bluuebunny/crossref_metadata_2025 huggingface dataset:
A Fine-Scale Genetic Map for Vervet Monkeys
Authors: Pfeifer Susanne P
Published: March 2020

Despite its important biological role, the evolution of recombination rates remains relatively poorly characterized. This owes, in part, to the lack of high-quality genomic resources to address this question across diverse species. Humans and our closest evolutionary relatives, anthropoid apes, have remained a major focus of large-scale sequencing efforts, and thus recombination rate variation has been comparatively well studied in this group—with earlier work revealing a conservation at the broad- but not the fine-scale. However, in order to better understand the nature of this variation, and the time scales on which substantial modifications occur, it is necessary to take a broader phylogenetic perspective. I here present the first fine-scale genetic map for vervet monkeys based on whole-genome population genetic data from ten individuals and perform a series of comparative analyses with the great apes. The results reveal a number of striking features. First, owing to strong positive correlations with diversity and weak negative correlations with divergence, analyses suggest a dominant role for purifying and background selection in shaping patterns of variation in this species. Second, results support a generally reduced broad-scale recombination rate compared with the great apes, as well as a narrower fraction of the genome in which the majority of recombination events are observed to occur. Taken together, this data set highlights the great necessity of future research to identify genomic features and quantify evolutionary processes that are driving these rate changes across primates.
Experimental Parasite Infection Causes Genome-Wide Changes in DNA Methylation
Authors: Sagonas Kostas , Meyer Britta S , Kaufmann Joshka , Lenz Tobias L , Häsler Robert , Eizaguirre Christophe
Published: March 2020

Parasites are arguably among the strongest drivers of natural selection, constraining hosts to evolve resistance and tolerance mechanisms. Although, the genetic basis of adaptation to parasite infection has been widely studied, little is known about how epigenetic changes contribute to parasite resistance and eventually, adaptation. Here, we investigated the role of host DNA methylation modifications to respond to parasite infections. In a controlled infection experiment, we used the three-spined stickleback fish, a model species for host–parasite studies, and their nematode parasite Camallanus lacustris. We showed that the levels of DNA methylation are higher in infected fish. Results furthermore suggest correlations between DNA methylation and shifts in key fitness and immune traits between infected and control fish, including respiratory burst and functional trans-generational traits such as the concentration of motile sperm. We revealed that genes associated with metabolic, developmental, and regulatory processes (cell death and apoptosis) were differentially methylated between infected and control fish. Interestingly, genes such as the neuropeptide FF receptor 2 and the integrin alpha 1 as well as molecular pathways including the Th1 and Th2 cell differentiation were hypermethylated in infected fish, suggesting parasite-mediated repression mechanisms of immune responses. Altogether, we demonstrate that parasite infection contributes to genome-wide DNA methylation modifications. Our study brings novel insights into the evolution of vertebrate immunity and suggests that epigenetic mechanisms are complementary to genetic responses against parasite-mediated selection.
Dietary plant and animal protein intake and decline in estimated glomerular filtration rate among elderly women: a 10-year longitudinal cohort study
Authors: Bernier-Jean Amélie , Prince Richard L , Lewis Joshua R , Craig Jonathan C , Hodgson Jonathan M , Lim Wai H , Teixeira-Pinto Armando , Wong Germaine
Published: March 2020

Background

Many older women demonstrate an age-related accelerating rate of renal decline that is associated with increased rates of bone disease, cardiovascular disease and mortality. Population-based protein restriction has been studied principally in patients with reduced renal function. In this investigation, we examined the hypothesis of a differential effect of plant-derived protein compared with animal-derived protein on renal function in older women.

Methods

We assessed dietary intake from a validated food frequency questionnaire and the estimated glomerular filtration rate (eGFR) (using the Chronic Kidney Disease Epidemiology Collaboration creatinine and cystatin C equation) at baseline, 5 and 10 years in the Longitudinal Study of Aging Women cohort. We tested the association between plant- and animal-sourced protein intake and kidney function using linear mixed modeling.

Results

A total of 1374 Caucasian women [mean (standard deviation, SD) age = 75 years (2.7) and mean (SD) baseline eGFR = 65.6 mL/min/1.73 m2 (13.1)] contributed to the analysis. The average decline in eGFR was 0.64 mL/min/1.73 m2/year [95% confidence interval (CI) 0.56–0.72]. Higher intakes of plant-sourced protein were associated with slower declines in eGFR after adjusting for covariates including animal protein and energy intake (P = 0.03). For each 10 g of plant protein, the yearly decline in eGFR was reduced by 0.12 mL/min/1.73 m2 (95% CI 0.01–0.23), principally associated with fruit-, vegetable- and nut-derived protein. The intake of animal protein was not associated with eGFR decline (P = 0.84).

