bluuebunny/crossref_metadata_2025 huggingface dataset:
Lower Limb Biomechanical Responses During a Standardized Load Carriage Task are Sex Specific
Authors: Wills Jodie A , Saxby David J , Lenton Gavin K , Doyle Timothy L A
Published: March 2021

Introduction

The purpose of this study was to investigate sex-specific lower limb biomechanical adaptations during a standardized load carriage task in response to a targeted physical training program.

Materials and Methods

Twenty-five healthy civilians (males [n = 13] and females [n = 12]) completed a load carriage task (5 km at 5.5 km·h−1, wearing a 23 kg vest) before and after a 10-week lower-body–focused training program. Kinematics and ground reaction force data were collected during the task and were used to estimate lower limb joint kinematics and kinetics (i.e., moments and powers). Direct statistical comparisons were not conducted due to different data collection protocols between sexes. A two-way repeated measures ANOVA tested for significant interactions between, and main effects of training and distance marched for male and female data, respectively.

Results

Primary kinematic and kinetic changes were observed at the knee and ankle joints for males and at the hip and knee joints for females. Knee joint moments increased for both sexes over the 5 km distance marched (P > .05), with males demonstrating significant reductions in peak knee joint extension after training. Hip adduction, internal rotation, and knee internal rotation angles significantly increased after the 5 km load carriage task for females but not males.

Conclusion

Differences in adaptive gait strategies between sexes indicate that physical training needs to be tailored to sex-specific requirements to meet standardized load carriage task demands. The findings highlighted previously unfound sex-specific responses that could inform military training and facilitate the integration of female soldiers into physically demanding military roles.
Review of Military Casualties in Modern Conflicts—The Re-emergence of Casualties From Armored Warfare
Authors: Khorram-Manesh Amir , Goniewicz Krzysztof , Burkle Frederick M , Robinson Yohan
Published: March 2021

Introduction

The re-emergence of armored warfare in modern conflicts has resulted in a higher number of extremity injuries, burns, and brain injuries. Despite this dramatic increase, little is reported on the type of injuries caused and their management. This review summarizes the publicly available literature and reports on the rate and type of injuries related to armored warfare, their medical outcomes, and management limitations.

Materials and Methods

This rapid evidence review involves a systematic literature search, followed by a non-systematic literature review. The reason for choosing this approach was the inherent lack of quantitative outcome data in the literature to satisfy the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study also used content analysis to study all peer-reviewed articles, focusing on similarities and differences in the findings necessary to formulate tentative results. The electronic search included PubMed, Scopus, and Web of Science, using the following search string: “Armored; Injuries; Mechanized; Morbidity; Mortality; War; Warfare”, alone or in combination.

Results

Modern conflicts are associated with higher number of extremity injuries, burns, and brain injuries among military casualties. Several publications claim that the characteristics of armored warfare and anticipated injuries in this type of warfare might require the far forward deployment of medical support supported by a reliable casualty evacuation chain. Still the quality of the available casualty data is low.

Conclusions

Because of the limited availability of reliable data or military trauma registries, up-to-date military casualty estimation remains a recognized knowledge gap, which needs to be addressed by armed forces worldwide. The future management of modern war casualties requires professional and well-trained staff in all levels, indicating a need for educational initiatives to provide both nurses and medics a greater proportion of medical care and management capabilities and responsibilities than in past conflicts.
Coevolution of ribosomal RNA expansion segment 7L and assembly factor Noc2p specializes the ribosome biogenesis pathway between Saccharomyces cerevisiae and Candida albicans
Authors: Wang Xiangxiang , Yue Zhiyong , Xu Feifei , Wang Sufang , Hu Xin , Dai Junbiao , Zhao Guanghou
Published: March 2021

Ribosomes of different species share an evolutionarily conserved core, exhibiting flexible shells formed partially by the addition of species-specific ribosomal RNAs (rRNAs) with largely unexplored functions. In this study, we showed that by swapping the Saccharomyces cerevisiae 25S rRNA genes with non-S. cerevisiae homologs, species-specific rRNA variations caused moderate to severe pre-rRNA processing defects. Specifically, rRNA substitution by the Candida albicans caused severe growth defects and deficient pre-rRNA processing. We observed that such defects could be attributed primarily to variations in expansion segment 7L (ES7L) and could be restored by an assembly factor Noc2p mutant (Noc2p-K384R). We showed that swapping ES7L attenuated the incorporation of Noc2p and other proteins (Erb1p, Rrp1p, Rpl6p and Rpl7p) into pre-ribosomes, and this effect could be compensated for by Noc2p-K384R. Furthermore, replacement of Noc2p with ortholog from C. albicans could also enhance the incorporation of Noc2p and the above proteins into pre-ribosomes and consequently restore normal growth. Taken together, our findings help to elucidate the roles played by the species-specific rRNA variations in ribosomal biogenesis and further provide evidence that coevolution of rRNA expansion segments and cognate assembly factors specialized the ribosome biogenesis pathway, providing further insights into the function and evolution of ribosome.
Clinical Effectiveness and Safety of Antivirals for Influenza in Pregnancy
Authors: Chow Eric J , Beigi Richard H , Riley Laura E , Uyeki Timothy M
Published: March 2021

