bluuebunny/crossref_metadata_2025 huggingface dataset:
Fabricating the Fall of Satan: Revelation 12:7–9 and its Interpretation in Early Christianity
Authors: Cardozo Mindiola Cristian
Published: March 2023

Some interpreters understand Rev. 12:7–9 as a depiction of (1) a primeval literal war between Michael and Satan that resulted in the subsequent expulsion of Satan from heaven or (2) Satan’s defeat (represented metaphorically as an expulsion) at Jesus’ death. Although these interpretations are common in contemporary exegetical works, early interpreters of Revelation explained these verses differently. This prompts the question of who were the innovative interpreters who first read the texts as we do today? Accordingly, tracing a history of interpretation of the passage, in this article I will argue that (1) Oecumenius was the first interpreter who understood Rev. 12:7–9 as a portrayal of a primeval war between Michael and Satan which resulted in the expulsion of the devil from heaven because of his pride and apostasy. (2) Oecumenius did not reach this conclusion by exegeting Rev. 12:7–9. Rather, he connected traditional patristic exegesis and reflection on Satan—condensed mainly from interpretations of texts like Ezek. 28:11–19, Isa. 14:12–15, and Luke 10:18—with Revelation 12. (3) Andrew of Caesarea not only replicated Oecumenius’ exegesis of the pericope but argued that this passage also portrayed Satan’s defeat at the cross of Jesus, due to the influence of the patristic exegesis of John 12:31. (4) Given that Andrew’s commentary was widely copied (whereas Oecumenius’ was not), Andrew is ultimately the catalyst for the dissemination of Oecumenius’ exegesis of this pericope as well as his own. (5) Therefore, Oecumenius and Andrew are the originators of the explanations of Rev. 12:7–9 present in many contemporary exegetical works.
Rapid CO2 changes cause oscillations in photosynthesis that implicate PSI acceptor-side limitations
Authors: McClain Alan M , Sharkey Thomas D
Published: March 2023

Oscillations in CO2 assimilation rate and associated fluorescence parameters have been observed alongside the triose phosphate utilization (TPU) limitation of photosynthesis for nearly 50 years. However, the mechanics of these oscillations are poorly understood. Here we utilize the recently developed dynamic assimilation techniques (DATs) for measuring the rate of CO2 assimilation to increase our understanding of what physiological condition is required to cause oscillations. We found that TPU-limiting conditions alone were insufficient, and that plants must enter TPU limitation quickly to cause oscillations. We found that ramps of CO2 caused oscillations proportional in strength to the speed of the ramp, and that ramps induce oscillations with worse outcomes than oscillations induced by step change of CO2 concentration. An initial overshoot is caused by a temporary excess of available phosphate. During the overshoot, the plant outperforms steady-state TPU and ribulose 1,5-bisphosphate regeneration limitations of photosynthesis, but cannot exceed the rubisco limitation. We performed additional optical measurements which support the role of PSI reduction and oscillations in availability of NADP+ and ATP in supporting oscillations.
Maize WRKY28 interacts with the DELLA protein D8 to affect skotomorphogenesis and participates in the regulation of shade avoidance and plant architecture
Authors: Zhang Ze , Chen Limei , Yu Jingjuan
Published: March 2023

Competition for light from neighboring vegetation can trigger the shade-avoidance response (SAR) in plants, which is detrimental to their yield. The molecular mechanisms regulating SAR are well established in Arabidopsis, and some regulators of skotomorphogenesis have been found to be involved in the regulation of the SAR and plant architecture. However, the role of WRKY transcription factors in this process has rarely been reported, especially in maize (Zea mays). Here, we report that maize Zmwrky28 mutants exhibit shorter mesocotyls in etiolated seedlings. Molecular and biochemical analyses demonstrate that ZmWRKY28 directly binds to the promoter regions of the Small Auxin Up RNA (SAUR) gene ZmSAUR54 and the Phytochrome-Interacting Factor (PIF) gene ZmPIF4.1 to activate their expression. In addition, the maize DELLA protein Dwarf Plant8 (D8) interacts with ZmWRKY28 in the nucleus to inhibit its transcriptional activation activity. We also show that ZmWRKY28 participates in the regulation of the SAR, plant height, and leaf rolling and erectness in maize. Taken together, our results reveal that ZmWRKY28 is involved in GA-mediated skotomorphogenic development and can be used as a potential target to regulate SAR for breeding of high-density-tolerant cultivars.
A transnational social contract: Social protection policies toward Non-Resident Keralites
Authors: Burmeister-Rudolph Mira
Published: March 2023

The migration process raises a set of migration-related risks and vulnerabilities, yet recognizing these as collective problems is paramount to formulating public policy responses. As one of the first subnational states globally, the South Indian state Kerala has institutionalized various social protection policies toward emigrants and returned migrants under the department of Non-Resident Keralites’ Affairs (NORKA) and its implementation agency NORKA ROOTS. Taking the case of Kerala, this article investigates why subnational states recognize their international emigrants and return migrants as deserving of social protection provisions. Subnational states matter as they are sites of diaspora identification, and it is where migration’s consequences, such as emigrants’ philanthropic development projects and the reintegration of returned migrants, unfold. At the same time, they have less legislative and infrastructural power than federal states in engaging with emigrants and destination countries. By drawing on original data, the article argues that (returned) emigrants’ access to social protection schemes is built on understandings of deservingness based on a combination of protection rationales and economic rationales, rooted in Kerala’s specific developmental and identity discourse. The study demonstrates that despite subnational states having limited institutional capabilities compared with federal states, they are essential stakeholders in articulating transnational social protection policies.
Two-dimensional (n = 1) ferroelectric film solar cells
Authors: Wang Chen , Gu Jiahao , Li Jun , Cai Jianyu , Li Lutao , Yao Junjie , Lu Zheng , Wang Xiaohan , Zou Guifu
Published: March 2023

