bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular profiling and management of mantle cell lymphoma
Authors: Ruan Jia
Published: December 2019

Mantle cell lymphoma (MCL) is a distinct subtype of B-cell non-Hodgkin lymphoma characterized by the t(11;14)(q13;q32) translocation leading to cyclin D1 overexpression and cell cycle dysregulation. Molecular profiling with gene expression and deep sequencing analyses has identified genomic and epigenomic alterations in pathways regulating the cell cycle, DNA damage response, proliferation, and survival, which contribute to disease progression with important prognostic and therapeutic implications. Clinically, the nonnodal MCL subset is notable for leukemic presentation, indolent behavior, and association with hypermutated IGHV and lack of SOX11 expression, which differentiates it from the conventional nodal MCL. In addition to the Mantle Cell Lymphoma International Prognostic Index score and proliferative gene signatures, 17p/TP53 and 9p/CDKN2A alterations, and genomic complexity have emerged as clinically useful biomarkers of high-risk disease associated with aggressive disease behavior, resistance to chemotherapy, and poor overall survival. Although intensive chemoimmunotherapy regimens that incorporate high-dose cytarabine and stem cell transplantation have improved survival in young and fit MCL patients, the introduction of Bruton tyrosine kinase inhibitors and other novel agents has made effective outpatient-based treatment accessible to nearly all MCL patients. Optimizing combinations of novel agents in the relapsed setting and moving novel agents to the first-line setting have the potential to fundamentally change the MCL therapeutic landscape for the better, especially for patients ineligible for chemotherapy or those with high-risk mutations that are resistant to chemotherapy.
Emerging strategies in peripheral T-cell lymphoma
Authors: Mehta-Shah Neha
Published: December 2019

Peripheral T-cell lymphomas (PTCLs) are a heterogenous group of aggressive non-Hodgkin lymphomas that are less chemosensitive than their B-cell counterparts. Until recently, standard therapy did not distinguish between subtypes, and deeper understanding of the biology of these diseases was lacking. The availability of targeted therapy and more sophisticated subtype classification has translated into the development of novel treatment options for these rare diseases. This includes the development of a brentuximab vedotin-based upfront chemotherapy regimen that confers an overall survival benefit for a subset of patients. Clinical trials of targeted agents, as well as development of better preclinical models of PTCL, are leading to therapeutic advances in the field, including the development of phosphoinositide-3-kinase inhibitors, histone deacetylase inhibitor-based strategies, CD30-directed strategies, Janus kinase inhibitors, and spleen-associated tyrosine kinase inhibitors. Better understanding of the biology of these diseases based on gene expression profiling, minimal residual disease evaluation, and modeling in patient-derived xenografts should help define mechanisms of response and resistance to therapy. Given the complex biology of these heterogeneous lymphomas, well-tolerated combination strategies targeted toward specific subtypes of PTCL can lead to advances in the field. Similar to the story of brentuximab vedotin, development of effective therapies in the salvage setting will likely lead to improved upfront strategies in PTCLs, and ultimately a more personalized approach.
How I treat a refractory myeloma patient who is not eligible for a clinical trial
Authors: Leng Siyang , Bhutani Divaya , Lentzsch Suzanne
Published: December 2019

Myeloma patients not eligible for clinical trials have many treatment options. Choosing the next best therapy starts with careful assessment of the biology and dynamics of the disease at relapse, as well as the condition and situation of the patient. Fit patients should be considered for triplet regimens, whereas intermediate and frail patients warrant dose-reduced triplets or doublets. An indolent serologic relapse may be treated with dose intensification, especially in a maintenance situation, whereas a rapid relapse requires a more aggressive approach with drug class change or a second-generation immunomodulatory drug (IMID) or proteasome inhibitor (PI). Monoclonal antibodies, in combination with PIs and IMIDs, have proven highly efficacious in early and late relapse. Key elements of supportive care include infection prevention, bone health, thromboprophylaxis, and management of active symptoms, such as pain and distress.
What's new in the prevention and treatment of cancer-associated thrombosis?
Authors: Kimpton Miriam , Carrier Marc
Published: December 2019

Venous thromboembolism (VTE) is a common complication in ambulatory cancer patients receiving chemotherapy. Current clinical guidelines recommend against the use of routine primary thromboprophylaxis in unselected ambulatory cancer patients. The Khorana score is a risk assessment tool derived and prospectively validated for the identification of cancer patients at high risk of thrombotic complications. Recently, 2 randomized, controlled trials have assessed the use of low-dose direct oral Xa inhibitors, apixaban and rivaroxaban, for the prevention of cancer-associated thrombosis in ambulatory patients at intermediate to high risk of VTE (Khorana score ≥2). Taken together, these trials have shown that low-dose direct oral Xa inhibitors reduce the risk of VTE in this patient population without a significant increase in major bleeding. These results should encourage clinicians to consider the use of primary thromboprophylaxis in ambulatory cancer patients at intermediate to high risk of VTE who do not have any apparent risk factors for bleeding. The direct oral Xa inhibitors have also been assessed in the acute management of cancer-associated thrombosis. Current evidence suggests that these drugs are a convenient, effective, and safe option for the management of acute VTE in many cancer patients. Low-molecular weight heparin, however, may continue to be the treatment of choice depending on the presence of bleeding risk factors, the type of cancer, drug-drug interactions, and patient preferences.
Update from the laboratory: mechanistic studies of pathways of cancer-associated venous thrombosis using mouse models
Authors: Hisada Yohei , Mackman Nigel
Published: December 2019