Seasonal influenza epidemics result in substantial health care burden annually. Early initiation of antiviral treatment of influenza has been shown to reduce the risk of complications and duration of illness. Pregnant and postpartum women may be at increased risk for influenza-associated complications; however, pregnant women have been generally excluded from clinical trials of antiviral treatment of influenza. In this review, we summarize the available evidence on the clinical effectiveness and safety of antiviral treatment of pregnant women with influenza. Observational data show a reduction of severe outcomes when pregnant and postpartum women are treated with oseltamivir and other neuraminidase inhibitors without increased risk of adverse maternal, fetal, or neonatal outcomes. Due to lack of safety and efficacy data for baloxavir treatment of pregnant and postpartum women, baloxavir is currently not recommended for use in these populations.
Navigating the complex realm of drug access in paediatric care
Authors: Dean Paige H , Carr Roxane , Jensen Chris , Strahlendorf Caron
Published: March 2021

A Drug Access Navigator (DAN) is a role that has been established in patient care settings with the goal of expediting the process by which patients obtain drugs through the Health Canada Special Access Program (SAP), individual drug companies’ patient access programs (PAP), and public and private drug plans. In the paediatric setting, the process of accessing many drugs has grown increasingly complex. The majority of paediatric prescriptions involve ‘off-label’ drug use. This leads to an increased need for drug access through the SAP and/or PAPs and demonstrates that the need for a DAN may be particularly prominent in the paediatric population. To our knowledge, there is no evidence in the literature of a DAN functioning in a paediatric setting, though there is a demonstrable need. We plan to address this need by introducing a DAN for shared use at BC Children’s Hospital, a paediatric tertiary care centre.
The effects of disease activity on neuronal and behavioural cognitive processes in systemic lupus erythematosus
Authors: Barraclough Michelle , McKie Shane , Parker Ben , Elliott Rebecca , Bruce Ian N
Published: March 2021

Objectives

Factors common across many chronic diseases, such as fatigue and depression affect cognitive dysfunction (CD) but the effect of SLE disease activity on CD remains unclear. We aimed to explore the effects of disease activity in SLE on cognitive function whilst taking into consideration other potential mediators.

Methods

Two groups of SLE patients were recruited; stable/low disease activity (SLE-S, n = 36) and active disease (SLE-F, n = 26). The SLE-F group were studied during a flare; with a second visit when disease activity had reduced. In addition to demographic, clinical and psychiatric data, CD was measured using a computerised battery of tests (CANTAB®). Functional MRI (fMRI) was used to examine neuronal responses to working memory and emotional processing tasks.

Results

No differences between the groups/visits were found using the CANTAB® battery. The fMRI results showed that the SLE-F group had a less attenuated response in the medial prefrontal cortex (a default mode network—DMN region) compared with the SLE-S group during the working memory task (P =0.012). Exploratory correlations within the SLE-F group showed associations between neuronal responses and depression, cognitive fatigue, disease activity measures and IL-6.

Conclusion

Functional brain processes but not cognitive behavioural measures were affected by disease activity. Flaring SLE patients were less able to suppress DMN regions during a working memory task. This could reflect emotional interference during cognitive tasks and may cause cognitive fatigue. A number of factors are associated with brain function in flaring patients, which has potential implications for holistic treatments.
IL-23 orchestrating immune cell activation in arthritis
Authors: Najm Aurélie , McInnes Iain B
Published: March 2021

IL-23 is a cytokine member of the IL-12 superfamily. These heterodimeric cytokines offer broad immune regulatory activity with potential effector function in inflammatory arthritis. IL-23 is a pro-inflammatory cytokine secreted by dendritic cells and macrophages. It plays a key role in both innate and adaptive immunity. By promoting and maintaining T cell differentiation into Th17 T cells, IL-23 is a key player in the pathogenesis of rheumatic diseases. Data from pre-clinical IL-23 knockout models show the major importance of IL-23 in development of arthritis. The induction and maintenance of type 17 cells, which secrete IL-17A and other pro-inflammatory cytokines, contributes to local synovial inflammation and skin inflammation in PsA, and perhaps in RA. Commensurate with this, therapeutic strategies targeting IL-23 have proven efficient in PsA in several studies, albeit not yet in RA.
Effects of providing artificial shade to pregnant grazing beef heifers on vaginal temperature, growth, activity, and behavior
Authors: Silva Gleise M , Cangiano Lautaro R , Fabris Thiago F , Merenda Victoria R , Chebel Ricardo C , Dubeux Jose Carlos Batista , DiLorenzo Nicolas , Laporta Jimena
Published: March 2021

