bluuebunny/crossref_metadata_2025 huggingface dataset:
CD4/CD8 Ratio Recovery of Children and Adolescents Living With HIV With Virological Suppression: A Prospective Cohort Study
Authors: Han Win Min , Apornpong Tanakorn , Handoko Ryan , Jantarabenjakul Watsamon , Gatechompol Sivaporn , Ubolyam Sasiwimol , Kerr Stephen J , Avihingsanon Anchalee , Ruxrungtham Kiat , Phanuphak Praphan , Puthanakit Thanyawee
Published: February 2020

Background

There are limited data on immune restoration of young adults living with virologically suppressed human immunodeficiency virus (HIV). We investigated recovery rates of CD4/CD8 ratio among Thai children and adolescents after they initiated combination antiretroviral therapy (cART).

Methods

Children and adolescents who started cART at age of ≥ 5 years were eligible in this study if they achieved HIV RNA < 50 copies/mL and had a CD4/CD8 ratio < 0.8 at the time of virological suppression. Normalization of CD4/CD8 ratio was defined as 2 consecutive values ≥ 1. Using group-based trajectory analysis, low- and high-recovery groups were identified in terms of CD4/CD8 ratio recovery.

Results

One hundred thirty-eight children and adolescents (101 perinatally infected and 37 behaviorally infected) with median age of 10.6 years at cART treatment initiation were included. After 559 person-years of follow-up (PYFU), overall incidence rate of CD4/CD8 ratio normalization was 4.1 (95% confidence interval, 2.7–6.2) per 100 PYFU. The probabilities of normalization at 2, 5, and 10 years after HIV suppression were 5.2%, 22.6%, and 35.6%, respectively. The low-recovery group had lower median pre-cART CD4 count (146 vs 304 cells/μL, P = .01), pre-cART CD4/CD8 ratio (0.15 vs 0.23, P = .03) and at first viral suppression (0.38 vs 0.65, P = .0001), compared to the high-recovery group.

Conclusions

Less than half of children and adolescents living with HIV on cART with viral suppression had CD4/CD8 ratio normalization. Those with older age at cART initiation, lower pre-cART CD4 count, or CD4/CD8 ratio had slower ratio recovery. Long-term prognoses such as ongoing immune activation and clinical outcomes among children and adolescents on suppressive cART without CD4/CD8 ratio normalization need to be further investigated.
Misexpression of a transcriptional repressor candidate provides a molecular mechanism for the suppression of awns by Tipped 1 in wheat
Authors: Würschum Tobias , Jähne Felix , Phillips Andrew L , Langer Simon M , Longin C Friedrich H , Tucker Matthew R , Leiser Willmar L
Published: February 2020

Awns are bristle-like structures formed at the tip of the lemma on the florets of some cereal grasses. Wild-type wheat is awned, but awnletted and awnless variants have been selected and nowadays all forms are cultivated. In this study, we dissected the genetic control underlying variation of this characteristic feature by association mapping in a large panel of 1110 winter wheat cultivars of worldwide origin. We identified the B1 (Tipped 1) locus on chromosome 5A as the major determinant of awnlessness globally. Using a combination of fine-mapping and expression analysis, we identified a putative C2H2 zinc finger protein with an EAR domain, characteristic of transcriptional repressors, as a likely candidate for Tipped 1. This gene was found to be up-regulated in awnless B1 compared with awned b1 plants, indicating that misexpression of this transcriptional regulator may contribute to the reduction of awn length in B1 plants. Taken together, our study provides an entry point towards a better molecular understanding of the evolution of morphological features in cereals through selection and breeding.
Crosstalk between heterotrimeric G protein-coupled signaling pathways and WRKY transcription factors modulating plant responses to suboptimal micronutrient conditions
Authors: Wu Ting-Ying , Krishnamoorthi Shalini , Goh Honzhen , Leong Richalynn , Sanson Amy Catherine , Urano Daisuke
Published: February 2020

Nutrient stresses induce foliar chlorosis and growth defects. Here we propose heterotrimeric G proteins as signaling mediators of various nutrient stresses, through meta-analyses of >20 transcriptomic data sets associated with nutrient stresses or G protein mutations. Systematic comparison of transcriptomic data yielded 104 genes regulated by G protein subunits under common nutrient stresses: 69 genes under Gβ subunit (AGB1) control and 35 genes under Gα subunit (GPA1) control. Quantitative real-time PCR experiments validate that several transcription factors and metal transporters changed in expression level under suboptimal iron, zinc, and/or copper concentrations, while being misregulated in the Arabidopsis Gβ-null (agb1) mutant. The agb1 mutant had altered metal ion profiles and exhibited severe growth arrest under zinc stress, and aberrant root waving under iron and zinc stresses, while the Gα-null mutation attenuated leaf chlorosis under iron deficiency in both Arabidopsis and rice. Our transcriptional network analysis inferred computationally that WRKY-family transcription factors mediate the AGB1-dependent nutrient responses. As corroborating evidence of our inference, ectopic expression of WRKY25 or WRKY33 rescued the zinc stress phenotypes and the expression of zinc transporters in the agb1-2 background. These results, together with Gene Ontology analyses, suggest two contrasting roles for G protein-coupled signaling pathways in micronutrient stress responses: one enhancing general stress tolerance and the other modulating ion homeostasis through WRKY transcriptional regulatory networks. In addition, tolerance to iron stress in the rice Gα mutant provides an inroad to improve nutrient stress tolerance of agricultural crops by manipulating G protein signaling.
Research trends on big data domain using text mining algorithms
Authors: Jalali Seyed Mohammad Jafar , Park Han Woo , Vanani Iman Raeesi , Pho Kim-Hung
Published: February 2020

