bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcomes of all‐ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta‐analyses
Authors: Spitznagel Frank Akito , Balmer Marc , Wiedemeier Daniel B. , Jung Ronald Ernst , Gierthmuehlen Petra Christine
Published: October 2021

Objective

To analyze the clinical outcomes of all‐ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants.

Materials and Methods

Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all‐ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient‐related outcome measurements. Meta‐analyses were performed after 1, 2, and 5 years using random‐effect meta‐analyses.

Results

Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement‐retained reconstructions (mean observation: 12.0–61.0 months). Meta‐analyses estimated a 5‐year survival rate of 94% (95% confidence interval [CI]: 82%–100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%–100%); veneered zirconia SCs, 89% (95%CI: 62%–100%); and veneered zirconia FDPs 94% (95%CI: 81%–100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%–11%); veneered zirconia SCs, 38% (95%CI: 24%–54%); and veneered zirconia FDPs, 57% (95%CI: 38%–76%). Further outcomes were summarized descriptively.

Conclusions

Due to the limited data available, only tendencies could be identified. All‐ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid‐term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
The role of ventilatory support for long‐term outcomes after critical infection with COVID‐19: A prospective cohort study
Authors: Hanna Gabriel , Bankler Sara , Schandl Anna , Roël Mari , Hedman Anders , Andersson Franko Mikael , Lyngå Patrik , Geborek Anne , Joelsson‐Alm Eva , Söderberg Mårten , Darlington Pernilla
Published: October 2021

Objectives

The full range of long‐term health consequences in intensive care unit (ICU) survivors with COVID‐19 is unclear. This study aims to investigate the role of ventilatory support for long‐term pulmonary impairment in critically ill patients and further to identify risk factors for prolonged radiological recovery.

Methods

A prospective observational study from a single general hospital, including all with COVID‐19 admitted to ICU between March and August 2020, investigating the association between ventilatory support and the extent of residual parenchymal changes on chest computed tomography (CT) scan and measurement of lung volumes at follow‐up comparing high‐flow nasal oxygen (HFNO) or non‐invasive ventilation (NIV) with invasive ventilation. A semi‐quantitative score (CT involvement score) based on lobar involvement and a total score for all five lobes was used to estimate residual parenchymal changes. The association was calculated with logistic regression and adjusted for age, sex, smoking, and severity of illness.

Results

Among the 187 eligible, 86 had a chest CT scan and 76 a pulmonary function test at the follow‐up with a median time of 6 months after ICU discharge. Residual lung changes were seen in 74%. The extent of pulmonary changes was similar regardless of ventilatory support, but patients with invasive ventilation had a lower total lung capacity 84% versus 92% of predicted (p < 0.001).

Conclusions

The majority of ICU‐treated patients with COVID‐19 had residual lung changes at 6 months of follow‐up regardless of ventilator support or not, but the total lung capacity was lower in those treated with invasive ventilation.
Avoiding a conservation pitfall: Considering the risks of unsuitably hot bat boxes: Adding context to Crawford & O'Keefe
Authors: Brack Virgil , Sparks Dale W.
Published: October 2021

As practitioners of mitigation and conservation of bats, we think use of artificial bat roosts contribute to bat conservation and should be encouraged. Problems with boxes identified by Reed and O'Keefe also exist with natural roosts, and they are more readily studied and managed with artificial than natural roosts. Use of boxes also provides an opportunity for citizen science, but more importantly engenders citizen conservation.
Enigma portal case: Cytological diagnosis of vesicouterine fistula
Authors: Chen Xian , Chen Yuzhu , Li Juan , Wang Yi , Tan Robert Yu‐Sheng , Huang Yefang
Published: October 2021

Vesicouterine fistulae (VUF) are uncommonly occurring pathological passages between the bladder and uterus, and usually occur incidental to cesarean sections. This submission presents a case of VUF that was uniquely diagnosed via immunohistochemical analysis, in contrast to traditional methods of diagnosis, including via cystoscopy or via filling the bladder with dye.
Endoscopic suturing using a new device to prevent adverse events after endoscopic submucosal dissection: Double‐arm‐bar Suturing System
Authors: Minato Yohei , Mori Hirohito , Ito Fumio
Published: October 2021

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Individual variation and vulnerability to angling: No apparent behavioral differences among fish captured using different fishing gears
Authors: Pollack Lea , Wiltsee Laura , Beittel Alice , Ganzorig Batsaikhan , Jensen Olaf P.
Published: October 2021

It is well known that fishing is size‐selective, but harvest may also inadvertently target certain behavioral types or personalities. Changes in the abundance of behavioral types within a population have implications for fisheries management, including affecting catch rates, individual growth, and food web dynamics. Using streamside behavioral assays, we quantified the repeatability of behaviors in a population of Baikal grayling (Thymallus baicalensis) in northern Mongolia, a popular sport fish and important local predator. We assessed whether different angling techniques (i.e., fly or spinning gear) collected different behavioral types and whether variation in behavior was associated with body condition or diet (i.e., using stable isotope analysis). Surprisingly, we found no evidence for consistent individual differences in several behaviors within this population. Furthermore, differences in mean behaviors were not predicted by angling gear, body condition, or carbon and nitrogen isotopic signatures. We suggest that since this is a fished population, the range of behavioral variability in the population may have been reduced through previous behaviorally selective harvest. This might explain both the lack of difference in mean behaviors between fish caught by both gear types and the lack of evidence for consistent individual differences in behavior within the sampled population.
Recovery of horses from general anaesthesia: A systematic review (2000–2020) of the influence of anaesthetic protocol on recovery quality
Authors: Loomes Kate , Louro Luís Filipe
Published: October 2021

