bluuebunny/crossref_metadata_2025 huggingface dataset:
Immediate postoperative high-sensitivity troponin T concentrations and long-term patient-reported health-related quality of life
Authors: Mol Kristin H.J.M. , van Lier Felix , Liem Victor G.B. , Stolker Robert J. , Hoeks Sanne E.
Published: July 2020

BACKGROUND

Myocardial injury after noncardiac surgery is associated with mortality and major adverse postoperative cardiovascular events. The effect of postoperative troponin concentrations on patient-reported health-related quality of life (HRQoL) is unknown.

OBJECTIVE

The study examined the association between immediate postoperative troponin concentrations and self-reported HRQoL 1 year after surgery.

DESIGN

Prospective cohort study.

SETTING

Single-centre tertiary care hospital in the Netherlands between July 2012 and 2015.

PATIENTS

Patients aged at least 60 years undergoing moderate and major noncardiac surgery.

INTERVENTION

None.

MAIN OUTCOME MEASURES

HRQoL total score was assessed with the EuroQol five-dimensional questionnaire. Tobit regression analysis was used to determine the association between postoperative troponin concentrations and 1-year HRQoL. Peak high-sensitivity troponin T values were divided into four categories: less than 14, 14 to 49, 50 to 149 and at least 150 ng l−1.

RESULTS

A total of 3085 patients with troponin measurements were included. 2634 (85.4%) patients were alive at 1-year follow-up of whom 1297 (49.2%) returned a completed questionnaire. The median score for HRQoL was 0.82 (0.85, 0.81, 0.77 and 0.71 per increasing troponin category). Multivariable analysis revealed betas of −0.06 [95% confidence interval (CI) −0.09 to −0.02], −0.11 (95% CI −0.18 to −0.04) and −0.18 (95% CI −0.29 to −0.07) for troponin levels of 14 to 49, 50 to 149 and at least 150 ng l−1 when compared with values less than 14 ng l−1. Other independent predictors for lower HRQoL were chronic obstructive pulmonary disease, female sex, peripheral arterial disease and increasing age.

CONCLUSION

Higher levels of postoperative troponin measured immediately after surgery were independently associated with lower self-reported HRQoL total score at 1-year follow-up.
Apolipoprotein E ε4 and cognitive function after surgery in middle-aged and elderly Danish twins
Authors: Dokkedal Unni , Wod Mette , Thinggaard Mikael , Hansen Tom G. , Rasmussen Lars S. , Christensen Kaare , Mengel-From Jonas
Published: July 2020

BACKGROUND

Transient cognitive impairment is common in adult patients of all ages following anaesthesia and surgery. Apolipoprotein E (APOE) ε4 carriers may have a larger deterioration in short-term cognitive function after major surgery compared with APOE ε4 noncarriers.

OBJECTIVES

The aim was to examine the effect of APOE ε4 on the association between exposure to surgery and anaesthesia, and subsequent cognitive functioning. A more pronounced deterioration in cognitive function in APOE ε4 carriers was hypothesised.

DESIGN

An observational cross-sectional and a 6 to 10 years longitudinal twin cohort design.

SETTING

Survey and register study of 2936 Danish twins aged 45 to 92 years.

MAIN OUTCOME MEASURES

Cognitive function was assessed using five age-sensitive cognitive tests. In the cross-sectional study, we compared twins exposed to surgery with a reference group (unexposed). Linear regression models were used adjusting for sex and age and stratified by APOE ε4 carrier status. In the longitudinal cognitive follow-up study 1671 twins participated. Intrapair analyses were also performed using 70 same-sexed twin pairs concordant for APOE ε4 carrier status, but discordant for major surgery.

RESULTS

APOE ε4 carriers had lower cognitive scores compared with noncarriers, and this was statistically significant in elderly twins 70+ years of age (mean difference, −0.67; 95% CI, −1.14 to −0.17). There was no significant impact on cognitive function after surgery according to APOE ε4 carrier status in the cross-sectional study. Similarly, there was no APOE ε4 modification in the longitudinal study. Also, in the intrapair analyses no evidence was found of lower cognitive score after major surgery compared with the nonexposed cotwins among APOE ε4 carriers.

CONCLUSION

No evidence was found of more pronounced long-term deterioration in cognitive function after surgery among APOE ε4 carriers, but elderly APOE ε4 carriers in general performed worse on the cognitive tests than noncarriers.
The accuracy of haemoglobin A1c as a screening and diagnostic test for gestational diabetes: a systematic review and meta-analysis of test accuracy studies
Authors: Amaefule Chiamaka Esther , Sasitharan Archana , Kalra Princee , Iliodromoti Stamatina , Huda Mohammed S.B. , Rogozinska Ewelina , Zamora Javier , Thangaratinam Shakila
Published: July 2020

Purpose of review

Gestational diabetes mellitus (GDM) is associated with adverse pregnancy complications. Accurate screening and diagnosis of gestational diabetes are critical to treatment, and in a pandemic scenario like coronavirus disease 2019 needing a simple test that minimises prolonged hospital stay. We undertook a meta-analysis on the screening and diagnostic accuracy of the haemoglobin A1c (HbA1c) test in women with and without risk factors for gestational diabetes.

Recent findings

Unlike the oral glucose tolerance test, the HbA1c test is simple, quick and more acceptable. There is a growing body of evidence on the accuracy of HbA1c as a screening and diagnostic test for GDM. We searched Medline, Embase and Cochrane Library and selected relevant studies. Accuracy data for different thresholds within the final 23 included studies (16 921 women) were pooled using a multiple thresholds model. Summary accuracy indices were estimated by selecting an optimal threshold that optimises either sensitivity or specificity according to different scenarios.

