bluuebunny/crossref_metadata_2025 huggingface dataset:
Publication Bias and Editorial Statement on Negative Findings
Authors: Blanco-Perez Cristina , Brodeur Abel
Published: January 2020

In February 2015, the editors of eight health economics journals sent out an editorial statement which aimed to reduce the extent of specification searching and reminds referees to accept studies that: ‘have potential scientific and publication merit regardless of whether such studies’ empirical findings do or do not reject null hypotheses’. Guided by a pre-analysis, we test whether the editorial statement decreased the extent of publication bias. Our differences-in-differences estimates suggest that the statement decreased the proportion of tests rejecting the null hypothesis by 18 percentage points. Our findings suggest that incentives may be aligned to promote more transparent research.
Bilateral giant inguinoscrotal hernia. Presentation of a novel combined two-stage repair approach
Authors: Menenakos Charalambos , Albrecht Hendrik C , Gretschel Stephan
Published: January 2020

Giant inguinoscrotal hernia is typically defined as hernia extending below the midpoint of the inner thigh, in the standing position. These hernias can be a demanding surgical problem as replacing bowel contents into the abdomen that can cause a life-threatening increase in intra-abdominal pressures. Various techniques such as preoperative progressive pneumoperitoneum (PPP), debulking of abdominal contents with visceral resections with or without omentectomy and phrenectomy have been suggested. We report the case of a 65-year-old patient with giant bilateral inguinal hernia. We applied a novel two-stage combined approach consisting of PPP with simultaneous single shot injection of botulinum toxin Type A into the anterior abdominal wall, and a second stage laparotomy with hernia repair (Stoppa technique). This technique makes possible the successful treatment of giant inguinal hernias without the need for visceral resection. To our knowledge, this is the first presented case of this combined treatment modality.
Functional Movement Screen Items Predict Dynamic Balance Under Military Torso Load
Authors: Scudamore Eric M , Stevens Sandra L , Fuller Dana K , Coons John M , Morgan Don W
Published: January 2020

Introduction

Musculoskeletal injuries threaten military readiness and impose a significant financial burden. The functional movement screen (FMS), a 7-item, preparticipation screening tool, may aid in identifying compensatory movement patterns that can hinder physical performance and lead to injuries in active-duty military personnel. The primary aim of our study was to determine if items scores from the traditional FMS or a modified FMS (mFMS) obtained under loaded conditions can predict dynamic balance scores while wearing a military load.

Materials and Methods

Thirty physically active adults (19 males and 11 females) who qualified for Army basic training completed unloaded and loaded FMS testing. Loaded balance was assessed using the Y balance test and the Biodex balance system. The mFMS and both loaded balance assessment protocols included a military load consisting of a standard issue rucksack (M.O.L.L.E.), kevlar helmet, and weighted vest (mass = 24.2 kg).

Results

mFMS item scores were significantly lower than FMS scores for six of the seven movement items. Both FMS and mFMS composite scores were correlated with Y balance scores (FMS: r = 0.53, P = 0.003; mFMS: r = 0.37, P = 0.043). Participants with higher composite scores (≥15) outperformed those with lower composite scores (≤14) for the FMS (P =0.006, d = 1.16) and mFMS (P = 0.031, d = 0.75). Lasso penalized regression analyses revealed that (1) higher unloaded in-line lunge subscores predicted better Y balance scores, (2) loaded trunk stability push-up scores of three predicted worse balance on the Biodex, and (3) unloaded and loaded shoulder mobility scores of 3 predicted better performance on the Biodex balance system.

Conclusions

The in-line lunge subscore from the FMS was the strongest predictor of torso-loaded balance, and the FMS may be more appropriate than a torso-loaded FMS battery when predicting torso-loaded balance among adults with body composition and fitness profiles similar to those of entering military recruits. These findings provide evidence supporting the use of the conventional FMS to identify active-duty personnel who exhibit greater balance deficits and may develop related musculoskeletal injuries while performing operational tasks that require the transport of heavy loads over long distances.
Practicing Military Medicine in Truly Austere Environments: What to Expect, How to Prepare, When to Improvise
Authors: Anagnostou Evangelos , Michas Athanasios , Giannou Christos
Published: January 2020

Introduction

The majority of the published literature on contemporary military medicine contradicts the concept of austere. Operational medicine is part of every armed conflict around the world, while armed forces of most countries internationally have limited medical resources especially in the front line. The aim of this review is to identify the particularities of a truly austere environment and present a short guide of preparation and action for military medical personnel internationally.

Materials and Methods

An exhaustive search of the existing English literature on operational and military medicine in austere environments was carried out in EMBASE and PubMed databases.

Results

This review included seminal and contemporary papers on the subject and synthesized a multiperspective short guide for operational medical personnel.

Discussion

Experience from forward surgical teams of the U.S. Army and humanitarian teams of physicians in war zones who work under precarious and austere circumstances has shown that the management of casualties requires different strategies than in higher levels of combat casualty care and in a civilian setting. A number of factors that must be controlled can be categorized into human, environmental, equipment-related, and socioeconomic. Surgeons and other medical personnel should have knowledge of these aspects beforehand and be adequately trained in peacetime. Physicians must master a number of essential skills and drugs, and be familiar with dosage regimens and side effects.

