bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on Adaptive Cruise Control Strategy for Battery Electric Vehicle
Authors: Zhang Sheng , Zhuan Xiangtao
Published: December 2019

This paper studies the control strategy for adaptive cruise control (ACC) system on a battery electric vehicle (BEV) in the car‐following process, and the highlight of this paper is that the regeneration braking of BEV is considered in the car‐following process. The hierarchical control structure is adopted for the ACC system. And the structure contains an upper controller and a lower controller. In the upper controller, multiple objectives including the safety, tracking, comfort, and energy consumption are optimized by using the model predictive control (MPC) method. In the lower controller, the energy is recovered during braking. So the energy economy is improved by reducing energy consumption and increasing energy recovery. The proposed ACC strategy is evaluated in simulation experiment. In the simulation experiment, safe tracking for the front vehicle is guaranteed, and the comfort and the energy economy are improved greatly. So the proposed adaptive cruise control strategy can make ACC more widely used in BEVs.
Effect of Tooth Profile Modification on Dynamic Tooth Load of Planetary Gear Train
Authors: Zhou Jiaming , Yi Fengyan , Xu Xiangyang , Lai Junbin , Liu Yanfang , Dong Peng
Published: December 2019

This paper aims at investigating the effects of tooth profile modification (TPM) on the dynamic response of planetary gear train (PGT). A numerical model is carried out to calculate two major excitation sources of PGT, time‐varying mesh stiffness (TVMS), and transmission errors (TEs). On this basis, a linear time‐varying dynamic model of a PGT considering TVMS, TEs, and TPM is developed. Dynamic deviation factor is further introduced to describe the dynamic response of the PGT. In this paper, TPM is only applied to the external meshes firstly. Effects of TPM parameters, such as amount of TPM, normalized modification angle, and modification curve, on the excitation sources and dynamic response of the PGT are discussed in detail. Subsequently, investigation on the effects of TPM only applied to internal meshes is conducted. Finally, with the aim to obtain the optimal TPM for the minimization of dynamic load of PGT in both external and internal gear meshes, the genetic algorithm (GA) is employed. This research may shed light upon design optimization of PGT with respect to improvement of vibration performance by means of optimized TPM.
Hospital Spiritual Care Can Complement Graduate Medical Trainee Well-Being
Authors: Shapiro Robert E. , Vallejo Manuel C. , Sofka Sarah H. , Elmo Rebecca M. , Anderson Allison H. , Ferrari Norman D.
Published: December 2019

Background. Burnout and depression among physician trainees is increasing at an alarming rate. Promoting well-being is of utmost importance for graduate medical education. The primary objective was to determine if spiritual care staff/chaplaincy can assist in building emotional well-being and resiliency within medical residency education. Methods. For the academic year of July 2017 through June 2018, all graduate medical trainees in our institution were given the option of attending either an individual or group spiritual care session as part of a universal “Call to Wellness” curriculum. A Post-Wellness Survey was administered to measure perceptions about the program. Results. 49% (N = 258) of residents chose to participate in a spiritual care session. Prior to the session, 51% (N = 132) rated their overall well-being as neutral and 25% (N = 64) rated their overall well-being as slightly positive, positive, or very positive. After their spiritual care session, significant improvement was seen. 25% (N = 64) rated their overall well-being as neutral, and 51% (N = 132) rated their overall well-being as slightly positive, positive, or very positive (p<0.001). Conclusion. Spiritual care staff/chaplaincy can have a positive influence on emotional well-being for physicians during residency training.
Experimental Study on Macro-Mesoscopic Components and Indexes of Buton Gilsonite-Modified Asphalt
Authors: Yang Sanqiang , Zhou Xiaoyu , Qin Lusheng , Liu Na , Cai Yongli
Published: December 2019

Gilsonite-modified asphalt is one of the hotspots of high-performance modified asphalt research. In this paper, the macroscopic composition and index of gilsonite-modified asphalt are analyzed; gilsonite, matrix asphalt, and modified asphalt with different gilsonite contents were analyzed by high- and low-temperature performance tests, antiaging performance test, four-component test, infrared spectral test, and SEM electroscope scanning test. The results showed that the content of aromatic fraction, colloid, and asphaltene in Buton gilsonite was 3.1%, 95.6%, and 32.9% higher than that of matrix asphalt, respectively. The gilsonite-modified asphalt had better high-temperature performance and antiaging performance. The optimum amount of gilsonite in gilsonite-modified asphalt should be 9%∼15%. The pore structure of gilsonite is more distributed, the surface is rough, which can produce greater cohesion with matrix asphalt, and the compatibility is better.
A Case of Cognitive Decline Resulting from Aging, Temporal Lobe Epilepsy, and Environmental Factors
Authors: Veluri Nikhila
Published: December 2019