Most of the theories have considered big data as an interesting subject in the information technology domain. Big data is a term for describing huge databases that traditional methods in data processing suffer from analyzing them. Recognizing and clustering emerging topics in this area will help researchers whose aim is to work on this interesting subject. Text mining and social network analysis algorithms are utilized for identifying the emerging trends for big data domain. In this study, at first, we gathered the whole papers that are relevant to big data domain and then the word co-occurrence network was created based on the extracted keywords. Then the best clusters were identified and the relationship between keywords was recognized by the association rules technique. In conclusion, some suggestions were mentioned for future studies.
Effect of chlorogenic and gallic acids combined with azoles on antifungal susceptibility and virulence of multidrug-resistant Candida spp. and Malassezia furfur isolates
Authors: Rhimi Wafa , Aneke Chioma Inyang , Annoscia Giada , Otranto Domenico , Boekhout Teun , Cafarchia Claudia
Published: February 2020

Chlorogenic acid (CHA) and gallic acid (GA) are safe natural phenolic compounds that are used as enhancers of some drugs in influencing antioxidant, anticancer, and antibacterial activities. Among fungi, Candida spp. and Malassezia spp. are characterized by an increasing prevalence of multidrug resistance phenomena and by a high morbidity and mortality of their infections. No data are available about the efficacy of CHA and GA combined with azoles on the antifungal susceptibility and on the virulence of both fungi. Therefore, their antifungal and antivirulence effects have been tested in combination with fluconazole (FLZ) or ketoconazole (KTZ) on 23 Candida spp. and 8 M. furfur isolates. Broth microdilution chequerboard, time-kill studies, and extracellular enzymes (phospholipase and hemolytic) activities were evaluated, displaying a synergistic antifungal action between CHA or GA and FLZ or KTZ on C. albicans, C. bovina, and C. parapsilosis, and antagonistic antifungal effects on M. furfur and Pichia kudriavzevii (Candida krusei) isolates. The time-kill studies confirmed the chequerboard findings, showing fungicidal inhibitory effect only when the GA was combined with azoles on Candida strains. However, the combination of phenolics with azoles had no effect on the virulence of the tested isolates. Our study indicates that the combination between natural products and conventional drugs could be an efficient strategy for combating azole resistance and for controlling fungistatic effects of azole drugs.
Assessing the virulence of Cryptococcus neoformans causing meningitis in HIV infected and uninfected patients in Vietnam
Authors: Thanh Lam Tuan , Toffaletti Dena L , Tenor Jennifer L , Giamberardino Charles , Sempowski Gregory D , Asfaw Yohannes , Phan Hai Trieu , Van Duong Anh , Trinh Nguyen Mai , Thwaites Guy E , Ashton Philip M , Chau Nguyen Va Vinh , Baker Stephen G , Perfect John R , Day Jeremy N
Published: February 2020

We previously observed a substantial burden of cryptococcal meningitis in Vietnam atypically arising in individuals who are uninfected with human immunodeficiency virus (HIV). This disease was associated with a single genotype of Cryptococcus neoformans (sequence type [ST]5), which was significantly less common in HIV-infected individuals. Aiming to compare the phenotypic characteristics of ST5 and non-ST5 C. neoformans, we selected 30 representative Vietnamese isolates and compared their in vitro pathogenic potential and in vivo virulence. ST5 and non-ST5 organisms exhibited comparable characteristics with respect to in vitro virulence markers including melanin production, replication at 37°C, and growth in cerebrospinal fluid. However, the ST5 isolates had significantly increased variability in cellular and capsular sizing compared with non-ST5 organisms (P < .001). Counterintuitively, mice infected with ST5 isolates had significantly longer survival with lower fungal burdens at day 7 than non-ST5 isolates. Notably, ST5 isolates induced significantly greater initial inflammatory responses than non-ST5 strains, measured by TNF-α concentrations (P < .001). Despite being generally less virulent in the mouse model, we hypothesize that the significant within strain variation seen in ST5 isolates in the tested phenotypes may represent an evolutionary advantage enabling adaptation to novel niches including apparently immunocompetent human hosts.
Predicting star formation properties of galaxies using deep learning
Authors: Surana Shraddha , Wadadekar Yogesh , Bait Omkar , Bhosale Hrushikesh
Published: February 2020

Understanding the star formation properties of galaxies as a function of cosmic epoch is a critical exercise in studies of galaxy evolution. Traditionally, stellar population synthesis (SPS) models have been used to obtain best-fitting parameters that characterize star formation in galaxies. As multiband flux measurements become available for thousands of galaxies, an alternative approach to characterizing star formation using machine learning becomes feasible. In this work, we present the use of deep learning techniques to predict three important star formation properties – stellar mass, star formation rate, and dust luminosity. We characterize the performance of our deep learning models through comparisons with outputs from a standard SPS code.
Sensitivity of the lower edge of the pair-instability black hole mass gap to the treatment of time-dependent convection
Authors: Renzo M , Farmer R J , Justham S , de Mink S E , Götberg Y , Marchant P
Published: February 2020

