bluuebunny/crossref_metadata_2025 huggingface dataset:
Worldwide trends in oral anticoagulant use in patients with atrial fibrillation from 2010 to 2018: a systematic review and meta-analysis
Authors: Grymonprez Maxim , Simoens Cynthia , Steurbaut Stephane , De Backer Tine L , Lahousse Lies
Published: November 2021

Aims

Non-vitamin K antagonist oral anticoagulants (NOACs) are effective and safe alternatives compared with vitamin K antagonists (VKAs) for thromboembolic prevention in atrial fibrillation (AF), while antiplatelets are no longer recommended. However, to which extent NOAC introduction and guideline updates have increased OAC use in AF, is unclear. Therefore, worldwide trends in real-life prescribing of OACs, NOACs, VKAs, and antiplatelet monotherapy in AF patients were investigated.

Methods and results

Using PubMed and Embase, observational nationwide cohort studies on annual prevalent and/or incident OAC use in non-selected AF patients since 2010 were included. A meta-analysis of single proportions was performed. Twenty-one studies were included assessing prevalent and incident use among 9 758 637 and 197 483 OAC-eligible AF patients, respectively. Worldwide prevalence and incidence of OAC users increased from 0.42 [95% confidence interval (CI) 0.22–0.65] and 0.43 (95% CI 0.37–0.49) in 2010 to 0.78 (95% CI 0.77–0.78) and 0.75 (95% CI 0.74–0.76) in 2018, respectively. Prevalent and incident NOAC users increased globally from 0 in 2010 to 0.45 (95% CI 0.45–0.46) and 0.68 (95% CI 0.67–0.69) in 2018, respectively, whereas prevalent and incident VKA use decreased from 0.42 (95% CI 0.22–0.65) and 0.42 (95% CI 0.36–0.49) in 2010 to 0.32 (95% CI 0.32–0.32) and 0.06 (95% CI 0.06–0.07) in 2018, respectively. Prevalent antiplatelet monotherapy use decreased from 0.37 (95% CI 0.32–0.42) in 2010 to 0.09 (95% CI 0.09–0.10) in 2018.

Conclusion

The proportion of OAC users worldwide almost doubled following NOAC introduction. As one-quarter of OAC-eligible AF subjects were not anticoagulated and 9% were only treated with antiplatelets in 2018, there is still room for improvement.
Promoting health literacy in people with intellectual disabilities via explanatory videos: scoping reviews
Authors: Vetter Nils Sebastian , Voß Matthias , Bruland Dirk , Seidl Norbert , Latteck Änne-Dörte
Published: November 2021

People with intellectual disabilities have a significant lower level of health literacy compared to the general population which exacerbates participation of the target group. Therefore, people with ID shall be strengthened with regard to health literacy. Explanatory videos are a promising approach to reach that goal. Yet, explanatory videos are neither frequently used in people with intellectual disabilities nor is known a lot about the efficacy of explanatory videos. Two scoping reviews were conducted. One review is an update of an existing review dealing with Health Literacy in people with intellectual disabilities. The second review focused on explanatory videos and people with intellectual disabilities. CINAHL, PubMed, PubPsych and Web of Science were searched. Health Literacy and intellectual disability: nine publications were identified: five publications focused on several aspects of Health Literacy in the target group. A total of four publications discussed ways to increase Health Literacy in people with intellectual disabilities. One publication described existing barriers in accessing and understanding health-related information for people with intellectual disabilities. Explanatory videos and intellectual disability: No eligible publications could be found. The conceptual discussion on health literacy in people with intellectual disabilities is continuing. Nevertheless, often only small subgroups are addressed. Although ideas for increasing health literacy in people with intellectual disabilities exist, there are only little interventions that were scientifically evaluated. There are publications that deal with explanatory videos in the context of intellectual disability, but they do not focus on the efficacy of these videos or special needs of the target group.
Folic Acid Treatment for Patients with Vascular Cognitive Impairment: A Systematic Review and Meta-Analysis
Authors: Gofir Abdul , Wibowo Samekto , Hakimi Muhammad , Putera David Dwi , Satriotomo Irawan , Mustofa Mustofa
Published: November 2021

Background

As the life expectancy of elderly people has drastically increased, the incidence of cardiovascular and cerebrovascular diseases in this population has proportionally grown. Vascular cognitive impairment (VCI) refers to all forms of cognitive disorder associated with cerebrovascular disease. Homocysteine has recently been recognized as a contributor to the pathomechanisms involved in cognitive impairment. B vitamins, such as folic acid, are known to be effective in lowering homocysteine levels.

Aim of the Study

To evaluate the efficacy of folic acid in patients with VCI.

Methods

We conducted a systematic review and meta-analysis of research on folic acid treatments for VCI. Only randomized controlled trials studies that compared the efficacy of folic acid to placebo or other interventions were considered, irrespective of publication status, year of publication, and languages. Two independent reviewers searched the Medline via Ovid, EMBASE and Cochrane Central Register of Controlled Trials (Central) journal databases up to July 2021 and independently appraised the included studies. We used mean difference outcome with 95% confidence intervals (CI) to calculate the change of Mini-Mental State Examination (MMSE), cognitive function domain, and concentration of homocysteine.

