bluuebunny/crossref_metadata_2025 huggingface dataset:
241 Transcatheter aortic valve replacement in aortic stenosis and cardiac amyloidosis: a systematic review and meta-analysis
Authors: Cannata Francesco , Chiarito Mauro , Pinto Giuseppe , Villaschi Alessandro , Sanz-sanchez Jorge , Fazzari Fabio , Regazzoli Damiano , Mangieri Antonio , Bragato Renato M , Colombo Antonio , Reimers Bernhard , Condorelli Gianluigi , Stefanini Giulio G
Published: December 2021

Aims

Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical diseases of the elderly. Up to 16% of older adults with severe AS referred to transcatheter aortic valve replacement (TAVR) have a concomitant diagnosis of CA. CA-AS population suffers from reduced functional capacity and worse prognosis than AS patients. As the prognostic impact of TAVR in patients with CA-AS has been historically questioned and in light of recently published evidence, we aim to provide a comprehensive synthesis of the efficacy and safety of TAVR in CA-AS patients.

Methods

We performed a systematic review and meta-analysis of studies: 1) evaluating mortality with TAVR as compared to medical therapy in CA-AS patients, and 2) reporting complications and clinical outcomes of TAVR in CA-AS patients as compared to patients with AS alone.

Results

A total of 8 observational studies were identified, 4 of which reporting mortality with TAVR and 4 reporting complications and clinical outcomes after TAVR of patients with CA-AS compared with AS alone patients. In patients with CA-AS, the risk of mortality was lower with TAVR as compared to medical therapy (OR 0.23, 95% CI 0.07–0.73, I²=0%, P=0.001, number needed to treat=3). The safety profile of TAVR seems to be similar in patients with CA-AS as compared to those with AS alone, with comparable risks of stroke, vascular complications, life-threatening bleeding, acute kidney injury and 30-day mortality, although CA-AS was associated with a trend towards an increased risk of permanent pacemaker implantation (OR 1.93, 95% CI 0.91–4.09, I2=0%, P=0.085). CA is associated with a numerically higher rate of long-term mortality and rehospitalizations following TAVR in patients with CA-AS as compared to those with AS alone.

Conclusions

TAVR is an effective and safe procedure in CA-AS patients, with a substantial survival benefit as compared to medical therapy, and a safety profile comparable to patients with AS alone except for a trend towards higher risk of permanent pacemaker implantation.
218 Coronary artery disease in athletes: a case report
Authors: Colangelo Lidia , Colangelo Maria , Gareri Clarice
Published: December 2021

Aims

Despite the proven benefits of regular physical exercise, and although sportsmen are the paradigm of healthy individuals, the athletes population is not risk-free and can suffer severe clinical conditions including coronary artery disease (CAD) and sudden cardiac death (SCD). Identification of athletes with higher cardiovascular risk is a crucial goal of pre-participation screening.

Methods and results

In this report, we discuss the case of a 79-year-old male. He was a cyclist, who performed a visit to the sports doctor to have issued a certificate for competitive fitness. He was dyslipidaemic, hypertensive, diabetic, and he reported no symptoms. The patient’s ECG revealed an advanced second-degree atrioventricular block. For this reason, he was admitted to the emergency department and he underwent urgent coronary angiography and a temporary Pacemaker. Indeed, a diagnosis of bivasal coronary artery disease was made, and for the first time the patient was subjected to angioplasty of the anterior descending branch and circumflex branch. Subsequently, for the persistence of bradyarrhythmia, he was subjected to a definitive Pacemaker implant.

Conclusions

The benefits of exercise in the overall population are multiple and indisputable, but in athletes with cardiovascular disease exercise can also be associated with adverse clinical events, including SCD. In veterans, a growing group of athletes, CAD is the most common cause of SCD. Detection of subclinical CAD should be the main objective of veteran athlete screening, since the performance of classical cardiovascular risk stratification based on clinical factors appears to be suboptimal.
806 Scout post-PCI instantaneous wave-free ratio as a driver of functional complete
Authors: Calderone Dario , Mauro Maria Sara , Legnazzi Marco , Agnello Federica , Scalia Lorenzo , Greco Antonio , Capodanno Davide , Tamburino Corrado
Published: December 2021

Aims

Physiology assessment by means of instantaneous wave-free ratio (iFR) is non-inferior to fractional flow reserve for the assessment of intermediate coronary lesions that are candidates to percutaneous coronary intervention (PCI). However, in pivotal trials assessing iFR, tandem coronary lesions (i.e. two serial lesions located in the same coronary artery) were excluded. In addition, the role of iFR after PCI as a way to optimize its success is poorly understood, particularly in the context of ST-segment elevation myocardial infarction (STEMI) with multivessel disease and tandem stenoses. We describe an illustrative case of post-PCI iFR in a STEMI patient with multivessel disease that led to a significant change in the revascularization strategy.