Cognitive functioning is imperative in our daily lives. It allows us to understand, process, and react appropriately to different situations. Aging has been linked to cognitive decline. The degree and rate of cognitive decline are crucial as they differentiate normal aging from dementia or memory loss secondary to medical conditions. A 63-year-old Caucasian woman with a 50-year history of temporal lobe epilepsy experienced memory difficulties in recent years. She was admitted voluntarily to the neuropsychiatry ward for a 3-day ambulatory electroencephalogram (EEG), which reported mild bitemporal structural or functional abnormality. The patient reported subjective seizure experiences that were not reflective of seizure activity on the EEG. Possible causes included panic attacks or other anxiety experiences. Routine laboratory test and magnetic resonance imaging results were unremarkable. During her hospital stay she showed improvement in cognitive functioning. However, anxiety continued to negatively impact her memory. We hypothesized that the memory impairments could have resulted from age, psychological factors, the patient’s own expectations, pressure from the environment and history of TLE. We diagnosed the patient with mild cognitive impairment and adjustment disorder with anxiety. She was discharged with seizure and anxiety medication. This report highlights the importance of both age-related and disease-related variables when diagnosing patients with cognitive decline.
IR Composite Image Generation by Wavelength Band Based on Temperature Synthesis Estimated from IR Target Signature and Background Scene
Authors: Bae Tae Wuk , Kim Young Choon , Ahn Sang Ho
Published: December 2019

Infrared (IR) target signatures and background scenes are mainly used for military research purposes such as reconnaissance and detection of enemy targets in modern IR imaging systems like IR search and track (IRST) system. For understanding and analyzing IR signatures and backgrounds in the IR imaging systems, an IR wavelength band (WB) conversion which transforms an arbitrary WB image to another WB is very important in the absence of equipment by WB. In addition, IR image synthesis of targets and backgrounds can provide a great deal of information in the IR target detection field. However, the WB conversion is actually a very challenging research due to lack of information on the absorptivity and transmittance of enormous components of an object or atmosphere. In addition, the radiation and reflectance characteristics of short-wave IR (SWIR)-WB are very different from those of long-wave IR (LWIR)-WB and middle-wave IR (MWIR)-WB. Therefore, the WB conversion in this paper is limited only to IR target signatures and monotonous backgrounds, which is commonly used for military purposes, at a long distance. This paper proposes an IR synthesis method for generating a synthesized IR image of three IR-WBs by synthesizing an IR target signature and a real background scene for an arbitrary IR-WB. In the proposed method, each temperature information is first estimated from an IR target signature and IR background image for an arbitrary IR-WB, and then a synthesized temperature image is generated by combining the respective temperature information estimated from the IR target signature and background scene. Finally, the synthesized temperature image is transformed into an IR radiance image of three IR-WBs. Through the proposed method, various IR synthesis experiments are performed for various IR target signature and background scenes.
Attention Deficit Predicts Intellectual Functioning in Children with Neurofibromatosis Type 1
Authors: Heimgärtner Magdalena , Granström Sofia , Haas-Lude Karin , Leark Robert A. , Mautner Victor-Felix , Lidzba Karen
Published: December 2019

Aims. Attention deficit hyperactivity disorder (ADHD) is one of the most frequent neurocognitive impairments in neurofibromatosis type 1 (NF1) and a well-known risk factor for intellectual dysfunction in general. Since NF1 is per se associated with intellectual difficulties, this comorbidity may be crucial for the cognitive development of affected patients. In our study, we investigated if attention deficits are associated with intellectual functioning in NF1 and if children with NF1 plus ADHD differ in their intellectual and attention profiles from children affected by NF1-only or ADHD only. Methods. 111 children aged between 6 and 12 years (53 NF1 plus ADHD, 28 NF1-only, 30 ADHD-only) performed the German version of the intelligence test WISC-IV and a continuous performance test (T.O.V.A.) to assess attention functions. Parents completed questionnaires about everyday attention and executive functions (Conners 3®, BRIEF). Results. Children with NF1 plus ADHD showed significantly lower intelligence test scores (full-scale IQ: 89.39 [1.40]) than patients with NF1-only (full-scale IQ: 101.14 [1.98]; p<.001), and intellectual functioning correlated significantly with attention performance in NF1 (p<.001). As compared to NF1-only, attention, and executive functioning were impaired on several dimensions (T.O.V.A., Conners 3® and BRIEF) in NF1 plus ADHD. ADHD-only was associated with significantly higher problem scores regarding hyperactivity/impulsivity and inattention (Conners 3®). NF1-only was associated with inattentiveness when compared to the normative sample of the T.O.V.A. Conclusion. NF1 is associated with variable attention problems. Severe attention deficits appear to be a risk factor for intellectual dysfunction in NF1, more than NF1 without attention deficit. NF1 plus ADHD presents a specific cognitive profile, which differs from that of NF1 and from neurotypical ADHD.
Effect of Repeated Remote Ischemic Preconditioning on Peripheral Arterial Disease in Patients Suffering from Intermittent Claudication
Authors: Balin Mehmet , Kıvrak Tarık
Published: December 2019

