bluuebunny/crossref_metadata_2025 huggingface dataset:
Blunted rest–activity rhythms link to higher body mass index and inflammatory markers in children
Authors: Qian Jingyi , Martinez-Lozano Nuria , Tvarijonaviciute Asta , Rios Rafael , Scheer Frank A J L , Garaulet Marta
Published: November 2020

Study Objectives

Disturbances of rest–activity rhythms are associated with higher body mass index (BMI) in adults. Whether such relationship exists in children is unclear. We aimed to examine cross-sectional associations of rest–activity rhythm characteristics with BMI z-score and obesity-related inflammatory markers in school-age children.

Methods

Participants included 411 healthy children (mean ± SD age 10.1 ± 1.3 years, 50.8% girls) from a Mediterranean area of Spain who wore wrist accelerometers for 7 consecutive days. Metrics of rest–activity rhythm were derived using both parametric and nonparametric approaches. Obesity-related inflammatory markers were measured in saliva (n = 121).

Results

In a multivariable-adjusted model, higher BMI z-score is associated with less robust 24-h rest–activity rhythms as represented by lower relative amplitude (–0.16 [95% CI –0.29, –0.02] per SD, p = 0.02). The association between BMI z-score and relative amplitude persisted with additional adjustment for sleep duration, and attenuated after adjustment for daytime activity level. Less robust rest–activity rhythms were related to increased levels of several salivary pro-inflammatory markers, including C-reactive protein, which is inversely associated with relative amplitude (–32.6% [–47.8%, –12.9%] per SD), independently of BMI z-score, sleep duration, and daytime activity level.

Conclusion

Blunted rest–activity rhythms are associated with higher BMI z-score and salivary pro-inflammatory markers already at an early age. The association with BMI z-score seem to be independent of sleep duration, and those with pro-inflammatory markers further independent of BMI z-score and daytime activity. Novel intervention targets at an early age based on improving the strength of rest–activity rhythms may help to prevent childhood obesity and related inflammation.

Clinical Trials Registration

NCT02895282
Macro- and microvascular reactivity during repetitive exposure to shortened sleep: sex differences
Authors: Yang Huan , Baltzis Dimitrios , Bhatt Vrushank , Haack Monika , Meier-Ewert Hans K , Gautam Shiva , Veves Aristidis , Mullington Janet M
Published: November 2020

Epidemiological studies have reported strong association between sleep loss and hypertension with unknown mechanisms. This study investigated macrovascular and microcirculation changes and inflammatory markers during repetitive sleep restriction. Sex differences were also explored. Forty-five participants completed a 22-day in-hospital protocol. Participants were assigned to, (1) eight-hour sleep per night (control), or (2) sleep restriction (SR) condition: participants slept from 0300 to 0700 h for three nights followed by a recovery night of 8-h sleep, repeated four times. Macrocirculation assessed by flow mediated dilation (FMD) and microcirculation reactivity tests were performed at baseline, last day of each experimental block and during recovery at the end. Cell adhesion molecules and inflammatory marker levels were measured in blood samples. No duration of deprivation (SR block) by condition interaction effects were found for FMD, microcirculation, norepinephrine, cell adhesion molecules, IL-6 or IL-8. However, when men and women were analyzed separately, there was a statistical trend (p = 0.08) for increased IL-6 across SR blocks in women, but not in men. Interestingly, men showed a significant progressive (dose dependent) increase in skin vasodilatation (p = 0.02). A novel and unexpected finding was that during the recovery period, men that had been exposed to repeated SR blocks had elevated IL-8 and decreased norepinephrine. Macrocirculation, microcirculation, cell adhesion molecules, and markers of inflammation appeared to be resistant to this model of short-term repetitive exposures to the blocks of shortened sleep in healthy sleepers. However, men and women responded differently, with women showing mild inflammatory response and men showing more vascular system sensitivity to the repetitive SR.
Digital cognitive behavioral therapy for insomnia promotes later health resilience during the coronavirus disease 19 (COVID-19) pandemic
Authors: Cheng Philip , Casement Melynda D , Kalmbach David A , Castelan Andrea Cuamatzi , Drake Christopher L
Published: November 2020

Study Objectives

Stressful life events contribute to insomnia, psychosocial functioning, and illness. Though individuals with a history of insomnia may be especially vulnerable during stressful life events, risk may be mitigated by prior intervention. This study evaluated the effect of prior digital cognitive-behavioral therapy for insomnia (dCBT-I) versus sleep education on health resilience during the COVID-19 pandemic.

Methods

COVID impact, insomnia, general- and COVID-related stress, depression, and global health were assessed in April 2020 in adults with a history of insomnia who completed a randomized controlled trial of dCBT-I (n = 102) versus sleep education control (n = 106) in 2016–2017. Regression analyses were used to evaluate the effect of intervention conditions on subsequent stress and health during the pandemic.

Results

Insomnia symptoms were significantly associated with COVID-19 related disruptions, and those who previously received dCBT-I reported less insomnia symptoms, less general stress and COVID-related cognitive intrusions, less depression, and better global health than those who received sleep education. Moreover, the odds for resurgent insomnia was 51% lower in the dCBT-I versus control condition. Similarly, odds of moderate to severe depression during COVID-19 was 57% lower in the dCBT-I condition.

Conclusions

Those who received dCBT-I had increased health resilience during the COVID-19 pandemic in adults with a history of insomnia and ongoing mild to moderate mental health symptoms. These data provide evidence that dCBT-I is a powerful tool to promote mental and physical health during stressors, including the COVID-19 pandemic.

