bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of Symptom-Based Case Definitions to Identify Influenza Virus Infection Among Pregnant Women in Middle-Income Countries: Findings From the Pregnancy and Influenza Multinational Epidemiologic (PRIME) Study
Authors: Wesley Meredith G , Tinoco Yeny , Patel Archana , Suntarratiwong Piyarat , Hunt Danielle , Sinthuwattanawibool Chalinthorn , Soto Giselle , Kittikraisak Wanitchaya , Das Prabir Kumar , Arriola Carmen Sofia , Hombroek Danielle , Mott Joshua , Kurhe Kunal , Bhargav Savita , Prakash Amber , Florian Richard , Gonzales Oswaldo , Cabrera Santiago , Llajaruna Edwin , Brummer Tana , Malek Parker , Saha Siddhartha , Garg Shikha , Azziz-Baumgartner Eduardo , Thompson Mark G , Dawood Fatimah S
Published: November 2020

Background

The World Health Organization (WHO) recommends case definitions for influenza surveillance that are also used in public health research, although their performance has not been assessed in many risk groups, including pregnant women in whom influenza may manifest differently. We evaluated the performance of symptom-based definitions to detect influenza in a cohort of pregnant women in India, Peru, and Thailand.

Methods

In 2017 and 2018, we contacted 11 277 pregnant women twice weekly during the influenza season to identify illnesses with new or worsened cough, runny nose, sore throat, difficulty breathing, or myalgia and collected data on other symptoms and nasal swabs for influenza real-time reverse transcription–polymerase chain reaction (rRT-PCR) testing. We calculated sensitivity, specificity, positive-predictive value, and negative-predictive value of each symptom predictor, WHO respiratory illness case definitions, and a de novo definition derived from results of multivariable modeling.

Results

Of 5444 eligible illness episodes among 3965 participants, 310 (6%) were positive for influenza. In a multivariable model, measured fever ≥38°C (adjusted odds ratio [95% confidence interval], 4.6 [3.1–6.8]), myalgia (3.0 [2.2–4.0]), cough (2.7 [1.9–3.9]), and chills (1.6 [1.1–2.4]) were independently associated with influenza illness. A definition based on these 4 (measured fever, cough, chills, or myalgia) was 95% sensitive and 27% specific. The WHO influenza-like illness (ILI) definition was 16% sensitive and 98% specific.

Conclusions

The current WHO ILI case definition was highly specific but had low sensitivity. The intended use of case definitions should be considered when evaluating the tradeoff between sensitivity and specificity.
Making ‘the Heads of the Proposals’: The King, the Army, the Levellers, and the Roads to Putney
Authors: Como David R
Published: November 2020

This article offers a comprehensive account of the drafting of ‘the Heads of the Proposals’, the peace plan framed by the New Model Army in July 1647. Using overlooked manuscript sources, including newly uncovered papers of Commissary General Henry Ireton, the article reconstructs the complex process of negotiation, revision, and bargaining through which the Heads of the Proposals emerged. It charts the influence of King Charles I on the peace programme, and offers new insight into the monarch’s response to the Proposals. However, the article also demonstrates that army leaders invited radical London activists to Reading to participate in framing the Proposals. These activists sought, with limited success, to bring the Heads into conformity with their own vision for the polity, but quickly revolted when they recognised the degree to which the king’s input and interests were reflected in the developing programme. The resulting tensions ensured that even before the Heads of the Proposals were completed and published in August 1647, the plan provoked serious controversy among the army’s supporters, helping to undermine its prospects. It is demonstrated that many of the political conflicts that shook the army and the ‘independent coalition’ later in 1647 grew out of these disagreements at Reading over the Heads of the Proposals. The article not only clarifies the reasons for the failure of the Heads, but provides new insight into the origins of the ‘Leveller’ agitation and the Putney Debates, including the famous ‘franchise debates’.
Modelling diurnal variation magnetic fields due to ionospheric currents
Authors: Egbert G D , Alken P , Maute A , Zhang H
Published: November 2020

Accurate models of the spatial structure of ionospheric magnetic fields in the diurnal variation (DV) band (periods of a few hours to a day) would enable use of magneto-variational methods for 3-D imaging of upper mantle and transition zone electrical conductivity. Constraints on conductivity at these depths, below what is typically possible with magnetotellurics, would in turn provide valuable constraints on mantle hydration and Earths deep water cycle. As a step towards this objective, we present here a novel approach to empirical modelling of global DV magnetic fields. First, we apply frequency domain (FD) principal components analysis (PCA) to ground-based geomagnetic data, to define the dominant spatial and temporal modes of source variability. Spatial modes are restricted to the available data sites, but corresponding temporal modes are effectively continuous in time. Secondly, we apply FD PCA to gridded surface magnetic fields derived from outputs of the physics-based Thermosphere–Ionosphere–Electrodynamics General Circulation Model (TIEGCM), to determine the dominant modes of spatial variability. The TIEGCM spatial modes are then used as basis functions, to fit (or interpolate) the sparsely sampled data spatial modes. Combining the two steps, we have a FD model of DV band global magnetic fields that is continuous in both space and time. We show that the FD model can easily be transformed back to the time domain (TD) to directly fit time-series data, allowing the use of satellite, as well as ground-based, data in the empirical modelling scheme. As an illustration of the methodology we construct global FD and TD models of DV band source fields for 1997–2018. So far, the model uses only ground-based data, from 127 geomagnetic observatories. We show that the model accurately reproduces surface magnetic fields in both active and quiet times, including those at sites not used for model construction. This empirical model, especially with future enhancements, will have many applications: improved imaging of electrical conductivity, ionospheric studies and improved external field corrections for core and crustal studies.
Presence of Obstructive Symptoms and Absence of Perianal Crohn Disease Is Predictive of Surgery After Endoscopic Balloon Dilation
Authors: Sivasailam Barathi , Manski Scott , Wentz Alicia , Cross Raymond K
Published: November 2020

Background

Patients with Crohn disease (CD) often develop strictures that require surgery. Endoscopic balloon dilation (EBD) is an alternative treatment that can be safe and effective. The objective of this study was to assess factors associated with the need for repeat EBD and surgery after initial EBD for stricturing CD.