Cancer patients have an increased risk of venous thromboembolism (VTE). The rate of VTE varies with cancer type, with pancreatic cancer having one of the highest rates, suggesting that there are cancer type–specific mechanisms of VTE. Risk assessment scores, such as the Khorana score, have been developed to identify ambulatory cancer patients at high risk of VTE. However, the Khorana score performed poorly in discriminating pancreatic cancer patients at risk of VTE. Currently, thromboprophylaxis is not recommended for cancer outpatients. Recent clinical trials showed that factor Xa (FXa) inhibitors reduced VTE in high-risk cancer patients but also increased major bleeding. Understanding the mechanisms of cancer-associated thrombosis should lead to the development of safer antithrombotic drugs. Mouse models can be used to study the role of different prothrombotic pathways in cancer-associated thrombosis. Human and mouse studies support the notion that 2 prothrombotic pathways contribute to VTE in pancreatic cancer patients: tumor-derived, tissue factor–positive (TF+) extracellular vesicles (EVs), and neutrophils and neutrophil extracellular traps (NETs). In pancreatic cancer patients, elevated levels of plasma EVTF activity and citrullinated histone H3 (H3Cit), a NET biomarker, are independently associated with VTE. We observed increased levels of circulating tumor-derived TF+ EVs, neutrophils, cell-free DNA, and H3Cit in nude mice bearing human pancreatic tumors. Importantly, inhibition of tumor-derived human TF, depletion of neutrophils, or administration of DNAse I to degrade cell-free DNA (including NETs) reduced venous thrombosis in tumor-bearing mice. These studies demonstrate that tumor-derived TF+ EVs, neutrophils, and cell-free DNA contribute to venous thrombosis in a mouse model of pancreatic cancer.
Management of iron deficiency
Authors: Ning Shuoyan , Zeller Michelle P.
Published: December 2019

Iron deficiency (ID) affects billions of people worldwide and remains the leading cause of anemia with significant negative impacts on health. Our approach to ID and iron deficiency anemia (IDA) involves three steps (I3): (1) identification of ID/IDA, (2) investigation of and management of the underlying etiology of ID, and (3) iron repletion. Iron repletion options include oral and intravenous (IV) iron formulations. Oral iron remains a therapeutic option for the treatment of ID in stable patients, but there are many populations for whom IV iron is more effective. Therefore, IV iron should be considered when there are no contraindications, when poor response to oral iron is anticipated, when rapid hematologic responses are desired, and/or when there is availability of and accessibility to the product. Judicious use of red cell blood transfusion is recommended and should be considered only for severe, symptomatic IDA with hemodynamic instability. Identification and management of ID and IDA is a central pillar in patient blood management.
Management of liver complications in sickle cell disease
Authors: Suddle Abid R.
Published: December 2019

Liver disease is an important cause of morbidity and mortality in patients with sickle cell disease (SCD). Despite this, the natural history of liver disease is not well characterized and the evidence basis for specific therapeutic intervention is not robust. The spectrum of clinical liver disease encountered includes asymptomatic abnormalities of liver function; acute deteriorations in liver function, sometimes with a dramatic clinical phenotype; and decompensated chronic liver disease. In this paper, the pathophysiology and clinical presentation of patients with acute and chronic liver disease will be outlined. Advice will be given regarding initial assessment and investigation. The evidence for specific medical and surgical interventions will be reviewed, and management recommendations made for each specific clinical presentation. The potential role for liver transplantation will be considered in detail.
In MDS, is higher risk higher reward?
Authors: Sanz Guillermo F.
Published: December 2019

Patients with higher-risk myelodysplastic syndrome (HR-MDS) are defined by the original or revised International Prognostic Scoring System and specific genetic features. Treatment of HR-MDS is challenging. Allogeneic hematopoietic stem cell transplantation, the only curative approach, is feasible in a minority of fit or intermediate fitness patients aged <70 to 75 years who are willing to face the risks of the procedure. Response to azacitidine and decitabine, the only approved drugs for HR-MDS and considered the standard of care, is partial and transient in most patients. The development of novel more personalized and efficient drugs is an unmet medical need. During the last decade, there have been substantial advances in understanding the multiple molecular, cellular, and immunological disturbances involved in the pathogenesis of myelodysplastic syndrome. As a result, a number of clinical and translational studies of new more focused treatment approaches for HR-MDS patients are underway. In contrast to acute myeloid leukemia, they have not resulted in any new drug approval. This review addresses the benefits and limitations of current treatment alternatives, offers a practical individualized treatment approach, and summarizes the clinical trials in progress for HR-MDS.
Selection of matched unrelated donors moving forward: from HLA allele counting to functional matching
Authors: Fleischhauer Katharina
Published: December 2019

Matched unrelated donors (URD) are the most frequent source of stem cells for allogeneic hematopoietic cell transplantation (HCT) to date, with HCT performed mainly under conventional immunosuppression by methotrexate and cyclosporine. In this setting, every single allelic donor–recipient mismatch for HLA-A, -B, -C, -DRB1 (8/8), but not for HLA-DQB1, -DPB1, has a significant negative effect on overall survival (OS). When several 8/8 HLA-matched URD are available, donor age is the most important factor impacting OS. Moving forward from the traditional way of counting the number of donor–recipient HLA allele mismatches to biology-driven algorithms for functional matching has led to the unraveling of an association between permissive, low-risk HLA-DPB1 mismatches and improved outcome after URD HCT for malignant disease but not for nonmalignant disease. Functional HLA matching might prove to have increasing importance for URD selection in the era of new immunosuppressive regimens that have the potential to substantially reshuffle the role of HLA mismatches in URD HCT.
Relapsed disease and aspects of undetectable MRD and treatment discontinuation
Authors: Eichhorst Barbara , Fürstenau Moritz , Hallek Michael
Published: December 2019

