bluuebunny/crossref_metadata_2025 huggingface dataset:
Asientos as sinews of war in the composite superpower of the 16th century
Authors: Alvarez-Nogal Carlos , Chamley Christophe
Published: April 2021

The full analysis of the text of a contract, asiento, between Philip II of Spain and a Genoese merchant–banker details how in this pre-modern composite state, merchant–bankers acted as agents of the Crown who gathered many scattered sources of income to the Crown and transformed them into large and regular cash flows, mesadas, for the army. Because of the uncertain availability of these sources, the contract provided flexibility to both parties and legal assistance to the banker who reported to accountants for audit and, if necessary, the charge of an interest at about 1 percent per month.
Short-chain fatty acid and fecal microbiota profiles are linked to fibrosis in primary biliary cholangitis
Authors: Lammert Craig , Shin Andrea S , Xu Huiping , Hemmerich Christopher , M. O'Connell Thomas , Chalasani Naga
Published: April 2021

The gut microbiota and metabolome could play a role in primary biliary cholangitis (PBC) progression. We aimed to assess fecal microbiota and fecal short-chain fatty acids (SCFAs) in PBC according to fibrosis. In a cross-sectional study of 23 PBC patients, fecal microbiota and SCFAs were determined using 16S rRNA sequencing and nuclear magnetic resonance spectroscopy, respectively. Fecal acetate and SCFAs were higher in advanced fibrosis. Advanced fibrosis microbiota exhibited decreased alpha diversity, increased Weisella and a distinct community composition. SCFAs correlated with individual taxa in non-advanced fibrosis. Fecal microbiota and SCFAs correspond to fibrosis in PBC.
Measuring Cognitive Health in Ethnically Diverse Older Adults
Authors: Hernandez Saucedo Hector , Whitmer Rachel A , Glymour Maria , DeCarli Charles , Mayeda Elizabeth-Rose , Gilsanz Paola , Miles Sunita Q , Bhulani Nihal , Tomaszewski Farias Sarah , Olichney John , Mungas Dan
Published: April 2021

Objectives

Understanding racial/ethnic disparities in late-life cognitive health is a public health imperative. We used baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study to examine how age, education, gender, and clinical diagnosis, a proxy for brain health, are associated with cross-sectional measures of cognition in diverse racial/ethnic groups.

Methods

Comprehensive measures of cognition were obtained using the Spanish and English Neuropsychological Assessment Scales and the National Institutes of Health Toolbox Cognitive Health Battery in a sample of 1,695 KHANDLE participants (Asians 24%, Blacks 26%, Latinos 20%, Whites 29%). A 25% random subsample was clinically evaluated and diagnosed with normal cognition, mild cognitive impairment (MCI), or dementia. Cognitive test scores were regressed on core demographic variables and diagnosis in the combined sample and in multiple group analyses stratified by racial/ethnic group.

Results

Race/ethnicity and education were variably associated with test scores with strongest associations with tests of vocabulary and semantic memory. Older age was associated with poorer performance on all measures, and gender differences varied across cognitive tests. Clinical diagnosis of MCI or dementia was associated with average decrements in test scores that ranged from −0.41 to −0.84 SD, with largest differences on tests of executive function and episodic memory. With few exceptions, associations of demographic variables and clinical diagnosis did not differ across racial/ethnic groups.

Discussion

The robust associations of cognitive test results with clinical diagnosis independent of core demographic variables and race/ethnicity support the validity of cognitive tests as indicators for brain health in diverse older adults.
Robot-assisted intrathoracic procedure for dumbbell tumour in the prone position
Authors: Okazaki Mikio , Takigawa Tomoyuki , Suzawa Ken , Toyooka Shinichi
Published: April 2021

A 24-year-old man presented with a dumbbell-shaped right posterior mediastinal mass. The patient was placed in the prone position following general anaesthesia and intubation. After laminectomy and dissection of the dorsal part of the tumour using a posterior approach were performed, the tumour was completely resected using a robotic approach in the thoracic cavity without repositioning. This is the first report of robotic resection for posterior mediastinal tumour in the prone position as well as a novel combined posterior approach and robotic resection for dumbbell tumours.
Usefulness of monitoring intrapleural pressure with digital chest drainage system for the management of air leakage after lung resection
Authors: Eriguchi Daisuke , Ito Hiroyuki , Nagashima Takuya , Adachi Hiroyuki , Samejima Joji , Nemoto Daiji , Nakayama Haruhiko , Ikeda Norihiko
Published: April 2021

OBJECTIVES

The objective of this study was to determine the variation in intrapleural pressure (IPP) with and without air leakage using a digital chest drainage system (DCS) for each pressure setting.

METHODS

In this retrospective single-centre study, we analysed 49,553 h of air leakage after anatomical lung resection in 714 patients between 2018 and 2020. The transition of mean IPP and mean air leak flow was monitored using DCS, and the association between mean IPP and mean air leak flow was examined. The relationship between the transition of mean IPP and air leakage according to the varying suction pressures on DCS was also investigated.

RESULTS

Overall, 272 patients (38.1%) showed air leakage after surgery. The mean IPP in patients without air leakage was −12.0 ± 2.9 cmH2O and maintained at about −12 cmH2O constantly, while the mean IPP in patients with air leakage was −8.3 ± 1.9 cmH2O, which changed to −12 cmH2O instantly if air leakage disappeared (P < 0.001). Among patients with air leakage, the mean IPP changed more distinctly in patients with mild suction management than in those with conventional suction management (−5.0 ± 2.6 to −11.5 ± 4.2 and −8.8 ± 1.3 to −12.1 ± 2.5 cmH2O, respectively; P < 0.001).