Conclusion

The military surgeon must be specially trained and prepared to use a wide range of skills in truly austere environments in contemporary conflicts.
Conflict-of-laws rules on assignments of receivables in the United States and Canada
Authors: Deschamps Michel
Published: January 2020

This article describes the conflict-of-laws rules of the USA and Canada on the effectiveness against third parties and priority of an assignment of trade receivables. Comparisons are also made with the rules proposed on these issues by the European Commission’s Proposal of 12 March 2018 and the UNCITRAL Model Law on Secured Transactions. The conflict-of-laws rules examined in the article generally designate the location of the assignor as the place whose law applies to the effectiveness against third parties and the priority of an assignment.

The article shows however that the definition of the location of the assignor varies from one jurisdiction to another (statutory seat, chief executive office, state of constitution, etc.) Moreover, the US rules and certain Canadian rules define the location of a business corporation using a criterion which is different depending on the corporation’s jurisdiction of incorporation. In addition, the European Commission’s Proposal allows the parties to an assignment made in the course of a securisation transaction to deviate from the assignor’s location rule and select the law governing the receivable as the applicable law. All of these differences result in a lack of harmonization.

The article also summarizes the analysis that a financier must conduct to identify the jurisdiction(s) where the financier would normally want that an assignment in its favour be recognized. The relevant jurisdictions are normally the jurisdiction(s) in which insolvency proceedings relating to the assignor may take place and the other jurisdiction(s) where the debtors of the receivables could be located; a dispute might sometimes occur in these other jurisdictions with a competing claimant attempting to claim priority (e.g. a judgement creditor who would seize receivables owed by the debtors located in those jurisdictions). As the insolvency jurisdiction(s) and the other jurisdiction(s) in which the debtors are located may have different conflict-of-laws rules, a prudent financier should examine the applicable rules of all relevant jurisdictions.
Observed Progression of Parents' Understanding of Preterm Infants' Behavioral Signs at 33 to 35 Weeks Corrected Age
Authors: Nakai Aya , Nakamura Nobue
Published: January 2020

Background:

Interventions aimed at improving parental understanding of preterm infants' behavioral signs have drawn increased attention in recent years. However, there are limited data regarding parents' actual perceptions of infants' behavior during parent–infant interactions while infants are in a light-sleep state.

Purposes:

(1) To describe parental perceptions of infants' behavior at 33 to 35 weeks' corrected age during light-sleep and (2) to identify changes in parental perceptions of preterm infants' behavior over time.

Methods:

This study used a qualitative, longitudinal design based on observations and interviews. Three sets of parents and their infants born between 29 and 30 weeks' gestational age were observed up to 3 times during light sleep states when the infants were 33 to 35 weeks' corrected age. Parents were interviewed regarding their perceptions of infant behavior/growth once at the time of observation and once more within 2 weeks of the final observation. The findings are based on the observation of parents' perception-driven interactions with infants.

Results:

Four themes emerged describing the transition of parental perception that progresses to gain a better understanding of their infant's behavior through repeated interaction.

Implications for Practice:

The findings of this study inform caregivers in neonatal intensive care units regarding the unique experience of parent–infant dyads. This knowledge can help promote family-centered developmental care efforts in neonatal intensive care units.

Implications for Research:

Further research should focus on studying a larger sample group to confirm the findings and refining strategies to incorporate the findings to enhance neonatal intensive care unit care.
Metabolic Responses to Metformin in Inoperable Early-stage Non–Small Cell Lung Cancer Treated With Stereotactic Radiotherapy
Authors: Chun Stephen G. , Liao Zhongxing , Jeter Melenda D. , Chang Joe Y. , Lin Steven H. , Komaki Ritsuko U. , Guerrero Thomas M. , Mayo Ray C. , Korah Bobby M. , Koshy Suja M. , Heymach John V. , Koong Albert C. , Skinner Heath D.
Published: January 2020

Background:

Metformin reduces glucose uptake in physiologic tissues and has been shown to affect non–small cell lung cancer (NSCLC) metabolism. We hypothesized that positron emission tomography (PET) scans could detect the impact of metformin on glucose uptake in NSCLC and we sought to test this hypothesis in a prospective clinical trial.

Materials and Methods:

A single-blinded phase II clinical trial was performed with subjects randomized 6:1 to 3 to 4 weeks of metformin versus placebo for inoperable early-stage NSCLC. PET scans were performed at baseline, mid-treatment (after 2 wk study medication), and 6 months postradiation. The primary endpoint of the trial was tumor metabolic response to metformin by PERCIST before definitive radiation. Stereotactic body radiotherapy to 50 Gy in 4 fractions was used for peripheral tumors and 70 Gy in 10 fractions for central tumors.

Results:

There were 14 subjects randomized to the metformin and 1 to placebo. Histologies were 60% adenocarcinoma, 33.3% squamous cell carcinoma, and 6.7% poorly differentiated carcinoma. At mid-treatment PET scan, 57% of subjects randomized to metformin met PERCIST criteria for metabolic response, of which 75% had progressive metabolic disease and 25% had partial metabolic response, whereas the placebo subject had stable metabolic disease. At 6 months, the metformin arm had 69% complete metabolic response, 23% partial metabolic response and 1 progressive metabolic disease, and the subject treated with placebo had a complete metabolic response. There were no CTCAE grade ≥3 toxicities.