Conclusions

Older women consuming a diet that is richer in plant-sourced protein have a slower decline in kidney function. These data extend support for the health benefits of plant-rich diets in the general population to maintain kidney health.
Information asymmetry in voluntary environmental agreements: theory and evidence from UK climate change agreements
Authors: Adetutu Morakinyo O , Stathopoulou Eleni
Published: March 2020

Voluntary environmental agreements (VEAs) are often plagued by adverse selection problems, because the regulator has imperfect information about firm-specific production technologies and abatement costs. We explore this issue using the UK climate change agreement (CCA) as a case study. First, we present a theoretical emulation of the programme. Second, we resolve the regulator’s asymmetric information problem by estimating unobserved energy efficiency (EE) using production theory. Third, we use microdata from three confidential manufacturing surveys to empirically test how limited information impacts resource allocation within the scheme. In line with the problem of limited information about firm production technologies, we find that firms with lower levels of EE receive higher CCA tax discounts. This finding holds over a range of robustness tests.
The Use of Trusts to Subvert the Law: An Analysis and Critique
Authors: Bennett Mark , Hofri-Winogradow Adam
Published: March 2020

This article closes a gap in the theory of trust law by supplying a normative account of the use of trusts to avoid and subvert legal norms outside trust law. While the use of trusts to subvert other law has been a major function thereof since the Middle Ages, theorists of trust law have largely steered clear of this function. We evaluate the commonly proffered justifications for the use of trusts to subvert the law, finding that such justifications are not plausible in liberal legal systems, so that the subversive use of trusts should be curtailed. Common law legal systems attempt to curtail this use by anti-subversive norms, but these attempts are far from completely successful. To the extent existing anti-subversive norms cannot be perfected so as to prevent the subversive use of trusts, an approach restricting the available types of trusts may be preferable.
Online Acceptance and Commitment Therapy for People with Painful Diabetic Neuropathy in the United Kingdom: A Single-Arm Feasibility Trial
Authors: Kioskli Kitty , Scott Whitney , Winkley Kirsty , Godfrey Emma , McCracken Lance M
Published: March 2020

Objective

This study aimed to assess the feasibility of online Acceptance and Commitment Therapy for painful diabetic neuropathy in the United Kingdom and to determine if a larger randomized controlled trial testing treatment efficacy is justified.

Methods

Participants with painful diabetic neuropathy were recruited online and from hospital services. This was a single-arm study in which all participants received online Acceptance and Commitment Therapy. Participants completed questionnaires at baseline and three months post-treatment. Primary feasibility outcomes were recruitment, retention, and treatment completion rates. Secondary outcomes were pre- to post-treatment effects on pain outcomes and psychological flexibility.

Results

Of 225 potentially eligible participants, 30 took part in this study. Regarding primary feasibility outcomes, the treatment completion and follow-up questionnaire completion rates were 40% and 100%, respectively. Generally, at baseline those who completed the treatment, compared with those who did not, had better daily functioning and higher psychological flexibility. With respect to secondary outcomes, results from the completers group showed clinically meaningful effects at post-treatment for 100% of participants for pain intensity and pain distress, 66.7% for depressive symptoms, 58.3% for functional impairment, 41.7% for cognitive fusion, 66.7% for committed action, 58.3% for self-as-context, and 41.7% for pain acceptance.

Conclusions

This preliminary trial suggests feasibility of recruitment and follow-up questionnaire completion rates, supporting planning for a larger randomized controlled trial. However, treatment completion rates did not achieve the prespecified feasibility target. Changes to the treatment content and delivery may enhance the feasibility of online Acceptance and Commitment Therapy for people with painful diabetic neuropathy on a larger scale.
The Health Inequalities Assessment Toolkit: supporting integration of equity into applied health research
Authors: Porroche-Escudero Ana , Popay Jennie
Published: March 2020

Background

Despite insistent calls for more and better evidence to inform action to reduce health inequities, applied health research sensitive to these inequalities is rare. Recognising this problem, the Collaboration for Leadership in Applied Research and Care in the North West Coast (England) developed the Health Inequalities Assessment Toolkit (HIAT) to support those involved in health research to integrate equity into their work.

Objective

This paper reports on an evaluation of the extent to which HIAT enhances the equity focus of the work of users.

Methods

The evaluation used semi-structured interviews, focus groups and workshops (n = 131 respondents including Public Advisers, university, NHS and local government partners). Routine data included HIAT feedback forms.

Findings

HIAT can help to strengthen the equity focus of applied health research by: increasing understanding of how socioeconomic inequities impact on health; building capacity for integrating equity into all aspects of research, implementation and capacity building; stimulating thinking on action to address local structural drivers of health inequalities; and increasing understanding of the positive contribution public involvement can make to research.

Conclusion

If we are to advance health equity goals delivering research and training needs to be combined with political commitment to create more equal societies.
Subchronic and Low Dose of Tributyltin Exposure Leads to Reduced Ovarian Reserve, Reduced Uterine Gland Number, and Other Reproductive Irregularities in Female Mice
Authors: Sarmento Isabela V , Merlo Eduardo , Meyrelles Silvana S , Vasquez Elisardo C , Warner Genoa R , Gonsioroski Andressa , De La Torre Kathy , Meling Daryl D , Flaws Jodi A , Graceli Jones B
Published: March 2020

