bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome implication of sex‐related effective orifice area normalized to body size in aortic stenosis
Authors: Gamaza Sergio , Díaz‐Retamino Enrique , Gaitero José Carlos , Giráldez Alberto , Zafra Francisco Manuel , Martín‐Santana Antonio , Oneto Jesús
Published: October 2020

Introduction

Although several echocardiographic parameters have different values according to sex, there are no studies in echocardiographic variables of aortic stenosis (AS) severity. Our aim was to evaluate the sex‐related prognosis of several echocardiographic parameters in AS.

Methods

Two hundred and twenty‐five patients with at least moderate AS (effective orifice area [EOA] ≤ 1.50 cm2) were prospectively enrolled. EOA was normalized to body surface area (BSA), height, and body mass index (BMI). Receiver operating characteristic curves, in women and men separately, were plotted to determine the best cutoff value for predicting cardiovascular death.

Results

The largest area under the curve (AUC) to predict cardiovascular death was EOA in men (AUC 0.74, P < .001) and EOA/height in women (AUC 0.81, P < .001). An EOA/height cutoff value of 0.55 cm2/m in women had a sensitivity of 100% and specificity of 61%; a cutoff of 0.50 cm2/m in men obtained a sensitivity of 92% and a specificity of 56%. During a mean follow‐up of 247 ± 183 days, there were 33 cardiovascular deaths. Women with EOA/height ≤ 0.55 cm2/m had higher cardiovascular mortality (22% vs 0%, P < .001) and men with EOA/height ≤ 0.50 cm2/m (21% vs 2%, P < .001). One‐year survival in women with EOA/height ≤ 0.55 cm2/m was 67 ± 8% and 100 ± 0% in EOA/height > 0.55 cm2/m (P < .001). In men, 1‐year survival was 70 ± 8% in EOA/height ≤ 0.50 cm2/m, and 93 ± 6% in EOA/height > 0.50 cm2/m (P = .004).

Conclusions

Normalization of EOA is useful in AS, especially in women. We recommend using an EOA/height cutoff value of 0.55 cm2/m in women, and 0.50 cm2/m in men to identify a subgroup with higher cardiovascular risk.
Mitral annular disjunction in patients with primary severe mitral regurgitation and mitral valve prolapse
Authors: Konda Toshiko , Tani Tomoko , Suganuma Naoko , Fujii Yoko , Ota Mitsuhiko , Kitai Takeshi , Kaji Shuichiro , Furukawa Yutaka
Published: October 2020

Background

Mitral annular disjunction is a structural abnormality of the mitral annulus fibrosus which is often associated with mitral leaflet prolapse. However, few reports have described mitral annular disjunction in mitral valve prolapse (MVP). This study aimed to investigate the characteristics of mitral annular disjunction in patients with severe mitral regurgitation (MR) caused by MVP.

Methods

We reviewed 185 consecutive patients with severe MR caused by fibroelastic deficiency (FED) and Barlow's syndrome from March 2009 to December 2010. The upper limit of the disjunction was defined at the level of the posterior scallop's insertion into the left atrial wall, whereas the lower limit was defined at the level of the left atrium's connection to the ventricular myocardium. The distance between the two levels was called mitral annular disjunction. Prolapse sites in FED patients were categorized into anterior leaflet, posterior leaflet, and commissure groups. Patients with a disjunction distance of ≥2 mm were diagnosed with mitral annular disjunction.

Results

Annular disjunction was found in 45 patients (24%). Among them, the most common site of prolapse was the posterior leaflet (n = 35, 77.8%). During a median follow‐up of 20.3 years, arrhythmic events and sudden death occurred in seven patients (3.8%).

Conclusions

Mitral annular disjunction was detected in 24% of patients with severe MR and in 90% of the patients with Barlow's syndrome. There were significant differences at its sites of prolapse in FED patients. The presence and site of prolapse with mitral annular disjunction should be actively determined in FED patients.
Echocardiographic diagnosis of Shone’s syndrome
Authors: Zhang Xin , Ma Guiqin , Zheng Lin , Zhang Hongju , Sun Yan , Li Jingya , Ma Ning
Published: October 2020

Shone’s syndrome is a rare congenital heart disease that includes 4 cardiovascular anomalies: supravalvular mitral ring, parachute mitral valve, subaortic stenosis, and coarctation of the aorta. Early diagnosis and treatment result in better outcomes. Echocardiography plays an important role in the diagnosis and is the optimal examination for detecting this disease. Pressure gradients are often unreliable and inaccurate; thus, careful anatomical observation of the left ventricular inflow and outflow tracts, particularly the mitral valve, is vital for accurate diagnosis and planning appropriate management. Herein, we describe 9 cases of Shone’s syndrome, diagnosed with echocardiography and treated surgically.
Validation of left ventricular volume and ejection fraction measurements by high‐definition blood flow imaging: Comparisons with cardiac magnetic resonance imaging and contrast echocardiography
Authors: Ahmad Masood , Wu Geru , Frank Luba , Dimaano Meneleo M.
Published: October 2020

Background

We recently reported the efficacy of High‐definition blood flow imaging (HDI) in the assessment of left ventricular (LV) function and demonstrated that the results are comparable to those obtained by contrast echocardiography (CE). The present study validates HDI in measurements of LV volumes and ejection fraction (EF) by simultaneous comparisons with CE and cardiac magnetic resonance imaging (CMR).

