bluuebunny/crossref_metadata_2025 huggingface dataset:
Early postoperative pain after subxiphoid uniportal thoracoscopic major lung resection: a prospective, single- blinded, randomized controlled trial
Authors: Chen Zhigang , Jiang Lei , Zheng Hua , Zhang Wentian , Lv Xin , Abdellateef Amr
Published: May 2022

OBJECTIVES

Preoperative selection bias led to the inability to generalize the proposed benefit of subxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) as having less postoperative pain than uniportal intercostal VATS. So, we conducted this prospective, single-blinded, randomized controlled trial to investigate the hypothesis that SVATS may have less early postoperative pain than UVATS in patients who undergo major lung resection for early-stage lung cancer.

METHODSA total of

262 patients were randomly allocated between 2 groups (each with 131 patients), the first being the UVATS group and the second being the SVATS group. The values indicated on the numerical rating scale (NRS) of pain were collected at 24 h and 48 h during rest and during coughing. In addition, different perioperative variables were analysed and compared between the 2 groups.

RESULTS

Multiple linear regression analysis showed that the type of surgical approach was a significant predictor of the postoperative NRS values. The postoperative NRS pain values were significantly lower in the SVATS group after 24 h during rest and coughing and after 48 h during coughing. Postoperatively, patients in the SVATS group got out of bed significantly earlier [16.37 (2.54) vs 18.05 (3.29) h, p < 0.001]. The SVATS group showed a significantly higher rate of intraoperative arrhythmia [20 (15.3%) vs 3 (2.3%) patients, p = 0.03].

CONCLUSIONS

SVATS major pulmonary resection in early-stage lung cancer is associated with less early postoperative pain than the UVATS approach. Operating on patients with cardiac problems using the SVATS approach is still a limiting factor for randomization due to the potential compression on the heart with resulting arrhythmia.

Clinical trial registration

The trial was registered under clinical trials.gov Identifier: NCT03331588. https://clinicaltrials.gov/ct2/show/NCT03331588.
Development and implementation of a prescription opioid registry across diverse health systems
Authors: Ray G Thomas , Altschuler Andrea , Karmali Ruchir , Binswanger Ingrid , Glanz Jason M , Clarke Christina L , Ahmedani Brian , Andrade Susan E , Boscarino Joseph A , Clark Robin E , Haller Irina V , Hechter Rulin , Roblin Douglas W , Sanchez Katherine , Yarborough Bobbi Jo , Bailey Steffani R , McCarty Dennis , Stephens Kari A , Rosa Carmen L , Rubinstein Andrea L , Campbell Cynthia I
Published: May 2022

Objective

Develop and implement a prescription opioid registry in 10 diverse health systems across the US and describe trends in prescribed opioids between 2012 and 2018.

Materials and Methods

Using electronic health record and claims data, we identified patients who had an outpatient fill for any prescription opioid, and/or an opioid use disorder diagnosis, between January 1, 2012 and December 31, 2018. The registry contains distributed files of prescription opioids, benzodiazepines and other select medications, opioid antagonists, clinical diagnoses, procedures, health services utilization, and health plan membership. Rates of outpatient opioid fills over the study period, standardized to health system demographic distributions, are described by age, gender, and race/ethnicity among members without cancer.

Results

The registry includes 6 249 710 patients and over 40 million outpatient opioid fills. For the combined registry population, opioid fills declined from a high of 0.718 per member-year in 2013 to 0.478 in 2018, and morphine milligram equivalents (MMEs) per fill declined from 985 MMEs per fill in 2012 to 758 MMEs in 2018. MMEs per member declined from 692 MMEs per member in 2012 to 362 MMEs per member in 2018.

Conclusion

This study established a population-based opioid registry across 10 diverse health systems that can be used to address questions related to opioid use. Initial analyses showed large reductions in overall opioid use per member among the combined health systems. The registry will be used in future studies to answer a broad range of other critical public health issues relating to prescription opioid use.
Impact of explainable artificial intelligence assistance on clinical decision-making of novice dental clinicians
Authors: Glick Aaron , Clayton Mackenzie , Angelov Nikola , Chang Jennifer
Published: May 2022

Objective

Despite artificial intelligence (AI) being used increasingly in healthcare, implementation challenges exist leading to potential biases during the clinical decision process of the practitioner. The interaction of AI with novice clinicians was investigated through an identification task, an important component of diagnosis, in dental radiography. The study evaluated the performance, efficiency, and confidence level of dental students on radiographic identification of furcation involvement (FI), with and without AI assistance.

Materials and Methods

Twenty-two third- and 19 fourth-year dental students (DS3 and DS4, respectively) completed remotely administered surveys to identify FI lesions on a series of dental radiographs. The control group received radiographs without AI assistance while the test group received the same radiographs and AI-labeled radiographs. Data were appropriately analyzed using the Chi-square, Fischer’s exact, analysis of variance, or Kruskal–Wallis tests.

Results

Performance between groups with and without AI assistance was not statistically significant except for 1 question where tendency was to err with AI-generated answer (P < .05). The efficiency of task completion and confidence levels was not statistically significant between groups. However, both groups with and without AI assistance believed the use of AI would improve the clinical decision-making.

Discussion

Dental students detecting FI in radiographs with AI assistance had a tendency towards over-reliance on AI.