Gravitational-wave detections are now probing the black hole (BH) mass distribution, including the predicted pair-instability mass gap. These data require robust quantitative predictions, which are challenging to obtain. The most massive BH progenitors experience episodic mass ejections on time-scales shorter than the convective turnover time-scale. This invalidates the steady-state assumption on which the classic mixing length theory relies. We compare the final BH masses computed with two different versions of the stellar evolutionary code $\tt{MESA}$: (i) using the default implementation of Paxton et al. (2018) and (ii) solving an additional equation accounting for the time-scale for convective deceleration. In the second grid, where stronger convection develops during the pulses and carries part of the energy, we find weaker pulses. This leads to lower amounts of mass being ejected and thus higher final BH masses of up to ∼$5\, \mathrm{M}_\odot$. The differences are much smaller for the progenitors that determine the maximum mass of BHs below the gap. This prediction is robust at $M_{\rm BH, max}\simeq 48\, \mathrm{M}_\odot$, at least within the idealized context of this study. This is an encouraging indication that current models are robust enough for comparison with the present-day gravitational-wave detections. However, the large differences between individual models emphasize the importance of improving the treatment of convection in stellar models, especially in the light of the data anticipated from the third generation of gravitational-wave detectors.
Simulating the spatial distribution and kinematics of globular clusters within galaxy clusters in illustris
Authors: Ramos-Almendares Felipe , Sales Laura V , Abadi Mario G , Doppel Jessica E , Muriel Hernan , Peng Eric W
Published: February 2020

We study the assembly of globular clusters (GCs) in 9 galaxy clusters using the cosmological simulation Illustris. GCs are tagged to individual galaxies at their infall time. The tidal removal of GCs from their galaxies and the distribution of the GCs within the cluster is later followed self-consistently by the simulation. The method relies on the simple assumption of a single power-law relation between halo mass (Mvir) and mass in GCs (MGC) as found in observations. We find that the GCs specific frequency SN as a function of V-band magnitude naturally reproduces the observed ‘U’-shape due to the combination of the power law MGC–Mvir relation and the non-linear stellar mass (M*)–halo mass relation from the simulation. Additional scatter in the SN values is traced back to galaxies with early infall times due to the evolution of the M*–Mvir relation with redshift. GCs that have been tidally removed from their galaxies form the present-day intracluster component, from which about $\sim \!60{{\ \rm per\ cent}}$ were brought in by galaxies that currently orbit within the cluster potential. The remaining ‘orphan’ GCs are contributed by satellite galaxies with a wide range of stellar masses that are fully tidally disrupted at z = 0. This intracluster component is a good dynamical tracer of the dark matter potential. As a consequence of the accreted nature of most intracluster GCs, their orbits are fairly radial with a predicted orbital anisotropy β ≥ 0.5. However, local tangential motions may appear as a consequence of localized substructure, providing a possible interpretation to the β < 0 values suggested in observations of M87.
Wind nebulae and supernova remnants of very massive stars
Authors: Meyer D M-A , Petrov M , Pohl M
Published: February 2020

A very small fraction of (runaway) massive stars have masses exceeding $60\!-\!70\, \rm M_{\odot }$ and are predicted to evolve as luminous blue variable and Wolf–Rayet stars before ending their lives as core-collapse supernovae. Our 2D axisymmetric hydrodynamical simulations explore how a fast wind ($2000\, \rm km\, \rm s^{-1}$) and high mass-loss rate ($10^{-5}\, \rm M_{\odot }\, \rm yr^{-1}$) can impact the morphology of the circumstellar medium. It is shaped as 100 pc-scale wind nebula that can be pierced by the driving star when it supersonically moves with velocity $20\!-\!40\, \rm km\, \rm s^{-1}$ through the interstellar medium (ISM) in the Galactic plane. The motion of such runaway stars displaces the position of the supernova explosion out of their bow shock nebula, imposing asymmetries to the eventual shock wave expansion and engendering Cygnus-loop-like supernova remnants. We conclude that the size (up to more than $200\, \rm pc$) of the filamentary wind cavity in which the chemically enriched supernova ejecta expand, mixing efficiently the wind and ISM materials by at least $10{{\ \rm per\ cent}}$ in number density, can be used as a tracer of the runaway nature of the very massive progenitors of such $0.1\, \rm Myr$ old remnants. Our results motivate further observational campaigns devoted to the bow shock of the very massive stars BD+43°3654 and to the close surroundings of the synchrotron-emitting Wolf–Rayet shell G2.4+1.4.
Complex Evolution of Insect Insulin Receptors and Homologous Decoy Receptors, and Functional Significance of Their Multiplicity
Authors: Smýkal Vlastimil , Pivarči Martin , Provazník Jan , Bazalová Olga , Jedlička Pavel , Lukšan Ondřej , Horák Aleš , Vaněčková Hana , Beneš Vladimír , Fiala Ivan , Hanus Robert , Doležel David
Published: February 2020