Clinical Trial Registration

NCT02988375
Models for predicting sleep latency and sleep duration
Authors: Vital-Lopez Francisco G , Balkin Thomas J , Reifman Jaques
Published: November 2020

Study Objectives

Planning effective sleep–wake schedules for civilian and military settings depends on the ability to predict the extent to which restorative sleep is likely for a specified sleep period. Here, we developed and validated two mathematical models, one for predicting sleep latency and a second for predicting sleep duration, as decision aids to predict efficacious sleep periods.

Methods

We extended the Unified Model of Performance (UMP), a well-validated mathematical model of neurobehavioral performance, to predict sleep latency and sleep duration, which vary nonlinearly as a function of the homeostatic sleep pressure and the circadian rhythm. To this end, we used the UMP to predict the time course of neurobehavioral performance under different conditions. We developed and validated the models using experimental data from 317 unique subjects from 24 different studies, which included sleep conditions spanning the entire circadian cycle.

Results

The sleep-latency and sleep-duration models accounted for 42% and 84% of the variance in the data, respectively, and yielded acceptable average prediction errors for planning sleep schedules (4.0 min for sleep latency and 0.8 h for sleep duration). Importantly, we identified conditions under which small shifts in sleep onset timing result in disproportionately large differences in sleep duration—knowledge that may be applied to improve performance, safety, and sustainability in civilian and military operations.

Conclusions

These models extend the capabilities of existing predictive fatigue-management tools, allowing users to anticipate the most opportune times to schedule sleep periods.
Characteristics associated with hypersomnia and excessive daytime sleepiness identified by extended polysomnography recording
Authors: Evangelista Elisa , Rassu Anna Laura , Barateau Lucie , Lopez Régis , Chenini Sofiène , Jaussent Isabelle , Dauvilliers Yves
Published: November 2020

Study Objectives

Hypersomnolence, defined by excessive daytime sleepiness (EDS) or excessive quantity of sleep (EQS), has been associated with increased morbidity. The aim of this study was to determine the clinical and polysomnographic characteristics associated with EQS and EDS assessed objectively during extended polysomnography recording.

Methods

A total of 266 drug-free subjects (201 women; mean age: 26.5 years [16.08; 60.87]) underwent 32-h bed-rest polysomnography recording preceded by polysomnography and modified multiple sleep latency test (mMSLT). Participants were categorized according to their total sleep time (bed-rest TST ≥19 h, hypersomnia), objective EDS (mean sleep latency on MSLT ≤8 min), and self-reported EDS (Epworth sleepiness scale score >10) and EQS (≥9 h/24 h per week).

Results

Subjects with hypersomnia were often younger, with normal sleep architecture, high nighttime sleep efficiency, and severe objective EDS. No association with sex, body mass index, Epworth sleepiness scale, EQS, and depressive symptoms was detected. Subjects with objective EDS had less EQS, higher sleep efficiency, and increased hypersomnia. Discrepancies were observed between objective and self-reported measures of sleep duration and EDS. Finally, 71 subjects were identified who had objective hypersomnia and/or EDS, no medical and psychiatric conditions and normal polysomnography parameters, and therefore met the stringent criteria of idiopathic hypersomnia, an orphan disorder.

Conclusions

Sleep duration and EDS should be quantified using self-reported and objective measures in a controlled procedure to differentiate long sleepers, patients with hypersomnia, and patients with idiopathic hypersomnia. This will help to better understand their biology, to identify specific biomarkers, and to assess related health outcomes.
Effects of exogenous α-amylases, glucoamylases, and proteases on ruminal in vitro dry matter and starch digestibility, gas production, and volatile fatty acids of mature dent corn grain
Authors: Amaro Felipe X , Kim Donghyeon , Agarussi Mariele C N , Silva Vanessa P , Fernandes Tatiane , Arriola Kathy G , Jiang Yun , Cervantes Andres P , Adesogan Adegbola T , Ferraretto Luiz F , Yu Shukun , Li Wenting , Vyas Diwakar
Published: November 2020

Two separate experiments were carried out to evaluate the effects of incremental doses of 10 exogenous endo-acting α-amylase and exo-acting glucoamylase; 1LAT (bacterial α-amylase), 2AK, 3AC, 4Cs4, 5Trga, 6Afuga, 7Fvga, and 10Tg (fungal α-amylases, glucoamylases, and α-glucosidase), 8Star and 9Syn (fungal amylase-mixtures; experiment 1) and three exogenous proteases; 11P14L, 12P7L, and 13P30L (bacterial proteases; experiment 2) on in vitro dry matter digestibility (IVDMD) and in vitro starch digestibility (IVSD) of mature dent corn grain using a batch culture system. Incremental doses of the exogenous enzymes (0, 0.25, 0.50, 0.75, and 1.00 mg/g of dried substrate) were applied directly to the substrate (0.5 g of ground corn, 4 mm) in sextuplicate (experiment 1) or quadruplicate (experiment 2) within F57 filter bags, which were incubated at 39 °C in buffered rumen fluid for 7 h. Rumen fluid was collected 2–3 h after the morning feeding from three lactating dairy cows and pooled. Cows were consuming a midlactation total mixed ration (TMR; 1.60 Mcal/kg DM and 15.4%; net energy of lactation and crude protein, respectively). Three independent runs were carried out for each experiment. Data were analyzed as a randomized complete block design using run as the blocking factor. Dose was used as a fixed factor while run was considered a random factor. Linear, quadratic, and cubic orthogonal contrasts were also tested. In experiment 1, enzymes 2AK, 3AC, and 10Tg did not increase (P > 0.10) IVDMD and IVSD, whereas 0.25 mg of enzymes 1LAT, 5Trga, and 8Star increased (P < 0.01) IVDMD by 23%, 47%, and 62% and IVSD by 35%, 41%, and 58%, respectively, compared with the control. Enzymes 4Cs4, 6Afuga, 7Fvga, and 9Syn linearly increased IVDMD and IVSD (P < 0.01). Greatest increases in IVDMD (82.9%) and IVSD (85.9%) resulted with 1 mg of 6Afuga compared to control. In experiment 2, the lowest dose of exogenous proteases 11P14L and 12P7L increased (P < 0.01) IVDMD by 98% and 87% and IVSD by 57% and 64%, respectively, whereas the highest dose of 13P30L increased (P = 0.02) IVDMD by 44.8% and IVSD by 30%, relative to the control. In conclusion, IVSD and IVDMD were increased by one α-amylase, certain glucoamylases, and all proteases tested, with the glucoamylase 6Afuga in experiment 1 and the neutral protease 12P7L in experiment 2, increasing IVDMD and IVSD to the greater extents. Future in vivo studies are required to validate these findings before these enzyme additives can be recommended for improving the digestibility of mature dent corn grain.
What best animal science teachers do
Authors: Whitaker B D , Lamberson W R , Smith M F , Walters B S , Youngs C R
Published: November 2020