Methods

Eighteen patients (age range 25‐79 years) with limited echocardiographic images had measurements of LV end‐diastolic volume (EDV, mL), end‐systolic volume (ESV, mL), and EF (%) by HDI, CE, and CMR.

Results

Using the three techniques, measurements of EDV, ESV, and EF correlated well with correlation coefficients (r) ranging from .91 to .98 in comparisons between HDI and CMR, and .89 to .97 in comparisons between CE and CMR. The limits of agreement for the inter‐methods comparisons by Bland‐Altman analysis (mean ± 1.96 SD) between HDI and CMR were 4.92 ± 16.87% for EF, 21.53 ± 32.18 mL for EDV, and 10.69 ± 36.12 mL for ESV, between CE and CMR, the agreement limits were 2.48 ± 18.52% (LVEF), 24.58 ± 47.41 mL (EDV), and 14.09 ± 43.55 mL (ESV).

Conclusions

Measurements of LV volumes and EF by HDI and CE correlated well with CMR. Using CMR as the gold standard, the agreements in measurements of LV volumes were superior for HDI compared to CE. In measurements of EF, CE showed less mean difference when compared to HDI. HDI measurements compared well with those obtained by CMR.
Artificial nightlight alters the predator–prey dynamics of an apex carnivore
Authors: Ditmer Mark A. , Stoner David C. , Francis Clinton D. , Barber Jesse R. , Forester James D. , Choate David M. , Ironside Kirsten E. , Longshore Kathleen M. , Hersey Kent R. , Larsen Randy T. , McMillan Brock R. , Olson Daniel D. , Andreasen Alyson M. , Beckmann Jon P. , Holton P. Brandon , Messmer Terry A. , Carter Neil H.
Published: October 2020

Artificial nightlight is increasingly recognized as an important environmental disturbance that influences the habitats and fitness of numerous species. However, its effects on wide‐ranging vertebrates and their interactions remain unclear. Light pollution has the potential to amplify land‐use change, and as such, answering the question of how this sensory stimulant affects behavior and habitat use of species valued for their ecological roles and economic impacts is critical for conservation and land‐use planning. Here, we combined satellite‐derived estimates of light pollution, with GPS‐data from cougars Puma concolor (n = 56), mule deer Odocoileus hemionus (n = 263) and locations of cougar‐killed deer (n = 1562 carcasses), to assess the effects of light exposure on mammal behavior and predator–prey relationships across wildland–urban gradients in the southwestern United States. Our results indicate that deer used the anthropogenic environments to access forage and were more active at night than their wildland conspecifics. Despite higher nightlight levels, cougars killed deer at the wildland–urban interface, but hunted them in the relatively darkest locations. Light had the greatest effect of all covariates on where cougars killed deer at the wildland–urban interface. Both species exhibited functional responses to light pollution at fine scales; individual cougars and deer with less light exposure increasingly avoided illuminated areas when exposed to greater radiance, whereas deer living in the wildland–urban interface selected elevated light levels. We conclude that integrating estimates of light pollution into ecological studies provides crucial insights into how the dynamic human footprint can alter animal behavior and ecosystem function across spatial scales.
Beyond conidiobolomycosis – the other ‘zygomycoses’
Authors: Johnson P. J. , Townsend K. S. , Martin L. M.
Published: October 2020

Disease resulting from infection by Zygomycetes fungi (including two groups of coenocytic fungal pathogens: the Mucormycota and the Entomophthoramycota) has been collectively referred to as zygomycosis. Clinical disease associated with both the Mucormycota and the Entomophthoramycota is rarely encountered in horses. Potentially life‐threatening, mucormycosis is an angioinvasive disease that principally affects immunocompromised individuals. The order of Entomophthorales include two genera: Conidiobolus and Basidiobolus. The most common of these,Conidiobolus coronatus, typically causes chronic necrohaemorrhagic tumefactions in the nostrils, nasal passages and nasopharyngeal walls of immunocompetent equine hosts, most commonly seen in the south‐eastern USA and parts of Australia. Infection byBasidiobolus ranarumis reported less frequently and usually causes solitary ulcerative skin lesions with pruritus. This short commentary intends to complement the accompanying review of conidiobolomycosis by summarising reported cases of mucormycosis and basidiobolomycosis in horses. Moreover, some new information regarding taxonomic challenges to traditional ‘Zygomycosis’ classification is presented.
Early settlement and growth of stocked European glass eels in a fragmented watercourse
Authors: Félix Pedro M. , Costa José Lino , Quintella Bernardo R. , Almeida Pedro R. , Monteiro Rui , Santos Joana , Portela Teresa , Domingos Isabel
Published: October 2020

One of the actions that has been implemented to support the recovery of the panmictic population of European eel is stocking of waterbodies where natural recruitment is low or null. However, growth conditions of the stocked eels can vary greatly. This circumstance emphasises the importance to determine ideal habitat conditions to contribute to the success of stocking actions and, consequently, to increase the production of silver eels. This study aims to evaluate the early settlement and growth of stocked glass eels in the upper reaches of a fragmented river. Stocking was carried out, in 2014, at three sites of an inland tributary of the Mondego river basin (Central Portugal), and its monitoring was conducted during the following two years, until 2016, along with the collection of environmental and hydromorphological parameters. The results showed a successful dispersion throughout the study area. Growth varied spatially, although environmental parameters have not clearly explained this variation, but overall with high growth rates and a positive allometric growth in this early stage of stocking, suggesting a good condition of the stocked individuals. This study showed that these upper reaches of fragmented watercourses, a shared feature amongst most European rivers that are currently inaccessible for natural recruitment, may be suitable habitats for eel stocking.
The appropriate cutoff gastric pH value for Helicobacter pylori eradication with bismuth‐based quadruple therapy
Authors: Ke Haoran , Li Jing , Lu Bingyun , Yang Chenghai , Wang Jiamin , Wang Zhiqing , Liu Le , Chen Ye
Published: October 2020

