bluuebunny/crossref_metadata_2025 huggingface dataset:
Exophthalmometry values in the Hong Kong Chinese adult population from a population-based study
Authors: Cheung Janice J.C. , Chang Dulcia L. , Chan Jonathan C. , Choy Bonnie N.K. , Shih Kendrick C. , Wong Jasper K.W. , Ng Alex L.K. , Shum Jennifer W.H. , Ni Michael Y. , Lai Jimmy S.M. , Leung Gabriel M. , Wong Ian Y.H.
Published: November 2019

This study aims to establish the range of exophthalmometry values (EV) in the adult Hong Kong (HK) Chinese population, its relationship with various anthropometric parameters, and to compare it with the EV in different ethnic groups.

About 1485 adult HK Chinese were drawn from a random sample from the community-based FAMILY Cohort. Participants were interviewed, and comprehensive ophthalmological assessments were conducted. EV was measured using the Hertel's exophthalmometer.

EV of both eyes from 630 male (42.4%) and 855 female (57.6%) participants, mean age 54 ± 17.2 and 52 ± 16 respectively were analyzed. The mean EV were found to be 15.3 ± 2.8 mm in the right eye, 15.2 ± 2.9 mm in the left eye for men and 14.4 ± 2.7 mm in the right eye, 14.3 ± 2.7 mm in the left eye for women. There were no differences in the EV between right and left eyes (P > .05). Men had significantly higher EV than women (P < .05) and age was found to be negatively correlated to EV (P < .05). Body height (r = 0.20), weight (r = 0.25), waist (r = 0.11), hip circumference (r = 0.15), body mass index (r = 0.17), interpupillary distance (r = 0.54), and axial length (AL) (r = 0.20) were all found to have statistically significant positive correlations with EV (P < .01). Spherical equivalent was found to have statistically significant negative correlation with EV (P < .01).

Our study provides normative data on EV in the HK Chinese population. Height, weight, interpupillary distance, waist, hip circumference, and AL had positive correlations with EV. Spherical equivalent had negative correlation with EV. There was no significant difference in EV between the right and left eye. Age and gender had significant effect on EV.
Efficacy and safety of acupuncture as a complementary therapy for sepsis
Authors: Xian Jin , Wang Ling , Zhang Changyun , Wang Jian , Zhu Yushuo , Yu Huijuan , Zhang Xin , Tan Qiwen
Published: November 2019

Introduction

Sepsis is a physiological, pathological, and biochemical syndrome caused by infection. Acupuncture may be useful for sepsis. This systematic review aims to assess the efficacy and safety of acupuncture as a complementary therapy for sepsis.

Methods and analysis

We will search PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wan Fang Database, Chinese Biomedicine (CBM) database, VIP database, and TCM Literature Analysis and Retrieval Database from inception to October 31, 2019 to identify any eligible study. We include all randomized controlled trials (RCTs) without any limitation of blinding or publication language, exclude cohort studies and case reports. Two reviewers will independently select studies, extract and manage data. The primary outcomes include the mortality at 28 days, acute physiology, and chronic health evaluation II scores. The secondary outcomes include the tumor necrosis factor α (TNF-α) counts, interleukin 6 (IL-6) counts, interleukin 10 (IL-10) counts, procalcitonin (PCT), lactic acid, the level of T cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+), monocytes of human leukocyte antigen DR (HLA-DR), C-reactive protein (CRP), the numeration of leukocyte, intra-abdominal pressure, and adverse events or reactions. Statistical analyses will be performed using the Review Manager V.5.3 and R packages Metafor. We will use the Cochrane risk of bias tool for randomized trials to assess the risk of bias of included studies.

Ethics and dissemination

This study will not involve personal information. Ethical approval will not be required. We will publish the results in a peer-reviewed journal.

PROSPERO Trial registration number

CRD42019141491
An atrial septal aneurysm with an organized thrombus in an asymptomatic patient
Authors: Wang Xinxin , Wang Chunguo , Ma Dehua , Jin Jiang , Zhang Bo , Zhu Chengchu , Chen Baofu
Published: November 2019

Introduction:

An atrial septal aneurysm (ASA) is a rare congenital cardiac deformity characterized by interatrial septum protruding into atria forming a saccular structure.

Patient concerns:

In our case, a 42-year-old female patient presented to our hospital complained of palpitation.

Diagnosis:

Transthoracic echocardiography detected a 3.4 × 3.4 cm circular mass attached to the interatrial septum in right atrium complicated with a 6 mm secundum atrial septal defects (ASD).

Interventions:

The patient received a cardiopulmonary bypass surgery to remove the mass and close the ASD.

Outcomes:

The mass turned out to be an organized thrombus with calcium deposition and fibrinoid necrosis.

Conclusion:

ASA is a potential location of atrial thrombus because of the stagnation of blood. Systemic embolism events are the main complications of ASA. Surgery or anticoagulation is both recommended in patients with ASA with thrombus.
Extracorporeal treatment in children with acute severe poisoning
Authors: Sun Xiaomei , Chen Xiuying , Lu Jing , Tao Yuhong , Zhang Lijuan , Dong Liqun
Published: November 2019

Acute poisoning in children is a clinical emergency. Prompt and effective treatment is critical for life-threatening poisoning. Extracorporeal treatment (ECTR) is a practical option for enhancing the elimination of poisons.