Continuous treatment vs fixed duration of monotherapies and combinations of targeted agents are treatment options in relapsed chronic lymphocytic leukemia. The optimal choice of relapse treatment is dependent on the prior frontline therapy, duration of remission after frontline, genetic markers, and patients’ condition, including age and comorbidities. Combination therapies may result in deep responses with undetectable minimal residual disease (uMRD). Although uMRD is an excellent predictive marker for disease progression, it is rarely used in clinical practice and needs additional evaluation in clinical trials before discontinuation of therapy should be guided according to uMRD.
Evidence-Based Minireview: The role of IV iron in management of patients with iron-deficiency anemia presenting to the emergency department
Authors: Ramos Julia G. , Zeller Michelle P.
Published: December 2019

A 45-year-old woman with a history of uterine fibroids and abnormal uterine bleeding presents to the emergency department (ED) with presyncope and weakness. A gynecology consultation for definitive management was requested. The complete blood count demonstrates a hemoglobin (Hb) of 6.5 g/dL and a mean corpuscular volume (MCV) of 65 fL. What is the role of IV iron in managing iron-deficiency anemia (IDA) presenting to the ED/urgent care?
What to do with minimal residual disease testing in myeloma
Authors: Manasanch Elisabet E.
Published: December 2019

The role and use of minimal residual disease (MRD) testing has changed significantly over the past few years as it has become part of the routine care for response assessment in multiple myeloma. The most widely used standardized methods to assess MRD in myeloma in the bone marrow are multicolor flow cytometry and next-generation sequencing. Importantly, the depth of MRD negativity in the bone marrow correlates with improved progression-free survival and overall survival in myeloma. Whole-body position emission tomography–computed tomography and magnetic resonance imaging are also used to evaluate patchy and extramedullary disease, which may not be readily visible through bone marrow assessment. This article reviews a clinical case in which MRD testing, both in bone marrow and in functional imaging, is part of the standard of care. It also reviews the different modalities of MRD testing and current practice guidelines. Finally, patients with myeloma may be tested for MRD after treatment because this is part of the routine response assessment according to International Myeloma Working Group criteria and correlates with clinical outcomes. Important questions such as when to stop therapy for sustained MRD-negative patients or whether to change treatments for patients who go from MRD negative to positive without other evidence of disease relapse are being evaluated in clinical trials and remain controversial.
Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy
Authors: Al-Samkari Hanny , Connors Jean M.
Published: December 2019

The association between malignancy and thrombosis has been recognized for over a century and a half. Patients with cancer have an elevated risk of both initial and recurrent venous thromboembolism (VTE) compared with patients without cancer owing to cancer- and patient-specific factors. Recurrent VTE is common despite anticoagulation, presenting additional management challenges. Patients with cancer also have an increased risk of bleeding when on anticoagulants compared with patients without cancer. This bleeding risk is heightened by the thrombocytopenia common in patients with hematologic malignancies and those treated with intensive myelosuppressive chemotherapy regimens. Despite the advancements in cancer-directed therapy made over the past 15 years, numerous large studies have confirmed that bleeding and VTE recurrence rates remain high in cancer patients. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult, because management of cancer-associated thrombosis requires anticoagulation despite known increased risks for bleeding. In the context of challenging illustrative cases, this review will describe management approaches to clinical scenarios in which data are sparse: cancer patients with recurrent VTE despite anticoagulation and cancer patients with a new VTE in the setting of severe thrombocytopenia.
Treatment-naive CLL: lessons from phase 2 and phase 3 clinical trials
Authors: Woyach Jennifer A.
Published: December 2019

The management of chronic lymphocytic leukemia (CLL) has undergone dramatic changes over the previous 2 decades with the introduction of multiple new therapies and new combinations. Management of the newly diagnosed asymptomatic patient has not significantly changed outside of the development of a number of prognostic factors and the CLL International Prognostic Index, which is helpful in discussions regarding prognosis and likelihood of requiring treatment. When therapy is required, initial treatment of most patients now includes either the Bruton tyrosine kinase inhibitor ibrutinib or the B-cell lymphoma 2 inhibitor venetoclax in combination with obinutuzumab. Current frontline trials are focused on the optimal sequencing or combination of targeted therapies. In this review, we will discuss the management of previously untreated CLL with an emphasis on the clinical trials that have formed the standard of care, as well as those newer studies that are likely to form the next generation of therapy.
A sensitive chemiluminescence based immunoassay for the detection of cortisol and cortisone as stress biomarkers
Authors: Abdulsattar Jwan O. , Greenway Gillian M.
Published: December 2019

An electrochemically based antibody immobilization was used to perform environmentally and clinically relevant immunoassays for stress hormones biomarkers (cortisol and cortisone) using chemiluminescence (CL) detection. To achieve CL detection, the ferrocene tag on the antibodies was first oxidised, and this then acted as a catalyst for the luminol and hydrogen peroxide CL reaction. The conditions were optimised and measurements were made with an incubation time of 30 min. Using this approach limits of detection were obtained of 0.47 pg ml−1and 0.34 pg ml−1alsoR20.9912 and 0.9902 for cortisol and cortisone respectively with a linear concentration from 0 to 50 ng ml−1. The method was then applied to Zebrafish whole body and artificial saliva samples. For the Zebrafish sample recoveries of 91.0% and 90.0% were obtained with samples spiked with cortisol and cortisone, for artificial saliva the recoveries were 92.59% and 90.73% respectively. Interference studies showed only minor effects on the measurement of the analyte. A comparison between this procedure and the standard enzyme-linked immunosorbent assay (ELISA) procedure gave approximately the sameR2values.
Effects of psychological treatment of mental health problems in pregnant women to protect their offspring: randomised controlled trial
Authors: Burger Huibert , Verbeek Tjitte , Aris-Meijer Judith L. , Beijers Chantal , Mol Ben W. , Hollon Steven D. , Ormel Johan , van Pampus Mariëlle G. , Bockting Claudi L.H.
Published: December 2019

Background

Perinatal depression and anxiety are associated with unfavourable child outcomes.