Background

This study aimed to investigate whether an increased proton pump inhibitor (PPI) dose enhanced the efficacy of Helicobacter pylori (H. pylori) eradication and determine the appropriate cutoff intragastric pH value that could predict H. pylori eradication with bismuth‐based quadruple therapy.

Materials and Methods

A total of 207 H. pylori infected, treatment naive patients were enrolled in this prospective, open‐label, randomized controlled trial. Patients were randomly allocated into Eso40‐group (esomeprazole 40 mg bid) and Eso20‐group (esomeprazole 20 mg bid), and their CYP2C19 genotyping status was assessed. The 24‐h intragastric pH monitoring on day 7 was performed, and percentage of time gastric pH ≥ 3, ≥4, ≥5, and ≥6 (pH holding time ratios; HTRs) were measured. H. pylori eradication was evaluated using 13C‐urea breath test.

Results

No significant difference in the eradication rates was observed between two groups. The median 24‐h intragastric pH value was not significant different between two groups but the Eso40 Group had a significant higher pH4 HTRs (91.11% [95%CI: 87.50%–95.83%] vs. 95.83% [95.83%–100%]; p = .002). Additionally, the median 24‐h intragastric pH value showed significantly difference between two groups in EM genotype (Eso20 Group 6.00 [95%CI; 5.75–6.15] vs. Eso40 Group 6.30 [6.05–6.30]; p = .019). Similar results were observed in pH4 HTRs. There were significant differences in intragastric pH value (6.10 [95%CI: 4.40–7.00] vs. 5.65 [4.85–5.95], p = .038) and in pH4 HTRs (96% [95%CI: 92.00%–96.00%] vs. 87.5% [67.00%–100.0%], p = .019) between eradication‐successful and eradication‐failed patients. Statistical analysis suggested that the median intragastric pH = 5.7 could identify the success of H. pylori eradication.

Conclusions

Bismuth‐based quadruple therapy resulted in high H. pylori eradication rates either in PPI standard or double doses. Double dose of esomeprazole is associated with better intragastric acid suppression. A median 24‐h intragastric pH of 5.7 could be appropriate cutoff value for predicting the successful H. pylori eradication.
Ten‐year trends in cardiac implantable electronic devices in New Zealand: a national data linkage study (ANZACS‐QI 51)
Authors: Foo Fang Shawn , Stiles Martin K. , Lee Mildred , Looi Khang‐Li , Clare Geoffrey C. , Webber Matthew , Boddington Dean , Jackson Rod , Poppe Katrina K. , Kerr Andrew J.
Published: October 2020

Background

Implant rates for cardiac implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), have increased globally in recent decades.

Aims

This is the first national study providing a contemporary analysis of national CIED implant trends by sex‐specific age groups over an extended period.

Methods

Patient characteristics and device type were identified for 10 years (2009–2018) using procedure coding in the National Minimum Datasets, which collects all New Zealand (NZ) public hospital admissions. CIED implant rates represent implants/million population.

Results

New PPM implant rates increased by 4.6%/year (P < 0.001), increasing in all age groups except patients <40 years. Males received 60.1% of new PPM implants, with higher implant rates across all age groups compared with females. The annual increase in age‐standardised implant rates was similar for males and females (3.4% vs 3.0%; P = 0.4). By 2018 the overall PPM implant rate was 538/million. New ICD implant rates increased by 4.2%/year (P < 0.001), increasing in all age groups except patients <40 and ≥ 80 years. Males received 78.1% of new ICD implants, with higher implant rates across all age groups compared to females. The annual increase in age‐standardised implant rates was higher in males compared with females (3.5% vs 0.7%; P < 0.001). By 2018 the overall ICD implant rate was 144/million.

Conclusion

CIED implant rates have increased steadily in NZ over the past decade but remain low compared with international benchmarks. Males had substantially higher CIED implant rates compared with females, with a growing gender disparity in ICD implant rates.
Fabrication and characterization of tetragonal yttria‐stabilized zirconia single‐crystalline thin film
Authors: Nakade Hiroaki , Tochigi Eita , Feng Bin , Nezu Yukio , Ohta Hiromichi , Shibata Naoya , Ikuhara Yuichi
Published: October 2020

Tetragonal yttria‐stabilized zirconia thin film was successfully fabricated by a pulsed laser deposition method. The thin film grew heteroepitaxially with the orientation relationship of ZrO2‖Al2O3. Energy dispersive X‐ray spectroscopy mapping revealed that Y3+ ions were distributed homogeneously without local segregations. X‐ray and electron‐diffraction analysis confirmed a single crystalline structural feature of the film. On the other hand, high‐resolution scanning transmission electron microscopy observations show that this film contains small‐angle tilt grain boundaries, which is composed of the periodic array of dislocations with the Burgers vector .
Venous leg ulcer recurrences – The relationship to self‐efficacy, social support and quality of life – A mixed method study
Authors: Probst Sebastian , Bobbink Paul , Séchaud Laurence , Buehrer Skinner Monika
Published: October 2020

Aim

The aim of this study was to explore the occurrence of venous leg ulcer recurrence and the relationship with self‐efficacy, social support and quality of life. Furthermore, we investigated the lived experiences of those patients and their understanding of why they developed a recurrence.