HbA1c is more useful as a specific test at a cut-off of 5.7% (39 mmol/mol) with a false positive rate of 10%, but should be supplemented by a more sensitive test to detect women with GDM.
Physiology of Fetal Heart Rate Monitoring
Authors: HEUSER CARA C.
Published: July 2020

Fetal heart tracings (FHTs) are useful as a window into the oxygenation status of the fetal brain. Patterns in the FHT reflect the oxygen status of the fetal brain. Fetal adaptive response to progressive hypoxemia and acidosis are detectable and produce recognizable patterns in the fetal heart rate. The basic physiology and adaptive responses that regulate the fetal heart rate and physiological fetal adaptations to stress as reflected in the FHTs are described. Mechanisms of oxygen delivery to the fetus including ways in which those mechanisms can be disrupted are reviewed.
Blood pressure lability is associated with subcortical atrophy in early Parkinson's disease
Authors: Yoo Sang-Won , Yun Eunkyeong , Bang Mirim , Yoon Uicheul , Yoo Ji-Yeon , Lee Kwang-Soo , Shin Na-Young , Kim Joong-Seok
Published: July 2020

Objective:

Increased cerebral white matter intensities associated with blood pressure (BP) lability were reported in patients with Parkinson's disease. However, this type of cardiovascular dysautonomia has seldom been associated with disruptions in deep gray matter structures in Parkinson's disease. In the present study, the associations between BP lability and subcortical deep gray matter structures in early Parkinson's disease were evaluated.

Methods:

The present study included 98 early nondemented Parkinson's disease patients. Supine and orthostatic BPs were measured using head-up tilt tests. BP variabilities, measured as standard deviations of 24-h daytime and nighttime BPs, were assessed using 24-h ambulatory BP monitoring. Every patient underwent brain MRI and measurement of deep gray matter volumes. The associations between BP lability and deep gray matter structures were analyzed.

Results:

Parkinson's disease patients with orthostatic hypotension had smaller volumes of striatum, particularly caudate, than patients without OH after adjusting for covariates of age, sex, disease duration, and Mini-Mental Status Examination score. Nocturnal BP variability was inversely associated with thalamus, hippocampus, and globus pallidus volumes.

Conclusion:

The results from the present study showed that BP lability was adversely associated with structural changes in early Parkinson's disease. Different forms of BP fluctuations influenced distinct deep gray matter structures.
Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension ∗
Authors: Mulatero Paolo , Sechi Leonardo A. , Williams Tracy Ann , Lenders Jacques W.M. , Reincke Martin , Satoh Fumitoshi , Januszewicz Andrzej , Naruse Mitsuhide , Doumas Michael , Veglio Franco , Wu Vin Cent , Widimsky Jiri
Published: July 2020

Primary aldosteronism is a frequent cause of secondary hypertension requiring a specific pharmacological treatment with mineralocorticoid receptor antagonist or with unilateral adrenalectomy. These treatments have shown to reduce the excess of cardiovascular risk characteristically associated with this disease. In part I of this consensus, we discussed the procedures for the diagnosis of primary aldosteronism. In the present part II, we address the strategies for the differential diagnosis of primary aldosteronism subtypes and therapy. We also discuss the evaluation of outcomes and provide suggestions for follow-up as well as cardiovascular and metabolic complications specifically associated with primary aldosteronism. Finally, we analyse the principal gaps of knowledge and future challenges for research in this field.
The associations of blood pressure parameters with all-cause and cardiovascular mortality in peritoneal dialysis patients: a cohort study in China
Authors: Xie Xishao , Lv Duo , Zheng Haiyan , Zhang Xiaohui , Han Fei , Chen Jianghua
Published: July 2020

Background:

It remains controversial to claim blood pressure (BP) as a leading risk factor for high risk of death in peritoneal dialysis patients, and less is known about the relationship between BP and mortality in Chinese peritoneal dialysis patients.

Methods:

From Zhejiang Renal Data System in China, we collected data on patients treated and followed up at 98 peritoneal dialysis centres from 2008 to 2016. The associations of BP parameters [SBP, DBP, mean arterial pressure (MAP) and pulse pressure (PP)] with all-cause and cardiovascular mortality were examined. We fitted Cox models for mortality with penalized splines using nonparametric smoothers. Several sensitivity analyses were performed to confirm the robustness of our primary findings.

Results:

A total of 7335 Chinese peritoneal dialysis patients were included. During a median follow-up of 35.8 months, 1281 (17.5%) patients died. SBP, DBP, MAP follow a U-shaped pattern of both all-cause and cardiovascular mortality. PP presents a reverse L-shaped association with all-cause mortality. Either a higher (SBP >141, DBP >85 or MAP >102 mmHg) or lower (SBP <119, DBP <67 or MAP <88 mmHg) BP tends to have a significantly higher all-cause and cardiovascular mortality risk. Higher PP (>60 mmHg) is related to a higher risk of all-cause mortality, but not cardiovascular mortality. These associations remain the same in our competing risk analysis and subgroup analyses.

Conclusion:

These data indicate U-shaped associations of SBP, DBP and MAP with all-cause mortality and cardiovascular mortality, respectively, and a reverse L-shaped association of PP with all-cause mortality. Further studies are needed to reliably establish the optimal BP targets for better hypertension control in peritoneal dialysis patients.
A speckle tracking echocardiographic study on right ventricular function in primary aldosteronism
Authors: Chen Yi-Lin , Xu Ting-Yan , Xu Jian-Zhong , Zhu Li-Min , Li Yan , Wang Ji-Guang
Published: July 2020

Objective:

We investigated right ventricular function using speckle tracking echocardiography (STE) in patients with primary aldosteronism.