CONCLUSIONS

The change in IPP on a DCS is useful for detecting air leakage. Furthermore, management with a mild suction setting on DCS makes it easy to recognize the disappearance of postoperative air leakage.
AACC Guidance Document on Laboratory Testing for the Assessment of Preterm Delivery
Authors: Farnsworth Christopher , Schuler Erin E , Woodworth Alison , Straseski Joely , Pschirrer E Rebecca , Nerenz Robert D
Published: April 2021

Identifying women with preterm labor who will go on to deliver prematurely is crucial to improving outcomes for mother and baby and for saving healthcare resources. Even among those with symptoms, the number of women who deliver preterm is low, and thus the low positive predictive value (PPV) and high negative predictive value (NPV) associated with available biomarkers does not substantially reduce the uncertainty of the clinical diagnosis. While there is some promise in the use of fetal fibronectin (fFN), interleukin 6 (IL-6), or placental alpha microglobulin 1 (PAMG-1) for predicting preterm birth (PTB), their use is unlikely to provide considerable clinical value in populations with a low prevalence. To provide real clinical benefit, a biomarker must demonstrate a high PPV to allow identification of the minority of symptomatic women who will deliver prematurely. As none of the currently available biomarkers exhibit this performance characteristic, we do not recommend their routine clinical use in populations with a pre-test probability of PTB of <5%. Limiting biomarker testing to only high-risk women identified on the basis of cervical length or other characteristics will increase the pre-testprobability in the tested population, thereby improving PPV. PAMG-1 is associated with a higher PPV than fFN and may show clinical utility in populations with a higher pre-test probability, but further work is required to conclusively demonstrate improved outcomes in this patient group.
MiR-20a-5p overexpression prevented diabetic cardiomyopathy via inhibition of cardiomyocyte apoptosis, hypertrophy, fibrosis and JNK/NF-κB signalling pathway
Authors: Liu Xiaoyu , Guo Bingyan , Zhang Wei , Ma Bocong , Li Yongjun
Published: April 2021

Diabetic cardiomyopathy (DCM) is a common cardiovascular disease. A declined miR-20a-5p was observed in hearts of diabetic mice, while its effect on DCM remains unknown. Herein, we established streptozotocin-induced DCM rat model and high glucose-stimulated H9C2 model of DCM. Then they were treated with adenovirus expressing miR-20a-5p to explore the function of miR-20a-5p. Insulin tolerance test and intraperitoneal glucose tolerance test assay revealed that miR-20a-5p reduced blood glucose level. Besides, miR-20a-5p improved cardiac dysfunction reflected by reduced heart weight/body weight and left ventricular diastolic pressure, and increased left ventricular systolic pressure and ±LV dp/dt max. MiR-20a-5p prevented cardiomyocyte apoptosis, along with the upregulated c-caspase-3, bax and downregulated bcl-2. Moreover, miR-20a-5p alleviated cardiac hypertrophy as the parameters of atrial natriuretic peptide, B-type natriuretic peptide and MyHC-β decreased. Also, miR-20a-5p attenuated the cardiac fibrosis demonstrated by decreased transforming growth factor-β1, collagen I levels and the inflammatory response manifested by reduced interleukin-6, tumour necrosis factor-α and IL-1β production. Furthermore, miR-20a-5p prevented Jun NH2-terminal kinase (JNK) phosphorylation and nuclear factor-κB (NF-κB) p65nuclear translocation. Similarly, the effects of miR-20a-5p on DCM were confirmed in our in vitro experiments. Additionally, ROCK2 is a possible target gene of miR-20a-5p. ROCK2 overexpression reversed the protective effect of miR-20a-5p on DCM. Overall, miR-20a-5p may effectively ameliorate DCM through improving cardiac metabolism, and subsequently inhibiting inflammation, apoptosis, hypertrophy, fibrosis and JNK/NF-κB pathway via modulating ROCK2.
Nile Tilapia: A Model for Studying Teleost Color Patterns
Authors: Wang Chenxu , Lu Baoyue , Li Tao , Liang Guangyuan , Xu Mengmeng , Liu Xingyong , Tao Wenjing , Zhou Linyan , Kocher Thomas D , Wang Deshou
Published: April 2021

The diverse color patterns of cichlid fishes play an important role in mate choice and speciation. Here we develop the Nile tilapia (Oreochromis niloticus) as a model system for studying the developmental genetics of cichlid color patterns. We identified 4 types of pigment cells: melanophores, xanthophores, iridophores and erythrophores, and characterized their first appearance in wild-type fish. We mutated 25 genes involved in melanogenesis, pteridine metabolism, and the carotenoid absorption and cleavage pathways. Among the 25 mutated genes, 13 genes had a phenotype in both the F0 and F2 generations. None of F1 heterozygotes had phenotype. By comparing the color pattern of our mutants with that of red tilapia (Oreochromis spp), a natural mutant produced during hybridization of tilapia species, we found that the pigmentation of the body and eye is controlled by different genes. Previously studied genes like mitf, kita/kitlga, pmel, tyrb, hps4, gch2, csf1ra, pax7b, and bco2b were proved to be of great significance for color patterning in tilapia. Our results suggested that tilapia, a fish with 4 types of pigment cells and a vertically barred wild-type color pattern, together with various natural and artificially induced color gene mutants, can serve as an excellent model system for study color patterning in vertebrates.
A rare case of gallstone ileus—the unanswered question
Authors: Tsang Chi Fai
Published: April 2021

Gallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis and found in 2–3% of all cases associated with recurrent episodes of cholecystitis. This case study demonstrates an atypical presentation of gallstone ileus. A 57-year-old woman was presented with abdominal pain and vomiting without previous history of gallstone disease. The features of gallstone ileus are evident on computed tomography. She underwent an emergency laparotomy and enterotomy for the removal of impacting gallstones, followed by an interval cholecystectomy and cholecystoduodenal fistula closure. This case report aims to explore the proper surgical management of gallstone ileus. Unfortunately, the question of whether interval biliary surgery should be performed remains unanswered, and surgeons will continue to make the decision based on their clinical judgement.
Transfer- or ‘transmission’-RNA fragments? The roles of tsRNAs in the reproductive system
Authors: Li Hui-Min , Tan Xia , Zhang Shun , Yao Jun , Li Hong-Gang
Published: April 2021

Transfer-RNAs (tRNAs) help ribosomes decode mRNAs and synthesize proteins; however, tRNA fragments produced under certain conditions, known as tRNA-derived small RNAs (tsRNAs), have been found to play important roles in pathophysiological processes. In the reproductive system, tsRNAs are abundant in gametes and embryos and at the maternal–fetal interface, as well as in microvesicles like epididymosomes, seminal plasma exosomes, and syncytiotrophoblast-derived extracellular vesicles. tsRNAs can affect gamete cell maturation, zygote activation, and early embryonic development. tsRNAs can transmit epigenetic information to later generations. In particular, exposure to environmental factors such as nutrition, isoproterenol, and poly(I:C) may allow tsRNAs to transfer information to the gametes or placenta to alter offspring phenotype. The underlying mechanisms of tsRNAs action include transposon silencing, translation regulation, and target mRNA degradation. Herein, we review the currently reported tsRNAs in the reproductive system, their validated functions, and potential roles. A better understanding of this field may help to provide useful recommendations or develop strategies to increase fertility and conception of healthy babies.
Endonuclease enrichment TAPS for cost-effective genome-wide base-resolution DNA methylation detection
Authors: Cheng Jingfei , Siejka-Zielińska Paulina , Liu Yibin , Chandran Anandhakumar , Kriaucionis Skirmantas , Song Chun-Xiao
Published: April 2021

Whole genome base-resolution methylome sequencing allows for the most comprehensive analysis of DNA methylation, however, the considerable sequencing cost often limits its applications. While reduced representation sequencing can be an affordable alternative, over 80% of CpGs in the genome are not covered. Building on our recently developed TET-assisted pyridine borane sequencing (TAPS) method, we here described endonuclease enrichment TAPS (eeTAPS), which utilizes dihydrouracil (DHU)-cleaving endonuclease digestion of TAPS-converted DNA to enrich methylated CpG sites (mCpGs). eeTAPS can accurately detect 87% of mCpGs in the mouse genome with a sequencing depth equivalent to 4× whole genome sequencing. In comparison, reduced representation TAPS (rrTAPS) detected less than 4% of mCpGs with 2.5× sequencing depth. Our results demonstrate eeTAPS to be a new strategy for cost-effective genome-wide methylation analysis at single-CpG resolution that can fill the gap between whole-genome and reduced representation sequencing.
Tumor Growth Rate as a New Predictor of Progression-Free Survival After Chordoma Surgery
Authors: Passeri Thibault , di Russo Paolo , Champagne Pierre-Olivier , Bernat Anne-Laure , Cartailler Jérome , Guichard Jean Pierre , Mammar Hamid , Giammattei Lorenzo , Adle-Biassette Homa , George Bernard , Mandonnet Emmanuel , Froelich Sébastien
Published: April 2021

BACKGROUND

Currently, different postoperative predictors of chordoma recurrence have been identified. Tumor growth rate (TGR) is an image-based calculation that provides quantitative information of tumor's volume changing over time and has been shown to predict progression-free survival (PFS) in other tumor types.

OBJECTIVE

To explore the usefulness of TGR as a new preoperative radiological marker for chordoma recurrence.

METHODS

A retrospective single-institution study was carried out including patients reflecting these criteria: confirmed diagnosis of chordoma on pathological analysis, no history of previous radiation, and at least 2 preoperative thin-slice magnetic resonance images available to measure TGR. TGR was calculated for all patients, showing the percentage change in tumor size over 1 mo.

RESULTS

A total of 32 patients were retained for analysis. Patients with a TGR ≥ 10.12%/m had a statistically significantly lower mean PFS (P < .0001). TGR ≥ 10.12%/m (odds ratio = 26, P = .001) was observed more frequently in recurrent chordoma. In a subgroup analysis, we found that the association of Ki-67 labeling index ≥ 6% and TGR ≥ 10.12%/m was correlated with recurrence (P = .0008).