Design

We used a convergent parallel mixed method design consisting of a cohort and an interpretative phenomenological study arm.

Methods

Consecutive patients (N = 145) were recruited into the study. Between 2014 and 2018, three primary care centres took part in the study. Data collection methods included chart review, administered questionnaires and semi‐structured interviews.

Results

The incidence of the venous leg ulcer recurrence was 33.1% within the study period. The scores for self‐efficacy, social support and venous leg ulcer health‐related quality of life show little variation between all measurement points and within subgroups. The qualitative findings identified two main themes: accidentally damaging the skin and avoiding venous leg ulcer recurrences. Venous leg ulcer recurrences frequently arose from accidents. Therefore, participants developed strategies to avoid additional ulcers.

Conclusion

To optimize recurrence prevention, improvements in knowledge of people with VLUs should be considered.

Impact

A mixed method, convergent, parallel design was used to explore the occurrence of venous leg ulcer recurrence and the relation of a venous leg ulcer recurrence with self‐efficacy, social support and health‐related quality of life. As well as the lived experiences of venous leg ulcer patients and why they developed a recurrence.

The incidence of venous leg ulcer recurrences within the study period was 33.1%.

Damaging the skin and avoiding a recurrence were the main identified themes.
Exploring how support workers understand their role in supporting adults with intellectual disabilities to access the Internet for intimate relationships
Authors: Lines Jason , Combes Helen , Richards Ruth
Published: October 2020

Background

Some adults with intellectual disabilities need support to access the Internet. This study explores how support workers understand their role in facilitating Internet access for intimate relationships.

Method

Eight support workers in the West Midlands of the UK were interviewed face‐to‐face, using semi‐structured interviews and a thematic analysis was used to interpret the data.

Results

Three main themes emerged; social and organizational dilemmas (including sub‐themes of; role and moral positioning, expectations of support, and protected and reflective space), power and position and policy dilemmas.

Conclusion

Support workers said that adults with intellectual disabilities should have access to the Internet for intimate relationships. There was a range of views on whether it was their job to support this. A lack of training in Internet use was highlighted.
Brugada syndrome and syncope: A systematic review
Authors: Mascia Giuseppe , Della Bona Roberta , Ameri Pietro , Canepa Marco , Porto Italo , Brignole Michele
Published: October 2020

Introduction

Distinguishing syncope due to malignant arrhythmias from an incidental benign form in Brugada syndrome (BrS) is often difficult. Through systematic literature review, we evaluated the role of syncope in predicting subsequent malignant arrhythmias in BrS.

Methods

A comprehensive literature search was performed on PubMed (MeSH search terms “Brugada syndrome” and “syncope”). Overall, 9 studies for a total of 1347 patients were included. Patients were stratified as affected by suspected arrhythmic syncope (SAS), undefined syncope (US) or neurally‐mediated syncope (NMS).

Results

Overall, 15.7% of the 279 patients with SAS had malignant arrhythmic events during a mean follow‐up of 67 months, corresponding to 2.8 events per 100/person year. At the same time, 7% of the 527 patients affected by US had malignant arrhythmias during a mean follow‐up of 39 months, corresponding 2.2 events per 100/person year. Conversely, 0.7% of 541 patients with NMS had malignant arrhythmic events at follow‐up, corresponding to 0.13 events per 100/person year (p = .0001 NMS versus SAS and US pooled).

Conclusion

In BrS population, the risk of arrhythmic events in the follow‐up may be stratified according to the clinical evaluation. The “relatively” low predictive value of the clinical diagnosis of SAS warrants for a more accurate multi‐parametric assessment, to restrict the number of candidates for implantable cardioverter‐defibrillator therapy.
Periosteum progenitors could stimulate bone regeneration in aged murine bone defect model
Authors: Xiao Han , Wang Linfeng , Zhang Tao , Chen Can , Chen Huabin , Li Shengcan , Hu Jianzhong , Lu Hongbin
Published: October 2020

Periosteal stem cells are critical for bone regeneration, while the numbers will decrease with age. This study focused on whether Prx1+ cell, a kind of periosteal stem cell, could stimulate bone regeneration in aged mice. Four weeks and 12 months old Prx1CreER‐GFP; Rosa26tdTomato mice were used to reveal the degree of Prx1+ cells participating in the femoral fracture healing procedure. One week, 8 weeks, 12 and 24 months old Prx1CreER‐GFP mice were used to analyse the real‐time distribution of Prx1+ cells. Twelve months old C57BL/6 male mice (n = 96) were used to create the bone defect model and, respectively, received hydrogel, hydrogel with Prx1− mesenchymal stem cells and hydrogel with Prx1+ cells. H&E staining, Synchrotron radiation‐microcomputed tomography and mechanical test were used to analyse the healing results. The results showed that tdTomato+ cells were involved in bone regeneration, especially in young mice. At the same time, GFP+ cells decreased significantly with age. The Prx1+ cells group could significantly improve bone regeneration in the murine bone defect model via directly differentiating into osteoblasts and had better osteogenic differentiation ability than Prx1− mesenchymal stem cells. Our finding revealed that the quantity of Prx1+ cells might account for decreased bone regeneration ability in aged mice, and transplantation of Prx1+ cells could improve bone regeneration at the bone defect site.
Phosphorylated STAT3 suppresses microRNA‐19b/1281 to aggravate lung injury in mice with type 2 diabetes mellitus‐associated pulmonary tuberculosis
Authors: Wang Xianhua , Lin Yuefu , Liang Ying , Ye Yang , Wang Dong , Tai Aer , Wu Shuimiao , Pan Jian
Published: October 2020