Evidence accumulates that the functional plasticity of insulin and insulin-like growth factor signaling in insects could spring, among others, from the multiplicity of insulin receptors (InRs). Their multiple variants may be implemented in the control of insect polyphenism, such as wing or caste polyphenism. Here, we present a comprehensive phylogenetic analysis of insect InR sequences in 118 species from 23 orders and investigate the role of three InRs identified in the linden bug, Pyrrhocoris apterus, in wing polymorphism control. We identified two gene clusters (Clusters I and II) resulting from an ancestral duplication in a late ancestor of winged insects, which remained conserved in most lineages, only in some of them being subject to further duplications or losses. One remarkable yet neglected feature of InR evolution is the loss of the tyrosine kinase catalytic domain, giving rise to decoys of InR in both clusters. Within the Cluster I, we confirmed the presence of the secreted decoy of insulin receptor in all studied Muscomorpha. More importantly, we described a new tyrosine kinase-less gene (DR2) in the Cluster II, conserved in apical Holometabola for ∼300 My. We differentially silenced the three P. apterus InRs and confirmed their participation in wing polymorphism control. We observed a pattern of Cluster I and Cluster II InRs impact on wing development, which differed from that postulated in planthoppers, suggesting an independent establishment of insulin/insulin-like growth factor signaling control over wing development, leading to idiosyncrasies in the co-option of multiple InRs in polyphenism control in different taxa.
The Lancet–O’Neill Institute/Georgetown University Commission on Global Health and Law: The Power of Law to Advance the Right to Health
Authors: Kaldor Jenny C , Gostin Lawrence O , Monahan John T , Gottschalk Katie
Published: February 2020

The Lancet–O’Neill Institute/Georgetown University Commission on Global Health and Law published its report on the Legal Determinants of Health in 2019. The term ‘legal determinants of health’ draws attention to the power of law to influence upstream social and economic influences on population health. In this article, we introduce the Commission, including its background and rationale, set out its methodology, summarize its key findings and recommendations and reflect on its impact since publication. We also look to the future, making suggestions as to how the global health community can make the best use of the Commission’s momentum in relation to using law and legal tools to advance population health.
Forty-two Million Ways to Describe Pain: Topic Modeling of 200,000 PubMed Pain-Related Abstracts Using Natural Language Processing and Deep Learning–Based Text Generation
Authors: Tighe Patrick J , Sannapaneni Bharadwaj , Fillingim Roger B , Doyle Charlie , Kent Michael , Shickel Ben , Rashidi Parisa
Published: February 2020

Objective

Recent efforts to update the definitions and taxonomic structure of concepts related to pain have revealed opportunities to better quantify topics of existing pain research subject areas.

Methods

Here, we apply basic natural language processing (NLP) analyses on a corpus of >200,000 abstracts published on PubMed under the medical subject heading (MeSH) of “pain” to quantify the topics, content, and themes on pain-related research dating back to the 1940s.

Results

The most common stemmed terms included “pain” (601,122 occurrences), “patient” (508,064 occurrences), and “studi-” (208,839 occurrences). Contrarily, terms with the highest term frequency–inverse document frequency included “tmd” (6.21), “qol” (6.01), and “endometriosis” (5.94). Using the vector-embedded model of term definitions available via the “word2vec” technique, the most similar terms to “pain” included “discomfort,” “symptom,” and “pain-related.” For the term “acute,” the most similar terms in the word2vec vector space included “nonspecific,” “vaso-occlusive,” and “subacute”; for the term “chronic,” the most similar terms included “persistent,” “longstanding,” and “long-standing.” Topic modeling via Latent Dirichlet analysis identified peak coherence (0.49) at 40 topics. Network analysis of these topic models identified three topics that were outliers from the core cluster, two of which pertained to women’s health and obstetrics and were closely connected to one another, yet considered distant from the third outlier pertaining to age. A deep learning–based gated recurrent units abstract generation model successfully synthesized several unique abstracts with varying levels of believability, with special attention and some confusion at lower temperatures to the roles of placebo in randomized controlled trials.

Conclusions

Quantitative NLP models of published abstracts pertaining to pain may point to trends and gaps within pain research communities.
The Atiyah–Patodi–Singer index on a lattice
Authors: Fukaya Hidenori , Kawai Naoki , Matsuki Yoshiyuki , Mori Makito , Nakayama Katsumasa , Onogi Tetsuya , Yamaguchi Satoshi
Published: February 2020

We propose a nonperturbative formulation of the Atiyah–Patodi–Singer (APS) index in lattice gauge theory in four dimensions, in which the index is given by the $\eta$ invariant of the domain-wall Dirac operator. Our definition of the index is always an integer with a finite lattice spacing. To verify this proposal, using the eigenmode set of the free domain-wall fermion we perturbatively show in the continuum limit that the curvature term in the APS theorem appears as the contribution from the massive bulk extended modes, while the boundary $\eta$ invariant comes entirely from the massless edge-localized modes.
Populus euphratica remorin 6.5 activates plasma membrane H+-ATPases to mediate salt tolerance
Authors: Zhang Huilong , Deng Chen , Wu Xia , Yao Jun , Zhang Yanli , Zhang Yinan , Deng Shurong , Zhao Nan , Zhao Rui , Zhou Xiaoyang , Lu Cunfu , Lin Shanzhi , Chen Shaoliang
Published: February 2020

