt-substitution strategies could be used for lowering SBP and DBP in patients with stage 2 HTN; providing a nutritional platform for the treatment, amelioration, and prevention of HTN.
The ability of different imputation methods for missing values in mental measurement questionnaires
Authors: Xu Xueying , Xia Leizhen , Zhang Qimeng , Wu Shaoning , Wu Mingcheng , Liu Hongbo
Published: February 2020

Background

Incomplete data are of particular important influence in mental measurement questionnaires. Most experts, however, mostly focus on clinical trials and cohort studies and generally pay less attention to this deficiency. We aim is to compare the accuracy of four common methods for handling items missing from different psychology questionnaires according to the items non-response rates.

Method

All data were drawn from the previous studies including the self-acceptance scale (SAQ), the activities of daily living scale (ADL) and self-esteem scale (RSES). SAQ and ADL dataset, simulation group, were used to compare and assess the ability of four imputation methods which are direct deletion, mode imputation, Hot-deck (HD) imputation and multiple imputation (MI) by absolute deviation, the root mean square error and average relative error in missing proportions of 5, 10, 15 and 20%. RSES dataset, validation group, was used to test the application of imputation methods. All analyses were finished by SAS 9.4.

Results

The biases obtained by MI are the smallest under various missing proportions. HD imputation approach performed the lowest absolute deviation of standard deviation values. But they got the similar results and the performances of them are obviously better than direct deletion and mode imputation. In a real world situation, the respondents’ average score in complete data set was 28.22 ± 4.63, which are not much different from imputed datasets. The direction of the influence of the five factors on self-esteem was consistent, although there were some differences in the size and range of OR values in logistic regression model.

Conclusion

MI shows the best performance while it demands slightly more data analytic capacity and skills of programming. And HD could be considered to impute missing values in psychological investigation when MI cannot be performed due to limited circumstances.
Leptospirosis in Indonesia: diagnostic challenges associated with atypical clinical manifestations and limited laboratory capacity
Authors: Gasem Muhammad Hussein , Hadi Usman , Alisjahbana Bachti , Tjitra Emiliana , Hapsari M. M. D. E. A. H. , Lestari Endang Sri , Aman Abu Tholib , Lokida Dewi , Salim Gustiani , Kosasih Herman , Merati Ketut Tuti Parwati , Laras Kanti , Arif Mansyur , Lukman Nurhayati , Sudarmono Pratiwi , Lisdawati Vivi , Lau Chuen-Yen , Neal Aaron , Karyana Muhammad
Published: February 2020

Background

The burden of leptospirosis in Indonesia is poorly understood. Data from an observational study conducted from 2013 to 2016 in seven cities across Indonesia was used to estimate the incidence of leptospirosis and document its clinical manifestations in patients requiring hospitalization.

Methods

Specimens from patients hospitalized with acute fever were collected at enrollment, 14–28 days, and 3 months. Demographic and clinical information were collected during study visits and/or retrieved from medical records and double-entered into clinical report forms. After initially screening for dengue virus and other pathogens, specimens were tested at a central Reference Laboratory for anti-Leptospira IgM using commercial ELISA kits and for Leptospira DNA using an in-house quantitative real-time PCR assay.

Results

Of 1464 patients enrolled, 45 (3.1%) confirmed cases (by PCR and/or sero-coversion or four-fold increase of IgM) and 6 (0.4%) probable cases (by high titer IgM) of leptospirosis were identified by the Reference Laboratory. Disease incidence at sites ranged from 0 (0%) cases in Denpasar to 17 (8.9%) cases in Semarang. The median age of patients was 41.2 years (range of 5.3 to 85.0 years), and 67% of patients were male. Twenty-two patients (43.1%) were accurately diagnosed at sites, and 29 patients (56.9%) were clinically misdiagnosed as having another infection, most commonly dengue fever (11, 37.9%). Clinically, 20 patients (39.2%) did not present with hyperbilirubinemia or increased creatinine levels. Two patients (3.9%) died, both from respiratory failure. Fifteen patients (29.4%) clinically diagnosed with leptospirosis at sites were negative based on IgM ELISA and/or PCR at the Reference Laboratory.

