bluuebunny/crossref_metadata_2025 huggingface dataset:
Male infertility and environmental factors
Authors: Perheentupa Antti
Published: May 2019

Semen quality in men is decreasing. Numerous chemicals act as endocrine-disrupting agents and their detrimental effect on fertility and spermatogenesis has been shown in rodent studies. Consequences in humans are challenging to study and effects of fetal exposure on fertility are apparent only 2 decades later. Appropriate animal models are needed to study the reproductive effects of the thousands of chemicals that humans come in contact with. The burden of proof of chemical safety must shift from the individual and health care provider to the manufacturers similar to the licensing of medical drugs.
Case Study: Periumbilical Pain in a 14-Year-Old Male
Authors: Donahue Hannah , Koonce Robin
Published: May 2019

This is a “Name the Diagnosis” for a 14-year-old male adolescent who presented with periumbilical pain. On ultrasound, he was noted to have intussusception. Because of his age, further imaging was performed to determine the lead point for his intussusception. During surgery, he was found to have a Meckel's diverticulum, which was acting as the lead point.
Is the evidence strong enough for acupuncture ameliorates clinical symptoms in patients with amyotrophic lateral sclerosis
Authors: Liao Qun , Li Zunjiang , Zeng Hai , Feng Xiaocong , Huang Wei , Fu Chuying , Liang Xiaolin , Li Tian
Published: May 2019

Background:

Amyotrophic lateral sclerosis (ALS) is the most common form of motor neuron diseases. Until now, it lacks effective drugs for its treatment, and the median survival time of ALS is reported as only 20 to 48 months after the onset of symptoms. Acupuncture served as part of traditional Chinese therapy, has been widely applied to clinical practice for patients with ALS but lacks studies to verify its efficacy. This study provides a protocol of systematic review, with which we will comprehensively verify the effects of acupuncture on ALS with evidence-based studies.

Methods:

The eligible studies will be collected from 4 English databases (the MEDLINE via PubMed, the Cochrane Library, EMBASE, the Web of Science, and Ovid database), and 4 Chinese databases (China Science and Technology Journal Database, Chinese Biomedical Literature Database, Wan-fang Database, China National Knowledge Infrastructure) from October 2000 to October 2022. The primary outcome measure is the change in amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) scores. We will use RevMan V.5.3 software to calculate the data synthesis and will conduct meta-analysis based on the collected data.

Results:

The primary outcome measure is the change in ALSFRS-R scores, and secondary outcome measures included changes in forced vital capacity, grasping power, pinch strength, modified Norris Scale, ALS assessment questionnaire-40, and time to activity of daily living-independent will be measured and comprehensively assessed to evaluate the effect of acupuncture on ALS from this systematic review and meta-analysis.

Conclusion:

The systematic review and meta-analysis will assess the effect of acupuncture in the treatment of ALS with up-to-date clinical evidence.

PROSPERO registration number:

PROSPERO CRD 42019124785.
Long non-coding RNA antisense non-coding RNA in the INK4 locus expression correlates with increased disease risk, severity, and inflammation of allergic rhinitis
Authors: Qian Xiaoqiong , Shi Song , Zhang Guijuan
Published: May 2019

The aim of the current study was to investigate the expression of long non-coding RNA (lncRNA) antisense non-coding RNA in the INK4 locus (ANRIL) in allergic rhinitis (AR) patients, and to further explore the association of lncRNA ANRIL expression with AR risk, severity, and inflammation.

In this case-control study, 96 AR patients and 96 non-atopic obstructive snoring patients who underwent adenoid surgery were consecutively recruited. Disease severity of AR patients was assessed via individual nasal symptom score (INSS) and total nasal symptom score (TNSS). Nasal mucosa samples were collected from AR patients and controls, then lncRNA ANRIL and inflammatory cytokine levels were assessed via quantitative polymerase chain reaction.

LncRNA ANRIL expression was increased in AR patients (3.605 [1.763–4.981]) compared with controls (1.183 [0.438–2.985]), and it well distinguished AR patients from controls with an area under curve of 0.746 (95% CI: 0.679–0.814). Correlation analyses revealed that lncRNA ANRIL expression was positively associated with itching score and congestion score, while it was not associated with nasal rhinorrhea score or sneezing score. Besides, lncRNA ANRIL was also positively correlated with TNSS, tumor necrosis factor α, interleukin (IL)-4, IL-6, IL-13, and IL-17, while negatively associated with IL-10 and interferon-γ. And no association of lncRNA ANRIL expression with IL-1β, IL-5, or IL-8 expression was discovered.

LncRNA ANRIL expression correlates with increased AR risk, severity, and inflammation, implying that lncRNA ANRIL might be involved in the pathogenesis of AR.
Expression of MIF, Beclin1, and LC3 in human salivary gland adenoid cystic carcinoma and its prognostic value
Authors: Li Chenxi , Chen Qingli , Tian Zhongqi , Li Shixiao , Gong Zhongcheng , Lin Zhaoquan , Wang Bing , Liu Hui
Published: May 2019

Adenoid cystic carcinoma (ACC) is an uncommon salivary gland malignancy with a poor long-term prognosis. Clinical reports show the high rates of local recurrences and distant metastases. This study aimed to investigate the expression of MIF, Beclin1, and light-chain 3 (LC3) in salivary adenoid cystic carcinoma (SACC).