Molecular ferroelectrics that have excellent ferroelectric properties, a low processing temperature, narrow bandgap, and which are lightweight, have shown great potential in the photovoltaic field. However, two-dimensional (2D) perovskite solar cells with high tunability, excellent photo-physical properties and superior long-term stability are limited by poor out-of-plane conductivity from intrinsic multi-quantum-well electronic structures. This work uses 2D molecular ferroelectric film as the absorbing layer to break the limit of multiple quantum wells. Our 2D ferroelectric solar cells achieve the highest open-circuit voltage (1.29 V) and the best efficiency (3.71%) among the 2D (n = 1) Ruddlesden–Popper perovskite solar cells due to the enhanced out-of-plane charge transport induced by molecular ferroelectrics with a strong saturation polarization, high Curie temperature and multiaxial characteristics. This work aims to break the inefficient out-of-plane charge transport caused by the limit of the multi-quantum-well electronic structure and improve the efficiency of 2D ferroelectric solar cells.
Prevalence of vitamin D deficiency in South America: a systematic review and meta-analysis
Authors: Mendes Marcela M , Gomes Anna P O , Araújo Maísa M , Coelho Alexandre S G , Carvalho Kênia M B , Botelho Patrícia B
Published: March 2023

Context

Vitamin D deficiency is considered a global public health issue, even in low-latitude countries where there is abundant sunlight radiation. Nevertheless, the prevalence of vitamin D insufficiency and deficiency in the South American continent has not been well characterized.

Objective

The aim of this review was to estimate the prevalence of vitamin D deficiency (25-hydroxy-calciferol < 20 ng/mL) in South American populations.

Data Sources

Seven electronic databases (MEDLINE, Web of Science, Embase, Biblioteca Virtual de Saúde, SciELO, Scopus, and Google Scholar) were searched systematically for observational studies published before July 1, 2021, and reporting vitamin D status of healthy adults in South America.

Data Extraction

Data were extracted using a standardized form. Risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence. All steps were conducted independently by two authors. Data were pooled using a random-effects model. Stratified meta-analysis and meta-regression were conducted (R software).

Data Analysis

Of 9460 articles identified, 96 studies with a total of 227 758 participants were included. The overall prevalence of vitamin D deficiency was 34.76% (79 studies; 95%CI, 29.68–40.21; I2 = 99%). There were significant differences in prevalence rates related to age, sex, country, latitude, season, and year of publication.

Conclusion

The prevalence of vitamin D deficiency is unexpectedly elevated in South American populations. Public health strategies should include efforts to prevent, detect, and treat vitamin D deficiency.

Systematic Review Registration

PROSPERO registration number CRD42020169439.
The Development of the Oncology Center of Excellence Patient-Friendly Language Glossary of Oncology Clinical Trial Terms
Authors: Krol Danielle , Kim Janice , Gao Jennifer , Amiri-Kordestani Laleh , Beaver Julia A , Kluetz Paul
Published: March 2023

Oncology clinical trials terms and definitions have become increasingly complex, which has led to shortcomings among research staff and healthcare providers in informing clinical trial participants with the study results and consenting procedures in simple language. Understanding oncology clinical trial terms is of critical importance to assist patients and caregivers in making cancer treatment decisions, including enrollment into clinical trials. The U.S. Food and Drug Administration’s (FDA) Oncology Center of Excellence (OCE) organized a physician and patient advocate-led focus group, with the primary goal of publishing a patient-centric public glossary of select cancer clinical trial terms for healthcare providers, patients, and caregivers. This commentary reports the results of the focus group sessions that gave FDA OCE valuable insights into how patients perceive clinical trial terms and how oncology clinical trial definitions can be improved to effectively communicate information to the patients to make better informed decisions about their treatment options.
Regulation of capsule spine formation in castor
Authors: Liu Yueying , Wang Xinyu , Li Zongjian , Tu Jing , Lu Ya-nan , Hu Xiaohang , Zhang Qingzhu , Zheng Zhimin
Published: March 2023

Castor (Ricinus communis L.) is a dicotyledonous oilseed crop that can have either spineless or spiny capsules. Spines are protuberant structures that differ from thorns or prickles. The developmental regulatory mechanisms governing spine formation in castor or other plants have remained largely unknown. Herein, using map-based cloning in 2 independent F2 populations, F2-LYY5/DL01 and F2-LYY9/DL01, we identified the RcMYB106 (myb domain protein 106) transcription factor as a key regulator of capsule spine development in castor. Haplotype analyses demonstrated that either a 4,353-bp deletion in the promoter or a single nucleotide polymorphism leading to a premature stop codon in the RcMYB106 gene could cause the spineless capsule phenotype in castor. Results of our experiments indicated that RcMYB106 might target the downstream gene RcWIN1 (WAX INDUCER1), which encodes an ethylene response factor known to be involved in trichome formation in Arabidopsis (Arabidopsis thaliana) to control capsule spine development in castor. This hypothesis, however, remains to be further tested. Nevertheless, our study reveals a potential molecular regulatory mechanism underlying the spine capsule trait in a nonmodel plant species.
Satisfaction with Democracy: A Review of a Major Public Opinion Indicator
Authors: Singh Shane P , Mayne Quinton
Published: March 2023