Methods

Patients with stricturing CD who underwent EBD from 2007 to 2017 were identified. Demographic and clinical information was obtained from the electronic medical record. A Cox proportional hazards regression model and Kaplan-Meier curves were generated for variables associated with repeat EBD and surgical resection.

Results

Ninety-nine patients underwent a total of 240 EBD proedures; 35% had a history of perianal disease, and 63% were on a biologic at the time of initial EBD. Fifty-one percent of patients had obstructive symptoms at the time of initial EBD, and 75% of the EBDs were successful. Complications occurred in 8 EBDs (3.3%). Repeat intervention after EBD was more likely in patients on biologics at baseline EBD (76% vs 54%; P = 0.029). Thirty-three percent of patients had surgical resection at a median of 5 months (interquartile ratio = 2.0-13.0 months) after initial EBD. The presence of obstructive symptoms at the time of EBD was associated with surgical resection (hazard ratio = 3.18; 95% confidence interval, 1.28-7.86). Conversely, a history of perianal disease was negatively associated with surgical resection (hazard ratio = 0.27; 95% confidence interval, 0.10-0.68).

Conclusions

Patients on biologic treatment at the time of EBD are more likely to need an intervention in the future. Patients with obstructive symptoms at the time of initial EBD and those without a history of perianal involvement are more likely to undergo surgical intervention.
Modifying Bradley–Terry and other ranking models to allow ties
Authors: Baker Rose , Scarf Philip
Published: November 2020

Models derived from distributions of order-statistics are useful for modelling ranked data. The well-known Bradley–Terry (BT) and Plackett–Luce (PL) models can be derived from the order statistics of the exponential distribution but cannot handle ties. However, ties often occur in sports, and the ability to accommodate them leads to more useful ranking models. In this paper, we use discrete distributions, principally the geometric distribution, to obtain modified BT and PL models and some others that allow tied ranks. Our methodology is introduced for some mathematically tractable and some less tractable distributions and is illustrated using test match cricket.
Efficacy of temocillin against MDR Enterobacterales: a retrospective cohort study
Authors: Alexandre Kévin , Leysour de Rohello François , Dahyot Sandrine , Etienne Manuel , Tiret Isabelle , Gillibert André , Pestel-Caron Martine , Caron François
Published: November 2020

Objectives

EUCAST recently advised against temocillin use, except for non-serious urinary tract infections (UTI) caused by Escherichia coli, Klebsiella spp. (except Klebsiella aerogenes) and Proteus mirabilis (EKP) treated with a dose of 2 g q8h. We aimed to analyse our practice in the context of a larger temocillin use in France.

Patients and methods

All ≥3 day temocillin prescriptions from 2016 to 2019 were reviewed, with reference to French recommendations and a susceptibility breakpoint of 8 mg/L. The primary outcome was early clinical failure (antibiotic switch, relapse or death within 10 days after the completion of antibiotic treatment).

Results

Overall, 153 cases were analysed: 123 cases of UTI (80.4%) and 133 cases of monomicrobial infection with Enterobacterales (86.9%). A total of 160 Enterobacterales were isolated, comprising 108 (67.5%) ESBL producers and 30 (20.7%) non-EKP species. The rate of early clinical failure was 9.2% and was significantly lower for UTI compared with non-UTI (4.9% versus 26.7%, P = 0.001) and for sepsis compared with severe sepsis or septic shock (6.2% versus 25%, P = 0.011). It was not different between 2 g q12h and 2 g q8h doses (10% versus 7.4%, P = 0.81) and between EKP and other Enterobacterales (8.7% versus 14.3%, P = 0.41).

Conclusions

EUCAST recommendations on urinary isolates seem to be too restrictive. Our data support the efficacy of temocillin at a dose of 2 g q12h to treat patients with non-severe complicated UTI caused by MDR Enterobacterales with an MIC of ≤8 mg/L, whatever the species.
A Multifunctional Electrochemical Sensor for the Simultaneous Detection of Ascorbic Acid, Dopamine, Uric Acid, and Nitrite
Authors: Wang Huimin , Zhang Xueli , Wang Shuangjue , Ma Hanyue , Shen Yaling , Wang Xia
Published: November 2020

Background

Ascorbic acid (AA), dopamine (DA), uric acid (UA), and nitrite (NO2−) are essential biomarkers for human metabolism and can be used to indicate some chronic diseases and metabolic disorders, including scurvy, Parkinson’s disease, hyperuricemia, and kidney disease.

Objective

A multifunctional electrochemical sensor that can integrate the detection of these species was constructed using nanoporous gold (NPG) as a recognition element to modify glassy carbon electrode (GCE).

Methods

The electrochemical performance of the multifunctional electrochemical sensor was investigated toward AA, DA, UA, and NO2− in citrate buffer solution (CBS, 100 mM, pH 4.0) and human serum using cyclic voltammetry (CV) and differential pulse voltammetry (DPV) methods.