Background

The recovery phase after equine general anaesthesia (GA) is a time of considerable risk and therefore has been the subject of extensive research over the last 20 years. Various pharmacological interventions have been developed and studied with the objective of improving recovery quality and reducing anaesthetic‐related mortality and morbidity. Nevertheless, some controversy remains regarding the influence of anaesthetic protocol choice on recovery quality from GA and its implications for recovery‐related mortality and morbidity. A systematic review of the literature investigating the influence of anaesthetic protocol choice on recovery quality is currently lacking.

Objectives

To perform a detailed evaluation of the equine veterinary literature investigating the effect of anaesthetic protocol choice on equine recovery quality utilising the GRADE framework.

Study design

A systematic evaluation of the equine veterinary literature was performed using the GRADE framework.

Methods

A literature search was performed and studies were assessed for eligibility by both authors utilising PRISMA guidelines. Studies meeting inclusion criteria were evaluated by both authors, categorically summarised and the quality of evidence for each sub‐topic was assessed using the GRADE framework.

Results

A total of 124 studies were identified which directly assessed the impact of anaesthetic protocol choice on recovery quality after GA in horses. Evaluation of the available evidence indicated that certain partial intravenous anaesthesia (PIVA) agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality.

Main limitations

The validity of the results of some studies may have been compromised by missing data and small sample sizes.

Conclusions

There is evidence to indicate that certain PIVA agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality.
Important role of mechanical microenvironment on macrophage dysfunction during keloid pathogenesis
Authors: Zhou Boya , Gao Zhen , Liu Wei , Wu Xiaoli , Wang Wenbo
Published: October 2021

Keloid is considered as a tumor‐like skin disease with multiple aetiologies including immunological factors and mechanical microenvironment. Macrophages are plastic and diverse immune cells that play a critical role in maintaining tissue homeostasis by removing dead cells, debris, pathogens and repairing tissues after inflammation. The imbalance of M1/M2 macrophages and disturbances in macrophage functions can steer the progression of chronic inflammation and lead to the development of pathological fibrosis in keloid disease. Recently, it has been shown that macrophages are sensitive to mechanical signals, especially stretching tension and tissue stiffness, which can determine macrophage polarization and functions. Higher stretching tension is known to be an important pathogenic factor of keloid, and the formation of keloid will lead to an increase in tissue stiffness. As little is known about the underlying reasons of macrophages dysfunction in keloid, an understanding of how the mechanical microenvironment interacting with macrophages and affecting their behaviours may help provide mechanism insights into keloid pathogenesis. We thus hypothesize that the synergistic effect of stretching tension and matrix stiffness may contribute to the major pathophysiological niche attributes of macrophages’ in vivo mechanical microenvironment in keloids. These mechanism insights of how macrophages sense and respond to their mechanical microenvironment would propel the development of novel strategies for keloid treatment.
The glycocalyx and immune evasion in cancer
Authors: Ghasempour Sina , Freeman Spencer A.
Published: October 2021

In order to establish malignant lesions, tumors must first evade their detection by immune cells. Tumors achieve this by embellishing and tailoring their glycocalyx, a network of polysaccharides and glycosylated proteins that refracts the phagocytic efforts of myeloid cells, shrouds neoantigens and other ligands from cells of the acquired immune system, and skews immune responses. The barriers imposed by the glycocalyx are biophysical and also linked to the inhibitory receptor signaling pathways of immune cells that engage tumor sialic acids as markers of healthy “self”. This would explain the pressure for cancers to upregulate the synthases, transmembrane mucins, and other heavily sialylated glycoproteins involved in establishing a repulsive glycocalyx. Accordingly, individual tumor cells that are best capable of constructing a shielding glycocalyx on their surface show higher metastatic potential in immunocompetent mice. Reciprocally, therapeutics have recently been devised to edit and dismantle the glycocalyx barrier in an effort to invigorate an immune response aimed at tumor destruction. We discuss the features of the tumor‐associated glycocalyx that afford immune evasion of cancers and how strategies that target this barrier may potentiate antitumor immunity.
Ephemeral forest regeneration limits carbon sequestration potential in the Brazilian Atlantic Forest
Authors: Piffer Pedro R. , Calaboni Adriane , Rosa Marcos R. , Schwartz Naomi B. , Tambosi Leandro R. , Uriarte María
Published: October 2021