Tissue specimens were obtained from 48 salivary glands adenoid cystic carcinoma (SACC) patients and 15 oral squamous cell carcinoma (OSCC) patients. Immunohistochemical staining was performed to estimate the level of LC3, Beclin1, and MIF. All SACC patients were followed up. The Kaplan–Meier method was used to compare the prognosis of patients after treatment.

The 3-year, 5 year-, and 10 year-survival rates of the SACC patients were 83.9%, 69.9%, and 46.6%, respectively. MIF, LC3, and Beclin1 in SACC were all obviously over-expressed. MIF showed an increased tendency in cases with advanced TNM stages, and at the same time, there was an inversely proportional relationship between MIF and LC3, Beclin1.

The long-term survival of SACC patients is poor. MIF might be a risk factor for SACC patients, whereas, LC3 and Beclin1 might be an effective strategy for treatment of SACC.
Single shot versus continuous technique adductor canal block for analgesia following total knee arthroplasty
Authors: Zhang Lu-kai , Zhang Bo-ya , Quan Ren-fu , Xu Hong , Sun Yu-jie , Zhou Jian-hong
Published: May 2019

Background:

An adductor canal block (ACB) provides recognized analgesia following total knee arthroplasty (TKA). This meta-analysis compared the single-injection ACB (SACB) with the continuous-injection ACB (CACB).

Method:

Relevant studies were searched from PubMed (1996–October 2018), Embase (1980–October 2018), and Cochrane Library (CENTRAL, October 2018). Four randomized controlled trials (RCTs), which compared SACB with CACB, were included in our meta-analysis.

Results:

Four RCTs met the inclusion criteria. Our pooled data indicated that the SACB group had similar efficacy compared with the CACB group in terms of morphine consumption (P = .19), time to first opioid request (P = .32), range of motion (P = .97), and visual analogue scale (VAS) scores at 24 hours at rest (P = .12) and movement (P = .24), without increasing the risk of complications (P = .97) and length of stay (P = .54).

Conclusion:

The SACB technique provides similar analgesia in the 24 hours following TKA compared with CACB, while the CACB method was better over 48 hours.
Dose-response relationship between higher serum calcium level and higher prevalence of hyperuricemia
Authors: Liu Zhichen , Ding Xiang , Wu Jing , He Hongyi , Wu Ziying , Xie Dongxing , Yang Zidan , Wang Yilun , Tian Jian
Published: May 2019

The aim of the study was to examine the relationship between serum calcium (Ca) levels and the prevalence of hyperuricemia (HU).

The data included in this analysis were extracted from a population-based study conducted at the Xiangya Hospital Health Management Centre. Serum Ca levels were measured using the Arsenazo III method. HU was defined as the uric acid ≥416 μmol/L for male subjects, and ≥360 μmol/L for female subjects. The association between serum Ca levels and the prevalence of HU was evaluated using logistic and spline regression.

The present study included a total of 6337 subjects. The overall prevalence of HU for the target population was 17.5%. Compared with the lowest quintile, the odds ratios adjusted by age, sex, body mass index, smoking, and drinking for HU were 1.51 [95% confidence interval (CI): 1.20–1.91], 1.43 (95% CI: 1.13–1.82), 2.02 (95% CI: 1.61–2.54), and 2.54 (95% CI: 2.02–3.18) for the second, third, fourth, and fifth quintiles of serum Ca levels, respectively (Pfor trend <.001), and a positive dose-response relationship was observed. Similar results were observed for men and women, respectively. The findings were not materially altered by the adjustment for further potential confounders.

Subjects with higher serum Ca levels are subject to a higher prevalence of HU in a dose-response relationship manner.
Bone transport with a unilateral external fixator for femoral infected nonunion after intramedullary nailing fixation
Authors: Liu Chunfeng , Zhang Xianghong , Zhang Xiangsheng , Li Zhihong , Xu Yaozeng , Liu Tang
Published: May 2019

This is a therapeutic study to evaluate the results of femoral infected nonunion using bone transport with an external fixator after debridement and irrigation. We retrospectively reviewed 15 patients with femoral infected nonunion after intramedullary nailing fixation of fractures from October 1999 to January 2010 in our institute. There were 7 males and 8 females with an average age of 32.5 years. First, the infection was eradicated completely, and the medullary canals were continuous irrigated for 2-3 weeks. After eradicating the infection tissues, the mean amount of bone defect was 8.7 cm (range, 4.0–16.0 cm). The unilateral consecutive distraction-compression osteosynthesis technique was applied after long-time medullary cavity-wound exclusion surgery. Enumeration data was described by frequency and measurement data by mean. Bone infections were controlled in all patients except 1 patient after the first debridement and irrigation. All patients have achieved bony union without recurrence of infection during the follow-up period, the mean external fixation index was 43.4 day/cm. According to the criteria recommended by Paley, the bone results were graded as excellent in 13 (86.7%) cases and good in 2 (13.3%) cases; the functional results were graded as excellent in 6 (40.0%) cases, good in 6 (40.0%) cases and fair in 3 (20.0%) cases. In management of femoral infectious nonunion which caused by intramedullary nailing fixation, the surgery of consecutive compression-distraction osteogenesis with unilateral external fixator achieves a highly effective treatment, and the method of debridement and irrigation is a compatible choice on the phase of infection-elimination.
Efficacy and safety of direct-acting antiviral therapy for chronic hepatitis C genotype 6
Authors: Luo Aoran , Xu Pan , Wang Jin , Li Zuli , Wang Shunli , Jiang Xiaoyan , Ren Hong , Luo Qiang
Published: May 2019

Background:

Because of the heterogeneity of hepatitis C virus (HCV) distribution of different genotypes, large-scale clinical trials on direct-acting antiviral (DAA) mainly included patients with genotype 1 and genotype 3 infection. Data on the efficacy of direct-acting antiviral agents in patients with chronic genotype 6 HCV infection are limited.

