bluuebunny/crossref_metadata_2025 huggingface dataset:
Antitumour Property of Pterocarpus santalinus Seeds Against DMBA-Induced Breast Cancer in Rats
Authors: Akhouri Vivek , Kumar Arun , Kumari Manorma
Published: August 2020

Breast cancer has been one of the most common form of malignancy globally among women, for more than a decade. Despite various preventive and treatment measures, it remains associated with high incidence and mortality rate. Pterocarpus santalinus Linn. f. has been extensively used in Indian medicine system Ayurveda, due to its various medicinal properties. However, despite various research works on the anticancer activity of P santalinus, no studies have been reported on animal model. Therefore, this study was aimed to decipher the antitumour activity of ethanolic seeds extract of P santalinus on DMBA (7,12-dimethylbenz(a)-anthracene)-induced breast cancer in rats. Fifty-five-days-old weighed (150 ± 10 g) female Charles Foster rats (12 females) were used for the study. The rats were divided into 3 groups of 4 rats each. 7,12-Dimethylbenz(a)-anthracene (single dose of 20 mg/mL dissolved in olive oil) was induced orally, to develop breast tumour. After the development of breast tumours (about 0.5 cm), the rats were treated with P santalinus ethanolic seeds extract (300 mg/kg body weight/day) orally for 5 weeks and then volume of tumour was measured. Oral administration of P santalinus extract resulted in about 49.5% tumour growth inhibition in the final week of treatment in DMBA +  P santalinus group as compared with the DMBA group. Pterocarpus santalinus administration also significantly reduced ( P < .0001) the serum malondialdehyde level from 58.81 ± 4.09 nmol/mL in DMBA group to 10.87 ± 1.20 nmol/mL in the DMBA +  P santalinus group. Serum tumour necrosis factor-α level reduced significantly ( P < .0001) from 80.43 ± 2.45 pg/mL in DMBA group to 28.30 ± 3.24 pg/mL in the DMBA +  P santalinus group. The blood serum glucose level also reduced significantly ( P < .0001) from 205.9 ± 22.22 mg/dL in DMBA group to 86.44 ± 8.36 in DMBA +  P santalinus group. There was significant ( P  < .0001) improvement in the both the liver and kidney serum biomarkers level after P santalinus administration. The histological study of mammary tissues of rats shows that, in the DMBA group immature fibrocytes are completely replacing the normal adipocytes suggestive of fibroma molle, whereas in the DMBA +  P santalinus group mature fibrocytes with multilayer glandular cells were seen denoting fibroadenoma. Thus, the P santalinus ethanolic seed extract possesses antitumorigenic, antioxidant and hypoglycaemic properties as well as hepato-renal protective effect. Hence, it may be concluded that P santalinus has therapeutic role against DMBA-induced breast cancer in rats and has a greater potential to develop as a chemotherapeutic agent in breast cancer treatment.
Staged Percutaneous Coronary Intervention with Rotational Atherectomy or Bypass Surgery in Chronic Hemodialysis and Severely Calcified Left Main True Bifurcation Lesion: A Case Report and Literature Review
Authors: Dan Kazuhiro , Shinoda Akira , Garcia-Garcia Hector M
Published: August 2020

Previous observational studies and meta-analyses reported that the optimal strategy of coronary revascularization (percutaneous coronary intervention [PCI] and bypass surgery) for anatomically complex coronary artery lesions in the chronic hemodialysis setting is still controversial because the long-term outcomes were superior with coronary artery bypass grafting, especially with regard to repeat revascularization; however, short-term mortality with PCI was significantly lower because it is less invasive. Moreover, no guidelines show a strategy for this setting. We report the case of a patient with chronic dialysis and calcified left main true bifurcation lesion who underwent staged PCI with rotational atherectomy and minimally invasive direct coronary artery bypass for in-stent restenosis who died of non-occlusive mesenteric ischemia.
Adverse event profile differences between rituximab and ocrelizumab: Findings from the FDA Adverse Event Reporting Database
Authors: Caldito Natalia Gonzalez , Shirani Afsaneh , Salter Amber , Stuve Olaf
Published: August 2020

Background:

Rituximab and ocrelizumab are anti-CD20 monoclonal antibodies that have shown a marked reduction in multiple sclerosis (MS) inflammatory activity. However, their real-world safety profile has not been adequately compared.