Background/Objective. Intermittent claudication (IC) is the symptom of peripheral artery disease (PAD) and causes functional disability. Remote ischemic preconditioning (RIPC), is a phenomenon in which a short period of sub-critical ischemia, protects tissues against ischemia/reperfusion/injury. We considered to test the hypothesis that RIPC in PAD patients suffering from IC would increase muscle resistance to ischemia and thus improve walking-capacity. Materials/Methods. A total of 63 patients with proven-IC underwent two treadmill tests (graded treadmill protocol) with a 28-day interval in between. Patients were consecutively assigned for the non/RIPC-group and RIPC-group procedure one by one. Patients received 5-cycles of alternating 5-minute inflation and 5-minute deflation of blood-pressure cuffs on nondominant upper-limb every day for four weeks. Initial claudication distance (ICD), total walking distance (TWD) and time to relief of claudication (TRC) were recorded during procedure. Results. Patients receiving-RIPC exhibited a marked increase in ICD and TWD between basal and last tests: 209.1 ± 15.4 m vs. 226 ± 15.0 m and 368.8 ± 21.0 m vs. 394 ± 19.9 m, respectively (p<0.001). In addition, patients receiving-RIPC represented a significant decrease in TRC between basal and last tests: 7.8 ± 1.3 min vs. 6.4 ± 1.1 min, respectively (p<0.001). Patients not receiving-RIPC did not exhibit improvement in ICD, TWD, and TRC between basal and last tests: 205.2 ± 12.1 min vs. 207.4 ± 9.9 min, 366.5 ± 24.2 min vs. 369.4 ± 23.2 min and 7.9 ± 1.4 min vs. 7.7 ± 1.3 min, respectively (p>0.05). Conclusion. A significant increase in ICD and TWD were observed in last/treadmill test in RIPC-group. In addition, a significant decrease in TRC was observed in last/treadmill test in RIPC-group. In non/RIPC-group, no improvement was observed in ICD, TWD and TRC.
Extracellular ATP and Purinergic P2Y2 Receptor Signaling Promote Liver Tumorigenesis in Mice by Exacerbating DNA Damage
Authors: Schulien Isabel , Hockenjos Birgit , van Marck Veerle , Ayata C. Korcan , Follo Marie , Thimme Robert , Hasselblatt Peter
Published: December 2019

Release of ATP to the extracellular compartment and subsequent activation of purinergic receptors is a conserved mechanism mediating inflammatory responses and cell fate decisions in various organs including the liver. Previous findings suggest that extracellular ATP may promote liver tumorigenesis, however, the underlying mechanisms are poorly understood. Therefore, our aim was to dissect the functions of extracellular ATP and P2Y2 receptors (P2Y2R) during hepatocarcinogenesis. Liver tumors were induced in wild-type and P2y2r−/− knockout mice by intraperitoneal diethylnitrosamine (DEN) injection. Tumorigenesis was analyzed after 8 to 10 months and molecular analyses were performed at different stages of tumorigenesis in vivo, as well as in primary mouse hepatocytes in vitro. Liver tumor incidence and tumor numbers were strongly reduced in P2y2r−/− mice, whereas tumor size and morphology were comparable to wild-type controls, suggesting that P2Y2R contributes to tumor initiation. Mechanistically, hepatocyte proliferation in DEN-treated P2y2r−/− mice was reduced, which correlated with reduced c-JUN and CCND1 but increased p21 expression. Moreover, DNA damage as determined by hepatocellular expression of γH2A.X and of genes related to genotoxic stress, as well as STAT3 phosphorylation, was reduced in the absence of P2y2r. Administration of genotoxic agents to primary hepatocytes in vitro confirmed that DNA damage was indeed exacerbated by extracellular ATP, subsequent P2Y2R activation, and downstream intracellular calcium-dependent signal transduction. In conclusion, our data reveal that extracellular ATP and subsequent P2Y2R function stimulate DNA damage responses and hepatocyte proliferation, thereby promoting hepatocarcinogenesis. Targeting this pathway may be an attractive approach for chemoprevention of hepatocellular carcinoma.

Significance:

Extracellular ATP and subsequent P2Y2 receptor function stimulate DNA damage responses and hepatocyte proliferation, thereby promoting hepatocarcinogenesis in mice. Targeting this pathway may be an attractive approach for chemoprevention of hepatocellular carcinoma.
Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography
Authors: Guirado Laura , Crispi Fàtima , Soveral Iris , Valenzuela-Alcaraz Brenda , Rodriguez-López Mérida , García-Otero Laura , Torres Ximena , Sepúlveda-Martínez Álvaro , Escobar-Diaz Maria Clara , Martínez Josep María , Friedberg Mark K. , Gratacós Eduard , Gómez Olga
Published: December 2019

Objectives: Fetal right ventricular (RV) function assessment is challenging due to the RV geometry and limitations of in utero assessment. Postnatally, 2D echocardiographic RV fractional area change (FAC) is used to assess RV global systolic function by calculating the percentage of change in RV area from systole to diastole. Reports on FAC are scarce in prenatal life, and nomograms throughout pregnancy are not available. Our aims were (1) to study prenatal RV FAC feasibility and reproducibility and (2) to construct nomograms for RV FAC and end-diastolic (ED) and end-systolic (ES) RV areas from 18 to 41 weeks of gestation. Methods: Prospective cohort study including 602 low-risk singleton pregnancies undergoing a fetal echocardiography from 18 to 41 weeks of gestation. RV ED and ES areas were measured following standard recommendations for ventricular dimensions and establishing strict landmarks to identify the different phases of the cardiac cycle. RV FAC was calculated as: ([ED area – ES area]/ED area) × 100. RV FAC intra- and inter-observer reproducibility was evaluated in 45 fetuses by calculating the intraclass correlation coefficient (ICC). Parametric regressions were tested to model each parameter against gestational age (GA) and estimated fetal weight (EFW). Results: RV areas and FAC were successfully obtained in ∼99% of fetuses with acceptable reproducibility throughout gestation (RV ED area inter-observer ICC [95% CI] 0.96 [0.93–0.98], RV ES area 0.97 [0.94–0.98], and FAC 0.69 [0.44–0.83]). Nomograms were constructed for RV ED and ES areas and FAC. RV areas showed a quadratic and logarithmic increase with GA and EFW, respectively. In contrast, RV FAC showed a slight quadratic decrease throughout gestation (mean RV FAC ranged from 36% at 18 weeks of gestation [10–90th centiles: 25–47%, respectively] to 29% at 41 weeks [10–90th centiles: 18–40%, respectively]). The best models for RV areas and FAC were a second-degree polynomial. Conclusions: RV FAC is a feasible and reproducible parameter to assess RV global systolic function in fetal life. We provide reference ranges adjusted by GA and EFW that can be used as normal references for the assessment of RV function in prenatal conditions.
Membrane Separation and Perinatal Outcomes after Laser Treatment for Twin-Twin Transfusion Syndrome
Authors: De Zoysa Madushka Y. , Chon Andrew H. , Korst Lisa M. , Llanes Arlyn , Chmait Ramen H.
Published: December 2019