Methods:

The PubMed, Embase, and the Cochrane Libraries were searched comprehensively. All published clinical trials assessing the efficacy of DAA therapy for patients with chronic genotype 6 HCV infection were included. Sustained virological response (SVR) and rapid virological response (RVR) were pooled. Additional meta-analyses were also performed to compare the efficacy of DAA therapy in HCV-6 versus HCV-1 or HCV-3 patients.

Results:

Seventeen studies met the inclusion criteria and were included in our meta-analysis. The pooled SVR of all single arms was 95% [95% confidence interval (CI): 0.90–0.97]. The pooled RVR of all single arms was 97% (95% CI: 0.95–0.99). The SVR and RVR were both similar between HCV-6 and HCV-1 or HCV-3. Adverse events were common but rarely caused treatment interruption.

Conclusion:

Based on the available data, our results indicate that DAA treatment is effective and safe for patients with genotype 6 HCV infection, and the efficacy was similar compared to patients with genotype 1 HCV or genotype 3 HCV infection.
The association between adherence and dementia in chronic obstructive pulmonary disease
Authors: Liao Kuang-Ming , Chen Chung-Yu
Published: May 2019

Our previous studies have shown that patients with chronic obstructive pulmonary disease (COPD) have an increased risk of dementia and that COPD combined with dementia confers an increased risk of acute respiratory dysfunction, severe sepsis, and hospital mortality. The aim of this study was to investigate whether medication adherence can decrease the risk of dementia in COPD.

This retrospective study enrolled COPD patients from 1 million beneficiaries randomly sampled from all beneficiaries in Taiwan. We excluded COPD patients not prescribed a bronchodilator or those using theophylline or short-acting β2-agonists for <1 year. To ensure a sufficient observation period, we excluded patients diagnosed with dementia within 1 year after the diagnosis of COPD or those prescribed bronchodilators after the diagnosis of dementia. Patients with COPD and a history of severe mental disorders were also excluded.

There was a total of 13,015 first diagnoses of COPD from 1998 to 2012, of whom 9,489 had a proportion of days covered (PDC) <80% and 1,206 had a PDC ≥80% before matching. In the high PDC group, 226 (18.74%) patients had acute exacerbations of COPD and were hospitalized within 1 year after diagnosis. Compared with the PDC <80% group, the PDC ≥80% group had a risk of dementia with an adjusted hazard ration of 0.88, but there were no statistically significant differences (95% confidence interval, 0.57–1.35).

Medication adherence to bronchodilators may not modify the risk of dementia in patients with COPD.
Corneal cross-linking for keratoconus caused by compulsive eye rubbing in patients with Tourette syndrome
Authors: Shinzawa Megumi , Kato Naoko , Kasai Kozue , Konomi Kenji , Chai Yuzhu , Shimazaki Jun
Published: May 2019

Rationale:

Eye rubbing is an important risk factor for keratoconus progression. Tourette syndrome (TS) is a neurological disorder, and approximately 50% of individuals with TS exhibit obsessive-compulsive behaviors including eye rubbing. We report the effects of corneal cross-linking (CXL) on the progression of keratoconus combined with psychiatric treatment for 3 patients with TS.

Patients’ concerns:

Three cases, 24-year-old male, 14-year-old male, and 17-year-old male, were all referred to our institute, due to decreased visual acuity.

Diagnosis:

All 3 patients were diagnosed with progressive keratoconus. They were found to rub their eyes, and were also diagnosed with TS by psychiatrists.

Intervention:

Upon diagnosis of keratoconus, we performed CXL on 1 eye of each patient.

Outcomes:

After CXL, there was no further progression. Psychiatric medication was also required.

Lessons:

For patients with keratoconus caused by eye rubbing due to TS, CXL seems to be effective when done in association with psychiatric treatment.
Recovery of paraplegia following postoperative epidural hematomas in lumbar canal stenosis surgery by closed kinetic chain (CKC) exercises
Authors: Komatsu Jun , Sato Keita , Iwabuchi Masumi , Fukuda Hironari , Kusano Keigo , Kaneko Kazuo , Shirado Osamu
Published: May 2019

Rationale:

A postoperative spinal epidural hematoma (PSEH) is among the most devastating complications following spine and spinal cord surgery, and it should be considered before performing microendoscopic decompression as part of minimally invasive surgery, since early recovery is one of the advantages of this procedure.

Patient concerns:

A 70-year-old woman with lumbar spinal stenosis at L4-5 underwent tubular surgery with the assistance of endoscopic laminectomy (MEL), but 2 days after the surgery, the patient noticed decreased lower limb sensation and power of the right leg, and she developed numbness from the level of L5 and weakness from the L4, 5 myotome distally.

Diagnoses:

An epidural hematoma at the L4-5 surgical site was found on magnetic resonance imaging of the lumbar spine and evacuated operatively. This rare complication appears to be the result of a PSEH. In the present case, complete neurological recovery was not achieved, despite rapid surgery.

