bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of vitrification and the superovulated environment on placental function and fetal growth in an IVF mouse model
Authors: Roeca C , Silva E , Barentsen C , Powell T L , Jansson T
Published: June 2020

In studies of human IVF, as compared to frozen embryo transfer (ET), fresh ET is associated with smaller infants and higher risk of small for gestational age infants. Recent observations suggest that ET using vitrified embryos is associated with higher pregnancy and live birth rates compared to fresh ET, but increased rates of large for gestational age infants. The mechanisms underlying these associations are largely unknown, and available evidence suggests that the influence of IVF, vitrification and the superovulated (SO) uterine environment on placental function and fetal growth is complex. This warrants further investigation given the prevalent practice in human IVF of both fresh ET into a SO uterine environment, and vitrification with ET into a more physiologic uterine environment. Using a mouse model that closely resembles human IVF, we investigated if vitrification of IVF embryos better preserves placental function and results in better pregnancy outcomes as compared to fresh ET because of transfer into a more physiologic endometrium. We found that the SO environment, independent of vitrification status, reduced implantation rates, inhibited placental mechanistic target of rapamycin signaling and induced placental stress signaling, resulting in fetal growth restriction (1.080 ± 0.05 g estrous fresh (n = 17 litters), 1.176 ± 0.05 g estrous vitrified (n = 12), 0.771 ± 0.06 g SO fresh (n = 15), 0.895 ± 0.08 g SO vitrified (n = 10), P < 0.0001). In addition, our study suggests that vitrification impairs the developmental potential of IVF blastocysts that resulted in a significantly smaller litter size (2.6 ± 2.3 fresh estrous vs 2.5 ± 2.4 fresh SO vs 1.6 ± 1.7 estrous vitrified vs 1.7 ± 1.8 SO vitrified, P = 0.019), with no effect on fetal growth or placental function at term. Our findings suggest that vitrification may negatively impact early embryonic viability, while the SO maternal uterine environment impairs both placental development and fetal growth in IVF.
Stable hooks: biomechanics of heteromorph ammonoids with U-shaped body chambers
Authors: Peterman David J , Shell Ryan , Ciampaglio Charles N , Yacobucci Margaret M
Published: June 2020

The biomechanics of uncoiled heteromorph ammonoids with body chambers that terminate in U-shaped hooks (ancylocones) were investigated with virtual and physical models of Audouliceras renauxianum. Virtual models were used to compute the hydrostatic properties of this morphotype. Audouliceras has the capacity for neutral buoyancy and this suggests that other taxa with similar proportions had this ability as well. Hydrostatic stability gradually increases during ontogeny, coincident with the larger degree of uncoiling. The juvenile planispiral stage has a similar stability and apertural orientation to the extant Nautilus. The adult stage, however, undergoes an increase in stability by a factor of over 3, while assuming an upward-facing posture. Counterintuitively, the stage during the formation of the shaft (before the growth of the U-shaped hook) is oriented horizontally. This intermediate stage would have had poor horizontal mobility due to the positioning of the hyponome below the centre of mass. The juvenile planispiral stage and mature stage, however, would have been well suited to horizontal backward movement with minimal rocking. Ancylocones are generally thought of as quasiplanktic vertical migrants. Thus, their relative horizontal swimming ability has been largely disregarded. Experiments on 3D printed, neutrally buoyant physical models reveal that hydrodynamic drag is indeed larger compared to Nautilus. However, Audouliceras could reach similar maximum horizontal velocities depending on the available thrust. Sepia-like thrusts yield velocities similar to equivalently sized Nautilus (c. 15 cm/s), while Nautilus-like thrusts yield velocities not much lower (c. 11 cm/s). Due to the hydrostatic properties of the ancylocone, the adult model undergoes less rocking (±4.5°) during movement than Nautilus (±10°). The minimal hydrodynamic consequences for ancylocones suggest that stability, orientation and directional efficiency are key selective pressures for some heteromorph shells, which may have primarily served as hydrostatic devices.
Resolving Toxic DNA repair intermediates in every E. coli replication cycle: critical roles for RecG, Uup and RadD
Authors: Romero Zachary J , Chen Stefanie H , Armstrong Thomas , Wood Elizabeth A , van Oijen Antoine , Robinson Andrew , Cox Michael M
Published: June 2020

DNA lesions or other barriers frequently compromise replisome progress. The SF2 helicase RecG is a key enzyme in the processing of postreplication gaps or regressed forks in Escherichia coli. A deletion of the recG gene renders cells highly sensitive to a range of DNA damaging agents. Here, we demonstrate that RecG function is at least partially complemented by another SF2 helicase, RadD. A ΔrecGΔradD double mutant exhibits an almost complete growth defect, even in the absence of stress. Suppressors appear quickly, primarily mutations that compromise priA helicase function or recA promoter mutations that reduce recA expression. Deletions of uup (encoding the UvrA-like ABC system Uup), recO, or recF also suppress the ΔrecGΔradD growth phenotype. RadD and RecG appear to avoid toxic situations in DNA metabolism, either resolving or preventing the appearance of DNA repair intermediates produced by RecA or RecA-independent template switching at stalled forks or postreplication gaps. Barriers to replisome progress that require intervention by RadD or RecG occur in virtually every replication cycle. The results highlight the importance of the RadD protein for general chromosome maintenance and repair. They also implicate Uup as a new modulator of RecG function.
Switching the activity of Taq polymerase using clamp-like triplex aptamer structure
Authors: Hu Yingxin , Wang Zhiyu , Chen Zhekun , Pan Linqiang
Published: June 2020