Remorins (REMs) play an important role in the ability of plants to adapt to adverse environments. PeREM6.5, a protein of the REM family in Populus euphratica (salt-resistant poplar), was induced by NaCl stress in callus, roots and leaves. We cloned the full-length PeREM6.5 from P. euphratica and transformed it into Escherichia coli and Arabidopsis thaliana. PeREM6.5 recombinant protein significantly increased the H+-ATPase hydrolytic activity and H+ transport activity in P. euphratica plasma membrane (PM) vesicles. Yeast two-hybrid assay showed that P. euphratica REM6.5 interacted with RPM1-interacting protein 4 (PeRIN4). Notably, the PeREM6.5-induced increase in PM H+-ATPase activity was enhanced by PeRIN4 recombinant protein. Overexpression of PeREM6.5 in Arabidopsis significantly improved salt tolerance in transgenic plants in terms of survival rate, root growth, electrolyte leakage and malondialdehyde content. Arabidopsis plants overexpressing PeREM6.5 retained high PM H+-ATPase activity in both in vivo and in vitro assays. PeREM6.5-transgenic plants had reduced accumulation of Na+ due to the Na+ extrusion promoted by the H+-ATPases. Moreover, the H+ pumps caused hyperpolarization of the PM, which reduced the K+ loss mediated by the depolarization-activated channels in the PM of salinized roots. Therefore, we conclude that PeREM6.5 regulated H+-ATPase activity in the PM, thus enhancing the plant capacity to maintain ionic homeostasis under salinity.
Heterotopic pregnancy
Authors: Hewlett Katie , Howell Christopher M.
Published: February 2020

Heterotopic pregnancy occurs when a patient has simultaneous intrauterine and ectopic pregnancies. Rates of heterotopic pregnancy have been rising with increased availability and access to in vitro fertilization and other advanced fertility technologies. Symptoms of heterotopic pregnancy are nonspecific, such as vague abdominal pain, so transvaginal ultrasound is a crucial part of the diagnostic process. Laparoscopy is the most commonly performed treatment of the ectopic pregnancy; other options include localized injections of methotrexate and/or potassium chloride. Following definitive termination of the ectopic pregnancy, many patients will successfully deliver the intrauterine pregnancy at term. Early identification of heterotopic pregnancy can reduce maternal morbidity and mortality.
Outcomes and Complications With Age in Spondylolisthesis
Authors: Karsy Michael , Chan Andrew K. , Mummaneni Praveen V. , Virk Michael S. , Bydon Mohamad , Glassman Steven D. , Foley Kevin T. , Potts Eric A. , Shaffrey Christopher I. , Shaffrey Mark E. , Coric Domagoj , Asher Anthony L. , Knightly John J. , Park Paul , Fu Kai-Ming , Slotkin Jonathan R. , Haid Regis W. , Wang Michael , Bisson Erica F.
Published: February 2020

Study Design.

Prospective database analysis.

Objective.

To assess the effect of age on patient-reported outcomes (PROs) and complication rates after surgical treatment for spondylolisthesis

Summary of Background Data.

Degenerative lumbar spondylolisthesis affects 3% to 20% of the population and up to 30% of the elderly. There is not yet consensus on whether age is a contraindication for surgical treatment of elderly patients.

Methods.

The Quality Outcomes Database lumbar registry was used to evaluate patients from 12 US academic and private centers who underwent surgical treatment for grade 1 lumbar spondylolisthesis between July 2014 and June 2016.

Results.

A total of 608 patients who fit the inclusion criteria were categorized by age into the following groups: less than 60 (n = 239), 60 to 70 (n = 209), 71 to 80 (n = 128), and more than 80 (n = 32) years. Older patients showed lower mean body mass index (P < 0.001) and higher rates of diabetes (P = 0.007), coronary artery disease (P = 0.0001), and osteoporosis (P = 0.005). A lower likelihood for home disposition was seen with higher age (89.1% in <60-year-old vs. 75% in >80-year-old patients; P = 0.002). There were no baseline differences in PROs (Oswestry Disability Index, EuroQol health survey [EQ-5D], Numeric Rating Scale for leg pain and back pain) among age categories. A significant improvement for all PROs was seen regardless of age (P < 0.05), and most patients met minimal clinically important differences (MCIDs) for improvement in postoperative PROs. No differences in hospital readmissions or reoperations were seen among age groups (P < 0.05). Multivariate analysis demonstrated that, after controlling other variables, a higher age did not decrease the odds of achieving MCID at 12 months for the PROs.

Conclusion.

Our results indicate that well-selected elderly patients undergoing surgical treatment of grade 1 spondylolisthesis can achieve meaningful outcomes. This modern, multicenter US study reflects the current use and limitations of spondylolisthesis treatment in the elderly, which may be informative to patients and providers.

Level of Evidence: 4
The Association Between Physicians’ Communication and Patient-Reported Outcomes in Spine Surgery
Authors: Rabah Nicholas M. , Levin Jay M. , Winkelman Robert D. , Mroz Thomas E. , Steinmetz Michael P.
Published: February 2020

Study Design.

Retrospective cohort study using prospectively collected data.

Objective.

Determine the association between satisfaction with physician communication and patient-reported outcomes in the inpatient spine surgery setting.

Summary of Background Data.

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys measure the patient experience of care and influence reimbursement for hospital systems and providers in the United States. It is not known whether patient satisfaction with physician communication is associated with better outcomes after spine surgery. Therefore, we evaluated the association between patient satisfaction with physician communication on the HCAHPS survey and improvements in validated patient-reported outcomes measures in a spine surgery population.

Methods.

HCAHPS responses were obtained for patients undergoing elective cervical or lumbar spine surgery from 2013 to 2015. Patient-reported health status measures were the primary outcomes, including EuroQol Five Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Visual Analog Scores for Back and Neck Pain (VAS-BP/NP). The association between satisfaction with communication and preoperative to 1 year postoperative changes in each health status measure was evaluated utilizing multivariable linear regression models.

Results.