Methods

A 71-year old man presented with infero-lateral STEMI and received PCI with 1 drug-eluting stent (DES) 2.25 × 18 mm on the distal right coronary artery. The left coronary artery presented a 30–40% stenosis of the proximal left circumflex (LCX) and a 90% bifurcation stenosis of the mid portion of the same artery. PCI of the distal lesion was performed with implantation of 1 DES 3.0 × 22 with flaring of the stent at the level of the side branch and proximal optimization technique. Post-PCI iFR of the LCX was performed to assess the success of the procedure, with a value of 0.74. To understand the relative contribution of the two tandem stenoses, a pullback of the iFR wire was performed, which showed an unexpectedly small jump of the pressure when the wire was between the two lesions (0.80).

Results

As such, the significant contribution of the proximal lesion was unravelled, which led to implantation of a second DES 4.0 × 26 mm, partially overlapping with the previously implanted DES. Post-PCI iFR confirmed the complete success of the procedure (1.00).

Conclusions

In the context of complete revascularization for STEMI presenting with non-infarct related artery tandem stenoses, post-PCI physiology contributes to unravel the relative contribution of low-grade angiographic stenoses corresponding to functionally significant atherosclerosis left untreated. This case example illustrates the emerging procedural value of post-PCI iFR in achieving the goal of complete functional revascularization.
807 Wellens syndrome: a rare entity not to underestimate
Authors: Calderone Dario , Mauro Maria Sara , Legnazzi Marco , Agnello Federica , Scalia Lorenzo , Greco Antonio , Capodanno Davide , Tamburino Corrado
Published: December 2021

Aims

Abrupt oppressive chest pain is a common reason of emergency department’s access. An accurate assessment of the clinical setting is needed to ensure the patient the correct management. This includes a good anamnesis, physical examination, electrocardiogram (ECG) and cardiac biomarkers evaluation. Wellens syndrome is a clinical entity characterized by acute chest pain, normal or minimal elevation of cardiac biomarker, specific ECG changes with no ST elevation or Q-waves. The ECG modifications contemplate: biphasic T waves in lead V2 and V3 (type A) initially positive and subsequent negative or deep and symmetrically inverted T waves in anterior leads (Type B, more often V1–V4). Recognizing these patterns can be so challenging for physician in emergency departments, especially in Type A, and failure in diagnosis can lead to deleterious outcomes. In fact, Wellens syndrome can be considered as a pre-infarction state that needs immediate intervention: if not treated appropriately, about 75% of patients can suffer anterior myocardial infarction due to a stenosis of left anterior descending (LAD) artery.

Methods

A 55-year-old male with hyperlipidaemia and a family history of cardiovascular disease, presented to emergency department with abrupt oppressive chest pain after mild physical effort. At presentation he presented a typical ECG of Wellens syndrome type A with negative cardiac biomarkers. His GRACE (Global Registry of Acute Coronary Events) score was 72 and his thrombolysis in myocardial infarction (TIMI) was 2. At second blood sample cardiac biomarkers was mildly higher than upper limit of normal.

Results

Despite low grade on risk stratification he immediately underwent coronary angiography, who resulted in a subocclusive stenosis from ostium to the medium tract of LAD. PCI was subsequently taken with implantation of TWO drug eluting stent (DES). After 3 days he was discharged asymptomatic and in optical medical therapy.

Conclusions

Wellens syndrome is a rare clinical entity that must be considered as a pre- infarction state difficult to individuate. Conventional management in these patients utilizing typical risk stratification scores may not be appropriate. In this context an early diagnosis of ECG patterns it’s crucial, in order to provide an urgent percutaneous intervention. Failure in recognition of signs and symptoms of Wellens syndrome can lead to disastrous outcome due to a critical, vulnerable, stenosis on proxymal LAD and to a possible imminent large anterior myocardial infarction.
Effect of Test Portion Mass on Vitamin A Testing in Animal Feed Materials
Authors: Inerowicz H Dorota , Novotny Lawrence , Ramsey Charles A , Riter Ken L , Swarbrick Michele , Thiex Nancy
Published: December 2021

Background

Vitamin A test results have historically been notorious for poor repeatability and reproducibility. This problem has been discussed at length in Association of American Feed Control Officials Laboratory Methods and Services Committee meetings.

Objective

The objective of this work was to assess the effect of test portion mass on the repeatability of vitamin A test results.

Methods

The study was conducted in two parts. In Part I, fundamental sampling error (FSE) was determined experimentally through replicated (n = 16) vitamin A testing of three animal feed materials. The testing followed rigorous test portion selection for 10 g and 100 g test portions. In Part II, FSE calculations were made (1) using theoretical equations based on vitamin A as a liberated analyte and (2) on representing the particles in feed materials. Particle size characterization of vitamin A ingredients was estimated by microscopy and further evaluated by particle size analysis.

Results

RSDs, % for vitamin A determinations ranged from 10.5–24.7, and 2.26–10.7 for 10 g and 100 g test portions, respectively. FSE calculated for Ingredient A ranged from 18.3–101% and 5.79–32.0% for 10 g and 100 g test portions, respectively, and for Ingredient B, ranged from 10.2–56.2% and 3.21–17.8% for 10 g and 100 g test portions, respectively.