Great teachers have the extraordinary ability to inspire and motivate even those students who resist learning. The top educators are knowledgeable not only about the content of the course they are teaching but also of the information, literature, and practice of instructional delivery to their audience. Many exemplary educators have been profiled and studied; however, there is a paucity of information pertaining to how the top animal science teachers teach. The objective of this study was to identify and describe characteristics of award-winning animal science teachers. The inclusion criterion for selecting faculty was being bestowed an excellence in teaching award through their professional organization. Each teacher answered a series of questions about themselves, their students, and the class being taught. Lecture was captured using a digital all-inclusive camera and later analyzed for pedagogical trends and instructor–student interactions. Despite a variety of topics being taught by award-winning teachers, there were multiple trends emerging from their classrooms. Common events included reviewing highlights of previous lectures, distributing something to students, posing questions during class, and calling on students by name. Each teacher taught differently, but they all understood their audience; they grasped the subject matter and most importantly, they valued students learning. Collectively, these findings can be utilized and applied by animal science teachers in their own environments in an attempt to foster improved student learning through excellent teaching.
Increased early activation of CD56dimCD16dim/- natural killer cells in immunological non-responders correlates with CD4+ T-cell recovery
Authors: Zhang Qiu-Yue , Zhang Xin , Su Bin , Liu Li-Feng , Yang Xiao-Dong , Tang Bin , Xia Huan , Ma Ping , Zhang Tong , Wu Hao
Published: November 2020

Background

Natural killer (NK) cells play a critical role in suppressing human immunodeficiency virus-1 (HIV-1) infection, but knowledge on whether and how NK cells affect immune reconstitution in HIV-1-infected individuals who receive antiretroviral therapy (ART) is limited.

Methods

We performed a case-control study with 35 healthy individuals and 66 HIV-1-infected patients including 32 immunological non-responders (INRs) with poor CD4+ T-cell recovery (<500 cells/μL after 4 years of ART) and 34 immunological responders (IRs) with improved CD4+ T-cell recovery (>500 cells/μL after 4 years of ART). NK cell phenotype, receptor repertoire, and early activation in INRs and IRs were investigated by flow cytometry.

Results

A significantly higher proportion of CD56dimCD16dim/- NK cells was observed in INRs than IRs before ART and after 4 years of ART. The number of CD56dimCD16dim/- NK cells was inversely correlated with CD4+ T-cell counts in INRs before ART (r = –0.344, P = 0.050). The more CD69-expressing NK cells there were, the lower the CD4+ T-cell counts and ΔCD4, and these correlations were observed in INRs after ART (r = –0.416, P = 0.019; r = –0.509, P = 0.003, respectively). Additionally, CD69-expressing CD56dimCD16dim/- NK cells were more abundant in INRs than those in IRs (P 
= 0.018) after ART, both of which had an inverse association trend towards significance with CD4+ T-cell counts. The expression of the activating receptors NKG2C, NKG2D, and NKp46 on CD56dimCD16dim/- NK cell subsets were higher in IRs than that in INRs after 4 years of ART (all P < 0.01). Strong inverse correlations were observed between CD69 expression and NKG2C, NKG2A-NKG2C+, NKG2D, and NKp46 expression on CD56dimCD16dim/- NK cells in INRs after ART (NKG2C: r = –0.491, P = 0.004; NKG2A-NKG2C+: r = –0.434, P = 0.013; NKG2D: r = –0.405, P = 0.021; NKp46: r = –0.457, P = 0.008, respectively).

Conclusions

INRs had a larger number of CD56dimCD16dim/- NK cells characterized by higher activation levels than did IRs after ART. The increase in the CD56dimCD16dim/- NK cell subset may play an adverse role in immune reconstitution. Further functional studies of CD56dimCD16dim/- NK cells in INRs are urgently needed to inform targeted interventions to optimize immune recovery.
The Serpent of Their Agonies
Authors: Prins Seth J. , McKetta Sarah , Platt Jonathan , Muntaner Carles , Keyes Katherine M. , Bates Lisa M.
Published: November 2020

Background:

Social stratification is a well-documented determinant of mental health. Traditional measures of stratification (e.g., socioeconomic status) reduce dynamic social processes to individual attributes downstream of mechanisms that generate stratification. In this study, we measure one process theorized to generate and reproduce social stratification—economic exploitation—and explore its association with mental health.