Type 2 diabetes mellitus (T2DM) is a risk factor for pulmonary tuberculosis (PTB) and increased mortality. This work focused on the functions of phosphorylated STAT3 in lung injury in mouse with T2DM‐associated PTB and the molecules involved. A mouse model with T2DM‐PTB was induced by administrations of streptozotocin, nicotinamide and mycobacterium tuberculosis (Mtb). A pSTAT3‐specific inhibitor AG‐490 was given into mice and then the lung injury in mice was observed. The molecules involved in AG‐490‐mediated events were screened out. Altered expression of miR‐19b, miR‐1281 and NFAT5 was introduced to identify their involvements and roles in lung injury and PTB severity in the mouse model. Consequently, pSTAT3 expression in mice with T2DM‐associated PTB was increased. Down‐regulation of pSTAT3 by AG‐490 prolonged the lifetime of mice and improved the histopathologic conditions, and inhibited the fibrosis, inflammation, Mtb content and number of apoptotic epithelial cells in mouse lung tissues. pSTAT3 transcriptionally suppressed miR‐19b/1281 expression to up‐regulate NFAT5. Inhibition of miR‐19b/1281 or up‐regulation of NFAT5 blocked the protective roles of AG‐490 in mouse lung tissues. To conclude, this study evidenced that pSTAT3 promotes NFAT5 expression by suppressing miR‐19b/1281 transcription, leading to lung injury aggravation and severity in mice with T2DM‐associated PTB.
Demographic transformation of the physiotherapy profession in South Africa: A retrospective analysis of HPCSA registrations from 1938 to 2018
Authors: Louw Quinette Abigail , Berner Karina , Tiwari Ritika , Ernstzen Dawn , Bedada Diribsa Tsegaye , Coetzee Marisa , Chikte Usuf
Published: October 2020

Rationale, aim and objective

The physiotherapy profession did not escape the effects of racially based segregatory practises. While numerous strategies and initiatives have been employed to redress the inequities of the past, the extent of demographic transformation within the physiotherapy profession in South Africa remains uncertain. Transformation is defined in this article as an intentional change aimed at addressing inequalities and the ultimate goal is for population group and gender profiles of higher education graduates to be representative of the national epidemiological profile. This paper describes the demographic patterns of Health Professions Council of South Africa (HPCSA) registered physiotherapists from 1938 to 2018.

Method

A retrospective record review of the HPCSA database from 1938 until 2018 was performed. De‐identified data were extracted, coded and analyzed for descriptive purposes. Z‐tests were used for analysis of proportion differences, along with P‐values and 95% confidence intervals for interpretation.

Results

In 2018, 7663 physiotherapists (6350 women and 1313 men) were registered with the HPCSA. Most registered physiotherapists (55.6%) were classified as white, followed by black (17.3%), coloured (10.3%) and Indian (9.8%). A progressive increase was found in the number of new registrations over time (1949‐2018) by black (0.00%‐24.38% of total new registrations), coloured (0.00%‐15.47%) and Indian individuals (0.00%‐10.03%), with a statistically significant increase in newly registered black therapists in the decade prior to 2018 (P = .005). Gender transformation appears to be occurring at a slower pace as the profession remains female‐dominated (82.9% of registered physiotherapists in 2018).

Conclusion

There has been a steady transformation of the South African physiotherapy graduates composition regarding population categories and gender. However, it is clear that much more than selection criteria is needed to transform the profession in a way that is nationally representative, remain actively accountable for transformation and apt for local context.
Towards a new understanding of uncertainty in medical education
Authors: Lee Ciara , Hall Katherine , Anakin Megan , Pinnock Ralph
Published: October 2020

Rationale, aims, and objectives

Uncertainty is a complex and constant phenomenon in clinical practice. How medical students recognize and respond to uncertainty impacts on their well‐being, career choices, and attitudes towards patients. It has been suggested that curricula should do more to prepare medical students for an uncertain world. In order to teach medical students about uncertainty, we need to understand how uncertainty has been conceptualized in the literature to date. The aim of this article is to explore existing models of uncertainty and to develop a framework of clinical uncertainty to aid medical education.

Method

A scoping literature review was performed to identify conceptual models of uncertainty in healthcare. Content and inductive analyses were performed to explore three dimensions of clinical uncertainty: sources of uncertainty, subjective influencers and responses to uncertainty.

Results

Nine hundred one references were identified using our search strategy, of which, 24 met our inclusion criteria. It was possible to classify these conceptual models using one or more of three dimensions of uncertainty; sources, subjective influencers, and responses. Exploration and further classification of these dimensions led to the development of a framework of uncertainty for medical education.