Satisfaction with democracy (SWD) is one of the most commonly studied topics in the fields of political behavior and public opinion. Gauged with a survey question that asks respondents whether they are satisfied with the way democracy works, SWD has featured as an independent or dependent variable in more than 400 publications. In this Synthesis, we review the evolution and findings of this nearly 50-year-old body of literature, identifying gaps and disagreements. We pay particular attention to issues of measurement and conceptualization, research methodology, and real-world importance. We conclude by highlighting critical areas of future research, including continued investigation into the measurement of SWD and what the question captures, more qualitative and (quasi-)experimental work, more focus on emotions and extreme (dis)satisfaction, and greater geographic coverage.
Visualization software for radioactive contamination based on Compton camera: COMRIS
Authors: Sato Yuki , Minemoto Kojiro , Nemoto Makoto
Published: March 2023

Identifying and visualizing the radiation source location are important in reducing the radiation exposure of workers at the decommissioning site of the Fukushima Daiichi Nuclear Power Station and in improving the radiation protection functions in other sites where radiation sources are handled. In this paper, we developed the COMpton camera for Radiation Imaging System (COMRIS) to identify and visualize the radiation source location in 3D using output data from a Compton camera and a simultaneous localization and mapping (SLAM) device as input data. Here, we presented COMRIS to visualize a 137Cs-radiation source in a dark environment using data acquired by a commercial Compton camera and a LiDAR-based SLAM device mounted on a robot as input data. The radiation source image obtained using the Compton camera was drawn on the 3D work environment model acquired by the SLAM device, and the radiation source location was visible in 3D.
Pain specialist management of sexual pain–IV. Pharmacological
Authors: Vogel John J
Published: March 2023

Introduction

The biopsychosocial model of care for women with sexual pain is a widely endorsed approach which includes pharmacologic treatments.

Objectives

In this study we formulated a summary of current pharmacologic treatments for female sexual pain within a chronic pain paradigm and reviewed evidence for existing pharmacologic treatments and present promising treatment approaches.

Methods

Internet, PubMed, and Cochrane Library databases were searched for relevant articles on female sexual pain within the clinical purview and scope of practice of pain management.

Results

A thorough review of the literature was conducted to include basic science studies, clinical trials, systematic reviews, consensus statements, and case-reports. An effort was made to also include a sampling of information on real-world patient self-directed therapies. The level of evidence for most pharmacologic therapies for female sexual pain is low. Results of clinical studies were summarized for a variety of sexual pain causes. The evidence for the use of topical and oral pharmacologic treatment strategies for sexual pain were reviewed.

Conclusion

Pharmacologic modalities play a significant role in treating female sexual pain, providing options to women as a part of multimodal care. Despite low evidence levels, current and novel treatment options have good safety and tolerability. Pain specialists can provide consultation on pharmacologic strategies to improve the care of women with chronic sexual pain.
The Assistive Benefits of Remote Microphone Technology for Normal Hearing Children With Listening Difficulties
Authors: Shiels Lucy , Tomlin Dani , Rance Gary
Published: March 2023

Objectives:

Children often present with listening difficulties (LiD) but with normal sound detection thresholds. These children are susceptible to learning challenges, and struggle with the suboptimal acoustics of standard classrooms. Remote microphone technology (RMT) is one way to improve the listening environment. The aim of this study was to determine the assistive potential of RMT for speech identification and attention skills in children with LiD, and to investigate whether the benefits obtained by these children were greater than for those with no listening concerns.

Design:

A total of 28 children with LiD and 10 control participants with no listening concerns aged 6 to 12 years were included in this study. Children attended two laboratory-based testing sessions, where their speech intelligibility and attention skills were behaviorally assessed with and without the use of RMT.

Results:

There were significant improvements in speech identification and attention skills when RMT was used. For the LiD group, use of the devices improved speech intelligibility to being comparable or better than control abilities without RMT. Auditory attention scores also improved from being poorer than controls without RMT to comparable to control performance with device assistance.

Conclusions:

Use of RMT was found to have a positive effect on both speech intelligibility and attention. RMT should be considered a viable option for addressing common behavioral symptoms of LiD, including for the many children that present with concerns of inattentiveness.
Novel Machine Vision Image Guidance System Significantly Reduces Procedural Time and Radiation Exposure Compared With 2-dimensional Fluoroscopy-based Guidance in Pediatric Deformity Surgery
Authors: Comstock Christopher P. , Wait Eric
Published: March 2023

Background:

Intraoperative 2-dimensional (2D) fluoroscopy imaging has been commonly adopted for guidance during complex pediatric spinal deformity correction. Despite the benefits, fluoroscopy imaging emits harmful ionizing radiation, which has been well-established to have deleterious effects on the surgeon and operating room staff. This study investigated the difference in intraoperative fluoroscopy time and radiation exposure during pediatric spine surgery between 2D fluoroscopy-based navigation and a novel machine vision navigation system [machine vision image guidance system (MvIGS)].