Tributyltin (TBT) chloride is an endocrine disrupting chemical associated with reproductive complications. Studies have shown that TBT targets the reproductive tract, impairing ovarian folliculogenesis, and uterine morphophysiology. In this investigation, we assessed whether subchronic and low dose of TBT exposure results in abnormal ovarian follicular reserve and other irregularities in female mice. TBT was administered to female mice (500 ng/kg/day for 12 days via gavage), and reproductive tract morphophysiology was assessed. We further assessed reproductive tract inflammation and oxidative stress. Improper functioning of the reproductive tract in TBT mice was observed. Specifically, irregular estrous cyclicity and abnormal ovarian morphology coupled with reduction in primordial and primary follicle numbers was observed, suggesting ovarian reserve depletion. In addition, improper follicular development and a reduction in antral follicles, corpora lutea, and total healthy ovarian follicles together with an increase in cystic follicles were apparent. Evidence of uterine atrophy, reduction in endometrial gland number, and inflammation and oxidative stress were seen in TBT mice. Further, strong negative correlations were observed between testosterone levels and primordial, primary, and total healthy ovarian follicles. Thus, these data suggest that the subchronic and low dose of TBT exposure impaired ovarian follicular reserve, uterine gland number, and other reproductive features in female mice.
Demand for Information on Environmental Health Risk, Mode of Delivery, and Behavioral Change: Evidence from Sonargaon, Bangladesh
Authors: Tarozzi Alessandro , Maertens Ricardo , Ahmed Kazi Matin , van Geen Alexander
Published: March 2020

Millions of villagers in Bangladesh are exposed to arsenic by drinking contaminated water from private wells. Testing for arsenic can encourage switching from unsafe wells to safer sources. This study describes results from a cluster randomized controlled trial conducted in 112 villages in Bangladesh to evaluate the effectiveness of different test selling schemes at inducing switching from unsafe wells. At a price of about US0.60, only one in four households purchased a test. Sales were not increased by informal inter-household agreements to share water from wells found to be safe, or by visual reminders of well status in the form of metal placards mounted on the well pump. However, switching away from unsafe wells almost doubled in response to agreements or placards relative to the one in three proportion of households that switched away from an unsafe well with simple individual sales.
Development and evolution of regionalization within the avian axial column
Authors: Bui Hoai-Nam N , Larsson Hans C E
Published: March 2020

The origin of birds from their terrestrial antecedents was accompanied by a wholesale transformation of their skeleton as they transitioned from a terrestrial to aerial realm. Part of this dramatic transformation is the reduction of separate vertebral elements into regional fusions to limit axial flexibility. This is partially mirrored within the development of the axial column, with regions of the axial column experiencing increasing morphological modularity and the loss of skeletal elements through vertebral fusions. Using a detailed description of the morphological development of the axial column in the model domestic chicken, Gallus gallus domesticus, we present a map of axial ossification based on discrete characters. Delays in ossification are found to occur in conjunction with the formation of fusions. Our study shows that the pattern and sequence of fusion and ossification during development may reflect the presence of independent modules as subsets within the typical regions of the avian axial column. Interestingly, few of these fusion modules correspond to the initial axial Hox expression patterns, suggesting another patterning mechanism is driving axial fusion regionalization. Additionally, two regions of fusion are discovered in the synsacrum. The anterior region of seven fused synsacrals may correspond to the non-ornithuran pygostylian synsacrum of the same number of vertebrae.
The Phytophthora infestans AVR2 Effector Escapes R2 Recognition Through Effector Disordering
Authors: Yang Li-Na , Liu Hao , Duan Guo-Hua , Huang Yan-Mei , Liu Shiting , Fang Zhi-Guo , Wu E-Jiao , Shang Liping , Zhan Jiasui
Published: March 2020

Intrinsic disorder is a common structural characteristic of proteins and a central player in the biochemical processes of species. However, the role of intrinsic disorder in the evolution of plant-pathogen interactions is rarely investigated. Here, we explored the role of intrinsic disorder in the development of the pathogenicity in the RXLR AVR2 effector of Phytophthora infestans. We found AVR2 exhibited high nucleotide diversity generated by point mutation, early-termination, altered start codon, deletion/insertion, and intragenic recombination and is predicted to be an intrinsically disordered protein. AVR2 amino acid sequences conferring a virulent phenotype had a higher disorder tendency in both the N- and C-terminal regions compared with sequences conferring an avirulent phenotype. In addition, we also found virulent AVR2 mutants gained one or two short linear interaction motifs, the critical components of disordered proteins required for protein-protein interactions. Furthermore, virulent AVR2 mutants were predicted to be unstable and have a short protein half-life. Taken together, these results support the notion that intrinsic disorder is important for the effector function of pathogens and demonstrate that SLiM-mediated protein-protein interaction in the C-terminal effector domain might contribute greatly to the evasion of resistance-protein detection in P. infestans.
Using Subepidermal Moisture Level as an Indicator of Early Pressure Damage to Local Skin and Tissue
Authors: Gershon Steve
Published: March 2020

OBJECTIVE

Inflammation triggered by tissue injury increases blood flow to the injured area, resulting in fluid accumulation below the epidermis known as subepidermal moisture (SEM). This accumulation can be assessed using an SEM scanner. The primary aim of this study was to determine whether levels of SEM from repeated measures at a localized area confirm the absence of a pressure injury at that site in healthy participants.

METHODS

Fifty patients attending a specialized pain clinic who were at very low risk of or unaffected by pressure injuries were enrolled. Subepidermal moisture readings were gathered at the center and near-proximate to the bony prominences of the heel and sacrum.

MAIN RESULTS

Among the participants, repeated localized measurements did not differ significantly at or around a single anatomic site. The heel had a slightly higher variation than the sacrum, although the variance was less than 0.6 SEM units, indicating that there is likely no inflammation at these sites in patients who are not at risk of pressure injuries and who show no visual signs of localized tissue inflammation. Demographic and other potential confounder data were gathered, but no statistically significant findings emerged from these data.