We conducted a retrospective observational study on 338 children with severe acute poisoning who received ECTR during hospitalization from January 2010 to December 2017. The poisonous substances, utilization of ECTR, adverse reactions to ECTR, and outcomes were recorded.

The top 3 poisoning categories, in order of frequency, were found to be pesticides (57.99%), biotoxins (25.15%), and pharmaceuticals (14.20%). Paraquat (35.21%), an organic heterocyclic herbicide with high toxicity to humans, was the most common toxic substance. The main modalities of ECTR use were hemoperfusion (50.59%) and therapeutic plasma exchange (42.60%), followed by continuous renal replacement therapy (4.44%) and hemodialysis (1.18%). There were also 4 patients (1.18%) with a combination of ECTR performed. Adverse events of ECTR included errhysis and hematomas around the catheter exit site, oral cavity bleeding, allergic reactions, hypothermia, hypotension, and blood coagulation. The adverse reactions were mostly mild to moderate and were manageable. During the study period, there were 295 patients (87.28%) who were cured, 9 (2.66%) who experienced some improvement, and 34 (10.06%) who died.

ECTR modalities were found to be clinically effective approaches to the treatment of poisoning by pesticides, biotoxins, and pharmaceuticals, indicating they are important modalities in toxicology and treatment, and are well tolerated by children.
Bilateral lung transplantation after caesarean section in pregnancy with severe pulmonary arterial hypertension
Authors: Ye Jia , Chen Jing-Yu , Xu Na , Wu Bo , Wang Zhi-Ping , Xu Hong-Yang , Ma Jin-Qi
Published: November 2019

Rationale:

Pulmonary arterial hypertension (PAH) can lead to an increase in right ventricular load and subsequently heart failure, making severe PAH a contraindication for pregnancy. In addition, PAH may worsen during pregnancy and puerperium, which requires high-quality critical care. This report is the first instance in which a patient with severe PAH, survived a successful atrial septal defect (ASD) repair and bilateral lung transplantation during puerperium.

Patient concerns:

A 42-year-old pregnant woman with congenital heart disease (CHD) and severe PAH was admitted to our hospital for the management of pregnancy and delivery. The patient was diagnosed with severe PAH in 2013, and no significant improvements or deteriorations were found until this pregnancy-related hospital admission.

Diagnosis:

The patient was diagnosed with CHD and severe PAH in 2013 with color Doppler echocardiography, right cardiac catheterization, and pulmonary perfusion imaging. The patient's mean pulmonary arterial pressure increased to 140 mm Hg during pregnancy, suggesting an exacerbated PAH with high risks to both her and the unborn child.

Interventions:

The patient was treated with PAH-targeting treprostinil injection to reduce pulmonary artery pressure. Caesarean section was performed at 27 weeks and 5 days of gestation. The patient was put under extracorporeal membrane oxygenation (ECMO) with the help of local anesthesia before the operation. The investigators finally conducted a bilateral lung transplantation with a shell incision of the sternum under cardiopulmonary bypass.

Outcomes:

The mother and the neonate survived and recovered well after the operation, and were discharged from the hospital on the fourth month post-hospitalization.

Lessons:

Severe PAH is an absolute contraindication for pregnancy. However, for patients who insist on a pregnancy, it could be plausible to proceed with a targeted drug therapy and ECMO after conducting a cesarean section, and finally, a lung transplantation. Multidisciplinary diagnosis and treatment is the key to the successful treatment of a PAH-complicated pregnancy.
The use of enamel matrix derivative for the treatment of the apically involved tooth
Authors: Park Jun-Beom
Published: November 2019

Introduction:

The aim of this report is to present a case of an apically involved tooth with successful regeneration by only applying enamel matrix derivative. The root of the tooth was planed and the defect area was well debrided using various instruments, including curettes and an ultrasonic scaler, and the root surface of the tooth and the defect area were loaded with enamel matrix derivative.

Patient concerns:

A 32-year-old man visited the clinic due to a referral for the evaluation of his mandibular left first molar.

Diagnosis:

The clinical and radiographic assessment displayed the loss of the periodontium around the tested tooth with apical involvement of the mesial root. Bleeding upon probing was noted at the mandibular first molar, with the deepest periodontal probing depth of 15 mm.

Interventions:

A nonsurgical approach was firstly performed on the tooth, and the deepest probing depth was reduced to 12 mm. After re-evaluation, elevation of a full-thickness flap was done, the root of the tooth was planed, and the defect area was well debrided using various instruments, including curettes and an ultrasonic scaler. The defect area on the mandibular left first molar was grafted with enamel matrix derivative.

Outcomes:

The 7-month postoperative clinical and radiographic evaluation showed healthy gingiva and an increase in radiopacity. The final 1-year and 9-month postoperative evaluation showed that regeneration of bony defect was well maintained up to the final evaluation with reduction of probing depth.

Conclusion:

In conclusion, a case of apically involved tooth can be treated only with enamel matrix derivative after meticulous debridement with curettes and an ultrasonic scaler.
Advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman
Authors: Wang Bin , Yang Hua-Di , Shi Xin-He , Li Hui
Published: November 2019

Rationale:

Uterine adenosarcoma (UA) with sarcomatous overgrowth (ASSO) is a rare and aggressive disease. Herein, wereported the case of a young patient with advanced uterine ASSO.