Results

In the quaternary mixture detection, the resulting NPG/GCE electrode displayed four independent oxidation peaks with wide peak separations. Further, the NPG/GCE electrode showed good linear responses with the sensitivities of 32, 1103, 71, and 147 μA/mM/cm2 and the detection limits of 1.58, 0.17, 0.37, and 0.36 μM for AA, DA UA, and NO2−, respectively. Additionally, the NPG/GCE electrode exhibited great anti-interference and was successfully applied in human serum samples.

Conclusions

These results indicate that the NPG/GCE electrode can simultaneously and selectively detect AA, DA, UA, and NO2−, which has the potential for application and diagnosis in the screening and diagnosis of chronic diseases and metabolic disorders.

Highlights

A multianalyte electrochemical sensor was fabricated for human metabolites detection. The sensor displayed good performance in the simultaneous detection of AA, DA, UA, and NO2− and applied to human serum samples.
Reduced pectin content of cell walls prevents stress-induced root cell elongation in Arabidopsis
Authors: Liu Xiaohui , Cui Huiying , Zhang Bochao , Song Min , Chen Shaolin , Xiao Chaowen , Tang Yunjia , Liesche Johannes
Published: November 2020

The primary cell walls of plants provide mechanical strength while maintaining the flexibility needed for cell extension growth. Cell extension involves loosening the bonds between cellulose microfibrils, hemicelluloses and pectins. Pectins have been implicated in this process, but it remains unclear if this depends on the abundance of certain pectins, their modifications, and/or structure. Here, cell wall-related mutants of the model plant Arabidopsis were characterized by biochemical and immunohistochemical methods and Fourier-transform infrared microspectroscopy. Mutants with reduced pectin or hemicellulose content showed no root cell elongation in response to simulated drought stress, in contrast to wild-type plants or mutants with reduced cellulose content. While no association was found between the degrees of pectin methylesterification and cell elongation, cell wall composition analysis suggested an important role of the pectin rhamnogalacturonan II (RGII), which was corroborated in experiments with the RGII-modifying chemical 2β-deoxy-Kdo. The results were complemented by expression analysis of cell wall synthesis genes and microscopic analysis of cell wall porosity. It is concluded that a certain amount of pectin is necessary for stress-induced root cell elongation, and hypotheses regarding the mechanistic basis of this result are formulated.
A Bayesian approach to modelling multimessenger emission from blazars using lepto-hadronic kinetic equations
Authors: Jiménez-Fernández Bruno , van Eerten Hendrik Jan
Published: November 2020

Blazar TXS 0506+056 is the main candidate for a coincident neutrino and gamma-ray flare event. In this paper, we present a detailed kinetic lepto-hadronic emission model capable of producing a photon and neutrino spectrum given a set of parameters. Our model includes a range of large-scale geometries and both dynamical and steady-state injection models for electrons and protons. We link this model with a Markov chain Monte Carlo sampler to obtain a powerful statistical tool that allows us to both fit the Spectral Energy Distribution and study the probability density functions and correlations of the parameters. Assuming a fiducial neutrino flux, we demonstrate how multimessenger observations can be modelled jointly in a Bayesian framework. We find the best parameters for each of the variants of the model tested and report on their cross-correlations. Additionally, we confirm that reproducing the neutrino flux of TXS 0506+056 requires an extreme proton to electron ratio either in the local acceleration process or from external injection.
Optical spectroscopy of Galactic field classical Be stars
Authors: Banerjee Gourav , Mathew Blesson , Paul K T , Subramaniam Annapurni , Bhattacharyya Suman , Anusha R
Published: November 2020

In this study, we analyse the emission lines of different species present in 118 Galactic field classical Be stars in the wavelength range of 3800–9000 Å. We re-estimated the extinction parameter (AV) for our sample stars using the newly available data from Gaia DR2 and suggest that it is important to consider AV while measuring the Balmer decrement (i.e. D34 and D54) values in classical Be stars. Subsequently, we estimated the Balmer decrement values for 105 program stars and found that ≈20 per cent of them show D34 ≥ 2.7, implying that their circumstellar disc are generally optically thick in nature. One program star, HD 60855 shows H α in absorption – indicative of disc-less phase. From our analysis, we found that in classical Be stars, H α emission equivalent width values are mostly lower than 40 Å, which agrees with that present in literature. Moreover, we noticed that a threshold value of ∼10 Å of H α emission equivalent width is necessary for Fe ii emission to become visible. We also observed that emission line equivalent widths of H α, P14, Fe ii 5169, and O i 8446 Å for our program stars tend to be more intense in earlier spectral types, peaking mostly near B1-B2. Furthermore, we explored various formation regions of Ca ii emission lines around the circumstellar disc of classical Be stars. We suggest the possibility that Ca ii triplet emission can originate either in the circumbinary disc or from the cooler outer regions of the disc, which might not be isothermal in nature.
The chemical composition of the accretion disc and donor star in ultra-compact X-ray binaries: A comprehensive X-ray analysis
Authors: Koliopanos Filippos , Péault Mathias , Vasilopoulos Georgios , Webb Natalie
Published: November 2020