Conclusion

AI input impacts clinical decision-making, which might be particularly exaggerated in novice clinicians. As it is integrated into routine clinical practice, caution must be taken to prevent overreliance on AI-generated information.
Maternal undernutrition during periconceptional period affects whole-genome ovine muscle methylation in adult offspring
Authors: Capra Emanuele , Toschi Paola , Del Corvo Marcello , Lazzari Barbara , Stella Alessandra , Williams John Lewis , Loi Pasqualino , Ajmone Marsan Paolo
Published: May 2022

Experimental and epidemiological studies suggest that maternal nutritional status during early pregnancy, including the period around the time of conception, may induce long-lasting epigenetic changes in the offspring. However, this remains largely unexplored in livestock. Therefore, the objective of this study was to evaluate if modification of the maternal diet of sheep (CTR: control; UND: 50% undernutrition) during the periconceptional period (42 d in total: −14/+28 from mating), would impact CpG methylation in muscle tissue (Longissimus dorsi) of adult offspring (11.5 mo old). Reduced representation bisulfite sequencing identified 262 (Edge-R, FDR < 0.05) and 686 (logistic regression, FDR < 0.001) differentially methylated regions (DMRs) between the UND and CTR groups. Gene ontology analysis identified genes related to development, functions of the muscular system, and steroid hormone receptor activity within the DMRs. The data reported here show that nutritional stress during early pregnancy leads to epigenetic modifications in the muscle of the resulting offspring, with possible implications for cardiac dysfunction, muscle physiology, and meat production.
Insulin resistance increases as days on feed advance in feedlot Bos indicus beef cattle offered a high-concentrate finishing diet
Authors: de Sousa Osvaldo A , Cappellozza Bruno I , Fonseca Vitor G L , Cooke Reinaldo F
Published: May 2022

This experiment evaluated the effects of advancing days on feed (DOF) on insulin resistance (IR) of finishing Bos indicus bulls offered a high-concentrate diet. On day 0, 100 Bos indicus Nellore bulls were housed in 12 feedlot pens (8 or 9 bulls/pen) for a 108-d feeding period, in a manner that all pens had an equivalent BW at the beginning of the finishing period. Bulls received the same diets throughout the 108-d feeding period. Diets were corn-based (38% starch) and were offered in amounts to ensure ad libitum intake. Individual shrunk BW was obtained on days 0 and 108 after 16 h of feed and water withdrawal, whereas unshrunk BW was recorded on days 19 and 60 for average daily gain (ADG) calculation. From days 0 to 108, feed intake and feed efficiency (FE) were calculated from each pen. Blood samples were collected on days 0, 60, and 108 to assess serum concentrations of haptoglobin, cortisol, glucose, and non-esterified fatty acids (NEFA), and insulin. Glucose, NEFA, and insulin concentrations were used to determine revised quantitative insulin sensitivity check index (RQUICKI), so that lower RQUICKI values indicate a greater IR of the herd. Pen was used as the experimental unit. Overall, DMI increased as DOF also increased (R2 = 0.71), being greater from days 19 to 60 and 60 to 108 vs. 0 to 19 (P < 0.0001), but did not differ between days 19 to 60 and 60 to 108 (P = 0.79). Conversely, ADG and FE linearly decreased as DOF increased from days 0 to 108 (P < 0.0001; R2 = 0.68 and 0.79, respectively). Log-transformed RQUICKI decreased as DOF increased up to 108 (P < 0.0001; r = −0.61). Similarly, serum concentrations of haptoglobin and cortisol increased as RQUICKI increased (P < 0.0001; r = 0.43 and 0.67, respectively). In summary, insulin resistance, per RQUICKI, increased and performance reduced in feedlot bulls with the advance of days on feed. Moreover, inflammatory markers were also positively associated with insulin resistance, suggesting that inflammation might be involved with the incidence of insulin resistance.
Agency Independence, Campaign Contributions, and Favoritism in US Federal Government Contracting
Authors: Fazekas Mihály , Ferrali Romain , Wachs Johannes
Published: May 2022

The impacts of money in US politics have long been debated. Building on principal-agent models, we test whether and to what degree companies’ political donations lead to their favored treatment in federal procurement. We expect the impact of donations on favoritism to vary by the strength of control by political principals over their bureaucratic agents. We compile a comprehensive dataset of published federal contracts and registered campaign contributions for 2004–15. We develop risk indices capturing tendering practices and outcomes likely characterized by favoritism. Using fixed effects regressions, matching, and regression discontinuity analyses, we find confirming evidence for our theory. A large increase in donations from $10,000 to $5m (in USD) increases favoritism risks by about 1/4th standard deviation (SD). These effects are largely partisan, with firms donating to the party that holds the presidency showing higher risk. Donations influence favoritism risks most in less independent agencies: the same donation increases the risk of favoritism by an additional 1/3rd SD in agencies least insulated from politics. Exploiting sign-off thresholds, we demonstrate that donating contractors are subject to less scrutiny by political appointees.
Population Genetics and Signatures of Selection in Early Neolithic European Farmers
Authors: Childebayeva Ainash , Rohrlach Adam Benjamin , Barquera Rodrigo , Rivollat Maïté , Aron Franziska , Szolek András , Kohlbacher Oliver , Nicklisch Nicole , Alt Kurt W. , Gronenborn Detlef , Meller Harald , Friederich Susanne , Prüfer Kay , Deguilloux Marie-France , Krause Johannes , Haak Wolfgang
Published: May 2022