In nature, allostery is the principal approach for regulating cellular processes and pathways. Inspired by nature, structure-switching aptamer-based nanodevices are widely used in artificial biotechnologies. However, the canonical aptamer structures in the nanodevices usually adopt a duplex form, which limits the flexibility and controllability. Here, a new regulating strategy based on a clamp-like triplex aptamer structure (CLTAS) was proposed for switching DNA polymerase activity via conformational changes. It was demonstrated that the polymerase activity could be regulated by either adjusting structure parameters or dynamic reactions including strand displacement or enzymatic digestion. Compared with the duplex aptamer structure, the CLTAS possesses programmability, excellent affinity and high discrimination efficiency. The CLTAS was successfully applied to distinguish single-base mismatches. The strategy expands the application scope of triplex structures and shows potential in biosensing and programmable nanomachines.
Emerging immunotherapies for malignant glioma: from immunogenomics to cell therapy
Authors: Dunn Gavin P , Cloughesy Timothy F , Maus Marcela V , Prins Robert M , Reardon David A , Sonabend Adam M
Published: June 2020

As immunotherapy assumes a central role in the management of many cancers, ongoing work is directed at understanding whether immune-based treatments will be successful in patients with glioblastoma (GBM). Despite several large studies conducted in the last several years, there remain no FDA-approved immunotherapies in this patient population. Nevertheless, there are a range of exciting new approaches being applied to GBM, all of which may not only allow us to develop new treatments but also help us understand fundamental features of the immune response in the central nervous system. In this review, we summarize new developments in the application of immune checkpoint blockade, from biomarker-driven patient selection to the timing of treatment. Moreover, we summarize novel work in personalized immune-oncology by reviewing work in cancer immunogenomics–driven neoantigen vaccine studies. Finally, we discuss cell therapy efforts by reviewing the current state of chimeric antigen receptor T-cell therapy.
Smoking Prevalence and COVID-19 in Europe
Authors: Tsigaris Panagiotis , Teixeira da Silva Jaime A
Published: June 2020

Introduction

This ecological study investigates the association between smoking prevalence and COVID-19 occurrence and mortality in 38 European nations as of May 30, 2020.

Methods

Data were collected from Our World in Data. Regression analysis was conducted to adjust for potential confounding factors such as economic activity (gross domestic product), the rate of COVID-19 testing, and the stringency of COVID-19 control policies.

Results

There was a statistically significant negative association between smoking prevalence and the prevalence of COVID-19 across the 38 European nations after controlling for confounding factors (p = 0.001). A strong association was found between the prevalence of COVID-19 per million people and economic activity (p = 0.002) and the rate of COVID-19 testing (p = 0.0006). Nations with stricter policy enactment showed fewer COVID-19 cases per million people, but the association was not significant (p = 0.122). Delaying policy enactment was associated with a greater prevalence of COVID-19 (p = 0.0535). Evidence of a direct association between smoking prevalence and COVID-19 mortality was not found (p = 0.626). There was a strong positive association between COVID-19 mortality rate and the prevalence of COVID-19 cases (p < 0.0001) as well as the proportion of the population over 65 years of age (p = 0.0034) and a negative association with the rate of COVID-19 testing (p = 0.0023).

Conclusions

We found a negative association between smoking prevalence and COVID-19 occurrence at the population level in 38 European countries. This association may not imply a true or causal relationship, and smoking is not advocated as a prevention or treatment of COVID-19.

Implications

Given the evidence of this ecological study, and of several other studies that found an underrepresentation of smoking prevalence in hospitalized cases, it may be worth examining, in laboratory experiments and controlled human trials, if nicotine offers any protection against COVID-19. Most importantly, to date, no study, including this one, supports the view that smoking acts as a treatment intervention or prophylaxis to reduce the impact or ameliorate the negative health impacts of COVID-19.
A call to action to address COVID-19–induced global food insecurity to prevent hunger, malnutrition, and eating pathology
Authors: Paslakis Georgios , Dimitropoulos Gina , Katzman Debra K
Published: June 2020

The coronavirus 2019 disease (COVID-19) pandemic has led to food shortages, increased food prices, and loss of income. As a result, global food insecurity alerts have been issued. The pandemic threatens millions of children and adolescents and their families currently living with or at risk for development of food insecurity. The lack of consistent access to nutritious food sources is associated with chronic physical and mental health problems and death. Studies on food insecurity and eating pathology have heightened our concern about the impact the added effect of the pandemic may have on eating behaviors of children and adolescents. Here, we want to draw attention to the need for making food security and healthy eating attitudes and behaviors a global priority during the COVID-19 pandemic to guarantee the current and future health and well-being of our children and adolescents.
Summary of the 9th Life Science Symposium: integration of nutrition and exercise sciences
Authors: Miyachi Motohiko
Published: June 2020