Although deforestation remains widespread in the tropics, many places are now experiencing significant forest recovery (i.e., forest transition), offering an optimistic outlook for natural ecosystem recovery and carbon sequestration. Naturally regenerated forests, however, may not persist, so a more nuanced understanding of the drivers of forest change in the tropics is critical to ensure the success of reforestation efforts and carbon sequestration targets. Here we use 35 years of detailed land cover data to investigate forest trajectories in 3014 municipalities in the Brazilian Atlantic Forest (AF), a biodiversity and conservation hotspot. Although deforestation was evident in some regions, deforestation reversals, the typical forest transition trajectory, were the prevalent trend in the AF, accounting for 38% of municipalities. However, simultaneous reforestation reversals in the region (13% of municipalities) suggest that these short‐term increases in native forest cover do not necessarily translate into persistent trends. In the absence of reversals in reforestation, forests in the region could have sequestered 1.75 Pg C, over three times the actual estimated carbon sequestration (0.52 Pg C). We also showed that failure to distinguish native and planted forests would have masked native forest cover loss in the region and overestimated reforestation by 3.2 Mha and carbon sequestration from natural forest regeneration by 0.37 Pg C. Deforestation reversals were prevalent in urbanized municipalities with limited forest cover and high agricultural productivity, highlighting the importance of favorable socioeconomic conditions in promoting reforestation. Successful forest restoration efforts will require development and enforcement of environmental policies that promote forest regeneration and ensure the permanence of regrowing forests. This is crucial not only for the fate and conservation of the AF, but also for other tropical nations to achieve their restoration and carbon sequestration commitments.
Surface prostatic metaplasia, transitional cell metaplasia and superficial clusters of small basophilic cells in the uterine cervix: prevalence in gender‐affirming hysterectomies and comparison with benign hysterectomies from cisgender women
Authors: McMullen‐Tabry Emily R , Sciallis Andrew P , Skala Stephanie L
Published: October 2021

Aims

As gender‐affirming surgery is becoming more common, it is important for pathologists to recognize potential benign findings to avoid misinterpretation. Cervical transitional cell metaplasia and superficial clusters of small basophilic cells have been described in the context of gender‐affirming testosterone therapy; these findings may be misdiagnosed as high‐grade squamous intraepithelial lesions or endometrial cells on Pap smears. Prostatic metaplasia has been reported in the surface squamous epithelium of the vagina and the uterine cervix in individuals undergoing gender‐affirming androgen therapy; this finding is often associated with NKX3.1‐positive basal keratinocytes. The aim of this study was to assess the morphological and immunohistochemical features of the uterine cervix in gender‐affirming hysterectomies in comparison with benign hysterectomies from cisgender women.

Methods and results

We assessed the morphological and immunohistochemical features of the uterine cervix in 49 gender‐affirming hysterectomies as compared with 57 hysterectomies from cisgender patients to establish the relative prevalences of surface prostatic metaplasia, NKX3.1‐positive basal keratinocytes, transitional cell metaplasia, and small basophilic cells in the cervical squamous epithelium. The cervical tissue from the gender‐affirming therapy cohort showed significantly higher prevalences of NKX3.1‐positive basal keratinocytes (86% versus 1.8%), transitional cell metaplasia (80% versus 3.5%), superficial clusters of small basophilic cells (67% versus 7%), and surface prostatic metaplasia (43% versus 3.5%).

Conclusion

NKX3.1‐positive basal keratinocytes, transitional cell metaplasia, small basophilic cells and surface prostatic metaplasia are all more prevalent in the cervices of individuals receiving gender‐affirming testosterone therapy; awareness of this fact allows pathologists to avoid the overdiagnosis of dysplasia or the recommendation of unnecessary follow‐up procedures.
Continuous tension reduction technique in facial scar management: A comparison of W‐plasty and straight‐line closure on aesthetic effects in Asian patients
Authors: Wang Danying , Ding Jinping , Jiang Yongkang , Liu Yuanbo , Chen Bo
Published: October 2021

W‐plasty is a very popular scar excisional revision technique. The core of the technique is to break up the scar margins into small triangular components, so as to cause light scattering and make the scar less noticeable. However, due to skin tension, facial incision scars tend to spread. Applying W‐plasty alone cannot achieve the ideal repair effect of facial scars. In this study, we proposed a scar revision technique combined W‐plasty with continuous tension‐reduction (CTR) technique to improve the appearance of facial scars. Sixty patients with facial scar were comprised in this retrospective study. Scars were assessed independently using the scar scale before and at 12‐month follow‐up. Clinical results showed a significant difference in scar appearance between different groups at 12‐month follow‐up. Vancouver scar scale (VSS), visual analogue scale (VAS) scores, and patient satisfaction were significant better in W‐plasty and CTR than other groups at 12‐month follow‐up. No severe complications were reported. The application of the tension offloading device provides an environment where the tension is continuously reduced, which could greatly decrease tension on the surgical incision. Combined with W‐plasty, this technique could significantly improve the scar's aesthetic appearance.
Advanced practice role delineation within Finland: A comparative descriptive study
Authors: Jokiniemi Krista , Heikkilä Asta , Meriläinen Merja , Junttila Kristiina , Peltokoski Jaana , Tervo‐Heikkinen Tarja , Mattila Elina , Mikkonen Santtu
Published: October 2021

Aim

To identify and differentiate the practice patterns of generalist, specialist and advanced practice nursing roles in specialist and central hospital contexts.