CONCLUSIONS

The relatively flat pattern of SEM values around the bony prominences of the heels and sacrum in healthy participants supports the hypothesis that healthy tissue is not inflamed.
“Virtual Biopsies” of Normal Skin and Thermal and Chemical Burn Wounds
Authors: Silver Frederick H. , Shah Ruchit
Published: March 2020

The search for noninvasive methods to image and measure the mechanical properties of skin has been a frequent subject of research for many years. Although suction testing, elastography, and other testing can be noninvasive, these tests fail to yield comparable results to destructive tests such as uniaxial tensile testing. Accordingly, researchers have developed a technique to combine optical coherence tomography with vibrational analysis (vibrational optical coherence tomography) to image and analyze the biomechanical properties of tissues noninvasively and nondestructively. The result of this analysis is a “virtual biopsy” of skin, along with a physical analysis of the major components of the epidermis and dermis.

In this study, the authors compare virtual biopsies of thermal and chemical burns to that of normal skin. They conclude that the enhanced optical coherence tomography images and measurements of the resonant frequency after thermal or chemical burns exhibit large differences when compared with the morphology and moduli of normal skin. Using vibrational optical coherence tomography, it is possible to follow changes in the morphology and physical properties of the epidermis and dermis associated with skin diseases and therapeutic treatments in situ.
Advances in chronic traumatic encephalopathy
Authors: McCambridge Megan , Stinson Matthew J.
Published: March 2020

Over the past decade, concern for negative outcomes associated with concussive brain trauma has grown immensely. These neuropathologic changes, termed chronic traumatic encephalopathy (CTE), have been linked to patients who exhibit neuropsychiatric symptoms and have experienced repetitive brain trauma. Recent publicity has brought about renewed interest in this progressive neurodegenerative disorder. This article will share the advances that have been made with CTE.
Benefits and limitations of noninvasive prenatal aneuploidy screening
Authors: Abel David Eric , Alagh Amy
Published: March 2020

The introduction of noninvasive prenatal screening (NIPS) using cell-free DNA (cfDNA) is the newest option for aneuploidy screening during pregnancy. Compared with other aneuploidy screening options, NIPS offers a higher detection rate for trisomy 21 with a low false-positive rate. However, pretest and post-test patient counseling is essential and should include a discussion of the benefits and limitations, the screening rather than diagnostic nature of the test, and the association of a test failure with an increased risk of aneuploidy. Refer patients for genetic counseling when appropriate, particularly if test failure occurs due to a low fetal fraction or if maternal mosaicism or malignancy is suspected.
Postpartum hemorrhage
Authors: Watkins Elyse J. , Stem Kelley
Published: March 2020

Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide, and incidence in the United States, although lower than in some resource-limited countries, remains high. Women of color are at a disproportionate risk of developing a life-threatening postpartum hemorrhage. Risk assessment tools are available but because they lack specificity and sensitivity, all pregnant women are considered at risk. Early identification of and intervention in a hemorrhage requires an interdisciplinary team approach to care and can save the lives of thousands of women each year.
Incidentally discovered primary mediastinal germ cell tumor
Authors: Wong Victoria , Geynisman Daniel M.
Published: March 2020

Most germ cell tumors arise from the testicles and often are self-diagnosed. Extragonadal germ cell tumors are rare and vary greatly in their clinical presentations. This case report describes a 24-year-old man with an unusual presentation for an extragonadal germ cell tumor.
Are Patient Privacy and Health Data at Risk?
Authors: Wielawski Irene M.
Published: March 2020

Partnerships between tech companies and health systems challenge privacy expectations and laws.
New Warning for Gabapentinoids
Authors: Aschenbrenner Diane S.
Published: March 2020

The Food and Drug Administration is requiring that a new warning be added to the labeling of gabapentinoids concerning the risk of respiratory depression, especially when the drug is combined with other central nervous system (CNS) depressants or the patient has respiratory risk factors.
Original Research: An Investigation of Career Choice Regret Among American Nurses
Authors: Dyrbye Liselotte , West Colin , Johnson Pamela , Cipriano Pamela , Peterson Cheryl , Beatty Dale , Major-Elechi Brittny , Shanafelt Tait
Published: March 2020

Purpose:

To explore whether burnout is an independent predictor of career choice regret among nurses.

Methods:

In November 2017 we invited a random sample of 89,995 members of the American Nurses Association to participate in an anonymous online survey. The survey collected demographic and professional information and included the Maslach Burnout Inventory–Human Services Survey for Medical Personnel (known as the MBI-HSS [MP]), as well as several items exploring career choice regret. Of the 86,858 nurses who received the e-mail invitation, 8,638 (9.9%) responded. Multivariable logistic regression analysis was conducted for the final sample of 6,933 nurses who provided complete responses to the MBI-HSS (MP) and the career choice regret survey items.

Results:

Fifteen percent of the 6,933 participating nurses had career choice regret. On multivariable analysis, experiencing burnout, working unplanned or mandatory overtime, being male, and having a higher academic degree related to nursing were independent predictors of career choice regret. Burnout was the strongest such predictor.