Interventions:

The patient's course and physical therapy, which focused on attitude maintenance practice and muscle-strengthening exercise of the closed kinetic change (CKC) type from the early stage of paraplegia, were specifically examined.

Outcomes:

The patient recovered complete motor function with attitude maintenance practice and muscle strengthening exercises after 3 months. CKC exercise in particular may contribute to improving caudal muscle weakness, including the L4, 5 innervated area (e.g., tibialis anterior [TA], extensor hallucis longus [EHL], flexor hallucis longus [FHL], gastrocnemius [GC], etc.).

Lessons:

Prevention of PSEH is needed to not only avoid neurological deterioration, but also avoid delaying the patient's recovery. CKC exercise may contribute to improving the prolonged paralysis associated with a PSEH. Future studies should involve larger numbers of patients to evaluate the clinical features of PSEH and treatment by rehabilitation with more effective muscle exercises and stretches.
Hypertensive disorders during pregnancy and elevated blood pressure in the offspring
Authors: Yu Huan , He Yuan , Mao Zhengxia , Dong Wenbing , Fu Xiaodong , Lei Xiaoping
Published: May 2019

Background:

Hypertensive disorders during pregnancy (HDP), including gestational hypertension, preeclampsia (PE), and chronic hypertension, affect approximately 10% of pregnancies worldwide. PE was associated with elevated blood pressure (BP) in the offspring confirmed by previous literature. No previous systematic review has investigated the associations between the subtypes of HDP and BP in offspring. Therefore, from the published literature, the present systematic review and meta-analysis aims to reach to a clear consensus on this topic.

Methods:

The Cochrane Handbook for Systematic Reviews of Interventions was used to structure our methodological approach, and the Preferred Reporting Items for Systematic Reviews and Meta Analyses Protocols guidelines to this protocol. We will include cohort, case-control, and cross-sectional studies, in which HDP or its subtypes were reported and BP in the offspring was the outcome of interest. A systematic search of PubMed, Embase, the Cochrane library, and Web of Science will be conducted according to a specific search strategy. The titles and abstracts of all literature will be reviewed independently by 2 authors. A standardized data collection form will be used for data extraction. The overall pooled estimates will be calculated by meta-analysis in Revman 5.3 based on an inverse variance method. According to the heterogeneity by the I
2, a random-effect model or a fixed-effect model will be chosen to pool data. Risk of bias and quality of the studies will be assessed by a suitable bias classification tool.

Results:

This study will provide high-quality evidence of the effects in offspring BP, which were influenced by different subtypes of HDP.

Conclusion:

This systematic review will infer a conclusion on the associations between different subtypes of HDP and BP in offspring.

Ethics and dissemination:

Due to the data come from the published study, the present systematic review and meta-analysis does not require ethics approval. Findings will be published in a peer-reviewed journal.

Registration:

Supporting data can be found at the International Prospective Register of Systematic Reviews (PROSPERO) website, with registration number CRD 42018110872.
Efficacy of low-dose rivaroxaban in an 88-year-old female with pulmonary embolism
Authors: Zhou Huanyu , Wei Qi , Wu Haidi , Tang Minglong , Yang Shuo , Liu Yang , Qin Ling
Published: May 2019

Rationale:

Rivaroxaban has numerous advantages over traditional anticoagulation therapy. Fixed doses can be administered without requiring routine monitoring of coagulation, and anticoagulation efficacy is more predictable. Safety, including fewer drug interactions, and reduced bleeding, is also improved with rivaroxaban based on current recommendations. The goal of this report was to explore if low-dose rivaroxaban 10 mg once daily was effective in an elderly patient who developed minor bleeding when treated with rivaroxaban (10 mg twice daily) for a pulmonary embolism.

Patient concerns:

We present an 88-year-old female with dyspnea and fatigue, which became increasingly worse over a month in the absence of medication. Her weight was 64 kg. Routine coagulation assays and renal function were normal at time of admission.

Diagnosis:

Deep vein thrombosis and pulmonary embolism were confirmed by venous compression ultrasonography and computed tomography pulmonary angiography.

Interventions:

Oral rivaroxaban 10 mg twice daily was administered, but the patient developed hemoptysis and gum bleeding 5 days later. The dose of rivaroxaban was reduced to 10 mg once daily, and bleeding gradually disappeared after 3 days.

Outcome:

At follow-up 90 days after treatment, the patient reported no discomfort. Venous compression ultrasonography and computed tomography pulmonary angiography showed normal results; therefore, treatment was terminated.

Lessons:

Elderly patients exhibit variable tolerance of anticoagulants, warranting careful consideration of the risk of bleeding. Low-dose rivaroxaban was an effective treatment for pulmonary embolism in the elderly patient presented here.
Percutaneous vertebroplasty with granulated allogeneic bone grafting using screw-view model of navigation for thoracolumbar compressive fracture
Authors: Zhao Jianwu , Zhao Xin , Yang Lili , Qu Yang , Dong Rongpeng , Kang Mingyang , Zhang Xiwen , Zheng Changjun , Yu Tong
Published: May 2019

Rationale:

The aim of this study was to assess the accuracy of percutaneous puncture needle with screw view model of navigation (SVMN) and the effect of periacetabular vertebroplasty (PVP) with granulated allogeneic bone grafting in thoracolumbar compressive fracture (TCF).

Patient concerns:

A 46-year-old female patient associated with high fall injury showed symptoms characterized by back pain and restricted movement of the right lower extremity.

