bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal body mass index and risk of obstetric, maternal and neonatal outcomes: A cohort study of nulliparous women with spontaneous onset of labor
Authors: Dalbye Rebecka , Gunnes Nina , Blix Ellen , Zhang Jun , Eggebø Torbjørn , Nistov Tokheim Linn , Øian Pål , Bernitz Stine
Published: October 2020

Introduction

This study investigates associations between maternal body mass index (BMI) early in pregnancy and obstetric interventions, maternal and neonatal outcomes.

Material and methods

This is a cohort study of nulliparous women originally included in a cluster randomized controlled trial carried out at 14 Norwegian obstetric units between 2014 and 2017. The sample included 7189 nulliparous women with a singleton fetus, cephalic presentation and spontaneous onset of labor at term, denoted as group 1 in the Ten‐Group Classification System. The women were grouped according to the World Health Organization BMI classifications: underweight (BMI <18.5), normal weight (BMI 18.5‐24.9), pre‐obesity (BMI 25.0‐29.9), obesity class I (BMI 30.0‐34.9), and obesity classes II and III (BMI ≥35.0). We used binary logistic regression to estimate crude and adjusted odds ratios (ORs) of the interventions and outcomes, with associated 95% confidence intervals (CIs), comparing women in different BMI groups with women of normal weight.

Results

We found an increased risk of intrapartum cesarean section in women of obesity class I and obesity classes II and III, with adjusted OR of 1.70 (95% CI 1.21‐2.38) and 2.31 (95% CI 1.41‐3.77), respectively. Women in obesity groups had a gradient of risk of epidural analgesia and use of continuous CTG (including STAN), with adjusted OR of 2.39 (95% CI 1.69‐3.38) and 3.28 (95% CI 1.97‐5.48), respectively. Women in obesity classes II and III had higher risk of amniotomy (adjusted OR = 1.42, 95% CI 1.02‐1.96), oxytocin augmentation (adjusted OR = 1.54, 95% CI 1.11‐2.15), obstetric anal sphincter injuries (adjusted OR = 2.21, 95% CI 1.01‐4.85) and postpartum hemorrhage ≥1000 mL (adjusted OR = 2.20, 95% CI 1.29‐3.78). We found a reduced likelihood of spontaneous vaginal delivery for pre‐obese women (adjusted OR = 0.85, 95% CI 0.74‐0.97) and no associations between maternal BMI and neonatal outcomes.

Conclusions

Obese women in Ten‐Group Classification System group 1 had increased risks of obstetric interventions and maternal complications. There was a gradient of risk for intrapartum cesarean section, with the highest risk for women in obesity classes II and III. No associations between maternal BMI and neonatal outcomes were observed.
Single‐ or double‐layer uterine closure techniques following cesarean: A randomized trial
Authors: Yılmaz Baran Şafak , Kalaycı Hakan , Doğan Durdağ Gülşen , Yetkinel Selçuk , Alemdaroğlu Songül , Çok Tayfun , Bulgan Kılıçdağ Esra
Published: October 2020

Introduction

Cesarean deliveries are commonly performed throughout the world. Although the uterine closure technique following this procedure may influence how the uterine scar heals, there is insufficient evidence for choosing the appropriate technique and so preventing long‐term negative consequences. This prospective, randomized study examined the effects of single‐ and double‐layer uterine closure techniques on uterine scar healing following cesarean delivery.

Material and methods

This study assessed a total of 282 women aged 18‐45 years who were in gestational weeks 24‐41 of singleton pregnancies. None had previously undergone uterine surgeries. These participants completed their first cesarean deliveries at the time of study and were randomized into the following two treatment groups: single‐layer closure with locking and double‐layer closure with locking in the first layer, but not in the second layer (NCT03629028). However, the decidua was not included for treatment in either group. Participants were evaluated at 6‐9 months after cesarean section by saline infusion sonohysterography to assess cesarean delivery scar defects. These procedures were conducted by experienced sonographers who were not aware of the uterine closure technique.

Results

Of the 225 final participants, 109 received the single‐layer closure technique, whereas 116 received the double‐layer technique. The niche rates were 37% (n = 40) for the single‐layer group and 45.7% (n = 53) for the double‐layer group (P = .22, relative risk 1.4, 95% CI = 0.8‐4.4).

Conclusions

The single‐ and double‐layer closure techniques did not produce different impacts on uterine scar niche development.
Bipolar disorder: Trimodal age‐at‐onset distribution
Authors: Bolton Sorcha , Warner Jeremy , Harriss Eli , Geddes John , Saunders Kate E. A.
Published: October 2020

Objective

Bipolar disorder (BD) is a chronic mental health disorder with significant morbidity and mortality. Age at onset (AAO) may be a key variable in delineating more homogeneous subgroups of BD patients. However, no known research has systematically assessed how BD age‐at‐onset subgroups should be defined.

Methods

We systematically searched the following databases: Cochrane Central Register of Controlled Trials, PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Proquest Dissertations and Theses, Google Scholar and BIOSIS Previews. Original quantitative English language studies investigating AAO in BD were sought.