Conclusions

Leptospirosis remains an important cause of hospitalization in Indonesia. It can have diverse clinical presentations, making it difficult to differentiate from other common tropical infections. PCR combined with ELISA is a powerful alternative to the cumbersome gold-standard microscopic agglutination test, particularly in resource-limited settings.
Paediatric glaucoma in Scotland
Authors: Beck Daniel , Galea Martin , Loo Cheng Yi , Schmoll Conrad , Burgess Frederick R. , Montgomery Donald , Tatham Andrew J.
Published: February 2020

Background

The primary aim was to estimate the incidence of primary and secondary childhood glaucoma in Scotland over a 2-year period. The secondary aim was to gauge the confidence and experience of ophthalmologists in Scotland in managing these patients.

Methods

A 7 question electronic survey was distributed to all consultant members of the Scottish Paediatric Club and Scottish Glaucoma Club. Respondents were asked to report the number of cases and types of childhood glaucoma they had managed in the last 2 years. Respondents were also asked about experience and confidence in a range of glaucoma procedures, number of patients requiring referral to specialist centres and interest in the development of a centre of excellence in Scotland.

Results

The survey returned a 56% response rate, reporting 85 new cases of paediatric glaucoma in Scotland over the preceding 2 years. 11 (12.9%) had primary glaucoma and 74 (87.1%) had secondary glaucoma. The most common subtype of secondary glaucoma was uveitic glaucoma (n = 29). None of the respondents declared confidence or experience in trabeculotomy or goniotomy procedures. Eleven children required referral to a specialist unit outside Scotland. 85.7% of respondents felt Scotland would benefit from a specialist unit for paediatric glaucoma.

Conclusions

This survey reflects an appetite for a specialist service for paediatric glaucoma in Scotland. However, further consideration is needed to determine if there is sufficient patient load to maintain such a service.
Uncommon clinical presentation of cystic fibrosis in a patient homozygous for a rare CFTR mutation: a case report
Authors: Jaworska Joanna , Marach-Mocarska Aleksandra , Sands Dorota
Published: February 2020

Background

Cystic fibrosis (CF) is the most common, life-threatening, autosomal-recessive disorder among Caucasians. To date, approximately 2000 mutations in the CFTR gene have been reported. Some of these mutations are very rare, and some represent individual sequence changes in the gene. The introduction of newborn screening (NBS) in high prevalence countries for CF has considerably changed the diagnosing of this metabolic disease. Currently, in most cases, a diagnosis is made based on NBS, including or expanded with DNA analysis and confirmed with sweat chloride tests, rather than waiting until the child has already developed signs and symptoms. However, in rare cases, NBS does not provide enough information to confirm or reject a CF diagnosis. Not only are there small groups of patients who have false-negative or false-positive NBS results, but there is also a growing number of patients with positive NBS results in whom results of sweat tests and genetic examinations do not provide definite conclusions. Despite all knowledge and modern diagnostic tools at our disposal, sometimes the clinical presentation is so inconclusive, that making a final diagnosis remains a challenge.

Case presentation

In this case report, we present a male infant of Polish origin, whose symptoms and laboratory findings (including metabolic acidosis) were strongly suggestive of metabolic disease other than cystic fibrosis. Newborn screening for CF was positive, but the first sweat test results were equivocal, and initial and extended molecular tests were negative. Finally, after considering broad differential diagnosis, introducing treatment specific for CF and excluding other metabolic diseases, a third expanded genetic test revealed the presence of a rare pathogenic mutation in both alleles of the CFTR gene: c.4035_4038dupCCTA (p.Ser1347ProfsX13).

Conclusion

Although CF is considered a monogenic disorder, the relationship between genotype and phenotype is very complex. The reported case shows the unusual presentation of the disease. The patient’s clinical symptoms and laboratory findings, in combination with molecular test results, provide useful information for further observing the genotype-phenotype correlations in cystic fibrosis.
Cost utility analysis of HIV pre exposure prophylaxis among men who have sex with men in Israel
Authors: Ginsberg G. M. , Chemtob D.
Published: February 2020

Background

Between 2011 and 2015, Men who have sex with men (MSM) accounted for nearly half of new HIV cases among men in Israel. This study carries out a cost-utility analysis of PrEP (HIV Pre Exposure Prophylaxis), an antiretroviral medication that can protect against the acquisition of HIV infection, whose incidence rate in Israel is around 1.74 per 1000 MSM.