Our study included 648 patients, of which, 479 (74.4%) created our satisfied cohort. Demographically, our two cohorts were similar with regards to preoperative clinical measures; however, the satisfied cohort had a higher self-rating of their mental health (P < 0.01), and overall health (P < 0.01). After adjusting for clinically relevant confounders, our results demonstrated no significant association between satisfaction with physician communication and improvement in EQ-5D (P = 0.312), PDQ (P = 0.498), or VAS pain scores (P = 0.592).

Conclusion.

Patient satisfaction with physician communication was not associated with 1-year postoperative improvement in EQ-5D, PDQ, and VAS-Pain after spine surgery. These findings do not diminish the importance of effective communication between doctor and patient, but instead suggest that within the spine surgery setting, using only patient experience data may not accurately reflect the true quality of care received during their inpatient stay.

Level of Evidence: 3
Key Radiographic Parameters That Influence the Improvement of Postoperative Gastroesophageal Reflux Disease in Patients Treated Surgically for Adult Spinal Deformity With a Minimum 2-Year Follow-up
Authors: Ohba Tetsuro , Ebata Shigeto , Oba Hiroki , Oda Kotaro , Tanaka Nobuki , Koyama Kenuke , Haro Hirotaka
Published: February 2020

Study Design.

Retrospective observational study.

Objective.

The study objectives were to: (1) determine radiographically which spinal malalignment parameters predominantly influence the risk of gastroesophageal reflux disease (GERD); (2) evaluate the outcome of GERD 2 years after surgery for adult spinal deformity (ASD); and (3) clarify key factors that influence the improvement of postoperative GERD in ASD.

Summary of Background Data.

Spinal deformity is reported to be involved in the pathology of GERD. Our previous study found that approximately 50% of patients treated surgically for ASD had GERD symptoms. However, the postoperative progress of GERD and the key factors that influence the improvement of postoperative GERD are largely unknown.

Methods.

Ninety-two patients with ASD treated with thoracolumbar corrective surgery and followed up for a minimum of 2 years were enrolled. All patients were asked to complete the Frequency Scale for Symptoms of GERD (FSSG) questionnaire preoperatively and at 1 and 2 years after surgery. GERD was diagnosed by FSSG score more than 8 points. Before, and at 1 and 2 years after surgery, full-length lateral radiographs were taken and radiographic parameters were obtained.

Results.

Patients were classified into two groups based on GERD symptoms, with 47 (51.1%) in the GERD+ group. Among parameters assessed, only thoracolumbar kyphosis (TLK) was significantly greater in the GERD+ group than in the GERD− group. The FSSG score improved significantly 1 year after surgery, but no significant difference was found between groups at 2 years. A significant correction loss of TLK was observed 2 years after surgery. There was a significant highly positive correlation between the FSSG score and TLK at 2 years after surgery.

Conclusion.

GERD improved with correction of the spinal deformity but significant correction loss of the TLK even within the fusion presumably due to subsidence or proximal junctional kyphosis resulted in a cessation of that improvement over time.

Level of Evidence: 3
Effect of vitamin D receptor polymorphisms on plasma oxidative stress and apoptotic biomarkers among breast cancer survivors supplemented vitamin D3
Authors: Kazemian Elham , Akbari Mohammad Esmaeil , Moradi Nariman , Gharibzadeh Safoora , Amouzegar Atieh , Jamshidi-Naeini Yasaman , Mondul Alison M. , Khademolmele Maryam , Ghodoosi Nasim , Zarins Katie R. , Shateri Zahra , Davoodi Sayed Hossein , Rozek Laura S.
Published: February 2020

We investigated whether plasma oxidative stress and apoptotic biomarkers were associated with the VDR polymorphisms in breast cancer survivors supplemented with vitamin D3. Two hundred fourteen breast cancer survivors received 4000 IU of vitamin D3 daily for 12 weeks. Linear regression was used to analyze whether the effect of vitamin D3 supplementation on response variables was associated with the selected VDR single nucleotide polymorphisms executing by ‘association’ function in the R package ‘SNPassoc’. Linear regression analyses adjusted for age, BMI and on-study plasma 25(OH)D changes indicated that the aa genotype of the ApaI [codominant model (aa vs. AA): −0.21 (−0.39 to −0.03); recessive model (aa vs. AA and Aa): −0.20 (−0.37 to −0.03)] and bb genotypes of the BsmI [recessive model (bb vs. BB and Bb): −0.20 (−0.39 to −0.01)] on VDR were associated with greater decrease in plasma Bcl2. Our findings indicated that, the Ff genotype of FokI was accompanied by higher increase in plasma MDA levels [codominant model (Ff vs. FF): 0.64 (0.18–1.11); dominant model (ff and Ff vs. FF): 0.52 (0.09–0.05)]. This observed association was not remained statistically significant after correction for multiple testing. Haplotype score analyses revealed statistically significant association between the FokI BsmI ApaI haplotype and circulating MDA changes (P-value for global score = 0.001) after false-discovery rate correction. Our study suggests that genetic variations in the VDR do not powerfully modify the effects of vitamin D3 intake on biomarkers associated with antioxidant activity, oxidative stress and apoptosis in breast cancer survivors.
Parental Use of “Cry Out” in a Community Sample During the First Year of Infant Life
Authors: Giesbrecht Gerald F. , Letourneau Nicole , Campbell Tavis , Hart Martha , Thomas Jenna C. , Tomfohr-Madsen Lianne ,   the APrON Study Team
Published: February 2020

Objective:

The primary objective was to identify the characteristics of parents and infants and parenting practices associated with delayed responsiveness to infant crying during the first year of infant life. A secondary objective was to evaluate, in a subsample of maternal-infant pairs, the associations between delayed responsiveness to infant crying and observational measures of maternal-infant interaction and infant-maternal attachment.