Methods:

Data are from the 1983 to 2017 waves of the Panel Study of Income Dynamics, a nationally representative cohort study (baseline N = 3059). We operationalized “unconcealed exploitation” as the percentage of individuals’ labor income they were hypothetically not paid for productive hours. We ascertained psychologic distress and mental illness with the Kessler-6 (K6) scale.

Results:

We fit inverse probability-weighted marginal structural models and found that for each unit increase in unconcealed exploitation, psychologic distress increased by 1.6 points (95% confidence interval = 0.71, 2.5) on the K6 scale and the odds of mental illness tripled (odds ratio = 3.0, 95% confidence interval = 1.5, 6.1). Results were not driven entirely by overwork and were robust to different inverse probability-weighted estimation strategies and sensitivity analyses.

Conclusions:

Exploitation is associated with mental illness. Focusing on exploitation rather than its consequences (e.g., socioeconomic status), shifts attention to a structural process that may be a more appropriate explanatory mechanism, and a more pragmatic intervention target, for mental illness.
ATYPICAL PROLIFERATIVE RETINOPATHY AS THE PRESENTING FEATURE OF CHRONIC MYELOID LEUKEMIA IN A PATIENT WITH DIABETES MELLITUS
Authors: Al Falah Mohammed , Ballios Brian G. , Yeung Shanna C. , Mehraban Far Parsa , Yan Peng
Published: November 2020

Purpose:

To describe a case of proliferative retinopathy as the presenting manifestation of chronic myeloid leukemia in a patient with poorly controlled diabetes mellitus (DM). Undiagnosed chronic myeloid leukemia in a patient with pre-existing poorly controlled DM is rarely encountered but must be recognized to treat appropriately with systemic chemotherapy. Significant fundus finding overlaps with DM making the recognition of chronic myeloid leukemia challenging.

Methods:

Case report.

Results:

Fundoscopy revealed scattered dot–blot hemorrhages, venous beading, and numerous Roth spots in all quadrants, in both eyes. In the right eye, there was also a vitreous hemorrhage with evidence of neovascularization near the inferior arcade. Intravenous fluorescein angiography showed significant peripheral capillary nonperfusion without evidence of exudation in both eyes. No macular edema was observed on optical coherence tomography. A review of systems and physical examination was negative for constitutional symptoms, lymphadenopathy, organomegaly, and other symptoms. Retinal findings prompted a complete blood count, which revealed significant leukocytosis. A bone marrow biopsy confirmed a diagnosis of chronic myeloid leukemia. Systemic chemotherapy and pan-retinal photocoagulation successfully normalized the leukocyte count and resolved the vitreous hemorrhage and neovascularization.

Conclusion:

The presence of numerous Roth spots in all quadrants, extensive areas of capillary nonperfusion on intravenous fluorescein angiography, and neovascularization in the absence of exudation or macular edema should prompt investigations to rule out hematologic disorders.
BILATERAL UVEITIS AND HYPOTONY FOLLOWING TREATMENT WITH TOPICAL CIDOFOVIR
Authors: Santilli Christopher M. , Koozekanani Dara , Armbrust Karen R.
Published: November 2020

Purpose:

To report a case of bilateral uveitis and hypotony associated with topical cidofovir treatment.

Methods:

Case report.

Results:

A 59-year-old diabetic man with HIV/AIDS presented with photophobia, ocular pain, and decreased vision. He was found to have bilateral hypotony, anterior uveitis, and serous choroidal detachments. Infectious disease workup, patient-reported history, and review of the patient's electronic medication list did not identify the etiology. Treatment with intensive topical corticosteroids led to resolution of uveitis and choroidal effusions within 3 months and resolution of hypotony within 9 months. Two years after his initial presentation, the patient developed acute recurrence of bilateral hypotony, anterior uveitis, and serous choroidal detachments shortly after intravenous cidofovir treatment. Careful reevaluation of the patient's outside medical records revealed that he had initiated treatment for rectal herpes simplex virus with compounded topical cidofovir one month before his initial presentation.

Conclusion:

To our knowledge, this is the first reported case of topical cidofovir causing ocular toxicity. Compounded and topical medications, like cidofovir in this case, may not appear on a patient's electronic medication list, so a focused review of outside medical records may be beneficial when a particular medication toxicity is suspected.
Person-Centered Care Environment Associated With Care Staff Outcomes in Long-Term Care Facilities
Authors: CHOI JiSun , KIM Da Eun , YOON Ju Young
Published: November 2020

Background

Although a general implementation of person-centered care in Korean long-term care delivery systems would be challenging, person-centered care has the potential to improve resident and staff outcomes through changes in current care services. However, little empirical evidence currently supports a positive relationship between person-centered care environments and staff outcomes.

Purpose

This study was designed to examine the relationship between person-centered care environments and staff outcomes, including job satisfaction and turnover intention, among care staff in Korean long-term care facilities.

Methods

This descriptive, correlational study used data from 235 care staff (94 nursing staff and 141 personal care workers) in 13 long-term care facilities in Korea. Data were collected using structured survey questionnaires, including items related to the person-centered care environment, job satisfaction, and turnover intention. Multilevel linear and logistic regression analyses were performed using Mplus Version 7.0.

Results

After controlling for individual (age, education, monthly income, position, shift work, and job tenure) and organizational (type of facility, location, ownership, bed size, and staffing levels) characteristics, a significant relationship was found between the person-centered care environment and job satisfaction and turnover intention among staff in Korean long-term care facilities.