Patients concerns:

A 29-year-old woman with the diagnoses of endometrial polyp and adenomyosis underwent hysteroscopic endometrial polypectomy for the giant endometrial polyp. Postoperative regular ultrasound scan indicated thickened endometriumand an ill-defined mass with continuous enlargement in the myometrium of the posterior wall of the uterus, which was considered as an adenomyoma. Two years after hysteroscopy, she was re-admitted due to lower abdominal distension and large pelvic mass. At that time, she had taken oral short-acting contraceptives for 2.5 years.

Diagnoses:

Magnetic resonance imaging (MRI) of the pelvis revealed an irregular mass with the size of 12∗56∗107 mm3 in the right annex area, without distinct border with the rectum, moreover, an uneven intrauterine echo that has no obvious boundary with uterine wall. Right ovarian cancer and adenomyoma were initially considered.

Interventions:

The patient received transperitoneal retroperitoneal pelvic combined with total viscera resection, including uterus, bilateral appendages and rectum, omentectomy, appendectomy, lymphadenectomy, and ileostomy. Postoperative pathology confirmed ASSO in the uterine cavity and muscular layer, the whole cervical duct and the right adnexal. She underwent 2 systemic chemotherapy sessions after the surgery. The chemotherapy regimen was ifosfamide 2.5 g day 1 to 3, with liposomal doxorubicin 40 mg day 1.

Outcomes:

The final diagnosis was uterine ASSO, International Federation of Gynecology and Obstetrics stage IVa. The patient has been following-up so far, with no progression.

Lessons:

Review of the case indicated that history of long-term oral short-acting contraceptives and giant endometrial polyps may be the high-risk factors for UA. For patients with high-risk factors, the follow-up ultrasound scan should be more frequently conducted. Moreover, 3D-ultrasound, MRI and outpatient hysteroscopy are recommended for routine screening. Placement of levonorgestrel-releasing intra-uterine system after hysteroscopy may be an effective intervention for patients with a high risk of giant polyps. Cluster of Differentiation 10, Estrogen receptor, Progesterone receptor, and nuclear antigen may be predictors for prognosis and selection of individualized treatment program.
A CARE-compliant case report: total pancreatectomy and total gastrectomy to treat pancreatic ductal adenocarcinoma
Authors: Wen Yanghui , Tu Junhao , Xue Xiaofeng , Shi Weiqiang , Qin Lei , Qian Haixin , Xu Yinkai , Xu Xiaolan
Published: November 2019

Rationale:

Total pancreatectomy (TP) is performed in cases of multifocal and large invasive tumors of the pancreas, and is associated with high rates of mortality and morbidity. Previously, the limitations and unsatisfactory effect of this surgery rendered it rarely performed; however, with improvements in surgical techniques and blood sugar management, TP is now more frequently performed. TP has a similar long-term survival rate as that for pancreatoduodenectomy (PD). However, the application of TP plus total gastrectomy (TG) for the treatment of invasive pancreatic ductal adenocarcinoma has not been reported previously.

Patient concerns:

The patient was a 64-year-old man with epigastric discomfort. Physical examination showed a hard mass. Preoperative computed tomography and magnetic resonance imaging revealed a solid mass located in the pancreatic body and involving the portal vein and stomach.

Diagnosis:

Pancreatic cancer.

Interventions:

The patient was treated with TP combined with TG and portal vein reconstruction.

Outcomes:

The patient had a smooth post-operative recovery but, regretfully, developed metastases 2 months after discharge.

Lessons:

Considering the poor outcome of the present case, the validity of the operation should be reevaluated. Although a single case does not elicit a convincing conclusion, the current case might serve as a warning against performing a similar surgery.
Moxibustion for treating patients with hyperlipidemia
Authors: Yao Qin , Zhang Xinyue , Huang Yueping , Wang Hao , Hui Xin , Zhao Baixiao
Published: November 2019

Background:

Hyperlipidemia has been a root cause of atherosclerosis, which leads to a high risk to serious cardio-cerebrovascular disease. Many trials have reported that moxibustion therapy is effective in lowering blood lipid levels when treating hyperlipidemia. The aim of this systematic review is to assess the effectiveness and safety of moxibustion therapy for hyperlipidemia.

Methods:

Two reviewers will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; China National Knowledge Infrastructure (CNKI); Chinese Biomedical Literature Database (CBM); Chinese Scientific Journal Database (VIP database); and Wan-Fang Database from the inception, without restriction of publication status and languages. Additional searching including researches in progress, the reference lists and the citation lists of identified publications. Study selection, data extraction, and assessment of study quality will be performed independently by 2 reviewers. Changes of blood lipid levels from baseline to the end of the treatment, including low-density lipoprotein cholesterol (LDL-C) level, total cholesterol (TC) level, triglycerides (TG) level and high-density lipoprotein cholesterol (HDL-C) level will be assessed as the primary outcomes. Quality of life, long-term effect and safety will be evaluated as secondary outcomes. If it is appropriate for a meta-analysis, RevMan 5.3 statistical software will be used; otherwise, a descriptive analysis will be conducted. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data.

Results:

This study will provide a comprehensive review of the available evidence for the treatment of moxibustion with hyperlipidemia.

Conclusions:

The conclusions of our study will provide an evidence to judge whether moxibustion is an effective and safe intervention for patients with hyperlipidemia.

Ethics and dissemination:

This systematic review will be disseminated in a peer-reviewed journal or presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualized.