We have analysed the X-ray spectra of all known Ultra-Compact X-ray Binaries (UCXBs), with the purpose of constraining the chemical composition of their accretion disc and donor star. Our investigation was focused on the presence (or absence) of the Fe Kα emission line, which was used as the probe of chemical composition of the disc, based on previously established theoretical predictions for the reflection of X-ray radiation off the surface of C/O-rich or He-rich accretion discs in UCXBs. We have contrasted the results of our spectral analysis to the history of type I X-ray bursts from these systems, which can also indicate donor star composition. We found that UCXBs with prominent and persistent iron Kα emission also featured repeat bursting activity. On the other hand, the UCXBs for which no iron line was detected, appear to have few or no type I X-ray bursts detected over more than a decade of monitoring. Based on Monte Carlo simulations, demonstrating a strong correlation between the Fe Kα line strength and the abundance of C and O in the accretion disc material and given the expected correlation between the H/He abundance and the recurrence rate of type I X-ray bursts, we propose that there is a considerable likelihood that UCXBs with persistent iron emission have He-rich donors, while those that do not, likely have C/O or O/Ne/Mg-rich donors. Our result strongly advocate for the development of more sophisticated simulations of X-ray reflection from hydrogen-poor accretion discs.
On the impact of the structural surface effect on global stellar properties and asteroseismic analyses
Authors: Jørgensen Andreas Christ Sølvsten , Montalbán Josefina , Angelou George C , Miglio Andrea , Weiss Achim , Scuflaire Richard , Noels Arlette , Mosumgaard Jakob Rørsted , Silva Aguirre Víctor
Published: November 2020

In a series of papers, we have recently demonstrated that it is possible to construct stellar structure models that robustly mimic the stratification of multidimensional radiative magnetohydrodynamic simulations at every time-step of the computed evolution. The resulting models offer a more realistic depiction of the near-surface layers of stars with convective envelopes than parametrizations, such as mixing length theory, do. In this paper, we explore how this model improvement impacts on seismic and non-seismic properties of stellar models across the Hertzsprung–Russell diagram. We show that the improved description of the outer boundary layers alters the predicted global stellar properties at different evolutionary stages. In a hare and hound exercise, we show that this plays a key role for asteroseismic analyses, as it, for instance, often shifts the inferred stellar age estimates by more than 10 per cent. Improper boundary conditions may thus introduce systematic errors that exceed the required accuracy of the PLATO space mission. Moreover, we discuss different approaches for computing stellar oscillation frequencies. We demonstrate that the so-called gas Γ1 approximation performs reasonably well for all main-sequence stars. Using a Monte Carlo approach, we show that the model frequencies of our hybrid solar models are consistent with observations within the uncertainties of the global solar parameters when using the so-called reduced Γ1 approximation.
The distances of 61 PGCCs in the second galactic quadrant
Authors: Guo H-L , Chen B-Q , Li G-X , Huang Y , Yang Y , Li X-Y , Sun W-X , Liu X-W
Published: November 2020

Determining the distances to the Planck Galactic cold clumps (PGCCs) is crucial for the measurement of their physical parameters and the study of their Galactic distribution. Based on two large catalogues of stars with robust distances and reddening estimates from the literature, we have estimated accurate distances to 61 PGCCs in the second Galactic quadrant. For this purpose, we have selected stars along the sightlines overlapping with the cores of the sample clumps and fitted the reddening profiles with a simple reddening model. The typical uncertainties of the resultant distances of these PGCCs are less than 8 per cent. The new estimates differ significantly from the kinematic values, well known to suffer from large errors. With the new distances, we have updated the physical properties including the radii, masses, and virial parameters of the cores of the PGCCs.
Dual function of GTPBP6 in biogenesis and recycling of human mitochondrial ribosomes
Authors: Lavdovskaia Elena , Denks Kärt , Nadler Franziska , Steube Emely , Linden Andreas , Urlaub Henning , Rodnina Marina V , Richter-Dennerlein Ricarda
Published: November 2020

Translation and ribosome biogenesis in mitochondria require auxiliary factors that ensure rapid and accurate synthesis of mitochondrial proteins. Defects in translation are associated with oxidative phosphorylation deficiency and cause severe human diseases, but the exact roles of mitochondrial translation-associated factors are not known. Here we identify the functions of GTPBP6, a homolog of the bacterial ribosome-recycling factor HflX, in human mitochondria. Similarly to HflX, GTPBP6 facilitates the dissociation of ribosomes in vitro and in vivo. In contrast to HflX, GTPBP6 is also required for the assembly of mitochondrial ribosomes. GTPBP6 ablation leads to accumulation of late assembly intermediate(s) of the large ribosomal subunit containing ribosome biogenesis factors MTERF4, NSUN4, MALSU1 and the GTPases GTPBP5, GTPBP7 and GTPBP10. Our data show that GTPBP6 has a dual function acting in ribosome recycling and biogenesis. These findings contribute to our understanding of large ribosomal subunit assembly as well as ribosome recycling pathway in mitochondria.
Renal gluconeogenesis: an underestimated role of the kidney in systemic glucose metabolism
Authors: Legouis David , Faivre Anna , Cippà Pietro E , de Seigneux Sophie
Published: November 2020

Glucose levels are tightly regulated at all times. Gluconeogenesis is the metabolic pathway dedicated to glucose synthesis from non-hexose precursors. Gluconeogenesis is critical for glucose homoeostasis, particularly during fasting or stress conditions. The renal contribution to systemic gluconeogenesis is increasingly recognized. During the post-absorptive phase, the kidney accounts for ∼40% of endogenous gluconeogenesis, occurring mainly in the kidney proximal tubule. The main substrate for renal gluconeogenesis is lactate and the process is regulated by insulin and cellular glucose levels, but also by acidosis and stress hormones. The kidney thus plays an important role in the maintenance of glucose and lactate homoeostasis during stress conditions. The impact of acute and chronic kidney disease and proximal tubular injury on gluconeogenesis is not well studied. Recent evidence shows that in both experimental and clinical acute kidney injury, impaired renal gluconeogenesis could significantly participate in systemic metabolic disturbance and thus alter the prognosis. This review summarizes the biochemistry of gluconeogenesis, the current knowledge of kidney gluconeogenesis, its modifications in kidney disease and the clinical relevance of this fundamental biological process in human biology.
Association between serum urate, gout and comorbidities: a case–control study using data from the UK Biobank
Authors: Sandoval-Plata Gabriela , Nakafero Georgina , Chakravorty Mithun , Morgan Kevin , Abhishek Abhishek
Published: November 2020

Objectives

To examine the association between comorbidities and serum urate (SU), gout and comorbidities, and to determine whether the association between gout and comorbidities is independent of SU.