Conclusions:

Despite low accrual, majority of subjects treated with metformin had metabolic responses by PERCIST criteria on PET imaging. Contrary to the effect of metformin on most physiologic tissues, most tumors had increased metabolic activity in response to metformin.
Recent Health Care Expenditure Trends Among Adult Cancer Survivors in United States, 2009-2016
Authors: Rubens Muni , Ramamoorthy Venkataraghavan , Saxena Anshul , Das Sankalp , Bhatt Chintan , Veledar Emir , McGranaghan Peter , Sundil Subrina , Shehadeh Nancy , Viamonte-Ros Ana , Linhares Yuliya , Odia Yazmin , Chuong Michael , Kotecha Rupesh , Mehta Minesh P.
Published: January 2020

Objective:

The objective of this study was to understand recent trends in direct health care expenditures among cancer survivors using novel cost-estimation methods and a nationally representative database.

Materials and Methods:

This study was a retrospective analysis of 193,003 adults, ≥18 years of age, using the Medical Expenditure Panel Survey during the years 2009-2016. Manning and Mullahy two-part model was used to calculate adjusted mean and incremental medical expenditures after adjusting for covariates.

Results:

The mean direct annual health care expenditure among cancer survivors ($13,025.0 [$12,572.0 to $13,478.0]) was nearly 3 times greater than noncancer participants ($4689.3 [$4589.2 to $4789.3]) and were mainly spent on inpatient services, office-based visits, and prescription medications. Cancer survivors had an additional health care expenditure of $4407.6 ($3877.6, $4937.6) per person per year, compared with noncancer participants after adjusting for covariates (P<0.001). The total mean annual direct health care expenditure for cancer survivors increased from $12,960.0 (95% confidence interval: $12,291.0-$13,628.0) in 2009-2010 to $13,807.0 ($12,828.0 to $14,787.0) in 2015-2016.

Conclusions:

Given the higher health care expenditures among cancer survivors and the increasing prevalence of cancers, cost-saving measures should be planned through multidisciplinary initiatives, collaborative research, and importantly, health care planning and policy changes. Our findings could be helpful in streamlining health care resources and interventions, developing national health care coverage policies, and possibly considering radically new insurance strategies for cancer survivors.
Geographic variations and potential macro-environmental exposure of hypertension: from the China hypertension survey
Authors: Pei Lijun , Wu Jilei , Wang Zengwu , Wang Xin , Chen Zuo , Li Jiajia , Zhang Linfeng , Fan Rujing , Zhang Zugui , Dong Ying , Zheng Congyi , Kang Yuting , Gao Runlin
Published: January 2020

Objectives:

The study aimed to investigate the spatial variation of hypertension (HTN) and the associations between the risk of HTN and altitude, longitude, latitude in Chinese population.

Methods:

The newest China Hypertension Survey (CHS) study, which used a nationally representative sample, was conducted between 2012 and 2015. A total of 451 755 participants aged at least 18 years from 262 county-level regions in 31 provinces were analyzed to explore the geographical variations of HTN prevalence at county-level. A total of 444 375 participants were included in two-level logistic regression model to examine the association between HTN risk and exposure to altitude, longitude, and latitude after adjusting for potential confounding variables at individual level.

Results:

The findings of spatial analysis indicated that there were remarkably high and low HTN prevalence zones. High HTN prevalence zones extended from parts of the southeast to northern China and the northeast. The risk of HTN increased with increasing longitude, with adjusted odds ratios (aORs, 95% confidence interval [CI]) of 2.08 (1.04--4.18), 2.21 (1.15--4.22), 2.54 (1.31--4.93), 2.59 (1.32--5.08), and 2.81 (1.12--7.08) for longitudes of 90–100°E, 100–110°E, 110–120°E, 120–130°E, and at least 130°E, respectively, with a significant dose--response relationship that HTN risks increase as longitude rises from 90°E to ≥130°E(P
trend <0.001), compared with the longitude group of less than 80°E, consistent with the conclusion that geographical variations of high HTN prevalence zones by spatial analysis.

Conclusion:

The findings of remarkably high HTN prevalence zones modified previous understandings about the regional difference of HTN distribution, and provide an important basis for future efforts to prevent and control HTN in different regions of China.
The Use of Sirolimus for Treatment of Orbital Lymphatic Malformations: A Systematic Review
Authors: Shoji Marissa K. , Shishido Sachie , Freitag Suzanne K.
Published: January 2020

Purpose:

Orbital lymphatic malformations are rare congenital choristomas associated with pain, proptosis, exposure keratopathy, and vision loss. Current treatments of surgery, drainage, and sclerotherapy may have adverse effects including risk of damage to surrounding structures, swelling, and malformation persistence or recrudescence. Sirolimus, which inhibits mammalian target of rapamycin, a regulator of cell growth and vascular endothelial growth factor expression, has successfully treated systemic vascular malformations. However, its efficacy and safety have not yet been well established for orbital lymphatic malformations.

Methods:

Systematic review and analysis of relevant published literature were performed. PubMed, Embase, and World of Science searches were conducted for studies involving sirolimus treatment of orbital lymphatic malformations through July 2019.