Trial registration number:

PROSPERO CRD42019130545.
Association of HLA-DRB1 genotype with younger age onset and elder age onset rheumatoid arthritis in Japanese populations
Authors: Oka Shomi , Furukawa Hiroshi , Shimada Kota , Hashimoto Atsushi , Komiya Akiko , Tsunoda Shinichiro , Saisho Koichiro , Tsuchiya Naoyuki , Katayama Masao , Shinohara Satoshi , Matsui Toshihiro , Fukui Naoshi , Sano Hajime , Migita Kiyoshi , Tohma Shigeto
Published: November 2019

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by joint destructions and human leukocyte antigen (HLA)-DRB1 is an important genetic risk factor for RA and influences the phenotype of RA. The clinical features of elder age onset RA (EORA) were known to be different from those of younger age onset RA (YORA). Previous studies reported the different association pattern of DRB1 alleles with YORA or EORA. The associations of DRB1 genotype with these RA subsets remained almost unknown. We investigated the genotype association of DRB1 with YORA or EORA in Japanese populations.

HLA genotyping was performed in Japanese RA patients and the association of allele or genotype carrier frequencies were analyzed.

The genotype frequency of DRB1

∗

04:05/DRB1

∗

04:06 (P = .0204, OR 7.69, 95%CI 1.39–42.72), DRB1

∗

04:05/DRB1

∗

12:01 (P = .0050, OR 5.53, 95%CI 1.71–17.88), and DRB1

∗

04:05/DRB1

∗

15:01 (P = .0124, OR 3.34, 95%CI 1.39–8.02) in YORA was higher than EORA. However, the frequencies of DRB1

∗

01:01/DRB1

∗

04:05 in YORA was tended to be lower than EORA (P = .0784, OR 0.14, 95%CI 0.01–2.42). The gene dosage effect of the shared epitope alleles was detected in EORA, but not in YORA. Trans-complementing DQ heterodimer molecules, formed by DQA1 and DQB1 of the haplotypes with and without shared epitope alleles, might explain the higher genotype frequencies of “shared epitope /not shared epitope”. Linear regression analyses showed the primary role of DQB1

∗

04:01 allele for the age at onset of RA.

This is the first report for the associations of DRB1 genotype with YORA or EORA in the Japanese population and the differential distribution of the genotypes was noted between these RA subsets. The involvement of DQ molecules for the age at onset of RA was suggested.
C-reactive protein/albumin ratio is a prognostic indicator in Asians with pancreatic cancers
Authors: Fu Yan-Jun , Li Ke-Zhi , Bai Ji-Hong , Liang Zhi-Qing
Published: November 2019

Background:

The prognostic value of C-reactive protein/albumin ratio (CAR) in pancreatic cancer remains controversial. This study aimed to determine the potential role of CAR as a prognostic indicator in pancreatic cancer.

Methods:

A comprehensive literature search up to December 2018 was conducted using PubMed, Web of Science, and other databases. The hazard ratio (HR) with 95% confidence interval (CI) was employed to quantitatively assess CAR as a prognostic indicator in patients with pancreatic cancer.

Results:

Eleven studies with 2047 pancreatic cancer patients were selected for the analysis. Ten out of 11 studies included only Asian patients. The pooled results showed that a higher CAR value was significantly associated with a poor overall survival of pancreatic cancer patients (random-effects model: HR = 1.86; 95% CI = 1.53–2.26). Sensitivity analysis indicated the stability of the overall pooled results. Subgroup analysis and meta-regression analysis revealed that the country under study, cut-off value of CAR, treatment of patients, and the period of follow-up did not affect the prognostic value of CAR in pancreatic cancer patients (P > .05). No publication bias was noted across the studies (P = .933).

Conclusion:

This meta-analysis suggests that CAR is associated with the survival of pancreatic cancer patients of Asian ethnicity, and a higher CAR may be a potential prognostic indicator in pancreatic cancers.
Hepatitis A hospitalizations among kidney transplant recipients in the United States: nationwide inpatient sample 2005–2014
Authors: Cheungpasitporn Wisit , Thongprayoon Charat , Ungprasert Patompong , Wijarnpreecha Karn , Mao Michael A. , Aeddula Narothama Reddy , Kaewput Wisit , Bathini Tarun , Kroner Paul T.
Published: November 2019

Background

This study aimed to evaluate the hospitalization rate for Hepatitis A virus (HAV) among kidney transplant (KTx) recipients and its outcomes as well as resource utilization.

Methods

The 2005–2014 National Inpatient Sample database was used to identify all hospitalized KTx recipients with an associated diagnosis of HAV. The hospital mortality, resource utilization, and associated liver conditions were compared between patients with and without HAV, adjusting for potential confounders.

Results

Of 871 024 KTx recipients identified, 204 had HAV. The overall inpatient prevalence of HAV in KTx recipients over 10 years in the United States was 23.42 cases per 100 000 admissions. There were no statistically significant changes in the inpatient prevalence of HAV in KTx recipients during the study period (P = 0.77), ranging from 9.2 to 34.3 per 100 000 admissions. Among hospitalized KTx recipients with HAV, 27.9% were from Northeast, 29.2% were from Midwest, 23.8% were from South, and 19.1% were from West. HAV was not significantly associated with increased hospital mortality, multiorgan failure, need for abdominal ultrasound, hospital length of stay, and total hospitalization costs and charges when compared with those without HAV. However, it is significantly associated with increased ICU stay, coexisting hepatitis B and C infection, and liver failure.