The Life Science Symposium held by the Nutrition Research Committee of the International Life Sciences Institute (ILSI) Japan in 2018, “Fusion of Nutrition and Exercise Sciences Leading to Extension of Healthy Life Expectancy,” covered current topics in the science of nutrition and exercise to address extending healthy life expectancy. Presentation topics included (1) lifestyle and gut microbiota; (2) how to use lipids in sports nutrition; (3) the effect and molecular mechanism of improvement of arteriosclerosis by exercise and nutrition; (4) physical activity and nutrition that support brain function; (5) skeletal muscles and food ingredients that support healthy longevity; (6) measures against sarcopenia by exercise and nutrient intake; (7) physical activity/exercise for disease prevention; (8) nutritional epidemiology research for the Japanese population; (9) new developments in health science in viewed from nutrition and intestinal flora; (10) why do Asians develop nonobese metabolic disease?; and (11) social implementation of the health promotion program by ILSI Japan. The speakers emphasized the promotion of research on exercise and nutrition interactions and encouraged social implementation of the research results in public and private sectors.
Techniques for Peripheral Nerve Stimulator Implantation of the Upper Extremity
Authors: Singh Vinita , Sandhu Diya , Xiang Nan
Published: June 2020

Objective

To present a technical note on how to perform upper extremity peripheral nerve stimulators for three major nerves: median, ulnar, and radial.

Design

Literature review and expert opinion.

Setting

Single academic center.

Results

Peripheral nerve stimulation has recently become popular with the development and availability of peripheral nerve stimulators with an external pulse generator. Here, we describe ultrasound anatomy and technical details for peripheral nerve stimulation in the upper extremity for three major nerves: median, ulnar, and radial.

Conclusions

Upper extremity peripheral nerve stimulation can be considered as an option for refractory neuropathic upper extremity pain.
Do Foreign Institutional Investors Improve Price Efficiency?
Authors: Kacperczyk Marcin , Sundaresan Savitar , Wang Tianyu
Published: June 2020

We study the impact of foreign institutional investors on price efficiency with firm-level international data. Using additions to the MSCI index and the U.S. Jobs and Growth Tax Relief Reconciliation Act as exogenous shocks to foreign ownership, we show that greater foreign ownership increases stock price informativeness, especially in developed economies. This increase arises from new information that foreign investors bring in and displacement of less-informed domestic retail investors. Finally, we show that foreign ownership, particularly from active investors, increases market liquidity, reduces firms’ cost of equity, and increases firms’ real investment growth.
Ultrasound-guided core needle biopsy compared with open biopsy: a new diagnostic approach to salivary gland enlargement in Sjögren’s syndrome?
Authors: Zabotti Alen , Zandonella Callegher Sara , Lorenzon Michele , Pegolo Enrico , Scott Cathryn A , Tel Alessandro , Giovannini Ivan , Robiony Massimo , Di Loreto Carla , Zuiani Chiara , De Vita Salvatore
Published: June 2020

Objective

Persistent (≥2 months) major salivary gland enlargement in primary SS (pSS) patients is a well-known sign of possible involvement by B cell lymphoma. The study aimed to evaluate the diagnostic accuracy and safety of US-guided core needle biopsy (CNB) of major salivary glands compared with open surgical biopsy.

Methods

Prospective pSS patients (cases) with clinically persistent salivary gland enlargement underwent US-guided CNB and were compared with retrospective pSS patients (controls) submitted to open surgical biopsy. The features analysed were pre-biopsy clinical and laboratory findings, adequacy of the material for histology and diagnostic-rendered and biopsy-related complications (reported by the patient with a questionnaire and clinically verified).

Results

Thirteen cases underwent US-guided CNB: in nine, biopsy was performed on the parotid gland and in four it was performed on the submandibular gland. Sufficient material was obtained for pathological diagnosis in all samples. The final diagnoses were 5 (38.5%) B cell lymphoma, 1 (7.7%) lymphoepithelial sialadenitis, 4 (30.7%) other sialadenitis (granulomatous consistent with sarcoidosis, IgG4-related disease, chronic sclerosing, diffuse chronic) and 3/13 (23.1%) miscellaneous lesions. Thirteen controls underwent open surgical biopsy of the parotid. In one, inadequate material was obtained, while in 12 (92.3%) the pathologic diagnoses were 4 (33.3%) B cell lymphoma, 2 (16.7%) lymphoepithelial sialadenitis, 4 (33.3%) uncertain lymphoproliferative lesions and 2 (16.7%) miscellaneous lesions. Six cases (46.1%) reported six transient complications and 12/13 (92.3%) controls had 2 persistent and 14 transient complications.

Conclusion

US-guided CNB represents a novel, clinically relevant and safe approach for the management of pSS patients with parotid or submandibular persistent enlargement.
Determining the phosphorus release of Smizyme TS G5 2,500 phytase in diets for nursery pigs
Authors: Wensley Madie R , DeRouchey Joel M , Woodworth Jason C , Tokach Mike D , Goodband Robert D , Dritz Steve S , Faser Jill M , Guo Baolin L
Published: June 2020