Methods:

This retrospective chart review was conducted at a pediatric hospital with patients who underwent posterior spinal fusion for spinal deformity correction from 2018 to 2021. Patient allocation to the navigation modality was determined by the date of their surgery and the date of implementation of the MvIGS. Both modalities were the standard of care. Intraoperative radiation exposure was collected from the fluoroscopy system reports.

Results:

A total of 1442 pedicle screws were placed in 77 children: 714 using MvIGS and 728 using 2D fluoroscopy. There were no significant differences in the male-to-female ratio, age range, body mass index, distribution of spinal pathologies, number of levels operated on, types of levels operated on, and the number of pedicle screws implanted. Total intraoperative fluoroscopy time was significantly reduced in cases utilizing MvIGS (18.6 ± 6.3 s) compared with 2D fluoroscopy (58.5 ± 19.0 s) (P < 0.001). This represents a relative reduction of 68%. Intraoperative radiation dose area product and cumulative air kerma were reduced by 66% (0.69 ± 0.62 vs 2.0 ± 2.1 Gycm2, P < 0.001) and 66% (3.4 ± 3.2 vs 9.9 ± 10.5 mGy, P < 0.001) respectively. The length of stay displayed a decreasing trend with MVIGS, and the operative time was significantly reduced in MvIGS compared with 2D fluoroscopy for an average of 63.6 minutes (294.5 ± 15.5 vs 358.1 ± 60.6 min, P < 0.001).

Conclusion:

In pediatric spinal deformity correction surgery, MvIGS was able to significantly reduce intraoperative fluoroscopy time, intraoperative radiation exposure, and total surgical time, compared with traditional fluoroscopy methods. MvIGS reduced the operative time by 63.6 minutes and reduced intraoperative radiation exposure by 66%, which may play an important role in reducing the risks to the surgeon and operating room staff associated with radiation in spinal surgery procedures.

Level of Evidence:

Level III; retrospective comparative study.
Clinical Characteristics and Treatment Patterns of Open Hand Fractures in the Pediatric Population
Authors: Parrado Raphael H. , Foster Lukas , Gilbert Megan , Movtchan Nellie , Sayrs Lois , Khoury Emily , Ballan Wassim , Schaub Timothy
Published: March 2023

Background:

Open hand fractures are one of the most common injuries in the pediatric population. These injuries are at higher risk of infection, especially in cases of frank contamination. Several studies on adult hand fractures are available in the literature; however, pediatric open hand fractures have yet to be extensively studied. This study aimed to define pediatric open hand fracture’s demographics, clinical characteristics, and treatment patterns.

Methods:

Using the Protected Health Information database, pediatric patients (<18 y old) with the diagnosis of open hand fracture from June 2016 to June 2018 were extracted. Demographic, treatment, and follow-up data were collected. Clinical outcomes included readmission and postoperative infection rates.

Results:

There were a total of 4516 patients who met the inclusion criteria; the median age was 7 years (interquartile range: 3 to 11); 60% males; 60% white. Displaced fractures occurred in 74% of patients, with the right hand (52%) and middle finger (27%) predominance. The most common mechanism of injury was a crushing injury in-between objects (56%). Associated nerve injury occurred in 78 patients (4%) and vascular injury in 43 patients (2%). Open reduction and internal fixation were performed in 30% of patients. Cephalosporins were the most commonly prescribed antibiotics (73%), followed by aminopenicillins (7%). Nine patients had complications related to surgical intervention (0.2%), and postoperative infection occurred in 44 patients (1%).

Conclusions:

Pediatric open hand fractures most often occur during childhood and more frequently in males. These fractures tend to be more distal and displaced; reduction and fixation are required in one-third of the cases. Despite the absence of treatment guidelines and variability, this injury exhibits low complication rates.

Level of Evidence:

Level III, retrospective study.
Ten-year Review of Acute Pediatric Hematogenous Osteomyelitis at a New Zealand Tertiary Referral Center
Authors: Hunter Sarah , Crawford Haemish , Baker Joseph F.
Published: March 2023

Background:

Acute hematogenous osteomyelitis (AHO) remains a cause of severe illness among children with the possibility of long-term consequences for growth and development. Recent research has highlighted an unusually high burden of disease in the New Zealand population compared with other Western regions. We have sought to identify trends in presentation, diagnosis, and management of AHO, with added focus on ethnicity and access to health care.

Methods:

A 10-year retrospective review of all patients <16 years with presumed AHO presenting to a tertiary referral center between 2008 and 2018 was performed.

Results:

One hundred fifty-one cases met inclusion criteria. The median age was 8 years with a male predominance (69.5%). Staphylococcus aureus was the most common pathogen using traditional laboratory culture method (84%). The number of cases per year decreased from 2008 to 2018. Assessment using New Zealand deprivation scores showed Māori children were most likely to experience socioeconomic hardship (P≤0.01). Median distance traveled by families to first hospital consult was 26 km (range 1 to 178 km). Delayed presentation was associated with need for prolonged antibiotic therapy. Incidence of disease varied by ethnicity with 1:9000 cases per year for New Zealand European, 1:6500 for Pacific, and 1:4000 for Māori. Overall recurrence rate was 11%.

Conclusions:

The incidence of AHO in New Zealand is concerningly high within Māori and Pacific populations. Future health interventions should consider environmental, socioeconomic, and microbiological trends in the burden of disease.