Results:

Nine case series and reports with 10 total patients who received sirolimus for treatment of orbital lymphatic malformations were included. The age at sirolimus initiation ranged from 1 week to 23 years. The malformation was lymphatic in 6 patients, lymphaticovenous in 3 patients, and lymphatic-arteriovenous in 1 patient. Six patients underwent ineffective prior therapy including sclerotherapy, surgery, or medical therapy. Initial sirolimus dosage ranged from 0.05 mg/kg twice a day to 1 mg twice a day, and duration ranged from 6 months to 53 months. Seven patients had partial response, and 3 patients, all of whom had a microcystic malformation component, experienced complete response. Adverse effects included mild reversible leukopenia, hypertriglyceridemia, hypercholesterolemia, and transaminitis with adverse effects denied or not specified for 6 patients.

Conclusions:

Sirolimus may be a safe and effective treatment for orbital lymphatic malformations, especially microcystic malformations.
Plasma levels of enoxaparin oligosaccharides, antifactor-Xa and thrombin generation in patients undergoing haemodialysis
Authors: Batt Tracey J. , Lincz Lisa F. , Prasad Ritam , Patel Rahul P. , Shastri Madhur , Lioufas Nicole , Smith Andrew G. , Jose Matthew D.
Published: January 2020

Low molecular weight heparins are used during haemodialysis for thromboprophylaxis of the dialysis circuit, with plasma antifactor-Xa (anti-Xa) activity used as a surrogate measure for effective anticoagulation. However, this pharmacokinetic parameter does not always correlate with pharmacodynamic effects in patients. The aim of this study was to investigate the relationship between actual plasma levels of the low molecular weight heparins enoxaparin, anti-Xa activity, and global coagulation measurement of thrombin generation during haemodialysis. Blood was analysed from 16 adult patients with end-stage kidney disease at 0, 2, 4 h, and at completion of 31 dialysis sessions where single fixed doses of 20 (n = 3), 40 (n = 16), 60 (n = 6), or 80 (n = 6) mg of enoxaparin (equating to 0.23–1.07 mg/kg) were used as thromboprophylaxis. Plasma enoxaparin oligosaccharides [degree of polymerization (dp)6–dp16] were measured by high-performance size exclusion chromatography, anti-Xa activity by colourimetric assay, and thrombin generation by calibrated automated thrombogram. Plasma enoxaparin fragments were undetectable at the beginning of each dialysis, peaked at 2 h to levels that correlated with dose (r = 0.68, P < 0.001) then remained relatively stable. In contrast, therapeutic anti-Xa levels achieved at 2 h in 18 cases (58%) quickly dropped to only six cases (19%) at the end of dialysis, by which time thrombin generation had also recovered in 81% of patients. Statistical modelling revealed a threshold value of anti-Xa at 0.53 IU/ml that supressed thrombin generation to 15.28% of baseline (P < 0.001). Despite loss of anticoagulant activity in the majority of patients, plasma levels of enoxaparin oligosaccharides remained detectable and relatively unchanged throughout dialysis.
A novel mutation of SERPINC1 in a patient presenting as recurrent cerebral sinus venous and portal vein thrombosis
Authors: Teng Xin-Yi , Han Yu , Yin Li , Xu Fang-Fang , Liu Zhen-Jie
Published: January 2020

Inherited antithrombin deficiency (OMIM 107300) is a rare autosomal dominant disorder that could increase the risk of venous thromboembolism and is usually caused by mutations of SERPINC1. Herein, we present a case of a novel mutation in the SERPINC1 gene in a Chinese patient. The patient was a 54-year-old man who presented with recurrent venous thromboembolism and was without a recent history of any precipitating factors. Whole exome sequencing and Sanger sequencing identified a novel heterozygous variant on exon 2 of SERPINC1 gene (c.142G>A, p.P48S).
Kaolin, used to trigger coagulation in thrombin generation test, increases sensitivity of the method in hemophilia patients
Authors: Gribkova Irina V. , Galstyan Gennady M. , Polyanskaya Tatyana Y. , Sinauridze Elena I.
Published: January 2020

Thrombin generation test (TGT) is well established tool to research blood coagulation in plasma of hemophilia patients. Traditionally coagulation in this test is triggered by a tissue factor (TF), an extrinsic coagulation pathway activator. However, it is known that disorders of the intrinsic pathway are most important for coagulation in hemophilia. In this study, we hypothesized that triggering coagulation via the intrinsic pathway could increase a sensitivity of the TGT to monitor hemophilia treatment. The aim of this study was to compare thrombin generation in hemophilia A patients with inhibitors to factor VIII before and after infusion of bypassing agent [recombinant-activated factor VIIa (rVIIa)] using standard activation of coagulation by TF or by kaolin, an activator of coagulation by intrinsic pathway. Endogenous thrombin potential (ETP) in nine patients was measured. ETP before (ETP0) and 60 min after rVIIa infusion (ETP60) were compared. It was shown that ETP0 and ETP60 were significantly different when using any coagulation activator (paired Student's t test, P = 0.017 and 3.7 × 10−5 for clotting activation by TF and kaolin, respectively). The ratios of ETP60/ETP0 were 1.2 ± 0.2 or 30.0 ± 22.4 (mean ± SD, n = 9) for coagulation activated by TF or kaolin, respectively, and were significantly different (paired Student's t test, P < 0.005). The TGT clearly distinguished between ETP0 and ETP60 in the case of any coagulation activator, but ETP increasing after rVIIa infusion was significantly higher when activated with kaolin. This provided increased sensitivity of this method for monitoring hemophilia therapy.
Does Maternal Omega 3 Supplementation Protect Against Infantile Hypertrophic Pyloric Stenosis?
Authors: Paran Maya , Freud Enrique , Samuk Inbal , Steiner Zvi
Published: January 2020

Objectives:

Infantile hypertrophic pyloric stenosis (IHPS) is potentially life threatening. The etiology of IHPS remains unknown and many risk factors have been reported. We aimed to assess the prevalence of known risk factors and investigate maternal nutrition and habits as possible additional risk factors for IHPS.