CONCLUSION

TGR may be considered as a preoperative radiological indicator of tumor proliferation and seems to preoperatively identify more aggressive tumors with a higher tendency to recur. Our findings suggest that the therapeutic strategy and clinical-radiological follow-up of patients with chordoma can be adapted also according to this new parameter.
Allometry and the calculation of zooplankton metabolism in the subarctic Northeast Pacific Ocean
Authors: Maas Amy E , Miccoli Andrea , Stamieszkin Karen , Carlson Craig A , Steinberg Deborah K
Published: April 2021

Using measurements of respiration and dissolved organic carbon (DOC) excretion from the subarctic Northeast Pacific Ocean (August 2018), we explore the efficacy of pre-existing allometric relationships to predict metabolic rates of diel vertically migrating zooplankton, and to test taxon-specific influences on these calculations at our study site. Non-taxon-specific allometric equations were associated with our best predictive model, and they underestimated measured respiratory values by ~10%. The best prediction of DOC release from estimates of biomass used taxon-specific coefficients and overestimated DOC production by 12%. There is a distinct allometric relationship for DOC excretion that varies between taxa, and slightly higher DOC production in more carnivorous groups. This study provides uncertainty estimates for zooplankton active flux analyses in the region, and identifies important research directions for allometry in biogeochemical studies.
Gendered Prices
Authors: Adams Renée B , Kräussl Roman , Navone Marco , Verwijmeren Patrick
Published: April 2021

We provide evidence that culture is a source of pricing bias. In a sample of 1.9 million auction transactions in 49 countries, paintings by female artists sell at an unconditional discount of 42.1%. The gender discount increases with measures of country-level gender inequality—even in artist fixed effects regressions. Our results are robust to accounting for potential gender differences in art characteristics and their liquidity. Evidence from two experiments supports the argument that women’s art may sell for less because it is made by women. However, the gender discount reduces over time as gender equality increases.
Returning to Growth: One Academic Medical Center’s Successful Five-Step Approach to Change Management
Authors: Vickers Selwyn M. , Agarwal Anupam , Patel Nisha , Benveniste Etty N. , Bulgarella Dawn , Fouad Mona N. , Hoesley Craig , Jones Keith , Kimberly Robert P. , Rogers David A. , Larson Jean Ann , Leeth Toni R. , Mack LaKisha , Dorman Paige , Furgerson Tyler , Longshore Jane , Watts Ray L.
Published: April 2021

The University of Alabama at Birmingham academic medical center (UAB AMC) had achieved great success and growth during the 50 years since its founding. However, the challenging and more competitive environment of the 2000s left the UAB AMC on a downward trajectory. The UAB AMC had to overcome difficult internal cultural and structural barriers that stood in the way of the transformational change needed to remain competitive. Competition rather than collaborative and strategic financial investment were the primary cultural barriers for the UAB AMC, while people were the primary structural barrier. Leadership identified 5 steps that were critical for the transformation that occurred between 2013 and 2018: alignment of leadership; creating a compelling and credible shared vision; identifying cultural and structural barriers; creating a thoughtful, data-driven intervention; and improved communication and accountability. Following these steps enabled the UAB AMC to transform its institutional structure and culture. As a result, the UAB AMC thrived, returning to substantial growth in research and clinical care. UAB AMC School of Medicine grew by $100 million in National Institutes of Health funding and moved up 10 spots in ranking. In 2018, UAB Hospital had 10 specialties ranked by U.S. News & World Report, 7 more than in 2013. This article outlines the approach taken and provides a conceptual framework for other AMCs eager to transform their structure and culture and position themselves for growth.
Video Game Addiction Among Students During COVID-19 Pandemic Based on Regulatory Focus Theory and Interpersonal Competence
Authors: Nugraha Yudhi P. , Awalya Awalya , Mulawarman Mulawarman
Published: April 2021

Video game addiction is one of the mental health problems due to the uncontrolled activities in accessing video game platforms. This study aimed to identify the tendencies of video game addiction among Senior High School students based on the aspects of Regulatory Focus Theory and interpersonal competence. It implemented a quantitative descriptive model with a 2×2 factorial design. A total of 1046 students participated in the survey. The findings revealed the increasing video game addiction cases among the students during the COVID-19 pandemic. The students with a high promotion focus and a high interpersonal competence as well as those with a low prevention focus and a low interpersonal competence tended to experience video game addiction.
Trends in Incidence of Adolescent Idiopathic Scoliosis: A Modern US Population-based Study
Authors: Thomas Joshua J. , Stans Anthony A. , Milbrandt Todd A. , Kremers Hilal M. , Shaughnessy William J. , Larson A. Noelle
Published: April 2021

Background:

A successful disease screening strategy requires a high incidence of the condition, efficacy of early treatment, and efficient detection. There is limited population-based data describing trends in incidence of adolescent idiopathic scoliosis (AIS) in the United States and potential role of school screening programs on the incidence of AIS. Thus, we sought to evaluate the incidence of AIS over a 20-year period between 1994 and 2013 using a population-based cohort.

Methods:

The study population comprised 1782 adolescents (aged 10 to 18 y) with AIS first diagnosed between January 1, 1994 and December 31, 2013. The complete medical records and radiographs were reviewed to confirm diagnosis and coronal Cobb angles at first diagnosis. Age-specific and sex-specific incidence rates were calculated and adjusted to the 2010 United States population. Poisson regression analyses were performed to examine incidence trends by age, sex, and calendar period.

Results:

The overall age-adjusted and sex-adjusted annual incidence of AIS was 522.5 [95% confidence interval (CI): 498.2, 546.8] per 100,000 person-years. Incidence was about 2-fold higher in females than in males (732.3 vs. 338.8/100,000, P<0.05). The incidence of newly diagnosed AIS cases with radiographs showing a Cobb angle >10 degrees was 181.7 (95% CI: 167.5, 196.0) per 100,000 person-years. The overall incidence of AIS decreased significantly after discontinuation of school screening in 2004 (P<0.001). The incidence of bracing and surgery at initial diagnosis was 16.6 (95% CI: 12.3, 20.9) and 2.0 (95% CI: 0.5, 3.4) per 100,000 person-years, respectively.