Aims

To assess among women with antenatal depression or anxiety the effectiveness of prenatally initiated cognitive–behavioural therapy (CBT) on mother and child compared with care as usual (CAU). Trial registration: Netherlands Trial Register number NTR2242.

Method

Pregnant women (n= 282) who screened positive for symptoms of depression and/or anxiety were randomised to either CBT (n= 140) or CAU (n= 142). The primary outcome was child behavioural and emotional problems at age 18 months, assessed using the Child Behavior Checklist (CBCL). Secondary outcomes were maternal symptoms during and up to 18 months after pregnancy, neonatal outcomes, mother–infant bonding and child cognitive and motor development at age 18 months.

Results

In total, 94 (67%) women in the CBT group and 98 (69%) in the CAU group completed the study. The mean CBCL Total Problems score was non-significantly higher in the CBT group than in the CAU group (mean difference: 1.38 (95% CI −1.82 to 4.57);t= 0.85,P= 0.399). No effects on secondary outcomes were observed except for depression and anxiety, which were higher in the CBT group than in the CAU group at mid-pregnancy. Apost hocanalysis of the 98 women with anxiety disorders showed lower infant gestational age at delivery in the CBT than in the CAU group.

Conclusions

Prenatally initiated CBT did not improve maternal symptoms or child outcomes among non-help-seeking women with antenatal depression or anxiety. Our findings are not in line with present recommendations for universal screening and treatment for antenatal depression or anxiety, and future work may include the relevance of baseline help-seeking.
Randomized, Double-Blind, Pharmacokinetic Equivalence Trial Comparing DRL-Rituximab With MabThera in Patients With Diffuse Large B-Cell Lymphoma
Authors: Viswabandya Auro , Shah Sandip , Mukhopadhyay Asis , Nagarkar Rajnish Vasant , Batra Sonica Sachdeva , Lopez-Lazaro Luis , Kankanwadi Suresh , Srivastava Alok
Published: December 2019

PURPOSE

We sought to compare the pharmacokinetics (PKs) of DRL-rituximab (DRL_RI; potential biosimilar) and innovator rituximab MabThera (Roche, Grenzach-Wyhlen, Germany; reference medicinal product [RMP]) in patients with diffuse large B-cell lymphoma (DLBCL). Efficacy, pharmacodynamics (PDs), safety, and immunogenicity were also compared.

PATIENTS AND METHODS

We conducted a double-blind, parallel-group study in patients with untreated DLBCL who were eligible to receive cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy. Patients were randomly assigned at a one-to-one ratio to receive DRL_RI or RMP for six 21-day cycles of rituximab plus CHOP, with 18 months of follow-up after day 1, cycle 6 (C6). Primary end point was C1 PKs, measured as area under the plasma concentration–time curve from day 0 to 21 (AUC0-21 days) and maximum plasma concentration (Cmax). Equivalence was defined as 90% CIs for the DRL_RI/RMP geometric mean ratios (GMRs) within 80% and 125%. Secondary end points included efficacy noninferiority measured by objective response rate (ORR) at C6 and event-free survival and overall survival at 87 weeks, PK equivalence at C6 and PD equivalence (rate of B-cell depletion and repletion), safety, and immunogenicity. The trial was stopped after sufficient patients for primary end point evaluation were enrolled. Secondary end points are reported as observed.

RESULTS

A total of 151 patients were randomly assigned (DRL_RI, n = 76; RMP, n = 75). DRL_RI/RMP GMRs for AUC0-21 days and Cmax in C1 were 99.77 (90% CI, 87.60 to 113.63) and 96.19 (90% CI, 88.65 to 104.38), respectively. ORR at C6 for DRL_RI and RMP were 82.0% and 84.8%, respectively. Rates of B-cell depletion/repletion, immunogenicity, and adverse events were comparable in both groups.

CONCLUSION

DRL_RI and RMP had equivalent PKs, with comparable efficacy, PDs, safety, and immunogenicity.
Criminal Justice or Public Health: A Comparison of the Representation of the Crack Cocaine and Opioid Epidemics in the Media
Authors: Shachar Carmel , Wise Tess , Katznelson Gali , Campbell Andrea Louise
Published: December 2019

Context: The opioid epidemic is a major US public health crisis. Its scope prompted significant public outreach, but this response triggered a series of journalistic articles comparing the opioid epidemic to the crack cocaine epidemic. Some authors claimed that the political response to the crack cocaine epidemic was criminal justice rather than medical in nature, motivated by divergent racial demographics.

Methods: We examine these assertions by analyzing the language used in relevant newspaper articles. Using a national sample, we compare word frequencies from articles about crack cocaine in 1988–89 and opioids in 2016–17 to evaluate media framings. We also examine articles about methamphetamines in 1992–93 and heroin throughout the three eras to distinguish between narratives used to describe the crack cocaine and opioid epidemics.

Findings: We find support for critics' hypotheses about the differential framing of the two epidemics: articles on the opioid epidemic are likelier to use medical terminology than criminal justice terminology while the reverse is true for crack cocaine articles.