Two experiments were conducted to determine the available P (aP) release of Smizyme TS G5 2,500 (Origination, LLC., Maplewood, MN) phytase. Pigs were weaned at approximately 21-d of age, randomly allotted to pens based on initial body weight (BW) and fed a common diet. On d 21 post-weaning, pens were blocked by BW and randomly allotted to 1 of 8 (experiment 1) or 7 (experiment 2) dietary treatments with five pigs per pen and eight pens per treatment. Treatments were formulated to include increasing aP from either inorganic P (0.12%, 0.18%, or 0.24% in experiment 1 and 0.11%, 0.19%, or 0.27% in experiment 2 from monocalcium P) or increasing phytase (150, 250, 500, 750, or 1,000 FTU/kg in experiment 1 and 250, 500, 1,000, or 1,500 FTU/kg in experiment 2). Prior to beginning the 21-d studies, all pigs were fed the lowest inorganic P diet for a 3-d period. At the conclusion of each experiment, the pig closest to the pen mean BW was euthanized and fibulas were collected to determine bone ash weight and percentage bone ash. Fibulas were processed using defatted bone mineral procedures. In both experiments, pigs fed increasing aP from inorganic P had increased (linear, P < 0.01) average daily gain (ADG), G:F, and final BW. Additionally, pigs fed diets with increasing phytase had increased (experiment 1 linear, P < 0.01; experiment 2 linear and quadratic, P < 0.05) performance across all growth response criteria. For bone composition, pigs fed increasing aP from inorganic P had increased bone ash weights (linear, P < 0.01) and percentage bone ash (experiment 1 quadratic, P < 0.01; experiment 2 linear, P < 0.01). Similarly, pigs fed increasing phytase had increased bone ash weights (linear, P < 0.01) and percentage bone ash (experiment 1 linear, P < 0.01; experiment 2 linear and quadratic, P < 0.05). The percentage aP released from Smizyme TS G5 2,500 for both experiments varied depending on the response criteria used. As the amount of phytase in the diet increased, the calculated aP release increased when ADG (experiment 1 linear, P < 0.01; experiment 2 linear and quadratic, P < 0.01), G:F (linear, P < 0.01), or percentage bone ash (experiment 1 linear and quadratic, P < 0.05; experiment 2 linear, P < 0.01) were used the predictor variable. When combining the data from experiment 1 and 2, the aP release prediction equations for Smizyme TS G5 2,500 are aP = (0.197 × FTU)/(584.956 + FTU), aP = (0.175 × FTU)/(248.348 + FTU), and aP = (0.165 × FTU)/(178.146 + FTU) when using ADG, G:F, and percentage bone ash, respectively as the predictor variable.
Lonomiaenvenomation in Brazil: an epidemiological overview for the period 2007–2018
Authors: Favalesso Marília Melo , Cuervo Pablo Fernando , Casafús Milena Gisela , Guimarães Ana Tereza Bittencourt , Peichoto Maria Elisa
Published: June 2020

Background

Among the Lepidoptera with medical importance in Brazil, larvae of Lonomia moth (Saturniidae: Hemileucinae) stand out by being the etiological agent of the lonomism, a form of erucism in which the most troubling symptoms include systemic hemorrhage that can lead to death.

Methods

This study provides an epidemiological overview of accident notifications with Lonomia registered by the Brazilian Reportable Disease Information System (SINAN) between 2007 and 2018. The categories of sociodemographic aspects of the victim, accident characteristics, and clinical data (6,636 records) were analysed by the chi-square test for goodness of fit (α=0.05). By the same test, accident frequencies by month, year, and state were also compared. To explore the spatial distribution of notifications and to identify significant space-time and purely spatial clusters, a spatial scan statistic (SaTScan) was used.

Results

The epidemiological profile of most of the victims had at least one of the following characteristics: male, >50 y of age, ethnically classified as white, and with a low level of education. Accidents in urban areas were as frequent as in rural areas. A higher frequency of non-work-related accidents was detected. Victims were mostly stung on the upper limbs. Most victims received medical care within the first 3 h after the accident. Most cases were classified as mild, although 12 deaths were reported. The south states of Brazil concentrate the highest frequencies of notifications. Summer was the season with the greatest number of cases, and the majority of the notifications occurred between 2017 and 2018.

Conclusion

These results provide an overall and current situation assessment of the lonomism in Brazil, and they should enable health authorities to improve the management of this envenomation in states/regions that share the high epidemiological risk of exposure to Lonomia.
Precision Medicine in Acute Brain Injury: A Narrative Review
Authors: Mahajan Charu , Kapoor Indu , Prabhakar Hemanshu
Published: June 2020

Over the past few years, the concept of personalized medicine has percolated into the management of different neurological conditions. Improving outcomes after acute brain injury (ABI) continues to be a major challenge. Unrecognized individual multiomic variations in addition to multiple interacting processes may explain why we fail to observe comprehensive improvements in ABI outcomes even when applied treatments appear to be beneficial logically. The provision of clinical care based on a multiomic approach may revolutionize the management of traumatic brain injury, delayed cerebral ischemia after subarachnoid hemorrhage, acute ischemic stroke, and several other neurological diseases. The challenge is to incorporate all the information obtained from genomic studies, other omic data, and individual variability into a practical tool that can be used to assist clinical decision-making. The effective execution of such strategies, which is still far away, requires the development of protocols on the basis of these complex interactions and strict adherence to management protocols. In this review, we will discuss various omics and physiological targets to guide individualized patient management after ABI.
Systematic Review on Late Cochlear Implantation in Early-Deafened Adults and Adolescents: Predictors of Performance
Authors: Debruyne Joke A. , Janssen A. Miranda , Brokx Jan P. L.
Published: June 2020

Objectives:

Early-deafened, late-implanted adolescents and adults constitute a unique group of cochlear implant (CI) users, showing a large variability in outcomes. The current systematic review aimed to determine which preimplantation factors are relevant in predicting postoperative outcomes in this patient group.