Background

In Finland, as in other Nordic countries, advanced practice nursing roles emerged around 2000. There are over 60,000 registered nurses/midwives in Finland and the clinical career pathway from a registered nurse to advanced practice nurse has been described yet not fully implemented in healthcare organizations. However, the number and activities of nonadvanced and advanced practitioner roles are not well known.

Design

A descriptive comparative study.

Methods

An online self‐report survey was conducted between August and October 2020 using an advanced practice role delineation tool. A census sample of registered nurses, registered midwives, specialist nurses and advanced practice nurses in five university hospitals and one central hospital was recruited. Descriptive statistics were used to summarize the characteristics of participants and group differences were compared using analysis of variance (ANOVA). The STROBE checklist was used as the reporting guideline.

Results

A total of 1497 responses were obtained (response rate = 10%). Overall, nurses used comprehensive care and education activities most frequently. The least used activities were research and publication and professional leadership. Univariate analysis of variance test between role effects, when education and grouped age were taken into account, showed statistically significant difference in all of the observed five activities (p < .001).

Conclusion

Identifying activities in different levels of nursing is a crucial first step in delineating nursing roles thus improving the governance of the human resource management.

Impact

The study results add to the international literature, delineating nursing roles in the spectrum of generalist to advanced practice nursing. As these roles become more formalized, we may incorporate novel ways of promoting the career development and optimal use and assessment of nursing roles and practice in various career levels.
Physiologic lead placement with electroanatomic mapping: A case series
Authors: Baman Jayson R. , Garg Varun , Kalluri Aravind G. , Wasserlauf Jeremiah , Trivedi Amar , Knight Bradley P. , Sharma Parikshit S , Verma Nishant
Published: October 2021

Introduction

His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) have emerged as attractive alternatives to traditional biventricular pacing to achieve cardiac resynchronization therapy. Early reported results have been inconsistent, particularly amongst patients in whom initial placement with traditional approaches has been unsuccessful or those with complex anatomy or congenital abnormalities. In this report, we describe the use of three‐dimensional electroanatomic mapping (EAM) in five selected cases.

Methods

Five patients from multiple clinical sites underwent EAM‐guided HBP or LBBAP by highly trained electrophysiologists with significant experience with conduction system pacing. Each patient in this series underwent EAM‐guided conduction system pacing due to complex anatomy and/or prior failed lead implantation.

Results

EAM‐guided lead implantation was successful in all five cases. Capture thresholds were relatively low and patients continued to have evidence of successful lead implantation with minimum 1‐month follow‐up. The fluoroscopy time varied, likely owing to the variable complexity of the cases.

Conclusions

The use of EAM, in combination with traditional intracardiac electrograms with or without fluoroscopy, allows more targeted and precise placement of leads for HBP and LBBAP pacing. Further investigation is needed to determine this strategy's long‐term performance and to optimize patient selection.
Dyslipidemia in diabetic kidney disease classified by proteinuria and renal dysfunction: A cross‐sectional study from a regional diabetes cohort
Authors: Hirano Tsutomu , Satoh Noriyuki , Kodera Rieko , Hirashima Takeshi , Suzuki Natsuko , Aoki Ema , Oshima Taito , Hosoya Mitsuru , Fujita Masahiro , Hayashi Toshiyuki , Ito Yasuki
Published: October 2021

Aims/Introduction

Diabetic kidney disease (DKD) exacerbates dyslipidemia and increases the incidence of atherosclerotic cardiovascular disease. DKD is a concept that includes typical diabetic nephropathy and an atypical phenotype without proteinuria. We investigated dyslipidemia in different DKD phenotypes that have not been fully studied.

Materials and Methods

Fasting plasma was obtained from 1,073 diabetes patients enrolled in the regional diabetes cohort (ViNA cohort). Non‐proteinuric and proteinuric DKD were defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 in the absence or presence of urinary albumin‐to‐creatinine ratio >300 mg/g. Novel lipid risk factors, low‐density lipoprotein (LDL) triglyceride (TG) and small dense LDL cholesterol were measured using our established homologous assay.

Results

The proportion of atherosclerotic cardiovascular disease patients was higher in non‐proteinuric DKD and even higher in proteinuric DKD than in non‐DKD. Increased estimated glomerular filtration rate grade and albuminuric stage were independently correlated with higher TG, TG‐rich lipoprotein cholesterol and apolipoprotein CIII. Therefore, proteinuric DKD had the highest of these levels. Small dense LDL cholesterol and LDL‐TG were higher in the proteinuria without renal dysfunction group in the lipid‐lowering drug‐free subset. Lipoprotein(a) was higher in DKD regardless of proteinuria.