Introduction: Postoperative membrane separation is a complication of selective laser photocoagulation of communicating vessels (SLPCV) for the treatment of twin-twin transfusion syndrome (TTTS). Objective: The aim of this work was to determine whether a quantitative grading system of membrane separation following SLPCV was associated with preterm premature rupture of membranes (PPROM) and preterm delivery (PTD). Methods: Patients with membrane separation after SLPCV on postoperative day 1 were stratified into greatest width of separation <1 cm (Group A) or ≥1 cm (Group B) and compared to patients without separation by the following outcomes: PPROM ≤21 postoperative days, PTD <28 gestational weeks, and PTD <32 gestational weeks. Results: Of 654 patients, 123 (18.8%) had membrane separation. Of these, 120 patients were eligible for study and divided into Groups A (n = 91) and B (n = 29). Multiple logistic regression analysis yielded associations with PPROM ≤21 days for Groups B (OR 8.60, 95% CI 3.38–21.90, p < 0.0001) and A (OR 2.39, 95% CI 1.05–5.40, p = 0.0369) compared to those without membrane separation. In similar models, Group B was associated with PTD <32 weeks (OR 2.41, 95% CI 1.10–5.28, p = 0.0274). Conclusion: Postoperative membrane separation was associated with an increased risk of PPROM ≤21 days. Membrane separation ≥1 cm had a higher risk of PTD <32 weeks.
Phenytoin Toxicity Treatment with Haemodialysis in Epilepsy due to Glioblastoma Multiforme: Case Report and Review of the Literature
Authors: Sharma Karishma , Vakil Aditi , Sokwala Ahmed , Sokhi Dilraj
Published: December 2019

Phenytoin is one of the most commonly used anticonvulsants in the developing world, but lack of monitoring and concurrent medications can easily lead to toxicity. We report the case of a 35-year-old female on phenytoin for symptomatic epilepsy due to previously treated glioblastoma multiforme, who presented with status epilepticus 1 week after being treated for a urinary tract infection. She was loaded with phenytoin and levetiracetam as per emergency protocol but had a persistently low level of consciousness, and her preloading phenytoin level result came back in the toxic range. She was managed conservatively, but after 4 days with no change she was dialyzed and her level of consciousness improved within 24 h, allowing for safe discharge home shortly after. Our case illustrates the option of haemodialysis in phenytoin-toxic patients who do not improve with conservative measures or who may need urgent reduction due to potentially fatal complications of phenytoin toxicity.
Hypothalamic Monoaminergic Pathology in a Neurodevelopmental Rat Model Showing Prenatal 5-Bromo-2′-Deoxyuridine Treatment-Induced Hyperactivity and Hyporeproductivity
Authors: Kuwagata Makiko , Muneoka Katsumasa , Honda Kazuho , Miyazaki Akira
Published: December 2019

Objective: Prenatal treatment of rats with 5-bromo-2′-deoxyuridine (BrdU) is a neurodevelopmental model showing hyperactivity and impaired sexual activity. Human neurodevelopmental disorders, such as autism, exhibit sex-related pathology, but sex-related neurodevelopment has not been fully investigated in this model. We conducted this study to facilitate the understanding of the pathophysiology of neurodevelopmental disorders. Methods: Pregnant rats received 50 mg/kg BrdU on gestational days 9–15. The tissue content of dopamine (DA), serotonin (5-HT), and their metabolites dihydroxyphenylacetic acid, homovanillic acid, and 5-hydroxyindoleacetic acid were measured in male and female offspring at 3 weeks (juveniles) and 10 weeks (adults) of age. Results: Prenatally BrdU-treated rats had reduced DA metabolism or DA content in the hypothalamus from the juvenile through the adult period without sex differences, but sex-specific striatal DA abnormalities emerged after maturation. A reduction in 5-HT metabolism was measured in the hypothalamus without sex differences throughout development. Developmental alterations in the striatal 5-HT states were sex-dependent. Temporal changes in DA or 5-HT metabolism were found in the frontal cortex and midbrain. Conclusion: The sex-specific influence of a genotoxic factor on the development of the DA and 5-HT systems was clarified in the hypothalamus and striatum. The results suggest that the observed sex dependence and region specificity are related to the pathology of social dysfunction in neurodevelopmental disorders.
Retroperitoneal Liposarcoma with Multilocular Cysts
Authors: Komine Chika , Fukuchi Minoru , Sakurai Shinji , Tabe Yuichi , Sano Akihiko , Saito Kana , Fukasawa Takaharu , Yamamoto Hideki , Tani Masachika , Naitoh Hiroshi , Saeki Hiroshi , Shirabe Ken
Published: December 2019