This experiment evaluated the effects of providing artificial shade during summer on activity, behavior, and growth performance of pregnant grazing beef heifers. Thirty-six black-hided Angus and Angus crossbred pregnant heifers [418 ± 9 kg body weight (BW); approximately 90 d of gestation] were stratified by breed, blocked by BW, and allocated to 12 “Pensacola” bahiagrass pastures (Paspalum notatum Flüggé; 1.3 ha, n = 3 heifers/pasture) with or without access to artificial shade (SHADE vs. NO SHADE; 6 pastures each) for 7 wk during summer. The shade structures were composed of shade cloth (11 × 7.3 m length, 2.4 m height: 26.8 m2 of shade per heifer). Shrunk BW was recorded on enrollment (day 0) and week 7 (day 47), whereas full BW was obtained on week 2 (day 14), 4 (day 28), and 6 (day 42) to assess average daily gain (ADG). Vaginal temperature was recorded for five consecutive days during weeks 1, 3, 5, and 7 using an intravaginal digital thermo-logger, and individual GPS devices were used to quantify the use of shade for an 8-h period. Activity was monitored using automated monitoring devices (HR-LDn tags SCR Engineers Ltd., Netanya, Israel) through the experimental period. Vaginal temperature was lower (P < 0.01) for heifers in the SHADE compared with heifers in the NO SHADE treatment from 1200 to 1600 h and 1100 to 1900 h for weeks 1 and 3, respectively. Heifers in the SHADE treatment spent 70% of the 8-h period evaluated under the shaded structure. Provision of shade increased (P < 0.01) daily lying time (11.4 ± 0.2 vs. 10.3 ± 0.2 h/d) and standing bouts per day (P < 0.01; 12.6 ± 0.4 vs. 10.8 ± 0.4 bouts/d), whereas it reduced (P < 0.01) standing bout duration (61.6 ± 3.0 vs. 82.9 ± 3.0 min/bout) relative to heifers without access to shade. The interaction between treatment and hour affected (P < 0.01) daily rumination time because heifers with access to SHADE had greater rumination between 1000 and 1200 h. Although ADG tended (P = 0.08) to be greater for the heifers in the SHADE treatment (0.20 vs. −0.02 kg, respectively), the access to shade did not (P = 0.79) affect the final BW. In conclusion, providing artificial shade during summer to pregnant grazing beef heifers was effective in reducing vaginal temperatures and exerted changes in heifer behaviors that translated into slight improvements in growth performance.
Transcriptome and proteome analysis suggest enhanced photosynthesis in tetraploid Liriodendron sino-americanum
Authors: Chen Tingting , Sheng Yu , Hao Zhaodong , Long Xiaofei , Fu Fangfang , Liu Yang , Tang Zhonghua , Ali Asif , Peng Ye , Liu Yang , Lu Lu , Hu Xiangyang , Shi Jisen , Chen Jinhui
Published: March 2021

Polyploidy generally provides an advantage in phenotypic variation and growth vigor. However, the underlying mechanisms remain poorly understood. The tetraploid Liriodendron sino-americanum (Liriodendron × sinoamericanum P.C Yieh ex C.B. Shang & Zhang R.Wang) exhibits altered morphology compared with its diploid counterpart, including larger, thicker and deeper green leaves, bigger stomata, thicker stems and increased tree height. Such characteristics can be useful in ornamental and industrial applications. To elucidate the molecular mechanisms behind this variation, we performed a comparative transcriptome and proteome analysis. Our transcriptome data indicated that some photosynthesis genes and pathways were differentially altered and enriched in tetraploid L. sino-americanum, mainly related to F-type ATPase, the cytochrome b6/f complex, photosynthetic electron transport, the light harvesting chlorophyll protein complexes, and photosystem I and II. Most of the differentially expressed proteins we could identify are also involved in photosynthesis. Our physiological results showed that tetraploids have an enhanced photosynthetic capacity, concomitant with great levels of sugar and starch in leaves. This suggests that tetraploid L. sino-americanum might experience comprehensive transcriptome reprogramming of genes related to photosynthesis. This study has especially emphasized molecular changes involved in photosynthesis that accompany polyploidy, and provides a possible explanation for the altered phenotype of polyploidy plants in comparison with their diploid form.
Alpha‐lipoic acid supplementation increases the efficacy of exercise‐ and diet‐induced obesity treatment and induces immunometabolic changes in female mice and women
Authors: Le Garf Sébastien , Sibille Brigitte , Mothe‐Satney Isabelle , Eininger Cyril , Fauque Philippe , Murdaca Joseph , Chinetti Giulia , Neels Jaap G. , Rousseau Anne‐Sophie
Published: March 2021

The decrease in the regulatory T cells (Tregs) population is highly involved in adipose tissue inflammation and insulin resistance in obesity. Tregs depend on fatty acids via β‐oxidation for immunosuppressive function adapting their antioxidant systems to allow survival to oxidative stress. In this study, we have hypothesized that a dietary supplementation with alpha‐lipoic acid (ALA), a powerful antioxidant, would improve immunometabolism when added to the classical strategy of obesity treatment. First, we showed by in vitro experiments that ALA favors the polarization of mice CD4 + T cells toward Tregs. Next, we have carried out a translational study where female obese mice and women were supplemented with ALA or vehicle/placebo (mice: 2.5 gALA/kgfood; 6 weeks; women: 600 mgALA/day, 8 weeks) while following a protocol including regular exercise and a change in diet. Fatty acid oxidation potential and activity of nuclear erythroid‐related factor 2 (NRF2) of mouse secondary lymphoid tissues were improved by ALA supplementation. ALA reduced visceral adipose tissue (VAT) mass and preserved Tregs in VAT in mice. In women, ALA supplementation induced significant metabolic changes of circulating CD4 + T cells including increased oxidative capacity and fatty acid oxidation, ameliorated their redox status, and improved the reduction of visceral fat mass. While appropriate biological markers are still required to be used in clinics to judge the effectiveness of long‐term obesity treatment, further studies in female mice and women are needed to determine whether these immunometabolic changes would reduce VAT mass‐associated risk for secondary health issues arising from obesity.
Placentas delivered by pre‐pregnant obese women have reduced abundance and diversity in the microbiome
Authors: Benny Paula A. , Al‐Akwaa Fadhl M. , Dirkx Corbin , Schlueter Ryan J. , Wolfgruber Thomas K. , Chern Ingrid Y. , Hoops Suzie , Knights Dan , Garmire Lana X.
Published: March 2021

Maternal pre‐pregnancy obesity may have an impact on both maternal and fetal health. We examined the microbiome recovered from placentas in a multi‐ethnic maternal pre‐pregnant obesity cohort, through an optimized microbiome protocol to enrich low bacterial biomass samples. We found that the microbiomes recovered from the placentas of obese pre‐pregnant mothers are less abundant and less diverse when compared to those from mothers of normal pre‐pregnancy weight. Microbiome richness also decreases from the maternal side to the fetal side, demonstrating heterogeneity by geolocation within the placenta. In summary, our study shows that the microbiomes recovered from the placentas are associated with pre‐pregnancy obesity.