Method:

This is a secondary analysis of the data from a community sample of pregnant women recruited to the Alberta Pregnancy Outcomes and Nutrition study. Mothers completed questionnaires during the first year of infant life (n = 1826), and a convenience subsample of maternal-infant pairs (n = 137) participated in laboratory assessments of maternal-infant interaction at 6 months of age and infant-maternal attachment at 20 months.

Results:

Parental use of “cry out” as a strategy to deal with a crying infant was associated with parental characteristics (being white and having a relatively higher income), infant characteristics (higher problematic behavior at 3 months and reduced problematic behavior at 12 months), sleep ecology (infants sleeping alone), and parental soothing strategies (less frequently taking the infant into the parent's bed, cuddling, or carrying the crying infant). Cry out was not associated with observational measures of maternal sensitivity or infant-maternal attachment.

Conclusion:

When used selectively and in response to the specific needs and characteristics of the infant, delayed responsiveness may reduce problematic behavior and does not harm the infant's socioemotional development.
Single-stage Composite Skin Reconstruction Using a Dermal Regeneration Template
Authors: Rudnicki Pamela A. , Purt Boonyapa , True Daniel , Siordia Hector , Lohmeier Steven , Chan Rodney K.
Published: February 2020

Background:

Composite reconstruction with a dermal substitute followed by skin graft is sometimes used for reconstructing high-quality skin while preserving donor sites. This often necessitates 2 separate procedures, additional general anesthetic, and longer hospitalization. Concurrent use of dermal substitutes and skin graft in a single stage has been previously reported in small series. Here, we report our experience with single-stage skin reconstruction with Integra and split-thickness skin graft for coverage of wounds post burn eschar excision and post burn scar contracture release.

Methods:

This is a retrospective review of consecutive operations from 2013 to 2017 in which single-stage bilayer reconstruction (SSBR) was performed. Data were obtained from electronic medical records and perioperative photographs.

Results:

In this 5-year period, 13 surgical sites were identified in which SSBR was used in 8 subjects. Average and median graft take was 86.2% and 95%, respectively. Graft take was over 90% in 10 out of 13 cases. One case required regrafting after initial graft failure.

Conclusions:

In the appropriate setting, SSBR is a practical technique in covering wounds post burn eschar excision and post burn scar contracture release resulting in reasonable graft take. Use of noncontaminated wound beds is crucial. Although there is risk of regrafting, it is not clear whether this risk is any higher than in split-thickness skin grafting alone. This study was unable to evaluate contribution of dermal substitute to contraction, function, and mobility, nor how hypothesized improvement of skin quality compares to the original thick dermal substitute. We recommend further investigation.
Associations Between Systemic Omega-3 Fatty Acid Levels With Moderate-to-Severe Dry Eye Disease Signs and Symptoms at Baseline in the Dry Eye Assessment and Management Study
Authors: Kuklinski Eric J. , Hom Milton M. , Ying Gui-Shuang , Lin Meng C. , Chapkin Robert S. , Jones Richard , Moser Ann , Kim Ka Yeun , Maguire Maureen G. , Asbell Penny A. ,   the DREAM Study Research Group
Published: February 2020

Purpose:

Omega-3 (n-3) fatty acid supplementation is used to treat systemic inflammatory diseases, but the role of n-3 in the pathophysiology and therapy of dry eye disease (DED) is not definitive. We evaluated the relationship of systemic n-3 levels with signs and symptoms at baseline in the Dry Eye Assessment and Management (DREAM) Study.

Methods:

Blood samples from participants at baseline were analyzed for n-3 and n-6, measured as relative percentage by weight among all fatty acids in erythrocytes. Symptoms were evaluated using the Ocular Surface Disease Index. Signs including conjunctival staining, corneal staining, tear breakup time (TBUT), and Schirmer's test with anesthesia were also evaluated.

Results:

There was no correlation between the systemic n-3 levels and DED symptoms. When the associations with signs of DED were assessed, lower DHA levels were associated with higher conjunctival staining, with mean scores of 3.31, 2.96, and 2.82 for low, medium, and high levels of DHA, respectively (linear trend P=0.007). None of the other signs were associated with DHA or the other measures of n-3.

Conclusion:

Previous studies have found varying results on the role of n-3 supplementation with the signs and symptoms of DED. Among patients with DED enrolled in the DREAM Study, lower systemic n-3 levels were not associated with worse symptoms and most signs of DED.
Laser-induced Damage to Disposable Single-mirror Trabeculoplasty Lens During Selective Laser Trabeculoplasty
Authors: Mukhtar Sabrina , Shazly Tarek A.
Published: February 2020

Purpose:

To demonstrate disposable trabeculoplasty lens damage after routine selective laser trabeculoplasty (SLT) for primary open-angle glaucoma.

Methods:

Disposable single-mirror laser lenses were used to perform SLT in 2 patients with primary open-angle glaucoma. Images of the single-use mirrors were taken before and after treatment.

Results:

One lens showed heavy focal loss of reflectivity of its mirror with SLT settings of 0.8 to 0.9 mJ × 97 shots on a patient with a lightly pigmented angle. Aiming beam splashing or loss was noted after most shots. The second lens showed much less damage with 0.6 mJ × 90 shots in a heavily pigmented angle.