Design:

A systematic search for studies published between 2000 and September 2017 was performed in five electronic databases (PubMed, Embase, the Cochrane library, CINAHL, and PsycInfo). Prognostic studies that assessed the relation between patient-related factors and CI outcomes in early-deafened but late-implanted adolescent and adult CI users were included. Study quality was assessed with the Quality In Prognosis Studies (QUIPS) tool.

Results:

The systematic search and subsequent full-text evaluation identified 13 studies that had a clear prognostic study goal. Eight out of these 13 studies had a high risk of bias for at least one of the five QUIPS domains. Analysis of the outcomes identified that communication mode (in childhood), preoperative speech intelligibility, and preoperative speech recognition scores were significantly related to speech perception outcomes for this group of CI users. A number of additional factors considered worth for further investigation were also identified.

Conclusions:

The analysis of the studies assessing the effect of a number of patient-related factors on outcome with CI in early-deafened adolescents and adults identified three potential prognostic factors and a number of additional factors to be incorporated in future research. More high-quality prognosis studies in the investigated patient population are still needed.
Desmoplastic melanoma: an updated clinical review and the emerging role of genetic markers and immunotherapies
Authors: Hadfield Matthew J. , Helsing Racquel , Grant-Kels Jane M.
Published: June 2020

Desmoplastic melanoma (DM) is a rare and histopathologically as well as prognostically distinct subset of melanoma that arises in chronically sun-damaged skin. DM is typically and relatively indolent in nature with most cases not progressing to metastatic disease. DM has been managed with both radiation and surgical approaches. Medical options for the treatment of metastatic DM have traditionally been limited. Recent advances in immunotherapies have shown promising responses in DM ushering in a new class of treatment options. Additionally, with the advent of whole exome sequencing, the genetic make-up of DM has been further characterized creating new possibilities for future targeted therapies.
Clinical and radiological evolution of cerebral amyloid angiopathy-related inflammation in the context of anti-PD-1 immunotherapy
Authors: Lasocki Arian , Kee Damien
Published: June 2020

Immune-related adverse events (irAEs) are a frequent complication of immunotherapy, but neurological irAEs are rare and varied. Here, we present a case of cerebral amyloid angiopathy-related inflammation (CAA-ri) attributable to nivolumab monotherapy, which has not been previously reported. The context of immunotherapy and availability of serial imaging also provide unique insights into the pathogenesis and evolution of CAA-ri. Routine surveillance neuroimaging in a patient with metastatic melanoma, in remission after treatment with nivolumab, demonstrated progressive microhaemorrhages and associated oedema, suspicious for CAA-ri. These changes progressed despite cessation of nivolumab. The patient was initially asymptomatic, but later developed an acute confusional state, warranting brain biopsy, which confirmed the diagnosis of CAA-ri. Treatment with methylprednisolone resulted in resolution of the oedema, and a marked decrease in the subsequent accumulation of microhaemorrhages. The temporal evolution prior to symptom development and subsequently related to treatment suggests that inflammation may be an important component of the pathogenesis of CAA-ri, rather than simply a secondary response. Given that immunotherapy is in its relative infancy, it is important to consider rare irAEs in patients exhibiting unusual imaging findings.
Paradox in melanoma
Authors: Tas Faruk , Erturk Kayhan
Published: June 2020

The incidence of melanoma has increased more dramatically than any other malignancy in the last years. In this study, we compared the numbers of publications between melanoma and other cancers over the last 20 years, and we aimed to understand the relationship between publications on melanoma and other cancers using publication rates and frequencies. We conducted a systematic search through PubMed using search terms ‘melanoma’ and ‘cancer’ to identify the numbers of publications on melanoma and other cancers. The numbers and life-time risk rates of both melanoma and other cancer patients over the years were obtained from ‘Cancer Statistics’ articles published annually by American Cancer Society. Both melanoma and other cancer related publications increased in number steadily at the same rate (3.01 times) and the ratio of melanoma-related publications to all cancer publications has not changed over the years: around 3.4% on average. The rates of melanoma increased more rapidly than those of other cancers; 2.02 and 1.44 times, respectively. Similarly, the incidence of melanoma among all malignancies has increased from 3.91 to 5.47%. The lifetime risk of developing cancer has stayed stable at around 40%, whereas the lifetime risk of developing melanoma has increased by 2.12 times over the years, from 1.47 to 3.1%. In conclusion, the increase in the melanoma-related publication numbers has failed short to meet the dramatic increment of melanoma patient numbers. We believe that more publications are required according to the rising incidence of the disease.
Prehospital Administration of Unfractionated Heparin in ST-Segment Elevation Myocardial Infarction Is Associated With Improved Long-Term Survival
Authors: McGinley Christopher , Mordi Ify R , Kell Paul , Currie Peter , Hutcheon Stuart , Koch Stephan , Martin Thomas , Irving John
Published: June 2020

Objective:

Administration of unfractionated heparin to STEMI patients by the ambulance service is an established practice in Scotland, but the efficacy is unknown. We studied the effects of unfractionated heparin in STEMI patients treated by primary percutaneous coronary intervention, on infarct artery patency and mortality.