Methods:

Our study included 51 primary aldosteronism patients and 50 age and sex-matched primary hypertensive patients. We performed two-dimensional echocardiography to measure cardiac structure and function. We performed STE offline analysis on right ventricular four-chamber (RV4CLS) and free wall longitudinal strains (RVFWLS).

Results:

Primary aldosteronism patients, compared with primary hypertensive patients, had a significantly (P ≤ 0.045) greater left ventricular mass index (112.0 ± 22.6 vs. 95.8 ± 18.5 g/m2) and left atrial volume index (26.9 ± 6.0 vs. 24.7 ± 5.6 ml/m2) and higher prevalence of left ventricular concentric hypertrophy (35.3 vs. 12.0%), although they had similarly normal left ventricular ejection fraction (55–77%). Primary aldosteronism patients also had a significantly (P ≤ 0.047) larger right atrium and ventricle, lower tricuspid annular plane systolic excursion, and higher E/E’t (the peak early filling velocity of trans-tricuspid flow to the peak early filling velocity of lateral tricuspid annulus ratio), estimated pulmonary arterial systolic pressure and right ventricular index of myocardial performance. On the right ventricular strain analysis, primary aldosteronism patients had a significantly (P < 0.001) lower RV4CLS (−18.1 ± 2.5 vs. −23.3 ± 3.4%) and RVFWLS (−21.7 ± 3.7 vs. −27.9 ± 4.5%) than primary hypertensive patients. Overall, RV4CLS and RVFWLS were significantly (r = −0.58 to −0.41, P < 0.001) correlated with plasma aldosterone concentration and 24-h urinary aldosterone excretion. After adjustment for confounding factors, the associations for RV4CLS and RVFWLS with 24-h urinary aldosterone excretion remained significant (P < 0.001), with a standardized coefficient of −0.48 and −0.55, respectively.

Conclusion:

In addition to left ventricular abnormalities, primary aldosteronism patients also show impaired right ventricular function, probably because of hyperaldosteronism.
Monte Carlo simulation of uncertainty to identify barriers to optimizing blood pressure control
Authors: Zanisi Lorenzo , Floyd Christopher N. , Barrett James E. , Bunce Catey , Frohmaier Chris , Shankar Francesco , Chowienczyk Phil J.
Published: July 2020

Objectives:

To assess the impact of variable drug response and measurement error on SBP control.

Methods:

We simulated a treat-to-target strategy for populations with different pretreatment SBP, whereby medications were added sequentially until measured SBP (mSBP) less than 140 mmHg. Monte Carlo simulations determined variability of both drug response (drugeff ± σdrug; 10 ± 5 mmHg base case) and measurement error (σmeas; 10 mmHg base case) of true SBP (tSBP). The primary outcome measure was the proportion of individuals who achieved target less than 140 mmHg.

Results:

Decision-making based on mSBP resulted in 35.0% of individuals with initial tSBP 150 mmHg being either inappropriately given, or inappropriately denied a second drug. When the simulation was run for multiple drug titrations, measurement error limited tSBP control for all populations tested. A strategy of drug titration based on a second measurement for individuals at risk of incorrect decisions (mSBP 120–150 mmHg; σmeas 15 mmHg) reduced the proportion above target from 40.1 to 30.0% when initial tSBP 160 mmHg. When the measurement variability for the second reading was reduced below that usually seen in clinical practice (σmeas 5 mmHg), the proportion above target decreased further to 17.4%.

Conclusion:

In this simulation, measurement error had the greatest impact on the proportion of individuals achieving their SBP target. Efforts to reduce this error through repeated measures, alternative measurement techniques or changing thresholds, are promising strategies to reduce cardiovascular morbidity and mortality and should be investigated in clinical trials. Here we have shown that Monte Carlo simulations are a useful technique to investigate the influence of uncertainty for different hypertension management strategies.
Anakinra And Etanercept Combination Treatment in a Child With Severe, Nonresponsive Kawasaki Disease
Authors: Walser Matthias , Hermann Matthias , Hufnagel Markus , Haas Nikolaus A. , Fischer Marcus , Dalla-Pozza Robert , Jakob André
Published: July 2020

Kawasaki disease (KD) patients’ resistance to treatment with intravenous immunoglobulins (IVIG) places them at high risk for an unfavorable progression of the disease. In these patients, there has been little evidence that alternative treatments are effective. Nevertheless, biologicals such as an interleukin-1-receptor blocker and tumor-necrosis-factor-α inhibitors increasingly have been used. If the patient does not respond to one of these therapeutics, a combination of 2 biologicals might be an alternative, but this is not yet generally accepted due to the potentially increased risk of infection. Here we report on a 3-month-old boy suffering from severe refractory KD. KD diagnosis was delayed due to the misinterpretation of a urinary tract infection and to the short and nonsimultaneous presence of classical KD symptoms. After complete KD later was able to be diagnosed, treatment with intravenous immunoglobulins was administered. However, the disease proved resistant to 2 courses of IVIG, as well as to corticosteroids. The patient developed giant coronary artery aneurysms early during the course of disease. Anakinra was initiated, but even with stepwise higher anakinra dosages, he remained febrile and coronary artery dimensions increased. Therefore, etanercept was added as a second biological. Only under combination treatment with anakinra and etanercept were his inflammation and fever able to be completely resolved. Coronary artery dimensions improved over time.
A Case of Rapidly Progressive Neurological Decline
Authors: Rishi Abdul R. , Garland Katherine , Logan William
Published: July 2020

Creutzfeldt-Jakob disease is the most common human prion disease. Because of rarity and heterogeneous clinical presentation, the diagnosis is difficult. We describe a very intriguing case of progressive neurological decline where the patient initially presented to the primary care physician and was ultimately diagnosed with Creutzfeldt-Jakob disease in a community hospital setting. We have highlighted the difficulties in diagnosing this uniformly fatal condition and its potential transmission from animals.
A Novel Case of Life-Threatening Thrombocytopenia Secondary to Anaplasmosis
Authors: Keltner Case
Published: July 2020