Conclusion

Test portion mass has a substantial impact on FSE and is an important factor in controlling the random error in vitamin A testing. FSE equations are useful to approximate minimum test portion mass.

Highlights

Vitamin A method development should use theoretical predictions and experimental verification to guide test portion mass. Strategies to deal with the larger test portion masses will be key to validating new methods.
Prenatal diagnosis of rapidly enlarging choledochal cyst with gastric outlet obstruction
Authors: Scalise P Nina , Yang Alex , Neumeyer Corinne , Perez-Atayde Antonio R , Robinson Jamie R , Kim Heung Bae , Cuenca Alex G
Published: December 2021

Choledochal cysts are congenital malformations of the biliary tract that involve aberrant configurations of the pancreaticobiliary ductal system. The pathology exists on a spectrum from fusiform dilation of the common bile duct to multiple dilations involving the intra- and extrahepatic bile ducts with potential risks of malignant transformation and hepatic fibrosis. Advancements in ultrasound technology have increased the incidence of prenatal diagnosis of choledochal cysts. Here, we present the case of a prenatally diagnosed initially asymptomatic Type I choledochal cyst with rapid progression in the neonatal period to a complete gastric outlet obstruction within the first month of life. We demonstrate the feasibility of cyst resection and reconstruction with Roux-en-Y hepaticojejunostomy in the neonatal age group. Finally, we discuss management of the case based on evolving imaging findings and laboratory evidence of impending liver dysfunction.
Contemporary Ashkenazic Hebrew: The Grammatical Profile of an Overlooked Twenty-First-Century Variety
Authors: Kahn Lily , Yampolskaya Sonya
Published: December 2021

Ashkenazic Hebrew is a unique language variety with a centuries-long history of written use among Central and Eastern European Jews. It has distinct phonological and grammatical features attested in texts composed by Ashkenazic Jews (e.g. adherents of the Hasidic and Maskilic movements) in Europe prior to the twentieth century. While Ashkenazic Hebrew is commonly believed to have been replaced by Israeli Hebrew in the twentieth century, this traditional written variety of the language actually continues to thrive in contemporary Diaspora Haredi (strictly Orthodox) communities, chiefly the Hasidic centres of New York, London, Montreal and Antwerp. This fascinating and understudied form of Hebrew is used widely and productively in the composition of a rich variety of original documents for a Hasidic audience (about e.g. Covid transmission, United States educational stipulations, Zoom schooling, lockdown rules, etc.). In this article we demonstrate that contemporary Ashkenazic Hebrew has many shared orthographic, phonological, grammatical and lexical features with its Eastern European antecedent. These include: orthography of loanwords based on Yiddish conventions (e.g. חולי הקאראנא xóylay ha-koróna ‘those ill with coronavirus’); morphology of plural loan nouns (בקאלידזשעס be-kóleǧes‘in colleges’, הפראגראמע״ן haprográmen ‘the programmes’); retention of the definite article with inseparable prepositions (בהשכונה be-ha-šxíne‘in the neighbourhood’);
Differentiating Negligent Standards of Care in Diagnosis
Authors: Liddell Kathleen , Skopek Jeffrey M , Le Gallez Isabelle , Fritz Zoë
Published: December 2021

Diagnosis lies at the heart of the medical encounter, yet it has received much less attention than treatment. It is widely assumed that negligent diagnosis claims should be governed by the Bolam test, but we demonstrate that this is not always the case. First, we disaggregate the diagnostic process into three different acts: forming the diagnosis, communicating it to the patient, and recording it. Second, we consider alternatives to Bolam for defining negligence, including less deferential profession-led standards, patient-led standards, and even a reasonable person standard. Third, bringing together these distinctions—within the diagnostic process, and between standards of care—we reveal the unappreciated complexity of negligent diagnosis. Analysing the standard of care that might apply to the three different acts in the diagnostic process, we identify reasons to think that Montgomery should apply to the communication of a diagnosis. We also argue that even in areas where the law is well-established, such as the application of Bolam to the formation of a diagnosis, challenging questions arise that require further attention. Throughout, the framework and analysis that we develop have significant implications for a set of negligence cases, as well as for medical education, clinical guidelines, and patient care.
Bipartite interaction sites differentially modulate RNA-binding affinity of a protein complex essential for germline stem cell self-renewal
Authors: Qiu Chen , Wine Robert N , Campbell Zachary T , Hall Traci M Tanaka
Published: December 2021