Diagnoses:

The patient was diagnosed with a TCF, right femoral neck fracture, and lumbar vertebrae hyperosteogeny.

Interventions:

A SVMN was used to guide our puncture needle insertion; and PVP was performed with granulated allogeneic bone grafting in this patient.

Outcomes:

The follow-up lasted for 29 months. It took 2.4 minutes to design the trajectory of puncture needle, 2.1 minutes to implant the puncture needle, and 6.3 minutes to undergone fluoroscopy. Postoperative visual analog scale and Oswestry disability index scores were improved obviously compared with those before the operation. The Cobb angle of fractured vertebrae improved from 9.3° to 7.3° after treatment. The height ratio of fractured vertebrae increased from 79.5% to 90.6% postoperatively. Intraoperative blood loss amounted to 11 ml. No clinical complications were observed, including neurovascular injury and new fracture of adjacent vertebra.

Lessons:

Puncture needle placement under the guidance of SVMN is verified as a convenient, safe and reliable method, and PVP with granulated allogeneic bone grafting can effectively restore the height of anterior fractured vertebra, filling the gaps in the fractured vertebrae, and reconstructing the completeness of the fractured vertebrae.
Information experiences, needs, and preferences of colonoscopy patients
Authors: Lee Eugene , Shafer Leigh Anne , Walker John R. , Waldman Celeste , Michaud Valerie , Yang Chengyue , Bernstein Charles N. , Hathout Linda , Park Jason , Sisler Jeff , Wittmeier Kristy , Restall Gayle , Singh Harminder
Published: May 2019

Better pre-colonoscopy education may lead to improved bowel preparation, decreased anxiety, and a willingness to go direct-to-colonoscopy. We assessed information experiences, needs, and preferences of patients undergoing colonoscopy.

A self-administered survey was distributed between 08/2015 and 06/2016 to patients in Winnipeg, Canada when they attended an outpatient colonoscopy. The amount, type, helpfulness, and satisfaction with information provided were analyzed. Linear and logistic regression analyses were used to assess predictors of satisfaction with various aspects of the information received, as well as overall satisfaction with the provided information.

Although the majority of the 1580 respondents were satisfied with the information they received, only 68% of respondents coming for a repeat colonoscopy and 59% of those coming for first colonoscopy perceived receiving just the right amount of information from their endoscopy doctor. One quarter or less of the respondents indicated they received just the right amount of information from any source other than their colonoscopy doctor. 38% coming for a first colonoscopy and 44% coming for a repeat colonoscopy indicated they received no information from their family physician. Those coming for their first colonoscopy had a lower average score (9.7 vs 11.1; P < .001) for amount of information received (scale 0-15), were less satisfied with the information they received (P = .005) and found the information to be less clear (P = .004).

Many patients going for colonoscopy in a large urban practice are inadequately informed about the various aspects of the procedure and it is worse for those going for first rather than repeat colonoscopy.
Non–English Language Availability of Community Health Center Websites
Authors: Rodriguez Jorge A. , Davis Roger B. , Percac-Lima Sanja
Published: May 2019

Background:

For limited English-proficient (LEP) patients, the digital divide has narrowed, creating a new population of Internet users. However, language-appropriate health information is difficult to find. Community health center (CHC) websites are health information resources and their homepages are critical access points for patients. CHCs supported by Health Resources and Services Administration (HRSA) care for many LEP patients.

Objective:

We sought to determine the number of HRSA-supported CHC websites providing translated homepage content.

Research Design:

In February 2017, we performed a cross-sectional analysis of the language availability of CHC homepages.

Measures:

The primary outcome was availability of translated content on CHC homepages. Secondary outcomes were method of translation and associations between homepage translation and CHC demographics, including percent LEP population and socioeconomic and Internet access characteristics.

Results:

Of the 1400 CHC homepages, 480 (34.3%) provided translated information with half using Google Translate. We found higher odds of having a translated homepage as the LEP population by county increased [odds ratio (OR): 1.26, confidence interval (CI): 1.07–1.49, P=0.005], Internet subscription at the state level increased (OR: 1.19, CI: 1.02–1.38, P=0.026), and if health centers were in metropolitan areas (OR: 1.81, CI: 1.31–2.51, P<0.001). There was also higher likelihood of having a homepage translated to Spanish in counties with higher Spanish LEP populations (OR: 1.39, CI: 1.19–1.63, P<0.001), but this did not extend to non-Spanish languages (OR: 0.85, CI: 0.71–1.04, P=0.131).

Conclusions:

Despite increased Internet use among LEP patients and linguistic diversity of the CHC populations, there is a lack of language-appropriate content on CHC website homepages.
Implementing an EHR-based Screening and Referral System to Address Social Determinants of Health in Primary Care
Authors: Buitron de la Vega Pablo , Losi Stephanie , Sprague Martinez Linda , Bovell-Ammon Allison , Garg Arvin , James Thea , Ewen Alana M. , Stack Marna , DeCarvalho Heloisa , Sandel Megan , Mishuris Rebecca G. , Deych Stella , Pelletier Patrick , Kressin Nancy R.
Published: May 2019

Background:

Social determinants affect health, yet there are few systematic clinical strategies in primary care that leverage electronic health record (EHR) automation to facilitate screening for social needs and resource referrals. An EHR-based social determinants of health (SDOH) screening and referral model, adapted from the WE CARE model for pediatrics, was implemented in urban adult primary care.