Methods

We performed a case–control study using UK Biobank data. Two separate analyses were conducted: one excluding participants with gout to investigate the association between comorbidities and SU and the other with participants with gout as the index condition to examine the association between gout and comorbidities. SU was measured at the baseline visit. Self-reported physician-diagnosed illnesses were used to define gout and comorbidities, except for chronic kidney disease (CKD), which was defined using an estimated glomerular filtration rate cut-off. Participants prescribed urate-lowering treatment were also classified as gout. Logistic regression was used to examine associations. Odds ratios (ORs) and 95% CIs were calculated and adjusted for covariates including comorbidities and SU.

Results

Data for 458 781 UK Biobank participants were used to examine the association between comorbidities and SU. There was an association between hypertension, ischaemic heart disease (IHD), congestive cardiac failure (CCF), hyperlipidaemia, CKD and SU with and adjusted OR (aOR) of 1.10–3.14 for each 1 mg/dl SU increase. A total of 10 265 gout cases and 458 781 controls were included in the analysis of association between gout and comorbidities. Gout associated independently with hypertension, IHD, CCF, hyperlipidaemia and diabetes, with aORs of 1.21–4.15 after adjusting for covariates including SU.

Conclusion

Comorbidities associate with increasing SU. The association between gout and cardiometabolic comorbidities was independent of SU, suggesting separate SU-independent mechanisms such as inflammation driven by crystal deposition, pro-inflammatory genotype or non-purine dietary factors.
Arterial wall inflammation is increased in rheumatoid arthritis compared with osteoarthritis, as a marker of early atherosclerosis
Authors: Agca Rabia , Blanken Annelies B , van Sijl Alper M , Smulders Yvo M , Voskuyl Alexandre E , van der Laken Conny , Boellaard Ronald , Nurmohamed Michael T
Published: November 2020

Objective

RA is associated with higher risk of cardiovascular (CV) disease. Ongoing systemic inflammation is presumed to accelerate atherosclerosis by increasing inflammation in the arterial wall. However, evidence supporting this hypothesis is limited. We aimed to investigate arterial wall inflammation in RA vs OA, and its association with markers of inflammation and CV risk factors.

Methods

18-fluorodeoxyglucose PET combined with CT (18F-FDG-PET/CT) was performed in RA (n = 61) and OA (n = 28) to investigate inflammatory activity in the wall of large arteries. Secondary analyses were performed in patients with early untreated RA (n = 30), and established RA, active under DMARD treatment (n = 31) vs OA.

Results

Patients with RA had significantly higher 18F-FDG uptake in the wall of the carotid arteries (beta 0.27, 95%CI 0.11—0.44, P <0.01) and the aorta (beta 0.47, 95%CI 0.17—0.76, P <0.01) when compared with OA, which persisted after adjustment for traditional CV risk factors. Patients with early RA had the highest 18F-FDG uptake, followed by patients with established RA and OA respectively. Higher ESR and DAS of 28 joints values were associated with higher 18F-FDG uptake in all arterial segments.

Conclusion

Patients with RA have increased 18F-FDG uptake in the arterial wall compared with patients with OA, as a possible marker of early atherosclerosis. Furthermore, a higher level of clinical disease activity and circulating inflammatory markers was associated with higher arterial 18F-FDG uptake, which may support a role of arterial wall inflammation in the pathogenesis of vascular complications in patients with RA.
How to Interpret Tinnitus Functional Index Scores: A Proposal for a Grading System Based on a Large Sample of Tinnitus Patients
Authors: Gos Elzbieta , Rajchel Joanna J. , Dziendziel Beata , Kutyba Justyna , Bienkowska Katarzyna , Swierniak Weronika , Gocel Maria , Raj-Koziak Danuta , Skarzynski Piotr H. , Skarzynski Henryk
Published: November 2020

Objectives:

The Tinnitus Functional Index (TFI) is considered the gold standard in measuring tinnitus severity. The aim of the study was to establish reference values to improve the interpretability of TFI scores.

Design:

Results from 1114 patients with tinnitus were retrospectively analyzed. The participants were consecutive patients who attended our tertiary referral Ear, Nose, and Throat Center. The eligibility criteria were: at least 18 years old, persistent tinnitus, completed pure-tone audiometry, and answered all 25 items on the TFI. Hearing status (normal hearing vs. hearing impairment) was established according to the recommendation of the Bureau International d’Audiophonologie. Means (M) and SD on the TFI were the basis for grading tinnitus severity on four levels: low, lower moderate, upper moderate, and high. To gauge individual scores in clinical practice, percentiles are also proposed.