Conclusion

Overall, inpatient prevalence of HAV in KTx recipients in the United States (years 2005–2014) was 23.42 cases per 100 000 admissions. Hospitalization for HAV after KTx is associated with increased ICU stay, coexisting hepatitis B and C infection, and liver failure.
Impact of 18F-fluorodeoxyglucose PET/CT in the management of patients with plasma cell disorders
Authors: Shachar Ben , Prica Anca , Anconina Reut , Hawsawy Asmaa , MacCrostie Pamela , Langer Deanna , Metser Ur
Published: November 2019

Objectives

To evaluate the impact of 18F-fluorodeoxyglucose PET/CT examinations on the management of patients with plasma cell disorders.

Methods

This is a retrospective review of patients in a provincial database with PET/CT performed for plasma cell disorders between 2011 and 2018. The impact of PET/CT on actual patient management and outcome was assessed by two independent readers who compared planned pre-PET/CT management, documented at time of PET/CT requisition, to actual management received through linkages to administrative databases. PET/CT was considered of high impact if it altered the provision of active treatment, changed the modality of treatment or chemotherapy regimen. Change in management and the proportion of patients with high impact PET/CT were assessed.

Results

There were 44 patients with plasma cell disorders, including multiple myeloma, solitary plasmacytoma, Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, Skin changes syndrome, or monoclonal gammopathy of undetermined significance or biclonal gammopathy of undetermined significance. Management was altered after 38/56 (67.9%) PET/CT scans. Considering just the initial PET/CT scan in patients who underwent multiple scans, 31/44 (70.5%) patients had their management altered subsequent to PET/CT.

Conclusion

PET/CT resulted in a change in planned management in more than two-thirds of patients with plasma cell disorders in the current selected patient cohort. These results should be validated in a larger prospective trial.
A New Video Aid for Communicating Risk in the Treatment of Pediatric Inflammatory Bowel Disease
Authors: Newman Noah E. , Williams Kathryn L. , Zikmund‐Fisher Brian J. , Adler Jeremy
Published: November 2019

Balancing risks of immune suppressive medications against risk of chronic disease is challenging for clinicians and families. Available aids commonly lack comparative information needed to inform treatment decisions. We developed a simple video aid to illustrate competing risks associated with medications and underlying disease in context of pediatric inflammatory bowel disease. Those who viewed the video aid had more realistic risk perceptions than those who did not view it. The video aid is adaptable for other conditions. It required only commonly accessible software and little cost, thereby making an aid of this style an attractive option for health care professionals interested in communicating comparative risk data to patients.
The effect of rolling walker use on interpretation of Timed Up and Go test scores: a preliminary study
Authors: Hatch Janine , Veneri Diana
Published: November 2019

Studies have shown that the type of assistive device used during the Timed Up and Go test impacts the time it takes to complete the test. This study examines the impact of the use of a rolling walker within individuals on Timed Up and Go scores and assessment of fall risk. The Berg Balance Scale, Timed Up and Go, and linear gait speed were used to measure balance and fall risk on 13 older adults as part of their usual reassessment in preparation for discharge. Timed Up and Go and gait speed scores were compared assistive device conditions. The Berg Balance Scale was used as a benchmark fall risk assessment. Linear gait speed was similar in both conditions. Timed Up and Go times were slower for all patients using a rolling walker versus a cane or no assistive device. Consideration for the effect of assistive device use on Timed Up and Go scores has important implications as it may influence interpretation of fall risk.
Communication Interventions to Improve Goal-Concordant Care of Seriously Ill Patients
Authors: Bennett Frank , O'Conner-Von Susan
Published: November 2019

Effective communication between clinicians and seriously ill patients and their families about a patient's goals of care is essential to patient-centered, goal-concordant, end-of-life care. Effective goals-of-care communication between clinicians and patients is associated with improved patient and family outcomes, increased clinician satisfaction, and decreased health care costs. Unfortunately, clinicians often face barriers in goals-of-care communication and collaboration, including a lack of education, time constraints, and no standardized protocols. Without clear goals-of-care communication, patients may not be able to provide guidance to clinicians about their end-of-life preferences. The purpose of this integrative review was to examine the efficacy of goals-of-care communication interventions between patients, families, and clinicians in randomized controlled trials published between 2009 and 2018. Twenty-three studies met the inclusion criteria with an overall sample (N = 6376) of patients, family members, and clinicians. Results revealed of the 6 different intervention modes, patient decision aids and patient-clinician communication consistently increased comprehension and communication. Twelve of the studies had nurses facilitate or support the communication intervention. Because nurses are a critical, trusted nexus for communication about end-of-life care, focusing on nurse interventions may significantly improve clinical outcomes and the patient experience.
New Insights on Lipedema: The Enigmatic Disease of the Peripheral Fat
Authors: Bauer Anna-Theresa , von Lukowicz Dominik , Lossagk Katrin , Aitzetmueller Matthias , Moog Philipp , Cerny Michael , Erne Holger , Schmauss Daniel , Duscher Dominik , Machens Hans-Guenther
Published: November 2019

Background:

Although a large number of adult women worldwide are affected by lipedema, the physiologic conditions triggering onset and progression of this chronic disease remain enigmatic. In the present study, a descriptive epidemiologic situation of postoperative lipedema patients is presented.