Results

A total of 9454 unique publications were identified. Twenty‐one of these were included in data analysis (n = 22981 BD participants). Fourteen of these studies (67%, n = 13626 participants) found a trimodal AAO distribution: early‐onset (µ = 17.3, σ = 1.19, 45% of sample), mid‐onset (µ = 26.0, = 1.72, 35%), and late‐onset (µ = 41.9, = 6.16, 20%). Five studies (24%, n = 1422 participants) described a bimodal AAO distribution: early‐onset (µ = 24.3, σ = 6.57, 66% of sample) and late‐onset (µ = 46.3, σ = 14.15, 34%). Two studies investigated cohort effects on BD AAO and found that when the sample was not split by cohort, a trimodal AAO was the winning model, but when separated by cohort a bimodal distribution fit the data better.

Conclusions

We propose that the field conceptualises bipolar disorder age‐at‐onset subgroups as referring broadly to life stages. Demarcating BD AAO groups can inform treatment and provide a framework for future research to continue to investigate potential mechanisms of disease onset.
A Bayesian approach to restricted latent class models for scientifically structured clustering of multivariate binary outcomes
Authors: Wu Zhenke , Casciola‐Rosen Livia , Rosen Antony , Zeger Scott L.
Published: October 2020

This paper presents a model‐based method for clustering multivariate binary observations that incorporates constraints consistent with the scientific context. The approach is motivated by the precision medicine problem of identifying autoimmune disease patient subsets or classes who may require different treatments. We start with a family of restricted latent class models or RLCMs. However, in the motivating example and many others like it, the unknown number of classes and the definition of classes using binary states are among the targets of inference. We use a Bayesian approach to RLCMs in order to use informative prior assumptions on the number and definitions of latent classes to be consistent with scientific knowledge so that the posterior distribution tends to concentrate on smaller numbers of clusters and sparser binary patterns. The paper derives a posterior sampling algorithm based on Markov chain Monte Carlo with split‐merge updates to efficiently explore the space of clustering allocations. Through simulations under the assumed model and realistic deviations from it, we demonstrate greater interpretability of results and superior finite‐sample clustering performance for our method compared to common alternatives. The methods are illustrated with an analysis of protein data to detect clusters representing autoantibody classes among scleroderma patients.
Long‐term magnesium supplementation improves glucocorticoid metabolism: A post‐hoc analysis of an intervention trial
Authors: Schutten Joëlle C. , Joris Peter J. , Minović Isidor , Post Adrian , van Beek André P. , de Borst Martin H. , Mensink Ronald P. , Bakker Stephan J. L.
Published: October 2020

Objective

Increasing magnesium intake might reduce the risk of cardiovascular disease (CVD). Whether potential effects on cortisol contribute to these beneficial effects on cardiovascular health remains unclear. We therefore studied effects of long‐term oral magnesium supplementation on glucocorticoid metabolism, specifically on the excretion of urinary cortisol, cortisone and their metabolites, as well as on the ratios reflecting enzymatic activity of 11β‐hydroxysteroid dehydrogenases (11β‐HSDs) and A‐ring reductases.

Design

A post‐hoc analysis of a randomized trial with allocation to a magnesium supplement (350 mg/day) or a placebo for 24‐week.

Patients

Forty‐nine overweight men and women, aged between 45 and 70 years.

Measurements

Cortisol, cortisone and their metabolites (tetrahydrocortisol [THF], allo‐tetrahydrocortisol [allo‐THF] and tetrahydrocortisone [THE]) were measured in 24‐h urine samples. Enzymatic activities of 11β‐HSD overall and of 11β‐HSD type 2 were estimated as the urinary (THF + allo‐THF [THFs])/THE and cortisol/cortisone ratios, respectively. A‐ring reductase activity was assessed by ratios of THF/allo‐THF, allo‐THF/cortisol, THF/cortisol and THE/cortisone.

Results

After 24‐week, urinary cortisol excretion was decreased in the magnesium group as compared with the placebo group (−32 nmol/24‐h, 95% CI: −59; −5 nmol/24‐h, p = .021). Ratios of THFs/THE and cortisol/cortisone were decreased following magnesium supplementation by 0.09 (95% CI: 0.02; 0.17, p = .018) and 0.10 (95% CI: 0.03; 0.17, p = .005), respectively. No effects were observed on A‐ring reductase activity.

Conclusions

We observed a beneficial effect of magnesium supplementation towards a lower 24‐h urinary cortisol excretion together with an increased activity of 11β‐HSD type 2. Our findings may provide another potential mechanism by which increased magnesium intake lowers CVD risk (ClinicalTrials.gov identifier: NCT02235805).
Parenting Black children in White spaces: Skilled African migrants reflect on their parenting experiences in Australia
Authors: Gatwiri Kathomi , Anderson Leticia
Published: October 2020

This paper employs a critical race theory (CRT) perspective to probe the experiences of skilled African migrants parenting Black children in Australia, a predominantly White country. Two key themes emerged from this study: (1) the need to explicitly teach children about race and racism and to foster positive racial identities and (2) the complexities of navigating tensions between ‘African’ and ‘Western’ cultural values. Participants demonstrated high levels of awareness of intercultural parenting approaches and a desire to blend the best aspects of African and Australian cultural values in their own parenting practice. A significant paradox was also apparent in the tension between parental desires to inculcate pride in African ancestry and culture, while simultaneously encouraging children to ‘curate’ their blackness to minimize experiences of racialization. Social workers in Australia often play a critical role in the lives of migrant families as they support them to negotiate transitions in parenting contexts. Although this paper only offers a perspective on the parenting experiences of skilled African migrants and how they creatively manage the tensions and change emerging from this process, we suggest that this understanding helps to expand knowledge on the complexity of parenting in multicultural, transcultural and intercultural contexts.
The Stuff of Contention and Care: Affective Materiality and Everyday Learning in Bristol, UK
Authors: Buchczyk Magdalena , Facer Keri
Published: October 2020