Objective:

To investigate the adverse event (AE) profile of rituximab and ocrelizumab reported to the Food and Drug Administration Adverse Event Reporting System (FAERS) database.

Methods:

The FAERS database was filtered by indication (MS) and drug (rituximab or ocrelizumab). Disproportionality analyses including but not limited to reporting odds ratio (ROR) were conducted to identify drug–AE associations. A signal was detected if the lower limit of the 95% confidence interval of ROR (ROR025) exceeded 1.

Results:

There were 623 and 7948 reports for rituximab and ocrelizumab, respectively. The most frequent AEs with rituximab and ocrelizumab were infusion-related reaction (4.82%) and urinary tract infection (10.52%), respectively. The strongest drug–AE association for rituximab and ocrelizumab were ear pruritus (ROR025: 47.53) and oral herpes (ROR025: 38.99), respectively. Ocrelizumab was associated with an almost two times higher frequency of infections than rituximab (21.93% vs 11.05%, respectively).

Conclusion:

This study revealed differences in reporting AEs between rituximab and ocrelizumab. Infections were reported more frequently with ocrelizumab. Although speculative, a potentially different or more extensive B-cell depletion by ocrelizumab might explain these findings. Additional pharmacovigilance studies need to be performed to better characterize differences in the AE profile in B-cell-depleting therapies.
The use of wearable devices in chronic disease management to enhance adherence and improve telehealth outcomes: A systematic review and meta-analysis
Authors: Kamei Tomoko , Kanamori Takuya , Yamamoto Yuko , Edirippulige Sisira
Published: August 2020

Introduction

Wearable device (WD) interventions are rapidly growing in chronic disease management; nevertheless, the effectiveness of these technologies to monitor telehealth outcomes has not been adequately discussed. This study aims to evaluate the effects of WDs in adherence and other health outcomes for people with chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), and cardiac disease (CD).

Methods

CINAHL, PsycINFO, CENTRAL, and EMBASE were searched for randomized controlled trials (RCTs) and non-RCTs from 1937 to February 2020. Studies comparing interventions with the use of WD were assessed for quality in RCTs and a meta-analysis was performed.

Results

Eleven studies were included in this review. All of the interventions involved WD use with educational support such as goal setting, virtual social support, e-health program, real-time feedback, written information, maintain diary, and text messaging. The meta-analysis showed no difference in adherence ( p = .38). The DM group showed effects of more than a 2% reduction in weight when WDs were implemented for three months (risk ratio = 2.20; 95% confidence interval (CI) 1.38 to 3.50; p = .0009), as well as blood glucose (mean difference (MD) = –32.39; 95% CI = –48.07 to –16.72; p < .0001), haemoglobin A1c (MD = –0.69; 95% CI = –1.28 to –0.10; p = .02), and physical exercise time in the CD group (MD = 9.53; 95% CI = 0.59 to 18.47; p = .04).

Discussion

WD with educational support may be particularly useful for people with DM and CD to enhance support beyond usual care. The results of this review showed insufficient evidence to support the use of WD for COPD to enhance telehealth outcomes for disease management.
The mechanical performance of concrete shear key for prefabricated structures
Authors: Zhang Xihong , Hao Hong , Zheng Jingbin , Hernandez Francisco
Published: August 2020