In C. elegans, PUF proteins promote germline stem cell self-renewal. Their functions hinge on partnerships with two proteins that are redundantly required for stem cell maintenance. Here we focus on understanding how the essential partner protein, LST-1, modulates mRNA regulation by the PUF protein, FBF-2. LST-1 contains two nonidentical sites of interaction with FBF-2, LST-1 A and B. Our crystal structures of complexes of FBF-2, LST-1 A, and RNA visualize how FBF-2 associates with LST-1 A versus LST-1 B. One commonality is that FBF-2 contacts the conserved lysine and leucine side chains in the KxxL motifs in LST-1 A and B. A key difference is that FBF-2 forms unique contacts with regions N- and C-terminal to the KxxL motif. Consequently, LST-1 A does not modulate the RNA-binding affinity of FBF-2, whereas LST-1 B decreases RNA-binding affinity of FBF-2. The N-terminal region of LST-1 B, which binds near the 5′ end of RNA elements, is essential to modulate FBF-2 RNA-binding affinity, while the C-terminal residues of LST-1 B contribute strong binding affinity to FBF-2. We conclude that LST-1 has the potential to impact which mRNAs are regulated depending on the precise nature of engagement through its functionally distinct FBF binding sites.
Patients’ Experiences With Staphylococcus aureus and Gram-Negative Bacterial Bloodstream Infections: Results From Cognitive Interviews to Inform Assessment of Health-Related Quality of Life
Authors: King Heather A , Doernberg Sarah B , Grover Kiran , Miller Julie , Oakes Megan , Wang Tsai-Wei , McFatrich Molly , Ruffin Felicia , Staman Karen , Lane Hannah G , Rader Abigail , Sund Zoë , Bosworth Hayden B , Reeve Bryce B , Fowler Vance G , Holland Thomas L
Published: December 2021

Background

We previously conducted a concept elicitation study on the impact of Staphylococcus aureus and gram-negative bacterial bloodstream infections (SAB/GNB) on health-related quality of life (HRQoL) from the patient’s perspective and found significant impacts on HRQoL, particularly in the physical and functional domains. Using this information and following guidance on the development of patient-reported outcome (PRO) measures, we determined which combination of measures and items (ie, specific questions) would be most appropriate in a survey assessing HRQoL in bloodstream infections.

Methods

We selected a variety of measures/items from the Patient-Reported Outcomes Measurement Information System (PROMIS) representing different domains. We purposefully sampled patients ~6–12 weeks post-SAB/GNB and conducted 2 rounds of cognitive interviews to refine the survey by exploring patients’ understanding of items and answer selection as well as relevance for capturing HRQoL.

Results

We interviewed 17 SAB/GNB patients. Based on the first round of cognitive interviews (n = 10), we revised the survey. After round 2 of cognitive interviewing (n = 7), we finalized the survey to include 10 different PROMIS short forms/measures of the most salient HRQoL domains and 2 adapted questions (41 items total) that were found to adequately capture HRQoL.

Conclusions

We developed a survey from well-established PRO measures that captures what matters most to SAB/GNB patients as they recover. This survey, uniquely tailored to bloodstream infections, can be used to assess these meaningful, important HRQoL outcomes in clinical trials and in patient care. Engaging patients is crucial to developing treatments for bloodstream infections.
The Senior Medical Resident’s New Role in Assessment in Internal Medicine
Authors: Rassos James , Ginsburg Shiphra , Stalmeijer Renée E. , Melvin Lindsay J.
Published: December 2021

Purpose

With the introduction of competency-based medical education, senior residents have taken on a new, formalized role of completing assessments of their junior colleagues. However, no prior studies have explored the role of near-peer assessment within the context of entrustable professional activities (EPAs) and competency-based medical education. This study explored internal medicine residents’ perceptions of near-peer feedback and assessment in the context of EPAs.

Method

Semistructured interviews were conducted from September 2019 to March 2020 with 16 internal medicine residents (8 first-year residents and 8 second- and third-year residents) at the University of Toronto, Toronto, Ontario, Canada. Interviews were conducted and coded iteratively within a constructivist grounded theory approach until sufficiency was reached.

Results

Senior residents noted a tension in their dual roles of coach and assessor when completing EPAs. Senior residents managed the relationship with junior residents to not upset the learner and potentially harm the team dynamic, leading to the documentation of often inflated EPA ratings. Junior residents found senior residents to be credible providers of feedback; however, they were reticent to find senior residents credible as assessors.

Conclusions

Although EPAs have formalized moments of feedback, senior residents struggled to include constructive feedback comments, all while knowing the assessment decisions may inform the overall summative decision of their peers. As a result, EPA ratings were often inflated. The utility of having senior residents serve as assessors needs to be reexamined because there is concern that this new role has taken away the benefits of having a senior resident act solely as a coach.
Understanding Health Care Graduates’ Conceptualizations of Transitions: A Longitudinal Qualitative Research Study
Authors: Rees Charlotte E. , Ottrey Ella , Kemp Caitlin , Brock Tina P. , Leech Michelle , Lyons Kayley , Monrouxe Lynn V. , Morphet Julia , Palermo Claire
Published: December 2021

Purpose

Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners’ conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa.

Method

The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally.

Results

The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2).