Conclusion

The developed framework of clinical uncertainty highlights sources, subjective influencers, responses to uncertainty, and the dynamic relationship among these elements. Our framework illustrates the different aspects of knowledge as a source of uncertainty and how to distinguish between those aspects. Our framework highlights the complexity of sources of uncertainty, especially when including uncertainty arising from relationships and systems. These sources can occur in combination. Our framework is also novel in how it describes the impact of influencers such as personal characteristics, experience, and affect on perceptions of and responses to uncertainty. This framework can be used by educators and curricula developers to help understand and teach about clinical uncertainty.
Examining the association between serum free fatty acids and blood levels of testosterone
Authors: Kao C.‐C. , Yang Z.‐Y. , Cheng Y.‐W. , Chen W.‐L.
Published: October 2020

Background

Multiple studies have uncovered the effects that ingested fat has on human blood levels of testosterone. Yet, few reports have discussed the effect of circulating serum free fatty acids (FFAs). The present study aimed to explore the relationship between serum free fatty acids and blood levels of testosterone.

Methods

In total, 5719 adults were pooled from the database of the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2012. Based on multivariable‐linear regression models, we employed a total of 30 FFAs to interpret the relationship of FFAs with blood levels of testosterone. Two models with covariate adjustments were designated for further evaluation and analysis.

Results

Capric acid [β = −0.014, 95% confidence interval (CI) = −0.023, −0.004, P = 0.005], myristic acid (β = −0.001, 95% CI = −0.001, 0.000, P ≤ 0.001), pentadecanoic acid (β = −0.013, 95% CI = −0.018, −0.008, P ≤ 0.001), margaric acid (β = −0.011, 95% CI = −0.017, −0.005, P ≤ 0.001) and alpha‐linolenic acid (β = −0.001, 95% CI = −0.002, 0.000, P = 0.004) in the fully adjusted model were significantly negatively correlated with the testosterone level inh obese men. In the fully adjusted model for the female analysis, myristic acid, pentadecanoic acid, palmitic acid, margaric acid, stearic acid, myristoleic acid, oleic acid, nervonic acid and alpha‐linolenic acid were found significantly associated with the testosterone level.

Conclusions

Our findings indicate a significant negative correlation between serum FFAs and blood levels of testosterone. Furthermore, we reveal the essentiality of serum FFAs and their potential effects on the reduction of testosterone levels.
Inhibitory effect of glutathione S‐transferase A3 in the progression of cutaneous squamous cell carcinoma
Authors: Li Weiwei , Qiu Cheng , Wang Shujun , Wu Lijun , Zhao Tianlan
Published: October 2020

Background

Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous malignancy with an incidence rate increasing each year. Glutathione S‐transferase A3 (GSTA3), a member of the glutathione S‐transferase family, is considered an antioxidative protease, but its role in cSCC remains unclear.

Aim

The present study was designed to explore the effect of GSTA3 on cSCC.

Patients/Methods

Through previous systematic studies, we screened GSTA3 to be a key gene with lower expression in cSCC. In the present study, we selected cSCC tissues and para‐carcinoma tissue specimens from 20 patients in plastic surgery department. A431 cells were treated with GSTA3 transfection. The cell proliferation, apoptosis, colony formation, and cell migration as well as invasion were examined, respectively. And the expressions of GSTA3, TGF‐β/Smad, and HIF‐1α signalings were measured by Western blot and qRT‐PCR.

Results

GSTA3 was downregulated in both cSCC tissues and A431 cells. Additionally, overexpression of GSTA3 induced a phenotype with a lower degree of malignancy, while GSTA3 silencing induced more malignant phenotypes, including cell proliferation, colony formation, apoptosis, migration, and invasion. Moreover, we found that the TGF‐β/Smad2/3 and HIF‐1α signalings were activated in cSCC under hypoxic conditions.

Conclusion

GSTA3 could inhibit cSCC progression through suppression of the TGF‐β/Smad and HIF‐1α signalings. Therefore, GSTA3 may prove to be a prospective therapeutic target for cSCC.
Annual report of the Women's Health Care Committee, Japan Society of Obstetrics and Gynecology, 2020
Authors: Kato Kiyoko , Terauchi Masakazu
Published: October 2020

Our committee was founded in 2010 with the goal of improving women's health. This academic year, we focused on five activities: cooperation between the departments of pediatric surgery and obstetrics and gynecology for the treatment of persistent cloaca and Mayer–Rokitansky–Küster–Hauser syndrome in Japan; assessment of the educational training of women's health‐care advisers; increasing screening for breast and cervical cancer; conducting the Nationwide Survey of Prescribing Practices for the Treatment of Menopausal Symptoms; and preventing osteoporosis in survivors of gynecologic cancer. The activities of each subcommittee are detailed below. This report is based on the Japanese version of the annual report (Acta Obst Gynaec Jpn 2020;72(6):697–707).
Adolescent Psychological Well‐being, Radicalism, and Activism: The Mediating Role of Social Disconnectedness and the Illegitimacy of the Authorities
Authors: Costabile Angela , Musso Pasquale , Iannello Nicolò Maria , Servidio Rocco , Bartolo Maria Giuseppina , Palermiti Anna Lisa , Scardigno Rosa
Published: October 2020