Conclusions/Implications for Practice

The study findings indicate that working in a person-centered care environment is key to higher job satisfaction, which is a significant predictor of turnover intention among staff in long-term care facilities. To recruit and retain qualified staff to provide high-quality person-centered care in long-term care facilities, a supportive work environment is crucial. Fostering a person-centered care environment will ultimately improve quality of care for residents.
Imaging Post Stereotactic Radiosurgery for Vestibular Schwannomas—When Should We Scan?
Authors: Ton Trung , Sheldon Anna , Tikka Theofano , Locke Richard , Crowther John A. , Kontorinis Georgios
Published: November 2020

Objective:

To identify the optimal time for imaging following stereotactic radiosurgery (SRS) in patients with vestibular schwannomas (VS).

Study Design:

Retrospective case series.

Setting:

Tertiary, university center.

Patients:

Patients with VS treated with SRS.

Interventions:

Pre- and post-SRS surveillance with magnetic resonance imaging (MRI); patients should have at least two pre- and two post-SRS scans available to be included.

Main Outcome Measures:

Patient demographics, tumor size, and growth per month ratio pre- and post-SRS and time interval between serial MRI.

Results:

Forty-two patients fulfilled the inclusion criteria. The average tumor size before the treatment was 16.9 mm (range, 10–28 mm) while 2 years posttreatment it was 16 mm (range, 7–25 mm) (p = 0.5). Average time of the first MRI post-SRS was 11 months (range, 5–14) with an average change in tumor size at that time of +0.53 mm (range, –5–8). Average time to second MRI was 22.3 months (range, 12–33) with an average change in tumor size at second scan of –1.14 (range, –5–2) mm (p = 0.117). The average growth/mo ratio before SRS was 0.26 mm/mo (range, 0–1), while post-SRS 0.05 mm/mo (range, –0.3–0.5) and –0.16 mm/mo (range, –18–0.25) at the time of the first and second scan, respectively (p < 0.001).

Conclusions:

Given the initial increase in size following SRS, unless clinically indicated, MRI post-SRS at less than 1 year has no clinical value. The growth per month ratio provides more meaningful values for response to treatment than tumor size measurements.
Relation between nocturnal decline in blood pressure and choroidal thickness: a comparative analysis in dipper vs. non-dipper hypertensive patients
Authors: Tas Sedat , Altinisik Muhammed , Tas Ümmü
Published: November 2020

Purpose

To compare choroidal thickness (ChT) and echocardiographical changes in patients with dipper and non-dipper systemic arterial hypertension (HT).

Methods

Patients with HT were evaluated in two groups according to the 24-hour ambulatory BP monitoring. Compared to day-time values, those whose night-time SBP decreased ≥10% were defined as dippers, and those whose SBP decreased <10% were defined as non-dippers. Transthoracic echocardiography was conducted in all patients. ChT and central macular thickness were measured with spectral-domain optical coherence tomography. ChT was obtained at the subfoveal, 1500 µm nasal and temporal to the fovea.

Results

Thirty non-dipper (18 females and 12 males) and 23 dipper (16 females and seven males) hypertensive patients were recruited. Sex distribution and the mean age were similar between the groups (P = 0.472; P = 0.12). Disease duration was longer in the non-dipper group (8 ± 3.39 vs. 4.96 ± 1.19 years, P = 0.001). The non-dipper group had lower ChT in subfoveal and temporal locations (P = 0.02 and 0.03, respectively) and higher left atrial volume index (LAVI) and pulmonary valve maximum flow (PV-max; P < 0.001). The night-time SBP was negatively correlated with ChT (P = 0.048) and positive correlated with LAVI and PV-max (P < 0.05). However those correlations were not significant when were controlled by the possible confounding factors as disease duration, age and gender.

Conclusion

Non-dipper HT patients may have thinner choroid than dippers due to longer duration of HT and higher ambulatory BP levels.
Incidence, Clinical Characteristics, Risk Factors, and Outcomes of Upper Gastrointestinal Bleeding in Patients With COVID-19
Authors: González González Rebeca , Jacob Javier , Miró Òscar , Llorens Pere , Jiménez Sònia , González del Castillo Juan , Burillo-Putze Guillermo , Martín Alfonso , Martín-Sánchez Francisco J. , Lamberechts Jorge G. , Alquézar-Arbé Aitor , Higa-Sansone Leopoldo , Gayoso Martín Sara , Carbajosa Virginia , Beddar Chaib Fahd , Salido Manuel , Marchena González María J. , Calvo López Ricardo , González Martínez Félix , Pavón Monzo José , Velarde Herrera Desiré M. , Niembro Valdés Ana P. , Quero Motto Eva , Ferreras Amez José M. , Piñera-Salmerón Pascual
Published: November 2020

Objective:

The authors investigated the incidence, risk factors, clinical characteristics, and outcomes of upper gastrointestinal bleeding (UGB) in patients with coronavirus disease 2019 (COVID-19), who were attending the emergency department (ED), before hospitalization.

Methods:

We retrospectively reviewed all COVID-19 patients diagnosed with UGB in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We formed 2 control groups: COVID-19 patients without UGB (control group A) and non-COVID-19 patients with UGB (control group B). Fifty-three independent variables and 4 outcomes were compared between cases and controls.