Human expansion in the course of the Neolithic transition in western Eurasia has been one of the major topics in ancient DNA research in the last 10 years. Multiple studies have shown that the spread of agriculture and animal husbandry from the Near East across Europe was accompanied by large-scale human expansions. Moreover, changes in subsistence and migration associated with the Neolithic transition have been hypothesized to involve genetic adaptation. Here, we present high quality genome-wide data from the Linear Pottery Culture site Derenburg-Meerenstieg II (DER) (N = 32 individuals) in Central Germany. Population genetic analyses show that the DER individuals carried predominantly Anatolian Neolithic-like ancestry and a very limited degree of local hunter-gatherer admixture, similar to other early European farmers. Increasing the Linear Pottery culture cohort size to ∼100 individuals allowed us to perform various frequency- and haplotype-based analyses to investigate signatures of selection associated with changes following the adoption of the Neolithic lifestyle. In addition, we developed a new method called Admixture-informed Maximum-likelihood Estimation for Selection Scans that allowed us test for selection signatures in an admixture-aware fashion. Focusing on the intersection of results from these selection scans, we identified various loci associated with immune function (JAK1, HLA-DQB1) and metabolism (LMF1, LEPR, SORBS1), as well as skin color (SLC24A5, CD82) and folate synthesis (MTHFR, NBPF3). Our findings shed light on the evolutionary pressures, such as infectious disease and changing diet, that were faced by the early farmers of Western Eurasia.
Human Herpesvirus-6 Detection in Cerebrospinal Fluid on the BioFire FilmArray Meningitis/Encephalitis Panel in a High Human Immunodeficiency Virus-Prevalence African Setting
Authors: Milburn James , Lechiile Kwana , Siamisang Keatlaretse , Williams Christopher G , Owen Leah , Gwakuba Ezekiel , Machiya Tichaona , Leeme Tshepo , Barton Hannah E , Doyle Ronan , Tenforde Mark W , Mine Madisa , Goldfarb David M , Mokomane Margaret , Jarvis Joseph N
Published: May 2022

The prevalence and clinical relevance of human herpesvirus-6 (HHV-6) detection in cerebrospinal fluid (CSF) using multiplex polymerase chain reaction (PCR) testing in patients with suspected meningoencephalitis in high human immunodeficiency virus-prevalence African settings are not known. We describe the clinical and laboratory characteristics of 13 patients with HHV-6 CSF PCR positivity in Botswana.
Ethnic Differences in Coronavirus Disease 2019 Hospitalization and Hospital Outcomes in a Multiethnic Population in the Netherlands
Authors: Collard Didier , Stronks Karien , Harris Vanessa , Coyer Liza , Brinkman Kees , Beudel Martijn , Bokhizzou Nejma , Douma Renee A , Elbers Paul , Galenkamp Henrike , Wolde Marije ten , Prins Maria , van den Born Bert Jan H , Agyemang Charles
Published: May 2022

Background

Evidence from the United States and United Kingdom suggests that ethnic minority populations are at an increased risk for developing severe coronavirus disease 2019 (COVID-19); however, data from other West-European countries are scarce.

Methods

We analyzed data from 1439 patients admitted between February 2020 and January 2021 to 4 main hospitals in Amsterdam and Almere, the Netherlands. Differences in the risk for hospitalization were assessed by comparing demographics to the general population. Using a population-based cohort as reference, we determined differences in the association between comorbidities and COVID-19 hospitalization. Outcomes after hospitalization were analyzed using Cox regression.

Results

The hospitalization risk was higher in all ethnic minority groups than in those of Dutch origin, with age-adjusted odds ratios ranging from 2.2 (95% confidence interval [CI], 1.7–2.6) in Moroccans to 4.5 (95% CI, 3.2–6.0) in Ghanaians. Hypertension and diabetes were similarly associated with COVID-19 hospitalization. For all other comorbidities, we found differential associations. Intensive care unit admission and mortality during 21-day follow-up after hospitalization was comparable between ethnicities.

Conclusions

The risk of COVID-19 hospitalization was higher in all ethnic minority groups compared to the Dutch, but the risk of adverse outcomes after hospitalization was similar. Our results suggest that these inequalities may in part be attributable to comorbidities that can be prevented by targeted public health prevention measures. More work is needed to gain insight into the role of other potential factors such as social determinants of health, which might have contributed to the ethnic inequalities in COVID-19 hospitalization.
Making Andesites and the Continental Crust: Mind the Step When Wet
Authors: Reubi Olivier , Müntener Othmar
Published: May 2022