Results

We found three studies comparing folic acid with placebo and one study comparing folic acid with other interventions. There is only slight evidence that the MMSE score in patients who received Folic Acid increased 0.3 point higher compared to the placebo group after 24 months (95% CI:-0.12-0.37; p=0.31). There is very strong evidence that the concentration of Homocysteine in the Folic Acid group became 6.16 μmol/L lower compared to the placebo group after 6 months (95% CI:2.32-8.21 lower; p<0.001).

Conclusions

Our review shows the effectiveness of folic acid in lowering plasma homocysteine concentration after 6 months period compared to placebo. However, this effect is not accompanied by improvement in cognitive function.
BSAC Vanguard Series: The future of antibiotic stewardship—managing access and excess
Authors: Goff Debra
Published: November 2021

Antibiotic stewardship is absolutely crucial in the fight to control antimicrobial resistance. Everyone has a part to play. Grassroots action is essential; it is no good sitting back and waiting for world leaders to solve this problem. In this article I outline some of the challenges and the steps that everyone can take to do their part in tackling the slow-moving crisis of AMR.
Responsible Rebels: Exploring Correlations Between Compliance and Reparations in Non-International Armed Conflicts
Authors: Heffes Ezequiel
Published: November 2021

This article aims at challenging certain conceptions related to the activities of non-State armed groups (NSAGs) in armed conflict. Contrary to the conventional thinking that all NSAGs are violent and disrespectful of international law, not only are some of them are aware of the applicable rules, they have even adopted measures to respect, implement and enforce the obligations contained therein, thus willingly restricting their own behaviours and prerogatives. In the context of these practices—and despite the lack of a clear legal framework addressing their international responsibility as collective entities, NSAGs have also dealt with violations of international law by their own members in various ways: some groups have publicly committed to provide compensation, while others have issued public apologies and modified their internal codes of conduct to prohibit the commission of certain acts by their members. NSAGs have also signed Geneva Call’s Deeds of Commitment, through which they pledge to prevent the violation of specific norms. Based on these responses, this article’s goal is to explore certain correlations that may exist between NSAGs’ degree of compliance with international humanitarian law and the manner in which they have reacted to possible breaches of this normative framework. In doing so, it examines the reasons why NSAGs may have a different attitude when responding to international law violations and concludes by proposing some causal factors that may serve to explain the adoption of restorative measures.
Genetic evidence for the requirements of antroquinonol biosynthesis byAntrodia camphorataduring liquid-state fermentation
Authors: Xia Yongjun , Zhou Xuan , Liang Lihong , Liu Xiaofeng , Li Hui , Xiong Zhiqiang , Wang Guangqiang , Song Xin , Ai Lianzhong
Published: November 2021

The solid-state fermentation of Antrodia camphorata could produce a variety of ubiquinone compounds, such as antroquinonol (AQ). However, AQ is hardly synthesized during liquid-state fermentation (LSF). To investigates the mechanism of AQ synthesis, three precursors (ubiquinone 0 UQ0, farnesol and farnesyl diphosphate FPP) were added in LSF. The results showed that UQ0 successfully induced AQ production; however, farnesol and FPP could not induce AQ synthesis. The precursor that restricts the synthesis of AQ is the quinone ring, not the isoprene side chain. Then, the Agrobacterium-mediated transformation system of A. camphorata was established and the genes for quinone ring modification (coq2-6) and isoprene synthesis (HMGR, fps) were overexpressed. The results showed that overexpression of genes for isoprene side chain synthesis could not increase the yield of AQ, but overexpression of coq2 and coq5 could significantly increase AQ production. This is consistent with the results of the experiment of precursors. It indicated that the A. camphorata lack the ability to modify the quinone ring of AQ during LSF. Of the modification steps, prenylation of UQ0 is the key step of AQ biosynthesis. The result will help us to understand the genetic evidence for the requirements of AQ biosynthesis in A. camphorata.
Increasing the information content of realized volatility forecasts
Authors: Pascalau Razvan , Poirier Ryan
Published: November 2021

Assuming N available calendar days, each with M intraday returns, the realized volatility literature suggests creating N end-of-day estimators by summing the M squared returns from each particular date. Instead of this “Calendar” [realized variance (RV)] approach, we propose a “Rolling” [rolling RV (RRV)] approach that simply sums trailing M returns at each timestamp, regardless if all M returns belong to the same calendar date. When estimating an out-of-sample 1-day realized volatility model, the former results in an ordinary least squares (OLS) regression with N−1 datapoints while the latter incorporates M(N−2)+1 datapoints, effectively lowering the standard errors, and potentially resulting in more accurate forecasts. We compare both models for the S&P 500 and 26 Dow Jones Industrial Average stocks; our results generally suggest that the Rolling approach yields both statistically and economically significant superior out-of-sample performance over the traditional Calendar approach.
Genetic diversity and population structure for ocelots (Leopardus pardalis) in Costa Rica
Authors: Salom-Pérez Roberto , Wultsch Claudia , Adams Jennifer R , Soto-Fournier Sofía , Gutiérrez-Espeleta Gustavo A , Waits Lisette P
Published: November 2021