Importance

Maternal pre‐pregnancy obesity may have an impact on both maternal and fetal health. The placenta is an important organ at the interface of the mother and fetus, and supplies nutrients to the fetus. We report that the microbiomes enriched from the placentas of obese pre‐pregnant mothers are less abundant and less diverse when compared to those from mothers of normal pre‐pregnancy weight. More over, the microbiomes also vary by geolocation within the placenta.
L‐lactate promotes intestinal epithelial cell migration to inhibit colitis
Authors: Yu Yu , Yang Wenjing , Bilotta Anthony J. , Zhao Xiaojing , Cong Yingzi , Li Yanqing
Published: March 2021

Lactate, one of the most common primary metabolites of bacteria and human cells, has been shown to play essential roles in the regulation of inflammatory diseases, including inflammatory bowel diseases. However, whether and how host‐derived lactate affects intestinal epithelial homeostasis is still not completely understood. Here, we investigated how L‐lactate, mainly produced by host cells, regulates intestinal epithelial cell (IEC) migration to promote intestinal wound healing. Using video microscopy and tracking individual cells, we found that L‐lactate enhanced IEC migration in direction persistence and speed. Mechanistically, L‐lactate promoted IEC mitochondrial ATP production. The mitochondrial ATP synthase inhibitor, oligomycin, significantly decreased IEC persistence and speed, which inhibited cell migration induced by L‐lactate. Furthermore, administering mice with L‐lactate suppressed colitis induced by dextran sulfate sodium. In conclusion, our study demonstrates that host‐derived L‐lactate promotes IEC mitochondrial ATP production to drive cell migration, promoting intestinal wound healing to alleviate intestinal inflammation.
Acute compartment syndrome in pediatric patients: a case series
Authors: Lin James , Samora Walter P. , Samora Julie B.
Published: March 2021

Pediatric acute compartment syndrome (ACS) is an orthopedic emergency which requires timely recognition and management. There are unique considerations in children, as they may present with a wide array of symptoms and capacities to communicate. We sought to investigate the presentations, treatments and outcomes of pediatric ACS, hypothesizing that decompressive fasciotomy results in good outcomes, even with delayed treatment (>24  h). We performed a retrospective review of pediatric ACS from 2009 to 2018. Exclusion criteria were age ≥18  years, exertional compartment syndrome, and incomplete data. Twenty-one patients (mean age 11 years) were included. Swelling (100%) and worsening pain (100%) were the most common presenting signs and symptoms followed by paresthesias (75%). Increasing analgesia requirements were documented in six (29%) patients. Compartment pressures were measured in 52% of patients. All patients were managed with decompressive fasciotomies, which were performed at a median time of 20  h from injury. Strength and range of motion deficits (10%) were the most commonly reported complications. There were no infections. All patients who were treated in a delayed fashion (≥24  h) were found to have a good functional recovery, but 38% had minor complications. Overall, patients had good outcomes, achieving full functional recovery with return to preinjury activity level. Pediatric ACS should be approached as a distinct clinical entity from adult ACS, where risks of infection and wound complications from delayed fasciotomy generally outweigh the benefits. We recommend considering decompressive fasciotomy for all cases of pediatric ACS, including those with prolonged time from injury to diagnosis.
The Clinical Assessment of the Extensor Pollicis Longus of the Thumb Revisited—A Useful Test
Authors: Al Hussainy Haydar Atheer
Published: March 2021

The loss of extensor pollicis longus (EPL) muscle function can be tested clinically in isolation using thumb retropulsion and thumb tenodesis tests. But the assessment of EPL can be challenging in cases where EPL is intact but dysfunctional due to overly elongated tendon like in severe shortening maluninion of distal radius fracture. We describe a clinical test that is based on the exclusive appreciation of the anatomy of EPL and its unique hyperextension capability at the interphalangeal joint of the thumb. The described test is useful in advanced assessment of the integrity of EPL, and in reverse for that of flexor pollicis longus too.
Sleep Duration, Bedtime Consistency, and School Readiness: Findings from the 2016 to 2018 National Survey of Children's Health
Authors: Jackson Dylan B. , Testa Alexander , Semenza Daniel C.
Published: March 2021

Objective:

The focus of this study is to assess the link between sleep duration, bedtime consistency, and school readiness among a nationally representative sample of preschool-age children in the United States.

Methods:

A sample of 15,402 preschool-age children (3 to 5 years old) from the 3 most recent cohorts (2016–2018) of the National Survey of Children's Health was used. Information about sleep duration, bedtime consistency, and school readiness was obtained from surveys administered to primary caregivers. Four distinct domains of school readiness were examined: early learning skills, self-regulation, social-emotional development, and physical health and motor development.