Conclusions

This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders’ transition conceptualizations over lengthier durations beyond the new graduate transition.
An Analysis of the Use of the Terms Sex and Gender in Research Reported in Nursing Journals
Authors: Blakeman John R. , Fillman Valentina M.
Published: December 2021

Accurately measuring and reporting the demographic characteristics of research participants are imperative to provide consumers of research with an understanding of who was included in a study. While researchers often, incorrectly, use the variables sex and gender interchangeably, these 2 variables are different. We conducted a content analysis of 239 randomly selected research articles, with the purpose of describing how researchers have used sex and gender in studies published in nursing journals and identifying opportunities for improved clarity and precision in measuring these 2 variables. We found that significant improvement is needed in the way these variables are used/reported.
An Exploratory Study of Social Media Use and Management by Nursing Journals
Authors: Dunlap Jayne Jennings , Waldrop Julee
Published: December 2021

Social media applications are growing across the globe to bring new knowledge and information to target audiences. The use and management of social media in nursing journals have yet to be investigated on a large scale. This cross-sectional study was the first to explore the management of social media and the role of social media editors at nursing journals. Seventy-five nursing journals have pioneered social media as platforms for knowledge dissemination. Almost 51% of nursing journals from this sample are now using social media editors or a designated person to manage online applications, promote journal contents, and increase journal reach.
Redefining Cheating on Written Exams
Authors: Killam Laura A. , Luctkar-Flude Marian , Brune Sara , Camargo-Plazas Pilar
Published: December 2021

Educators who recognize the value of authentic written exams for promoting student critical thinking may struggle with concerns about cheating. In this article, we explore how educators may use open-web take-home exams to help students develop integrity and evidence-based practice skills. Lang's theory is used to explore why students may cheat. We discuss the importance of caring assessment practices by drawing on critical caring pedagogy and universal design for learning. Throughout the discussion, we illustrate how authentic questions and instruction that is focused on dialogue, collaboration, and resource use may reduce cheating possibilities while improving student learning.
Dysbiosis of Ocular Surface Microbiota in Patients With Refractive Allergic Conjunctival Diseases
Authors: Inada Noriko , Shoji Jun , Harata Gaku , Miyazawa Kenji , He Fang , Tomioka Akiko , Hirota Akira , Tonozuka Yukiko , Yamagami Satoru
Published: December 2021

Purpose:

We investigated ocular surface microbiota dysbiosis in patients with refractory allergic conjunctival diseases (ACDs; stratified into mild and severe groups) treated with topical tacrolimus.

Methods:

Patients (n = 21) with refractory ACDs (including vernal and atopic keratoconjunctivitis) actively treated with topical tacrolimus and 6 healthy controls were evaluated. Based on clinical scores and expression of specific cytokines on the ocular surface, patients with ACDs were divided into mild and severe groups using cluster analysis. The microbial composition of tear specimens collected from patients with mild and severe ACD and control subjects using the Schirmer test paper was determined through next-generation 16S rRNA sequencing analysis.

Results:

Compared with healthy controls, patients with ACDs exhibited significantly decreased ocular surface microbiota α-diversity. Ocular surface microbiota mainly comprised members of the phyla Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria in all groups. The relative abundance of ocular surface microbiota in patients with ACDs was increased for phylum Firmicutes and decreased for phylum Proteobacteria (compared with control subjects). The genera Blautia (vs. mild ACD group) and Morganella (vs. control group) exhibited significantly increased abundance only in the severe ACD group.

Conclusions:

The ocular surface microbiota in patients with severe ACD exhibited decreased diversity and exacerbation of dysbiosis compared with that in patients with mild ACD and control subjects. Patients with mild refractory ACD also exhibited decreased diversity of these microbiota. These alterations in microbiota indicated a change in the ocular surface of patients with refractory ACD (be it because of disease pathogenesis or topical immunomodulatory treatment).
Occupational Heat Exposure as a Risk Factor for End-Stage Kidney Disease
Authors: Doueihy Celina , Chelala Dania , Ossaili Hadi , Hachem Gebrael El , Zeidan Sandy , Ghoul Balsam El , Aoun Mabel
Published: December 2021

Objective:

More patients are reaching end-stage kidney disease without evident cause. This study aims to explore occupational risk factors associated with hemodialysis.

Methods:

A multicenter matched case–control study included dialysis patients and age, sex, and diabetes-matched controls (normal kidney function). Conditional logistic regression analysis assessed occupational factors associated with dialysis.

Results:

Two hundred thirty eight hemodialysis patients and 238 controls were included. History of occupational heat exposure (odds ratio [OR] = 1.93; 95% confidence interval [CI]: 1.24 to 3.00), working as a cook (OR = 12; 95% CI: 1.56 to 92.29), as construction worker (OR = 10; 95% CI: 1.28 to 78.12) were associated with higher risk of dialysis. These results were significant in men and in those with kidney disease of unknown etiology.

Conclusions:

Occupational heat exposure was found to be associated with hemodialysis. This is an important step for future development of preventive strategies in high-risk professions.
Kidney transplant program specific reporting and transplant metrics
Authors: Andreoni Kenneth A.
Published: December 2021

Purpose of review

Kidney transplantation is a heavily regulated medical procedure with the Secretary of HHS ultimately responsible for oversight and authority derived from the NOTA and the Final Rule. Transplant Programs undergo publicly reported evaluations every 6 months based on outcomes from a 2-and-a-half-year period. The current Bayesian metrics for kidney transplant programs were created such that over ten percentage of programs are deemed underperformers, or ‘flag’, every 6 months. Newly suggested transplant metrics have been released for public comment in Summer 2021. In addition to graft outcomes, waiting list mortality and organ acceptance rate ratios are proposed.