Ocelots (Leopardus pardalis) are a wide-ranging felid species, occurring from southern United States to northern Argentina. They occupy various habitats and are usually considered the most abundant wild cat species in the Neotropics. However, genetic studies that include free-ranging Mesoamerican ocelots are rare and generally based on small sample sizes. This is the first conservation genetics study on ocelots in Costa Rica and the second one in Mesoamerica that has conducted a genetic assessment of the species at a countrywide scale. We evaluated genetic diversity and population structure of ocelots using 15 microsatellite loci in 28 successfully genotyped individuals from throughout the country. We also compared genetic diversity of Costa Rican ocelots with that of jaguars (Panthera onca) and pumas (Puma concolor) in the country, and with ocelots in Belize. Genetic diversity of ocelots in Costa Rica was relatively high as measured by rarified allelic richness (AR = 5.50 ± 1.36) and expected heterozygosities (HE = 0.79 ± 0.08). We did not detect patterns of genetic substructure, suggesting high levels of gene flow throughout the country and no strong barriers to movement. As expected, genetic diversity of Costa Rican ocelots was higher than co-occurring jaguars and pumas. Additionally, levels of genetic diversity were slightly higher in Costa Rican ocelots when compared with their counterparts in Belize, confirming the south to north decrease in genetic diversity reported in other studies. Our study provides critical baseline information to understand the status of wild ocelot populations in Costa Rica. Future studies on ocelots and other threatened or keystone species should also integrate genetic monitoring and conservation genetics analysis to properly inform management decisions, guarantee their long-term survival, and improve the resilience of ecosystems.
Dissecting the genetic control of natural variation in sorghum photosynthetic response to drought stress
Authors: Ortiz Diego , Salas-Fernandez Maria G
Published: November 2021

Drought stress causes crop yield losses worldwide. Sorghum is a C4 species tolerant to moderate drought stress, and its extensive natural variation for photosynthetic traits under water-limiting conditions can be exploited for developing cultivars with enhanced stress tolerance. The objective of this study was to discover genes/genomic regions that control the sorghum photosynthetic capacity under pre-anthesis water-limiting conditions. We performed a genome-wide association study for seven photosynthetic gas exchange and chlorophyll fluorescence traits during three periods of contrasting soil volumetric water content (VWC): control (30% VWC), drought (15% VWC), and recovery (30% VWC). Water stress was imposed with an automated irrigation system that generated a controlled dry-down period for all plants, to perform an unbiased genotypic comparison. A total of 60 genomic regions were associated with natural variation in one or more photosynthetic traits in a particular treatment or with derived variables. We identified 33 promising candidate genes with predicted functions related to stress signaling, oxidative stress protection, hormonal response to stress, and dehydration protection. Our results provide new knowledge about the natural variation and genetic control of sorghum photosynthetic response to drought with the ultimate goal of improving its adaptation and productivity under water stress scenarios.
Ultra-diffuse galaxies in the perseus cluster: comparing galaxy properties with globular cluster system richness
Authors: Gannon Jonah S , Forbes Duncan A , Romanowsky Aaron J , Ferré-Mateu Anna , Couch Warrick J , Brodie Jean P , Huang Song , Janssens Steven R , Okabe Nobuhiro
Published: November 2021

It is clear that within the class of ultra-diffuse galaxies (UDGs), there is an extreme range in the richness of their associated globular cluster (GC) systems. Here, we report the structural properties of five UDGs in the Perseus cluster based on deep Subaru/Hyper Suprime-Cam imaging. Three appear GC-poor and two appear GC-rich. One of our sample, PUDG_R24, appears to be undergoing quenching and is expected to fade into the UDG regime within the next ∼0.5 Gyr. We target this sample with Keck Cosmic Web Imager (KCWI) spectroscopy to investigate differences in their dark matter haloes, as expected from their differing GC content. Our spectroscopy measures both recessional velocities, confirming Perseus cluster membership, and stellar velocity dispersions, to measure dynamical masses within their half-light radius. We supplement our data with that from the literature to examine trends in galaxy parameters with GC system richness. We do not find the correlation between GC numbers and UDG phase space positioning expected if GC-rich UDGs environmentally quench at high redshift. We do find GC-rich UDGs to have higher velocity dispersions than GC-poor UDGs on average, resulting in greater dynamical mass within the half-light radius. This agrees with the first order expectation that GC-rich UDGs have higher halo masses than GC-poor UDGs.
Event rate predictions of strongly lensed gravitational waves with detector networks and more realistic templates
Authors: Yang Lilan , Wu Shichao , Liao Kai , Ding Xuheng , You Zhiqiang , Cao Zhoujian , Biesiada Marek , Zhu Zong-Hong
Published: November 2021