The mechanical performance of concrete connection plays an important role in the response of precast concrete structures. Unlike conventional small concrete shear key which is mainly to help with alignment at installation, large concrete shear keys have been often designed in recent engineering practice to improve joint shear resistance. However, the mechanical properties of large concrete shear keys have not been properly studied. This paper utilizes experimental and numerical methods to investigate both direct shear and flexural bending properties of shear keys. Four types of shear keys comprised of trapezoidal shape, semi-spherical shape, dome shape and wave shape are investigated, which are found to strongly influence the mechanical properties of the keyed joint. Laboratory shear test found unlike conventional shear key, with increased tenon size failure moves to concrete mortise. A detailed numerical model is built to help understand stress developed at the key joint. Flexural bending tests are carried out to evaluate the flexural bending properties of these key joints. Through comparing with theoretical derivation for plain flat joint, similar bending moment resistances from the keyed joints are measured with that of plain flat joint, but larger rotation angles are recorded probably because more damages at the key joint. Among the four different joint patterns, shear key with smoothed pattern could effectively relief concrete damages.
Symptom experience as a predictor of cardiac rehabilitation education programme attendance after percutaneous coronary intervention: A prospective questionnaire survey
Authors: Kim Ji-Su , Kim Gwang S , Kang Seok-Min , Chu Sang H
Published: August 2020

Background

Despite evidence that participation in cardiac rehabilitation programmes after percutaneous coronary intervention is associated with better clinical outcomes, many patients with coronary artery disease do not participate in such programmes. A traditional educational approach is recommended to provide patients with information regarding the benefits of cardiac rehabilitation in relation to their underlying coronary artery disease and modification of risk factors.

Aims

The purpose of this study was to examine the role of patient factors (symptom experience and health belief) on cardiac rehabilitation education programme attendance among Korean patients subjected to percutaneous coronary intervention.

Methods

A prospective survey was conducted enrolling 173 patients who underwent percutaneous coronary intervention. Information on symptom experience, health belief (perceived susceptibility/severity/benefits/ barriers) and sociodemographic and clinical characteristics was collected at baseline (after percutaneous coronary intervention). Three to four weeks later, information on disease-related knowledge and health behaviour was compared between cardiac rehabilitation education programme attendees and non-attendees.

Results

Eighty of 173 (46.2%) patients surveyed attended the cardiac rehabilitation education programme. Symptom experience before percutaneous coronary intervention was the most significant predictor of programme attendance (odds ratio = 3.46; 95% confidence interval 1.45–8.27), followed by higher perceived socioeconomic status (odds ratio = 2.90; 95% confidence interval 1.28–6.58), perceived susceptibility (odds ratio = 1.22, 95% confidence interval 1.08–1.39), perceived benefits (odds ratio = 1.09; 95% confidence interval 1.02–1.17) and perceived severity (odds ratio = 1.04; 95% confidence interval 1.00–1.08). Better disease-related knowledge and health behaviour were significantly associated with cardiac rehabilitation education programme attendance.

Conclusion

This study provides evidence that educational programmes to help improve patients’ perceptions of their disease susceptibility and severity, especially health behaviour benefits in patients without symptom experience before percutaneous coronary intervention, are necessary.
Examining Perceptions of Spanish Language Health Information Among Hispanics Living in the United States: A Qualitative Study Assessing Videos, Brochures, and Websites
Authors: De Alba Rosales Armando , Schober Daniel , Johansson Patrik
Published: August 2020

Background

Nationally, Hispanics experience health disparities manifested as a higher prevalence of chronic diseases in comparison to non-Hispanic Whites. Factors that influence health disparities in this population include inadequate dissemination of culturally and linguistically appropriate health information.

Method

Our qualitative analysis is based on data obtained from three focus groups with Spanish-speaking Hispanic adults conducted at a clinic in Nebraska. Participants were asked about their perceptions of health information in the form of videos, brochures, and websites. We followed the consolidated criteria for reporting qualitative research and used the theoretical framework of content analysis.

Results

For videos, attributes associated with higher levels of trust included a friendly health professional, the logo or name of a health care institute, and a reference specifying “se habla Español.” For brochures, attributes associated with trust included use of visual aids, use of numerous colors and big font sizes, the year of printing, and a health care agency logo. For websites, characteristics associated with trust were inclusion of plain language, use of pictures and videos, and date of last update. In all focus groups, participants perceived the use of mixed English/Spanish language in health information from pamphlets and websites as unprofessional. The use of unknown governmental logos in health promotional videos and websites was perceived as untrustworthy information.