Methods and Results:

Consecutive patients (n = 1000) admitted to Ninewells Hospital, Dundee, from 2010 to 2014 for primary percutaneous coronary intervention were allocated to 2 groups: 437 (44%) prehospital heparin (PHH) administered by paramedics, and 563 (56%) in-hospital heparin. A trained medical student assessed coronary flow at presentation and collected the data. Mortality status was ascertained at 30 days and 5 years. Cox proportional hazards regression models were generated. The patient groups were similar, although PHH had shorter symptom onset-treatment time (187 vs. 251 minutes, P < 0.001) and less cardiogenic shock (3.9% vs. 8.0%, P = 0.008). Initial coronary flow was not different between the groups. Thirty day mortality in PHH was 2.5% versus 8.3%, P < 0.001. Independent predictors of 30-day mortality were age (odds ratio 1.07, 95% CI 1.04–1.09), cardiogenic shock (5.97, 3.33–10.69), radial access (0.53, 0.28–0.98), and PHH (0.33, 0.17–0.66). Five-year mortality in PHH was 13.0% versus 21.6%, P < 0.001. Significant predictors of long-term mortality were age (1.07, 1.06–1.09), cardiogenic shock (3.40, 2.23–5.17), and PHH (0.68, 0.49–0.96).

Conclusions:

PHH was associated with reduced short- and long-term mortality after adjusting for important potential confounders.
Beneficial Effects of Sacubitril/Valsartan at Low Doses in an Asian Real-World Heart Failure Population
Authors: Hu Jingwen , Wu Yucheng , Zhou Xiujuan , Wang Xiaozhi , Jiang Wanying , Huo Junyu , Shan Qijun
Published: June 2020

This study aimed at analyzing the clinical profile of real-world patients with heart failure with reduced ejection fraction (HFrEF) and evaluating the safety and efficacy of sacubitril/valsartan among Asian patients in daily practice. We conducted a single-center prospective observational cohort study of HFrEF patients treated with sacubitril/valsartan from September 2017 to September 2018 with a follow-up of 6 months. The mean (SD) age of the 110 patients enrolled was 59.7 ± 13.3, 85 (77.3%) were men and 41 (37.3%) had ischemic cardiomyopathy. Thirty-one (27.2%) patients with low systolic blood pressure initiated sacubitril/valsartan on a tiny dose of 12/13 mg. Despite the low mean daily dose achieved in real world mainly because of hypotension, left ventricular ejection fraction increased significantly from 35.4 ± 8.9% at baseline to 43.0 ± 12.2% after 6-month follow-up (P < 0.001). We also observed a significant improvement in a 6-minute walk test (6-MWT) distance and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration reduction. No severe adverse event was recorded. Low dose sacubitril/valsartan induces beneficial cardiac reverse remodeling and improves clinical functional performance in real-world HFrEF patients without severe adverse effect. A tiny initial dose may enhance tolerability and reduce discontinuation rate by minimizing hypotension events in patients with low systolic blood pressure. These data further support using low-dose sacubitril/valsartan among eligible patients with HFrEF in Asia.
A Brief Overview of a Round Table Discussion About Venous Thromboembolism in Pregnancy During the First International Forum on Chinese Maternal-Fetal Medicine
Authors: Wang Chen , Yang Hui-Xia
Published: June 2020

Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality though with low rates. Compared to non-pregnant women of comparable age, women during pregnancy have five- to ten-fold increased risk of VTE, additional risk factors for VTE during pregnancy include a personal history of thrombosis, the presence of a thrombophilia, cesarean delivery, obesity, hypertension, preeclampsia, autoimmune disease, heart disease, sickle cell disease and multiple gestation. Thus, early clinical evaluation, preferably in peri-conceptional period, is crucial for VTE risk detection and, thus, for prophylaxis decision making. VTE thromboprophylaxis brought significant advantages in pregnancy outcomes and maternal deaths. Common pharmacological and mechanical forms of thromboprophylaxis includes heparin compounds, anti-embolic stockings and intermittent pneumatic compression devices. Low-molecular-weight heparin as first line strategy. Current guidelines or expert opinions on VTE treatment or prophylaxis during pregnancy diverge significantly. High quality research in this area is still needed, and China needs to develop its own VTE guidelines. Importantly, absolute risks and potential benefits of VTE thromboprophylaxis should be evaluated to make the best decisions on VTE screening, prevention, and treatment.
Reduced Fine Particulate Matter Air Pollution Exposures Using In-Home Portable Air Cleaners
Authors: Bard Robert L. , Rubenfire Melvyn , Fink Samantha , Bryant Joseph , Wang Lu , Speth Kelly , Zhou Nina , Morishita Masako , Brook Robert D.
Published: June 2020

Purpose:

Fine particulate matter (PM2.5) air pollution is a leading risk factor for cardiovascular disease. Even low levels common to millions of Americans pose health risks. However, no study has tested protective measures such as in-home portable air cleaners (PACs) among at-risk cardiac patients. We conducted a pilot phase of the Cardiac Rehabilitation Air Filter Trial (CRAFT)—a randomized, double-blind, crossover study of outpatient cardiac rehabilitation patients at Michigan Medicine.

Methods:

During a routine visit, patients were provided with 2 PACs to run continuously for 5 d in both the bedroom and the main living space. PACs were randomized as active (with HEPA filter) versus sham. On day 4, subjects wore a personal PM2.5 monitor for 24-hr without activity restrictions. After a 1-wk washout, patients crossed over to the opposite mode.