The identification of factors that counter youth’s radicalization while promoting democratic activism is a timely social issue. This paper examines the association of psychological well‐being (PWB) with violent radicalism and nonviolent activism, by focusing on the mediating role of both social disconnectedness (SD) and the perceived illegitimacy of the authorities (PIoA). Two mediation structural equation models (full vs. partial) were applied to data collected from 328 Italian adolescents (14–19 years). The results showed how SD and PIoA fully mediated the link of PWB with radicalism (negatively) and activism (positively). This model was further supported when compared with an alternative one proposing PWB as a mediator between SD and PIoA. The findings are discussed in light of the existing literature and provide potential implications for practice.
Yakima Valley Farm Workers Clinic oral health transformation project
Authors: Koday Mark , Davis Stephen , Melbye Molly
Published: October 2020

The Yakima Valley Farm Workers Clinic (YVFWC) is one of the largest community health centers in the country with clinics throughout south‐central Washington and northern Oregon. Its dental program consists of 14 dental clinics providing general and specialty services to the low‐income populations it serves. Modeling itself after the YVFWC medical managed care program; the Dental program recently added value‐based metrics to its dental practice after Oregon offered a value‐based dental reimbursement plan in 2019. This is the first‐step YVFWC's dental program that has taken to prepare for value‐based reimbursement and transform its dental practice in order to reduce the disease burden in its patient population. The purpose of this article is to describe the processes YVFWC undertook to prepare itself for the new reimbursement model, which included the development of metrics, a metric validation process, a clinical dashboard, and a method for improving metrics. It also outlines its medical/dental integration improvement brought about by embedding hygienists into the medical primary care teams.
The effect of blood transfusion on sublingual microcirculation in critically ill patients: A scoping review
Authors: Liu Wanglin , He Huaiwu , Ince Can , Long Yun
Published: October 2020

Purpose

To investigate the effects of red blood cell (RBC) transfusion on sublingual microcirculation in critically ill patients.

Methods

Systematic strategy was conducted to search studies that measured sublingual microcirculation before and after transfusion in critically ill patients. This review was reported according to the Preferred Reporting Items for Systematic Review and Meta‐Analyses Scoping Review Extension.

Results

The literature search yielded 114 articles. A total of 11 studies met the inclusion criteria. Observational evidence showed diffusive capacity of the microcirculation significantly improved in intraoperative and anemic hematologic patients after transfusion, while the convective parameters significantly improved in traumatic patients. RBC transfusion improved both diffusive and convective microcirculatory parameters in hypovolemic hemorrhagic shock patients. Most of the studies enrolled septic patients showed no microcirculatory improvements after transfusion. The positive effects of the leukoreduction were insufficiently supported. The effects of the storage time of the RBCs were not conclusive. The majority of the evidence supported a negative correlation between baseline proportion of perfused vessels (PPV) and changes in PPV.

Conclusions

This scoping review has catalogued evidence that RBC transfusion differently improves sublingual microcirculation in different populations. The existing evidence is not sufficient to conclude the effects of the leukoreduction and storage time of RBCs.
The return of economic nationalism to East Central Europe: Right‐wing intellectual milieus and anti‐liberal resentment
Authors: Varga Mihai
Published: October 2020

This article emphasises the non‐economic goals of economic nationalism and in particular its often overlooked political goals. Drawing parallels between economic nationalisms in Central Europe and East Asia, it focuses on Poland and Hungary and asks why did these countries turn to economic nationalism. The article traces this turn to ideational foundations developed by right‐wing intellectuals over the last two decades, arguing that right‐wing intellectuals believed that liberalism has failed what they conceived of its most important (political) purpose, the need of a radical break with the communist past. Based on a study of the writings and careers of leading Polish and Hungarian right‐wing intellectuals, the article draws attention to the nature of the perceived threat to the nation. It contributes to the sociology of nationalism an analysis of how such a threat emerges and translates into a guiding idea of illiberal economic policies.
Arabidopsis AZG2 transports cytokinins in vivo and regulates lateral root emergence
Authors: Tessi Tomás M. , Brumm Sabine , Winklbauer Eva , Schumacher Benjamin , Pettinari Georgina , Lescano Ignacio , González Claudio A. , Wanke Dierk , Maurino Verónica G. , Harter Klaus , Desimone Marcelo
Published: October 2020

Cytokinin and auxin are key regulators of plant growth and development. During the last decade transport mechanisms have turned out to be the key for the control of local and long‐distance hormone distributions. In contrast with auxin, cytokinin transport is poorly understood.

Here, we show that Arabidopsis thaliana AZG2, a member of the AZG purine transporter family, acts as cytokinin transporter involved in root system architecture determination. Even though purines are substrates for both AZG1 and AZG2, we found distinct transport mechanisms.

The expression of AZG2 is restricted to a small group of cells surrounding the lateral root (LR) primordia and induced by auxins. Compared to the wild‐type (WT), mutants carrying loss‐of‐function alleles of AZG2 have higher LR density, suggesting that AZG2 is part of a regulatory pathway in LR emergence. Moreover, azg2 is partially insensitive to exogenous cytokinin, which is consistent with the observation that the cytokinin reporter TCSnpro:GFP showed lower fluorescence signal in the roots of azg2 compared to the WT.