Conclusion:

Career choice regret among U.S. nurses is relatively common. Of the independent predictors this study identified, burnout had the strongest relationship with career choice regret. Organizational strategies aimed at reducing burnout and supporting nurses' ongoing professional development should be pursued.
Defining Recovery in Chronic Whiplash
Authors: Griffin Alexandra R. , Moloney Niamh , Leaver Andrew , Jagnoor Jagnoor , Michaleff Zoe A. , Lin Chung-Wei Christine , Trudy Rebbeck
Published: March 2020

Objective:

The meaning of recovery from musculoskeletal injury is complex, and understanding recovery from whiplash may be particularly important, given the chronic, often recalcitrant nature of the condition. Gaining a better understanding of recovery may also aid in the development and interpretation of future clinical trials. The aim of this study was to define the meaning of recovery from whiplash, and the factors influencing recovery, by exploring the perceptions of people with chronic whiplash, and their treating physiotherapists.

Materials and Methods:

This qualitative study was embedded within a larger randomized-controlled trial, and consisted of semistructured interviews. Interviews were conducted with 13 patient participants with chronic whiplash and 7 physiotherapists. Patient participants were asked what recovery meant to them, and perceptions around barriers and facilitators to recovery were explored. Physiotherapists were also asked to share their beliefs on the meaning of recovery, and what they believe recovery means to their patients.

Results:

Both patient participants and physiotherapists perceived recovery to be defined within the themes of pain, function, and emotional well-being. Patient participants also identified self-perception as important, whereas physiotherapists identified ownership on the part of the patient, and the multidimensional nature of recovery, including cultural values and beliefs, as important. Several themes relating to barriers and facilitators to recovery were also identified, and included personal and social characteristics and aspects of the therapeutic relationship.

Discussion:

Recovery is a multidimensional and complex construct. In addition to pain intensity and disability, measurement and conceptualization of recovery should focus on emotional well-being, self-perception, and the cultural values and beliefs of the individual. A positive therapeutic relationship, with attention to psychological and social influences, appears to be important in facilitating recovery and well-being.
Proximal Femoral Deformity Following Threaded Prophylactic Fixation for Slipped Capital Femoral Epiphysis: Risk Stratification Using the Modified Oxford Score
Authors: Kulkarni Vedant A. , Boyles Aaron D. , Carl Jacob , Boakes Jennette L. , Wilson Benjamin , Bagley Anita M. , Muchow Ryan D.
Published: March 2020

Background:

This study assesses the effect of skeletal maturity on the development of iatrogenic proximal femoral deformity following threaded prophylactic screw fixation in patients presenting with unilateral slipped capital femoral epiphysis (SCFE).

Methods:

Children who underwent threaded screw prophylaxis of the uninvolved hip (Group P) and those who were observed with no prophylaxis (Group N) on presentation with unilateral SCFE were compared. Skeletal maturity was assessed with the Modified Oxford Score (MOS). Proximal femoral morphology was characterized by femoral neck length, femoral neck width, neck shaft angle, and trochanteric femoral head overlap percentage (TFHOP). Femoral head deformity at final follow-up was characterized as spherical (Type 1), mildly aspherical (Type 2), or ovoid (Type 3). Analysis of variance and t test were used to compare the groups.

Results:

Thirty-eight patients in Group P and 17 patients in Group N met inclusion criteria. The average follow-up was 2.6 years. Group P was younger than Group N by an average of 9.6 months (P=0.04), but the MOS for skeletal maturity was not different between groups (P=0.15). Group P had significantly diminished neck length (P=0.008) and significantly increased relative trochanteric overgrowth as evidenced by increased trochanteric femoral head overlap percentage (P<0.001), but there was no difference between groups in neck shaft angle and neck width. No patient in Group N developed femoral head deformity (all Type 1). In Group P, 14 patients (37%) developed Types 2 and 3 deformity. In patients with MOS 16 in Group P, 60% (3/5) developed Type 2 deformity and 40% (2/5) developed Type 3 deformity. In patients with MOS 17 in Group P, 45% (5/11) had Type 2 deformity.

Conclusions:

Skeletally immature patients with an MOS of 16 and 17 are at high risk for developing the triad of relative trochanteric overgrowth, coxa breva, and femoral head asphericity with prophylactic threaded screw fixation for SCFE. When prophylactic surgery is indicated, consideration should be given to growth friendly fixation strategies to avoid iatrogenic proximal femoral deformity.

Levels of Evidence:

Level III—therapeutic retrospective comparative study.
Prevention of Proximal Junctional Kyphosis or Failure: Cement Augmentation
Authors: Martin Christopher T.
Published: March 2020

Vertebral cement augmentation (vertebroplasty) has recently garnered increasing attention as a possible prophylactic treatment for the prevention of proximal junctional kyphosis and proximal junctional failure in osteoporotic patients undergoing long spinal fusions. The supporting data mostly comes from small retrospective case series, but indicates a modest benefit, particularly in the prevention of proximal junctional failure. Common risks include possible cement extravasation leading to embolization events, and a theoretical increased risk of adjacent segment fracture. Deformity surgeons should familiarize themselves with the pros and cons of this technique and may wish to utilize it in appropriately selected cases.
Wagner Technique of Transphyseal Proximal Femoral Fixation
Authors: Randall Rachel M. , Singh Satbir , Klingele Kevin E.
Published: March 2020