Methods:

The authors developed an online survey questionnaire for lipedema patients in Germany. The survey was conducted on 209 female patients who had been diagnosed with lipedema and had undergone tumescent liposuction.

Results:

Most of the participants (average age, 38.5 years) had noticed a first manifestation of the disease at the age of 16. It took a mean of 15 years to accomplish diagnosis. Liposuction led to a significant reduction of pain, swelling, tenderness, and easy bruising as confirmed by the majority of patients. Hypothyroidism [n = 75 (35.9 percent) and depression [n = 48 (23.0 percent)] occurred at a frequency far beyond the average prevalence in the German population. The prevalence of diabetes type 1 [n = 3 (1.4 percent)], and diabetes type 2 [n = 2 (1 percent)] was particularly low among the respondents. Forty-seven of the lipedema patients (approximately 22.5 percent) suffered from a diagnosed migraine. Following liposuction, the frequency and/or intensity of migraine attacks became markedly reduced, as stated by 32 patients (68.1 percent).

Conclusions:

Quality of life increases significantly after surgery with a reduction of pain and swelling and decreased tendency to easy bruising. The high prevalence of hypothyroidism in lipedema patients could be related to the frequently observed lipedema-associated obesity. The low prevalence of diabetes, dyslipidemia, and hypertension appears to be a specific characteristic distinguishing lipedema from lifestyle-induced obesity.
Virological and immunological impact of integrase inhibitor-based regimens initiated during primary HIV-1 infection
Authors: Veil Raphael , Poizot-Martin Isabelle , Reynes Jacques , Goujard Cecile , Seng Remonie , Delobel Pierre , Cotte Laurent , Duvivier Claudine , Rey David , Tran Laurent , Surgers Laure , Allavena Clotilde , Lascoux Combe Caroline , Cheret Antoine , Meyer Laurence
Published: November 2019

Design:

Current international guidelines recommend either boosted protease inhibitor (PI/r)-based or integrase inhibitors (INSTI)-based regimens during primary HIV infection (PHI), even though the latter have only demonstrated their superiority at the chronic stage. We compared the effectiveness of INSTI-based versus PI/r-based combined antiretroviral therapy (cART) initiated during PHI.

Methods:

This study was conducted among patients who initiated cART between 2013 and 2017, using data from the ANRS-PRIMO cohort and the Dat’AIDS study. Cumulative proportions of patients reaching viral suppression (HIV-1 RNA <50 copies/ml) were calculated using Turnbull's estimator for interval-censored data. CD4+cells and CD4+/CD8+ratio increases were estimated using mixed linear models. Results were adjusted for the data source.

Results:

Among the 712 study patients, 299 received an INSTI-based cART. Patients’ baseline characteristics were similar between groups. Viral suppression was reached more rapidly in INSTI-treated versus PI/r-treated patients (P < 0.01), with cumulative proportions of 32 versus 6% at 4 weeks, 72 versus 31% at 12 weeks, 91 versus 78% at 24 weeks and about 95% in both groups at 48 weeks. At 4 weeks, INSTI-treated patients had gained on average 40 CD4+cells/μl (P = 0.05) over PI/r-treated ones; mean CD4+counts were similar in the two groups at 48 weeks. The CD4+/CD8+ratio followed the same pattern. Results were similar when restricted to a comparison between dolutegravir-based versus darunavir-based cART.

Conclusion:

On the basis of this study and available literature, we recommend the use of INSTI-based cART for treatment initiation during PHI, as it leads to faster viral suppression and immune restoration.
Public Health Practice-Driven Research to Improve HIV Prevention in the United States
Authors: Dombrowski Julia C. , Irvine Mary , Nash Denis , Harriman Graham , Golden Matthew R.
Published: November 2019

Background:

The evidence-practice gap in HIV prevention and the care continuum in the United States often reflects a mismatch between the perspectives of researchers and public health practitioners. The traditional research paradigm of sequential progress from efficacy research to implementation in practice and widespread scale-up is not well-aligned with the reality of health department program implementation.

Setting:

This article focuses on public health practice carried out by state and local health departments in the United States and the research intended to inform it.

Methods and Results:

In this narrative review, we discuss approaches to HIV prevention and care continuum research that are shaped by and responsive to public health practice implementation priorities and what is needed to promote productive and successful university–health department research partnerships. We review research methods of particular relevance to health departments to evaluate the effectiveness of HIV prevention and care continuum interventions and how these approaches diverge from traditional research approaches. Finally, we highlight the roles of federal agencies in supporting practice-driven HIV implementation research.