Strong lensing of gravitational waves (GWs) is attracting growing attention of the community. The event rates of lensed GWs by galaxies were predicted in numerous papers, which used some approximations to evaluate the GW strains detectable by a single detector. The joint detection of GW signals by a network of instruments will increase the detecting ability of fainter and farther GW signals, which could increase the detection rate of the lensed GWs, especially for the 3rd generation detectors, e.g. Einstein Telescope (ET) and Cosmic Explorer (CE). Moreover, realistic GW templates will improve the accuracy of the prediction. In this work, we consider the detection of galaxy-scale lensed GW events under the 2nd, 2.5th, and 3rd generation detectors with the network scenarios and adopt the realistic templates to simulate GW signals. Our forecast is based on the Monte Carlo technique which enables us to take Earth’s rotation into consideration. We find that the overall detection rate is improved, especially for the 3rd generation detector scenarios. More precisely, it increases by ∼37 per cent adopting realistic templates, and under network detection strategy, further increases by ∼58 per cent comparing with adoption of the realistic templates, and we estimate that the 3rd generation GW detectors will detect hundreds lensed events per year. The effect from the Earth’s rotation is weakened in the detector network strategy.
H I in and behind the Hubble Frontier Field clusters: a deep MeerKAT pilot search out to z ∼ 0.5
Authors: Ranchod Shilpa , Deane Roger , Obreschkow Danail , Blecher Tariq , Heywood Ian
Published: November 2021

The Hubble Frontier Fields (HFF) are a selection of well-studied galaxy clusters used to probe dense environments and distant gravitationally lensed galaxies. We explore the 21cm neutral hydrogen (H i) content of galaxies in three of the HFF clusters, Abell 2744 (z = 0.308), Abell S1063 (z = 0.346), and Abell 370 (z = 0.375), to investigate the evolution of gas in galaxies within intermediate redshift clusters. Using Early Science MeerKAT observations, we perform spectral-line stacking with H i cubes and make a 3σ stacked detection for blue galaxies in Abell S1063 ($M_\mathrm{HI} = 1.22^{+0.38}_{-0.36}\, \times 10^{10}\, \mathrm{M}_\odot$). We determine the 3σ H i mass detection limits of Abell 2744 and Abell 370 to be at the knee of the H i mass function. A final, more ambitious objective of this work is to search for gravitationally lensed H i emission behind these clusters, enabled by MeerKAT’s wide instantaneous bandwidth. We find no evidence of highly magnified H i emission at 0.33 < z < 0.58. The low thermal noise levels achieved in these pilot observations, despite short integration times, highlights the enormous potential of future MeerKAT H i observations of dense environments, and the intermediate-redshift Universe.
Observed versus simulated halo c–Mvir relations
Authors: Leier Dominik , Ferreras Ignacio , Negri Andrea , Saha Prasenjit
Published: November 2021

The concentration – virial mass relation is a well-defined trend that reflects the formation of structure in an expanding universe. Numerical simulations reveal a marked correlation that depends on the collapse time of dark matter haloes and their subsequent assembly history. However, observational constraints are mostly limited to the massive end via X-ray emission of the hot diffuse gas in clusters. An alternative approach, based on gravitational lensing over galaxy scales, revealed an intriguingly high concentration at Milky Way-sized haloes. This letter focuses on the robustness of these results by adopting a bootstrapping approach that combines stellar and lensing mass profiles. We also apply the identical methodology to simulated haloes from eagle to assess any systematic. We bypass several shortcomings of ensemble type lens reconstruction and conclude that the mismatch between observed and simulated concentration–to–virial–mass relations are robust, and need to be explained either invoking a lensing-related sample selection bias, or a careful investigation of the evolution of concentration with assembly history. For reference, at a halo mass of 1012M⊙, the concentration of observed lenses is c$_{12}\, \sim 40\ \pm$ 5, whereas simulations give c$_{12}\, \sim 15\ \pm$ 1.
Slow Recovery from Inbreeding Depression Generated by the Complex Genetic Architecture of Segregating Deleterious Mutations
Authors: Adams Paula E , Crist Anna B , Young Ellen M , Willis John H , Phillips Patrick C , Fierst Janna L
Published: November 2021

The deleterious effects of inbreeding have been of extreme importance to evolutionary biology, but it has been difficult to characterize the complex interactions between genetic constraints and selection that lead to fitness loss and recovery after inbreeding. Haploid organisms and selfing organisms like the nematode Caenorhabditis elegans are capable of rapid recovery from the fixation of novel deleterious mutation; however, the potential for recovery and genomic consequences of inbreeding in diploid, outcrossing organisms are not well understood. We sought to answer two questions: 1) Can a diploid, outcrossing population recover from inbreeding via standing genetic variation and new mutation? and 2) How does allelic diversity change during recovery? We inbred C. remanei, an outcrossing relative of C. elegans, through brother-sister mating for 30 generations followed by recovery at large population size. Inbreeding reduced fitness but, surprisingly, recovery from inbreeding at large populations sizes generated only very moderate fitness recovery after 300 generations. We found that 65% of ancestral single nucleotide polymorphisms (SNPs) were fixed in the inbred population, far fewer than the theoretical expectation of ∼99%. Under recovery, 36 SNPs across 30 genes involved in alimentary, muscular, nervous, and reproductive systems changed reproducibly across replicates, indicating that strong selection for fitness recovery does exist. Our results indicate that recovery from inbreeding depression via standing genetic variation and mutation is likely to be constrained by the large number of segregating deleterious variants present in natural populations, limiting the capacity for recovery of small populations.
A periplasmic cupredoxin with a green CuT1.5 center is involved in bacterial copper tolerance
Authors: Durand Anne , Fouesnard Mélanie , Bourbon Marie-Line , Steunou Anne-Soisig , Lojou Elisabeth , Dorlet Pierre , Ouchane Soufian
Published: November 2021