Proximal femoral fractures and deformities in children are often difficult to treat because of high complication rates and risk of physeal closure resulting from the treatment fixation. The Wagner technique of smooth pin fixation through the femoral neck and across the proximal femoral physis provides stable fixation of the femoral neck and reduces the risk of avascular necrosis and growth disturbance. Eighteen consecutive cases in which the Wagner technique was used were reviewed. Diagnoses included fixation after proximal femur osteotomy, slipped capital femoral epiphysis reduction with associated valgus-producing osteotomy secondary to pre-existing coxa vara, traumatic femoral neck fractures, and pathologic femoral neck fractures secondary to aneurysmal bone cyst, unicameral bone cyst, fibrous dysplasia, or osteomyelitis in which bone defects were bone grafted before fixation. Outcomes included proximal femoral physeal closure, avascular necrosis (AVN), maintenance of alignment, and need for revision or implant removal surgery. There was no AVN, unintended proximal femoral physeal closure, or loss of fracture alignment requiring revision surgery. One patient required revision to an antegrade femoral nail for correction of progressive varus deformity. Four required implant removal: 2 because of continued growth and need for prophylaxis, 1 because of patient preference, and 1 for infection. Revision curettage and fixation was required for 1 of 10 patients with cyst recurrence after fixation for a pathologic femoral neck fracture. The Wagner technique is a versatile, safe, and effective method of transphyseal fixation for pediatric femoral neck fractures or proximal femoral deformity correction. In this series, there were no cases of AVN, premature unexpected proximal femoral physeal closure, or fracture malalignment requiring revision.
Diagnostic Test Accuracy of Glasgow Prognostic Score as a Prognostic Factor for Renal Cell Carcinoma
Authors: Kim Sun Il , Kim Se Joong , Kim Seong Jang , Cho Dae Sung
Published: March 2020

Objective:

The objective of this study was to perform a meta-analysis of the diagnostic test accuracy of Glasgow Prognostic Score (GPS) as a prognostic factor for renal cell carcinoma (RCC).

Materials and Methods:

Studies were retrieved from PubMed, Cochrane, and Embase databases, and we performed comprehensive searches to identify studies that evaluated the prognostic impact of pretreatment GPS in RCC patients. We assessed sensitivity, specificity, summary receiver operating characteristic curve, and area under the curve (AUC).

Results:

Totally, studies were searched under the prespecified criteria, and 8 studies with a total of 1191 patients were included to evaluate the prognostic impact of GPS in RCC finally. They indicated a pooled sensitivity of 0.785 (95% confidence interval [CI]: 0.705-0.848), specificity of 0.782 (95% CI: 0.656-0.871), diagnostic odds ratio of 13.089 (95% CI: 7.168-23.899), and AUC of 0.83 (95% CI: 0.79-0.86). Heterogeneity was significant, and meta-regression revealed that the presence of metastasis might be the potential source of heterogeneity. Subgroup analysis also demonstrated that the presence of metastasis might be the source of heterogeneity.

Conclusion:

GPS demonstrated a good diagnostic accuracy as a prognostic factor for RCC and especially in the case of nonmetastatic RCC.
Efficacy and Safety of Two Resilient Hyaluronic Acid Fillers in the Treatment of Moderate-to-Severe Nasolabial Folds: A 64-Week, Prospective, Multicenter, Controlled, Randomized, Double-Blinded, and Within-Subject Study
Authors: Monheit Gary , Kaufman-Janette Joely , Joseph John H. , Shamban Ava , Dover Jeffrey S. , Smith Stacy
Published: March 2020

BACKGROUND

A range of monophasic dermal fillers made of high-molecular-weight hyaluronic acid (HA) chains with reduced cross-linking was developed for aesthetic procedures.

OBJECTIVE

The efficacy, durability, and safety of 2 of these resilient HA (RHA) fillers, and their noninferiority to an effective HA comparator available in the United States, were tested in the treatment of dynamic facial wrinkles.

METHODS

A 15-month, prospective, multicenter, active-controlled, randomized, double-blinded, split-face clinical trial was carried out on 174 subjects presenting moderate-to-severe bilateral nasolabial folds (NLFs). Assessed parameters included improvement on a proprietary Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale, according to Blind Live Evaluators, subjects, and treating investigators. Self-perception was evaluated with FACE-Q and satisfaction scales.

RESULTS

The per-protocol populations included 67 and 62 subjects of all Fitzpatrick skin-phototypes, in the 2 comparison groups. Significant improvement of mean WSRS scores and associated responder rates established the noninferiority of RHA fillers to their comparator, over 15 months. Aesthetic improvement and subject satisfaction were durably high, with no meaningful differences between the fillers. Treatments were safe and well tolerated.

CONCLUSION

The 2 RHA fillers are at least equivalent to a well-established comparator for the correction of NLF in subjects of diverse skin-phototypes.
Three-Dimensional Analysis of Age-Related Orbital and Midfacial Bone Remodeling in Asians
Authors: Feng Wen-Jie , Li Fang-Wei , Zhan Wen-Feng , Lin Fu-Chuan , Luo Sheng-Kang
Published: March 2020

BACKGROUND

Facial bony changes vary among races, yet few studies have been conducted in Asians.

OBJECTIVE

To analyze the aging of orbital and midfacial bones in Asians.