Results:

All 1114 patients (586 women and 528 men) were Caucasian and aged from 19 to 87 years (M = 50.96; SD = 13.10 years). Tinnitus duration ranged from 0.5 to 50 years (M = 7.17; SD = 7.71 years). There were 258 patients with normal hearing and 856 patients with hearing loss. A score of above 65 points on TFI was established as the cutoff point for diagnosing high tinnitus severity. A regression model associating tinnitus severity with gender, age, tinnitus duration, and hearing loss was statistically significant: F(4,1109) = 8.99; p < 0.001, but the effect was very small (R
2
adj = 0.028) and only gender and age were associated with TFI global score, while tinnitus severity was not related to tinnitus duration or hearing loss.

Conclusions:

The reference values proposed here support those reported previously by Meikle et al. They are empirically based and can be used as benchmarks in clinical practice and scientific research. They make it possible to assess tinnitus severity, evaluate individual scores, and categorize individuals with tinnitus. This allows researchers to set inclusion or exclusion criteria when assigning patients to specific groups during clinical trials involving tinnitus intervention strategies.
Proximal Junctional Kyphosis According to the Type of Lumbar Degenerative Kyphosis Following Lumbosacral Long Fusion
Authors: Jeon Woong-Ki , Cho Chang-Hee , Kim Hun-Chul , Kim Young-Hoon , Kim Sang-Il , Ha Kee-Yong , Park Hyung-Youl
Published: November 2020

Study Design.

A retrospective study.

Objective.

The aim of this study was to investigate proximal junctional kyphosis (PJK) after lumbosacral long fusion according to preoperative Roussouly and lumbar degenerative kyphosis (LDK) types.

Summary of Background Data.

Although previous studies have suggested some risk factors for PJK, the effects of preoperative grade of sagittal imbalance and paraspinal muscles degeneration on PJK remain unclear.

Methods.

Eighty-seven patients who had undergone lumbosacral fusion more than five levels with available clinical and radiological data were enrolled. The presence of PJK defined as sagittal Cobb angle ≥20° between the uppermost instrumented vertebra (UIV) and two supra-adjacent vertebrae at postoperative 2-year radiographs was recorded. Its occurrence was compared according to preoperative Roussouly and LDK types (Takemistu type) and the degree of paraspinal muscle degeneration at the upper level of UIV. Other sagittal radiographic parameters were also measured.

Results.

In this series, 28 patients (group I, 32.2%) showed radiological PJK, whereas 59 patients did not show radiological PJK (non-PJK patients, group II, 67.8%) at postoperative 2 years. PJK presented more prevalence in type III and type IV of LDK types (26/27, 96.3%). However, Roussouly types did not show any significant difference in PJK prevalence. In radiological parameters, a larger preoperative SVA (P = 0.018) and PI-LL (P = 0.015) were associated with PJK. Also, smaller quantity and lower quality of paraspinal muscles at T12-L1 level showed significant (P < 0.001) relationship with PJK. On multivariate logistic regression, higher LDK type (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.24–3.56), smaller quantity (OR: 1.03, 95% CI: 1.00–1.07), and higher degree of paraspinal muscle degeneration (OR: 1.46, 95% CI: 0.92–2.31) were independent predictors of postoperative PJK.

Conclusion.

Although various factors are related to PJK following long segment fusion, preoperative conditions such as LDK types and degree of paraspinal muscle degeneration might be related to the development of PJK.

Level of Evidence: 3
Use and Cost of Orthosis in Conservative Treatment of Acute Thoracolumbar Fractures
Authors: Linhares Daniela , Sousa-Pinto Bernardo , Ribeiro da Silva Mnuel , Fonseca João A. , Neves Nuno
Published: November 2020

Study Design.

Survey study.

Objective.

Assess practices and opinions of spine specialists from Europe and North America on orthosis use in adult patients with acute thoracolumbar (TL) fractures. Evaluate cost of the devices.

Summary of Background Data.

Although orthosis are traditionally used in conservative treatment of TL fractures, recent systematic reviews showed no benefit in patient's outcomes.

Methods.

A search for contact authors with publications on spine fractures from all European and North American countries was performed. An online questionnaire was sent on demographic data, practice setting, mean number of fractures treated, use of orthosis upon choice for conservative treatment, and average orthosis cost. Data was analyzed based in world regions, economic rank of the country, and health expenditure.

Results.

We received 130 answers, from 28 European and five North American countries. Most responders had more than 9 years of practice and worked at a public hospital. 6.2% did not prescribe a brace in any patient with acute TL fractures conservatively treated and 11.5% brace all patients. In a scale from 1 to 5, 21 considered that there is no/low benefit (1) and 14 that bracing is essential (5), with a mean of 3.18. Europeans use orthosis less commonly than North Americans (P < 0.05). Orthosis mean cost was $611.4 ± 716.0, significantly higher in North America compared with Europe and in high income, when compared with upper middle income countries (both P < 0.05). Although hospital costs were not evaluated, orthosis is costlier when it involves admission of the patient (P < 0.05). An increase in orthosis cost associated with higher gross domestic product (GDP) per capita and higher health expenditure was found.

Conclusion.

More than 90% of spine specialists still use orthosis in conservative treatment of adult patients with acute TL fractures. Orthosis cost vary significantly between continents, and it is influenced by the country's economy.

Level of Evidence: 4
Decreasing Incidence of Lumbar Discectomy Surgery in Finland in 1997–2018
Authors: Ponkilainen Ville T. , Mäntymäki Heikki , Huttunen Tuomas T. , Mattila Ville M.
Published: November 2020

Study Design.

Retrospective register study.

Objective.

The aim of this study was to assess the incidence and trends of lumbar disc surgeries in Finland from 1997 through 2018.

Summary of Background Data.