Objectives:

This study aimed to: (1) understand the burden of SDOH among patients at Boston Medical Center; and (2) evaluate the feasibility of implementing a systematic clinical strategy to screen new primary care patients for SDOH, use EHR technology to add these needs to the patient’s chart through autogenerated ICD-10 codes, and print patient language-congruent referrals to available resources upon patient request.

Research Design:

This observational study assessed the number of patients who were screened to be positive and requested resources for social needs. In addition, we evaluated the feasibility of implementing our SDOH strategy by determining the proportion of: eligible patients screened, providers signing orders for positive patient screenings, and provider orders for resource referral guides among patients requesting resource connections.

Results:

In total, 1696 of 2420 (70%) eligible patients were screened. Employment (12%), food insecurity (11%), and problems affording medications (11%) were the most prevalent concerns among respondents. In total, 367 of 445 (82%) patients with ≥1 identified needs (excluding education) had the appropriate ICD-10 codes added to their visit diagnoses. In total, 325 of 376 (86%) patients who requested resources received a relevant resource referral guide.

Conclusions:

Implementing a systematic clinical strategy in primary care using EHR workflows was successful in identifying and providing resource information to patients with SDOH needs.
The Use of a Mobile Application to Increase Access to Interpreters for Cancer Patients With Limited English Proficiency
Authors: Narang Bharat , Park So-Young , Norrmén-Smith Ingrid O. , Lange Michelle , Ocampo Alex J. , Gany Francesca M. , Diamond Lisa C.
Published: May 2019

Background:

Language barriers can influence the quality of health care and health outcomes of limited English proficient patients with cancer. The use of medical interpretation services can be a valuable asset for improving communications in emergency care settings.

Objective:

To evaluate whether a mobile translation application increased call frequency to interpreter services among providers in an Urgent Care Center at a comprehensive cancer center and to assess provider satisfaction of the mobile application.

Research Design:

Prospective pre-post nonrandomized intervention of a mobile translation application with access to an over the phone interpreter (OPI) service at the push of a button and poststudy satisfaction survey.

Subjects:

Sixty-five clinicians working at the Urgent Care Center in a cancer center in New York City.

Measures:

Mean call frequency to OPI services, tested by the nonparametric Wilcoxon Mann Whitney test, and self-reported provider satisfaction descriptives.

Results:

The mobile application contributed to increasing the frequency of phone calls to OPI services during the intervention period (mean=12.8; P=0.001) as compared with the preintervention period (mean=4.3), and showed continued use during the postintervention period (mean=5.7). Most clinicians were satisfied with the use of the mobile application and access to the OPI services.

Conclusions:

The results suggest that mobile application tools contribute to increasing the use and ease of access to language services. This has the potential to improve the quality of communication between medical providers and limited English proficient patients in the delivery of cancer care in urgent care settings.
Novel Health Information Technology to Aid Provider Recognition and Treatment of Major Depressive Disorder and Posttraumatic Stress Disorder in Primary Care
Authors: Sorkin Dara H. , Rizzo Shemra , Biegler Kelly , Sim Susan Elliott , Nicholas Elisa , Chandler Maria , Ngo-Metzger Quyen , Paigne Kittya , Nguyen Danh V. , Mollica Richard
Published: May 2019

Background:

Millions of traumatized refugees worldwide have resettled in the United States. For one of the largest, the Cambodian community, having their mental health needs met has been a continuing challenge. A multicomponent health information technology screening tool was designed to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder (PTSD) in the primary care setting.

Methods:

In a clustered randomized controlled trial, 18 primary care providers were randomized to receive access to a multicomponent health information technology mental health screening intervention, or to a minimal intervention control group; 390 Cambodian American patients empaneled to participating providers were assigned to the providers’ randomized group.

Results:

Electronic screening revealed that 65% of patients screened positive for depression and 34% screened positive for PTSD. Multilevel mixed effects logistic models, accounting for clustering structure, indicated that providers in the intervention were more likely to diagnose depression [odds ratio (OR), 6.5; 95% confidence interval (CI), 1.48–28.79; P=0.013] and PTSD (OR, 23.3; 95% CI, 2.99–151.62; P=0.002) among those diagnosed during screening, relative to the control group. Providers in the intervention were more likely to provide evidence-based guideline (OR, 4.02; 95% CI, 1.01–16.06; P=0.049) and trauma-informed (OR, 15.8; 95% CI, 3.47–71.6; P<0.001) care in unadjusted models, relative to the control group. Guideline care, but not trauma-informed care, was associated with decreased depression at 12 weeks in both study groups (P=0.003), and neither was associated with PTSD outcomes at 12 weeks.

Conclusions:

This innovative approach offers the potential for training primary care providers to diagnose and treat traumatized patients, the majority of whom seek mental health care in primary care (ClinicalTrials.gov number, NCT03191929).
Role of Health Information Technology in Addressing Health Disparities
Authors: Zhang Xinzhi , Hailu Benyam , Tabor Derrick C. , Gold Rachel , Sayre Michael H. , Sim Ida , Jean-Francois Beda , Casnoff Cheryl A. , Cullen Theresa , Thomas Vincent A. , Artiles Ligia , Williams Kesi , Le Phuong-Tu , Aklin Courtney F. , James Regina
Published: May 2019