The importance of copper resistance pathways in pathogenic bacteria is now well recognized, since macrophages use copper to fight bacterial infections. Additionally, considering the increase of antibiotic resistance, growing attention is given to the antimicrobial properties of copper. It is of primary importance to understand how bacteria deal with copper. The Cu-resistant cuproprotein CopI is present in many human bacterial pathogens and environmental bacteria and crucial under microaerobiosis (conditions for most pathogens to thrive within their host). Hence, understanding its mechanism of function is essential. CopI proteins share conserved histidine, cysteine, and methionine residues that could be ligands for different copper binding sites, among which the cupredoxin center could be involved in the protein function. Here, we demonstrated that Vibrio cholerae and Pseudomonas aeruginosa CopI restore the Cu-resistant phenotype in the Rubrivivax gelatinosus ΔcopI mutant. We identified that Cys125 (ligand in the cupredoxin center) and conserved histidines and methionines are essential for R. gelatinosus CopI (RgCopI) function. We also performed spectroscopic analyses of the purified RgCopI protein and showed that it is a green cupredoxin able to bind a maximum of three Cu(II) ions: (i) a green Cu site (CuT1.5), (ii) a type 2 Cu binding site (T2) located in the N-terminal region, and (iii) a third site with a yet unidentified location. CopI is therefore one member of the poorly described CuT1.5 center cupredoxin family. It is unique, since it is a single-domain cupredoxin with more than one Cu site involved in Cu resistance.
Donaldson–Thomas Invariants For 3-Calabi–Yau Varieties Of Dihedral Quotient Type
Authors: Mozgovoy Sergey , Reineke Markus
Published: November 2021

We compute motivic Donaldson–Thomas invariants for crepant resolutions of quotients of affine three-space by even dihedral groups in terms of an affine type D root system, using double dimensional reduction and the representation theory of affine type D quivers.
Approaching Identity Problems Common in Clinical Practice
Authors: Peteet John R.
Published: November 2021

The concept of identity is pervasive in psychology and culture, but clinicians have lacked a conceptual framework for addressing problems related to identity. After reviewing the development of identity, I distinguish four of the most common categories of such problems and consider approaches to each: identity diffusion, distorted identity, threats to identity, and difficulty integrating disparate aspects of one’s identity. While making identity a focus of clinical attention can strengthen the alliance and place the treatment within a larger context, doing so raises moral questions about the clinician’s role as an agent of validation or change.
Dramatic Growth of a Vestibular Schwannoma After 16 Years of Postradiosurgery Stability in Association With Exposure to Tyrosine Kinase Inhibitors
Authors: Carlstrom Lucas P. , Muñoz-Casabella Amanda , Perry Avital , Graffeo Christopher S. , Link Michael J.
Published: November 2021

Background:

Vestibular schwannoma (VS) is a benign nerve-sheath tumor that sporadically displays aggressive behavior – often attributable to intrinsic tumor biology and an unfavorable immune microenvironment. However, the potential for idiosyncratic responses on VS growth to novel biologics is largely unknown.

Methods:

Case report.

Results:

A 57-year-old man underwent stereotactic radiosurgery (SRS) for a small intracanalicular presumed VS, which presented with left-sided hearing loss and episodic vertigo. Treatment response was excellent, with >50% reduction in tumor volume and confirmed stability at 14 years post-SRS radiographic follow-up. The patient subsequently developed an unrelated metastatic gastrointestinal tumor, and was started on tyrosine kinase inhibitors. Within 12-months of regorafenib treatment, and 16-years since SRS, the patient developed ipsilateral House-Brackmann Grade IV facial weakness. Dramatic VS expansion from 14 to 25 mm in maximum diameter, with new brain stem compression, was seen on MRI. Due to poor prognosis of his gastrointestinal malignancy, he declined surgical resection, and elected for palliative salvage SRS.

Conclusion:

We report the case of VS with radiographically proven stability for >14 years that underwent dramatic tumor progression after treatment with tyrosine kinase inhibitors. The dynamics between systemic immunomodulation and VS disease phenotype remain incompletely understood, and there may be potential for unintended iatrogenic VS progression.
Parenting Stress, Self-Efficacy, and Involvement: Effects on Spoken Language Ability Three Years After Cochlear Implantation
Authors: Cejas Ivette , Mitchell Christine M. , Barker David H. , Sarangoulis Christina , Eisenberg Laurie S. , Quittner Alexandra L.
Published: November 2021

Objective:

This study evaluated associations among parenting stress, self-efficacy, and involvement in relation to spoken language outcomes in young children 3 years following cochlear implantation.

Study Design:

Cross-sectional.

Setting:

Six university tertiary medical centers.

Patients:

One hundred sixty-four young children with bilateral, severe-to-profound sensorineural hearing loss who had 3 years of experience with a CI; children with substantial cognitive impairments were excluded from the study.

Main Outcome Measures(s):

Family Stress Scale (FSS), Scale of Parental Involvement and Self-Efficacy (SPISE), Oral and Written Language Scales (OWLS).