Conclusions:

Overall population-based incidence of AIS decreased after school screening was discontinued. However, incidence of patients with a Cobb angle >10 degrees, initiation of bracing and surgery did not change significantly over time. This provides further data to help determine the role of scoliosis screening.

Level of Evidence:

Level III.
Mental Health Interventions to Improve Psychological Outcomes in Informal Caregivers of Critically Ill Patients: A Systematic Review and Meta-Analysis*
Authors: Cherak Stephana J. , Rosgen Brianna K. , Amarbayan Mungunzul , Wollny Krista , Doig Christopher J. , Patten Scott B. , Stelfox Henry T. , Fiest Kirsten M.
Published: April 2021

OBJECTIVES:

Determine effect of mental health interventions on psychologic outcomes in informal caregivers of critically ill patients.

DATA SOURCES:

Searches conducted in MEDLINE, Embase, and other databases from inception to October 31, 2019.

STUDY SELECTION:

Interventions for informal caregivers of critically ill patients in adult ICU, PICU, or neonatal ICU.

DATA EXTRACTION:

Two independent, blinded reviewers screened citations and extracted data. Random-effects models with inverse variance weighting pooled outcome data when suitable. Psychologic outcomes categorized: 1) negative (anxiety, depression, post-traumatic stress disorder, distress, and burden) or 2) positive (courage, humanity, justice, transcendence, temperance, and wisdom and knowledge). Stratification according to intervention type and patient population was performed.

DATA SYNTHESIS:

Of 11,201 studies, 102 interventional trials were included (n = 12,676 informal caregivers). Interventions targeted caregiver experience (n = 58), role (n = 6), or support (n = 38). Meta-analysis (56 randomized controlled trials; n = 22 [39%] in adult ICUs; n = 34 [61%] in neonatal ICU or PICU) demonstrated reduced anxiety (ratio of means = 0.92; 95% CI, 0.87–0.97) and depression (ratio of means = 0.83; 95% CI, 0.69–0.99), but not post-traumatic stress disorder (ratio of means = 0.91; 95% CI, 0.80–1.04) or distress (ratio of means = 1.01; 95% CI, 0.95–1.07) among informal caregivers randomized to mental health interventions compared with controls within 3 months post-ICU discharge. Increased humanity (ratio of means = 1.11; 95% CI, 1.07–1.15), transcendence (ratio of means = 1.11; 95% CI, 1.07–1.15), and caregiver burden (ratio of means = 1.08; 95% CI, 1.05–1.12) were observed. No significant effects of mental health interventions observed after 3 months postdischarge.

CONCLUSIONS:

Mental health interventions for caregivers of critically ill patients improved short-term anxiety, depression, humanity, and transcendence while increasing burden. Clinicians should consider short-term prescriptions of mental health interventions to informal caregivers of critically ill patients with capacity to manage interventions.
Depression and Long-Term Survival Among South Korean Sepsis Survivors: A Nationwide Cohort Study From 2011 to 2014
Authors: Oh Tak Kyu , Park Hye Youn , Song In-Ae
Published: April 2021

OBJECTIVES:

We investigated the prevalence of pre- and postsepsis depression and examined the association between diagnosis of pre- and postsepsis depression and 5-year all-cause mortality among survivors of sepsis.

DESIGN:

A population-based cohort study.

SETTING:

Data were obtained from the National Health Insurance Service database in South Korea.

PATIENTS:

Sepsis survivors were defined as those who were admitted with a main diagnosis of sepsis or septic shock and had survived for over 365 days.

MEASUREMENTS AND MAIN RESULTS:

Sepsis survivors who were diagnosed with depression before sepsis were defined as the presepsis depression group, whereas those who had no history of depression but were newly diagnosed with depression within 1 year of diagnosis of sepsis were defined as the postsepsis depression group. All other participants comprised the control group. A total of 45,826 sepsis survivors were included in the final analysis. Among the survivors, 1,105 (2.4%) were in the postsepsis depression group, whereas 9,626 (21.0%) were in the presepsis depression group. The 5-year all-cause mortality rate in the pre- and postsepsis depression group was 44.1% and 46.2%, whereas that in the control group was 30.4%. Multivariable Cox regression modeling revealed that the risk of 5-year all-cause mortality rate in the postsepsis depression group was 1.29-fold (hazard ratio = 1.29; 95% CI = 1.18–1.41; p < 0.001) higher than that of the control group, whereas the presepsis depression group was not significantly associated with 5-year all-cause mortality (p = 0.509).

CONCLUSIONS:

Among sepsis survivors in South Korea, 2.4%% were newly diagnosed with depression within 1 year after their sepsis diagnosis. In addition, postsepsis depression was independently associated with higher 5-year all-cause mortality among sepsis survivors. Our results suggest that patients with a history of sepsis and associated depression may be a high-risk group that interventions may be directed toward.
Predictors of the age at which natural menopause occurs in women with type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study
Authors: Yi Yan , El Khoudary Samar R. , Buchanich Jeanine M. , Miller Rachel G. , Rubinstein Debra , Orchard Trevor J. , Costacou Tina
Published: April 2021

Objective:

Women with type 1 diabetes (T1D) are thought to experience menopause earlier than women without diabetes, although not all studies agree. We assessed metabolic predictors of the age at which natural menopause occurs among women with T1D participating in the Epidemiology of Diabetes Complications study.