Drawing on fieldwork in Bristol, UK, the article resituates the increasingly popular policy framing of a “learning city” within recent anthropological debates on urban political materiality. Using research findings from fieldwork conducted in sites of informal and non‐formal learning on the margins of a UNESCO Learning City, we argue for an ethnography that is attentive to the ways in which learning manifests itself in everyday life. Through three field sites—a community space, a bicycle workshop, and a contested heritage campaign—we demonstrate the significance of material culture, controversy, and care as constitutive of learning processes within urban life. Through these examples, we aim to reframe questions on the complexity of learning at a city scale as part of affect‐driven knowledge and the material, embodied transmission of skill and everyday practice. By tracing how learning plays out in everyday life, we can begin to interrogate what happens beyond the neoliberal forms of educational governance, and the extent to which the everyday practices challenge or reinforce top‐down formulations as well as potentially transforming forms of knowledge production.
N6‐methyladenosine (m6A) RNA modification in human cancer
Authors: Huo Fu‐Chun , Zhu Zhi‐Man , Pei Dong‐Sheng
Published: October 2020

N6‐methyladenosine (m6A) RNA modification, first discovered in 1974, is the most prevalent, abundant and penetrating messenger RNA (mRNA) modification in eukaryotes. This governs the fate of modified transcripts, regulates RNA metabolism and biological processes, and participates in pathogenesis of numerous human diseases, especially in cancer through the reciprocal regulation of m6A methyltransferases (“writers”) and demethylases (“erasers”) and the binding proteins decoding m6A methylation (“readers”). Accumulating evidence indicates a complicated regulation network of m6A modification involving multiple m6A‐associated regulatory proteins whose biological functions have been further analysed. This review aimed to summarize the current knowledge on the potential significance and molecular mechanisms of m6A RNA modification in the initiation and progression of cancer.
The role of typical and atypical pathogens in acute exacerbations of chronic obstructive pulmonary disease
Authors: Yildiz Sevilay , Gonullu Nevriye , Yildiz Birsen Pinar , Hattatoglu Didem Gorgun , Kuskucu Mert , Midilli Kenan , Aygun Gokhan , Mayda Pelin Yuksel , Musellim Benan
Published: October 2020

Objectives

The exact role of Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila in the development of chronic obstructive pulmonary disease exacerbations remains to be elucidated. This study was conducted to identify nonspecific and atypical pathogens associated with acute exacerbations of COPD.

Materials and Methods

Between February 2013 and February 2015, 107 patients were analyzed. Sixty‐nine comprised the inpatient and 38 comprised the outpatient treatment group.

Results

When nonspecific culture results were taken into consideration only a causative organism could be detected in 46.7% of the patients. The detection rate increased to 85.1% with the additional use of polymerase chain reaction (PCR), direct fluorescent antibody (DFA) test, and culture methods. More than one causative agent was responsible for COPD exacerbation in 53.3% of patients: two agents in 37.3%, three agents in 15%, and four agents in 0.9%. H. influenzae was detected in 63 (58.9%) patients, S. pneumoniae in 57 (53.2%), P. aeruginosa in 15 (14.0%), and L. pneumophila in 11 (10%). L. pneumophila was the more commonly isolated agent in the inpatient group (P = 0.002). Patients receiving continuous oxygen therapy and noninvasive mechanical ventilation were more likely to have an exacerbation associated with P. aeruginosa (P = 0.008 and P = 0.009, respectively).

Conclusion

The additional use of DFA for Legionella and multiplex PCR in combination with nonspecific microbiological culturing methods greatly improves the ability to identify infectious agents in acute exacerbations of COPD. There should be a high index of suspicion for P.aeruginosa as a causative organism, particularly in subjects receiving continuous oxygen therapy and/or using NIV and L. pneumophila should certainly be taken into consideration in severe COPD exacerbations.
Political Elite in Contemporary Vietnam: The Origin and Evolution of the Dominant Stratum
Authors: Ishizuka Futaba
Published: October 2020

Michael Voslensky's concept of nomenklatura has three main features: comprehensive state authority, monopoly of wealth, and a hierarchical personnel system. Such features were found in party‐state leaders in pre‐reform Vietnam. In the doi moi period, the environment in which party‐state leaders operate has changed greatly, but ambiguities remain under the names of the socialist‐oriented market economy and socialist law‐governed state. With the party‐state personnel system essentially unchanged from the pre‐reform period, party‐state leaders have taken advantage of the ambiguous nature of such reforms and consolidated their dominant position in society through acts of corruption and nepotism. The intensive anti‐corruption drive by the 12th tenure party leadership dealt a blow to those who committed such deviations. Nevertheless, it did not fundamentally change the situation of political elite dominance, as it aimed to strengthen the concentration of decision‐making power and added more requirements for would‐be officeholders.
Large‐scale longitudinal climate gradient across the Palearctic region affects passerine feather moult extent
Authors: Kiat Yosef , Davaasuren Batmunkh , Erdenechimeg Tuvshinjargal , Troupin David , Sapir Nir
Published: October 2020