Results:

The findings reveal that children who obtain 7 or fewer hours of sleep per night exhibit significant reductions in school readiness both within and across all 4 domains. Similar but more modest patterns emerge among children with inconsistent bedtimes.

Conclusion:

Given the potential implications of young children's sleep for school readiness, pediatricians should be prepared and trained to effectively counsel parents about children's sleep patterns during routine well-child visits. Future research should examine whether improvements in sleep hygiene education for parents, behavioral sleep interventions, and/or later school start times once children enter preschool might enhance school readiness by improving children's health and well-being as they enter school.
Parent-Reported Social Skills in Children with Neurofibromatosis Type 1: Longitudinal Patterns and Relations with Attention and Cognitive Functioning
Authors: Glad Danielle M. , Casnar Christina L. , Yund Brianna D. , Lee Kristin , Klein-Tasman Bonita P.
Published: March 2021

Objective:

Social skills difficulties are commonly reported by parents and teachers of school age (SA) children with neurofibromatosis type 1 (NF1). Investigations of social skills of young children with NF1 are scarce. This study aimed to characterize the emergence of social skills challenges beginning in early childhood, examine social skills longitudinally into SA, and explore interrelations with attention-deficit hyperactivity disorder (ADHD) symptomatology and cognitive functioning among children with NF1 cross-sectionally and longitudinally.

Method:

Three samples of children with NF1 and their parents participated: (1) early childhood (n = 50; ages 3–6; mean [M] = 3.96, SD = 1.05), (2) SA (n = 40; ages 9–13; [M] = 10.90, SD = 1.59), and (3) both early childhood and SA (n = 25). Parent-reported social skills (Social Skills Rating System and Social Skills Improvement System), ADHD symptomatology (Conners Parent Rating Scales – Revised and Conners – Third Edition), and parent-reported cognitive abilities (Differential Ability Scales – Second Edition) were evaluated.

Results:

Parental ratings of social skills were relatively stable throughout childhood. Ratings of social skills at the end of early childhood significantly predicted school-age social skills. Parental ratings of ADHD symptomatology showed significant negative relations with social skills. Early childhood inattentive symptoms predicted school-age social skills ratings. Cognitive functioning was not significantly related to social skills.

Conclusion:

Parent-reported social skills difficulties are evident during early childhood. This work adds to the literature by describing the frequency and stability of social skills challenges in early childhood and in the school-age period in NF1. Research about interventions to support social skills when difficulties are present is needed.
Helped into Harm
Authors: Rudolph Kara E. , Gimbrone Catherine , Díaz Iván
Published: March 2021

Background:

Interventions can have harmful effects among subgroups they intend to help. The Moving To Opportunity experiment, in which families were randomized to receive a Section 8 housing voucher, was one example. Voucher receipt generally resulted in better long-term mental health and lower substance use and risk behavior outcomes among adolescent girls, but resulted in worse outcomes among adolescent boys. Reasons for this discrepancy and the unintended harmful health effects for boys are unclear. We used mediation analysis to estimate processes through which voucher receipt was hypothesized to affect adolescent mental health and substance use.

Methods:

We used longitudinal data (10–15 years) on boys enrolled in Moving To Opportunity. We estimated interventional (also known as stochastic) indirect effects of voucher receipt on mental health and substance use outcomes through mediators capturing aspects of the school environment, neighborhood poverty, and instability of the social environment. We also estimated interventional direct effects not operating through these mediators. We used a robust, efficient, nonparametric substitution estimator in the targeted minimum loss-based framework.

Results:

Housing voucher receipt increased long-term risk of any diagnostic statistical manual disorder, any mood disorder, any externalizing disorder, and cigarette smoking among boys. The majority (between 69% and 90%) of the total negative long-term effects could be explained by indirect effects through the mediators considered.

Conclusions:

This evidence suggests that, even though the intervention had the desired effects on neighborhood poverty and the school environment, these “positives” ultimately negatively impacted the long-term mental health and behaviors of boys.
Rocuronium reversed with sugammadex for thymectomy in myasthenia gravis
Authors: Tsukada Sayomi , Shimizu Sayuri , Fushimi Kiyohide
Published: March 2021

BACKGROUND

Postoperative respiratory failure is a serious problem in the anaesthetic management of patients with myasthenia gravis who undergo thymectomy. Although the classical recommendation is to avoid neuromuscular blockers, there is no strong evidence to support it.

OBJECTIVES

To evaluate the postoperative outcomes in patients with myasthenia gravis after thymectomy when anaesthetic management included rocuronium reversed with sugammadex.

DESIGN

A retrospective cohort study.

SETTING

Nationwide acute in-patient care database.

PATIENTS

A total of 1143 patients with myasthenia gravis who underwent thymectomy were included. Data were collected from the medical insurance claims data of acute care in-patient hospitals.

MAIN OUTCOME MEASURES

The postoperative complications when rocuronium reversed with sugammadex was compared against no muscle relaxant use using propensity score matching. The primary outcomes were the rates of in-hospital mortality, plasma exchange following thymectomy and the use of immunoglobulins. The secondary outcomes were the length of stay in the high dependency/ICUs, the total length of hospital stay and the duration and type of respiratory support following thymectomy.