Results:

Correlations were of moderate strength between FSS scores and SPISE scores (Parental Self-Efficacy, r = −0.45, p < 0.01, Parental Involvement r = −0.32, p < 0.01). As hypothesized, parents reporting higher levels of stress reported lower perceptions of self-efficacy and involvement. In addition, results showed that family stress had a direct, negative effect on spoken language (−4.43 [95% confidence interval: −6.97; −1.89]). After controlling for maternal education and activation age, parental self-efficacy mediated the negative effect between family stress and spoken language (indirect effect = −1.91 [3.45; −0.69]; proportion mediated = 0.43). No mediating effects were found for parental involvement.

Conclusions:

These findings highlight the need for parenting interventions that focus on reducing stressors and increasing parents’ perceptions of self-efficacy in families of children using cochlear implants. Integration of mental health screening and tailored parenting interventions in CI clinics may increase parental self-efficacy and involvement, with measurable benefits in the child's use of spoken language.
Self-Identified Patient Barriers to Pursuit of Cochlear Implantation
Authors: Balachandra Sanjana , Tolisano Anthony M. , Qazi Shafeen , Hunter Jacob B.
Published: November 2021

Introduction:

Cochlear implantation (CI) is an underutilized treatment for hearing loss in the United States for reasons which remain unclear. This study explores self-identified barriers to CI employing a survey of adults who qualified for CI.

Methods:

A single-institutional review of CI candidates between December 2010 and December 2018 was performed to identify patients who did not pursue surgery. A 21-question survey was developed, aimed at rating patients’ concerns regarding CI, including surgical risks, adaptation, costs, time commitment, loss of residual hearing, and lack of benefit, among others. Current hearing aid usage and familiarity with other CI users were also analyzed. The survey was administered to patients who did not pursue CI and a control group who eventually did pursue CI, via email or telephone.

Results:

There were 199 patients who initially did not pursue CI. Fifty-two survey responses were received, comprised of 27 patients who did not pursue CI and 25 patients who did. A belief that CI would not significantly improve the ability to communicate was the most common reported barrier, followed by the postoperative recovery process, risks of surgery, and risks of losing music appreciation. Anesthetic risk and cost were the least important reasons not to pursue CI. Half of patients reported concerns regarding the period of adjustment with the CI.

Conclusion:

The decision not to pursue CI despite eligibility is multifactorial and includes concern for minimal hearing benefit and perioperative risks. These factors should be taken into consideration when counseling patients on CI surgery.
An online survey on emotions, impact on everyday life, and educational needs of women with HPV positivity or abnormal Pap smear result
Authors: Ciavattini Andrea , Delli Carpini Giovanni , Giannella Luca , Del Fabro Anna , Banerji Vivek , Hall Genevieve , Barbero Maggiorino , Sopracordevole Francesco
Published: November 2021

This study aimed to evaluate the emotional path, impact on everyday life, and adequacy of patient education throughout the diagnostic and therapeutic journey of women who received a positive human papillomavirus (HPV) test or Pap smear result.

An online survey was designed to determine the demographic characteristics, dominant feelings throughout the diagnostic and therapeutic procedures, major lifestyle changes, impact on social life, and perceived adequacy of patient information in Italian women with a positive HPV test or abnormal cervical cytology result. In this study, the phases of the “patient's journey” included the initial test, waiting for colposcopy or biopsy, waiting for surgery, and follow-up.

Anxiety, worry, and fear were the most frequently cited emotions during the initial tests and intervals between procedures. Anxiety and fear gradually decreased during the journey until surgery, and higher levels of optimism were observed postsurgery. The most frequently reported lifestyle changes were attempts to boost the immune system, increased precautions in sexual practices, and dietary changes. Social life is affected by changes in sexual and intimate relationships with partners. Women reported receiving insufficient patient education on the diagnosis and its implications, progression, management, personal care, and resolution.

Significant attention should be given to the psychosocial aspects of the entire patient journey after receiving a positive HPV test or an abnormal Pap smear result. It is essential to establish a good rapport between patients and healthcare professionals, and to educate women regarding the condition by minimizing the gap between the perceived and desired adequacy of information.
Evaluation on curative effects of isokinetic muscle strength training for improving muscle function in patients with knee osteoarthritis
Authors: Wu Ji-Qian , Che Xin-Chong
Published: November 2021

Background:

Knee osteoarthritis (KOA) refers to a chronic deteriorating disease distinguished by degeneration of joint cartilage. Many clinical studies have demonstrated that isokinetic muscle strength training can improve muscle function in patients with KOA. However, although such studies deduce an excellent effect, the results remain controversial. Therefore, the present systematic review seeks to explore the curative effects of isokinetic muscle strength training to establish if it can improve muscle function in patients experiencing KOA.

Methods:

This review will entail a systematic review and a comprehensive examination to establish all randomized controlled studies covering curative effects of isokinetic muscle strength training to improve muscle function in patients with KOA. We will obtain data from PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and WanFang databases from inception to September 2021. In addition, the study will employ the criterion postulated by Cochrane to ascertain a quality evaluation and risk assessment of the studies included for analysis. Also, we will employ relative risk, mean differences, and standardized mean differences with 95% confidence intervals to estimate the effective measures. Also, we will employ Cochran Q test and I

2
statics to assess heterogeneity among the 2 studies.

Results:

Overall, this study anticipates providing accurate results and balanced inferences on curative effects of isokinetic muscle strength training for improving muscle function in patients with KOA.