Results:

We identified 83 UGB in 74,814 patients with COVID-19 who were attending EDs (1.11%, 95% CI=0.88-1.38). This incidence was lower compared with non-COVID-19 patients [2474/1,388,879, 1.78%, 95% confidence interval (CI)=1.71-1.85; odds ratio (OR)=0.62; 95% CI=0.50-0.77]. Clinical characteristics associated with a higher risk of COVID-19 patients presenting with UGB were abdominal pain, vomiting, hematemesis, dyspnea, expectoration, melena, fever, cough, chest pain, and dysgeusia. Compared with non-COVID-19 patients with UGB, COVID-19 patients with UGB more frequently had fever, cough, expectoration, dyspnea, abdominal pain, diarrhea, interstitial lung infiltrates, and ground-glass lung opacities. They underwent fewer endoscopies in the ED (although diagnoses did not differ between cases and control group B) and less endoscopic treatment. After adjustment for age and sex, cases showed a higher in-hospital all-cause mortality than control group B (OR=2.05, 95% CI=1.09-3.86) but not control group A (OR=1.14, 95% CI=0.59-2.19) patients.

Conclusions:

The incidence of UGB in COVID-19 patients attending EDs was lower compared with non-COVID-19 patients. Digestive symptoms predominated over respiratory symptoms, and COVID-19 patients with UGB underwent fewer gastroscopies and endoscopic treatments than the general population with UGB. In-hospital mortality in COVID-19 patients with UGB was increased compared with non-COVID patients with UGB, but not compared with the remaining COVID-19 patients.
The Clinical Utility of Provocative Maneuvers at Esophageal High-resolution Manometry (HRM)
Authors: Horton Anthony , Jawitz Nicole , Patel Amit
Published: November 2020

Esophageal high-resolution manometry (HRM) assesses esophageal motor function and is indicated both for evaluation of esophageal symptoms and before antireflux interventions. HRM studies are interpreted and esophageal motor diagnoses made according to the Chicago Classification, version 3.0 algorithm, which is based on ten 5 mL supine water swallows. However, this practice of single liquid swallows performed in the supine position does not reflect typical “real-life” swallowing, and may not reproduce the patient’s presenting symptoms. Therefore, provocative maneuvers at HRM—beyond these 10 standard swallows—can afford additional insights into esophageal motor function with clinically significant implications, and represent areas of exciting investigation and innovation. Accordingly, the 2020 American College of Gastroenterology Guidelines on Esophageal Physiologic Testing conditionally recommend their inclusion in the HRM protocol. In this clinical review, we discuss the supporting data for and clinical utility of provocative maneuvers at HRM that include changes in body position or accessories (upright swallows, “bridge” position, straight leg raise, abdominal compression), bolus consistency (solid swallows, test meals, postprandial high-resolution impedance manometry), bolus frequency (multiple rapid swallows), the volume of bolus (rapid drink challenge/multiple water swallows), and the use of pharmacological agents.
Needle-based Confocal Laser Endomicroscopy (nCLE) for Evaluation of Pancreatic Cystic Lesions
Authors: Konjeti Venkata R. , McCarty Thomas R. , Rustagi Tarun
Published: November 2020

Background and Aims:

Given the variable diagnostic yield of endoscopic ultrasound and endoscopic ultrasound–guided fine-needle aspiration for pancreatic cystic lesions (PCLs), novel imaging techniques including needle-based confocal laser endomicroscopy (nCLE) have been devised. The aim of this study was to perform a structured systematic review and meta-analysis to evaluate the diagnostic performance and safety of nCLE for the diagnosis of PCLs.

Methods:

Individualized search strategies were developed in accordance with PRISMA and MOOSE guidelines and meta-analysis analyzed according to the Cochrane Diagnostic Test Accuracy working group methodology. Measured outcomes included diagnostic characteristics and procedure-associated adverse events. A bivariate model was used to compute combined weighted sensitivity, specificity, positive/negative likelihood ratio (LR), diagnostic odds ratio, and summary receiver operating characteristic curve with corresponding 95% confidence intervals (CIs).

Results:

Seven studies (n=324; mean age: 63.99±5.36 y; 52.47% female) were included. The pooled sensitivity, specificity, positive LR, and negative LR of nCLE was 85% (95% CI, 71-93; I
2=74.20%), 99% (95% CI, 90-100; I
2=72.60%), 78.66 (95% CI, 7.99-774.68; I
2=26.86%), and 0.15 (95% CI, 0.07-0.31; I
2=75.84%), respectively. Diagnostic accuracy as measured by summary receiver operating characteristic curve was 99% (95% CI, 98-100). The pooled diagnostic odds ratio was 534 (95% CI, 50-5664; I
2=58.00%). Postprocedure pancreatitis developed in 1% (95% CI, 0-3; I
2=5.64%) of cases.

Conclusions:

On the basis of this meta-analysis, nCLE appears to be an effective and safe technique for the diagnostic evaluation of PCLs. Although moderate-to-high amounts of heterogeneity were present, our results demonstrated that nCLE has a diagnostic accuracy of 99% with a low rate of adverse events.
Intermittent Appearance of Antibodies to Infliximab Is Not Associated With Reduced Efficacy in Patients With Inflammatory Bowel Diseases
Authors: Awadie Halim , Waterman Matti
Published: November 2020

Goals:

To assess the clinical significance of antibodies to infliximab (ATI) formation in patients with inflammatory bowel disease (IBD).

Background:

Infliximab therapy in patients with IBD is highly effective though up to 50% of patients lose response to infliximab. ATI formation occurs in 6% to 60% of patients on scheduled infliximab maintenance therapy.