Large‐scale spatial gradients of environmental conditions shape organisms, populations and ecosystems. Even though environmental gradients are a key research theme in macro‐ecology and biogeography, the effects of large‐scale, east–west, environmental gradients are largely overlooked compared with north–south gradients. Our study focused on feather moult, an important and energy demanding process in birds. By comparing Western and Eastern Palearctic populations of 21 species, we found that juvenile passerines in the Western and Eastern Palearctic differ in the number of feathers moulted as part of their post‐juvenile moult. This difference is most likely the result of a large‐scale climatic gradient in cold season duration and consequent differences in the time available for moulting. Eastern populations were characterized by a limited extent of feather moult that was additionally affected by migration distance and body mass. The longer migration distance in the Eastern Palearctic caused a generally less extensive moult while high body mass was correlated with a low difference in moult extent between the Western and Eastern Palearctic regions. These results highlight the importance of linking annual cycle processes at the organismal level to the specific environmental conditions within the distribution range of each species.
Onward but not always upward: individualistic elevational shifts of tree species in subtropical montane forests
Authors: O'Sullivan Kirsten S. W. , Ruiz‐Benito Paloma , Chen Jan‐Chang , Jump Alistair S.
Published: October 2020

Ongoing global climate change is driving widespread shifts in species distributions. Trends show frequent upwards shifts of treelines, but information on changes in montane forest below the treeline and in the tropics and subtropics is limited, despite the importance of these areas for biodiversity and ecosystem function. Patterns of species shifts in tropical and subtropical regions are likely to be more complex and individualistic than global averages suggest due to high species diversity and strong influence of competition, alongside direct climatic limitations on distributions. To address the question of how subtropical montane tree species are likely to move as climate changes, we used an extensive national forest inventory to estimate distribution shifts of 75 tree species in Taiwan by comparing the optimum elevation and range edges of adults and juveniles within species. Overall there was a significant difference in optimum elevation of adults and juveniles. Life stage mismatches suggested upward shifts in 35% of species but downward shifts of over half (56%), while 8% appeared stable. Upward elevation shifts were disproportionately common in high elevation species, whilst mid to low elevation species suggested greater variation in shift direction. Whilst previous research on mountain forest range shifts has been dominated by work addressing changes in treeline position, we show that although high elevation species shift up, below the treeline species may shift individualistically, heralding widespread changes in forest communities over coming decades. The wide variation of responses indicated is likely driven by individual species responses to interacting environmental factors such as competition, topography and anthropogenic influences across the broad range of forest types investigated. As global environmental changes continue, more detailed understanding of tree range shifts across a wide spectrum of forests will allow us to prepare for the implications of such changes for biodiversity, ecosystem function and dependent human populations.
Increasing climate‐driven taxonomic homogenization but functional differentiation among river macroinvertebrate assemblages
Authors: Mouton Théophile L. , Tonkin Jonathan D. , Stephenson Fabrice , Verburg Piet , Floury Mathieu
Published: October 2020

Global change is increasing biotic homogenization globally, which modifies the functioning of ecosystems. While tendencies towards taxonomic homogenization in biological communities have been extensively studied, functional homogenization remains an understudied facet of biodiversity. Here, we tested four hypotheses related to long‐term changes (1991–2016) in the taxonomic and functional arrangement of freshwater macroinvertebrate assemblages across space and possible drivers of these changes. Using data collected annually at 64 river sites in mainland New Zealand, we related temporal changes in taxonomic and functional spatial β‐diversity, and the contribution of individual sites to β‐diversity, to a set of global, regional, catchment and reach‐scale environmental descriptors. We observed long‐term, mostly climate‐induced, temporal trends towards taxonomic homogenization but functional differentiation among macroinvertebrate assemblages. These changes were mainly driven by replacements of species and functional traits among assemblages, rather than nested species loss. In addition, there was no difference between the mean rate of change in the taxonomic and functional facets of β‐diversity. Climatic processes governed overall population and community changes in these freshwater ecosystems, but were amplified by multiple anthropogenic, topographic and biotic drivers of environmental change, acting widely across the landscape. The functional diversification of communities could potentially provide communities with greater stability, resistance and resilience capacity to environmental change, despite ongoing taxonomic homogenization. Therefore, our study highlights a need to further understand temporal trajectories in both taxonomic and functional components of species communities, which could enable a clearer picture of how biodiversity and ecosystems will respond to future global changes.
Clinical comparison of an electric‐powered ionic toothbrush and a manual toothbrush in plaque reduction: A randomized clinical trial
Authors: Ikawa Takahiro , Mizutani Koji , Sudo Takeaki , Kano Chihiro , Ikeda Yuichi , Akizuki Tatsuya , Kobayashi Hiroaki , Izumi Yuichi , Iwata Takanori
Published: October 2020

Objectives

This study aimed to evaluate the plaque removal efficacy of a newly developed electric‐powered ionic toothbrush vs. a manual toothbrush.

Materials and Methods

Manual or electric‐powered ionic toothbrushes were randomly assigned to 30 healthy volunteers divided into two groups (Phase I). After 2 min of brushing, all tooth surfaces were stained with a plaque staining solution, and blinded examiners performed scoring using the Rustogi Modification of the Navy Plaque Index. Plaque removal rate was calculated at the central incisors, first premolar and first molar, as representative teeth, in the maxilla and mandibula. One week following Phase I, the same examinations were repeated in all subjects using another toothbrush (Phase II), as a crossover design.