Conclusion:

The study's inferences will offer evidence to decide whether isokinetic muscle strength training is an effective measure for improving muscle function in patients with KOA.
Comparative analysis of the recent publication trends in 4 representative journals in the spine field
Authors: Yang Kuhyun , Baek Hong-Gyu , Cho Dae-Chul , Jung Yoon Gyo , Lee Subum , Park Jin Hoon
Published: November 2021

We have analyzed and compared the publication trends in 4 representative spinal journals [Spine, European Spinal Journal (EUS), The Spine Journal (TSJ), and the Journal of Neurosurgery – Spine (JNS spine)] from 2016 to 2018.

A total of 3784 articles were published in the 4 representative journals: 1358, 1128, 685, and 613 articles in Spine, EUS, TSJ, and JNS spine, respectively. We compared and analyzed each periodical for the time taken (days) for the publication process, the distribution of specialties of the corresponding author, multicity of the investigative institutions, main disease entity, study type, and design.

The period from submission to online publication was 133, 216, 181, and 318 days in Spine, EUS, TSJ, and JNS spine, respectively. Corresponding authors with orthopedic specialties were more common in Spine, EUS, and TSJ than in JNS spine. Of particular note, corresponding authors who were neurosurgeons were the majority (55.8%) only in JNS spine. Single institution articles were by far the most common (average 92.8%) in all 4 journals. In all of the analyzed journals, the proportion of degenerative diseases was dominant with an average of 44.9%. The most frequent study type in all 4 journals was a clinical article (79.6, 72.1, 63.3, and 63.1%, respectively). In general, meta-analyses (average 4%) and randomized controlled comparative studies (average 5.2%) accounted for a very low percentage of the study types.

We believe that periodic analyses and comparisons of the characteristics of representative spine journals will help to shape the direction of future improvements.
Identification of chloride intracellular channels as prognostic factors correlated with immune infiltration in hepatocellular carcinoma using bioinformatics analysis
Authors: Huang Juan-Jun , Lin Jing , Chen Xiaoli , Zhu Wei
Published: November 2021

Chloride intracellular channel (CLIC) proteins are novel Cl-channels with 6 family members (CLIC1–6) that are known to play crucial roles in multiple physiological functions, such as neurological, cardiovascular, pulmonary, and auditory functions, and in various malignancies, including hepatocellular carcinoma (HCC). However, considerable challenges exist in identifying appropriate CLICs as therapeutic target molecules and prognostic biomarkers for HCC because the transformation of soluble or integral membrane protein forms, and specific pharmacological agents (agonists and antagonists) for distinct CLICs remains enigmatic.

To address this issue and the possible molecular basis and the signaling networks activated by CLICs in HCC, we examined the transcriptional, promoter methylation, DNA mutation, survival, and immune infiltration data of CLICs in patients with HCC using the ONCOMINE, UALCAN, GEPIA, cBioPortal, and TIMER databases.

The data showed that the expression levels of CLIC family members were differed between tumor and normal tissues. High expression levels of CLIC1 and CLIC3 were associated with advanced cancer stage in HCC patients. Low CLIC1 expression was associated with a better overall survival (OS). The DNA methylation levels of the CLIC1–3 and CLIC5–6 promoters in tumor tissue with HCC were significantly lower in HCC tissues than in normal tissues. Patients with CLIC1 alterations had a shorter OS than patients with unaltered CLIC1. Moreover, the expression levels of CLICs correlated with the infiltration of 6 different immune cells (B cells, CD4+ T cells, CD8+ T cells, neutrophils, macrophages, and dendritic cells).

These results indicate that the increased mRNA expression and decreased promoter DNA methylation level of CLICs may play crucial roles in HCC tumorigenesis. The expression of CLIC family members was significantly correlated with the tumor immune status. High CLIC1 and CLIC3 expression levels could serve as biomarkers for identifying advanced-stage HCC. Moreover, a CLIC1 mutation rate of 18% was also observed and CLIC1 genetic alterations were significantly associated with lower OS in HCC patients.
In vivo effectiveness of visual inspection and laser fluorescence in the diagnosis of early pit-and-fissure carious lesions
Authors: Monea Monica , Eşian Daniela , Vlad Ramona Elena , Bica Cristina Ioana
Published: November 2021

General practitioners are still facing great challenges in the management of occlusal caries. Therefore, the development of better diagnostic protocols and assessment of caries activity might improve the results of nonoperative treatment. This study aimed to evaluate the effectiveness of visual inspection based on ICDAS-II (International Caries Detection and Assessment System) and DiagnoDent pen in the detection of pit-and-fissure early lesions in young permanent molars. The evaluation of 237 occlusal surfaces and caries risk assessment were performed in 96 children aged 7 to 15 years. The presence of pit-and-fissure noncavitated lesions was recorded using ICDAS-II scoring system and laser fluorescence. Statistical analysis was performed using McNemar test, with a level of significance of P < .05. The caries risk was measured for all participants. In 109 occlusal surfaces both methods identified enamel changes (46%) and in 62 cases both methods excluded the carious lesion (26.2%). The statistical analysis showed a significant moderate agreement between ICDAS-II code and DiagnoDent pen measurements (McNemar chi-squared statistic 9.5, P = .002 and Cohen kappa coefficient = 0.427). The majority of children (69.8%) had moderate caries risk and the most frequent risk factors recorded were sugar intake between meals, lack of regular dental control and poor oral hygiene. We concluded that ICDAS-II is a valuable and reliable diagnostic tool for early pit-and-fissure lesions and could be used alone during dental examination in children. The evaluation of caries risk should become clinical routine, as parameters belonging to high risk were frequently recorded in our study group.
Vestibular paroxysmia caused by contralateral tortuous vertebral artery
Authors: Choi Jin Woo , Kim Chang-Hee
Published: November 2021

Rationale:

Vestibular paroxysmia (VP) is characterized by spontaneous, recurrent, short, paroxysmal attacks of vertigo with or without tinnitus.