Methods:

Infliximab trough levels and ATI at trough were prospectively determined in patients with IBD on maintenance infliximab therapy. Patients on infliximab maintenance therapy with at least 3 ATI measurements were included. Patients were divided into 2 groups: sustained negative (<1 µg/mL) ATI levels, and fluctuating ATI levels (at least 1 sample with ATI <1 and at least one >1 µg/mL).

Results:

Forty-eight patients with IBD with available clinical data and serum samples were included. 25 patients had sustained low ATI levels and 23 patients had fluctuating ATI levels. Both groups were similar in IBD subtype distribution (Crohn’s disease in 73.9% and 60%), mean serum albumin levels (4.2 vs. 3.9 g/dL), and mean trough serum infliximab levels (3.3 vs. 4.6 µg/mL) in fluctuating ATI and low ATI groups, respectively. There were no significant differences in the rate of clinical response (64% vs. 76%) and mean serum C-reactive protein levels (9.4 vs. 8.5 mg/dL, ULN=5) in the fluctuating ATI and low ATI groups. Similar rates of clinical response in the fluctuating ATI and low ATI groups were observed in ulcerative colitis (33% vs. 40%) and Crohn’s disease (76% vs. 100%).

Conclusions:

The fluctuating pattern of appearance of ATI in patients with IBD was not associated with loss of clinical response or a rise in C-reactive protein. The authors suggest that in clinical decision making, only sustained appearance of ATI should be considered as an adverse therapeutic factor.
The Distribution of Gastrointestinal Pathogens on Stool PCR Prior to the Development of IBD
Authors: Varma Sanskriti , Green Peter H. , Krishnareddy Suneeta
Published: November 2020

Goals:

We investigated the distribution of pathogens on stool gastrointestinal (GI) polymerase chain reaction (PCR) testing in those who subsequently developed inflammatory bowel disease (IBD).

Background:

Infectious gastroenteritis has been associated with later development of IBD.

Study:

This retrospective study includes patients of all ages hospitalized for diarrhea with positive GIPCR panel and subsequently a new diagnosis of IBD [confirmed by chart review and International Classification of Disease, Clinical Modification code for Crohn’s disease (CD) or ulcerative colitis (UC)], between March 2015 to September 2019 at our quaternary care institution. Patients with IBD diagnosis before GIPCR were excluded. Descriptive statistics characterized the distribution of microbial pathogens in relation to later IBD diagnosis.

Results:

Fifty-four participants were eligible (UC 44%; CD 56%). Median age at time of IBD diagnosis was 35 years [interquartile range (IQR) 18 to 65]. Median time between GIPCR and IBD diagnosis was 3 months (IQR 2 to 9) for all patients. When stratified by organism class, median time to diagnosis was 6 months (IQR 2 to 10) for patients with bacteria, 3 months (IQR 1 to 8) for patients with viruses, and 1 month (IQR 0.75 to 1) for patients with parasites (log-rankP=0.001). Sixty-nine unique pathogens (83% bacteria) were identified on all tests.Escherichia coliwas the most common species (71%), of which enteropathogenicE. coliwas predominant (38%).

Conclusions:

TheE. colispecies, specifically enteropathogenicE. coli, may be implicated in the development of IBD. This is one of the first studies to evaluate the results of stool GIPCR in the link between the microbiome and IBD pathogenesis.
The effect of malnutrition on the infectious outcomes of hospitalized patients with cirrhosis: analysis of the 2011–2017 hospital data
Authors: Lee David Uihwan , Fan Greg Hongyuan , Ahern Ryan Richard , Karagozian Raffi
Published: November 2020

Background

In patients with cirrhosis, there is a clinical concern that the development of protein-calorie malnutrition will affect the immune system and predispose these patients to increased infectious outcomes.

Aims

In this study, we evaluate the effects of malnutrition on the infectious outcomes of patients admitted with cirrhosis.

Materials and methods

This study used the 2011–2017 National Inpatient Sample to identify patients with cirrhosis. These patients were stratified using malnutrition (protein-calorie malnutrition, cachexia, and sarcopenia) and matched using age, gender, and race with 1:1 nearest neighbor matching method. The endpoints included mortality and infectious outcomes.

Results

After matching, there were 96 842 malnutrition-present cohort and equal number of controls. In univariate analysis, the malnutrition cohort had higher hospital mortality [10.40 vs. 5.04% P < 0.01, odds ratio (OR) 2.18, 95% confidence interval (CI) 2.11–2.26]. In multivariate models, malnutrition was associated with increased mortality [P < 0.01, adjusted odds ratio (aOR) 1.32, 95% CI 1.27–1.37] and infectious outcomes, including sepsis (P < 0.01, aOR 1.94, 95% CI 1.89–2.00), pneumonia (P < 0.01, aOR 1.68, 95% CI 1.63–1.73), UTI (P < 0.01, aOR 1.39, 95% CI 1.35–1.43), cellulitis (P < 0.01, aOR 1.09, 95% CI 1.05–1.13), cholangitis (P < 0.01, aOR 1.39, 95% CI 1.26–1.55), and clostridium difficile (P < 0.01, aOR 2.11, 95% CI 1.92–2.31).