Methods:

This case‐control study includes mothers of infants diagnosed with IHPS and control mothers of infants, age 2 to 11 months, hospitalized in the pediatric department due to other conditions. Cases of IHPS were identified by review of all infants diagnosed with IHPS and operated upon in 2010 to 2016 at 2 major hospitals in central Israel. Data regarding potential risk factors were collected via questionnaires in both study groups.

Results:

Sixty‐six cases and 67 controls were included in the study. Maternal omega 3 supplement consumption during pregnancy was significantly less common among cases of IHPS as compared with controls (P = 0.031). Consumption of omega 3 supplement was defined as consumption of at least 1 to 2 per week during the pregnancy period. Following adjustment for known risk factors, including male sex and maternal smoking, maternal omega 3 supplement consumption remained associated with a significantly lower risk of developing IHPS (odds ratio = 0.303, 95% confidence interval 0.111–0.828, P = 0.02).

Conclusions:

Maternal omega 3 supplement consumption during pregnancy was associated with a significantly reduced risk of IHPS. Further studies are needed to support these results and investigate possible mechanisms of the effect of omega 3.
Factors Associated With Childhood Vaccination Adherence in Kindergartens of the Houston Independent School District
Authors: Rajan Suja S. , Roy Debanshu , Delgado Rigoberto
Published: January 2020

Objective:

Adequate childhood vaccination rates are crucial for successful control of infectious diseases. Nevertheless, exemption requests, lack of health care access and information and other barriers can reduce vaccination adherence rates, and increase the risk of epidemics. This study aimed to identify factors associated with kindergarten vaccination adherence in the Houston Independent School District (HISD).

Design and Setting:

This study was a retrospective observational data analysis. The study used data from 155 elementary schools of the HISD. The data sets included were (1) Elementary School Profile Reports (2015-2016) and (2) Annual Report of Immunization Status (2016-2017). Logistic regression was used to examine the association between vaccination adherence in schools and the school's student demographic and economic profile, student behavior indicators, teacher profile, and school rank.

Main Outcome Measure:

A binary variable measuring adequate vaccination adherence rates in schools is the main outcome variable.

Results:

Lower vaccination adherence among the kindergarten students was associated with higher enrollment, a higher percentage of African American students and students with English as second language, and a lower percentage of gifted/talented students in the schools.

Conclusions:

The school characteristics that were found to be significantly associated with kindergarten student vaccination adherence in this study are the ones that have historically been associated with socioeconomic determinants of health and socioeconomic privilege. Hence, the findings of this study suggest the need for development of policies and interventions that can help overcome the barriers associated with low socioeconomic status, language, and marginalization in order to improve vaccination rates in school districts. These include culturally appropriate polices and health promotion, patient navigation, and educational interventions that can overcome the challenges faced by socially and economically vulnerable minorities and immigrant communities in order to improve vaccination rates.
Pain-related anxiety promotes pronociceptive processes in Native Americans: bootstrapped mediation analyses from the Oklahoma Study of Native American Pain Risk
Authors: Rhudy Jamie L. , Huber Felicitas , Kuhn Bethany L. , Lannon Edward W. , Palit Shreela , Payne Michael F. , Hellman Natalie , Sturycz Cassandra A. , Güereca Yvette M. , Toledo Tyler A. , Demuth Mara J. , Hahn Burkhart J. , Shadlow Joanna O.
Published: January 2020

Introduction:

Evidence suggests Native Americans (NAs) experience higher rates of chronic pain than the general US population, but the mechanisms contributing to this disparity are poorly understood. Recently, we conducted a study of healthy, pain-free NAs (n = 155), and non-Hispanic whites (NHWs, n = 150) to address this issue and found little evidence that NAs and NHWs differ in pain processing (assessed from multiple quantitative sensory tests). However, NAs reported higher levels of pain-related anxiety during many of the tasks.

Objective:

The current study is a secondary analysis of those data to examine whether pain-related anxiety could promote pronociceptive processes in NAs to put them at chronic pain risk.

Methods:

Bootstrapped indirect effect tests were conducted to examine whether pain-related anxiety mediated the relationships between race (NHW vs NA) and measures of pain tolerance (electric, heat, ischemia, and cold pressor), temporal summation of pain and the nociceptive flexion reflex (NFR), and conditioned pain modulation of pain/NFR.

Results:

Pain-related anxiety mediated the relationships between NA race and pain tolerance and conditioned pain modulation of NFR. Exploratory analyses failed to show that race moderated relationships between pain-related anxiety and pain outcomes.