Recent findings

Under the newly proposed kidney transplant metrics, over 10% of programs are expected to be deemed underperformers or ‘flagged’. Transplant Center flagging is well correlated with decreased transplantation due to the transplant centres move to more conservative organ and patient acceptance. Death on the waiting list is a proposed metric over which transplant centres have little influence.

In the USA, the harsh regulation continued by Health Resources and Services Administration (HRSA) through the national organ procurement and transplant network (OPTN) and Scientific Registry for Transplant Recipients (SRTR) leads directly to high organ discard rates and limitations to transplanting patients with perceived unadjusted risks. Instead of loosening regulation in a highly functioning industry that achieves remarkable outcomes in end stage kidney patients, the OPTN with the SRTR persist in increasing potential penalties through more proposed metrics that continue to deem 10% of US kidney transplant programs as underperformers. HRSA must establish a reasonable regulatory environment that allows for innovation and increased transplant opportunities for US end-stage renal disease patients.
Bilateral vestibulopathy: the causes, diagnosis, and treatments
Authors: Kim Ji-Soo , Kim Hyo-Jung
Published: December 2021

Purpose of review

The current review covers recent advances in bilateral vestibulopathy (BVP) in terms of its etiology, diagnosis, and treatments.

Recent findings

The etiology of BVP depends on its clinical course and associated findings, and genetic abnormalities are increasingly recognized in isolated as well as complicated form of BVP. Recent developments in evaluation of the vestibular function have greatly enhanced the detection of BVP, and introduction of the consensus diagnostic criteria by Barany Society has facilitated research on BVP. Vestibular prosthesis may improve vestibular function, posture, gait and quality of life in patients with BVP and would expand the therapeutic options for BVP in near future.

Genetics is expanding its role in identifying the causes of BVP of hitherto unknown etiology. The detection and investigation of BVP have been greatly enhanced by introduction of consensus diagnostic criteria and recent developments in methodology evaluating the vestibular function. Vestibular prothesis appears promising in managing BVP.

Video abstract

http://links.lww.com/CONR/A59.
CLARITY: comparing heterogeneous data using dissimilarity
Authors: Lawson Daniel J. , Solanki Vinesh , Yanovich Igor , Dellert Johannes , Ruck Damian , Endicott Phillip
Published: December 2021

Integrating datasets from different disciplines is hard because the data are often qualitatively different in meaning, scale and reliability. When two datasets describe the same entities, many scientific questions can be phrased around whether the (dis)similarities between entities are conserved across such different data. Our method, CLARITY, quantifies consistency across datasets, identifies where inconsistencies arise and aids in their interpretation. We illustrate this using three diverse comparisons: gene methylation versus expression, evolution of language sounds versus word use, and country-level economic metrics versus cultural beliefs. The non-parametric approach is robust to noise and differences in scaling, and makes only weak assumptions about how the data were generated. It operates by decomposing similarities into two components: a ‘structural’ component analogous to a clustering, and an underlying ‘relationship’ between those structures. This allows a ‘structural comparison’ between two similarity matrices using their predictability from ‘structure’. Significance is assessed with the help of re-sampling appropriate for each dataset. The software, CLARITY, is available as an R package from
github.com/danjlawson/CLARITY
.
A new goniopholidid from the Upper Jurassic Morrison Formation, USA: novel insight into aquatic adaptation toward modern crocodylians
Authors: Yoshida Junki , Hori Atsushi , Kobayashi Yoshitsugu , Ryan Michael J. , Takakuwa Yuji , Hasegawa Yoshikazu
Published: December 2021

Goniopholididae is a group of basal neosuchian crocodyliforms closely related to Paralligatoridae and Eusuchia that lived during the Jurassic and Early Cretaceous. Goniopholidids have the long, flat snout and secondary palate of modern crocodylians, the acquisition of which is regarded as a key feature in the early evolution of crocodylian body plan and their aquatic adaptation. Here, we report a new species,Amphicotylus milesi, with the description from the best-preserved specimen to date of Goniopholididae from Wyoming, USA. Its posterior extension of the nasopharyngeal passage (pterygoid secondary palate) and the shortening and dorsal deflection of the ceratobranchial suggest that basal neosuchians could raise their gular valve to separate oral and pharyngeal cavities as in modern crocodylians. The anatomy ofAmphicotylus milesisheds light on the acquisition of this new respiratory system in the crocodyliform evolution and their early aquatic adaptation, leading to modern crocodylians.
Stalling interkinetic nuclear migration in curved pseudostratified epithelium of developing cochlea
Authors: Ishii Mamoru , Tateya Tomoko , Matsuda Michiyuki , Hirashima Tsuyoshi
Published: December 2021