In this study, we describe a 60-year-old man with a giant retroperitoneal liposarcoma with multilocular cysts. He was admitted to our hospital because of a 5-month history of abdominal distention. Abdominal computed tomography revealed a giant lobulated cystic mass occupying the retroperitoneal space that contained partially solid fat components. Magnetic resonance imaging indicated that this complex mass exhibited a low signal intensity on a T1-weighted image, whereas it exhibited a high and focally intermediate signal intensity on a T2-weighted image. This patient was diagnosed with a mucinous type of retroperitoneal sarcoma, which was then resected. During surgery, the tumor was isolated from the retroperitoneum and other organs, but the detachment was required only because of fixation around the left external iliac artery. The histological diagnosis was a well-differentiated liposarcoma with multilocular cysts that contained old bloody, serous, and mucinous fluids, which are a rare phenomenon in liposarcoma. This case indicates that retroperitoneal liposarcoma should also be considered as a differential diagnosis of retroperitoneal cystic mass.
Utility of Genomic Testing after Renal Biopsy
Authors: Murray Susan L. , Dorman Anthony , Benson Katherine A. , Connaughton Dervla M. , Stapleton Caragh P. , Fennelly Neil K. , Kennedy Claire , McDonnell Ciara A. , Kidd Kendrah , Cormican Sarah M. , Ryan Louise A. , Lavin Peter , Little Mark A. , Bleyer Anthony J. , Doyle Brendan , Cavalleri Gianpiero L. , Hildebrandt Friedhelm , Conlon Peter J.
Published: December 2019

Background: Renal biopsy is the mainstay of renal pathological diagnosis. Despite sophisticated diagnostic techniques, it is not always possible to make a precise pathological diagnosis. Our aim was to identify a genetic cause of disease in patients who had undergone renal biopsy and determine if genetic testing altered diagnosis or treatment. Methods: Patients with suspected familial kidney disease underwent a variety of next-generation sequencing (NGS) strategies. The subset of these patients who had also undergone native kidney biopsy was identified. Histological specimens were reviewed by a consultant pathologist, and genetic and pathological diagnoses were compared. Results: Seventy-five patients in 47 families underwent genetic sequencing and renal biopsy. Patients were grouped into 5 diagnostic categories based on pathological diagnosis: tubulointerstitial kidney disease (TIKD; n = 18); glomerulonephritis (GN; n = 15); focal segmental glomerulosclerosis and Alport Syndrome (n = 11); thrombotic microangiopathy (TMA; n = 17); and nonspecific pathological changes (n = 14). Thirty-nine patients (52%) in 21 families (45%) received a genetic diagnosis; 13 cases (72%) with TIKD, 4 (27%) with GN, 6 (55%) with focal segmental glomerulosclerosis/Alport syndrome, and 10 (59%) with TMA and 6 cases (43%) with nonspecific features. Genetic testing resulted in changes in understanding of disease mechanism in 21 individuals (54%) in 12 families (57%). Treatment would have been altered in at least 26% of cases (10/39). Conclusions: An accurate genetic diagnosis can result in changes in clinical diagnosis, understanding of pathological mechanism, and treatment. NGS should be considered as a complementary diagnostic technique to kidney biopsy in the evaluation of patients with kidney disease.
Chronic equine proliferative pododermatitis
Authors: Azzolini Essayra Fortes Oliveira Tregnago , Bastos Samuel Freitas , Barros Rafaela Magalhães
Published: December 2019

Chronic equine proliferative pododermatitis (canker) is a chronic hypertrophic disease of the hoof, denoted by an excessive proliferation of the horn-producing tissues, which results from a dyskeratosis of the keratinocytes. It occurs mainly at the frog and sulci regions, but can sometimes also affect the heels, sole, bulbs or hoof wall. The etiology still remains unclear. Infectious agents such as anaerobic bacteria, viruses, spirochetes and fungi have been isolated from diseased tissues, but, moreover, an immune cause has been suggested, possibly related to a genetic predisposition. This report shows a case of a Brazilian Sport Horse, 10 years old, that had been affected on the right hindlimb for more than two years without a concise diagnosis. Success was achieved with the treatment consisting of oral prednisolone and topical Purple Mush®.
Evaluation of at-risk infant care: comparison between models of primary health care
Authors: Samelli Alessandra Giannella , Tomazelli Gislene Andrade , Almeida Maria Helena Morgani de , Oliver Fátima Corrêa , Rondon-Melo Silmara , Molini-Avejonas Daniela Regina
Published: December 2019

OBJECTIVES: To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS: A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool – child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS: Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS: Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants’ health care.
Adiposity, depression and anxiety: interrelationship and possible mediators
Authors: Gomes Ana Paula , Soares Ana Luiza G. , Menezes Ana M.B. , Assunção Maria Cecília , Wehrmeister Fernando C. , Howe Laura D. , Gonçalves Helen
Published: December 2019