This case report discusses an atypical presentation of anaplasmosis characterized by severe, potentially life-threatening thrombocytopenia. From the case and the ensuing discussion, medical professionals should appreciate the growing incidence of anaplasmosis across the country, as well as its potential to provoke profound hematologic disturbances in humans.
Physicians' Counseling on Toxoplasma gondii Prepregnancy Screening Tests
Authors: Sanei Zahra , Sheybani Fereshte , Eslami Saeid , Naderi HamidReza , Taherzadeh Zhila , Vatanchi Atiyeh Mohammadzadeh , Varzandeh Marjan
Published: July 2020

Objective

The aim of the study was to evaluate the ability of obstetrics and gynecologists about interpretation and counseling regarding Toxoplasma gondii prepregnancy screening tests.

Methods

This research was a simulation-based study that was conducted using simulated patients from April 2018 to March 2019 in Mashhad, Iran. Cluster sampling of practicing obstetricians and gynecologists (OBGYNs) was performed by municipal districts. In this study, 2 scenarios were constructed to address the approach to a T. gondii seronegative (both IgG and IgM were negative) and seropositive (IgG was positive, and IgM was negative) women who are planning to become pregnant in scenario 1 and scenario 2, respectively.

Results

With regard to scenario 1, T. gondii serological tests in seronegative individuals were correctly interpreted by approximately 90% of OBGYNs. However, in less than 10% of cases, counseling regarding Toxoplasma infection prevention was performed, most of which were not performed appropriately. With regard to scenario 2, the interpretation of test results was performed correctly by 80% of OBGYNs of whom almost 80% followed by appropriate counseling. Except for the relationship between T. gondii infection and cats as well as risk of abortion, level of physicians' knowledge regarding toxoplasmosis was estimated to be inadequate.

Conclusions

Although it has been shown that physicians play an important role in raising awareness of toxoplasma-seronegative pregnant women about appropriate preventive measures, according to the results of our study, most T. gondii seronegative women who plan to become pregnant do not receive any consultation about the importance of following preventive measures, and in a minority of them, only avoidance of cat exposure is emphasized. Insufficient knowledge of providers was identified regarding immunopathogenesis of toxoplasmosis, preventive measures, interpretation of T. gondii serological test results, and optimal approach to the T. gondii prepregnancy serological test results that emphasizes on the importance of more effective education in these areas of knowledge and practice.
Antidepressant Augmentation
Authors: Catalano Glenn , Robeel Rhonda A. , Cheney Grace A. , Spurling Benjamin C. , Catalano Maria C. , Schultz Susan K. , Sanchez Deborah L.
Published: July 2020

Purpose

Antidepressant augmentation strategies for treatment-resistant depression (TRD) are discussed here with an analysis of patient out-of-pocket costs for various medications. The choice of agent ranges from newer atypical antipsychotics (aripiprazole, brexpiprazole, quetiapine) to older agents including buspirone, liothyronine (T3), and lithium. We sought to better understand the differences among these agents to aid in clinical decision making.

Methods

We conducted a focused review of the support for each of the aforementioned agents in antidepressant augmentation. We then compared the approximate out-of-pocket cost for each medication during a typical augmentation trial using the typical prescription costs on ClinCalc.com derived from the Medical Expenditure Panel Survey. We calculated the cost to achieve response for one patient with TRD based on the number needed to treat (NNT).

Findings

We observed significant variance in cost to achieve response based on the NNT derived from our review of each of the medications. For example, the overall out-of-pocket cost for one patient to achieve response with aripiprazole (the costliest generic agent) could cover lithium prescriptions for 4 to 5 patients with TRD to achieve response. Although brexpiprazole was estimated separately because of its brand name cost, we estimated that 324 patients receiving lithium could achieve response for same cost of single patient receiving brexpiprazole.

Implications

These findings suggest that among augmentation agents, there are differences in cost that may be highly important in clinical decision making. Other issues of medication monitoring may incur additional costs, and brand name medications offer significantly greater complexity and potential out-of-pocket costs to patients. The use of lithium as a first-line agent for TRD should be considered based on low cost, lowest NNT, and data in support of its efficacy.
Vortioxetine on Cognition in Schizophrenia
Authors: Bruno Antonio , Zoccali Rocco Antonio , Troili Giulia Maria , Scala Loredana , Pandolfo Gianluca , Cedro Clemente , Mento Carmela , Santoro Vincenza , Spina Edoardo , Muscatello Maria Rosaria Anna
Published: July 2020

Background

Given the wide implications of cognitive impairment for prognosis and outcome in schizophrenia, the research on pharmacological approaches aimed at addressing dysfunctional cognition has been extensive; nevertheless, there are no currently available licensed drugs, and the evidence in this field is still unimpressive. Vortioxetine is a multimodal antidepressant, which has been proposed as a suitable treatment option for cognitive symptoms in depression.

Methods

Twenty schizophrenia outpatients (mean age ± SD, 40.7 ±10.6 years) on stable clozapine treatment, assessed by neuropsychological (Wisconsin Card Sorting Test, Verbal Fluency, and Stroop task) and psychodiagnostic instruments (Positive and Negative Syndrome Scale [PANSS] and Calgary Depression Scale for Schizophrenia), received vortioxetine at the single daily dose of 10 mg/d until week 12; the dose was increased at 20 mg/d afterward, and this dosage was maintained unchanged until week 24. A physical examination, electrocardiogram with QTc measurement, and laboratory tests were also performed.