The evidence on lumbar spine discectomy has shifted from supporting surgical treatment toward nonoperative treatment. Still, the incidence of lumbar discectomy operations increased until the 1990 s. In the United States, the incidence began to decline after a downward turn in 2008, yet recent trends from countries with public and practically free health care are not widely known.

Methods.

Data for this study were obtained from the Finnish nationwide National Hospital Discharge Register. The study population covered all patients 18 years of age or older in Finland during a 22-year period from January 1, 1997, to December 31, 2018.

Results.

A total of 65,912 lumbar discectomy operations were performed in Finland from 1997 through 2018. The annual population-based incidence of lumbar discectomy decreased 29% during the 22-year period, from 83 per 100,000 person-years in 1997 to 58 per 100,000 person-years in 2018. In addition, the incidence of microdiscectomy increased 12%, from 41 per 100,000 person-years in 1997 to 47 per 100,000 person-years in 2018, whereas the incidence of open discectomy decreased 71%, from 41 per 100,000 person-years in 1997 to 12 per 100,000 person-years in 2018. The total reoperation rate for microendoscopic, microscopic, and open discectomy surgeries was 16.3%, 15.3%, and 14.9%, respectively.

Conclusion.

The nationwide incidence of lumbar discectomy decreased in Finland from 1997 through 2018. Additionally, the incidence of open discectomy is decreasing rapidly, whereas the incidence of microsurgical techniques is increasing.

Level of Evidence: 3
Arginine metabolism: a potential target in pancreatic cancer therapy
Authors: Yang Jin-Shou , Wang Cheng-Cheng , Qiu Jiang-Dong , Ren Bo , You Lei
Published: November 2020

Pancreatic ductal adenocarcinoma (PDAC) is an extremely malignant disease, which has an extremely low survival rate of <9% in the United States. As a new hallmark of cancer, metabolism reprogramming exerts crucial impacts on PDAC development and progression. Notably, arginine metabolism is altered in PDAC cells and participates in vital signaling pathways. In addition, arginine and its metabolites including polyamine, creatine, agmatine, and nitric oxide regulate the proliferation, growth, autophagy, apoptosis, and metastasis of cancer cells. Due to the loss of argininosuccinate synthetase 1 (ASS1) expression, the key enzyme in arginine biosynthesis, arginine deprivation is regarded as a potential strategy for PDAC therapy. However, drug resistance develops during arginine depletion treatment, along with the re-expression of ASS1, metabolic dysfunction, and the appearance of anti-drug antibody. Additionally, arginase 1 exerts crucial roles in myeloid-derived suppressor cells, indicating its potential targeting by cancer immunotherapy. In this review, we introduce arginine metabolism and its impacts on PDAC cells. Also, we discuss the role of arginine metabolism in arginine deprivation therapy and immunotherapy for cancer.
The Challenge of Contact Lens Visual Rehabilitation for Open Globe Injuries in Children Under 5 Years of Age
Authors: Itoi Motohiro , Higashihara Hisayo , Yamagishi Keiko , Hyakutake Yoko , Sotozono Chie
Published: November 2020

Purpose:

To investigate the clinical course of children younger than 5 years old who underwent rigid gas-permeable (RGP) contact lens (CL) wearing as visual rehabilitation of open globe injuries (OGIs) in Japan.

Methods:

This retrospective case series involved six eyes of six children (four boys and two girls) with OGIs. The mean patient age at injury was 4.0±0.83 SD (range: 2.5–5 years), and the mean follow-up period was 42.9 months (range: 31.6–52.8 months). In each child, data regarding injury type, ocular surgery performed, outcomes of amblyopia management (including best-corrected visual acuity [BCVA] with RGP CL or spectacles), the RGP CL-wear training period, and rate of continuous RGP CL-wear were analyzed.

Results:

Trauma type was penetrating injury (four eyes) and globe rupture (two eyes). All six cases showed lens penetration, and underwent corneal suture, lensectomy, and pars plana vitrectomy under general anesthesia. The mean RGP CL-wear training period was 3.5 months, and only one of the six cases discontinued RGP CL use. The mean BCVA with spectacles and with RGP CL was LogMAR: 1.52±0.41 (range 1.00–2.00) and 0.73±0.41 (range: 0.30–1.15), respectively. In all patients, except in one case in which strabismus developed, BCVA improved with RGP CL wear more than 0.2 logMAR compared with that with spectacles.

Conclusion:

Although the training period for RGP CL-wear is long in pediatric patients with OGIs, the treatment can be effective for refractive problems and for preventing the development of strabismus.
Non-SARS-CoV-2 Infections Among Patients Evaluated for MIS-C Associated With COVID-19
Authors: Campbell Jeffrey I. , Roberts Jordan E. , Dubois Melanie , Naureckas Li Caitlin , Sandora Thomas J. , Lamb Gabriella S.
Published: November 2020

Clinical features of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 are nonspecific. In this retrospective cohort study of 39 patients evaluated for MIS-C, 11 had non-SARS-CoV-2 infections, 3 of whom were also diagnosed with MIS-C. Clinical features were similar in patients with MIS-C and patients with non-SARS-CoV-2 infections. Clinicians should consider non-SARS-CoV-2 infections in patients undergoing MIS-C evaluation.
Double-Organ Bias in Controlled Trials on Eyelid Ptosis
Authors: Mangan Mehmet Serhat , Esen Fehim
Published: November 2020

Purpose:

Proper statistical analysis is an essential element in the evaluation of clinical trial outcomes. We had the informal observation that double-organ bias was a neglected issue during the statistical analyses of clinical trials on eyelid ptosis. The aim of this study was to formally document the prevalence of this bias in these studies.