OBJECTIVES: To explore the association between adiposity, major depressive disorder and generalized anxiety disorder, and to assess the role of inflammation, diet quality and physical activity in this association. METHODS: We used data from 2,977 individuals from the 1993 Pelotas Cohort (Brazil) who attended the 18- and 22-year follow-ups. We assessed general obesity using body mass index, fat mass index, and abdominal obesity using waist circumference. Major Depressive Disorder and generalized anxiety disorder were assessed using the mini-international neuropsychiatric interview. C-reactive protein and interleukin-6 (IL-6) levels were used as a measure of inflammation; diet quality was estimated using the revised diet quality index, and physical activity was assessed by the International physical activity questionnaire (IPAQ, min/day). The association between adiposity and major depressive disorder and generalized anxiety disorder was assessed using logistic regression, and the natural indirect effect via the mediators was estimated using G-computation. RESULTS: General obesity assessed by body mass index (OR: 2.3; 95% CI:1.13; 4.85), fat mass index (OR: 2.6; 95%CI: 1.37; 4.83), and abdominal obesity (OR: 2.5; 95%CI: 1.18; 5.39) were associated with higher odds of major depressive disorder, whereas major depressive disorder was only associated with obesity assessed by body mass index (OR=1.9; 95% CI: 1.09; 3.46). Obesity and generalized anxiety disorder were not associated. C-reactive protein, diet quality and physical activity did not mediate the effect of obesity on major depressive disorder, and C-reactive protein mediated about 25% of the effect of major depressive disorder on adiposity. CONCLUSIONS: Depression, but not generalized anxiety disorder, is associated with adiposity in both directions, with a stronger evidence for the direction obesity-depression. Inflammation explains part of the effect of major depressive disorder on obesity but not the other way around. Further research should explore other mechanisms that could be involved in the association between obesity and depression.
Public open spaces and physical activity: disparities of resources in Florianópolis
Authors: Manta Sofia Wolker , Reis Rodrigo Siqueira , Benedetti Tânia Rosane Bertoldo , Rech Cassiano Ricardo
Published: December 2019

ABSTRACT OBJECTIVE: To analyze the association between sociodemographic characteristics of census tracts and the presence/quality of public open spaces and physical activity facilities. METHODS: A cross-sectional study was conducted in 643 census tracts in Florianópolis, Brazil, the presence and quality of public open spaces and physical activity facilities were objectively analyzed and the data by census tracts using Geographic Information Systems was treated. Outcomes were analyzed considering the census tracts as having: ≥ 1 public open spaces; ≥ 1 public open spaces with high quality; ≥ 2 physical activity facilities and high-quality physical activity facilities. Sociodemographic characteristics were the independent variables. Logistic regression analysis was performed. RESULTS: Census tracts with a medium-income (OR = 1.8; 95%CI 1.1–3.0) and high-income (OR = 2.4; 95%CI 1.4–4.0), in those with medium (OR = 1.7; 95%CI 1.0–2.7) and high residential density (OR = 2.0; 95%CI 1,2–3.3), and with higher proportions of older adults (OR = 3.3; 95%CI 1.9–5.7) had a higher proportion of public open spaces. Census tracts with higher proportions of children/adolescents (OR = 0.3; 95%CI 0.2–0.6) and non-white residents (OR= 0.6; 95%CI 0.3–0.9) were less likely to contain public open spaces. The tracts with medium (OR = 4.0; 95%CI 1.4–11.3) and high-income (OR = 3.6; 95%CI 1.2–10.2) were more likely to contain public open spaces with ≥ 2 structures for physical activity, compared with those with low-income. We observed the inverse in sectors with a high proportion of non-white residents (OR = 0.3; 95%CI 0.1–0.9). CONCLUSIONS: Census tracts with higher proportions of children or adolescents, non-white individuals and those in the low-income strata had lower odds of containing public open spaces and physical activity facilities.
Factors associated with fetal macrosomia
Authors: Agudelo-Espitia Vanessa , Parra-Sosa Beatriz Elena , Restrepo-Mesa Sandra L
Published: December 2019

OBJECTIVE: To evaluate the clinical factors, as well as weight gain, in a group of pregnant women, associating them with fetal macrosomia in a public institution in Antioquia, Colombia, from 2010-2017. METHODS: A case-control study, using secondary information registries. Cases were defined using newborn weight of ≥ 4000g, while controls were defined as newborn weight between 3000– 3999g. A proportion ratio (PR) was established to evaluate factors associated with macrosomia, and a generalized linear model (GLM) of Poisson regression with robust variance was used to evaluate the aspects that best explained macrosomia in the neonate. RESULTS: 122 pregnant women participated in the study, of which 611 were cases and 61 were controls. Of the participants, 44.3% had pre-pregnancy overweight and 48.4% had excess gestational weight gain. Statistically significant differences were found between the groups in the following variables: pre-pregnancy BMI (p = 0.004), gestational weight gain (p = 0.000), gestational diabetes (p = 0.000), and type of delivery (p = 0.004). According to the regression model, a macrosomic newborn is 3.5 times more likely in women with excessive gestational weight gain (95%CI 1.78-7.18) and twice more likely in women who have gestational diabetes (95%CI 1.51-2.76). Of women with pre-pregnancy excess weight, 63% had excess gestational weight gain. CONCLUSIONS: Within this cohort, pre-pregnancy BMI, excess weight gain in pregnancy, and the presence of gestational diabetes were associated with an increased risk of neonatal macrosomia. pre-pregnancy BMI and weight gain in pregnancy are modifiable risk factors that are responsive to nutrition interventions, which can minimize adverse perinatal outcomes.
Developing a deprivation index to study geographical health inequalities in Ecuador
Authors: Peralta Andrés , Espinel-Flores Verónica , Gotsens Mercè , Pérez Glòria , Benach Joan , Marí-Dell’Olmo Marc
Published: December 2019

OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013–2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.
Differentiated thyroid carcinoma: a 5-years survival study at a referral hospital in Brazil
Authors: Borges Anne Karin Da Mota , Ferreira Jeniffer Dantas , Koifman Sergio , Koifman Rosalina Jorge
Published: December 2019

BACKGROUND: Although the prognosis of differentiated thyroid carcinoma (DTC) therapy is considered excellent over time, some cases have a poorer prognosis and evolve into death. OBJECTIVE: This study aimed to estimate the 5-year specific survival and to identify prognosis factors in a cohort of DTC adult subjects. METHODS: Survival probability was estimated by Kaplan-Meier’s method in a retrospective hospital-based cohort study. Comparisons were made by log-rank test. Prognosis factors were identified using Cox risk modeling and crude and adjusted Hazard Ratio measures were obtained. Two models were estimated, considering age grouping of the 7th and 8th editions of TNM. RESULTS: Specific 5-year survival in the cohort was 98.5% (95%CI: 94.2 – 97.5). Considering TNM 7th edition, the risk estimates were 9.88 (95%CI: 1.67 – 58.33) for age group ≥ 55 years, 18.87 (95%CI: 7.38 – 48.29) for individuals with distant metastasis, 6.36 (95%CI: 2.26 – 17.91) for patients who underwent lymphadenectomy and 0.16 (95%CI: 0.06 – 0.43) for those who received radioiodine therapy. For TNM 8th edition, the risk estimates were 10.12 (95%CI: 2.05 – 50.09) for age group ≥ 55 years, 12.43 (95%CI: 4.58 – 33.77) for individuals with distant metastasis, 5.06 (95%CI: 1.82 – 14.05) for patients who underwent lymphadenectomy and 0.19 (95%CI: 0.07 – 0.51) for those who received radioiodine therapy. CONCLUSIONS: This cohort had a very high survival over a 5-year period. The prognosis was negatively influenced by age, distant metastasis and lymphadenectomy, whereas radioiodine therapy was found to be protective.
How important is school environment in explaining individual variance of health behaviors?
Authors: Boing Antonio Fernando , Subramanian SV , Boing Alexandra Crispim
Published: December 2019

We analyzed data from the National School-based Health Survey (PeNSE) carried out in Brazil in 2015 (n = 102,072 adolescents) to estimate how much of the individual variance in the prevalence of health behaviors is attributable to the school level. Multilevel logistic regression models were calculated to estimate the variance partitional coefficient (VPC) of the use of drugs, intake of unhealthy food, leisure physical activity and weight-related behaviors. The between-schools variance was significant in all tested models. The highest VPCs were observed when the use of drugs was analyzed (15%-20% of the total variance of smoking and use of illegal drugs). Lower, but still significant, values were observed in the other outcomes. The school context plays an important role in the adolescents’ health and should be considered in the design of public policies and actions in public health.
Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure
Authors: Kelly Jacob P. , DeVore Adam D. , Wu JingJing , Hammill Bradley G. , Sharma Abhinav , Cooper Lauren B. , Felker G. Michael , Piccini Jonathan P. , Allen Larry A. , Heidenreich Paul A. , Peterson Eric D. , Yancy Clyde W. , Fonarow Gregg C. , Hernandez Adrian F.
Published: December 2019

Background

Limited data exist to guide treatment for patients with heart failure with preserved ejection fraction and atrial fibrillation, including the important decision regarding rate versus rhythm control.

Methods and Results

We analyzed the Get With The Guidelines—Heart Failure (GWTG‐HF) registry linked to Medicare claims data from 2008 to 2014 to describe current treatments for rate versus rhythm control and subsequent outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation using inverse probability weighted analysis. Rhythm control was defined as use of an antiarrhythmic medication, cardioversion, or
AF
ablation or surgery. Rate control was defined as use of any combination of β‐blocker, calcium channel blocker, and digoxin without evidence of rhythm control. Among 15 682 fee‐for‐service Medicare patients, at the time of discharge, 1857 were treated with rhythm control and 13 825 with rate control, with minimal differences in baseline characteristics between groups. There was higher all‐cause death at 1 year in the rate control compared with the rhythm control group (37.5% and 30.8%, respectively,
P
<0.01). The lower 1‐year all‐cause death in the rhythm control group remained after risk adjustment (adjusted hazard ratio, 0.86; 95%
CI
, 0.75–0.98;
P
=0.02).

Conclusions

Rhythm control in patients aged 65 and older with heart failure with preserved ejection fraction and
AF
was associated with a lower risk of 1 year all‐cause mortality. Future prospective randomized studies are needed to explore this potential benefit.
Association of High‐Density Lipoprotein Particles and High‐Density Lipoprotein Apolipoprotein C‐III Content With Cardiovascular Disease Risk According to Kidney Function: The Multi‐Ethnic Study of Atherosclerosis
Authors: Lamprea‐Montealegre Julio A. , McClelland Robyn L. , Otvos James D. , Mora Samia , Koch Manja , Jensen Majken K. , de Boer Ian H.
Published: December 2019

Background

Chronic kidney disease is associated with structural and compositional abnormalities in high‐density lipoprotein particles (HDLp). We examined associations of HDLp size, particle subfractions, and apolipoprotein C‐
III
content with incident cardiovascular disease (
CVD
) events across categories of estimated glomerular filtration rate (
eGFR
).