Results

Vortioxetine supplementation significantly improved Stroop test (P = 0.013) at week 12 and Stroop test (P = 0.031) and Semantic Fluency (P = 0.002) at end point. Moreover, a significantly reduction of PANSS domains “positive” (P = 0.019) at week 12 and of PANSS domains positive (P = 0.019) and total score (P = 0.041) and of depressive symptoms (Calgary Depression Scale for Schizophrenia, P = 0.032) at end point. There was no significant change in clinical, metabolic, and safety parameters, and no subject spontaneously reported adverse effects.

Conclusions

Despite the limitations (open design, lack of a control group, small sample size, and short intervention period), our findings suggest for the first time that vortioxetine augmentation of clozapine may be a promising therapeutic strategy for addressing cognitive deficits in patients with schizophrenia.
Machine learning methods in organ transplantation
Authors: Guijo-Rubio David , Gutiérrez Pedro Antonio , Hervás-Martínez César
Published: July 2020

Purpose of review

Machine learning techniques play an important role in organ transplantation. Analysing the main tasks for which they are being applied, together with the advantages and disadvantages of their use, can be of crucial interest for clinical practitioners.

Recent findings

In the last 10 years, there has been an explosion of interest in the application of machine-learning techniques to organ transplantation. Several approaches have been proposed in the literature aiming to find universal models by considering multicenter cohorts or from different countries. Moreover, recently, deep learning has also been applied demonstrating a notable ability when dealing with a vast amount of information.

Organ transplantation can benefit from machine learning in such a way to improve the current procedures for donor--recipient matching or to improve standard scores. However, a correct preprocessing is needed to provide consistent and high quality databases for machine-learning algorithms, aiming to robust and fair approaches to support expert decision-making systems.
Steatohepatitic Variant of Hepatocellular Carcinoma Is Associated With Both Alcoholic Steatohepatitis and Nonalcoholic Steatohepatitis
Authors: Qin Jia , Higashi Takaaki , Nakagawa Shigeki , Fujiwara Naoto , Yamashita Yo-ichi , Beppu Toru , Baba Hideo , Kobayashi Masahiro , Kumada Hiromitsu , Gunasekaran Ganesh , Schiano Thomas D. , Thung Swan N. , Fiel Maria Isabel , Hoshida Yujin , Ward Stephen C.
Published: July 2020

Steatohepatitic hepatocellular carcinoma (SH-HCC) is a variant of hepatocellular carcinoma (HCC) with established association with nonalcoholic steatohepatitis (NASH), while its association with alcoholic steatohepatitis (ASH) is unclear. We studied 2 cohorts of patients who underwent resection for HCC in the setting of steatohepatitis. In our Mount Sinai (New York) cohort, we found SH-HCC in 17/24 (71%) patients with NASH and in 14/19 (74%) patients with ASH, while SH-HCC was the predominant tumor morphology in 12/24 (50%) in the NASH group and 9/19 (47%) in the ASH group. Upon review, 12/19 patients diagnosed with ASH also had diabetes and/or a body mass index >30. When these patients were removed, we still found similar rates of SH-HCC (6/7 [86%] showed SH-HCC, while SH-HCC was predominant in 3/7 [43%]. Interestingly, glycogenated hepatocyte nuclei were seen in the nontumor liver in 4/7 (57%) of these cases. In our Japan cohort, we also found similar rates of SH-HCC in NASH and ASH patients with HCC, 15/58 (26%), and 16/45 (36%), respectively. We determined molecular subclassification of tumors from the Japan cohort and found no difference in the distribution of S1, S2 and S3 subclasses among the ASH and NASH groups, though, among cases of SH-HCC, there was a trend toward an association of ASH with S1 (P=0.054) and NASH with S3 (P=0.052). Our study shows that SH-HCC is common in both ASH and NASH and that both underlying liver diseases produce tumors with similar molecular profiles, though different pathways may underlie the development of SH-HCC in ASH versus NASH.
Fumarate Hydratase–Deficient Renal Cell Carcinoma: A Review
Authors: Chen Diane A. , Virk Renu K.
Published: July 2020

Fumarate hydratase (FH)–deficient renal cell carcinoma (RCC) has emerged in recent years as a subtype of renal tumors that show diverse morphologic patterns with predominance of papillary architecture. Most of these tumors show high-grade cytologic features and at least focally prominent eosinophilic macronucleoli with perinuclear halos. Infrequently, these tumors show low-grade oncocytic cytologic features. Fumarate hydratase–deficient RCCs are characterized by inactivating FH gene mutations resulting in FH loss and 2-succinocysteine [2SC] accumulation, demonstrable by immunohistochemistry. A vast majority of these tumors occur in the setting of hereditary leiomyomatosis and RCC syndrome. Fumarate hydratase–deficient RCCs show slight male preponderance and present at relatively younger age. These tumors are often locally advanced at the time of presentation. Prospective recognition of these tumors upon histologic examination is of paramount importance not only for the appropriate management of the patient but also for a potential to detect undiagnosed hereditary leiomyomatosis and RCC syndrome in at-risk family members.
Efficacy of Botulinum Toxin in Treating Lateral Epicondylitis—Does Injection Location Matter?
Authors: Song Bo , Day Derek , Jayaram Prathap
Published: July 2020

Objective

Clinical trials assessing the efficacy of botulinum toxin in treating recalcitrant lateral epicondylitis have demonstrated varied results and differed greatly in methodology. The objective of this systematic review was to demonstrate injection location as a significant contributor to outcome heterogeneity.

Design

Two reviewers independently conducted a systematic review using Scopus, Embase, and PubMed for randomized controlled trials assessing botulinum toxin in the treatment of lateral epicondylitis. After applying inclusion/exclusion criteria to abstracts and reviewing the full-text articles, seven studies were found representing six separate injection locations. Reduction in visual analog scale pain and change in grip strength were the principal outcomes of interest.