Results

Electric ionic toothbrushes demonstrated a significantly higher plaque removal rate than manual toothbrushes in the premolar and molar areas (p < .05). However, in the central incisor area, no statistically significant difference was observed.

Conclusions

Compared with manual toothbrushes, electric‐powered ionic ones were significantly efficient in removing plaque in the premolar and molar areas.
Association of the Non‐Alcoholic Fatty Liver Disease Fibrosis Score with subclinical myocardial remodeling in patients with type 2 diabetes: A cross‐sectional study in China
Authors: Fan Nengguang , Ding Xiaoying , Zhen Qin , Gu Liping , Zhang Aifang , Shen Tingting , Wang Yufan , Peng Yongde
Published: October 2020

Aims/Introduction

Non‐alcoholic fatty liver disease, especially with liver fibrosis, is associated with cardiovascular diseases. The Non‐Alcoholic Fatty Liver Disease Fibrosis Score (NFS), a non‐invasive marker of advanced fibrosis, was found to be associated with cardiovascular diseases in different populations. The aim of the present study was to determine whether the NFS is associated with subclinical myocardial remodeling in type 2 diabetes patients.

Materials and Methods

A cross‐sectional study was carried out in type 2 diabetes patients. The NFS derived from available parameters was calculated, and the participants were divided according to the quartiles of the NFS and grades of the NFS (low, intermediate and high). Fibrosis‐4 and Aspartate Aminotransferase to Platelet Ratio Index, another two liver fibrosis scores, were also calculated. Subclinical myocardial remodeling was examined by echocardiography, and its associations with NFS, Fibrosis‐4 and Aspartate Aminotransferase to Platelet Ratio Index were analyzed.

Results

A total of 1,878 type 2 diabetes patients were enrolled in the present study. The NFS was independently associated with sex, age, body mass index, low‐density lipoprotein cholesterol and glycated hemoglobin in type 2 diabetes patients. Parameters of subclinical myocardial remodeling including left atrial dimension, interventricular septum thickness, left ventricular end‐diastolic diameter, left ventricular end‐systolic diameter, left ventricular posterior wall thickness (LVPWT) and left ventricular mass index were all gradually increased with the increment of the NFS. Linear regression analysis further showed that the NFS was positively associated with left atrial dimension, interventricular septum thickness, left ventricular end‐diastolic diameter, left ventricular end‐systolic diameter, LVPWT and left ventricular mass index after adjustment for the confounding factors. Similarly, Fibrosis‐4 was associated with left atrial dimension, interventricular septum thickness, LVPWT and left ventricular mass index. In contrast, the Aspartate Aminotransferase to Platelet Ratio Index was only associated with LVPWT.

Conclusions

Non‐invasive liver fibrosis scores, especially the NFS, are independently associated with subclinical myocardial remodeling in type 2 diabetes patients.
Twelve‐week secukinumab treatment is consistently efficacious for moderate‐to‐severe psoriasis regardless of prior biologic and non‐biologic systemic treatment: Post hoc analysis of six randomised trials
Authors: Hampton P. , Halliday A. , Aassi M. , Subramanian S. , Jain M. , Griffiths C.E.M.
Published: October 2020

Background

The efficacy of biologic therapies is greater among biologic‐naïve vs. biologic‐experienced psoriasis patients. However, little is known as to whether prior use of other systemic therapies impacts secukinumab efficacy in patients with moderate‐to‐severe psoriasis.

Objective

To investigate the impact of prior exposure to systemic therapies upon the efficacy and safety of secukinumab 300 mg for moderate‐to‐severe psoriasis.

Methods

Post hoc analysis of six randomised controlled trials (RCTs) comparing secukinumab with placebo, ustekinumab or etanercept at 12 weeks of treatment. Data comparing secukinumab with placebo and ustekinumab were meta‐analysed, while comparisons between secukinumab and etanercept were from a single RCT. Four subgroups of patients were assessed: (i) naïve to non‐biologic systemics (NBS) and biologics; (ii) exposed to NBS but naïve to biologics; (iii) naïve to NBS but exposed to biologics; and (iv) exposed to NBS and biologics. Outcomes of interest included the following: investigator’s global assessment (IGA) score, absolute psoriasis area and severity index (PASI) response, PASI 75, PASI 90 and PASI 100 responses, and dermatology life quality index (DLQI). Safety was also assessed.

Results

One thousand three hundred and eighty‐three patients were included in the secukinumab vs. placebo meta‐analysis: 1776 in the secukinumab vs. ustekinumab meta‐analysis and 653 in the within‐trial analyses of secukinumab vs. etanercept. For all subgroups, secukinumab was significantly more efficacious than placebo for all outcomes measured. Secukinumab generated greater responses in biologic‐naïve patients, while prior NBS had a negligible impact on treatment response. Furthermore, secukinumab was more efficacious than both ustekinumab and etanercept on many outcomes, with an even greater difference for biologic‐naïve than biologic‐exposed patients. Safety results were consistent with individual clinical trial results.