Over the last decade, health information technology (IT) has dramatically transformed medical practice in the United States. On May 11–12, 2017, the National Institute on Minority Health and Health Disparities, in partnership with the National Science Foundation and the National Health IT Collaborative for the Underserved, convened a scientific workshop, “Addressing Health Disparities with Health Information Technology,” with the goal of ensuring that future research guides potential health IT initiatives to address the needs of health disparities populations. The workshop examined patient, clinician, and system perspectives on the potential role of health IT in addressing health disparities. Attendees were asked to identify and discuss various health IT challenges that confront underserved communities and propose innovative strategies to address them, and to involve these communities in this process. Community engagement, cultural competency, and patient-centered care were highlighted as key to improving health equity, as well as to promoting scalable, sustainable, and effective health IT interventions. Participants noted the need for more research on how health IT can be used to evaluate and address the social determinants of health. Expanding public-private partnerships was emphasized, as was the importance of clinicians and IT developers partnering and using novel methods to learn how to improve health care decision-making. Finally, to advance health IT and promote health equity, it will be necessary to record and capture health disparity data using standardized terminology, and to continuously identify system-level deficiencies and biases.
Systemic Amyloidosis in a Patient With Familial Mediterranean Fever and Hodgkin Lymphoma: A Case Report
Authors: Demir Ferhat , Bahadir Ayşenur , Mungan Sevdegül , Çobanoğlu Ümit , Kalyoncu Mukaddes
Published: May 2019

Systemic amyloidosis is a clinical manifestation of the accumulation of amyloid fibrils in tissues because of persistent acute phase elevation and chronic inflammation. Its most common causes are inflammatory diseases and malignancies. Here, we present a 12-year-old girl diagnosed with systemic amyloidosis and Hodgkin lymphoma (HL) who was also previously diagnosed with familial Mediterranean fever (FMF). Despite colchicine treatment for FMF, the patient had a persistent elevation of acute phase reactants and AA-type amyloid deposits were observed in a kidney biopsy. Anakinra, an interleukin-1 antagonist, was added to the treatment. Shortly after the diagnosis of amyloidosis, mediastinal lymphadenopathy was recognized, and she was also diagnosed with HL. A chemotherapy protocol of doxorubicin, bleomycin, vinblastine, and dacarbazine was initiated. After 6 cycles of the chemotherapy and 8 months of the anakinra treatment, no recurrence or residual malignancy was observed and proteinuria was decreased. To the authors’ knowledge, this is the first reported case of systemic amyloidosis in the literature associated with both FMF and HL.
The Diagnostic Dilemma of Psychosis
Authors: Lingiardi Vittorio , Boldrini Tommaso
Published: May 2019

The term “pseudoneurotic schizophrenia” was introduced in 1949 by Hoch and Polatin to describe apparently neurotic patients showing formal thought disorders, emotional dysregulation, and transient psychotic symptoms. Even if this diagnostic entity is no longer included in modern diagnostic systems, its evolution is intertwined with the history of schizophrenia in the 20th century. This article retraces the development of pseudoneurotic (or “borderline”) schizophrenia in modern psychiatry, finding it a pioneering concept in psychopathology. In particular, we demonstrate that recent findings about the positive syndrome, good-outcome, type I “distress” subtype of schizophrenia (associated with high emotionality, including anxiety, depression, and sensitivity to stress) show surprising consistency with the clinical concept of pseudoneurotic schizophrenia. Finally, we discuss the historical development of pseudoneurotic schizophrenia in modern psychiatry as a meaningful example of the difficulty of confining severe psychological disturbances lying at the edge of full-blown schizophrenia within a widely accepted diagnostic category.
Factors Associated With Delirium Following Electroconvulsive Therapy
Authors: Tsujii Takashi , Uchida Takahito , Suzuki Takefumi , Mimura Masaru , Hirano Jinichi , Uchida Hiroyuki
Published: May 2019

Objectives

Delirium following electroconvulsive therapy (ECT) has been a clinical challenge, which, however, has not been investigated through a systematic literature review. The objective of this study was to systematically synthesize available evidence regarding factors associated with post-ECT delirium.

Methods

We conducted a systematic literature search for any type of original investigations that reported risk factors of post-ECT delirium, using PubMed.

Results

The literature search identified 43 relevant articles. One study found an association between catatonic feature and increased risk of postictal delirium. Five studies reported that the presence of cerebrovascular disease, Parkinson disease, or dementia was related to higher incidence of post-ECT delirium. Incidence of post-ECT course delirium was increased with bitemporal stimulation (3 studies). One study showed that ultrabrief pulse ECT reduced reorientation time following seizure compared with brief pulse ECT. High stimulus intensity resulted in more prolonged reorientation time after ECT than lower stimulus intensity (2 studies). Longer seizure length was significantly associated with post-ECT delirium in 1 study. Eight studies that examined postictal delirium in association with medications used, including lithium, did not show any consistent finding in their relationships. Four studies showed decreased incidence of postictal delirium in those receiving dexmedetomidine.