These results indicate a defective cytokinin signalling pathway in the region of LR primordia. The integration of AZG2 subcellular localization and cytokinin transport capacity data allowed us to propose a local cytokinin : auxin signalling model for the regulation of LR emergence.
Production and turnover of mycorrhizal soil mycelium relate to variation in drought conditions in Mediterranean Pinus pinaster, Pinus sylvestris and Quercus ilex forests
Authors: Hagenbo Andreas , Piñuela Yasmine , Castaño Carles , Martínez de Aragón Juan , de‐Miguel Sergio , Alday Josu G. , Bonet José Antonio
Published: October 2020

In forests, ectomycorrhizal mycelium is pivotal for driving soil carbon and nutrient cycles, but how ectomycorrhizal mycelial dynamics vary in ecosystems with drought periods is unknown. We quantified the production and turnover of mycorrhizal mycelium in Mediterranean Pinus pinaster, Pinus sylvestris and Quercus ilex forests and related the estimates to standardised precipitation index (SPI), to study how mycelial dynamics relates to tree species and drought‐moisture conditions.

Production and turnover of mycelium was estimated between July and February, by quantifying the fungal biomass (ergosterol) in ingrowth mesh bags and using statistical modelling. SPI for time scales of 1–3 months was calculated from precipitation records and precipitation data over the study period.

Forests dominated by Pinus trees displayed higher biomass but were seasonally more variable, as opposed to Q. ilex forests where the mycelial biomass remained lower and stable over the season. Production and turnover, respectively, varied between 1.4–5.9 kg ha−1 d−1 and 7.2–9.9 times yr−1 over the different forest types and were positively correlated with 2‐month and 3‐month SPI over the study period.

Our results demonstrated that mycorrhizal mycelial biomass varied with season and tree species and we speculate that production and turnover are related to physiology and plant host performance during drought.
Leadless pacemaker: State of the art and incoming developments to broaden indications
Authors: Curnis Antonio , Salghetti Francesca , Cerini Manuel , Fabbricatore Davide , Ghizzoni Giulia , Arrigoni Luca , Generati Greta , Arabia Gianmarco , Maiolo Vincenzo , Aboelhassan Mohamed , Bontempi Luca
Published: October 2020

Theleadless pacemaker (LLPM) therapy has been developed in recent years to overcome the transvenous lead and device pocket‐related complications. The LLPMs now available are self‐contained right ventricular pacemakers and are limited to single‐chamber ventricular pacing modality. This literature review deals with the current status of LLPM technology and current areas of clinical applicability. The safety and efficacy outcomes published from randomized clinical trials and real world registries are analyzed and compared with historical conventional transvenous pacemaker data. Furthermore, new pacing modalities and future perspectives to broaden the clinical use and cover most of pacing indications are discussed. Due to the overall safe and effective profile in the short term and intermediate term, also in fragile patients, the LLPM use is constantly growing in daily clinical practice. Actually, it can be considered a landmark innovation, through which a new era of cardiac pacing has begun.
Coaching for the pediatric anesthesiologist: Becoming our best selves
Authors: Schwartz Jamie McElrath , Wittkugel Eric , Markowitz Scott D. , Lee Jennifer K. , Deutsch Nina
Published: October 2020

Anesthesiologists must balance demanding clinical workloads with career development goals. Leadership, conflict management, and other skills can improve medical outcomes, reduce stress at work, and increase career satisfaction. However, Medicine in general and Anesthesiology in particular have not traditionally emphasized physician growth in these areas. Coaching utilizes concepts from psychology, adult learning, and adult development theory to support an individual in personal and professional growth through inquiry, reflection, and shared discovery. This manuscript reviews the history and evidence basis for coaching, differentiates coaching from traditional mentorship, and presents some constructs of coaching and working with a coach. An example of a successful pilot program to disseminate coaching skills and support leadership growth among anesthesiologists, the Women's Empowerment and Leadership Initiative within the Society for Pediatric Anesthesia, is described.
Three AP2/ERF family members modulate flavonoid synthesis by regulating type IV chalcone isomerase in citrus
Authors: Zhao Chenning , Liu Xiaojuan , Gong Qin , Cao Jinping , Shen Wanxia , Yin Xueren , Grierson Donald , Zhang Bo , Xu Changjie , Li Xian , Chen Kunsong , Sun Chongde
Published: October 2020

Flavanones and flavones are excellent source of bioactive compounds but the molecular basis of their highly efficient production remains elusive. Chalcone isomerase (CHI) family proteins play essential roles in flavonoid biosynthesis but little are known about the transcription factors controlling their gene expression. Here, we identified a type IV CHI (designated as CitCHIL1) from citrus which enhances the accumulation of citrus flavanones and flavones (CFLs). CitCHIL1 participates in a CFL biosynthetic metabolon and assists the cyclization of naringenin chalcone to (2S)‐naringenin, which leads to the efficient influx of substrates to chalcone synthase (CHS) and improves the catalytic efficiency of CHS. Overexpressing CitCHIL1 in Citrus and Arabidopsis significantly increased flavonoid content and RNA interference‐induced silencing of CitCHIL1 in citrus led to a 43% reduction in CFL content. Three AP2/ERF transcription factors were identified as positive regulators of the CitCHIL1 expression. Of these, two dehydration‐responsive element binding (DREB) proteins, CitERF32 and CitERF33, activated the transcription by directly binding to the CGCCGC motif in the promoter, while CitRAV1 (RAV: related to ABI3/VP1) formed a transcription complex with CitERF33 that strongly enhanced the activation efficiency and flavonoid accumulation. These results not only illustrate the specific function that CitCHIL1 executes in CFL biosynthesis but also reveal a new DREB‐RAV transcriptional complex regulating flavonoid production.