Patient concerns:

We report a case of paroxysmal recurrent vertigo accompanying clicking tinnitus on the left side in a 61-year-old patient. He had undergone microvascular decompression to treat the left-side hemifacial spasm 6 years prior. The patient first developed vertigo attacks about 3 years after microvascular decompression, and the attacks increased in frequency over the last 4 months. Video-nystagmography revealed a background right-beating nystagmus which was reversed every 55 seconds, to left-beating nystagmus for 17 seconds.

Diagnosis:

Brain magnetic resonance imaging and angiography demonstrated a compression of the cisternal segment of the left vestibulocochlear nerve between the tortuous right vertebral artery and the posterior wall of the left porus acusticus internus.

Interventions and outcomes:

Under the diagnosis of VP, 300 mg oxcarbazepine was administered daily, which relieved the symptoms dramatically.

Lesson:

The neurovascular cross-compression of the vestibulocochlear nerve by the contralateral vertebral artery tortuosity can cause VP. Periodic paroxysms of right-beating nystagmus accompanying the left-side tinnitus during vertigo attacks in our patient can be explained by secondary central hyperactivity in both vestibular and cochlear nuclei following long-standing neurovascular cross-compression.
An empyema caused by Streptococcus constellatus in an older immunocompetent patient
Authors: Lee Young Joo , Lee Jeonghun , Kwon Byung Su , Kim Youngsun
Published: November 2021

Rationale:

Empyema caused by Streptococcus constellatus is rare in patients without underlying diseases. However, the importance of the Streptococcus anginosus group, which consists of S constellatus, S anginosus, and Streptococcus intermedius, as causative organisms of empyema has been increasing.

Patient concerns:

A 78-year-old man initially presented with dyspnea and chills for 4 days. He had no medical history.

Diagnosis:

Chest X-ray and chest computed tomography showed a large and multiloculated pleural effusion with an air bubble on the right side. Cultivation of the pleural effusion using clone library analysis of the 16S rRNA gene revealed S constellatus positivity.

Interventions:

The patient was treated by drainage of the pleural effusion and intravenous ceftriaxone and clindamycin for the possibility of anaerobes, followed by 10 weeks of oral antibiotics.

Outcomes:

On the 11th day of admission, the thoracic drainage tube was removed. After 1 year of treatment, there were no sequelae of empyema.

Lessons:

Although S constellatus can cause serious infections in patients with underlying diseases and immunosuppression, physicians need to consider S constellatus infection in community-acquired empyema in elderly individuals. It should be treated with early pleural drainage and antibiotics to avoid surgical decortication and prolonged hospitalization.
Insight in Obsessive-Compulsive Disorder: Relationship With Sociodemographic and Clinical Characteristics
Authors: Guillén-Font M. Asunción , Cervera Mònica , Puigoriol Emma , FOGUET-BOREU QUINTÍ , Arrufat Francesc X. , Serra-Millàs Montserrat
Published: November 2021

Insight is considered a multidimensional concept and, in the context of obsessive-compulsive disorder (OCD), impairment in insight has been widely reported to be associated with severity and other clinical and sociodemographic variables. However, the studies concerning insight in OCD have produced heterogenous data as a result of the scales used to measure insight. To overcome this heterogeneity, the study presented here used 4 different widely used and validated insight scales. The objective was to evaluate various aspects of insight using these scales to identify the relationships between different aspects of insight and clinical and sociodemographic variables to assess which scale or scales might possess greater efficiency in clinical practice. For this purpose, a descriptive, observational, and cross-sectional study of 81 patients in treatment in a mental health center was conducted. Patients were evaluated using the Brown Assessment of Beliefs Scale, the Overvalued Ideas Scale, the Scale of Unawareness of Mental Disorders, the Yale-Brown Obsessive Compulsive Scale, the Clinical Global Impressions Scale, the Global Assessment of Functioning Scale, and the Rey-Osterrieth Complex Figure Test. The results reported significant relationships between insight and scores on the Yale-Brown Obsessive Compulsive Scale (Thoughts, Compulsions, and Total scales), Clinical Global Impressions Scale, and the Global Assessment of Functioning Scale, and significant differences with regard to sex, level of education, working status, and course of the disorder. A correlation analysis was conducted to assess the relationships among the 4 insight scales. The results of this analysis suggest that the scales that measure insight in a multidimensional way (Brown Assessment of Beliefs Scale and Overvalued Ideas Scale) provide more information about the severity of the disorder in patients with OCD.