Results:

Patients (n = 20; 4 women) were elderly (70.8 ± 9.6 yr) nonsmokers with cardiovascular disease living near the facility (10.7 ± 6.0 mi). Compared with sham, active in-home PAC use significantly lowered personal-level 24-hr PM2.5 exposures by 43.8% (−12.2 μg·m−3; 95% CI, −24.2 to −0.2). Sensitivity analyses corroborated the reductions in most patients.

Conclusion:

An inexpensive in-home PAC can effectively lower personal PM2.5 exposures in cardiac patients. These benefits occurred even in a region with overall good air quality and if maintained over the long-term could translate into major reductions in cardiovascular events.
Aortic Aneurysm
Authors: Ehrman Jonathan K. , Fernandez Antonio B. , Myers Jonathan , Oh Paul , Thompson Paul D. , Keteyian Steven J.
Published: June 2020

Background:

Some patients who participate in cardiac rehabilitation have aortic abnormalities, including abdominal and thoracic aneurysm (AAA and TAA, respectively). There is scant guidance on implementing exercise training in these individuals. This article reviews the epidemiology, diagnostic process, medical issues, and the available exercise training literature, and provides recommendations for performing regular exercise.

Clinical Considerations:

Patients with aortic abnormalities are at risk for enlargement, aneurysm development, dissection, and rupture. During exercise, individuals with large aneurysms may be at greater risk of an adverse event. The available literature suggests little increased risk of complications when training at low and moderate intensities in those with an AAA, and exercise may be protective for aneurysm expansion. There is little exercise data for TAA, but the available literature suggests training at lower intensities and avoidance of excessive increases of blood pressure.

Exercise Testing and Training:

When exercise testing and training are performed, the intensity should be controlled to avoid complications. It is prudent to keep systolic blood pressure <180 mm Hg in most patients and <160 mm Hg in those at greater risk of dissection or rupture (eg, women and larger sized aneurysm) during aerobic training. During resistance training, patients should avoid sudden excessive blood pressure increases (ie, avoid the Valsalva maneuver), and keep intensity below 40-50% of the 1-repetition maximum. Existing data suggest these patients may improve functional capacity and reduce the rate of aneurysm expansion.

Most patients with AAA can safely perform exercise training when conservative guidelines are followed. Additional research is needed to fully determine whether exercise is protective against aneurysm expansion, and the effects of exercise in those who have had surgical repair. More research is necessary to provide specific recommendations for those with a TAA.
Extended depth-of-focus intraocular lenses: power calculation and outcomes
Authors: Coassin Marco , Di Zazzo Antonio , Antonini Marco , Gaudenzi Daniele , Gallo Afflitto Gabriele , Kohnen Thomas
Published: June 2020

The extended depth-of-focus intraocular lenses (EDOF IOLs) represent one of the most exciting advancements in the field of lens surgery. EDOF IOLs promise an excellent visual experience, minimizing visual disturbances (ie, halos and glare) commonly associated with multifocal IOLs. The pros and cons of EDOF IOLs should be evaluated in comparison with other more traditional multifocal or monofocal IOLs. The aim of this review is to provide the most current information regarding EDOF IOLs for power calculating formulas, refractive outcomes, incidence of photic phenomena, and patient satisfaction.
Evidence of Large Vestibulo-Ocular Reflex Reduction in Patients With Menière Attacks
Authors: Yacovino Dario A. , Schubert Michael C. , Zanotti Estefania
Published: June 2020

Objective:

To examine the high frequency horizontal vestibular ocular-reflex (hVOR) during acute attacks of vertigo in Menière's disease (MD).

Study Design:

Retrospective case series and literature review.

Setting:

Tertiary academic medical center.

Patients:

Patients with clinical diagnosis of unilateral “definite MD.”

Intervention:

Review of medical records.

Main Outcome Measures:

Spontaneous nystagmus and the dynamic hVOR gain change at different stages of an acute episode of MD attack.

Results:

We studied 10 vertigo attacks during the unique stages of the episode. During the acme stage of the attack, lower hVOR gain was recorded on the affected side (mean 0.48 ± 0.23), which was associated with a paralytic nystagmus (beating away from the affected ear). Additionally, the mean hVOR gain remained significantly (p < 0.05) reduced during each of the other stages of the attack as compared with the unaffected side and a control group. After the attack, mean hVOR gains normalized in the affected ear. Mean hVOR gain of the unaffected ear remained normal during all stages.

Conclusion:

Vestibular function during an attack of MD is a dynamic process associated with fluctuation of the dynamic (hVOR gain) and static (spontaneous nystagmus) processes, which exist in parallel with the perception of vertigo. Our data support vHIT monitoring during an episode to provide objective and accurate evidence of the ear with active disease. This would be particularly useful for those patients with MD presentations of unreliable hearing or assisting to identify the ear to be treated in the case of bilateral MD.
Consequences of Mastoidectomy on Bone Conducted Sound Based on Simulations in a Whole Human Head
Authors: Prodanovic Srdjan , Stenfelt Stefan
Published: June 2020

Hypothesis:

The aim of this study is to investigate how a mastoidectomy surgery affects bone conduction (BC) sound transmission using a whole head finite element model.