Methods:

Women with childhood-onset (<17 y) of T1D who underwent natural menopause without use of hormone therapy during their menopausal transition were included in the analysis (n = 105; mean baseline age, 29.5 and diabetes duration, 20.2 y). Self-reported reproductive history and the Women's Ischemia Syndrome Evaluation hormonal algorithms were used to determine menopause status. Linear regression was used to ascertain whether time-weighted metabolic factors (eg, BMI, lipids, HbA1c, insulin dose, albumin excretion rate [AER]) were associated with age at natural menopause.

Results:

Univariately, only insulin dose (β = −4.87, P = 0.04) and log (AER) (β = −0.62, P = 0.02) were associated (negatively) with age at natural menopause. Adjusting for BMI, smoking status, lipids, HbA1c, number of pregnancies, and oral contraceptive use, each 0.1 unit increase in the daily dose of insulin per kilogram body weight was associated with 0.64 years younger age at natural menopause (P = 0.01), while for every 30% increase in AER, age at natural menopause decreased by 0.18 years (P = 0.03).

Conclusion:

Higher average levels of insulin dose and AER over time were significantly associated with a younger age at which natural menopause occurred among women with T1D. The biologic mechanisms underlying the observed associations between exogenous insulin dose and AER on reproductive health should be investigated among women with T1D.
Stages of menopause and abnormal lung function: a cross-sectional study of middle-aged women
Authors: Hong Yun Soo , Park Hye Yun , Chang Yoosoo , Jang Eun Hee , Zhao Di , Kim Seolhye , Guallar Eliseo , Kim Hoon , Cho Juhee , Ryu Seungho
Published: April 2021

Objective:

Whether hormonal changes during menopausal transition postmenopause stages influence pulmonary function is not clearly understood. We evaluated the association between each stage of menopause and the prevalence of abnormal lung function in healthy middle-aged women. We hypothesized that the prevalence of abnormal lung function would increase from the late menopausal transition stage during menopausal transition postmenopause stages.

Methods:

The study population included women 40 to 65 years of age who underwent comprehensive health screening examination at the Kangbuk Samsung Hospital Total Healthcare Centers from January 2015 to December 2017. Stages of menopause (premenopausal, early menopausal transition, late menopausal transition, and postmenopausal) were defined using the 2011 Stages of Reproductive Aging Workshop (STRAW + 10) criteria. Abnormal lung function was defined based on spirometry as forced expiratory volume in 1 second/forced vital capacity less than70% or forced vital capacity less than 80% predicted. Prevalence ratios (PRs) for abnormal lung function by stages of menopause were estimated from logistic regression models adjusted for age, anthropometric measurements, lifestyle factors, medical history, lipid and inflammatory biomarkers, and reproductive factors.

Results:

Among 43,822 participants, there were 4,615 participants (10.5%) with restrictive ventilatory disorder and 653 participants (1.5%) with obstructive ventilatory disorder. The fully adjusted PRs (95% confidence interval) for abnormal ventilatory disorder comparing early menopausal transition, late menopausal transition, and postmenopausal stage to premenopausal stage were 1.01 (0.94-1.08), 1.13 (1.03-1.22), and 1.10 (0.98-1.22), respectively. The fully adjusted PRs for restrictive ventilatory disorder comparing early menopausal transition, late menopausal transition, and postmenopausal stages to premenopausal stage were 1.02 (0.94-1.11), 1.18 (1.06-1.30), and 1.15 (1.00-1.31), respectively. There was, however, no clear association between stages of menopause and obstructive ventilatory disorder.

Conclusions:

In this large study of middle-aged women, the fully adjusted prevalence of abnormal lung function, particularly that of restrictive ventilatory disorder, was higher in women in late menopausal transition and menopausal stages compared to women in premenopausal stage.
Restoring Facial Contour and Harmony Using Biphasic Calcium Phosphate Bioceramics
Authors: Moreira Filho Oromar , Wykrota Francisco H.L. , Lobo Sonja Ellen
Published: April 2021

Background:

The restoration of facial contour is one of the pillars for the treatment of facial disharmonies and deformities. Fat transplantation and fillers have been widely used to improve the positioning of soft tissues, which are, however, directly related to the conditions and positioning of the underlying bone tissue. Recontouring of the latter has been performed using osteotomies and several types of bone grafts or biomaterials, as inlay or onlay grafts/implants. Here, biphasic calcium phosphate bioceramics were applied in a series of cases, their long-term results are shown, and their advantages, discussed.

Methods:

A retrospective analysis of 20 patients, who were subjected to facial recontour with onlay implants of biphasic calcium phosphate bioceramics, is reported. Patients were seeking to improve facial harmony due to congenital deformities, trauma, tumor resection or signs of aging, and were followed for up to 16 years. Clinical data, radiographic images, and information regarding pain and other findings were retrieved from medical records.

Results:

Six patients were men and 14 were women. Their ages ranged from 19 to 64 years. Bioceramics were implanted under the periosteum through external or intraoral incisions. Some patients underwent combined procedures, such as rhinoplasties or facial lifting. None of the patients presented exacerbated inflammation or pain. One of them had infection in the intraoral incision, which was resolved with medication.