The bending of epithelial tubes is a fundamental process in organ morphogenesis, driven by various multicellular behaviours. The cochlea in the mammalian inner ear is a representative example of spiral tissue architecture where the continuous bending of the duct is a fundamental component of its morphogenetic process. Although the cochlear duct morphogenesis has been studied by genetic approaches extensively, it is still unclear how the cochlear duct morphology is physically formed. Here, we report that nuclear behaviour changes are associated with the curvature of the pseudostratified epithelium during murine cochlear development. Two-photon live-cell imaging reveals that the nuclei shuttle between the luminal and basal edges of the cell is in phase with cell-cycle progression, known as interkinetic nuclear migration, in the flat region of the pseudostratified epithelium. However, the nuclei become stationary on the luminal side following mitosis in the curved region. Mathematical modelling together with perturbation experiments shows that this nuclear stalling facilitates luminal-basal differential growth within the epithelium, suggesting that the nuclear stalling would contribute to the bending of the pseudostratified epithelium during the cochlear duct development. The findings suggest a possible scenario of differential growth which sculpts the tissue shape, driven by collective nuclear dynamics.
Evidence of joint commitment in great apes' natural joint actions
Authors: Heesen Raphaela , Zuberbühler Klaus , Bangerter Adrian , Iglesias Katia , Rossano Federico , Pajot Aude , Guéry Jean-Pascal , Genty Emilie
Published: December 2021

Human joint action seems special, as it is grounded in joint commitment—a sense of mutual obligation participants feel towards each other. Comparative research with humans and non-human great apes has typically investigated joint commitment by experimentally interrupting joint actions to study subjects’ resumption strategies. However, such experimental interruptions are human-induced, and thus the question remains of how great apes naturally handle interruptions. Here, we focus on naturally occurring interruptions of joint actions, grooming and play, in bonobos and chimpanzees. Similar to humans, both species frequently resumed interrupted joint actions (and the previous behaviours, like grooming the same body part region or playing the same play type) with their previous partners and at the previous location. Yet, the probability of resumption attempts was unaffected by social bonds or rank. Our data suggest that great apes experience something akin to joint commitment, for which we discuss possible evolutionary origins.
Development of a nucleic acid chromatography assay for the detection of commonly isolated rapidly growing mycobacteria
Authors: Igarashi Yuriko , Chikamatsu Kinuyo , Sano Sotaro , Miyamoto Shigehiko , Aono Akio , Osugi Asami , Morishige Yuta , Murase Yoshiro , Yamada Hiroyuki , Takaki Akiko , Mitarai Satoshi
Published: December 2021

Introduction. Non-tuberculosis mycobacterium infections are increasing worldwide, including those caused by rapidly growing mycobacteria (RGM).

Gap Statement. The identification of the aetiological agent in the context of infections is essential for the adoption of an adequate therapeutic approach. However, the methods for the rapid distinction of different RGM species are less than optimal.

Aim. To develop a nucleic acid chromatography kit to identify clinically common RGM.

Methodology. We tried to develop a nucleic acid chromatography kit designed to detect four RGM species (including three subspecies) i.e.

Mycobacterium abscessus

subsp.

abscessus

,

Mycobacterium abscessus

subsp.

bolletii

(detected as M. abscessus/bolletii)

Mycobacterium abscessus

subsp.

massiliense

,

Mycobacterium fortuitum

,

Mycobacterium chelonae

and

Mycobacterium peregrinum

. The amplified target genes for each species/subspecies using multiplex PCR were analysed using a nucleic acid chromatography assay.

Results. Among the 159 mycobacterial type strains and 70 RGM clinical isolates tested, the developed assay correctly identified all relevant RGM without any cross-reactivity or false-negatives. The limits of detection for each species were approximately 0.2 pg µl-1.

Conclusion. The rapid and simple nucleic acid chromatography method developed here, which does not involve heat denaturation, may contribute to the rapid identification and treatment of RGM infections.
Effects of the Lysine Methyltransferase Inhibitor AZ505 on Bone Metabolism
Authors: Song Min-Kyoung , Jung Suhan , Hong Seojin , Kwon Jun-Oh , Kim Min Kyung , Kim Hong-Hee
Published: December 2021

Background: Protein methylation has important role in regulating diverse cellular responses, including differentiation, by affecting protein activity, stability, and interactions. AZ505 is an inhibitor of the SET and MYND domain-containing protein 2 lysine methylase. In this study, we investigated the effect of AZ505 on osteoblast and osteoclast differentiation in vitro and evaluated the effect of AZ505 in vivo on the long bones in mice.Methods: Osteoblast differentiation was assessed by alkaline phosphatase (ALP) and Alizarin red staining after culturing calvarial preosteoblasts in an osteogenic medium. Osteoclast differentiation was analyzed by tartrate-resistant acid phosphatase (TRAP) staining in bone marrow-derived macrophages cultured with macrophage-colony stimulating factor and receptor activator of nuclear factor-κB ligand (RANKL). For in vivo experiments, mice were intraperitoneally injected with AZ505 and femurs were examined by micro-computed tomography.Results: AZ505 increased ALP and Alizarin red staining in cultured osteoblasts and the expression of osteoblast marker genes, including Runx2 and osteocalcin. AZ505 resulted in decreased TRAP-staining of osteoclasts and expression of c-Fos and nuclear factor of activated T cells transcription factors and osteoclast marker genes, including cathepsin K and dendritic cell-specific transmembrane protein. Unexpectedly, in vivo administration of AZ505 markedly decreased the trabecular bone mass of femurs. In support of this catabolic result, AZ505 strongly upregulated RANKL expression in osteoblasts.Conclusions: The results indicate that AZ505 has a catabolic effect on bone metabolism in vivo despite its anabolic effect in bone cell cultures. The findings indicate that cell culture data should be extrapolated cautiously to in vivo outcomes for studying bone metabolism.
Validation of the Updated Korean Calcium Assessment Tool
Authors: Jin Joowon , Lee Yunjung , Park Yongsoon
Published: December 2021