Background:

Air conduction (AC) and BC hearing thresholds are normally used to evaluate the effect of an ear surgery. It is then assumed that the BC hearing thresholds are unaffected by the surgery. Moreover, BC hearing aids are used in cases of unilateral or conductive hearing loss in heads that have undergone a mastoidectomy surgery. Given the invasiveness of the surgery, the BC hearing sensitivity may be altered by the surgery itself.

Methods:

Two types of mastoid surgery, canal wall up and canal wall down, with and without obliteration, were simulated in a whole head finite element model for BC stimulation, the LiUHead. The evaluations were conducted for two different methods of applying the BC sound, at the skin surface (B71 transducer) and directly at the bone (BC hearing aid).

Results:

The results showed that a mastoidectomy surgery increased the cochlear vibration responses with BC stimulation. The increase was less than 5 dB, except for a canal wall down surgery which gave an increase of up to 8 dB at frequencies close to 10 kHz. The increase was greater at the ipsilateral cochlea compared with the contralateral cochlea.

Conclusion:

A mastoidectomy surgery increases the vibration at both cochleae for BC stimulation and the increase generally improved with frequency. Obliteration of the surgical cavity does not influence BC sound transmission.
Ultrasound in Diagnosis of Magnet Dislocation of Cochlear Implants: A Retrospective Study in Patients With Surgical Magnet Repositioning and Preinterventional Ultrasound Examination
Authors: Rupp Robin , Hornung Joachim , Balk Matthias , Hoppe Ulrich , Iro Heinrich , Gostian Antoniu-Oreste
Published: June 2020

Objective:

To investigate whether ultrasound is a reliable diagnostic tool to identify magnet dislocation in patients with cochlear implant.

Design:

Retrospective analysis.

Setting:

A tertiary referral medical center.

Patients:

Patients with cochlear implant who presented with the suspicion of magnet dislocation between January 1, 2009 and July 31, 2019.

Interventions:

Preinterventional ultrasound with subsequent surgical magnet repositioning.

Main Outcome Measures:

Accuracy of ultrasound in detecting magnet dislocation; intraoperative extent of magnet dislocation.

Results:

Out of the 28 included patients (n = 28 magnets, 36% ♀; 51.6 years [±19.0 yr]) the diagnosis by the preoperative ultrasound was confirmed intraoperatively in 25 patients (89%). In two cases (7%), tissue swelling impeded the determination of the magnet by the preoperative ultrasound. In one case, ultrasound misdiagnosed the magnet as not dislocated. During revision surgery, all 28 magnets were repositioned successfully revealing a predominant partial dislocation (86%) compared with complete magnet dislocation (14%).

Conclusion:

In CI-patients undergoing 1.5 Tesla MRI, partial magnet dislocation occurs much more frequently than complete magnet dislocation. The clinical suspicion of a dislocated cochlear implant magnet can be accurately confirmed by preoperative ultrasound. Thus, preoperative diagnostic ultrasound can be advocated as the diagnostic tool of first choice.
Successful Rituximab Monotherapy in Advanced-stage, Epstein-Barr Virus-positive Diffuse Large B-Cell Lymphoma in an Adolescent With Systemic Juvenile Idiopathic Arthritis
Authors: Takahashi Takuto , Hobday Patricia M. , Pozos Tamara C. , Gordon Peter M.
Published: June 2020

Epstein-Barr virus-positive diffuse large B-cell lymphoma (EBV+ DLBCL) in pediatrics most commonly occurs as an iatrogenic immunodeficiency-associated lymphoproliferative disease. We report an 18-year-old female individual with refractory systemic juvenile idiopathic arthritis, treated with multiple immunosuppressive agents, who was diagnosed with stage III, EBV+ DLBCL. The patient achieved sustained complete remission after 4 weekly doses of rituximab monotherapy and reduction of immunosuppression. This case suggests that a post-transplant lymphoproliferative disease-like treatment approach can be a safe and effective therapy in a nontransplant, yet severely immunosuppressed, patient with EBV+ DLBCL.
Dysfunctional Immune System Reconstitution After Rituximab Exposure In Utero
Authors: Clark Rebecca , Lindsey Diana , Whiteway Susan , Mikita Cecilia , Lieuw Kenneth
Published: June 2020

Rituximab is an antibody that binds to B-lymphocytes and is increasingly used during pregnancy. As an immunoglobulin G, it will transfer across the placenta. Previous case reports describe a diversity of clinical presentations in neonates born following rituximab exposure in utero. Our case is the first to offer the long-term experience in the care of an infant with severe neutropenia and prolonged profound hypogammaglobulinemia and class-switching B cell defect after in utero rituximab exposure.
An Unusual Presentation of Recurrent Childhood Kimura Disease: Ileocecal Involvement
Authors: Ranjith Kumar Venkataraman , Ramamoorthy Jaikumar G. , Basu Debdatta , Arumugom Archana , Jose Divakar , Cherian Anchu A.
Published: June 2020

Kimura disease commonly presents as an isolated swelling over the head and neck region. Intestinal involvement by Kimura disease in children is uncommonly reported. We report a 10-year-old boy who had presented with an ileocaecal mass with peripheral blood eosinophilia and elevated immunoglobulin E levels. The histopathologic examination from the ileocaecal mass was suggestive of Kimura disease. He had 2 recurrences once in the left axillary region and once in the bilateral cervical region. Ileocaecal involvement in Kimura disease is an uncommon presentation in childhood. Careful evaluation of complete blood count is critical in making diagnosis and avoiding unnecessary invasive procedures.