Conclusions

Twelve‐week treatment with secukinumab 300 mg is consistently more efficacious than placebo, etanercept and ustekinumab in patients with moderate‐to‐severe psoriasis, regardless of prior exposure to biologics or NBS. Secukinumab had a comparable safety profile to both etanercept and ustekinumab.
Differences in otolith shape and fluctuating‐asymmetry between reared and wild gilthead seabream (Sparus aurata Linnaeus, 1758)
Authors: Geladakis George , Somarakis Stylianos , Koumoundouros George
Published: October 2020

Otolith structure is a useful tool in discrimination among fish populations as it is a permanent record of the influence of endogenous and exogenous factors. In the present study we examined otolith morphology and fluctuating asymmetry (FA) for differences between wild‐caught (by bottom trawl) and reared specimens of Gilthead seabream (Sparus aurata). Based on the frequency of regenerated scales (degree of scale regeneration, SRD) on each specimen, a threshold of 30% SRD was used to assign wild‐caught fish individuals as wild (≤30% SRD, LR group) or as possible aquaculture escapees (>30% SRD, HR group). Based on the analysis of elliptic Fourier descriptors, significant differences were found in otolith shape between reared (Rr) and the wild‐caught groups (LR, HR). Reared fish had otoliths with significantly larger perimeter (OP) than wild‐caught fish. Furthermore, FA was significantly higher in the Rr than the LR group for OP and all except one shape descriptors (harmonics 2–7). The HR group exhibited intermediate levels of FA between the low and high FA levels observed in the LR and Rr groups. Results are discussed in terms of the value of combining otolith and scale morphology for the identification of escapees in wild Gilthead seabream stocks.
Cognitive and motor deficits in older adults with HIV infection: Comparison with normal ageing and Parkinson’s disease
Authors: Müller‐Oehring Eva M. , Fama Rosemary , Levine Taylor F. , Hardcastle Cheshire , Goodcase Ryan , Martin Talora , Prabhakar Varsha , Brontë‐Stewart Helen M. , Poston Kathleen L. , Sullivan Edith V. , Schulte Tilman
Published: October 2020

Despite the life‐extending success of antiretroviral pharmacotherapy in HIV infection (HIV), the prevalence of mild cognitive impairment in HIV remains high. Near‐normal life expectancy invokes an emerging role for age–infection interaction and a potential synergy between immunosenescence and HIV‐related health factors, increasing risk of cognitive and motor impairment associated with degradation in corticostriatal circuits. These neural systems are also compromised in Parkinson’s disease (PD), which could help model the cognitive deficit pattern in HIV. This cross‐sectional study examined three groups, age 45–79 years: 42 HIV, 41 PD, and 37 control (CTRL) participants, tested at Stanford University Medical School and SRI International. Neuropsychological tests assessed executive function (EF), information processing speed (IPS), episodic memory (MEM), visuospatial processing (VSP), and upper motor (MOT) speed and dexterity. The HIV and PD deficit profiles were similar for EF, MEM, and VSP. Although only the PD group was impaired on MOT compared with CTRL, MOT scores were related to cognitive scores in HIV but not PD. Performance was not related to depressive symptoms, socioeconomic status, or CD4+ T‐cell counts. The overlap of HIV‐PD cognitive deficits implicates frontostriatal disruption in both conditions. The motor‐cognitive score relation in HIV provides further support for the hypothesis that these processes share similar underlying mechanisms in HIV infection possibly expressed with or exacerbated by ageing.
Dermatologic adverse reactions to proton‐pump inhibitors: A synthetized review
Authors: Salloum Antoine , Nasr Dayana , Maalouf Diane
Published: October 2020

Background

Proton‐pump inhibitors (PPIs) are one of the most prescribed drugs. Their dermatological adverse reactions are multiple and vary in severity.

Aims

This review discusses all reported cutaneous side effects of PPIs in order to help physicians understand them and provide appropriate management.

Methods

A thorough search of PubMed, Embase, and FDAAQ8 drugs websites was conducted. 56 articles including case reports, case series, and review articles of PPI‐induced cutaneous adverse reactions were selected. Data were recorded regarding patient age, gender, history, clinical manifestations, diagnostic tests, management, and clinical outcomes.

Results

PPI‐induced adverse skin reactions are mostly immunological and include both immediate and delayed‐type hypersensitivity reactions. These reactions are sometimes life‐threatening. All PPIs can induce immediate IgE‐mediated reactions. Most of previously published cases of delayed‐type hypersensitivity reactions have involved esomeprazole, omeprazole, and lansoprazole. Skin tests are helpful in confirming PPI‐induced hypersensitivity reactions and diagnosing potential cross‐reactivities. PPIs should also be added to our list of usual suspects when considering possible culprits for a new presentation of drug‐induced subacute lupus erythematosus. PPI‐related occupational contact dermatitis has also been numerously reported.

Conclusion

PPIs should be considered in our list of culprits when considering a patient with a cutaneous drug reaction, taking into account that these drugs can cause severe immunological manifestations.
Psychodermatology of acne: Psychological aspects and effects of acne vulgaris
Authors: Stamu‐O'Brien Caroline , Jafferany Mohammad , Carniciu Simona , Abdelmaksoud Ayman
Published: October 2020

Introduction

Acne is a chronic inflammatory skin condition seen commonly in adolescence and young adulthood. Despite being a frequent and nonthreatening life condition, acne has a significant psychological impact and comorbidity.

Aims

This review will describe prevalence, common clinical features, different clinical presentations, differential diagnoses, and treatment recommendation. Special focus has been put on psychological aspects.