Conclusion:

Although single-use Gonio lenses have gained popularity for their role in infection control and elimination of wear and tear of reusable lenses, our cases show that damage occurs to the silver mirror because of high laser fluence, interfering with proper aiming and possibly diminishing delivered energy and treatment efficacy.
What is Number of Days in Number of Times? Associations Between, and Responsiveness of, Two Sickness Presenteeism Measures
Authors: Aboagye Emmanuel , Gustafsson Klas , Jensen Irene , Hagberg Jan , Aronsson Gunnar , Marklund Staffan , Leineweber Constanze , Bergström Gunnar
Published: February 2020

Objective:

To examine the associations between sickness presenteeism (SP) reported as number of days with SP reported as number of times and to evaluate their responsiveness.

Methods:

The study population (n = 454) consisted of employed individuals, at risk of long-term sickness absence. Correlation analyses were performed to examine associations between the two SP measures and external constructs such as work performance, general health, and registered sick leave. Both SP constructs were measured several times to examine responsiveness.

Results:

The SP measures are moderately correlated. They moderately correlated with work performance and health status measures. SP reported as number of times seems to be more sensitive than number of days in detecting changes after rehabilitation.

Conclusions:

Numerical or categorical constructs are valid sources of data on SP. However, categorized SP seems to be more responsive.
Electronic primary care to specialist referral: A pilot project to evaluate referral expedience and efficacy
Authors: Olson Ernestine , Fruh Sharon , Kleinpell Ruth
Published: February 2020

Background:

Delayed referrals to specialists often result in increased morbidity and mortality.

Local problem:

A time delay in specialist care access of over 1 month identified a gap in efficient care provision in a rural south central United States outreach clinic within a multispecialty group affiliated with a hospital system.

Methods:

A pilot project with a mixed-methods design that compared the established referral process with direct primary provider referral to a specialist's electronic medical record (EMR) schedule. Authors conducted the study over 16 weeks using a convenience sample size of 74 patients.

Interventions:

Direct primary care nurse practitioner provider to specialist EMR schedule referral based on specialty referral needs.

Results:

All electronically referred patients were seen by specialists in less than 1 month.

Conclusions:

All electronic specialist referrals were completed more expediently than those referred by the standard process and patients reported an efficient and satisfactory process.
Clinical Profiles of DFNA11 at Diverse Stages of Development and Aging in a Large Family Identified by Linkage Analysis
Authors: Yamamoto Nobuko , Mutai Hideki , Namba Kazunori , Goto Fumiyuki , Ogawa Kaoru , Matsunaga Tatsuo
Published: February 2020

Hypothesis:

The phenotype of DFNA11 consists of specific features at diverse developmental and age stages.

Background:

Only eight mutations have been identified for autosomal dominant non-syndromic hearing loss related to MYO7A (DFNA11), and the onset and progression of DFNA11 are poorly understood.

Methods:

After linkage analysis and following Sanger sequencing in a family suspected to have autosomal dominant hereditary hearing loss, we analyzed the audiometric and vestibular functions and their long-term changes in the subjects carrying the variant.

Results:

A reported variant of uncertain significance, NP_000251.3:p.Arg853His, in MYO7A was detected and cosegregation data of this large family provided evidence that the variant was likely pathogenic for DFNA11. Family members with the variant had no other symptoms associated with hearing loss and were confirmed to have autosomal dominant non-syndromic sensorineural hearing loss. Audiograms tended to show gently sloping configuration in childhood and flat configuration after the age of 30 years. Hearing loss at high frequencies progressed slowly, while hearing at low frequencies started to deteriorate later but progressed more rapidly. Some subjects showed partly abnormal results in the distortion products of otoacoustic emissions before the elevation of hearing thresholds. Vestibular function was within the normal range in all the subjects tested.

Conclusion:

We revealed that hearing loss at high frequencies was mainly noted in early developmental stages and that thresholds increased more rapidly in the low frequency range, resulting in changes in audiometric configuration. Deterioration of distortion product otoacoustic emissions (DPOAE) before the elevation of hearing thresholds was considered as a clinical feature of DFNA11.
Hepatic manifestations of cystic fibrosis
Authors: Dana Jeremy , Girard Muriel , Debray Dominique
Published: February 2020

Purpose of review

Liver disease in cystic fibrosis (CF) usually develops before puberty, is often asymptomatic and slowly progressive. Multilobular cirrhosis develops in approximately 5–10% of patients by the age of 18, and is a significant contributor to the morbidity and mortality. No therapy, including ursodeoxycholic acid and cystic fibrosis transmembrane conductance regulator correctors or potentiators, has proven effective to prevent or halt the progression of liver disease towards cirrhosis and portal hypertension. This review provides the current knowledge in the epidemiology of CF liver disease and development of noninvasive tools to assess liver disease severity and progression overtime in order to optimize clinical management and therapeutic options.

Recent findings

Liver disease not only develops during childhood but also later in the lifetime of patients with CF; the incidence of cirrhosis with portal hypertension increases progressively reaching 10% by age 30. Several noninvasive tools to measure liver stiffness as an indirect measure of fibrosis are being investigated, and show promising results for the assessment of early stages of liver fibrosis and disease progression.

Identifying noninvasive biomarkers is fundamental to improving early diagnosis, monitoring disease evolution and measuring treatment effects. A prerequisite is the use of consistent definitions for CF- liver disease (LD) in clinical trials.