RESULTS

There were no significant differences between the propensity score matched groups in terms of plasma exchange [relative risk, 0.96; 95% confidence interval (CI), 0.64 to 1.43] and use of immunoglobulins (relative risk, 1.09; 95% CI, 0.60 to 1.97). The length of hospital stay was significantly shorter in patients in whom rocuronium and sugammadex were used: 29.0 vs. 35.4 days, P = 0.035.

CONCLUSIONS

Anaesthetic management with rocuronium reversed by sugammadex was not associated with increased risk of respiratory complications. These findings could help in the anaesthetic management of patients with myasthenia gravis.
Racial differences in outcomes after receiving advanced heart failure therapies
Authors: Steinberg Rebecca S. , Nayak Aditi , Morris Alanna A.
Published: March 2021

Purpose of review

Despite advances in medical and device-based therapies for advanced heart failure as well as public policy, disparities by race/ethnicity persist in heart failure clinical outcomes. The purpose of this review is to describe disparities in outcomes by race--ethnicity in patients after receipt of heart transplantation and left ventricular assist device (LVAD), and the current understanding of factors contributing to these disparities.

Recent findings

The proportion of black and Latinx patients receiving advanced heart failure therapies continues to rise, and they have worse hemodynamic profiles at the time of referral for heart transplantation and LVAD. Black patients have lower rates of survival after heart transplantation, in part because of higher rates of cellular and humoral rejection that may be mediated through unique gene pathways, and increased risk for allosensitization and de-novo donor-specific antibodies. Factors that have previously been cited as reasons for worse outcomes in race--ethnic minorities, including psychosocial risk and lower SES, may not be as strongly correlated with outcomes after LVAD.

Black and Latinx patients are sicker at the time of referral for advanced heart failure therapies. Despite higher psychosocial risk factors among race--ethnic minorities, outcomes after LVAD appear to be similar to white patients. Black patients continue to have lower posttransplant survival, because of a complex interplay of immunologic susceptibility, clinical and socioeconomic factors. No single factor accounts for the disparities in clinical outcomes for race--ethnic minorities, and thus consideration of these components together is critical in management of these patients.
Beyond DNA Damage: Exploring the Immunomodulatory Effects of Cyclophosphamide in Multiple Myeloma
Authors: Swan Dawn , Gurney Mark , Krawczyk Janusz , Ryan Aideen E. , O'Dwyer Michael
Published: March 2021

The alkylating agent cyclophosphamide has been used in the treatment of multiple myeloma for over 60 years. At low doses, cyclophosphamide also has significant immunomodulatory activity, which can be used to modify the immunosuppressive tumor microenvironment in order to augment responses to existing therapies. Immune‐mediated therapies are becoming more widespread in modern approaches to myeloma treatment. In this review, we discuss the effects cyclophosphamide has on the immune system, and how it can be used synergistically with other treatment modalities including the immunomodulatory agents, monoclonal antibodies and cellular therapies.
Quantitative Evaluation of Facial Expression in a Patient With Minimally Conscious State After Severe Traumatic Brain Injury
Authors: Obayashi Yota , Uehara Shintaro , Kokuwa Ryu , Otaka Yohei
Published: March 2021

Objective:

To investigate whether automatic facial expression analysis can quantify differences in the intensity of facial responses depending on the affective stimuli in a patient with minimally conscious state (MCS).

Methods:

We filmed the facial responses of a patient with MCS during the delivery of three 1-minute auditory stimuli: audio clips of comedy movies, a nurse hilariously talking, and recitation of a novel (comedy, nurse, and recitation conditions, respectively). These measures were repeated at least 13 times for each condition on different days for approximately 10 months. The intensity of being “happy” was estimated from the smiling face using a software called FaceReader. The intensity among 5 conditions including those at 2 resting conditions (pre- and poststimuli) was compared using the Kruskal-Wallis test and the Dunn-Bonferroni test for multiple comparisons.

Results:

Significantly higher values were found in the intensity of being “happy” in the comedy and nurse conditions versus other conditions, with no significant differences between the recitation and pre- or poststimulus conditions. These findings indicate that the automated facial expression analysis can quantify differences in context-dependent facial responses in the patient recruited in this study.

Conclusions:

This case study demonstrates the feasibility of using automated facial expression analysis to quantitatively evaluate the differences in facial expressions and their corresponding emotions in a single patient with MCS.
Longitudinal Vestibular and Oculomotor Impairments Among Amateur Athletes 1 Year Following Sport-Related Concussion: A Prospective Follow-Up
Authors: Büttner Fionn , Howell David R. , Doherty Cailbhe , Blake Catherine , Ryan John , Delahunt Eamonn
Published: March 2021

Objectives:

To investigate (i) the presence of vestibular and oculomotor impairments and (ii) the self-perceived effects of concussion-associated dizziness on health-related quality of life among amateur athletes 6 months and 1 year following sport-related concussion compared with nonconcussed, control athletes.

Design:

Prospective, matched-cohort study.

Setting:

Clinical assessment laboratory.

Participants:

Amateur athletes who were diagnosed with sport-related concussion within 1 week of injury, and sex-, age-, and activity-matched nonconcussed, control athletes.

Main Measures:

Participants were evaluated 6 months and 1 year following sport-related concussion and enrollment in the longitudinal study using the Vestibular and Oculo-Motor Screening and the Dizziness Handicap Inventory. We performed multivariate analyses of variance and chi-square analyses to compare concussion and control group scores at each study assessment.