Conclusion:

These findings imply that pain-related anxiety is not a unique mechanism of pain risk for NAs, but that the greater tendency to experience pain-related anxiety by NAs impairs their ability to engage descending inhibition of spinal nociception and decreases their pain tolerance (more so than NHWs). Thus, pain-related anxiety may promote pronociceptive processes in NAs to place them at risk for future chronic pain.
Pulmonary infections in the hematopoietic cell transplant patient
Authors: Ford Emily S. , Crothers Kristina , Cheng Guang-Shing
Published: January 2020

Purpose of review

Despite progress in the management of pulmonary infections in the hematopoietic cell transplant (HCT) population, substantial diagnostic, and therapeutic uncertainty remains.

Recent findings

A growing HCT population reflects more transplants and improved long-term survival. We continue to learn about the epidemiologic and prognostic significance of posttransplant pulmonary infections. Mold-active triazoles have removed invasive fungal pneumonia as a barrier to transplant eligibility. Ibrutinib and respiratory viruses are newly recognized risk factors for invasive fungal disease. Prophylaxis has elevated concerns of resistance in invasive fungal species and late onset Cytomegalovirus. The impact of human herpesviruses, community-associated respiratory viruses, and the microbiome is increasingly appreciated. Multiple antiviral therapies are currently in clinical trials and novel molecular diagnostics may improve the performance of bronchoscopy for infectious causes.

Fungal and viral pneumonias remain an important cause of morbidity and mortality in the HCT population. Despite our increased understanding of the epidemiology and outcomes of species-specific diagnoses, the utility of invasive diagnostic testing continues to be debated and effective therapies for many clinically relevant pathogens remain limited. Pulmonary infections are a priority for research efforts in this immunocompromised population.
Predictors of Emergency Room Admission in Patients With Liver Cirrhosis
Authors: Kim Eun Kyung , Park Heeok
Published: January 2020

This study aimed to identify the predictors of emergency room (ER) admission in patients with liver cirrhosis. The data of 215 patients with liver cirrhosis who visited the ER were collected from January 1 to March 15, 2017, at Yeungnam hospital in Daegu city, South Korea. Measurement scales were designed on the basis of the liver function test and evaluation of anxiety and depression, self-care, and family support. Diseases that cause liver cirrhosis, their associated characteristics, and respective hematologic examination results were reviewed from the hospital's electronic medical records. Among the 215 patients with liver cirrhosis who visited the ER, 47 (21.9%) had previous ER admissions, whereas 168 (78.1%) had none. Fifteen predictive factors that were significantly different between the ER admission and non-ER admission groups were included as variables in logistic regression analysis. This analysis revealed that the 3 significant predictors of ER admission in patients with liver cirrhosis were number of prior complications, serum bilirubin level, and self-care compliance. An increased number of prior complications, increased bilirubin level, and low self-care compliance increased the ER admission rates in patients with liver cirrhosis. Thus, further studies are necessary to measure the effects of nursing intervention strategies based on these findings.
Presacral Anatomy in Women With a Horseshoe Kidney
Authors: Ortega Marcus V. , Pierce Theodore T. , O’Shea Aileen , James Kaitlyn , Von Bargen Emily , Weinstein Milena M.
Published: January 2020

Objective

Horseshoe kidney (HSK) is the most common renal fusion defect that can alter vascular and upper urinary tract anatomy. Anatomic variations in the presacral space can make surgical dissection very challenging. The aim of this study was to characterize presacral anatomy in women with HSK.

Methods

Large academic centers’ database was queried to identify imaging studies in adult women with HSK. Available multiplanar computed tomography and magnetic resonance imaging images were reviewed, and relevant vascular and upper urinary tract anatomy was measured and compared with published normal values. Study population was compared with the normal controls using Student t test, χ2 test, or Fisher exact test as appropriate.

Results

One hundred seventy-eight women were identified initially, and 20 confirmed to have HSK on imaging. The mean ± SD age was 54.5 ± 16.9 years, and body mass index was 27.3 ± 7.5 kg/m2. Women with HSK had a narrower angle of aortic bifurcation (39.1 ± 18.7 degrees vs 55.6 ± 4.5 degrees, P = 0.014); the right ureter was closer to midline (22.9 ± 8.8 mm vs 32.3 ± 1.2 mm, P < 0.001) when compared with normal controls anatomy. In 40% of women with HSK, the bifurcation of the vena cava was below the level of L5 in contrast to the 8% in the normal population (P < 0.001). In 60% of women with HSK, the inferior pole of the kidney was at or below L5.

Conclusions

Ureteral, renal, and vascular anatomic alterations in women with HSK may make presacral surgical anatomy challenging by obscuring the anterior longitudinal ligament anchoring point. Preoperative imaging is warranted to determine the feasibility of female pelvic reconstructive surgery in HSK patients.
Alzheimer Disease and Cancer
Authors: Sherzai Ayesha Z. , Parasram Melvin , Haider Janelle M. , Sherzai Dean
Published: January 2020

Introduction:

Studies have demonstrated an inverse relationship between Alzheimer dementia (AD) and cancer. This inverse relationship was further explored. In addition, Pin1 expression has been implicated in the cell cycle regulation of both disease processes. The relationship of Pin1 expression in 10 cancer types and secondary diagnosis of AD was examined.

Materials and Methods:

A cross-sectional analysis was performed using discharge data from the National Inpatient Sample from 1999 to 2008. Cancer was defined as the primary discharge diagnosis and AD was defined as the secondary discharge diagnosis. Cancer types were grouped according to their Pin1 expression to examine its relationship with AD. Analysis was performed by logistic regression.