Conclusions: Our analysis suggests that race and legality may influence policy responses to substance-use epidemics. Comparisons also suggest that the evolution of the media narrative on substance use cannot alone account for the divergence in framing between the two epidemics.
Heavy and Explosive Training Differentially Affect Modeled Cyclic Muscle Power
Authors: TANGHE KIRA K. , MARTIN JAMES C.
Published: December 2019

Introduction/Purpose

Muscular power is important in applications ranging from elite sport to activities of daily living. Results for improvements in power after resistance training have been mixed, possibly because of changes in muscle activation and deactivation rates. Our purpose was to determine the effects of heavy and explosive training programs on maximal power across a range of frequencies during cyclical contractions using a mathematical model.

Methods

Maximal force production and time constants for muscle activation and deactivation after heavy and explosive training programs were determined using previously reported data. A muscle–tendon model was subjected to sinusoidal length change, and activation and deactivation were set to maximize power for a range of cycle frequencies (0.5–3.0 Hz). Power for shortening/lengthening cycles was modeled for each training program and for a hypothetical periodized program with the best results from each program.

Results

The heavy training program increased strength by 26.8%, and increased time required for activation (20%) and deactivation (48%). The explosive training program increased strength by 10.8%, but decreased time required for activation (24%) and deactivation (10%). Increases in maximal power were similar after heavy (13.6%) and explosive (13.8%) training, but with different power–frequency relationships (optimal frequencies of 1.56 and 1.94 Hz for heavy and explosive, respectively). The hypothetical periodized program increased power by 30.3% (optimal frequency at 1.94 Hz).

Conclusion

Power during low-frequency movements (e.g., swimming) improved more after heavy training, whereas power during high-frequency movements (e.g., running) improved more after explosive training. These findings suggest that changes in time required for activation and deactivation in response to training are highly influential for maximal power across a range of functional frequencies, ultimately altering the ideal training regimen for specific activities.
Greater Lower Limb Fatigability in People with Prediabetes than Controls
Authors: SENEFELD JONATHON W. , HARMER ALISON R. , HUNTER SANDRA K.
Published: December 2019

Introduction

The study purpose was to compare perceived fatigability and performance fatigability after high-velocity contractions with knee extensor muscles between people with prediabetes, people with type 2 diabetes (T2D), and controls without diabetes matched for age, body mass index, and physical activity.

Methods

Twenty people with prediabetes (11 men, 9 women: 63.1 ± 6.0 yr, 26.9 ± 4.2 kg·m−2, 8030 ± 3110 steps per day), 39 with T2D (23 men, 16 women: 61.2 ± 8.5 yr, 29.4 ± 6.4 kg·m−2, 8440 ± 4220 steps per day), and 27 controls (13 men, 14 women: 58.1 ± 9.4 yr, 27.3 ± 4.3 kg·m−2, 8400 ± 3000 steps per day) completed the Fatigue Impact Scale as a measure of perceived fatigability and a fatigue protocol including 120 maximal-effort, high-velocity concentric contractions (MVCC; 1 contraction/3 s) with the knee extensors using a submaximal load (30% maximum) to quantify performance fatigability. Electrical stimulation was used to assess voluntary activation and contractile function of the knee extensor muscles before and after the fatigue protocol.

Results

Fatigue Impact Scale scores were not different between people with prediabetes, people with T2D, and controls (12.5 ± 15.1, 18.3 ± 22.7, and 12.6 ± 18.6, respectively; P = 0.517). However, people with prediabetes had greater reductions in MVCC power during the fatigue protocol than did controls (31.8% ± 22.6% vs 22.1% ± 21.1%, P < 0.001), and both groups had lesser reductions than the T2D group (44.8% ± 21.9%, P < 0.001). Similarly, the prediabetes group had larger reductions in electrically evoked twitch amplitude than the control group (32.5% ± 24.9% vs 21.3% ± 33.0%, P < 0.001), but lesser reductions than those with T2D (44.0% ± 23.4%, P < 0.001). For all three groups, a greater decline in MVCC power was associated with larger reductions of twitch amplitude (r
2 = 0.350, P < 0.001).

Conclusion

People with prediabetes have greater performance fatigability of the knee extensors due to contractile mechanisms compared with controls, although less performance fatigability than that of people with T2D.
Pacing Behavior Development of Youth Short-Track Speed Skaters: A Longitudinal Study
Authors: MENTING STEIN GERRIT PAUL , HUIJGEN BARBARA CATHARINA , KONINGS MARCO JOHANNES , HETTINGA FLORENTINA JOHANNA , ELFERINK-GEMSER MARIJE TITIA
Published: December 2019

Purpose

This study aimed to analyze the development of pacing behavior of athletes during adolescence using a longitudinal design.

Methods

Lap times of male short-track speed skaters (140 skaters, 573 race performances) over two or more 1500-m races during Junior World Championships between 2010 and 2018 were analyzed. Races were divided into four sections (laps 1–3, 4–7, 8–11, and 12–14). Using MLwiN (P < 0.05), multilevel prediction models in which repeated measures (level 1) were nested within individual athletes (level 2) were used to analyze the effect of age (15–20 yr), race type (fast, slow), and stage of competition (final, nonfinal) on absolute section times and relative section times (percentage of total time spent in a section).

Results

Between the ages of 15 and 20 yr, total race time decreased (−6.99 s) and skaters reached lower absolute section time in laps 8–11 (−2.33 s) and 12–14 (−3.28 s). The relative section times of laps 1–3 (1.42%) and 4–7 (0.66%) increased and of laps 8–11 (−0.53%) and 12–14 (−1.54%) decreased with age. Fast races were more evenly paced compared with slow races, with slow races having a predominantly slow first half and fast finish. Athletes in finals were faster (2.29 s), specifically in laps 4–7 (0.85 s) and laps 8–11 (0.84 s).