METHODS

Based on the two-dimensional data obtained from the computed tomography scanner of imaging department, 3D reconstructions were conducted to take measurements (orbital diagonal diameter, orbital width, orbital area, maxillary angle, midfacial height, pyriform angle, pyriform width, and pyriform area).

RESULTS

In this retrospective study of 261 subjects, a significant decrease in the orbital diagonal diameter, orbital width, and midfacial height was found in men, whereas women displayed a significant increase in the pyriform width and a significant decrease in maxillary angle and midfacial height by three-dimensional analysis.

CONCLUSION

This study verifies the minor female changes in the orbital region and less dramatic male changes in the midfacial region compared with that in Caucasians. Individualized treatment should be performed according to different genders and races. Further exploration of facial bone metabolism may have valuable implications for Asians.
Association between common mental disorders, sleep quality, and menopausal symptoms: a population-based study in Southern Brazil
Authors: Neutzling Agnes L. , Leite Heloísa M. , Paniz Vera Maria V. , de Bairros Fernanda Souza , Dias da Costa Juvenal S. , Olinto Maria Teresa A.
Published: March 2020

Objective:

To investigate the association between common mental disorders (CMD), sleep quality, and moderate and severe menopausal symptoms in adult women in southern Brazil.

Methods:

This cross-sectional, population-based study investigated a representative sample of 393 women (age 40-69 years) living in an urban area. A standardized and pretested questionnaire that included the Self-Reporting Questionnaire-20 for CMD (Self-Reporting Questionnaire-20 ≥7), the Pittsburgh Sleep Quality Index-BR for sleep disorders (Pittsburgh Sleep Quality Index >5), and the Menopause Rating Scale for moderate/severe menopausal symptoms (Menopause Rating Scale >8) was used for data collection. Unadjusted and adjusted prevalence ratios and 95% confidence intervals (95% CIs) were estimated using robust Poisson regression.

Results:

The prevalence of moderate/severe menopausal symptoms in the sample was 58.0% (95% CI 53.0-63.0), the prevalence of CMD was 40.2% (95% CI 35.3-45.2), and the prevalence of poor sleep quality was 49.4% (95% CI 44.3-54.5). CMD and poor sleep quality occurred simultaneously in 34.4% of participants (95% CI 29.6-39.3). Moderate/severe menopausal complaints were significantly more prevalent in women with CMD (P < 0.001) and poor sleep quality (P < 0.001); the presence of both CMD and poor sleep quality increased the likelihood of moderate/severe menopausal complaints threefold. After adjustment, CMD and poor sleep quality remained strongly and significantly associated with moderate/severe menopausal complaints (P < 0.001).

Conclusions:

Considering the complex time-course relationship between CMD, sleep quality, and menopausal symptoms, longitudinal studies should follow women with these issues throughout the menopausal period to identify a possible temporal link between exposures and outcome.

Video Summary:
http://links.lww.com/MENO/A554.
Improvements in Skin Quality Biological Markers in Skin Explants Using Hyaluronic Acid Filler VYC-12L
Authors: Nakab Lauren , Hee Christopher K. , Guetta Olivier
Published: March 2020

Background:

Hyaluronic acid (HA), both crosslinked and uncrosslinked, is used clinically to treat fine lines and provides additional improvements in skin quality attributes. The purpose of this study was to assess potential early differences in the expression of biological markers of skin quality in living human skin explants injected with uncrosslinked and crosslinked HA gels.

Methods:

Living human skin explants injected with VYC-12L or noncrosslinked HA with mannitol (HYD) and noninjected controls were assessed via microscopy, histology, and immunohistochemistry on days 3 and/or 8 for biological markers of elasticity (collagen density, elastin, fibrillin-1) and hydration [aquaporin-3, acidic glycosaminoglycans (GAGs), HA]. Hydration was also assessed via a corneometer probe on days 0, 1, 2, and 8.

Results:

On day 3 versus controls, VYC-12L moderately increased collagen density in the upper reticular dermis and clearly increased fibrillin-1 expression, with slight increases persisting on day 8. Increases with HYD were smaller and did not persist on day 8. Both VYC-12L and HYD increased aquaporin-3 expression and GAG content on days 3 and 8, but VYC-12L produced greater GAG increases in the reticular dermis. Day 8 instrument-assessed hydration increased by 49% and 22% for VYC-12L and HYD, respectively. Elastin expression in oxytalan and elaunin fibers was unchanged. Upper-dermal HA reductions suggested HA injection-induced hyaluronidase expression.

Conclusion:

VYC-12L produced greater, more lasting improvements in biological markers of skin quality than HYD.
Single-phase computed tomography angiography sufficiently predicts outcomes after mechanical thrombectomy
Authors: Yu Kai-Wei , Lin Chung-Jung , Luo Chao-Bao , Lin Yung-Yang , Guo Wan-Yuo , Chang Feng-Chi , Lee I-Hui , Lin Chun-Jen , Chung Chih-Ping , Chien Chun
Published: March 2020

Background:

Arterial collateral (AC) assessed by single-phase computed tomography angiography (CTA) or multiphase CTA has been used to predict clinical outcomes in patients undergoing mechanical thrombectomy (MT). Recently, venous opacification (VO) was proposed as another accurate image marker. This study aimed to compare the efficacy using AC and VO as predictors of MT outcome.