Conclusion:

All patients had improved facial contours following the use of bio-ceramics to augment bone tissue and presented stable results at long-term evaluation.
Targeted Peripheral Nerve Interface: Case Report with Literature Review
Authors: Bhashyam Abhiram R. , Liu Yusha , Kao Dennis S.
Published: April 2021

Nerve transection injuries can result in painful neuromas that adversely affect patient recovery. This is especially significant following amputation surgeries in the setting of prosthetic wear and function. Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface (RPNI) are 2 modern surgical techniques that provide neuromuscular targets for these transected nerve endings to reinnervate. These strategies have been previously shown to reduce phantom limb pain, residual limb pain, and neuroma-related pain.
1,2,7,11
Two recent articles described technical adaptations of combining targeted muscle reinnervation and RPNI to create a hybrid procedure.
3,12
In this article, we propose a different modification of targeted muscle reinnervation and RPNI, where the transected nerve stump is coapted to a recipient unit consisting of an intact distal nerve branch with its associated muscle graft. We called this recipient unit a targeted peripheral nerve interface because it contains a distal nerve branch for nerve coaptation and can guide axonal regeneration from the donor nerve to its target muscle graft. We theorize that targeted peripheral nerve interface may lead to more even distribution of regenerating axons with potentially less pain and stronger signals for prosthetic control when compared with standard RPNI.
IMPACT OF RESIDUAL SUBRETINAL FLUID VOLUMES ON TREATMENT OUTCOMES IN A SUBRETINAL FLUID–TOLERANT TREAT-AND-EXTEND REGIMEN
Authors: Grechenig Christoph , Reiter Gregor S. , Riedl Sophie , Arnold Jennifer , Guymer Robyn , Gerendas Bianca S. , Bogunović Hrvoje , Schmidt-Erfurth Ursula
Published: April 2021

Purpose:

To investigate associations between residual subretinal fluid (rSRF) volumes, quantified using artificial intelligence and treatment outcomes in a subretinal fluid (SRF)–tolerant treat-and-extend (T&E) regimen in neovascular age-related macular degeneration.

Methods:

Patients enrolled in the prospective, multicenter FLUID study randomized in an SRF-tolerant T&E regimen were examined by spectral-domain optical coherence tomography and tested for best-corrected visual acuity (BCVA). Intraretinal fluid and SRF volumes were quantified using artificial intelligence tools. In total, 375 visits of 98 patients were divided into subgroups: extended intervals despite rSRF and extended intervals without fluid. Associations between BCVA change, SRF volume, subgroups, and treatment intervals were estimated using linear mixed models.

Results:

In extended intervals despite rSRF, increased SRF was associated with reduced BCVA at the next visit in the central 1 mm (−0.138 letters per nL;P= 0.014) and 6 mm (−0.024 letters per nL;P= 0.049). A negative association between increased interval and BCVA change was found for rSRF in 1 mm and 6 mm (−0.250 and −0.233 letter per week interval, respectively; bothP< 0.001). Extended intervals despite rSRF had significantly higher SRF volumes in the central 6 mm at the following visit (P= 0.002).

Conclusion:

Artificial intelligence–based analysis of extended visits despite rSRF demonstrated increasing SRF volumes associated with BCVA loss at the consecutive visit. This negative association contributes to the understanding of rSRF volumes on treatment outcomes in neovascular age-related macular degeneration.
Radial EBUS-Guided Cryobiopsy of Peripheral Lung Lesions With Flexible Bronchoscopy Without Using Guide-Sheath
Authors: Goel Manoj K. , Kumar Ajay , Maitra Gargi , Singh Balkar , Ahlawat Sunita , Jain Priti , Garg Neeraj , Verma Radha Krishan
Published: April 2021

Background:

A guide-sheath (GS) is conventionally used as a conduit for biopsy forceps under the guidance of radial endobronchial ultrasound (REBUS) for sampling the peripheral pulmonary lesions (PPLs). As compared with forceps, the cryoprobe has the advantage of obtaining larger samples. There is a paucity of literature on the use of cryobiopsy for PPL. We evaluated the diagnostic yield and safety of the REBUS-guided cryobiopsy (REBUS-CB) without using GS for the diagnosis of PPL.

Methods:

We retrospectively analyzed the database of 126 patients with PPL between November 2015 and December 2019. The REBUS-CB was performed using a flexible bronchoscopy without GS. Multidisciplinary consensus diagnostic yield was determined and procedural complications were recorded.

Results:

The histopathologic diagnosis by REBUS-CB, which is the primary objective of the study was obtained in 99 (78.6%) of total 126 cases. Yield was significantly higher in central lesions as compared to adjacent lesions visualized by the REBUS probe (81.4% versus 53.8%, P=0.021) but not significantly different between large (≥30 mm) and small (<30 mm) lesions (81.6% versus 71.8%, P=0.214). The average largest diameter of biopsy specimens was 6.9 mm (range 1-12, SD 2.132). We witnessed moderate bleeding in 7 (5.6%) and post procedure hypoxic respiratory failure in 4 (3.2%) cases which could be managed without escalation of care.

Conclusion:

The REBUS-CB from peripheral lung lesions are feasible even without using GS and significantly large samples can be obtained.
Genomic analysis of pancreatic cancer reveals 3 molecular subtypes with different clinical outcomes
Authors: Hwang Ji Woong , Jang Soo Kyung , Lee Dong Jin
Published: April 2021

Pancreatic cancer has a very high mortality with a 5-year survival of <5%. The purpose of this study was to classify specific molecular subtypes associated with prognosis of pancreatic cancer using The Cancer Genome Atlas (TCGA) multiplatform genomic data.

Multiplatform genomic data (N = 178), including gene expression, copy number alteration, and somatic mutation data, were obtained from cancer browser (https://genome-cancer.ucsc.edu, cohort: TCGA Pancreatic Cancer). Clinical data including survival results were analyzed. We also used validation cohort (GSE50827) to confirm the robustness of these molecular subtypes in pancreatic cancer.