Andesites are iconic of subduction zone magmatism. Yet intermediate magmas (57–66 wt % SiO2) are less abundant than generally thought in arc settings. A comparison of experimental hydrous liquid lines of descent, melt inclusions and bulk-rock compositions demonstrates the importance of polybaric crystallization–differentiation in producing the compositional range and dictating the relative abundance of arc melts, but also highlights the preponderant role of mixing (sensu lato) in producing andesitic magmas. Based on their P2O5 contents, at least 74% of the arc magmas with around 64 wt % SiO2 are inferred to be mixing products. In addition to their surprisingly low abundance, andesitic melt inclusions are characterized by relatively low H2O, Al2O3, ± Na2O contents compared to the ranges measured in mafic and silicic melt inclusions. These compositional characteristics suggest that there is a sweet spot for the production of andesitic melts delimited by the low-pressure stability limit of amphibole (<150 MPa) and the adiabatic ascent path of mafic melts, but that this low-pressure differentiation pathway plays a minor role in the production of silicic arc magmas that principally form along high-pressure hydrous liquid line of descents (>700 MPa) before decompression. The compositional bimodality recorded by the melt inclusions and in well-preserved intra-oceanic arc crustal sections is a fundamental characteristic of differentiation in transcrustal arc magmatic systems, with important consequences for the chemical evolution of the continental crust. We propose that the overall bimodality shown by arc melts does not relate to a compositional gap in the differentiation mechanisms but results from a combination of (1) the disparity in volume of differentiated magmas produced by low and high-pressure crystallization–differentiation and (2) the strong nonlinearity of the high-pressure liquid lines of descent in composition–temperature–crystallinity space related to crystallization of amphibole-rich assemblages. In this context, the compositional characteristics shared by andesitic magmas and the continental crust principally depict the central role of mixing and mass balance processes in producing andesitic compositions. The step in differentiation efficiency encountered by hydrous magmas entering the amphibole stability field at high pressure plays an important role in defining the silicic component involved in these scenarios.
Distinctive roles of mPFC subregions in forming impressions and guiding social interaction based on others’ social behaviour
Authors: Lim Gahyun , Kim Hackjin
Published: May 2022

People can quickly form impressions of others from their social behaviour, which can guide their future social interactions. This study investigated how the type and timing of others’ social decisions affect the impression formation and social interactions. In each trial, participants watched a responder’s decision in an ultimatum game, decided whether to choose the responder as their next partner for proposer or responder and reported the perceived warmth, competence and likability of the responder. Participants preferred responders who accepted (i.e. accepters) unfair offers for the responder and those who rejected (i.e. rejecters) unfair offers for the proposer in their next ultimatum game, and the rostral medial prefrontal cortex (mPFC) activity encoded such a strategic context-dependent valuation when choosing partners. Slow rejecters were perceived as warmer than fast rejecters, which was mirrored by the anterior mid-cingulate cortex activity when watching others’ decisions, possibly detecting and resolving conflicting impressions. Finally, those who perceived accepters vs rejecters as warmer showed higher ventral mPFC responses to accepters vs rejecters when choosing a partner, regardless of the context. The present study suggests that distinctive subregions of the mPFC may be differentially involved in forming impressions and guiding social interactions with others based on their social behaviours.
Effects of a Bacillus-based direct-fed microbial on in vitro nutrient digestibility of forage and high-starch concentrate substrates
Authors: Pan Liyi , Harper Karen , Queiroz Oscar , Copani Giuseppe , Cappellozza Bruno I
Published: May 2022

Two experiments evaluated the effects of a Bacillus-based direct-fed microbial (DFM) on in vitro dry matter (DM) and neutral detergent fiber (NDF; experiment 1) and starch (experiment 2) digestibility of a variety of ruminant feedstuffs. In experiment 1, 10 forage sources were evaluated: ryegrass, alfalfa hay, leucaena, corn silage, spinifex, buffel grass, flinders grass, Mitchell grass, Rhodes grass hay, and Queensland bluegrass. Experimental treatments were control (forages with no probiotic inoculation; CON) and forage sources inoculated with a mixture containing Bacillus licheniformis and Bacillus subtilis (3.2 × 109 CFU per g; DFM). In vitro DM and NDF digestibility were evaluated at 24- and 48-h post-treatment inoculation. Treatment × hour interactions were noted for IVDMD (in vitro dry matter digestibility) and IVNDFD (in vitro neutral detergent fibre digestibility) (P ≤ 0.05). More specifically, DFM inoculation increased (P ≤ 0.03) IVDMD at 24 h in four forages and increased 48-h IVDMD (P ≤ 0.02) in alfalfa hay, ryegrass, leucaena, and Mitchell grass hay, but opposite results were observed for Queensland bluegrass (P < 0.01). A 24- and 48-h IVNDFD increased following DFM inoculation (P ≤ 0.02) in five forage sources, but reduced for Queensland bluegrass (P < 0.01). When the forages were classified according to their quality, main treatment effects were detected for IVDMD (P ≤ 0.02) and IVNDFD (P < 0.01). In experiment 2, five common cereal grains were evaluated—high-density barley (82 g/100 mL), low-density barley (69 g/100 mL), corn, sorghum, and wheat—under the same treatments as in experiment 1. In vitro starch digestibility (IVSD) was evaluated at 6- and 12-h following treatment inoculation. Treatment × hour interactions were observed for starch digestibility in three out of five concentrate sources (P ≤ 0.001). Inoculation of DFM yielded greater 24-h starch digestibility for high-, low-density barley, and wheat (P ≤ 0.02), but also greater at 48 h in wheat (P < 0.0001). Moreover, mean starch digestibility improved for corn and sorghum inoculated with DFM (P < 0.01). Using a Bacillus-based DFM (B. licheniformis and B. subtilis) improved the mean in vitro DM and NDF digestibility of different forage sources of varying qualities (based on crude protein content). Similarly, IVSD was also greater following DFM inoculation, highlighting the potential of this probiotic to improve nutrient digestibility and utilization in the beef and dairy cattle herd.
29 ENDOTHELIN-1 LEVEL IN HYPERTENSIVE SUBJECTS BETWEEN CORONARY ARTERY DISEASE AND HEALTHY POPULATIONS
Authors: Putri Mutiara , Hartopo Anggoro Budi , Inggriani Maria Patricia , Fachiroh Jajah , Dewi Fatwa Sari Tetra
Published: May 2022

Background: Hypertension is known as independent factor in correlation with coronary artery disease (CAD) and play important part in atherosclerotic process. In an animal model with hypertension which endothelin-1 play as a vasoconstrictor, there was overexpression of endothelin-1 in the vessel walls. This overexpression suggests a role of endothelin-1 in hypertension patient, especially among CAD.