Conclusions:

Health departments are key stakeholders, consumers, and generators of the evidence base for public health practice. High-impact research to improve HIV prevention and the care continuum is informed by health department priorities and current practice from the start. Long-term, equitable relationships between universities and health departments are crucial to advance practice-driven research.
Chronic Pain After Gastric Bypass: Another Argument to Support Mesenteric Windows Closure
Authors: Douissard Jonathan , Gambon-Stow Petra , Dupuis Arnaud , Jung Minoa K. , Toso Christian , Hagen Monika E.
Published: November 2019

Chronic pain is frequent after Roux-en-Y gastric bypass (RYGB). Recurrent internal hernias (IHs) may be responsible for chronic abdominal pain. Physical examination and computed tomography are often inconclusive. This observational retrospective study describes 11 patients who underwent elective laparoscopy for post-RYGB chronic abdominal pain of undetermined etiology after noninvasive investigations and failure of conservative treatment. Open intermesenteric and/or Peterson spaces were found in all cases; IH was present in 6 cases. Nine patients were totally relieved from symptoms after mesenteric windows closure; substantial improvement was noted in the remaining 2 cases. Peterson space was found more likely to be responsible for chronic IH. In such selected patients, laparoscopic exploration and windows closure should be discussed. These findings add support to initial windows closure during RYGB.
Artificial intelligence for detection of optic disc abnormalities
Authors: Milea Dan , Singhal Shweta , Najjar Raymond P.
Published: November 2019

Purpose of review

The aim of this review is to highlight novel artificial intelligence-based methods for the detection of optic disc abnormalities, with particular focus on neurology and neuro-ophthalmology.

Recent findings

Methods for detection of optic disc abnormalities on retinal fundus images have evolved considerably over the last few years, from classical ophthalmoscopy to artificial intelligence-based identification methods being applied to retinal imaging with the aim of predicting sight and life-threatening complications of underlying brain or optic nerve conditions.

Artificial intelligence and in particular newly developed deep-learning systems are playing an increasingly important role for the detection and classification of acquired neuro-ophthalmic optic disc abnormalities on ocular fundus images. The implementation of automatic deep-learning methods for detection of abnormal optic discs, coupled with innovative hardware solutions for fundus imaging, could revolutionize the practice of neurologists and other non-ophthalmic healthcare providers.
The HMGB1-RAGE axis modulates the growth of autophagy-deficient hepatic tumors
Authors: Khambu Bilon , Hong Honghai , Liu Sheng , Liu Gang , Chen Xiaoyun , Dong Zheng , Wan Jun , Yin Xiao-Ming
Published: November 2019

Autophagy is an intracellular lysosomal degradative pathway important for tumor surveillance. Autophagy deficiency can lead to tumorigenesis. Autophagy is also known to be important for the aggressive growth of tumors, yet the mechanism that sustains the growth of autophagy-deficient tumors is not known. We previously reported that progression of hepatic tumors developed in autophagy-deficient livers required high mobility group box 1 (HMGB1) that is released from autophagy-deficient hepatocytes. However, the mechanism by which HMGB1 promotes hepatic tumorigenesis is not understood. In this study we examined the pathological features of the hepatic tumors and the mechanism of HMGB1-mediated tumorigenesis using liver-specific autophagy-deficient (Atg7-/-) and Atg7-/-/Hmgb1-/- mice. We found that in Atg7-/- mice the tumors cells were still deficient in autophagy and could also release HMGB1. Histological analysis using cell-specific markers suggested that fibroblast and ductular cells were present only outside the tumor whereas macrophages were present both inside and outside the tumor. Genetic deletion of HMGB1 or one of its receptors, receptor for advanced glycated end product (Rage), retarded liver tumor development. In addition, we found that expression of RAGE was only on ductual cells and Kupffer’s cells but not on hepatoctyes, which suggested that HMGB1 might promote hepatic tumor growth through a paracrine mode that altered the tumor microenvironment. Furthermore, HMGB1 and RAGE enhanced the proliferation capability of the autophagy-deficient hepatocytes and tumors. Finally, RNAseq analysis of the tumors indicated that HMGB1 induced a much broad changes in tumors. In particular, genes related to mitochondrial structures or functions were enriched among those differentially expressed in tumors in the presence or absence of HMGB1, revealing a potential key role of mitochondria in sustaining the growth of autophagy-deficient liver tumors via HMGB1 stimulation.
Obstacles to the reuse of study metadata in ClinicalTrials.gov
Authors: Miron Laura , Gonçalves Rafael S. , Musen Mark A.
Published: November 2019

Metadata that are structured using principled schemas and that use terms from ontologies are essential to making biomedical data findable and reusable for downstream analyses. The largest source of metadata that describes the experimental protocol, funding, and scientific leadership of clinical studies is ClinicalTrials.gov. We evaluated whether values in 302,091 trial records adhere to expected data types and use terms from biomedical ontologies, whether records contain fields required by government regulations, and whether structured elements could replace free-text elements. Contact information, outcome measures, and study design are frequently missing or underspecified. Important fields for search, such as condition and intervention, are not restricted to ontologies, and almost half of the conditions are not denoted by MeSH terms, as recommended. Eligibility criteria are stored as semi-structured free text. Enforcing the presence of all required elements, requiring values for certain fields to be drawn from ontologies, and creating a structured eligibility criteria element would improve the reusability of data from ClinicalTrials.gov in systematic reviews, metanalyses, and matching of eligible patients to trials.
Biological data questions the support of the self inhibition required for pattern generation in the half center model
Authors: Kohler Matthias , Stratmann Philipp , Röhrbein Florian , Knoll Alois , Albu-Schäffer Alin , Jörntell Henrik
Published: November 2019

Locomotion control in mammals has been hypothesized to be governed by a central pattern generator (CPG) located in the circuitry of the spinal cord. The most common model of the CPG is the half center model, where two pools of neurons generate alternating, oscillatory activity. In this model, the pools reciprocally inhibit each other ensuring alternating activity. There is experimental support for reciprocal inhibition. However another crucial part of the half center model is a self inhibitory mechanism which prevents the neurons of each individual pool from infinite firing. Self-inhibition is hence necessary to obtain alternating activity. But critical parts of the experimental bases for the proposed mechanisms for self-inhibition were obtained in vitro, in preparations of juvenile animals. The commonly used adaptation of spike firing does not appear to be present in adult animals in vivo. We therefore modeled several possible self inhibitory mechanisms for locomotor control. Based on currently published data, previously proposed hypotheses of the self inhibitory mechanism, necessary to support the CPG hypothesis, seems to be put into question by functional evaluation tests or by in vivo data. This opens for alternative explanations of how locomotion activity patterns in the adult mammal could be generated.