Conclusions

Proteinuria was associated with an atherogenic subspecies of LDL, whereas renal dysfunction was associated with increased lipoprotein(a). Proteinuria and renal dysfunction independently exacerbated TG‐rich lipoprotein‐related dyslipidemia. This is in good agreement with the results of large‐scale clinical studies in which proteinuria and renal dysfunction synergistically increased the risk of atherosclerotic cardiovascular disease in populations with diabetes.
Site fidelity and shallow genetic structure in the common smooth‐hound shark Mustelus mustelus confirmed by tag‐recapture and genetic data
Authors: Klein Juliana D. , Asbury Tamaryn A. , da Silva Charlene , Hull Kelvin L. , Dicken Matthew L. , Gennari Enrico , Maduna Simo N. , Bester‐van der Merwe Aletta E.
Published: October 2021

The common smooth‐hound shark, Mustelus mustelus, is a widely distributed demersal shark under heavy exploitation from various fisheries throughout its distribution range. To assist in the development of appropriate management strategies, the authors evaluate stock structure, site fidelity and movement patterns along the species’ distribution in southern Africa based on a combination of molecular and long‐term tag‐recapture data. Eight species‐specific microsatellite markers (N = 73) and two mitochondrial genes, nicotinamide adenine dehydrogenase subunit 4 and control region (N = 45), did not reveal any significant genetic structure among neighbouring sites. Nonetheless, tagging data demonstrate a remarkable degree of site fidelity with 76% of sharks recaptured within 50 km of the original tagging location. On a larger geographic scale, dispersal is governed by oceanographic features as demonstrated by the lack of movements across the Benguela‐Agulhas transition zone separating the South‐East Atlantic Ocean (SEAO) and South‐West Indian Ocean (SWIO) populations. Microsatellite data supported very shallow ocean‐based structure (SEAO and SWIO) and historical southward gene flow following the Agulhas Current, corroborating the influence of this dynamic oceanographic system on gene flow. Moreover, no movements between Namibia and South Africa were observed, indicating that the Lüderitz upwelling formation off the Namibian coast acts as another barrier to dispersal and gene flow. Overall, these results show that dispersal and stock structure of M. mustelus are governed by a combination of behavioural traits and oceanographic features such as steep temperature gradients, currents and upwelling systems.
RegioFEM– Informing future‐oriented flood risk management at the regional scale (Part I)
Authors: Löschner Lukas , Eder Markus , Herrnegger Mathew , Hogl Karl , Nordbeck Ralf , Scherhaufer Patrick , Schober Bernhard , Seher Walter , Wesemann Johannes , Zahnt Nina , Habersack Helmut
Published: October 2021

This contribution presents an integrated method to inform future‐oriented flood risk management across policy domains at the scale of river sections and (sub)catchments. The RegioFEM (Regional Floodplain Evaluation Matrix) combines approaches from hydrology, hydraulic engineering, spatial planning and stakeholder engagement to assess the dynamic changes in floodplains in consideration of projected investments in flood protection, expected settlement and infrastructure development and the likely climate‐induced changes in flood runoff. In this paper, we present the step‐by‐step approach of the RegioFEM, outlining how the method can be applied and replicated in practice in support of catchment‐oriented and forward‐looking flood management policies. The RegioFEM builds on the understanding of floodplains as coupled human and natural systems. It supports the simple comparative evaluation of the expected impacts of future developments in riparian areas on flood risk change and thus provides a basis to anticipate reciprocal effects between flood defence and land development to improve the sectoral interplay of integrated flood policies.
Patterns of incident dementia codes during the COVID‐19 pandemic at an integrated healthcare system
Authors: Borson Soo , Chen Aiyu , Wang Susan E. , Nguyen Huong Q.
Published: October 2021

Background

The COVID‐19 pandemic delayed diagnosis and care for some acute conditions and reduced monitoring for some chronic conditions. It is unclear whether new diagnoses of chronic conditions such as dementia were also affected. We compared the pattern of incident Alzheimer's disease and related dementia (ADRD) diagnosis codes from 2017 to 2019 through 2020, the first pandemic year.

Methods

Retrospective cohort design, leveraging 2015–2020 data on all members 65 years and older with no prior ADRD diagnosis, enrolled in a large integrated healthcare system for at least 2 years. Incident ADRD was defined as the first ICD‐10 code at any encounter, including outpatient (face‐to‐face, video, or phone), hospital (emergency department, observation, or inpatient), or continuing care (home, skilled nursing facility, and long‐term care). We also examined incident ADRD codes and use of telehealth by age, sex, race/ethnicity, and spoken language.

Results

Compared to overall annual incidence rates for ADRD codes in 2017–2019, 2020 incidence was slightly lower (1.30% vs. 1.40%), partially compensating later in the year for reduced rates during the early months of the pandemic. No racial or ethnic group differences were identified. Telehealth ADRD codes increased fourfold, making up for a 39% drop from face‐to‐face outpatient encounters. Older age (85+) was associated with higher odds of receiving telecare versus face‐to‐face care in 2020 (OR:1.50, 95%CI: 1.25–1.80) and a slightly lower incidence of new codes; no racial/ethnic, sex, or language differences were identified in the mode of care.

Conclusions

Rates of incident ADRD codes dropped early in the first pandemic year but rose again to near pre‐pandemic rates for the year as a whole, as clinicians rapidly pivoted to telehealth. With refinement of protocols for remote dementia detection and diagnosis, health systems could improve access to equitable detection and diagnosis of ADRD going forward.
Effect of gestational weight gain on placental weight: A single tertiary referral center study of Japanese women
Authors: Jin Toki , Kyozuka Hyo , Fukuda Toma , Fujimori Mimori , Murata Tsuyoshi , Nomura Shinji , Suzuki Daisuke , Nomura Yasuhisa , Imamura Takashi , Yasuda Shun , Yamaguchi Akiko , Fujimori Keiya
Published: October 2021

Aim

The effect of gestational weight gain on placental weight has not been elucidated. We aimed to examine the effect of body weight gain during pregnancy on the Japanese standardized z‐score of placental weight, based on the pre‐pregnancy body mass index.