Conclusion

Throughout adolescence, short-track speed skaters develop more conservative pacing behavior, reserving energy during the start of the race in order to achieve a higher velocity in the final section of the race and a decrease in total race time. Coaches should take into consideration that the pacing behavior of young athletes develops during adolescence, prepare athletes for the differences in velocity distribution between race types, and inform them on how to best distribute their efforts over the different stages of competition.
BeamDelta: simple alignment tool for optical systems
Authors: Hall Nicholas J. , Pinto David Miguel Susano , Dobbie Ian M.
Published: December 2019

BeamDelta is a tool to help align optical systems. It greatly assists in assembling bespoke optical systems by providing a live view of the current laser beam position and a reference position. Even a simple optical setup has multiple degrees of freedom that affect the alignment of beam paths. These degrees of freedom rise exponentially with the complexity of the system. The process of aligning all the optical components for a specific system is often esoteric and poorly documented, if it is documented at all. Alignment methods used often rely on visual inspection of beams impinging on pinholes in the beam path, typically requiring an experienced operator staring at diffuse reflections for extended periods of time. This can lead to a decline in accuracy due to eye strain, flash blindness as well as symptoms such as headaches and, possibly, more serious retinal damage. Here we present BeamDelta a simple alignment tool and accompanying software interface which allows users to obtain accurate alignment as well as removing the necessity of staring at diffuse laser reflections. BeamDelta is a robust alignment tool as it doesn't require any precise alignment itself.
When Seeing Helps Believing: The Interactive Effects of Previews and Reviews on E-Book Purchases
Authors: Choi Angela Aerry , Cho Daegon , Yim Dobin , Moon Jae Yun , Oh Wonseok
Published: December 2019

For many products, particularly digital content, consumers base purchase-related decisions on not only others’ evaluations (e.g., online reviews) but also their own direct experiences (e.g., previews). Many of them therefore combine “seeing” through their own encounters with “believing” the assessments of others, often being confronted with a situation wherein the former contradicts the latter. This study investigates the dynamics underlying the interactive relationships between online reviews and previews to shed light on how consumers collectively use these pre-buying resources as guidance in purchasing e-books. Our research reveals that consumers wisely leverage previews in accordance with the characteristics of reviews (e.g., volume, valence, and variance). The positive effects of previews increase with decreasing review volume and average valence. Consumers also rely heavily on previews in situations wherein a high variance exists among the indirect evaluations of reviewers. We detect the presence of order effects with respect to exposure to previews and reviews; exposure to previews after accessing reviews more effectively drives sales than when exposure to reviews precedes the encounters. These results provide content providers with useful managerial insights into how they can maximize consumers’ overall prepurchase experiences and enhance content sales through the excellent leveraging of previews and reviews.
INTERAÇÃO MEDICAMENTOSA: UM AGRAVO A SAÚDE FRAGILIZADA
Authors: Barbosa Kledson Lopes , Medeiros Karina Crislane da Silva de
Published: December 2019

Introdução: A facilidade na compra de medicamentos isentos de prescrição (MIP’s) e a falta de informação são as causas mais comuns de interação medicamentosa em indivíduos que convivem em múltipla terapia medicamentosa. Sabe-se que a interação fármaco-fármaco pode ocorrer quando o efeito de um medicamento é alterado pela presença da substância de outro medicamento, ou de algum alimento, o que pode causar diminuição da sua eficácia ou até mesmo a sua toxicidade. Nesse sentido, duas motivações surgiram para o desenvolvimento dessa pesquisa: o valor clínico dado a interação medicamentosa e a importância da assistência farmacêutica na prevenção desse agravo. Objetivo: refletir sobre os potenciais agravos à saúde individual e pública a medida que aumenta-se o uso de múltiplos medicamentos, e avaliar a frequência de publicações acerca do tema bem como o tipo de informação veiculada por esses. Método: Trata-se de uma revisão narrativa realizada com base em periódicos nacionais e internacionais abordando assuntos relacionados ao tema. As bases consultadas para esta produção foram Bireme, LILACS, SciELO, Pubmed e portal de periódicos CAPES. Resultados: A pesquisa bibliográfica revelou que a adoção do uso racional de fármacos está relacionado com o aconselhamento do profissional farmacêutico que promove o uso seguro dos medicamentos, bem como, o esclarecimento dos processos farmacoterapêuticos. Conclusões: Através do estudo reforça-se a importância do farmacêutico frente à prevenção e gerenciamento dos casos de interação medicamentosa, de modo a averiguar criteriosamente as prescrições médicas antes da dispensação a fim de reorientar os pacientes ao uso seguro dos medicamentos prescritos.
PREVALÊNCIA DA POLIFARMÁCIA NOS IDOSOS DE UMA UNIDADE BÁSICA DE SAÚDE NO ESTADO DE MINAS GERAIS
Authors: Assis da Silveira Priscila , Campos Silva Samuel , Siqueira Cabral Rocha Karine
Published: December 2019