Results

The largest reduction in pain was seen in injection at 1/3 of the length of the forearm from the lateral epicondyle at 16-wk follow-up, whereas the smallest reduction was seen at 12-wk follow-up after injection at the 0-cm mark. Differences were also identified in grip strength, although all studies reported return to baseline strength by weeks 12–18.

Conclusions

This study demonstrates injection location as a potential source of heterogeneity. This clinical question warrants further evaluation with direct comparison of outcomes at different injection locations while controlling for dosage, toxin type, and ultrasound/electromyographic guidance.
A Rare Case of Nontraumatic Thoracic Compression Fracture in a 28-Year-Old Man
Authors: Donohue Nicholas K. , Braza Diane W.
Published: July 2020

A 28-yr-old African American man with a history of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome, tobacco use, and sickle cell trait was referred to a physiatrist at a multidisciplinary spine center with a 1-yr history of nontraumatic thoracic back pain that had significantly worsened over the previous 4 wks. In the context of recurrent infections requiring hospital admissions and the patient’s immunosuppressed status, magnetic resonance imaging of his thoracic spine was obtained, showing an acute or subacute anterior compression deformity of the T7 vertebral body. He was subsequently provided with a hyperextension brace, physical therapy referral, and a trial of intranasal calcitonin. The patient reported significant improvement in pain at his 3-mo follow-up appointment and continued to show pain and functional improvement in physical therapy sessions up to 6 mos later.
Peripheral Neuropathy in the Lower Limbs of Individuals With Spinal Cord Injury or Disease
Authors: Liang Jason , Furlan Julio C.
Published: July 2020

Purpose

This study investigated the frequency and types of peripheral neuropathy in the lower limbs of patients undergoing rehabilitation after traumatic spinal cord injury or spinal cord disease.

Methods

This study included consecutive patients with spinal cord injury/spinal cord disease who had electrophysiological assessments during their admission in a rehabilitation center from October 2015 to July 2019. Patients with traumatic spinal cord injury were compared with patients with nontraumatic spinal cord disease.

Results

There were 67 patients (52 male patients, 15 female patients; mean age = 56.5 yrs) of whom 36 patients had spinal cord injury and 31 patients had spinal cord disease. Most of the patients were middle-aged men with at least one preexisting medical comorbidity, who were mostly admitted for rehabilitation of cervical, incomplete spinal cord injury/spinal cord disease. Most patients (86.6%) had abnormal electrophysiological studies representing 5.57% of all admissions. A length-dependent polyneuropathy was diagnosed in 0.77% of all admissions (n = 8). The group of patients with spinal cord injury was comparable with the group of patients with spinal cord disease regarding the other baseline data, clinical, and electrophysiological findings.

Conclusions

Diseases of the peripheral nervous system were similarly found among patients undergoing rehabilitation for either spinal cord injury or spinal cord disease. A length-dependent polyneuropathy was diagnosed in 0.77% of all admissions. Timely diagnosis and proper treatment of the cause of peripheral neuropathies in the lower limbs in these patients may potentially influence rehabilitation protocols and improve patient outcomes.
The Use of Upper-Body Intermittent Sequential Pneumatic Compression Arm Sleeves on Recovery From Exercise in Wheelchair Athletes
Authors: Oliver Alison , Driller Matthew
Published: July 2020

Objective

The aim of the current study was to investigate the efficacy of an upper-body intermittent sequential pneumatic compression device on recovery after wheelchair team sport activity.

Design

Eleven well-trained wheelchair basketball and rugby athletes (male, 8; female, 3; mean ± SD age = 33 ± 10 yrs) performed a series of performance measures pre-exercise, postexercise, and postrecovery (grip strength, pressure-to-pain threshold, medicine ball throw, wheelchair sprints, repeated sprints). Subjective muscle soreness and fatigue measurements were taken at the same time points as performance tests, with an additional 24-hr postrecovery measure. Participants completed two recovery trials, separated by 1 wk, of either passive recovery (control) or 20 mins of wearing recovery arm sleeves (intermittent sequential pneumatic compression) applied to both arms.

Results

No statistically significant differences were found between trials for any of the performance or perceptual measures (P > 0.05). However, effect size analysis revealed a moderate decrease (d = −0.67) from postexercise to postrecovery for muscle fatigue in favor of intermittent sequential pneumatic compression. A large decrease (d = −0.96) in muscle soreness was also found after exercise to 24 hrs after recovery in favor of intermittent sequential pneumatic compression over control.

Conclusions

Intermittent sequential pneumatic compression may provide some benefit for perceptual recovery measures immediately after and 24 hrs after a high-intensity wheelchair activity with negligible effects on performance recovery.
Electrodiagnostic Testing of Small Fiber Neuropathies: A Review of Existing Guidelines
Authors: Casanova-Molla Jordi , Valls-Solé Josep
Published: July 2020

This article reviews the literature on neurophysiological techniques for the diagnosis of small fiber neuropathy. The review is focused on clinical approach to suspected small fiber neuropathy, letting aside techniques whose clinical applicability is doubtful. We include, however, the special techniques required to examine C and Aδ fibers, which cannot be evaluated directly with conventional neurophysiological methods. The most relevant publications are summarized and recommendations for the clinical assessment of small fiber neuropathy are provided.
Reclassification of Streptomyces hygroscopicus subsp. glebosus and Streptomyces libani subsp. rufus as later heterotypic synonyms of Streptomyces platensis
Authors: Komaki Hisayuki , Tamura Tomohiko
Published: July 2020