Material and methods: This was a cross-sectional study. A total 226 subjects were analysed, consisted of 127 subjects with CAD and 99 healthy population. The CAD subjects were patients underwent elective coronary angiography with significant CAD lesion. The healthy population were respondents of Sleman-HDSS survey (year 2019). Hypertensive subjects were defined those with history of hypertension from anamnesis. Diabetic subjects were excluded. The endothelin-1 was measured from peripheral serum samples by ELISA method. The comparative analysis was performed with Mann-Whitney test and the correlation was performed with Spearman correlation test.

Results: Mean serum endothelin-1 level was 2.1±1.2 pg/mL in hipertensive and 2.6±1.6 pg/mL in normotensive (p=0.063) among CAD subjects. Among healthy population, mean serum endothelin-1 level was 1.7±0.7 pg/mL in hypertensive and 1.8±0.8 pg/mL) in normotensive, (p=0.675). In addition, Spearman correlation between serum endothelin-1 and systolic blood pressure showed correlation coefficient —0.045 (p = 0.543) in CAD subjects and -0.165 (p=0.069) in healthy population which indicated inverse correlation between those parameters in both populations.

Conclusion: Serum endothelin-1 level did not differ significantly based on hypertensive status both in CAD and healthy population. There was a tendency toward decreased serum endothelin-1 level in hypertensive subjects.
32 BLOOD PRESSURE DIARY AS A COMMUNITY-BASED INTERVENTION TO INCREASE HYPERTENSIVE PATIENTS' PERCEPTION OF TREATMENT: A PRELIMINARY STUDY
Authors: Aryaputra A.B. , Putri A.V. , Magfirah M. , Sulmi N. , Sumartono N.N.
Published: May 2022

Background: Hypertension is one of global health issues that become a leading modifiable risk factor of various illnesses. As one of twelve indicators of The Healthy Indonesia Program-a family approach (PIS-PK), comprehensive hypertension treatment is a parameter of a healthy community.

Objective: This preliminary study aim was to determine demographic profile of hypertension patients and improve patients' perceptions of hypertension treatment.

Method: In this cross-sectional descriptive study, we used patients with hypertension who reside in Panjeng village, Ponorogo, Indonesia in November 2020 as population sample. Definition of hypertension was based on the 2020 International Society of Hypertension practice guidelines. The intervention of this study was distribution of a blood pressure diary, which consists blood pressure evaluation page for each visitation as well as educational page about risk factors and management of hypertension. Healthy Family Index, a PIS-PK outcome, was used to assess the intervention's effectiveness.

Result: This study has 21 participants, with an average age of 63,3 ± 10,5 years, and 76,2% were female. Among those subjects, 61,9% of participants had grade 2 hypertension, 33,3 % had grade 1 hypertension, and 4,8% had normal-high blood pressure. Only 23,8% of patients were committed to taking their medicine regularly. Based on the results of the Healthy Family Index, there was a 6% rise in the indicator of adherence to treatment in patients with hypertension in the year following the intervention (36.4 % (2020) vs. 42.2 % (2021)). One of the factor that affect this result was Covid-19 pandemy, that patients may feel hesitate to visits to healthcare facility.

Conclusion: Blood pressure diary can be considered as potential community-based intervention to improve patient perception of treatment, as well as to monitor and evaluate hypertension therapy. Further and bigger-scale research is needed to determine the direct effect of this intervention to medication adherence.
42 BLOOD PRESSURE DURING INFECTION AND SERUM CREATININE CONCENTRATIONS PREDICT SEVERE DISEASE IN COVID-19
Authors: Widiana I. Gde Raka , Bagiada I. Made , Mahandita Wira
Published: May 2022

The severe of Covid-19 infection may associated with blood pressure and abnormality of kidney function. These abnormalities may contribute to the pathogenesis of severe Covid-19 infection.

This study aims to determine blood pressure during infection and creatinine concentrations are able to predict the severity of Covid-19 infection.

An observational analytical study was done at Sanglah Hospital during June to August 2021, using secondary data from hospital data system. Diagnosis of Covid-19 infection was made based of clinical and PCR positive of Covid-19. Data of patients was taken from blood test results at admission. SCAP was used for determination of disease severity, score 3 10 is defined as severe Covid-19 infection.

During the study 131 patients were included consisted of 77(58.8%) males and 54(41.2%) females. As many as 65 (49,6%) among 131 Covid-19 patients had severe disease (SCAP score 10 or more) with median SCAP score 10 (inter-quartile range 5-14. History of Hypertension were suffered by 57(43,5%), and Reduced kidney function were 65(49,6%) of the patients. At admission, patient with history of hypertension were significantly had higher (126 vs 113 mmHg; p<0.001) systolic BP than without history of hypertension, however there were negative significant association between systolic blood pressure during the disease and SCAP score (r=-0.14; p=0.04), and positive significant creatinine levels (r=0.33; p<0.001) with SCAP score. Using logistic regression analysis, it was found that during the disease, every ten mmHg reduction of SBP increases risk by (100%-87%,) =13% and every single unit (mg/dL) increased of serum concentrations increases (172%-100%)= 72% of severe Covid-19 patients.