Conclusion

The results of this study indicate that malnutrition is an independent risk factor of hospital mortality and local/systemic infections in patients admitted with cirrhosis.
Peroral endoscopic myotomy treatment for symptomatic esophageal diverticulum: a systematic review and meta-analysis
Authors: Ren Lihua , Xie Weihua , Mulmi Shrestha Sachin , Ji Qinghua , Xie Ting , Lu Xuejia , Dong Jingwu , Shi Ruihua
Published: November 2020

Peroral endoscopic myotomy (POEM) is a rapidly evolving technique for the treatment of esophageal diverticulum. The aim of this study was to perform a systematic review and meta-analysis of the literature focusing on POEM for symptomatic esophageal diverticula, including an in-depth evaluation of its efficacy, safety, and limitations. A comprehensive literature search was completed to identify articles that examined the efficacy and safety of POEM for esophageal diverticula. Heterogeneity among studies was assessed using the I
2 statistic. Meta-regression and sensitivity analyses were performed to explore the sources of heterogeneity and assess potentially important covariates influencing the main outcomes. Primary endpoints such as rates of success, adverse events, and recurrences were evaluated. P values of ≤0.05 were considered statistically significant. Nine studies with a total of 153 patients were enrolled. Pooled technical success, clinical success, adverse events, and recurrence rates were 99% [95% confidence interval (CI), 97–100%; I
2 = 0%), 94% (95% CI, 89–97%; I
2 = 24%), 2% (95% CI, 0–6%, I
2 = 0%), and 0% (95% CI, 0–1%; I
2 = 0%), respectively. The pooled perforation rate was 6% (95% CI, 1–11%; I
2 = 0%). Meta-regression analysis indicated that esophageal diverticula types and motility disorders were not associated with the clinical success rate (P > 0.05). POEM is a feasible, safe, and effective treatment for symptomatic esophageal diverticula, with low adverse events and recurrence rates.
Alpha-1 antitrypsin deficiency is under-recognized in individuals with cirrhosis undergoing liver transplantation
Authors: Shah Ravi S. , Alsuleiman Bayan , Bena James , Stoller James K. , Wakim-Fleming Jamile
Published: November 2020

Objective

Under-recognition of alpha-1 antitrypsin deficiency (AATD) is well documented in AATD-lung disease but is rarely reported in patients with liver cirrhosis requiring liver transplantation. This report examines the frequency of newly diagnosed AATD based on pathologic examination of explanted livers following liver transplantation, trends in diagnosis over time, and prognostic correlates of under-recognition outcomes following liver transplantation.

Methods

This study retrospectively reviewed 1473 pathology reports from adult patients (>18 years) undergoing liver transplantation at Cleveland Clinic between 2004 and 2017. Pathology reports of explanted livers exhibiting periodic acid-Schiff, diastase-resistant inclusion bodies (PAS+G) suggestive of AATD were included and medical records were reviewed regarding demographics, AATD genotype, alternative etiologies for cirrhosis, presence of emphysema, and survival outcomes. Kaplan–Meier estimates of survival outcomes were compared between patients diagnosed pre-liver transplantation and that newly diagnosed post-liver transplantation.

Results

Of 1473 explanted liver pathology reports examined, 117 (7.9%) showed PAS+G suggestive of AATD. The diagnosis of AATD in these 117 patients was established pre-liver transplantation in 36 (30.8%, group 1) and in 46 (39.3%) post-liver transplantation (group 2a). Testing for AATD was not undertaken in 35 (29.9%) of patients despite having PAS+G on explanted livers (group 2b). Post-liver transplantation survival analysis showed a trend (P = 0.098) towards enhanced survival in group 1 vs. group 2 at 10 years.

Conclusions

This study shows that diagnosis of AATD is overlooked and frequently delayed in patients with cirrhosis undergoing liver transplantation. The observed trend towards higher survival in patients diagnosed with AATD pre-liver transplantation suggests the opportunity to enhance outcomes by earlier recognition of AATD.
Impact of interferon-free therapies in HIV/HCV co-infected patients on real clinical practice: results from a multicenter region-wide cohort study (2014–2018)
Authors: Rial-Crestelo David , Sepúlveda María Antonia , González-Gasca Francisco Javier , Geijo-Martínez Paloma , Martínez-Alfaro Elisa , Barberá José Ramón , Yzusqui Miguel , Casallo Sonia , García María , Muñoz Hornero Constanza , Espinosa-Gimeno Alfredo , Torralba Miguel
Published: November 2020

Background

Here, we assess the efficacy and safety of direct antiviral agents (DAAs) in a real-world cohort of co-infected individuals, and evaluate the consistency between clinical practice and guideline recommendations.

Methods

Multicenter, prospective cohort study of HIV/HCV co-infected patients followed-up in nine sites in Spain. All patients with detectable HCV-RNA naive to second-generation DAAs were enrolled. The primary endpoint was the assessment of sustained virological response at week 12 (SVR12). We performed intention-to-treat (ITT), per-protocol (PP), and multivariable analyses to identify factors associated with therapeutic failure. We compared the DAAs we administered to available guideline recommendations. Schemes not perfectly adjusted to the recommendations were defined as sub-optimal.

Results

Overall, 316 patients (82.1% male) received a total of 330 treatments. Of these, 43.9% were cirrhotic and 40.6% were treatment-experienced. In the ITT and PP analyses, SVR12 was achieved in 90.9% [95% confidence interval (CI) 87.3–93.6] and 93.7% (95% CI 90.5–95.6), respectively. Only alcohol abuse [odds ratio (OR): 0.33; 95% CI 0.138–0.789, P = 0.013] and a higher basal bilirubin level (OR: 0.595; 95% CI 0.416–0.851, P = 0.004) were independently associated to therapeutic failure. A progressive decrease in the proportion of sub-optimal treatments was observed over time, from 75% in 2014 to 0% in 2018. Being treated with a sub-optimal regimen was not associated with failure.

Conclusion

Despite numerous difficulties in treatment access and in adaptation to the changing guidelines, we detected no differences among the DAAs used, nor did we detect a lower efficacy when the chosen treatment was not optimal.