We investigated the taxonomic relationships among

Streptomyces hygroscopicus

subsp.

glebosus

,

Streptomyces libani

subsp.

rufus

and

Streptomyces platensis

. The three species formed a single clade in the phylogenetic trees based on 16S rRNA gene sequence and multilocus sequence analyses. Digital DNA–DNA hybridization using whole genome sequences suggested that

S. hygroscopicus

subsp.

glebosus

,

S. libani

subsp.

rufus

and

S. platensis

belong to the same genomospecies. Previously reported phenotypic data also supported this synonymy. Therefore,

S. hygroscopicus

subsp.

glebosus

and

S. libani

subsp.

rufus

should be reclassified as later heterotypic synonyms of

S. platensis

.
Alcanivorax sediminis sp. nov., isolated from deep-sea sediment of the Pacific Ocean
Authors: Liao Xianzhi , Lai Qiliang , Yang Junpeng , Dong Chunming , Li Dengfeng , Shao Zongze
Published: July 2020

A taxonomic study was carried out on strain PA15-N-34T, which was isolated from deep-sea sediment of Pacific Ocean. The bacterium was Gram-stain-positive, oxidase- and catalase-positive and rod-shaped. Growth was observed at salinity of 0–15.0% NaCl and at temperatures of 10–45 °C. Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain PA15-N-34T belonged to the genus

Alcanivorax

, with the highest sequence similarity to

Alcanivorax profundi

MTEO17T (97.7 %), followed by

Alcanivorax nanhaiticus

19 m-6T (97.3 %) and 12 other species of the genus

Alcanivorax

(93.4 %–97.0 %). The average nucleotide identity and DNA–DNA hybridization values between strain PA15-N-34T and type strains of the genus

Alcanivorax

were 71.46–81.78% and 18.7–25.2 %, respectively. The principal fatty acids (>10 %) were summed feature 8 (C18 : 1
 ω7c and/or C18 : 1
 ω6c; 31.2 %), C16 : 0 (25.0 %) and summed feature 3 (14.6 %). The DNA G+C content was 57.15 mol%. The polar lipids were phosphatidylethanolamine, phosphatidylglycerol, diphosphatidylglycerol, four unidentified aminolipids and three unidentified lipids. The novel strain can be differentiated from its closest type strain by a negative test for urease and the presence of diphosphatidylglycerol and aminolipid. The combined genotypic and phenotypic data show that strain PA15-N-34T represents a novel species within the genus

Alcanivorax

, for which the name Alcanivorax sediminis sp. nov. is proposed, with the type strain PA15-N-34T (=MCCC 1A14738T=KCTC 72163T).
Raineyella fluvialis sp. nov., an actinobacterium isolated from freshwater sediment
Authors: Kim Yeon Bee , Kim Joon Yong , Song Hye Seon , Lee Changsu , Kim Juseok , Whon Tae Woong , Lee Se Hee , Rhee Jin-Kyu , Roh Seong Woon
Published: July 2020

A novel, facultatively anaerobic actinobacterium, designated strain CBA3103T, was isolated from sediment of the Geum River in South Korea. Phylogenetic analysis indicated that strain CBA3103T is most closely related to

Raineyella antarctica

LZ-22T (98.47 % 16S rRNA gene sequence similarity). The genome of strain CBA3103T was 3 649 865 bp with a DNA G+C content of 69.6 mol%. The average nucleotide identity value between strain CBA3103T and

R. antarctica

LZ-22T was 79.22 %. Cells of strain CBA3103T were Gram-positive, rod-shaped, 0.6–0.9 µm wide and 1.4–2.4 µm long. Growth occurred at 15–40 °C (optimum, 35 °C), at pH 6.0–7.0 (optimum, pH 7.0) and with 0–2 % NaCl (w/v) (optimum, 0–1 %, w/v). The major cellular fatty acids in strain CBA3103T were anteiso-C15 : 0, anteiso-C15 : 1 A and iso-C14 : 0. The major respiratory quinone was menaquinone-9(H4). The polar lipids of strain CBA3103T were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, five unidentified glycolipids and three unidentified phospholipids. Based on the genotypic, phenotypic and chemotaxonomic analyses, strain CBA3103T represents a novel species of the genus

Raineyella

, for which the name Raineyella fluvialis sp. nov. (type strain CBA3103T=KACC 21446T=DSM 110288T) is proposed.
Frigidibacter oleivorans sp. nov., isolated from a deep well with oil reservoir water
Authors: Zhang Ya-Xi , Li Fang-Ling , Ma Su-Chen , Zheng Guo-Di , Chen Wen-Feng , Li Wen-Jun , Wang Lei
Published: July 2020

A Gram-stain-negative, rod-shaped bacterium, designated XJ4T, was isolated from oil-contaminated water, collected from Xinjiang Province, north-west PR China (45° 1′ 27″ N, 85° 6′ 14″ E). Growth occurred at 20–45 °C (optimum, 30 °C) and pH 6.0–10.0 (optimum, pH 6.0–7.0). Strain XJ4T could tolerate up to 7 % (w/v) NaCl and grow optimally in the absence of NaCl. Phylogenetic analysis based on comparative sequence analysis of 16S rRNA gene sequences indicated that strain XJ4T belonged to the genus

Frigidibacter

, and that was closely related to

Frigidibacter mobilis

cai42T (97.2 %),

Frigidibacter albus

SP32T (97.0 %) and

Rhodobacter aestuarii

JA296T (97.0 %). The average nucleotide identity values between XJ4T and three type strains were 77.9, 77.6 and 71.9 %, respectively. The DNA G+C content of strain XJ4T was 69.5 mol%. The sole respiratory quinone was Q-10. The major cellular fatty acid was summed feature 8 (C18 : 1
 ω7c and/or C18 : 1
 ω6c), C18 : 0 and 11-methyl C18 : 1
 ω7c. The polar lipids were diphosphatidylglycerol, phosphatidylglycerol, unidentified phospholipids, an unidentified aminolipid and unidentified lipids. On the basis of phenotypic, chemotaxonomic and phylogenetic analyses, strain XJ4T represents a novel species of the genus