Author summary

Locomotion control in animals is hypothesized to be controlled through an intrinsic central pattern generator in the spinal cord. This was proposed over a hundred years ago and has subsequently been formed into a consistent theory, through experimentation and computer modeling. However, critical data that support the neuronal circuitry mechanisms underpinning this theory has been obtained in experiments that greatly differ from intact animals. We propose, after trying to fill in this critical part, that new ideas are required to explain locomotion of intact animals.
Host-adaptation inLegionellalesis 2.4 Ga, coincident with eukaryogenesis
Authors: Hugoson Eric , Ammunét Tea , Guy Lionel
Published: November 2019

Bacteria adapting to living in a host cell caused the most salient events in the evolution of eukaryotes, namely the seminal fusion with an archaeon1, and the emergence of both the mitochondrion and the chloroplast2. A bacterial clade that may hold the key to understanding these events is the deep-branching gammaproteobacterial orderLegionellales– containing among othersCoxiellaandLegionella– of which all known members grow inside eukaryotic cells3. Here, by analyzing 35 novelLegionellalesgenomes mainly acquired through metagenomics, we show that this group is much more diverse than previously thought, and that key host-adaptation events took place very early in its evolution. Crucial virulence factors like the Type IVB secretion (Dot/Icm) system and two shared effector proteins were gained in the lastLegionellalescommon ancestor (LLCA), while many metabolic gene families were lost in LLCA and its immediate descendants. We estimate that LLCA lived circa 2.4 Ga ago, predating the last eukaryotic common ancestor (LECA) by at least 0.5 Ga4. These elements strongly indicate that host-adaptation arose only once inLegionellales, and that these bacteria were using advanced molecular machinery to exploit and manipulate host cells very early in eukaryogenesis.
Predicting Latent Links from Incomplete Network Data Using Exponential Random Graph Model with Outcome Misclassification
Authors: Wu Qiong , Zhang Zhen , Waltz James , Ma Tianzhou , Milton Donald , Chen Shuo
Published: November 2019

Summary

Link prediction is a fundamental problem in network analysis. In a complex network, links can be unreported and/or under detection limits due to heterogeneous noises and technical challenges during data collection. The incomplete network data can lead to an inaccurate inference of network based data analysis. We propose a new link prediction model that builds on the exponential random graph model (ERGM) by considering latent links as misclassified binary outcomes. We develop new algorithms to optimize model parameters and yield robust predictions of unobserved links. The new method is applied to a partially observed social network data and incomplete brain network data. The results demonstrate that our method outperforms the existing latent-contact prediction methods.
Atypical spatial frequency dependence of visual metacognition among schizophrenia patients
Authors: Koizumi Ai , Hori Tomoki , Maniscalco Brian , Hayase Makoto , Mishima Ryou , Kawashima Takahiko , Miyata Jun , Aso Toshihiko , Lau Hakwan , Takahashi Hidehiko , Amano Kaoru
Published: November 2019

Although altered early stages of visual processing have been reported among schizophrenia patients, how such atypical visual processing may affect higher-level cognition remains largely unknown. Here we tested the hypothesis that metacognitive performance may be atypically modulated by spatial frequency (SF) of visual stimuli among individuals with schizophrenia, given their altered magnocellular function. To study the effect of SF on metacognitive performance, we asked patients and controls to perform a visual detection task on gratings with different SFs and report confidence, and analyzed the data using the signal detection theoretic measure meta-d’. Control subjects showed better metacognitive performance after yes- (stimulus-presence) than after no- (stimulus-absence) responses (‘yes-response advantage’) for high SF (HSF) stimuli but not for low SF (LSF) stimuli. The patients, to the contrary, showed a ‘yes-response advantage’ not only for HSF but also for LSF stimuli, indicating atypical SF dependency of metacognition. An fMRI experiment using the same task revealed that the dorsolateral prefrontal cortex (DLPFC), known to be crucial for metacognition, shows activity mirroring the behavioral results: decoding accuracy of perceptual confidence in DLPFC was significantly higher for HSF than for LSF stimuli in controls, whereas this decoding accuracy was independent of SF in patients. While individuals without schizophrenia may flexibly adapt metacognitive computations across SF ranges, patients may employ a different mechanism that is independent of SF. Because visual stimuli of low SF have been linked to top-down processing in predictive coding, this may reflect atypical functioning in these processes in schizophrenia.

Highlights

Visual metacognition of controls was dependent on spatial frequency.

Visual metacognition of schizophrenia patients was independent of spatial frequency.

Patients and controls differently rely on the dorsolateral prefrontal cortex.

Sensory inputs may reach metacognitive circuits in an atypical manner among patients.