Methods

We conducted a literature search on PubMed from January 2001 to June 2020 with the search terms of Acne vulgaris, psychological, adolescents, anxiety, suicide, mood disorders. Reference lists of identified articles were examined for further relevant studies. The search was limited to English language articles. No specified quality criteria were used for study inclusion.

Results

The clinical manifestations of acne are very important in the differential diagnosis and its psychological implications.

Conclusion

Through this article, we conclude that despite being a frequent and nonthreatening life condition, acne has a significant psychological impact which requires effective treatment to improve the patient’s skin and self‐esteem.
Genetic polymorphism of liver X receptor gene in vitiligo: Does it have an association?
Authors: Shehata Wafaa A. , Maraee Alaa , Mehesin Marwa , Tayel Nermin , Azmy Rania
Published: October 2020

Background

Vitiligo is an acquired depigmentation of the skin and the mucous membranes, exhibited as white macules and patches due to selective loss of melanocytes. Etiological theories of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress, and newer theories of melanocytorrhagy and diminished melanocytes survival. It has been revealed that liver X receptor alpha gene is expressed in skin tissue such as sebaceous glands, hair follicle, keratinocytes, and fibroblasts and is linked to various skin disorders as acne vulgaris and psoriasis.

Aim of the Study

To evaluate the association between liver X receptor‐α gene polymorphism (rs11039155 and rs2279238) and vitiligo and whether they are related to disease activity and severity or not.

Subjects and Methods

50 vitiligo patients and 20 age‐ and sex‐matched apparently healthy controls were enrolled. All the included subjects were genotyped using polymerase chain reaction‐restriction fragment length polymorphism analysis technique for (−6G/A) and (+1257C/T) SNPs.

Results

Significant statistical difference between cases and controls regarding genotype and allele frequencies for −6G/A polymorphism with predominance of AA genotype (OR: 5.1, 95% CI: 1.6‐15.9) and A allele (OR: 5.3, 95% CI: 1.6‐15.9) in cases and also for +1257C/T polymorphism with predominance of TT genotype OR: 9.2 (95% CI: 1.4‐82.9) and T allele OR: 3.4 (95% CI: 1.4‐8.1) in vitiligo cases. No significant relationship between −6G/A genotypes nor +1257C/T genotypes and disease activity and severity.

Conclusion

The study showed significant association between Liver X receptor gene polymorphisms (−6G/A, +1257 C/T) and development of vitiligo in Egyptian patients. However, it failed to show any relation with disease activity nor severity.
Incidence patterns of gynecological sarcomas in Iran analysis of National Cancer Registry data between 2009 and 2014
Authors: Akbari Atieh , Khalili Neda , Asef‐Kabiri Leila , Negahi Alireza , Raeisi Alireza , Akbari Mohammad E.
Published: October 2020

Aim

Gynecological sarcomas (GS) are rare malignant tumors arising in the female genital organs. Due to the low incidence and diverse histology, information on the epidemiology of these tumors is sparse. We aimed to investigate the incidence rates of GS in Iran that in our knowledge is the first report from Eastern Mediterranean Region.

Methods

In this retrospective study, all malignant tumors with a sarcoma morphology arising in the female genital organs diagnosed between 2009 and 2014 were extracted from the Iran National Cancer Registry dataset. All the cancer cases were categorized according to ICD‐O‐3 morphologic and topographic codes. Age‐standardized incidence rates, age‐specific incidence rates, morphologic and geographic distribution of all cases were analyzed and compared with other parts of the world.

Results

A total of 1174 cases were diagnosed over the period 2009–2014. The overall age‐standardized incidence rate for all sites combined was 6.13 per million females. Analysis of trends in incidence did not show a significant change over time according to annual average percent change analysis (P‐value = 0.300). The most common anatomical site was the uterus, accounting for 77% of all cases. The mean (±SD) age at diagnosis, irrespective of tumor site, was 52.3 (±15) years. In terms of morphology, leiomyosarcoma was the most frequently observed subtype, constituting 34% of all GS. Also, the highest ASIR was observed in women aged 60–64 years.

Conclusion

Based on the findings, GS are relatively rare tumors that occur more in old women. The results of this study provide a comprehensive picture of GS incidence patterns in Iran for more investigation.
Density of nerve fibres and expression of substance P, NR2B‐receptors and nerve growth factor in healthy human masseter muscle: An immunohistochemical study
Authors: Alhilou Abdelrahman M. , Shimada Akiko , Svensson Camilla I. , Ernberg Malin , Cairns Brian E. , Christidis Nikolaos
Published: October 2020

Background

In skeletal muscle, free nerve endings are mostly located within the connective tissue. However, the distribution of sensory afferent fibres in healthy human masseter muscle tissues has not been studied.

Objectives

Primarily to investigate human masseter muscle nerve fibre densities as well as expression of NR2B receptors, substance P (SP) and nerve growth factor (NGF), and secondarily to compare this between a) nerve fibres associated with myocytes and within connective tissue; b) sexes; and c) ages.

Methods

Microbiopsies of the masseter muscle were obtained from 60 sex‐ and age‐matched healthy participants. Biopsy sections were analysed using immunohistochemistry and were visualised with a Leica TCS SPE confocal microscope. The Mann‐Whitney U test was used for statistical analyses.

Results

The density of nerve fibres within connective tissue was significantly greater than in nerve fibres associated with myocytes (P < .001). Nerve fibres within connective tissue expressed SP alone or together with NR2B significantly more often than those associated with myocytes (P < .001). The frequency of nerve fibres, which expressed SP alone or in combination with NR2B or NGF, was significantly greater in women than in men (P < .050). Moreover, the co‐expression of the three markers together was inversely correlated with age in women (P < .002).