Results:

Forty-seven participants with concussion and 47 control participants completed the study. The concussion group reported similar mean symptom provocation scores on the Vestibular and Oculo-Motor Screening and exhibited a similar near-point convergence distance compared with the control group at the 6-month and 1-year study assessments. The concussion and control groups had similar perceptions of the effects of dizziness on their health-related quality of life at both study assessments.

Conclusion:

Meaningful differences in vestibular and oculomotor symptom provocation and self-perceived effects of dizziness on everyday life were not observed between concussed and nonconcussed, control athletes 6 months and 1 year following sport-related concussion.
Normative Data for the Fear Avoidance Behavior After Traumatic Brain Injury Questionnaire in a Clinical Sample of Adults With Mild TBI
Authors: Cairncross Molly , Debert Chantel T. , Hunt Cindy , Bayley Mark T. , Comper Paul , Chandra Tharshini , Silverberg Noah D.
Published: March 2021

Objective:

Fear avoidance behavior after a concussion or mild traumatic brain injury (mTBI) is associated with a number of adverse outcomes, such as higher symptom burden, emotional distress, and disability. The Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire (FAB-TBI) is a recently developed and validated self-report measure of fear avoidance after mTBI. The objective of this study was to derive clinical normative data for the FAB-TBI. To determine whether demographic stratification was necessary and to further support clinical interpretation, we also explored associations between fear avoidance behavior and demographic and injury variables.

Setting:

Five concussion clinics in Canada.

Participants:

Adults who sustained an mTBI (N = 563).

Design:

Cross-sectional.

Main Measures:

Participants completed the Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire (FAB-TBI) and measures of postconcussion symptom burden (Rivermead Postconcussion Symptoms Questionnaire, Sport Concussion Assessment Tool-5) at clinic intake.

Results:

Generalized linear modeling revealed that females reported more fear avoidance than males (95% CI = 0.66 to 2.75), indicating that FAB-TBI normative data should be stratified by sex. Differences between recruitment sites on FAB-TBI scores were reduced but not eliminated by controlling for potential confounds. Loss of consciousness (95% CI =0.61 to 2.76) and higher postconcussion symptom burden (95% CI = 0.79 to 1.03) were also associated with higher FAB-TBI scores, but time since injury was not (95% = CI −0.4 to 0.03). Tables to convert FAB-TBI raw scores to Rasch scores to percentiles are presented.

Conclusion:

These findings support clinical interpretation of the FAB-TBI and further study of fear avoidance after mTBI.
Network Analysis of Research on Mild Traumatic Brain Injury in US Military Service Members and Veterans During the Past Decade (2010-2019)
Authors: Eagle Shawn R. , Collins Michael W. , Dretsch Michael N. , Uomoto Jay M. , Connaboy Chris , Flanagan Shawn D. , Kontos Anthony P.
Published: March 2021

Objective:

To evaluate trends in the extant literature on mild traumatic brain injury (mTBI) in military service members and veterans using network analysis based on a comprehensive search of original, peer-reviewed research articles involving human participants published between January 1, 2010, and December 31, 2019. Specifically, we employed network analysis to evaluate associations in the following areas: (1) peer-reviewed journals, (2) authors, (3) organizations/institutions, and (4) relevant key words.

Participants:

Included studies were published in peer-reviewed journals available on Web of Science database, using US military service members or veterans.

Design:

Bibliometric network analytical review.

Main Measures:

Outcomes for each analysis included number of articles, citations, total link strength, and clusters.

Results:

The top publishing journals were (1) Journal of Head Trauma and Rehabilitation, (2) Military Medicine, (3) Brain Injury, (4) Journal of Neurotrauma, and (5) Journal of Rehabilitation Research and Development. The top publishing authors were (1) French, (2) Lange, (3) Cooper, (4) Vanderploeg, and (5) Brickell. The top research institutions were (1) Defense and Veterans Brain Injury Center, (2) Uniformed Services University of the Health Sciences, (3) University of California San Diego, (4) Walter Reed National Military Medical Center, and (5) Boston University. The top co-occurring key words in this analysis were (1) posttraumatic stress disorder (PTSD), (2) persistent postconcussion symptoms (PPCS), (3) blast injury, (4) postconcussion syndrome (PCS), and (5) Alzheimer's disease.

Conclusions:

The results of this network analysis indicate a clear focus on veteran health, as well as investigations on chronic effects of mTBI. Research in civilian mTBI indicates that delaying treatment for symptoms and impairments related to mTBI may not be the most precise treatment strategy. Increasing the number of early, active, and targeted treatment trials in military personnel could translate to meaningful improvements in clinical practices for managing mTBI in this population.
Polymorphism of rs6426749 at 1p36.12 is associated with the risk of osteoarthritis in Taiwanese female population
Authors: Tsai Dung-Jang , Tai Ming-Cheng , Kao Chung-Cheng , Chen Wei-Teing , Wu Li-Wei , Chiu Chih-Chien , Tu Ming-Yu , Chen Yi-Chou , Wu Chia-Chun , Su Sui-Lung
Published: March 2021

Background:

Osteoarthritis (OA) is a multifactorial disease that is associated with several genetic factors. TFAP2A with a motif of C allele at rs6426749 demonstrates a higher binding ability, thereby increasing CDC42 expression, potentially affecting OA occurrence. In this study, we evaluated the role of rs6426749 polymorphisms on knee OA in a female Taiwanese population.