In conclusion, systolic blood pressure during infection and serum creatinine concentrations predict severe covid-19 infection
44 BETA-BLOCKER TREATMENT OPTIONS AND RISK OF ERECTILE DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Sulastri Rana Amalia , Hadi Alfian Rahman , Pintaningrum Yusra
Published: May 2022

Background: Erectile dysfunction (ED) has a variety of causes. Certain antihypertensive medications usage is known to exacerbate and increase the risk of ED. One type of antihypertensive agent associated with a greater risk of ED is beta-blockers. Among the available options of beta-blocker, further comparison needs to be done to evaluate which beta-blocker has a lower risk of ED.

Objective: This study aimed to assess which beta-blocker has a lower risk of ED.

Methods: Search for published articles using the PRISMA (Preferred Reporting, Items for Systematic Reviews and Meta-Analysis) method conducted on PubMed, Cochrane Library, and Medline databases published in the last 20 years on “beta-blocker” and “erectile dysfunction”. Further systematic review and meta-analysis using RevMan version 5.4 were performed based on the included published articles.

Results: Based on 6 studies included with total of 1578 participants, 5 kinds of beta-blocker used on the participants include atenolol (17,8%), bisoprolol (31,1%), carvedilol (10,8%), metoprolol (9,8%), and nebivolol (30,5%). Nebivolol (RR = 0.87: 95% CI: 0.79-0.95) found to has the lowest risk ratio compared with another beta-blocker such as carvedilol (RR = 1.00: 95% CI: 0.92-1.09), metoprolol (RR = 1.05: 95% CI: 0.94-1.17), atenolol (RR = 1.07: 95% CI: 0.98-1.16), and bisoprolol (RR = 1.37: 95% CI: 1.01-1.87).

Conclusions: Nebivolol is a beta-blocker option recommended to avoid ED because of its lower risk of ED compared with other beta-blockers. Bisoprolol was found to be associated with a higher risk of ED, followed by atenolol, metoprolol, and carvedilol, respectively.
45 EARLY DETECTION OF LEFT ATRIAL STRAIN ABNORMALITIES BY SPECKLE TRACKING IN HYPERTENSION
Authors: Phalguna S. , Yaqzhan I. , Firmansyah A. , Nani  , Yanni M.
Published: May 2022

Background: Arterial hypertension is associated with morphologic and functional left atrial (LA) abnormalities. An increase in LA size in patients with hypertension may suggest early sign of LV diastolic impairment leading to heart failure. Peak Atrial Longitudinal Strain (PALS) is a new echocardiographic method reflecting LA reservoir function. This method is particularly useful when changes are subtle and not easily determined by traditional parameters, as it is in arterial hypertension.

Objective: The aim of this study was to evaluate PALS using 2D strain in patients with and without hypertensionas an indicator for early diastolic LV impairment.

Methods: 60 patients with normal Ejection Fraction (30 patients as control group vs 30 hypertensive patients) underwent echocardiography examination. Peak Atrial Longitudinal Strain was measured using speckle tracking 2D echocardiography. Mean PALS between both group was analysed statistically.

Result: Of 60 patients, 56,7% were male and 43,3% were female. There were no statistically difference in mean age, body mass index and history of diabetes between control and hypertensive group (58 years vs 54 years, p = 0,300; 24,5 vs 22,5 p= 0,061, 1,9 % vs 1,8%, p=0,398, respectively). Echocardiography examination showed LA diameter and LA volume index were higher in hypertensive group (31,47 vs 28,43 mm, p=0,090; 24,04 ml/m2 vs 18,03 ml/m2, p= 0,100, respectively). There was no diastolic dysfunction found in both group. Comparison between PALS in hypertensive group and control group showed significant result statistically (25,05% vs 46,36%, p=0,001) with lower value in hypertensive group.

Conclusion: Patients with arterial hypertension have decreased PALS reflecting abnormality of reservoir LA function even in the absence of echocardiographic signs of LV diastolic dysfunction. PALS may be considered as a promising tool for the early diastolic LV impairment in hypertension.
Standardizing Screw Head Orthopaedic Trauma Implants. Is There an Interest? An OTA Member Survey
Authors: Cunningham Brian P. , Higgins Thomas F. , Vallier Heather A. , Patterson Brendan M. , Only Arthur J.
Published: May 2022

Objective:

To determine the level of interest in standardization of design for fracture fixation implants within the orthopaedic trauma community.

Methods:

A survey regarding implant removal concerns and implant design preferences was electronically distributed to members of Orthopaedic Trauma Association (OTA).

Results:

Three hundred thirty respondents participated in the survey (response rate of 19%) Only 2.4% of respondents indicated a consistent ability to identify the implant vendor and/or manufacturer of retained implants in the preoperative planning phase of care; >75% of respondents reported investing a minimum of an additional 30 minutes to their operative times to remove screw(s) to successfully extract a plate. More than 80% of respondents reported multiple occurrences requiring modification of their surgical plans because of implants that could not be removed, preventing the completion of the planned procedure. The majority of respondents expressed interest in the adoption of standardized locking head screws for mini, small, and large screw sizes sets (63.5%); 84.8% of respondents desire standardization of screw head and driver sizes across the industry. Also, 83.6% of respondents expressed interest in the adoption of a standardized locking screw head for each cannulated screw, regardless of manufacturer.