Methods

This retrospective cohort study included Japanese women with singleton pregnancies who gave birth during 2013–2019 at Ohta Nishinouchi Hospital. Participants (n = 3610) were categorized by their pre‐pregnancy body mass index: G1 (<18.5 kg/m2), G2 (18.5 to <20.0 kg/m2), G3 (20.0 to <23.0 kg/m2), G4 (23.0 to <25.0 kg/m2), and G5 (≥25.0 kg/m2). Multiple linear regression analysis was used to identify associations between insufficient or excessive gestational weight gain in each body mass index category and z‐score of placental weight, with adjustments for maternal age, assisted reproductive technology, and maternal pre‐pregnancy conditions, such as hypertension, diabetes mellitus, myoma uteri, and uterine anomalies.

Results

Among the 3610 women assessed, 479, 692, 1292, 435, and 711 were in G1–G5, respectively. In G1, G3, and G4, excessive weight gain increased the placental weight z‐score ([B: 0.50, 95% confidence interval [CI]: 0.23–0.76], [B: 0.19, 95% CI: 0.19–0.33], and [B: 0.18, 95% CI: 0.10–0.26]). Insufficient weight gain decreased the placental weight z‐score in G3 (B: −0.19, 95% CI: −0.33 to −0.06) and G4 (B: −0.21, 95% CI: −0.29 to −0.13) women.

Conclusion

The effect of weight gain during pregnancy on placental size varies by pre‐pregnancy body mass index. This result may guide personalized pre‐conception counseling to improve the outcomes of offspring.
Periodontal disease inequities among Indigenous populations: A systematic review and meta‐analysis
Authors: Nath Sonia , Poirier Brianna , Ju Xiangqun , Kapellas Kostas , Haag Dandara , Jamieson Lisa
Published: October 2021

The prevalence of periodontal disease varies considerably between Indigenous and general populations. The aim of this systematic review was to assess the global prevalence of periodontal disease among Indigenous populations in comparison with non‐Indigenous populations. A systematic electronic search of databases and grey literature sources was conducted of all records through to February 2021. Study selection criteria included original data that reported the prevalence of periodontal diseases among an Indigenous population and compared with a non‐Indigenous population, without any restriction on age, sex, language or geographical location. Critical appraisal was conducted with the Joanna Briggs Institute (JBI) tool for prevalence studies. A random‐effects model using standardised mean difference (SMD) as the effect measure was used to estimate the pooled prevalence of periodontitis. Subgroup analysis of study location and publication source was also performed. Publication bias was assessed using Egger's test, and funnel plots were used for visualisation. A total of 19 articles were included for descriptive and meta‐analysis. The overall prevalence of periodontitis was 35% (95% CI: 0.18, 0.52) higher among the Indigenous population than the non‐Indigenous population. The pooled prevalence of periodontitis was consistently higher among the Indigenous populations when stratified according to periodontitis definition employed, study location and publication source. Indigenous populations have a higher prevalence of periodontitis than non‐Indigenous populations. To decrease oral health inequities, more emphasis should be given to oral health promotion and specific culturally safe interventions working in partnership with Indigenous populations.
Context‐dependent effects of glucocorticoids on the lizard gut microbiome
Authors: MacLeod Kirsty J. , Kohl Kevin D. , Trevelline Brian K. , Langkilde Tracy
Published: October 2021

The vertebrate gut microbiota (bacterial, archaeal and fungal communities of the gastrointestinal tract) can have profound effects on the physiological processes of their hosts. Although relatively stable, changes in microbiome structure and composition occur due to changes in the environment, including exposure to stressors and associated increases in glucocorticoid hormones. Although a growing number of studies have linked stressor exposure to microbiome changes, few studies have experimentally explored the specific influence of glucocorticoids on the microbiome in wild animals, or across ecologically important processes (e.g., reproductive stages). Here we tested the response of the gut microbiota of adult female Sceloporus undulatus across gestation to ecologically relevant elevations of a stress‐relevant glucocorticoid hormone (CORT) in order to determine (i) how experimentally elevated CORT influenced microbiome characteristics, and (ii) whether this relationship was dependent on reproductive context (i.e., whether females were gravid or not, and, in those that were gravid, gestational stage). We show that the effects of CORT on gut microbiota are complex and depend on both gestational state and stage. CORT treatment altered microbial community membership and resulted in an increase in microbiome diversity in late‐gestation females, and microbial community membership varied according to treatment. In nongravid females, CORT treatment decreased interindividual variation in microbial communities, but this effect was not observed in late‐gestation females. Our results highlight the need for a more holistic understanding of the downstream physiological effects of glucocorticoids, as well as the importance of context (here, gestational state and stage) in interpreting stress effects in ecology.
History or demography? Determining the drivers of genetic variation in North American plants
Authors: López‐Delgado Julia , Meirmans Patrick G.
Published: October 2021