Methods:

Patients with occlusion of the proximal anterior circulation undergoing MT were included retrospectively. We assessed the AC status respectively according to different methods: modified Tan score, Miteff score in single-phase CTA, and pial arterial filling score in multiphase CTA. VO was assessed according to cortical vein opacification score. Favorable clinical outcome was defined as modified Rankin Scale 0-2 90 days after MT. Logistic regression models were established and receiver operating characteristics curve were used to determine the predictability of favorable outcome in patients with adequate AC and VO.

Results:

A total of 75 patients were enrolled. Adequate AC identified by modified Tan score (odds ratio, 7.3; p < 0.001), Miteff score (odds ratio, 4.5; p = 0.009), significantly predicted favorable outcome, but not adequate VO. The area under the curve was largest for adequate AC in model of modified Tan score 0.730 (95% CI, 0.60-0.86), while adequate VO showed the least area under the curve: 0.577 (95% CI, 0.43-0.73).

Conclusion:

We considered adequate AC in single-phase CTA could be reliable enough as an imaging marker rather than adequate VO to predict favorable outcome after MT.
The update of chimeric antigen receptor-T cells therapy in glioblastoma
Authors: Chou Chi-Jen , Lin Chun-Fu , Chen Yi-Wei , Huang Pin-I , Yang Yi-Ping , Wang Mong-Lien , Hung Kai-Feng , Lee Yi-Yen
Published: March 2020

Glioblastoma (GBM) is the most malignant central nervous system neoplasm and the outcome is difficult to break through for decades. Ninety percent of patients who suffered from treatment failed. Since 2010, the chimeric antigen receptor (CAR)-T cell therapy has achieved a durable effect in the treatment of B-cell hematologic malignancies. Although several preclinical and clinical trials have emerged as a potential option in solid tumor including high-grade gliomas, the results are limited at present. The challenges of CAR-T cells in GBM are including identification of tumor-specific antigens, preservation activity of T cell, trafficking of enough CAR-T cells to the tumor site, and reversed unique immune suppressive environment of the central nervous system. The success of targeting brain tumors with CAR-T cells has more consideration. In this review article, we will summarize the current key clinical trials of CAR-T therapies in this field. And will outline the obstacles of application of CAR-T cells for the treatment of GBM as well. This review is intended to help guide the future direction of CAR-T therapy in GBM that will move the outcome forward in the future.
Comparison of objective nutritional indexes for the prediction of in-hospital mortality among elderly patients with acute heart failure
Authors: Alataş Ömer Doğan , Biteker Murat , Yildirim Birdal , Acar Ethem , Gökçek Kemal
Published: March 2020

Objectives:

The association between objective nutritional indexes and prognosis in patients with acute heart failure have not been well studied. Therefore, we aimed to compare the prognostic value of modified Glasgow prognostic score, prognostic nutritional index, controlling nutritional status score, and geriatric nutritional risk index for the prediction of in-hospital mortality in patients with acute heart failure.

Methods:

All consecutive elderly patients (aged ≥65 years) who had tests for C-reactive protein, total lymphocyte count, total cholesterol, and albumin levels at admission, and hospitalized due to acute heart failure were retrospectively included. The primary endpoint of the study was in-hospital mortality. We used a base model for the prediction of in-hospital mortality, including age, gender, log N-terminal pro-B-type natriuretic peptide, and the presence of coronary artery disease. We added each of the malnutrition scores, in turn, to the base model and used C-statistics to evaluate model discrimination in survival analysis.

Results:

A total of 628 patients were included, and 80 (12.7%) of the patients died during the hospital stay. Multivariate analysis showed that older age, prognostic nutritional index < 41.2, controlling nutritional status score > 5, geriatric nutritional risk index <92, and modified Glasgow prognostic score were independent predictors of in-hospital mortality. Among the malnutrition scores, geriatric nutritional risk index increased model performance most compared with base model.

Conclusion:

Though all objective nutritional indexes were associated with prognosis in elderly patients with acute heart failure, geriatric nutritional risk index was superior to other scores in predicting in-hospital mortality.
Dysfunction of the hypothalamic-pituitary-adrenal axis in critical illness: a narrative review for emergency physicians
Authors: Marino Lucas Oliveira , Souza Heraldo Possolo
Published: March 2020

The stress response to acute disease is characterized by activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathoadrenal system, increased serum cortisol levels, increased percentage of its free fraction and increased nuclear translocation of the glucocorticoid-receptor complex, even though many pathways may be inhibited by poorly understood mechanisms. There is no consensus about the cutoff point of serum cortisol levels for defining adrenal insufficiency. Furthermore, recent data point to the participation of tissue resistance to glucocorticoids in acute systemic inflammatory processes. In this review, we evaluate the evidence on HPA axis dysfunction during critical illness, particularly its action on the inflammatory response, during acute severe injury and some pitfalls surrounding the issue. Critical illness-related corticosteroid insufficiency was defined as a dynamic condition characterized by inappropriate cellular activity of corticosteroids for the severity of the disease, manifested by persistently elevated proinflammatory mediators. There is no consensus regarding the diagnostic criteria and treatment indications of this syndrome. Therefore, the benefits of administering corticosteroids to critically ill patients depend on improvements in our knowledge about the possible disruption of its fragile signalling structure in the short and long term.