Conclusions:

Members of the orthopaedic community, as represented in the membership of the OTA, are interested in the adoption of universal standards in implant design. Establishing standard screw heads and drivers will optimize the delivery of operative care.
Female melanoma and estrogen receptors expression: an immunohistochemical pilot study
Authors: Dika Emi , Lambertini Martina , Lauriola Mattia , Veronesi Giulia , Ricci Costantino , Tartari Federico , Tassone Daniela , Campione Elena , Scarfì Federica
Published: May 2022

Epidemiologic data highlight sex differences in melanoma outcome. A putative role of sex hormones is still under investigation. Very few laboratory investigations have focused on the level of expression of estrogen receptors in melanoma. We evaluated the presence of estrogen receptors alpha (ERα) and beta (ERβ) in melanoma specimens from female patients with a previous history of breast carcinoma (BC). Moreover, another group of female patients undergoing ovarian stimulation (OS) were also compared to two control groups matched for age and melanoma staging. The study was performed at the IRCCS Policlinico di Sant’Orsola Hospital’s Melanoma Unit from January 2017 to December 2019. The nuclear and cytoplasmatic immunohistochemical staining was evaluated and scored by the percentage of stained tumour cells: 0 (≤20%), 1 (21–50%) or 2 (≥50%). Twenty-eight specimens were analysed. ERβ nuclear presence was detected in all cases of women with a history of breast cancer. Cytoplasmatic ERβ was clearly expressed with a score of 2 in seven cases. In the respective control group, nuclear and cytoplasmatic ERβ expression was much lower. A cytoplasmatic ERα positivity was also detected in almost all cases. In the second group of women who experienced ovarian stimulation for Assisted Reproductive Technology (ART), a lower abundance of nuclear ERs was detected. Conversely, cytoplasmatic ERβ and α expression ranged widely. Melanoma of women treated with anti-estrogen therapy is generally more prone to express estrogen receptors compared with women of the same age and CM staging but also compared with women in fertile age with and without a history of OS.
The Behavioral Phenotype of 7q11.23 Duplication Syndrome Includes Risk for Oppositional Behavior and Aggression
Authors: Klein-Tasman Bonita P. , Yund Brianna D. , Mervis Carolyn B.
Published: May 2022

Objective:

7q11.23 duplication syndrome (Dup7) is a genetic disorder with a variable phenotype associated with cognitive and behavioral characteristics including a high incidence of expressive language difficulties, social anxiety, and oppositional or disruptive behavior. Correlates of aggression and oppositionality were examined.

Method:

Participants were 63 children with genetically confirmed Dup7 between the ages of 4 and 17 years. A multimethod, multi-informant approach was used to assess aggression and oppositional behavior, and the contributions of cognitive functioning, expressive language, autism spectrum, social anxiety, and hyperactivity/impulsivity (H/I) symptomatology were considered.

Results:

Elevated levels of aggression and oppositional behavior were found. Cognitive functioning, expressive language, and autism spectrum disorder symptomatology were not significantly related to parent ratings of aggression, although young children who had language and nonverbal cognitive delays were most likely to demonstrate examiner-observed aggression. Social anxiety and H/I symptomatology were related to defiant/aggressive and oppositional behavior.

Conclusion:

Genes in the 7q11.23 region duplicated in Dup7, in transaction with the environment, may contribute to aggressive and oppositional behavior.
Assessment of Executive Function in Infants and Toddlers: A Potential Role of the Bayley-4
Authors: Aylward Glen P. , Taylor H. Gerry , Anderson Peter J. , Vannier Louis Charles
Published: May 2022

Objective:

The development of executive function (EF) in infants and toddlers has received increased interest by clinicians and researchers. Higher rates of deficits in EF have been reported in at-risk groups of infants such as those born extremely preterm. These deficits play an important role in the etiology of early neurodevelopmental problems and are predictive of subsequent nonoptimal educational outcomes. In this study, the Bayley-4 is used to follow the developmental course of EF and to determine whether EF is a unitary concept or can be parsed into discrete components over the first 42 months.

Method:

All 81 cognitive items from the Bayley-4 normative sample of 1700 infants and toddlers were classified a priori into 6 EFs, and then, 5 age groups derived from Bayley-4 start points were factor analyzed to determine at what age EFs emerge and to address the controversy of whether the factor structure of the cognitive items for each of 5 age groups reflect a single factor or multiple factors.

Results:

Bayley-4 items form 1 to 5 EF factors for each age group, accounting for 59% to 74% of the variance. There is a developmental progression in EF as well. The results indicate EF constructs can be identified early.

Conclusion:

Executive function tasks in infants and toddlers are interrelated with task content either remaining the same or changing with advancing age (i.e., content that is homotypic or heterotypic, respectively). EFs measured by Bayley-4 items are useful clinically and become more complex with increasing age, corresponding to more advanced brain development and integration. The findings have the potential of providing additional information in the assessment of infants at risk such as those born preterm.
Virtual management of hypertension: lessons from the COVID-19 pandemic–International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension
Authors: Khan Nadia A. , Stergiou George S. , Omboni Stefano , Kario Kazuomi , Renna Nicolas , Chapman Niamh , McManus Richard J. , Williams Bryan , Parati Gianfranco , Konradi Aleksandra , Islam Shariful M. , Itoh Hiroshi , Mooi Ching S. , Green Bev B. , Cho Myeong-Chan , Tomaszewski Maciej
Published: May 2022

The coronavirus disease 2019 pandemic caused an unprecedented shift from in person care to delivering healthcare remotely. To limit infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension.