Conclusions

There is a higher density and greater expression of sensory nerve fibres within the connective tissue than associated with myocytes in healthy human masseter muscle. This suggests that nerve fibres within connective tissue are more involved in nociception than nerve fibres associated with myocytes.
Tele‐ICUs for COVID‐19: A Look at National Prevalence and Characteristics of Hospitals Providing Teleintensive Care
Authors: Williams Dunc , Lawrence John , Hong Young‐Rock , Winn Aaron
Published: October 2020

Purpose

Amidst the COVID‐19 outbreak, the use of intensive care unit telemedicine (tele‐ICUs) may be one mechanism to provide patient care, particularly in rural parts of the United States. The purpose of this research was to inform hospital decision makers considering tele‐ICUs, policy makers weighing immediate and longer‐term funding and reimbursement decisions relative to tele‐ICU care, and researchers conducting future work evaluating tele‐ICUs.

Methods

We compared hospitals that reported providing teleintensive care to hospitals that reported not providing teleintensive care in the 2018 American Hospital Association Annual Survey (AHAAS). Differences between groups were tested using Pearson's chi‐square (categorical variables) and t‐tests (continuous variables) using 0.05 as the probability of Type 1 error. The study sample included all US short‐term, acute care hospitals that responded to the AHAAS in 2018. Our key variable of interest was whether a hospital reported having any tele‐ICU capabilities in the 2018 AHAAS. Other factors evaluated were ownership, region, beds, ICU beds, outpatient visits, emergency department visits, full‐time employees, and whether a hospital was rural, a critical access hospital, a major teaching hospital, or part of a health system.

Findings

Larger, not‐for‐profit, nonrural, noncritical access, teaching hospitals that were part of a health system, particularly in the Midwest, were more likely to have tele‐ICUs. Over one‐third of hospital referral regions (HRRs) had zero hospitals with tele‐ICUs, 4 had all hospitals with tele‐ICU, and the median percent of hospitals with tele‐ICU by HRR, weighted by outpatient visits, was 11.3%.

Conclusions and Implications

We found wide variation in the prevalence of tele‐ICUs across HRRs and states. Future work should continue the evaluation of tele‐ICU effectiveness and, if favorable, explore the variation we identified for improved access to teleintensive care.
Severe paediatric obesity and sleep: A mutual interactive relationship!
Authors: Ischander Mariam M. , Lloyd Robert D.
Published: October 2020

Childhood severe obesity is a serious, urgent and complex global health problem with long‐term co‐morbidities. Obstructive sleep‐disordered breathing is more common in obese children and adolescents. Increased body mass index is associated with an increase in apnea−hypopnea index. Obstructive sleep apnea leads to a decrease in rapid eye movement sleep, and obese children have been noted to have a decrease in rapid eye movement sleep, leading to weight gain. Short sleep duration and poor sleep quality are associated with childhood obesity and cardiometabolic risks. Public health strategies for obesity prevention should focus more on sleep. Targeting childhood obesity is important in the prevention and management of obstructive sleep‐disordered breathing.
Prevalence and risk factors for atrial fibrillation in dogs with myxomatous mitral valve disease
Authors: Guglielmini Carlo , Goncalves Sousa Marlos , Baron Toaldo Marco , Valente Carlotta , Bentivoglio Vinicius , Mazzoldi Chiara , Bergamin Ilaria , Drigo Michele , Poser Helen
Published: October 2020

Background

Atrial fibrillation (AF) is a common supraventricular arrhythmia more frequently observed in large breed dogs.

Objectives

Estimate the prevalence of AF in dogs with myxomatous mitral valve disease (MMVD) and identify risk factors for developing AF.

Animals

A total of 2194 client‐owned dogs with MMVD, including 1280, 588, 290, and 36 dogs in ACVIM stages B1, B2, C, and D, respectively.

Methods

Retrospective, cross‐sectional study. The medical databases of 3 veterinary teaching hospitals were reviewed. Inclusion criteria were a diagnosis of MMVD after complete cardiovascular evaluation and cardiac rhythm assessment using routine 2‐minute ECG or good quality ECG tracing during echocardiographic examination.

Results

Atrial fibrillation was diagnosed in 59 dogs with a prevalence of 2.7%. Univariate analysis showed that mixed breed, male sex, advanced ACVIM stage, left atrial and ventricular enlargement, fractional shortening (FS), and presence of pulmonary hypertension were significantly associated with development of AF. According to 2 multivariable models, the left atrium (LA)‐to‐aorta ratio (odds ratio [OR] = 14.011, 7.463‐26.304), early trans‐mitral velocity (OR = 2.204, 1.192‐4.076), body weight (OR = 1.094, 1.058‐1.130), and FS (OR = 0.899, 0.865‐0.934) and LA (OR = 5.28, 3.377‐8.092), advanced ACVIM stage (OR = 4.922, 1.481‐16.353), and FS (OR = 0.919, 0.881‐0.959) were significant predictors of AF for models 1 and 2, respectively.

Conclusions and Clinical Importance

Atrial fibrillation is an uncommon complication of MMVD and is significantly associated with the more advanced stage of the disease, increased LA dimension and body weight, and decreased FS.