Level of Evidence:

Retrospective study, Level III.
Txnip Gene Knockout Ameliorated High-Fat Diet–Induced Cardiomyopathy Via Regulating Mitochondria Dynamics and Fatty Acid Oxidation
Authors: Li Aiyun , Zhang Yichao , Wang Jin , Zhang Yan , Su Wanzhen , Gao Feng , Jiao Xiangying
Published: March 2023

Epidemic of obesity accelerates the increase in the number of patients with obesity cardiomyopathy. Thioredoxin interacting protein (TXNIP) has been implicated in the pathogenesis of multiple cardiovascular diseases. However, its specific role in obesity cardiomyopathy is still not well understood. Here, we evaluated the role of TXNIP in obesity-induced cardiomyopathy by feeding wild-type and txnip gene knockout mice with either normal diet or high-fat diet (HFD) for 24 weeks. Our results suggested that TXNIP deficiency improved mitochondrial dysfunction via reversing the shift from mitochondrial fusion to fission in the context of chronic HFD feeding, thus promoting cardiac fatty acid oxidation to alleviate chronic HFD-induced lipid accumulation in the heart, and thereby ameliorating the cardiac function in obese mice. Our work provides a theoretical basis for TXNIP exerting as a potential therapeutic target for the interventions of obesity cardiomyopathy.
Bulging after DIEP Breast Reconstruction: New Insights Concerning Rectus Diastasis and Medial Perforator Harvest
Authors: Nelissen Sophie H. , Krijnen Nienke A. , Tsehaie Jonathan , Schellekens Pascal P.A. , Paes Emma C. , Simmermacher Rogier K.J. , Maarse Wiesje
Published: March 2023

Background:

The aim of this study was to evaluate the association between flap harvest technique and occurrence of abdominal bulging.

Methods:

A retrospective analysis of 159 patients undergoing DIEP flap breast reconstruction between 2014 and 2021 in the University Medical Center Utrecht was conducted. Outcomes measured were preoperative rectus diastasis, flap weight, laterality of flap harvest (unilateral or bilateral), timing of the harvest (immediate or delayed), number of perforators harvested (single or multiple), and location of the harvested perforator (medial, lateral, or both).

Results:

In 159 patients, 244 DIEP flaps were performed, 16 of these donor-sites (6.6%) developed a clinically evident abdominal bulge. When preoperative rectus abdominis diastasis was found (n = 97), postoperative bulging occurred significantly more often (P < 0.01). Patients in whom the medial perforator artery was harvested for reconstruction (n = 114) showed less abdominal bulging than patients in whom the lateral (n = 92) was harvested (P = 0.02). Using single versus multiple perforators for the DIEP flap, bilateral versus unilateral reconstruction or timing of the operation showed no significant difference in outcome of bulging (P = 1.00, P = 0.78, P = 0.59, respectively).

Conclusions:

The incidence of bulging in our study cohort is comparable to the literature. Harvesting the medial perforator artery for the DIEP flap showed less abdominal bulging than using the lateral perforator artery in a DIEP flap breast reconstruction. Also, preoperative rectus diastasis was found to be an important risk factor for the occurrence of bulging.
A Rare Case of Microblading Complicated by Orbital Exenteration and Frontal Defect Reconstructed Using Crane Principle
Authors: Soltany Amjad , Alajieh MHD Essam , Al Aissami Maen
Published: March 2023

This is a case of a rare complication of microblading in a middle-aged woman in a developing country, resulting in a right orbital exenteration and a forehead defect associated with bone exposure reconstructed using the crane principle. To the best of our knowledge, this case is the first one to report such an entity. We are aiming to highlight the importance of proper hygiene in such cosmetic procedures and to shed light on the crane principle as a suitable reconstructive choice, especially in circumstances where other reconstructive options are not available, or in specific situations like mass causalities when shorter operation time is required.
Seasonal variation in blood pressure control across US health systems
Authors: Nilles Ester Kim , Champon XiaoXia , Mulder Hillary , Shaw Kathryn M. , Smith Myra , Lampron Zachary M. , Wozniak Gregory , Chamberlain Alanna M. , Carton Thomas , Viera Anthony J. , Ahmad Faraz S. , Steinberg Benjamin A. , Chuang Cynthia H. , Mctigue Kathleen M. , McClay James C. , Polonsky Tamar S. , Maeztu Carlos , Sanders Margaret , Warren Nate , Singh Rajbir , Liu Mei , VanWormer Jeffrey J. , Park Soo , Modrow Madelaine Faulkner , Rakotz Michael , Cooper-Dehoff Rhonda M. , Pletcher Mark J. , O’Brien Emily C.
Published: March 2023

Objective:

We aimed to characterize seasonal variation in US population-based blood pressure (BP) control and BP-related metrics and evaluate the association between outdoor temperature and BP control variation.

Methods:

We queried electronic health records (EHRs) from 26 health systems, representing 21 states, to summarize BP metrics by quarters of 12-month periods from January 2017 to March 2020. Patients with at least one ambulatory visit during the measurement period and a hypertension diagnosis during the first 6 months or prior to the measurement period were included. Changes in BP control, BP improvement, medication intensification, average SBP reduction after medication intensification across quarters and association with outdoor temperature were analyzed using weighted generalized linear models with repeated measures.