Methods:

We performed a case–control study of 368 OA cases and 379 controls between March 2017 and October 2018. Knee OA was defined using the Kellgren-Lawrence grading system, and genotypes were determined using the Sequenom MassArray iPLEX Gold assay. Stratified sex and body mass index (BMI) analyses were performed using logistic regression to explore interactions between genes and the environment. We also used expression quantitative trait loci data from the genotype-tissue expression project to conduct functional analyses.

Results:

The C allele of rs6426749 was associated with the risk of knee OA (odds ratio [OR] = 1.31, 95% confidence interval [CI], 1.01-1.71; p = 0.042), after adjusting for gender, age, and BMI. In addition, subgroup analyses indicated that females expressing C alleles showed an increased risk for knee OA (OR = 1.56; 95% CI, 1.12-2.18; p = 0.009). Females with a normal BMI and the C allele had the highest OA risk (OR = 1.73; 95% CI, 1.08-2.76; p = 0.022).

Conclusion:

Our findings indicated that rs6426749 may be related to OA susceptibility in the Taiwanese population. This was particularly true for women with normal BMI.
Factors associated with the dosing of edoxaban for stroke prevention in patients with atrial fibrillation from South Korea and Taiwan: 1-year data from the Global ETNA-AF Program
Authors: Chao Tze-Fan , Hong Keun-Sik , Lee Byung-Chul , De Caterina Raffaele , Kirchhof Paulus , Reimitz Paul-Egbert , Chen Cathy , Unverdorben Martin , Wang Chun-Chieh
Published: March 2021

Background:

Direct oral anticoagulants (DOACs) have replaced vitamin K antagonists as the standard of care for stroke prevention in patients with atrial fibrillation (AF). However, DOAC prescriptions at dosages that do not adhere to labeling are common in daily practice. This analysis from the observational Global Edoxaban Treatment in routiNe clinical prActice (ETNA)-AF program focuses on edoxaban-treated patients from South Korea and Taiwan to identify patient baseline characteristics that may be associated with non-recommended dosing.

Methods:

We report baseline data from ETNA-AF, including patient demographics, clinical characteristics, and bleeding/stroke history of patients receiving recommended or non-recommended edoxaban dosing.

Results:

A total of 2677 patients were enrolled. Among 1543 patients who did not meet dose-reduction criteria, 1033 (66.9%) were prescribed the recommended 60-mg dose, and 510 (33.1%) were prescribed the non-recommended 30-mg dose. Among 1134 patients meeting ≥1 of the dose-reduction criteria, 863 (76.1%) were prescribed the recommended 30-mg dose; 271 (23.9%) were prescribed the nonrecommended 60-mg dose. Compared with the recommended 60-mg group, the nonrecommended 30-mg group had a higher proportion of patients aged ≥75 years, higher stroke and bleeding risks, and a history of major bleeding. The non-recommended 60-mg group had a lower proportion of patients aged ≥75 years, a higher history of stroke, and lower history of bleeding compared with the recommended 30-mg group.

Conclusion:

The baseline data from ETNA-AF indicate that physicians take patient clinical characteristics (e.g., bleeding risks) into consideration when deviating from the dosing recommendation per label.
Persistent liver inflammation in chronic hepatitis C patients with advanced fibrosis after direct-acting antivirals induced sustained virological response
Authors: Hsieh Yun-Cheng , Lee Kuei-Chuan , Su Chien-Wei , Lan Ken-Hsin , Huo Teh-Ia , Wang Yuan-Jen , Huang Hui-Chun , Lin Han-Chieh , Chu Chi-Jen , Huang Yi-Hsiang , Hou Ming-Chih
Published: March 2021

Background:

Direct-acting antivirals (DAA) improve sustained virological response (SVR) rates with normalization of liver enzymes in patients with hepatitis C. However, liver inflammation may persist despite virus eradication. We aimed to investigate the rate and risk factors for persistent elevated aminotransferase levels in patients with advanced fibrosis after DAA-induced SVR.

Methods:

From January 2017 to April 2018, chronic hepatitis C patients with advanced fibrosis and SVR after DAA treatment at the Taipei Veterans General Hospital were prospectively enrolled. Persistent liver inflammation after SVR was defined as an increase in levels of alanine aminotransferase (ALT) (>40 U/L) at SVR12.

Results:

A total of 461 patients were included (57.9% females, mean age 64 years, 69.6% genotype 1b, 46.4% cirrhosis). At SVR12, there was a decline in ALT levels (90.5 ± 80.8 U/L to 25.3 ± 26.5 U/L) from baseline levels. Persistent liver inflammation at SVR12 was detected in 45 patients (9.8%). The presence of cirrhosis, markers of impaired liver functions, history of interferon-based therapy, steatosis, and elevated ALT levels at baseline was associated with persistent liver inflammation after SVR12. Results of multivariate analysis indicated that levels of baseline serum total bilirubin (odds ratio [OR]: 2.605, 95% CI: 1.158-5.858), international normalized ratio (OR: 14.389, 95% CI: 1.754-118.049), ALT (OR: 1.006, 95% CI: 1.003-1.009), and the presence of steatosis (OR: 3.635, 95% CI: 1.716-7.698) were independent predictors of persistent liver inflammation at SVR12.

Conclusion:

Persistent liver inflammation is not uncommon in chronic hepatitis C patients with advanced fibrosis after DAA-induced SVR. It is associated with impaired baseline liver function and steatosis. Long-term follow-up is required to assess the implication of liver inflammation on disease progression.