Understanding the impact of historical and demographic processes on genetic variation is essential for devising conservation strategies and predicting responses to climate change. Recolonization after Pleistocene glaciations is expected to leave distinct genetic signatures, characterised by lower genetic diversity in previously glaciated regions. Populations’ positions within species ranges also shape genetic variation, following the central‐marginal paradigm dictating that peripheral populations are depauperate, sparse and isolated. However, the general applicability of these patterns and relative importance of historical and demographic factors remains unknown. Here, we analysed the distribution of genetic variation in 91 native species of North American plants by coupling microsatellite data and species distribution modelling. We tested the contributions of historical climatic shifts and the central‐marginal hypothesis on genetic diversity and structure on the whole data set and across subsets based on taxonomic groups and growth forms. Decreased diversity was found with increased distance from potential glacial refugia, coinciding with the expected make‐up of postglacially colonised localities. At the range periphery, lower genetic diversity, higher inbreeding levels and genetic differentiation were reported, following the assumptions of the central‐marginal hypothesis. History and demography were found to have approximately equal importance in shaping genetic variation.
Spatial and host related genomic variation in partially sympatric cactophagous moth species
Authors: Poveda‐Martínez Daniel , Varone Laura , Fuentes Corona Malena , Hight Stephen , Logarzo Guillermo , Hasson Esteban
Published: October 2021

Surveys of patterns of genetic variation in natural sympatric and allopatric populations of recently diverged species are necessary to understand the processes driving intra‐ and interspecific diversification. The South American moths Cactoblastis cactorum, Cactoblastis doddi and Cactoblastis bucyrus are specialized in the use of cacti as host plants. These species have partially different geographic ranges and differ in patterns of host plant use. However, there are areas that overlap, particularly, in northwestern Argentina, where they are sympatric. Using a combination of genome‐wide SNPs and mitochondrial data we assessed intra and interspecific genetic variation and investigated the relative roles of geography and host plants on genetic divergence. We also searched for genetic footprints of hybridization between species. We identified three well delimited species and detected signs of hybridization in the area of sympatry. Our results supported a hypothetical scenario of allopatric speciation in the generalist C. cactorum and genetic interchange during secondary geographic contact with the pair of specialists C. bucyrus and C. doddi that probably speciated sympatrically. In both cases, adaptation to new host plants probably played an important role in speciation. The results also suggested the interplay of geography and host plant use as drivers of divergence and limiting gene flow at intra and interspecific levels.
Lophozia svalbardensis (Lophoziaceae) in continental North America, Greenland and Siberia, its identity, variation and differentiation
Authors: Potemkin Alexey D. , Vilnet Anna A.
Published: October 2021

Lophozia excisa var. succulenta (≡ Lophoziopsis excisa var. succulenta) is a synonym of Lophozia svalbardensis. This conclusion is based on morphological investigation and a subsequent molecular‐genetic study which revealed an absence of variability among nucleotide sequences of ITS1‐2 nrDNA and trnL‐F cpDNA in specimens from Arctic Alaska, West Siberian Arctic and Svalbard. Lophozia svalbardensis is reported for the first time for continental North America, Greenland and Siberia based on revised data on the distribution of Lophozia excisa var. succulenta. An expanded description of Lophozia svalbardensis, its variation, differentiation and photomicrographs of specimens from the Seward and Gydanskiy peninsulas are provided. The variability of pigmentation pattern, cell walls, perianth structure and gemmae is described.
How chance explains
Authors: Hicks Michael Townsen , Wilson Alastair
Published: October 2021

What explains the outcomes of chance processes? We claim that their setups do. Chances, we think, mediate these explanations of outcome by setup but do not feature in them. Facts about chances do feature in explanations of a different kind: higher‐order explanations, which explain how and why setups explain their outcomes. In this paper, we elucidate this 'mediator view' of chancy explanation and defend it from a series of objections. We then show how it changes the playing field in four metaphysical disputes concerning chance. First, it makes it more plausible that even low chances can have explanatory power. Second, it undercuts a circularity objection against reductionist theories of chance. Third, it redirects the debate about a prominent argument against epistemic theories of chance. Finally, it sheds light on potential chancy explanations of the Universe's origin.
Physical performance after pediatric solid organ transplantation
Authors: Mäenpää Heidi , Tainio Juuso , Jalanko Hannu , Arokoski Jari , Jahnukainen Timo
Published: October 2021

Introduction

Low physical activity is a well‐recognized problem in pediatric solid organ transplant recipients; however, little is known about the differences between transplant groups. Physical performance testing was performed in a cohort of pediatric kidney, liver, and heart transplant recipients.

Methods

Fifty‐one patients (54.9% boys), including 17 liver, 20 kidney, 2 combined liver‐kidney, and 12 heart transplant recipients, were tested at the median age of 11.5 (7.5–14.9) years. The results were compared with a control group, which consisted of 425 healthy schoolchildren. The physical performance test included six different tests of endurance, strength, flexibility, and speed.