Results:

Among 1 818 041 people with hypertension, the majority were more than 65 years of age (52.2%), female (52.1%), white non-Hispanic (69.8%) and had stage 1/2 hypertension (64.8%). Overall, BP control and process metrics were highest in quarters 2 and 3, and lowest in quarters 1 and 4. Quarter 2 had the highest percentage of improved BP (31.95 ± 0.90%) and average SBP reduction after medication intensification (16 ± 0.23 mmHg). Quarter 3 had the highest percentage of BP controlled (62.25 ± 2.55%) and lowest with medication intensification (9.73 ± 0.60%). Results were largely consistent in adjusted models. Average temperature was associated with BP control metrics in unadjusted models, but associations were attenuated following adjustment.

Conclusion:

In this large, national, EHR-based study, BP control and BP-related process metrics improved during spring/summer months, but outdoor temperature was not associated with performance following adjustment for potential confounders.
Prevalence of masked hypertension and its association with left ventricular hypertrophy in children and young adults with chronic kidney disease: a systematic review and meta-analysis
Authors: Goulas Ioannis , Evripidou Kleo , Doundoulakis Ioannis , Kollios Konstantinos , Nika Thomai , Chainoglou Athanasia , Kotsis Vasilios , Stabouli Stella
Published: March 2023

Objectives:

There are limited studies using ambulatory blood pressure monitoring (ABPM) to assess blood pressure (BP) status in young patients with chronic kidney disease (CKD) on dialysis or after kidney transplantation. The aim of this meta-analysis is to estimate the prevalence of both white-coat hypertension (WCH) and masked hypertension, along with the prevalence of left ventricular hypertrophy (LVH), in children and young adults with CKD on dialysis or after kidney transplantation.

Methods:

We performed a systematic review and meta-analysis of observational studies assessing the prevalence of BP phenotypes using ABPM, in children and young adults with CKD stages 2–5d. Records were identified by search in databases (Medline, Web of Science, CENTRAL) and sources of grey literature, until 31 December 2021. A random-effects meta-analysis of proportions (double arcsine transformation) was conducted.

Results:

Ten studies were included in the systematic review, reporting data from 1140 individuals (children and young adults with CKD with a mean age of 13.79 ± 4.35 years). Masked hypertension and WCH were diagnosed in 301 and 76 patients, respectively. It was estimated an overall pooled masked hypertension prevalence of 27% [95% confidence interval (95% CI) 18–36, I
2 = 87%] and an overall pooled WCH prevalence of 6% (95% CI 3–9, I
2 = 78%). Among kidney transplant recipients, masked hypertension had a prevalence of 29% (95% CI 14–47, I
2 = 86%). The prevalence of LVH was found 28% (95% CI 0.19–0.39) in a total of 238 CKD patients with ambulatory hypertension. In 172 CKD patients with masked hypertension, LVH was present in 49, with the estimated prevalence being 23% (95% CI 0.15–0.32).

Conclusion:

Masked hypertension has a significant prevalence in children and young adults with CKD. Masked hypertension carries an adverse prognosis, with an increased risk of LVH, warranting clinical attention when assessing cardiovascular risk in this population. Therefore, ABPM and echocardiography is of high importance when assessing BP status in children with CKD.

Protocol registration number (DOI):

10.17605/OSF.IO/UKXAF
Retinal vessel caliber and tortuosity and prediction of 5-year incidence of hypertension
Authors: Xue Can C. , Li Cai , Hu Jing F. , Wei Chuan C. , Wang Hua , Ahemaitijiang Kailimujiang , Zhang Qi , Chen Dong N. , Zhang Chun , Li Fan , Zhang Jicong , Jonas Jost B. , Wang Ya X.
Published: March 2023

Purpose:

With arterial hypertension as a global risk factor for cerebrovascular and cardiovascular diseases, we examined whether retinal blood vessel caliber and tortuosity assessed by a vessel-constraint network model can predict the incidence of hypertension.

Methods:

The community-based prospective study included 9230 individuals who were followed for 5 years. Ocular fundus photographs taken at baseline were analyzed by a vessel-constraint network model.

Results:

Within the 5-year follow-up, 1279 (18.8%) and 474 (7.0%) participants out of 6813 individuals free of hypertension at baseline developed hypertension and severe hypertension, respectively. In multivariable analysis, a higher incidence of hypertension was related to a narrower retinal arteriolar diameter (P < 0.001), wider venular diameter (P = 0.005), and a smaller arteriole-to-venule diameter ratio (P < 0.001) at baseline. Individuals with the 5% narrowest arteriole or the 5% widest venule diameter had a 17.1-fold [95% confidence interval (CI):7.9, 37.2] or 2.3-fold (95% CI: 1.4, 3.7) increased risk for developing hypertension, as compared with those with the 5% widest arteriole or the 5% narrowest venule. The area under the receiver operator characteristic curve for predicting the 5-year incidence of hypertension and severe hypertension was 0.791 (95% CI: 0.778, 0.804) and 0.839 (95% CI: 0.821, 0.856), respectively. Although the venular tortuosity was positively associated with the presence of hypertension at baseline (P = 0.01), neither arteriolar tortuosity nor venular tortuosity was associated with incident hypertension (both P ≥ 0.10).