Frigidibacter

, for which the name Frigidibacter oleivorans sp. nov. is proposed. The type strain is XJ4T (=CGMCC 1.13778T=LMG 30952T).
Nitratireductor alexandrii sp. nov., from phycosphere microbiota of toxic marine dinoflagellate Alexandrium tamarense
Authors: Jiang Zhiwei , Duan Yuhan , Yang Xi , Yao Bing , Zeng Teer , Wang Xiaoyan , Feng Qi , Qi Min , Yang Qiao , Zhang Xiaoling
Published: July 2020

A taxonomic study was carried out on a novel algae-associated bacterial strain Z3-1T, which was isolated from phycosphere microbiota of toxic marine dinoflagellate Alexandrium tamarense 880. Cells of strain Z3-1T were Gram-stain-negative, rod-shaped and strictly aerobic and were motile by means of flagella. Strain Z3-1T grew at 25–42 °C, pH 5.0–10.0 and 1.0–5.0 % (w/v) NaCl. Strain Z3-1T reduced nitrate to nitrite, but did not reduce nitrite to nitrogen gas. Phylogenetic analysis based on 16S rRNA gene sequences showed that strain Z3-1T belongs to the genus

Nitratireductor

showing the highest sequence similarity (97.0 %) to

Nitratireductor basaltis

JCM 14935T. The average nucleotide identity and digital DNA–DNA hybridization relatedness between strain Z3-1T and type strains of genus

Nitratireductor

with available genome sequences were in the ranges of 72.4–74.4 % and 22.7–23.3 %, respectively. The major fatty acids were summed in feature 8 (C18:1
ω7c and/or C18:1
ω6c), C19:0
ω8c cyclo, C18:1
ω7c 11-metyl and iso-C17:0. The major polar lipids were determined as diphosphatidylglycerol, phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, two unidentified phospholipids and four unidentified polar lipids. The genomic DNA G+C content calculated from genome sequence was 65.6 mol%. Based on genotypic, chemotaxonomic and phenotypic data obtained, strain Z3-1T represents a novel species of the genus

Nitratireductor

, for which the name Nitratireductor alexandrii sp. nov. is proposed with the type strain Z3-1T (=KCTC 62458T=CCTCC AB 2017227T).
Mutations in the cytoplasmic domain of dengue virus NS4A affect virus fitness and interactions with other non-structural proteins
Authors: Tan Min Jie Alvin , Brown Nancy G. , Chan Kitti Wing Ki , Jin Jocelyn Y. , Zu Kong Sean Yao , Vasudevan Subhash G.
Published: July 2020

The dengue virus (DENV) replication complex is made up of its non-structural (NS) proteins and yet-to-be identified host proteins, but the molecular interactions between these proteins are not fully elucidated. In this work, we sought to uncover the interactions between DENV NS1 and its fellow NS proteins using a yeast two-hybrid (Y2H) approach, and found that domain II of NS1 binds to an N-terminal cytoplasmic fragment of NS4A. Mutations in amino acid residues 41 and 43 in this cytoplasmic region of NS4A disrupted the interaction between NS1 and the NS4A-2K-4B precursor protein. When the NS4A Y41F mutation was introduced into the context of the virus via a DENV2 infectious clone, this mutant virus exhibited impaired viral fitness and decreased infectious virus production. The NS4A Y41F mutant virus triggered a significantly muted transcriptional activation of interferon-stimulated genes compared to wild-type virus that is independent of NS4A’s ability to antagonize type I interferon signalling. Taken together, we have identified a link between DENV NS1 and the cytoplasmic domain in NS4A that is important for its cellular and viral functions.
Early life bacterial airway colonization, local immune mediator response and risk of otitis media
Authors: Christensen Emil Dalgaard , Thorsen Jonathan , Stokholm Jakob , Pedersen Tine Marie , Brix Susanne , Krogfelt Karen Angeliki , Schjørring Susanne , Chawes Bo , Bønnelykke Klaus , Bisgaard Hans , Rasmussen Morten Arendt
Published: July 2020

Introduction. Acute otitis media (AOM) is the most common bacterial infection in early childhood, but the underlying mechanisms making some children more susceptible are poorly understood.

Aim. To examine the associations between bacterial airway colonization in early life and the risk of AOM and tympanostomy tube insertion (TTI), and whether such associations are modulated by an insufficient local immune mediator response to bacterial colonization.

Methodology. Bacterial cultures from hypopharyngeal samples were obtained at 1 week, 1 month and 3 months of age in the Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC2010) cohort comprising 700 children. Twenty immune mediators were quantified from airway mucosal lining fluid sampled at 1 month. AOM symptoms were registered in a daily diary until 3 years. Information on TTI in the first 3 years was obtained from national registers.

Results. Children colonized with

Streptococcus pneumoniae

at 1 month of age had increased incidence of AOM [aIRR 2.43 (1.14–5.21)] and children colonized with

Moraxella catarrhalis

at 1 month or

Haemophilus influenzae

at 3 months had an increased risk of TTI [aHR 1.45 (1.00–2.10) and 1.73 (1.10–2.71)]. There were no associations between the local immune mediator response to colonization and risk of AOM or TTI.

Conclusion. Pathogenic bacterial airway colonization in early life was found to be associated with an increased risk of otitis media, albeit not consistently. These associations were independent of the local immune response to colonization.