Background: We previously developed the Korean Calcium Assessment Tool (KCAT) for assessing the intake of calcium and vitamin D in Korean women. However, based on the Korea National Health and Nutrition Examination Survey (KNHANES) VI and VII (2013–2018), major food sources for calcium and vitamin D have changed, and the National Standard Food Composition database was updated. Therefore, the present study aimed to update the KCAT and validate the Updated KCAT.Methods: A total of 285 women aged >19 years were asked to complete questionnaires of the KCAT and the Updated KCAT.Results: Calcium intake did not differ significantly between the KCAT (566±245 mg/day) and the Updated KCAT (569±248 mg/day; P=0.343). A correlation coefficient of 0.99 indicated a positive correlation on calcium intake between the KCAT and the Updated KCAT, with an almost perfect agreement by Cohen’s κ coefficients (0.95). Vitamin D intake assessed by the Updated KCAT was significantly higher than that assessed by the KCAT, which was positively correlated with a moderate agreement measured by Cohen’s κ coefficients (0.41).Conclusions: The present study demonstrated that the Updated KCAT was a valid tool for the rapid evaluation of calcium and vitamin D intake for Korean women.
Preoperative Vitamin D Deficiency is Associated with Postoperative Functional Recovery and Complications after Hip Fracture Surgery
Authors: Lim Chaemoon , Roh Young Ho , Kim Saeil , Nam Kwang Woo
Published: December 2021

Background: Low concentrations of vitamin D are considered one of the risk factors for hip fracture and are associated with worse outcomes. The purpose of this retrospective study was to compare vitamin D deficient group and vitamin D sufficient group and assess the association preoperative vitamin D deficiency and postoperative walking ability after hip fracture surgery.Methods: Between January 2014 and January 2020, 1,029 elderly patients with hip fracture (243 in men and 785 in women) were measured preoperative serum 25-hydroxy-vitamin D3 levels. Among 1,029 elderly patients, 702 patients were classified as Vitamin D deficient group (<20 ng/mL). Outcome parameters for functional recovery were the length of the hospital stay and KOVAL score, and those for complications were delirium, pneumonia, and thromboembolism.Results: The mean length of the hospital stay in the vitamin D deficient group was significantly longer than in the vitamin D sufficient group (27.7±17.8 vs. 2.9±11.8 days; odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05; P=0.001). The mean postoperative KOVAL score in the deficient group was significantly higher than in the sufficient group (4.0±2.1 vs. 3.1±1.9 days; OR, 1.21; 95% CI, 1.11-1.32; P=0.001). Vitamin D deficiency was significantly associated with a higher risk of delirium and pneumonia in deficiency group.Conclusions: Preoperative vitamin D deficiency in hip fractures patients was associated with prolonged duration of hospital stay and decrease of postoperative ambulatory status, and may increase the risk of delirium and pneumonia. Therefore, it is necessary to evaluate the preoperative vitamin D level and recommend vitamin D supplementation in elderly patients with a high probability of hip fracture.
Conditional Freezing, Flight and Darting?
Authors: Trott Jeremy M. , Hoffman Ann N. , Zhuravka Irina , Fanselow Michael S.
Published: December 2021

Fear conditioning is one of the most frequently used laboratory procedures for modeling learning and memory generally, and anxiety disorders in particular. The conditional response (CR) used in the majority of fear conditioning studies in rodents is freezing. Recently, it has been reported that under certain conditions, running, jumping or darting replaces freezing as the dominant CR. These findings raise both a critical methodological problem and an important theoretical issue. If only freezing is measured but rodents express their learning with a different response, then significant instances of learning, memory, or fear may be missed. In terms of theory, whatever conditions lead to these different behaviors may be a key to how animals transition between different defensive responses and different emotional states. We replicated these past results but along with several novel control conditions. Contrary to the prior conclusions, running and darting were entirely a result of nonassociative processes and were actually suppressed by associative learning. Darting and flight were taken to be analogous to nonassociative startle or alpha responses that are potentiated by fear. On the other hand, freezing was the purest reflection of associative learning. We also uncovered a rule that describes when these movements replace freezing: When afraid, freeze until there is a sudden novel change in stimulation, then burst into vigorous flight attempts. This rule may also govern the change from fear to panic.