Results

The transplant recipients performed worse on most tests when compared with the control subjects (leg‐lift test 42.0 vs. 44.9 repetitions, p = .002; repeated squatting 21.6 vs. 23.9 repetitions, p < .001; sit‐up test 9 vs. 17 vs. 9 repetitions, p < .001, back extension 20 vs. 35 repetitions, p < .001; and shuttle run test 26.5 vs. 23.7 seconds, p < .001). None of the test results differed statistically significantly between the transplant groups.

Conclusion

The physical performance of pediatric solid organ transplant recipients is lower than that of their healthy peers but do not differ between different transplant groups. More systematic rehabilitation programs and follow‐up are needed.
A Neonatal ABO non‐compatible heart transplant from a circulatory‐determined death donor using NRP/Cold storage
Authors: Gil‐Jaurena Juan‐Miguel , Pérez‐Caballero Ramón , Murgoitio Uxue , Pardo Carlos , Pita Ana , Calle Corazón , Camino Manuela , Medrano Constancio
Published: October 2021

Background

Donation after Circulatory death is gaining worldwide acceptance. Most protocols regard their first cases to be performed with donor and recipient in the same institution. Few records of children or distant procurement have been published.

Methods

Our institution was offered a heart from a 3‐day‐old, 3.4‐kg child, blood group A, suffering irreversible encephalopathy. Parents accepted withdrawal of life‐sustaining therapy and agreed to donation. The donor hospital was located 340 km away. Concomitantly, a 2‐month‐old, 3.1 kg, blood group type B and with non‐compaction ventricles was awaiting for the heart transplant in our unit.

Results

Thirty‐seven minutes after withdrawal of life‐sustaining therapy, the heart arrested. Five minutes afterwards, a sternotomy was performed. The supra‐aortic vessels were clamped altogether. Aorta and right appendage were cannulated and connected to heart‐lung machine. The innominate artery above the clamp was severed. The heart resumed spontaneous rhythm in less than 1 min. Ventilation was restored and extracorporeal circulation was maintained for 32 min. Upon cardiologic arrest, the graft was harvested as routinely. The heart was cold‐stored and transported by plane to our Hospital. An orthotopic bicaval transplant was performed. Overall cold ischaemia was 245 min. Ten weeks later, the child was discharged home in good condition.

Conclusion

Donation in circulatory death could increase the pool in neonates. Extracorporeal circulation proves successful for procurement in neonates. Distant procurement plus cold storage for donation in circulatory death is feasible. Donation in circulatory death and ABO non‐compatible strategies are complementary to each other.
Suffering as significantly disrupted agency
Authors: Corns Jennifer
Published: October 2021

This article offers a new theory of suffering as significantly disrupted agency. In presenting it, I here make three significant contributions. First, I subject the leading account of suffering as undesired unpleasant experience (Brady, 2018) to its first dose of sustained scrutiny. Second and drawing on this discussion, I identify and liberate eight desiderata for any account of suffering. Third, I present the novel account of suffering as significantly disrupted agency and argue that it satisfies these desiderata. Moreover, I argue that elaborating this proposal with a minimal model of agency allows us to capture both the suffering of a wide range of organisms and the complex dynamics of suffering as it is endured. I conclude by briefly highlighting some of the potential implications of the theory for further theoretical and practical inquiries.
Summer temperatures reach the thermal tolerance threshold of photosynthetic decline in temperate conifers
Authors: Kunert N. , Hajek P. , Hietz P. , Morris H. , Rosner S. , Tholen D.
Published: October 2021

Climate change‐related environmental stress has been recognized as a driving force in accelerating forest mortality over the last decades in Central Europe. Here, we aim to elucidate the thermal sensitivity of three native conifer species, namely Norway spruce (Picea abies), Scots pine (Pinus sylvestris) and silver fir (Abies alba), and three non‐native species, namely Austrian pine (Pinus nigra), Douglas fir (Pseudotsuga menziesii) and Atlas cedar (Cedrus atlantica).

Thermal sensitivity, defined here as a decline of the maximum quantum yield of photosystem II (Fv/Fm) with increasing temperature, was measured under varying levels of heat stress and compared with the turgor loss point (πtlp) as a drought resistance trait. We calculated three different leaf thermotolerance traits: the temperature at the onset (5%) of the Fv/Fm decline (T5), the temperature at which Fv/Fm was half the maximum value (T50) and the temperature at which only 5% Fv/Fm remained (T95).

T5 ranged from 38.5 ± 0.8 °C to 43.1 ± 0.6 °C across all species, while T50 values were at least 9 to 11 degrees above the maximum air temperatures on record for all species. Only Austrian pine had a notably higher T5 value than recorded maximum air temperatures. Species with higher T5 values were characterized by a less negative πtlp compared to species with lower T5.

The six species could be divided into ‘drought‐tolerant heat‐sensitive’ and ‘drought‐sensitive heat‐tolerant’ groups. Exposure to short‐term high temperatures thus exhibits a considerable threat to conifer species in Central European forest production systems.
Oral corticosteroid stewardship for asthma: Time to move from theory to routine clinical practice
Authors: Watchorn David , Menzies‐Gow Andrew
Published: October 2021

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