Introdução: Sabe-se que o uso excessivo de medicamentos é na atualidade um grande problema de saúde pública, que pode repercutir negativamente na vida dos indivíduos, principalmente na população idosa. De acordo com a Organização Mundial da Saúde a população idosa é aquela a partir de 60 anos de idade. Polifarmácia é a utilização de pelo menos cinco medicamentos de uso contínuo. Objetivo: Analisar a prevalência da polifarmácia em idosos de uma unidade básica de saúde (UBS), correlacionando com o gênero e a faixa etária. Metodologia: Trata-se de um estudo observacional retrospectivo dos idosos de uma UBS, no município de Patos de Minas, cadastrados no Sistema Único de Saúde. Resultados: De acordo com as análises, dos 282 participantes, 40,4% (114) encontravam-se em polifarmácia, sendo que 45,2% (84) eram mulheres e apenas 31,25% (30) eram homens. A pesquisa também mostrou uma relação significativa entre polifarmácia e faixa etária, onde 31,09% dos idosos entre 60 e 69 anos encontravam-se em polifarmácia, 46,49% dos entre 70 e 79 anos e 48,97% dos entre 80 e 89 anos. A prevalência encontrada de polifarmácia em idosos no presente estudo foi maior que os dados encontrados na literatura. Conclusão: Os dados analisados evidenciam a relação entre o gênero feminino com a polifarmácia, ou seja, ser idosa no estudo constituiu um fator de risco para polifarmácia.
TERAPIA COMUNITÁRIA INTEGRATIVA: CONSTRUÇÃO DA AUTONOMIA DE FAMÍLIAS DE CRIANÇAS RENAIS
Authors: Lucietto Grasiele Cristina , Ribeiro Rosa Lucia Rocha , Silva Rondinele Amaral da , Nascimento Vagner Ferreira do
Published: December 2019

Introdução: A Terapia Comunitária Integrativa (TCI) é uma metodologia de cuidado que possibilita aos participantes partilhar experiências e tecer redes sociais, minimizando o sofrimento psíquico. Objetivo: Conhecer as repercussões da TCI para familiares de crianças e adolescentes renais crônicos. Materiais e Métodos: O estudo foi realizado no Ambulatório de Nefrologia Pediátrica de um Hospital Universitário, no município de Cuiabá, Mato Grosso. O material empírico é composto da transcrição das rodas, que foram filmadas, e das anotações da observação participante. Resultados: evidenciaram a TCI como um espaço privilegiado para compartilhar experiências e elevar a autoestima. A TCI tem demonstrado que a troca, a fala, o conhecimento dos sofrimentos alheios tem sido fonte de construção da resiliência. Essa prática viabiliza a formação de redes solidárias e promoção da autonomia. Conclusão: A TCI se mostrou efetiva como cuidado complementar a atenção integral dessas famílias.
CUIDADO COM PACIENTES E FAMÍLIAS QUE VIVENCIAM O PROCESSO DE MORTE: REPRESENTAÇÕES SOCIAIS DO ENFERMEIRO
Authors: Gois Amanda Regina da Silva , Abrão Fatima Maria da Silva , França Inacia SatiroXavier
Published: December 2019

Introdução: Enfermeiros cuidam da pessoa, família e coletividade, sendo assim, quando o sujeito inicia a vivencia do processo de morte a família também passa a ser alvo cuidar desses profissionais. Objetivo: Compreender e analisar as representações sociais dos enfermeiros sobre o cuidado com pacientes e famílias que vivenciam o processo de morte. Materiais e Métodos: Trata-se de estudo de campo, exploratório, qualitativo de representações sociais. Realizado em unidades oncológicas de um hospital universitário, vinte um enfermeiros foram entrevistados, estas passaram por análise de conteúdo temático-categorial. Resultados: Emergiram da análise das falas, as seguintes unidades temáticas: 1) Cuidando do paciente em processo de morte; 2) Cuidando da família do paciente em processo de morte; 3) As relações e estratégias entre o enfermeiro, paciente e família diante do processo de morte; 4) Quando ou se é o seu familiar em processo de morte. Conclusão: O cuidado com a família do paciente em processo de morte é um desafio pelos diversos aspectos que envolvem. Destacando-se que a conversa, o diálogo, o respeito e o olhar introspectivo, podem mediar estas relações.
OS EFEITOS DE UM PROGRAMA DE ATIVIDADE FÍSICA NA PRESSÃO ARTERIAL E FREQUÊNCIA CARDÍACA DE PACIENTES HIPERTENSOS E DEFICIENTES FÍSICOS
Authors: Damázio Laila Cristina Moreira , Filho Gustavo Ribeiro de Souza , Pereira Amanda Chinellato de Lima , Leão Thaís Lany de Oliveira , Ferreira Lívia Candian , Mourão Felipe Nunes
Published: December 2019

Objetivo: Investigar os efeitos de um programa de atividade física, com intensidade moderada, na pressão arterial e frequência cardíaca dos pacientes com deficiência física e hipertensão arterial em um município do interior de Minas Gerais/Brasil. Métodos: Foram utilizados 21 pacientes, sendo 11 do gênero feminino e 10 do gênero masculino. Desses, 6 são hipertensos e 9 deficientes físicos. Os dados foram coletados todos os dias antes do paciente realizar o exercício físico e após a realização do mesmo, sendo aferida sua pressão arterial e frequência cardíaca nos dois momentos. O programa de atividade física, ocorreu em uma academia adaptada, onde os pacientes exercitavam 3 vezes por dia, durante 50 minutos, por 6 meses. Em seguida, os valores foram analisados com auxílio do programa GraphPad Prism 5.0, utilizando o teste estatístico t-student e ANOVA. Resultados: Os dados demonstraram que ocorreu redução da pressão sistólica e frequência cardíaca de todos os pacientes após a prática de exercícios físicos. Quando analisados isoladamente, os grupos de idosos sem comorbidades e deficientes apresentaram uma melhora na pressão sistólica antes do exercício, enquanto o grupo de hipertensos apresentou melhora da pressão sistólica após a atividade física. Já a frequência cardíaca dos hipertensos apresentou uma queda após o exercício físico. Conclusão: O presente estudo demonstra que um programa de atividade física moderado foi eficaz para a redução dos níveis pressóricos e da frequência cardíaca de indivíduos hipertensos e com deficiência.
ANÁLISE DA CONDIÇÃO DE SAÚDE BUCAL DE MULHERES EM SITUAÇÃO DE VIOLÊNCIA NO NORTE DO BRASIL
Authors: Da Silva Jessica Miranda , Euclides Kelly Lene Lopes Calderaro , Do Nascimento Borborem Izadora Virgolino , Zarpellon Barbosa Paulla Iáddia , Corrêa Pontes Flávia Sirotheau , Do Nascimento Liliane Silva
Published: December 2019