Conclusion and relevance:

Narrower retinal arterioles and wider venules indicate an increased risk for incident hypertension within 5 years, while tortuous retinal venules are associated with the presence rather than the incidence of hypertension. The automatic assessment of retinal vessel features performed well in identifying individuals at risk of developing hypertension.
Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder
Authors: Kozlowska Kasia , Chudleigh Catherine , Savage Blanche , Hawkes Clare , Scher Stephen , Nunn Kenneth P.
Published: March 2023

Learning objectives

• Develop and implement treatment plans for children and adolescents with functional neurological disorder (FND)

• Outline a plan to increase awareness and standardize the care for patients with FND using evidence-based interventions

Functional neurological disorder (FND) in children and adolescents involves the biological embedding of lived experience in the body and brain. This embedding culminates in stress-system activation or dysregulation and in aberrant changes in neural network function. In pediatric neurology clinics, FND represents up to one-fifth of patients. Current research shows good outcomes with prompt diagnosis and treatment using a biopsychosocial, stepped-care approach. At present, however—and worldwide—FND services are scarce, the result of long-standing stigma and ingrained belief that patients with FND do not suffer from a real (“organic”) disorder and that they therefore do not require, or even deserve, treatment. Since 1994, the Mind-Body Program for children and adolescents with FND at The Children’s Hospital at Westmead in Sydney, Australia—run by a consultation-liaison team—has deliveredinpatientcare to hundreds of patients with FND andoutpatientcare to hundreds of others. For less-disabled patients, the program enables community-based clinicians to implement biopsychosocial interventions locally by providing a positive diagnosis (by a neurologist or pediatrician), a biopsychosocial assessment and formulation (by clinicians from the consultation-liaison team), a physical therapy assessment, and clinical support (from the consultation-liaison team and the physiotherapist). In this Perspective we describe the elements of a biopsychosocial mind-body program intervention capable of providing, as needed, effective treatment to children and adolescents with FND. Our aim is to communicate to clinicians and institutions around the world what is needed to establish effective community treatment programs, as well as hospital inpatient and outpatient interventions, in their own health care settings.
Group Differences in Postconcussion Cognitive, Physical, Sleep-Arousal, and Affective Symptom Subscales in High School and Collegiate Athletes by Race, Gender, and Competitive Level
Authors: Wallace Jessica , Karr Justin E. , Yengo-Kahn Aaron , Loftin Megan , Anand Malini , Hibbler Tamaria , Brewer Claire , Covassin Tracey
Published: March 2023

Objective:

Prior psychometric research has identified symptom subscales for the Post-Concussion Symptom Scale (PCSS) based on confirmatory factor analysis (CFA), including cognitive, physical, sleep-arousal, and affective symptom factors. Study objectives included: (1) replicate the 4-factor PCSS model in a diverse sample of athletes with concussion, (2) test the model for invariance across race, gender, and competitive level, and (3) compare symptom subscale and total symptom scores across concussed groups with established invariance.

Setting:

Three regional concussion care centers.

Participants:

A total of 400 athletes who completed the PCSS within 21 days of concussion (64% boys/men, 35% Black, and 69.5% collegiate athletes).

Design:

Cross-sectional.

Main Measures:

A CFA tested the 4-factor model and measurement invariance testing was performed across racial, competitive level, and gender groups. Symptom subscales and total symptom severity scores were compared based on demographic groupings with established invariance.

Results:

The 4-factor model fit well and strong invariance was established across all demographic categories, indicating symptom subscales could be meaningfully compared across groups. Black and White athletes differed on total symptoms (U = 15 714.5, P = .021, r = 0.12), sleep-arousal symptoms (U = 15 953.5, P = .026, r = 0.11), and physical symptoms (U = 16 140, P = .051, r = 0.10), with Black athletes reporting slightly more symptoms. Collegiate athletes reported greater total symptom severity (U = 10 748.5, P < .001, r = 0.30), with greater symptom reporting on the cognitive (U = 12 985, P < .001, r = 0.21), sleep-arousal (U = 12 594, P < .001, r = 0.22), physical (U = 10 959, P < .001, r = 0.29), and emotional (U = 14 727.5, P = .005, r = 0.14) symptom subscales. There were no significant differences by gender in the total symptom score or subscale scores. After controlling for time since injury, no racial differences persisted, but a significant difference by competitive level in physical symptom reporting (F = 7.39, P = .00, η2 = 0.02) and total symptom reporting (F = 9.16, P = .003, η2 = 0.02) remained.

Conclusion:

These results provide external validation for the PCSS 4-factor model and demonstrate that symptom subscale measurements are comparable across race, genders, and competitive levels. These findings support the continued use of the PCSS and 4-factor model for assessing a diverse population of concussed athletes.
OCT to identify macular changes not clinically detectable in elderly patients with cataract
Authors: dos Santos Bruno Boalento , Ribeiro Junior Maurélio de Lima Batista , Garcia Nathalia Perussi , Colombo Barboza Guilherme Novoa , Colombo Barboza Marcello Novoa
Published: March 2023

Purpose:

To demonstrate the importance of optical coherence tomography (OCT) in identifying macular changes not detected at clinical examination preceding cataract surgery in patients older than 60 years.

Setting:

Hospital Oftalmológico Visão Laser, Santos, São Paulo, Brazil.

Desing:

Prospective case series.

Methods:

Patients older than 60 years were selected for this cross-sectional prospective study conducted during preoperative examination for cataract surgery. Eyes with a previous diagnosis or clinical evidence of macular disease or with media opacity preventing OCT from being performed were excluded from the study. All the study participants underwent OCT and were then divided into 2 groups: patients with macular changes and patients without macular changes found on OCT.