It is likely that virtual care of chronic diseases including hypertension will continue in some form into the future. The purpose of the International Society of Hypertension's (ISH) position paper is to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control based on the currently available evidence and international experts’ opinion for nonpregnant adults. Virtual care represents the provision of healthcare services at a distance with communication conducted between healthcare providers, healthcare users and their circle of care. This statement provides consensus guidance on: selecting blood pressure monitoring devices, accurate home blood pressure assessments, delivering patient education virtually, health behavior modification, medication adjustment and long-term virtual monitoring. We further provide recommendations on modalities for the virtual assessment and management of hypertension across the spectrum of resource availability and patient ability.
Scleral Lens Thickness and Corneal Edema Under Closed Eye Conditions
Authors: Fisher Damien , Collins Michael J. , Vincent Stephen J.
Published: May 2022

Objectives:

To examine the relationship between central lens thickness and central corneal edema during short-term closed eye scleral lens wear.

Methods:

Nine participants (mean age 30 years) with normal corneas wore scleral lenses (Dk 141) under closed eye conditions on separate days with nominal center thicknesses of 150, 300, 600, and 1,200 μm. Epithelial, stromal, and total corneal edema were measured using high-resolution optical coherence tomography immediately after lens application and after 90 min of wear, before lens removal. Data were corrected for variations in initial fluid reservoir thickness and compared with predictions from theoretical modeling of overnight scleral lens wear.

Results:

Scleral lens–induced central corneal edema was primarily stromal in nature. The mean±standard error of corrected total corneal edema was 4.31%±0.32%, 4.55%±0.42%, 4.92%±0.50%, and 4.83%±0.22% for the 150-, 300-, 600-, and 1,200-μm lenses, respectively. No significant differences in the corrected total corneal edema were observed across all thickness groups (P=0.20). Theoretical modeling of overnight scleral lens wear seemed to overestimate the relative increase in central corneal edema as a function of decreasing lens Dk/t for values lower than 25.

Conclusion:

The magnitude of scleral lens–induced central corneal edema during short-term closed eye lens wear did not vary significantly with increasing central lens thickness. Theoretical modeling of overnight closed eye scleral lens wear seems to overestimate the effect of increasing lens thickness.
Caustic Ingestion in Children
Authors: Shcherbaeva Tanya , Muallem Kalmovich Limor , Shalem Tzippora , Broide Efrat , Gavriel Haim , Pitaro Jacob
Published: May 2022

Objectives

Caustic ingestion in children is a significant cause of morbidity despite preventive measures. Upon arrival to the emergency department, these children are often initially seen by the otolaryngologist and later on by the gastroenterologist. This study aimed to determine which otolaryngological and gastrointestinal signs and symptoms can better predict abnormal findings on imaging, esophagogastroduodenoscopy (EGD), and complications development.

Methods

We performed a retrospective chart review of children 18 years or younger admitted because of caustic ingestion between January 2007 and November 2019.

Results

Forty-one children with a median age of 4.2 years (interquartile range, 1.7–16.7 years) were included; of them, 22 (53.6%) were males. Nineteen children (46.3%) underwent EGD, which revealed no pathology in 13 cases (68.4%). Most ingested substances were in the form of liquid (82.9%), accidentally ingested (82.9%), and with an alkaline pH (57.5%). Stridor, dyspnea, drooling, abnormal oral cavity findings, dysphagia, and vomiting were significantly associated with pathological findings on imaging and/or EGD and/or complications development (P = 0.028, P = 0.028, P = 0.022, P = 0.02, P < 0.001, and P = 0.01 respectively). Laryngopharyngeal group of findings (dyspnea, stridor, hoarseness, sore throat, and/or drooling) predicted a higher risk for complications development than the gastrointestinal group (dysphagia, abdominal pain, vomiting, or abdominal swelling and/or tenderness) (P = 0.011, P = 0.31 respectively).

Conclusions

In children, after caustics ingestion, laryngopharyngeal signs and symptoms may predict a higher risk for complications development in comparison with gastrointestinal signs and symptoms. We therefore stress the importance of otolaryngological examination upon arrival to the emergency department.
Point-of-Care Ultrasound Assessment of Orbital Rhabdomyosarcoma in a Pediatric Patient
Authors: Nichols Francesca R. , Nguyen Mylinh T. , Ekpenyong Atim , Pade Kathryn H.
Published: May 2022

Rhabdomyosarcoma is the most common soft tissue tumor in children and orbital lesions account for 10% of these diagnoses. This case describes a young boy who presented with eyelid swelling that was initially concerning for an expanding hematoma given a history of recent trauma to the eye. Point-of-care ultrasound identified 2 distinct lesions surrounding the globe, which prompted further investigation, including ophthalmology consult and computed tomography. The case presented highlights the initial misdiagnosis on both point-of-care ultrasound and computed tomography and the importance of using color Doppler on ultrasound to distinguish an orbital rhabdomyosarcoma from a posttraumatic hematoma.