Method

Epidemiological, demographic, health service utilisation and economic data were integrated into a spread-sheet model in order to calculate the cost per averted disability-adjusted life year (DALY) of the intervention from a societal perspective, in mid-2018 US$ using a 3% discount rate. Cost utility analyses were performed for both types of PrEP delivery (continuous regimen and on-demand), together with sensitivity analyses on numbers of condom users who take up PrEP (baseline 25%) and subsequently abandon condom use (baseline 75%), PrEP efficacy (baseline 86%), PrEP prices and monitoring costs.

Results

Around 21.3% of MSM are high risk (as defined by having unprotected anal intercourse). Offering PrEP to this group would have a ten year net cost of around 1563 million USD, preventing 493 persons from becoming HIV-positive, averting around 1616 DALYs at a cost per averted DALY of around 967,744 USD. This will render the intervention to be not cost-effective. PrEP drug prices would have to fall dramatically (by 90.7%) for the intervention to become cost-effective (i.e. having a cost per averted DALY less than thrice GNP per capita) in Israel. PrEP remains not cost-effective (at 475,673 USD per averted DALY) even if intervention costs were reduced by using an “on demand” instead of a daily schedule. Even if there were no changes in condom use, the resultant 411,694 USD cost-utility ratio is still not cost-effective.

Conclusions

Despite PrEPs high effectiveness against HIV, PrEP was found not to be cost-effective in the Israeli context because of a combination of relatively low HIV incidence, high PrEP costs, with a likelyhood that some low-risk MSM (ie: who use condoms) may well begin taking PrEP and as a consequence many of these will abandon condom use. Therefore, ways of minimizing these last two phenomena need to be found.
A report on the use of a single intra-articular administration of autologous platelet therapy in a naturally occurring canine osteoarthritis model - a preliminary study
Authors: Alves J. C. , Santos A. , Jorge P. , Lavrador C. , Carreira L. Miguel
Published: February 2020

Background

Osteoarthritis (OA) represents a significant burden to societies, as it affects quality of life, performance and poses a large healthcare cost. We aimed to describe the use of a single intra-articular (IA) injection of an autologous platelet therapy in the management of osteoarthritis (OA) in a naturally occurring canine model.

Methods

Fifteen police working dogs with bilateral hip OA were treated with 3 ml of platelet concentrate per hip joint, produced with the V-PET kit. Response to treatment was measured by the Canine Brief Pain Inventory (CBPI, divided in pain interference score – PIS, and Pain Severity Score - PSS), Liverpool Osteoarthritis in Dogs (LOAD), Canine Orthopedic Index (COI, divided in four dimensions: function, gait, stiffness and quality of life - QOL) and the Hudson Visual Analogue Scale (HVAS). Seven different time points were considered: T0 (before treatment), T1 (after 15 days), T2, T3, T4, T5 and T6 (after 1, 2, 3, 4 and 5 months respectively). Results from each evaluation moment were compared with T0 with a Paired Samples T-Test, and ap < 0.05 was set.

Results

Significant differences were observed at T1 (p < 0.01 for HVAS, PSS, COI, Gait and QOL;p = 0.01 for PIS;p = 0.02 for Function; andp < 0.05 for Stiffness), T2 (p < 0.01 for PSS, PIS and Gait;p = 0.01 for COI;p = 0.02 for HVAS, Function and QOL; andp = 0.04 for Stiffness), T3 (p < 0.01 for HVAS, PSS, PIS, Function and Gait;p = 0.01 for COI; andp = 0.02 for QOL), T4 (p < 0.01 for PSS;p = 0.03 for PIS and Gait), T5 (p < 0.01 for COI, Function and Gait;p = 0.03 for PSS, PIS and Stiffness), T6 (p < 0.01 for PSS, Function and Gait;p = 0.04 for PIS;p < 0.05 for COI) and T7 (p < 0.01 for PSS, Function and Gait;p = 0.01 for COI; andp < 0.05 for PIS).

Conclusions

Autologous platelet therapy was used without apparent harm in the subjects. A single administration produced significant improvements, which lasted several months, and therefore warrants further study.