Methods and Results

Analyses included 6699 participants in MESA (Multi‐Ethnic Study of Atherosclerosis) with measurements of HDLp and 5723 participants with measurements of
HDL
apolipoprotein C‐
III
. Cox‐regression methods were used to evaluate associations between HDLp and apolipoproteins with
CVD
events. Larger HDLp size was associated with lower
CVD
risk in participants with lower
eGFR
: hazard ratio (95%
CI
) per SD higher mean
HDL
size was 1.00 (0.90–1.11) in
eGFR
≥60 mL/min per 1.73 m
2
, 0.65 (0.48–0.86) in
eGFR
45 to 59 mL/min per 1.73 m
2
, and 0.48 (0.25–0.93) in
eGFR
<45 mL/min per 1.73 m
2
(
P
for interaction=0.05). Associations of HDLp subfractions with
CVD
varied significantly by
eGFR
(
P
for interaction=0.04), with significant inverse associations between higher concentrations of large HDLp and
CVD
events across categories of kidney function, but nonsignificant results for small HDLp. Only HDLp without apolipoprotein C‐
III
was associated with lower risk of
CVD
events, with seemingly (albeit not statistically significant) stronger associations among participants with lower
eGFR
(
P
for interaction=0.19).

Conclusions

HDL
particles of larger size and higher concentrations of large
HDL
and of
HDL
without apolipoprotein C‐
III
were associated with lower
CVD
risk, with risk estimates seemingly stronger among participants with lower
eGFR
. Future larger studies are needed to corroborate these findings.
Novel Self‐Report Tool for Cardiovascular Risk Assessment
Authors: Mansoor Hend , Jo Ara , Beau De Rochars V. Madsen , Pepine Carl J. , Mainous Arch G.
Published: December 2019

Background

The currently used atherosclerotic cardiovascular disease risk calculator relies on several measured variables and does not incorporate some well‐established risk factors such as family history of premature myocardial infarction and other nontraditional risk factors. Our study aimed to develop and validate a simple risk score to predict 10‐year risk of incident cardiovascular events using patient‐reported information.

Methods and Results

Using data from the Atherosclerosis Risk in Communities cohort, we identified adults with no previous history of cardiovascular disease and randomly divided the cohort into “development” (70%) and “validation” (30%) subgroups. Adjusted Cox regression modeling was used to develop a prediction model. The predictive performance of the new risk score was compared with the score derived from the atherosclerotic cardiovascular disease risk calculator. A total of 9285 individuals met the inclusion criteria. During follow‐up (median 8.93 years), a total of 694 (7.47%) incident cardiovascular events occurred. The following 6 factors were included: male sex, age, current smoking, diabetes mellitus, hypertension, and family history of premature myocardial infarction. The C‐statistic was 0.72 in the validation cohort with good calibration. The area under the curve for the simple risk score was comparable to the atherosclerotic cardiovascular disease risk score.

Conclusions

The novel simple risk score is an easy‐to‐use tool to predict cardiovascular events in adults from self‐reported information without need for laboratory or physical examination data. This risk score included 6‐items and had comparable predictive performance to the guideline recommended atherosclerotic cardiovascular disease risk score but relies solely on self‐reported information.
Mobile Health Access and Use Among Individuals With or At Risk for Cardiovascular Disease: 2018 Health Information National Trends Survey (HINTS)
Authors: Shan Rongzi , Ding Jie , Plante Timothy B. , Martin Seth S.
Published: December 2019

Background

Mobile health (
mH
ealth) technologies can deliver interventions to prevent and manage cardiovascular disease (
CVD
), but
mH
ealth uptake among those with or at risk for
CVD
remains incompletely explored. Therefore, in this group, we assessed the prevalence of
mH
ealth access and usage, and the association between
CVD
risk and
mH
ealth uptake.

Methods and Results

Data were from 3248 adults in the 2018 Health Information National Trends Survey. We defined
CVD
risk as reporting a heart condition, diabetes mellitus, hypertension, and/or current smoking (n=1903). Multivariable logistic regression, adjusting for demographics, was used to assess the relationship between
CVD
risk and
mH
ealth uptake. Most individuals with
CVD
risk owned a smartphone (73%, 95%
CI
: 69%–76%) and 48% (95%
CI
: 44%–52%) had a health app. Among men, those with
CVD
risk were more likely to use a wearable device (odds ratio 2.43, 95%
CI
: 1.44–4.10) than those without
CVD
risk, while there was no difference among women. In both sexes,
CVD
risk was associated with sharing information from a smartphone/wearable with a clinician (odds ratio 1.63, 95%
CI
1.12–2.35 in women; odds ratio 3.99, 95%
CI
2.30–6.95 in men). However, there was no difference in the odds of using
mH
ealth to track health progress, make health decisions, aid healthcare discussions, or text a clinician.

Conclusions

In a nationally representative sample, there was high prevalence of smartphone ownership but incomplete
mH
ealth uptake. Having
CVD
or its risk factors was associated with sharing information from smartphone/wearables, suggesting potential to leverage clinically validated
mH
ealth interventions for
CVD
prevention.