When we performed unsupervised clustering using TCGA gene expression data, we found three distinct molecular subtypes associated with different survival results. Copy number alteration and somatic mutation data showed different genomic patterns for these three subtypes. Ingenuity pathway analysis revealed that each subtype showed differentially altered pathways. Using each subtype-specific genes (200 were selected), we could predict molecular subtype in another cohort, confirming the robustness of these molecular subtypes of pancreatic cancer. Cox regression analysis revealed that molecular subtype is the only significant prognostic factor for pancreatic cancer (P = .042, 95% confidence interval 0.523–0.98).

Genomic analysis of pancreatic cancer revealed 3 distinct molecular subtypes associated with different survival results. Using these subtype-specific genes and prediction model, we could predict molecular subtype associated with prognosis of pancreatic cancer.
A giant Brunner gland hamartoma successfully treated by endoscopic excision followed by transanal retrieval
Authors: Maruo Motonobu , Tahara Tomomitsu , Inoue Fumihiro , Kasai Takeshi , Saito Natsuko , Aoi Kazunori , Takeo Masahiro , Sumimoto Kimi , Yamashina Masao , Murata Miki , Koyabu Masanori , Wakamatsu Takahiro , Yamashiki Noriyo , Nishio Akiyoshi , Okazaki Kazuichi , Naganuma Makoto
Published: April 2021

Rationale:

Brunner gland hamartoma (BGH) is a rare tumor of the duodenum. Although BGH is a benign tumor, larger lesion with gastrointestinal symptoms requires tumor removal. We report a giant BGH, successfully treated by endoscopic excision followed by transanal retrieval.

Patient concerns:

A 38-year-old woman complained of severe anemia, tarry stool, and vomiting.

Diagnoses:

Esophagogastroduodenoscopy (EGD) showed a pedunculated giant submucosal mass at the duodenal bulb.

Interventions:

We attempted to remove it because the lesion seemed to be responsible for patient's anemia and vomiting. The lesion had clear but bulky stalk. We carefully cut the stalk using needle-knife and IT knife2. We tried to retrieve specimen, but the mass could not pass through the pyloric ring because of its size. Then we tried to obtain the specimen from anus. Polyethylene glycol solution was administered to accelerate rapid excretion.

Outcomes:

The mass was successfully removed and was histologically confirmed as a giant BGH, measuring 55 mm in size.

Lessons:

Reports about endoscopic resection of giant BGH are rare. Moreover, our case is the first report of transanal retrieval of resected specimen using polyethylene glycol solution. Endoscopic resection of BGH is less-invasive but can be more challenging if the mass is large. Our case provides useful option for endoscopic treatment of giant BGH.
Effectiveness and safety of repetitive transcranial magnetic stimulation for the treatment of morphine dependence
Authors: Li Xin , Song Guang-fu , Yu Jia-nan , Ai Si-hui , Ji Qing , Peng Ying , Zhu Xiao-feng , Liu Ji-guang
Published: April 2021

Morphine dependence (MD) is a very common complication because of the chronic morphine consumption. Studies suggest that repetitive transcranial magnetic stimulation (rTMS) can be used for the treatment of MD. However, there is still lacking evidence to support rTMS for MD. Thus, this retrospective study aimed to investigate the effectiveness and safety of rTMS for patients with MD.

In this retrosepctive study, a total of 100 patients with MD were included, and they were divided into a rTMS group (n = 50), and a control group (n = 50). All patients in both groups received occupational therapy. In addition, patients in the rTMS group received rTMS. All patients in both groups received a total of 8 weeks treatment. The outcomes comprised of morphine craving intensity, depression, anxiety, and sleep quality, which were appraised by Visual Analogue Scale (VAS), Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI), respectively. In addition, treatment-related adverse events were also considered for assessment.

After 8 weeks treatment, patients in the rTMS group exerted better benefits in improving VAS (P < .01), SDS (P < .01), SAS (P < .01), and PSQI (P < .01), than patients in the control group. In addition, this study did not identify treatment-related adverse events in both groups.

The findings of this study showed that rTMS treatment showed promising effectiveness on patients with MD. However, future studies should focus on warranting the present findings.
Wrist-hand extension function recovery in spastic hemiplegia patient by botulinum toxin injection plus surface electromyography biofeedback therapy
Authors: Wu Zhang-xiang , Wang Chao , Huang Zheng , Liu Xue-han , Shen Mei
Published: April 2021

Rationale:

Wrist-hand extension function rehabilitation is a vital and difficult part of hand function recovery in spastic stroke patients. Although botulinum toxin type A (BoNTA) injection plus post injection therapy was applied to the wrist-hand rehabilitation in previous reports, conclusion was inconsistent in promoting function. For this phenomenon, proper selection of patients for BoNTA injection and correct choice of post-injection intervention could be the crucial factors for the function recovery.

Patient concerns:

We reported a 46-year-old male suffered a spastic hemiplegia with wrist- hand extension deficit.

Diagnoses:

Computed tomography showed cerebral hemorrhage in the left basal ganglia region.

Interventions:

Four hundred units of BoNTA were injected into the spasticity flexors, and four-week post injection surface electromyography (sEMG) biofeedback therapy was applied to the patient.

Outcomes:

The patient exhibited post-intervention improvement in wrist-hand extensors performance (strength, range of motion, sEMG signals), the flexors spasticity, and upper extremity function.

Lessons:

The present case showed that 4-week of BoNTA injection plus sEMG biofeedback exercise improved the performance and function of wrist-hand extensors in the patient for short- and long-term. Proper selection of patients for BoNTA injection and correct choice of post injection exercise could play a vital role in the hand rehabilitation for patient with spastic hemiplegia.