Results:

Of ∼3 million cancer discharge diagnoses, 1.0% had a secondary diagnosis of AD. Discharge data of all 10 cancer types revealed a lower likelihood of secondary AD diagnosis. Prostate [crude odds ratios (OR): 0.26 (0.24 to 0.29), multivariate OR: 0.39 (0.35 to 0.43)], ovarian [crude OR: 0.38 (0.32 to 0.44), multivariate OR: 0.35 (0.30 to 0.41)], and lung cancer [crude OR: 0.39 (0.36 to 0.41), multivariate OR: 0.41 (0.39 to 0.44)] demonstrated the lowest odds of secondary AD diagnosis. When cancer types were grouped per Pin1 expression, cancer types with Pin1 underexpression were more likely to be associated with secondary diagnosis of AD than cancer types with Pin1 overexpression [crude OR: 1.4 (1.3 to 1.4), multivariate OR: 1.08 (1.02 to 1.14)].

Discussion:

This secondary data analysis further demonstrated an inverse relationship between AD and 10 cancer types, with prostate, ovarian, and lung cancers displaying the greatest inverse relationship. Pin1 underexpressing cancer types had a significantly higher likelihood of secondary diagnosis of AD than Pin1 overexpressing cancer types.
Systematic Monitoring of Cognitive Function During Electroconvulsive Therapy
Authors: Alvarez-Grandi Sebastian Alfredo , Groves Samantha J. , Douglas Katie M. , Porter Richard J.
Published: January 2020

Objective

International guidelines suggest repeating cognitive testing at intervals throughout a course of electroconvulsive therapy (ECT) to monitor its effects on cognitive function. However, it is apparent that few services do this, and an optimal battery of testing has not yet been established. We aimed to evaluate the utility of such routine cognitive testing in a clinic where patients had been routinely tested at intervals throughout a course of ECT.

Methods

All patients referred for ECT at a public ECT clinic were offered routine cognitive testing to monitor cognitive function during their course of ECT. Testing was conducted at baseline and after 3, 6, and 9 treatments. Analyses examined whether change in individual measures predicted reduction in autobiographical memory at subsequent measures and whether the results that were given to clinicians informed treatment decisions.

Results

Changes in cognitive test results were not associated with clinician decisions to change treatment parameters. Only change in digit span forwards after 3 treatments was associated with later reduction in Colombia University Autobiographical Interview - Short Form (CUAMI-SF) of greater than 25%, with a larger improvement in digit span forwards being associated with greater chance of having a 25% reduction in CUAMI-SF.

Conclusions

There was no evidence that the screening undertaken in this clinic had been helpful in determining treatment decisions or that changes in cognitive tests predicted in a reliable way who would later experience changes in autobiographical memory. However, follow-up testing was not completed reliably, and longer-term data regarding autobiographical memory were not collected.
A synthetic biochemical device for sensing microgravity
Authors: Mukhopadhyay Sayak , Bagh Sangram
Published: January 2020

Biological solutions to human space travel must consider microgravity as an important component, which is unknown by the biochemical worlds on the Earth. Thus, one of the fundamental challenges of space biotechnology is to create engineered biochemical systems to integrate microgravity as a signal within molecular and cellular processes. Here we created the first molecular or biochemical microgravity sensor by creating a synthetic-small-regulatory-RNA based molecular network inE.coli, which sensed microgravity and responded by altering the expression of a target protein. We demonstrated that the design was universal, could work potentially with any promoter and against any target gene. This device was applied to target cell division process and rescue the deformed cell shape by applying microgravity. The work showed for the first time, a way to integrate microgravity as physical signals within biochemical process of a living cell in a human designed way and thus, opens a new direction in space biotechnology, space chemistry and space technology.
Clinical predictors for etiology of acute diarrhea in children in resource-limited settings
Authors: Brintz Benjamin , Howard Joel , Haaland Benjamin , Platts-Mills James A. , Greene Tom , Levine Adam C. , Nelson Eric , Pavia Andrew T. , Kotloff Karen L. , Leung Daniel T.
Published: January 2020

Background

Diarrhea is one of the leading causes of childhood morbidity and mortality in lower- and middle-income countries. In such settings, access to laboratory diagnostics are often limited, and decisions for use of antimicrobials often empiric. Clinical predictors are a potential non-laboratory method to more accurately assess diarrheal etiology, the knowledge of which could improve management of pediatric diarrhea.

Methods

We used clinical and quantitative molecular etiologic data from the Global Enteric Multicenter Study (GEMS), a prospective, case-control study, to develop predictive models for the etiology of diarrhea. Using random forests, we screened the available variables and then assessed the performance of predictions from random forest regression models and logistic regression models using 5-fold cross-validation.

Results

We identified 1049 cases where a virus was the only etiology, and developed predictive models against 2317 cases where the etiology was known but non-viral (bacterial, protozoal, or mixed). Variables predictive of a viral etiology included lower age, a dry and cold season, increased height-for-age z-score (HAZ), lack of bloody diarrhea, and presence of vomiting. Cross-validation suggests an AUC of 0.825 can be achieved with a parsimonious model of 5 variables, achieving a specificity of 0.85, a sensitivity of 0.59, a NPV of 0.82 and a PPV of 0.64.