Methods:

Clinical trials on eyelid ptosis, published in the last 20 years, were searched in PubMed with the terms; “((blepharoptosis) OR upper eyelid ptosis) OR eyelid ptosis” and with the filters “Randomized Controlled Trial (RCT), Clinical Trial, Humans.” Two independent observers evaluated the articles for eligibility, field of the journal, field of the authors, presence of randomization, type of the study (surgical, medical), and statistical approach to double organ bias.

Results:

The PubMed search yielded 101 articles and 23 of them met the above-mentioned criteria. In 3 articles, primary outcome measure was not related with the eyes. Among the remaining 20 articles, 14 (70%) had double-organ bias in the statistics. The bias was slightly less common in randomized trials (60% vs. 80%), but the difference was not statistically significant. Its prevalence was similar between ophthalmology journals and the rest (p = 0.64). Interestingly, the bias tended to be more in Q1 journals (87.5%) compared to Q2 and Q3 journals (58.3%) and median impact factor was higher in biased articles (1.82 vs. 1.29), but the differences weren’t statistically significant (p = 0.32, p = 0.24). There was no difference between the last 2 decades (66.6% vs. 75%, p = 0.64).

Conclusions:

The prevalence of the double-organ bias was very high in published clinical trials on eyelid ptosis (70%) and even among RCTs (60%). The prevalence of the bias didn’t prevent publication in higher impact factor journals and didn’t change between journals from different disciplines or over time.
Relationships Between Job Satisfaction and Job Demand, Job Control, Social Support, and Depression in Iranian Nurses
Authors: BAGHERI HOSSEIN ABADI Majid , TABAN Ebrahim , KHANJANI Narges , NAGHAVI KONJIN Zahra , KHAJEHNASIRI Farahnaz , SAMAEI Seyed Ehsan
Published: November 2020

Background

Nurses often experience a wide variety of stressful situations. Excessive work stress influences the physical and mental health of nurses and decreases their life quality and professional efficacy. In addition, high levels of psychological stress may cause job dissatisfaction and job strain.

Purpose

The objective of this study was to explore the relationship between several work-related risk factors and job satisfaction in Iranian nurses.

Methods

A cross-sectional study was conducted on 730 nurses from four public hospitals in, respectively, northern, southern, eastern, and western Iran. Variables in the job demand–control–support (JDCS) model were measured using the Job Content Questionnaire, and job satisfaction was measured using the Minnesota Satisfaction Questionnaire.

Results

The mean score for job satisfaction was 62.94 ± 14.24, which is considered moderate. Nurses with a low level of job satisfaction had significantly higher psychological and physical job demands (p < .05). Significant relationships were found between job satisfaction and several dimensions of the JDCS model, including psychological job demands (β = −0.11, p < .001), physical job demands (β = −0.86, p = .004), skill discretion (β = 0.48, p = .033), decision authority (β = 0.43, p = .028), and supervisor support (β = 1.85, p = .004). The sociodemographic and JDCS model variables used in this study explained 42% of the variation in job satisfaction (R
2 = .42).

Conclusions/Implications for Practice

Enhancing the job satisfaction of nurses is possible by creating a balance between job demands, job control, and social support.
Burnout Among Hospital Non-Healthcare Staff
Authors: Clinchamps Maëlys , Auclair Candy , Prunet Denis , Pfabigan Daniela , Lesage Francois-Xavier , Baker Julien S. , Parreira Lenise , Mermillod Martial , Gerbaud Laurent , Dutheil Frédéric
Published: November 2020

Objectives:

To study the prevalence of burnout among non-health care workers (NHCW), the risk and protective factors and to quantify the risk of burnout.

Method:

We conducted a cross-sectional study on the 3142 NHCW of the University Hospital of Clermont-Ferrand. They received a self-assessment questionnaire.

Results:

Four hundred thirty seven (13.9%) NHCW completed the questionnaires. More than three quarter (75.4%) of NHCW was in burnout, with one in five (18.7%) having a severe burnout. Job demand was the main factor explaining the increase in exhaustion and overinvestment was the main factor explaining the increase in cynicism. Effort-reward imbalance (ERI) multiplied the risk of severe burnout by 11.2, job strain by 3.32 and isostrain by 3.74.

Conclusion:

NHCW from hospital staff are at high risk of burnout. The two major models of stress at work, the job demand-control-support and the ERI, were highly predictive of burnout, with strong dose-response relationships.
The Short-Term Effects of Ambient Air Pollutants are Associated With Daily Mortality in Northeast China From 2014 to 2018
Authors: Liu Xiao-Bo , Wen Xi-Mei , Sun Xiao-Hong , Hong Qian-Qi , Wang Qian , Kang Zhen , Xia Su-Jian , Yang Chao , Zhu Sui
Published: November 2020

Objective:

We aimed to examine the associations between ambient air pollutants and daily mortality in Northeast China from 2014 to 2018.

Methods:

A two-stage approach was used to estimate particulate matter with an aerodynamic diameter of 10 μm (PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2) exposure and daily mortality.

Results:

An increase of 10 μg/m3 of PM10 exposure and NO2 at lag of 0 to16 days was associated with the cumulative relative risk of 1.011 (95% confidence interval [CI]: 1.004, 1.019) and 1.026 (95% CI: 1.004, 1.049), respectively, in non-accident mortality. Meanwhile, significant association was observed in people aged under 60 years between SO2 exposure and respiratory mortality at lag of 0 to 9 days.

Conclusions:

Our findings strengthen the evidence of PM10 and NO2 exposures were independent risk for daily mortality.