Results:

Of 364 eyes screened (212 patients), 300 eyes (180 patients) were included in the study. OCT identified macular changes in 40 eyes (13.3%), with age-related macular degeneration being found in 13 eyes (4.3%), epiretinal membrane in 12 eyes (4%), intraretinal fluid in 12 eyes (4%), and macular hole in 3 eyes (1%). In the group with macular changes, the mean age was 74.4 ± 6.3 years compared with 70.4 ± 6.7 years for those without changes (P < .001).

Conclusions:

OCT proved an effective method for identifying macular diseases not detected at clinical evaluation before cataract surgery. Therefore, the relevance of performing OCT in these cases was confirmed and should be taken into consideration, particularly when evaluating patients older than 60 years.
Cutaneous adverse events under new clinical therapies: drug-induced vitiligo-like depigmentation
Authors: Ma Jing , Chen Kun , Luan Chao
Published: March 2023

Various types of drug-induced vitiligo-like depigmentation have been reported in recent years. Commonly implicated drugs include immune checkpoint inhibitors, targeted drugs, monoclonal antibodies, immunomodulators, chemotherapy drugs, and imiquimod. Unlike the mechanism of vitiligo, the mechanism of drug-induced vitiligo-like depigmentation is not clear, and it has some different characteristics. We herein summarize the vitiligo-like depigmentation induced by different drugs, which will help dermatologists to further understand its pathogenesis and clinical features.
Two independent variants causing neurofibromatosis type 1 in one Chinese family
Authors: Wang Yu-Meng , Cao Qiao-Yu , Zhang Jia , Pan Chao-Lan , Wang Xiao-Xiao , Li Ming
Published: March 2023

Objective:

Neurofibromatosis type 1, resulting from NF1 mutation, is estimated to affect one in 3000 people worldwide. NF1 is a pathogenic gene with one of the highest mutation rates in humans. This study was aimed to report a case in which members of a Chinese family had two distinct NF1 variants.

Methods:

DNA was isolated from the peripheral blood of the proband and his wife and affected son. Whole-exome sequencing was performed on the proband, while next-generation sequencing was used to detect NF1 and other related genes in his wife and son. Sanger sequencing was conducted to confirm the variants.

Results:

An unreported variant c.6143T>G and a recurrent variant c.1063-2A>G of NF1 were identified in the proband and his affected son, respectively. The latter variant was not found in the peripheral blood lymphocytes of the proband and his wife. Paternity testing confirmed their parent-child relationship. We summarized the findings of similar reported cases.

Conclusion:

Our study described a rare phenomenon in which one Chinese family had independent NF1 variants. The findings indicate that clinicians need to sequence the whole NF1 gene of all family members rather than merely verifying the suspect variant detected in the proband.
Efficacy of microneedling with injectable platelet-rich fibrin (i-PRF) for facial skin rejuvenation
Authors: Vesala Anna-Maria , Nacopoulos Cleopatra , Karypidis Dimitrios , Ruga Emanuele
Published: March 2023

Objective:

Autologous blood concentrates have been used in the field of aesthetics for more than two decades. Injectable platelet-rich fibrin (i-PRF) remains more advantageous than other concentrates because it can both initiate fibrin clotting and preserve the secretion of growth factors to promote tissue repair. This study was performed to assess the effectiveness of microneedling therapy with i-PRF for facial skin revitalization using validated patient-reported outcome measures.

Methods:

Twelve patients with facial wrinkles were enrolled in the study. Their ages ranged from 26 to 71 years. Three i-PRF therapy sessions were offered at 4-week intervals. The patients’ photographs were taken at all sessions without exception and throughout the treatment course. The results were clinically evaluated after the final stage of therapy. All 12 patients’ data were statistically analyzed.

Results:

Three i-PRF sessions resulted in moderate improvement in the patients’ skin texture, color, and elasticity as well as filling of soft wrinkles. Statistically significant improvement was found in both skin elasticity (P = 0.02) and filling of soft wrinkles (P = 0.001). No complications occurred in any of the three treatment sessions, and the treatments were well tolerated by all patients.

Conclusions:

The literature indicates that i-PRF has been a favorable substitute for platelet-rich plasma in all settings in which it has been used. Nevertheless, further trials involving large numbers of patients are required to verify the promising results of i-PRF in the field of dermatology.
Patients' Experiences, Needs, and Expectations of Cooperation Between Medical Specialists and Occupational Health Physicians
Authors: Oosting Ilse J. , Kluit Lana , Schaafsma Frederieke G. , Beumer Annechien , van Bennekom Coen A. M. , de Boer Angela G. E. M. , de Wind Astrid
Published: March 2023

Objective

Cooperation between clinical and occupational health care practitioners is a key aspect of clinical work-integrating care. This study aimed to gain insight into patients' experiences, needs, and expectations regarding cooperation between medical specialists and occupational health physicians.

Methods

A thematic qualitative study was conducted involving a total of 33 participants in eight online focus groups.

Results

Participants indicated practitioners are currently working in an isolated manner. However, participants desired for partnership between specialists and occupational health physicians to address work-related concerns and showed a need for explanation of the consequences of their diagnosis, so this can be translated into their ability to work.

Conclusions

Currently, cooperation between clinical and occupational health care is lacking. Yet, some participants experienced that these disciplines could complement each other by working together to support patients in work participation.