A violência de gênero é um problema de saúde pública que requer estratégias para o seu enfrentamento, prevenção e reparação de danos. Quando há ocorrência de violência física em mulheres, a cabeça e pescoço despontam como regiões frequentemente afetadas. Também, o sistema estomatognático sofre com agravos de ordem crônica e silenciosa. Este estudo analisou a condição de saúde bucal de 120 mulheres em situação de violência atendidas na Delegacia de Atendimento Especializado em Belém do Pará/Brasil no ano de 2017 e 2018. Identificou-se as características sociodemográficas e quanto a sua saúde bucal. Os resultados mostraram que 40 (33%) apresentavam entre 26 e 35 anos, 74 (61,67%) se autodeclararam pardas, 50 (41,67%) eram donas de casa/desempregadas, e) 56 (46,67%) possuíam o ensino médio completo. A análise de correspondência indicou que o tipo de violência e as categorias relacionadas à satisfação com as condições dos seus dentes e boca, sensibilidade dentinária e índice CPO-D são dependentes, apresentando um nível de significância de 0,05 (5%) e do critério Beta (?) maior ou igual a 3. Assim percebe-se que a alta prevalência de agravos bucais associada à situação de violência corrobora para a insatisfação e autoimagem feminina.
IDENTIFICAÇÃO DA PREVALÊNCIA DE BACTÉRIAS GRAM NEGATIVAS EM ESTETOSCÓPIOS E A PRÁTICA DA HIGIENIZAÇÃO POR PROFISSIONAIS DA SAÚDE EM UM HOSPITAL DO OESTE PAULISTA
Authors: Coradini Matheus Henrique de Souza , Neto Nelson Pereira dos Santos , Magnesis Larissa Gasquez , De Melo Carolina Ferreira , Almeida Mércia de Carvalho , Zago Sueli Cristina Schadeck
Published: December 2019

Os serviços de saúde, particularmente o ambiente hospitalar, apresentam um ambiente com potencial risco de contaminação, por bactérias Gram-negativas. A transmissão dessas bactérias pode ser adquirida através do ar, gotículas e principalmente por contato no qual se inclui o estetoscópio e o manejo das mãos. O estudo tem por objetivo identificar a prevalência de microrganismos Gram negativos encontrados nos diafragmas dos estetoscópios de um hospital escola de Presidente Prudente. Além disto, analisar as variáveis contidas no questionário que foi aplicado sobre higienização das mãos e dos estetoscópios. Trata-se de um estudo transversal analítico descritivo que avaliou quantitativamente em 150 estetoscópios a prevalência de microrganismos Gram negativos em um Hospital Escola de Presidente Prudente e quantitativa e qualitativamente o conhecimento de 200 profissionais da saúde e acadêmicos deste hospital sobre a prática de limpeza e desinfecção das mãos e dos estetoscópios. Foram observadas 21 amostras com microrganismos Gram negativos. Além disso, registramos através do questionário uma higienização ineficaz das mãos e dos estetoscópios com déficit principalmente na orientação de tal prática. O estudo conclui que a prevalência de microrganismos Gram negativos nas amostras analisadas é baixa, 14%, no entanto, recomenda-se adoção de medidas mais severas para a formação dos acadêmicos e na prática dos profissionais com relação a higienização das mãos e dos estetoscópios.
IDOSOS EM INSTITUIÇÃO DE LONGA PERMANÊNCIA E RELAÇÕES FAMILIARES
Authors: Cataneo Fernanda Monteiro , Cardozo Tuane Maiara , Monterrosa ayala Arlene laurenti
Published: December 2019

Introdução: As condições de vida do idoso em instituições de longa permanência tem sido objeto de pesquisas visto à falta de suporte, sobretudo de natureza afetiva e de apoio familiar. Objetivo: Este estudo teve por objetivo conhecer as características socioeconômicas e de proximidade familiar dos idosos que vivem em uma instituição de longa permanência localizada em Joinville, Santa Catarina. Materiais e Métodos: Trata-se de um estudo descritivo de caráter exploratório que foi realizado com dez idosos. Os dados foram coletados por meio de um questionário semiestruturado. As variáveis investigadas consideraram as características socioeconômicas, aspectos relacionados à saúde, à família e a instituição de longa permanência. Resultados: A idade dos idosos variou entre 66 a mais de 80 anos. A maioria era do sexo masculino, possuía ensino médio completo e referiu  problemas de saúde. O tempo de institucionalização dos idosos variou de 4 meses a 10 anos e motivo mais frequente para a institucionalização foi a dependência física. Mais da metade dos entrevistados tiveram resposta positivas sobre gostar de estar na Instituição de Longa Permanência. Conclusões: A institucionalização do idoso pode ser geradora de sofrimento, mas também pode constituir-se um ambiente de conformação de vínculos afetivos. O idoso atribui considerável importância aos cuidados, o que impõe aos profissionais uma atenção que abranja os vários aspectos da vida da pessoa envelhecida. Em razão do envelhecimento populacional, seria desejável que fossem realizados estudos que aprofundassem a analise de outros fatores que poderiam estar contribuindo para qualidade de vida dos idosos institucionalizados.