Conclusion

Predictors of the etiology of pediatric diarrhea can be used by providers in low-resources setting to inform clinical decision-making. The use of non-laboratory methods to diagnose viral causes of diarrhea could be a step towards reducing inappropriate antibiotic prescription worldwide.

Author Summary

Diarrhea is one of the leading causes of death in young children worldwide. In low-resource settings, diarrhea testing is not available or too expensive, and the decision to prescribe antibiotics is often made without testing. Using clinical information to predict which cases are caused by viruses, and thus wouldn’t need antibiotics, would help to improve appropriate use of antibiotics. We used data from a large study of childhood diarrhea, paired with advanced statistical methods including machine learning, to come up with the top clinical factors that could predict a viral cause of diarrhea. We compared 1049 cases where a virus was the only cause, with 2317 cases where the cause was known but not a virus. We found that a lower age, dry and cold season, nutritional status defined by increased height, lack of blood diarrhea, and vomiting, were the clinical factors most predictive of whether the diarrhea was caused by a virus. We found that, using just those 5 factors, we were able to predict a viral cause with good accuracy. Our findings can be used by doctors to guide the appropriate use of antibiotics for diarrhea in children.
Schizophrenia Risk Alleles Often Affect the Expression of Many Genes and Each Gene May Have a Different Effect on The Risk; A Mediation Analysis
Authors: Peng Xi , Bader Joel S. , Avramopoulos Dimitrios
Published: January 2020

Variants identified by genome-wide association studies (GWAS) are often expression quantitative trait loci (eQTLs), suggesting they are proxies or are themselves regulatory. Across many datasets analyses show that variants often affect multiple genes. Lacking data on many tissue types, developmental time points and homogeneous cell types, the extent of this one-to-many relationship is underestimated. This raises questions on whether a disease eQTL target gene explains the genetic association or is a by-stander and puts into question the direction of expression effect of on the risk, since the many variant - regulated genes may have opposing effects, imperfectly balancing each other. We used two brain gene expression datasets (CommonMind and BrainSeq) for mediation analysis of schizophrenia-associated variants. We confirm that eQTL target genes often mediate risk but the direction in which expression affects risk is often different from that in which the risk allele changes expression. Of 38 mediator genes significant in both datasets 33 showed consistent mediation direction (Chi2test P=6*10−6). One might expect that the expression would correlate with the risk allele in the same direction it correlates with disease. For 15 of these 33 (45%), however, the expression change associated with the risk allele was protective, suggesting the likely presence of other target genes with overriding effects. Our results identify specific risk mediating genes and suggest caution in interpreting the biological consequences of targeted modifications of gene expression, as not all eQTL targets may be relevant to disease while those that are, might have different than expected directions.
Epithelial-to-mesenchymal transition proceeds through directional destabilization of multidimensional attractor
Authors: Wang Weikang , Poe Dante , Yang Yaxuan , Hyatt Thomas , Xing Jianhua
Published: January 2020

How a cell changes from one stable phenotype to another one is a fundamental problem in developmental and cell biology. Epithelial-to-mesenchymal transition (EMT) is a phenotypic transition process extensively studied recently but mechanistic details remain elusive. Through time-lapse imaging we recorded single cell trajectories of human A549/Vim-RFP cells undergoing EMT induced by different concentrations of TGF-β in a multi-dimensional cell feature space. The trajectories cluster into two distinct groups, indicating that the transition dynamics proceeds through parallel paths. We then reconstructed the reaction coordinates and corresponding pseudo-potentials from the trajectories. The potentials reveal a plausible mechanism for the emergence of the two paths as the original stable epithelial attractor collides with two saddle points sequentially with increased TGF-β concentration, and relaxes to a new one. Functionally the directional saddle-node bifurcation ensures a CPT proceeds towards a specific cell type, as a mechanistic realization of the canalization idea proposed by Waddington.
Hidden state dynamics reveal the prolonged inactive state across the adult lifespan
Authors: Chen Keyu , Wang Ruidi , Liu Dong-Qiang
Published: January 2020

Adult lifespan is accompanied by functional reorganization of brain networks, but the dynamic patterns behind this reorganization remain largely unclear. This study focuses on modelling the dynamic process of spontaneous activity of large-scale networks using hidden Markov model (HMM), and investigates how it changes with age. The HMM with 12 hidden states was applied to temporally concatenated resting state fMRI data from two dataset of 176 / 170 subjects (aged 20-80 years), and each hidden state was characterized by distinct activation patterns of 17 brain networks. Results showed that (a) For both datasets, the elder tended to spend less time on and had less transitions to states showing antagonistic activity between various pairs of networks including default mode network, cognitive control and salience/ventral attention networks. (b) For both datasets, the elder were probable to spend more time on, have less transitions from and have more transitions to an ‘baseline’ state with only moderate-level activation of all networks, the time spent on this state also showed an U-shaped lifespan trajectory. (c) For both datasets, HMM exhibited higher specificity and reproducibility in uncovering the age effects compared with temporal clustering method, especially for age effects in transition probability. (d) These results demonstrate the age-correlated decrease of the anti-correlation between various networks, and further validate the prediction of Naik et al. (2017) that the existence of a particular network state with lower transition probability and higher fractional occupancy in old cohort, which may reflect the shift of the dynamical working point across the adult lifespan.