Conclusions

Limited evidence suggests that catatonic feature, cerebrovascular disease, Parkinson disease, dementia, bitemporal electrode placement, high stimulus intensity, or longer seizure length are associated with an increased risk of post-ECT delirium. Moreover, dexmedetomidine and ultrabrief pulse ECT seem to have preventive effects of post-ECT delirium.
A sparse negative binomial classifier with covariate adjustment for RNA-seq data
Authors: Rahman Tanbin , Huang Hsin-En , Tai An-Shun , Hsieh Wen-Ping , Tseng George
Published: May 2019

Supervised machine learning methods have been increasingly used in biomedical research and in clinical practice. In transcriptomic applications, RNA-seq data have become dominating and have gradually replaced traditional microarray due to its reduced background noise and increased digital precision. Most existing machine learning methods are, however, designed for continuous intensities of microarray and are not suitable for RNA-seq count data. In this paper, we develop a negative binomial model via generalized linear model framework with double regularization for gene and covariate sparsity to accommodate three key elements: adequate modeling of count data with overdispersion, gene selection and adjustment for covariate effect. The proposed method is evaluated in simulations and two real applications using cervical tumor miRNA-seq data and schizophrenia post-mortem brain tissue RNA-seq data to demonstrate its superior performance in prediction accuracy and feature selection.
Bridging the gap between theory and data: the Red Queen Hypothesis for sex
Authors: Park Sang Woo , Bolker Benjamin M
Published: May 2019

Sexual reproduction persists in nature despite its large cost. The Red Queen Hypothesis postulates that parasite pressure maintains sexual reproduction in the host population by selecting for the ability to produce rare genotypes that are resistant to infection. Mathematical models have been used to lay theoretical foundations for the hypothesis; empirical studies have confirmed these predictions. For example, Lively used a simple host-parasite model to predict that the frequency of sexual hosts should be positively correlated with the prevalence of infection. Lively et al. later confirmed the prediction through numerous field studies of snail-trematode systems in New Zealand. In this study, we fit a simple metapopulation host-parasite coevolution model to three data sets, each representing a different snail-trematode system, by matching the observed prevalence of sexual reproduction and trematode infection among hosts. Using the estimated parameters, we perform a power analysis to test the feasibility of observing the positive correlation predicted by Lively. We discuss anomalies in the data that are poorly explained by the model and provide practical guidance to both modelers and empiricists. Overall, our study suggests that a simple Red Queen model can only partially explain the observed relationships between parasite infection and the maintenance of sexual reproduction.
A new model for the implementation of positive and negative emotion recognition
Authors: Sorinas Jennifer , Fernandez-Troyano Juan C. , Val-Calvo Mikel , Ferrández Jose Manuel , Fernandez Eduardo
Published: May 2019

The large range of potential applications, not only for patients but also for healthy people, that could be achieved by affective BCI (aBCI) makes more latent the necessity of finding a commonly accepted protocol for real-time EEG-based emotion recognition. Based on wavelet package for spectral feature extraction, attending to the nature of the EEG signal, we have specified some of the main parameters needed for the implementation of robust positive and negative emotion classification. 12 seconds has resulted as the most appropriate sliding window size; from that, a set of 20 target frequency-location variables have been proposed as the most relevant features that carry the emotional information. Lastly, QDA and KNN classifiers and population rating criterion for stimuli labeling have been suggested as the most suitable approaches for EEG-base emotion recognition. The proposed model reached a mean accuracy of 98% (s.d. 1.4) and 98.96% (s.d. 1.28) in a subject-dependent approach for QDA and KNN classifier, respectively. This new model represents a step forward towards real-time classification. Although results were not conclusive, new insights regarding subject-independent approximation have been discussed.
Actin chromobody imaging reveals sub-organellar actin dynamics
Authors: Schiavon Cara R. , Zhang Tong , Zhao Bing , Andrade Leonardo , Wu Melissa , Sung Tsung-Chang , Dayn Yelena , Feng Jasmine W. , Quintero Omar A. , Grosse Robert , Manor Uri
Published: May 2019

The actin cytoskeleton plays multiple critical roles in cells, from cell migration to organelle dynamics. The small and transient actin structures regulating organelle dynamics are difficult to detect with fluorescence microscopy. We developed an approach using fluorescent protein-tagged actin nanobodies targeted to organelle membranes to enable live cell imaging of sub-organellar actin dynamics with unprecedented spatiotemporal resolution. These probes reveal that ER-associated actin drives fission of multiple organelles including mitochondria, endosomes, lysosomes, peroxisomes, and the Golgi.
Role of Water-bridged Interactions in Metal Ion Coupled Protein Allostery
Authors: Guan Xingyue , Tan Cheng , Li Wenfei , Wang Wei , Thirumalai D.
Published: May 2019

Allosteric communication between distant parts of proteins controls many cellular functions, in which metal ions are widely utilized as effectors to trigger the allosteric cascade. Due to the involvement of strong coordination interactions, the energy landscape dictating the metal ion binding is intrinsically rugged. How metal ions achieve fast binding by overcoming the landscape ruggedness and thereby efficiently mediate protein allostery is elusive. By performing molecular dynamics simulations for the Ca2+ binding mediated allostery of the calmodulin (CaM) domains, each containing two Ca2+ binding helix-loop-helix motifs (EF-hands), we revealed the key role of water-bridged interactions in Ca2+ binding and protein allostery. The bridging water molecules between Ca2+ and binding residue reduces the ruggedness of ligand exchange landscape by acting as a lubricant, facilitating the Ca2+ coupled protein allostery.

Calcium-induced rotation of the helices in the EF-hands, with the hydrophobic core serving as the pivot, leads to exposure of hydrophobic sites for target binding. Intriguingly, despite being structurally similar, the response of the two symmetrically arranged EF-hands upon Ca2+ binding is asymmetric. Breakage of symmetry is needed for efficient allosteric communication between the EF-hands. The key roles that water molecules play in driving allosteric transitions are likely to be general in other metal ion mediated protein allostery.