Conclusions

Spanish-speaking Hispanics prefer health information supported by a health care agency or delivered by a health care professional. Health communication strategies should avoid the use of mixed English/Spanish language in sensitive information especially when combined with governmental logos.
Ultrasound of the adrenal gland in children
Authors: Aderotimi Tobi SM , Kraft Jeannette K
Published: August 2020

Introduction

Ultrasound is the modality of choice in the evaluation of neonates and young children with suspected adrenal lesions including adrenal haemorrhage and congenital adrenal hyperplasia. It is also the initial imaging modality in children presenting with an upper abdominal mass, which may be adrenal in origin. Topic discussion: This paper shows adrenal anatomy and demonstrates how the sonographic features change with age. It reviews the imaging features of congenital adrenal lesions, as well as benign and malignant conditions affecting the adrenal gland in childhood. Discussion and Conclusion: Ultrasound is a useful primary imaging modality in the assessment of the adrenal gland in children. Knowledge of the changes of the adrenal gland with age is important when assessing the adrenal gland. Ultrasound is also useful for assessing abdominal masses. However, it cannot differentiate adrenal masses, therefore correlation with biochemical findings, multimodality imaging, and histology is usually required.
Futures in Practice: Regimes of Engagement and Teleoaffectivity
Authors: Welch Daniel , Mandich Giuliana , Keller Margit
Published: August 2020

The article triangulates Schatzki’s practice theory (2002) and Thévenot’s (2001) ‘regimes of engagement’ with the nascent field of ‘social futures’ or future-oriented cultural sociology (e.g. Coleman and Tutton 2017; Mische 2009). We present a reading of Thévenot’s regimes of engagement that is ontologically compatible with Schatzki’s account of social practices and argue that practices are more or less enmeshed in distinct regimes of engagement. We aver that while people engage reality through distinct regimes of engagement they do so, to follow Schatzki, primarily in the context of social practices. We then articulate this account with Giuliana Mandich’s (2019) work on the different modes of engagement with the future, or forms of reflexive projectivity, that are expressed through Thévenot’s regimes: that of practical anticipation for the regime of the familiar; of probability for the regime of the plan; of possibility for the regime of justification; and of discovery for the regime of exploration. This synthesis enables a practice theoretical account of the different modes through which actors engage with the future that is, we suggest, analytically superior to both Thévenot’s and Schatzki’s tendency towards a mono-dimensional view of agents’ projectivity towards the future. We illustrate the synthesis of practices, regimes of engagement and modes of projectivity chiefly through a study of domestic laundry practice conducted by Southerton and Mylan (2018). We suggest this theoretical development may be productively applied to practice theoretical work informing understanding of issues such as sustainable consumption, mobility and energy use, as well as social change more broadly.
Distribution of High-Volume Ankle Replacement Surgeons in United States Metropolitan Areas
Authors: Stein Brandon , Somerson Jeremy , Janney Cory , Panchbhavi Vinod
Published: August 2020

Background

Ankle osteoarthritis is increasing, thus creating greater demand for high-volume total ankle arthroplasty (TAA) surgeons. The Medicare Provider Utilization and Payment Data Public Use File (MPUPD-PUF) provides volume and reimbursement data for procedures performed by physicians participating in Medicare. This study analyzes surgeon prevalence, surgeon distribution, and factors affecting surgeon prevalence in metropolitan areas.

Methods

The MPUPD-PUF was reviewed from 2012 to 2015, and data were extracted for physicians performing ≥11 TAA procedures. Physicians in metropolitan areas (population >1 million) were grouped together, and reimbursement, number of high-volume surgeons, and procedures were calculated. Presence of an American Orthopaedic Foot and Ankle Society (AOFAS) fellowship program was analyzed for associations with high-volume TAA surgeons.

Results

Fifty-three surgeons performed ≥11 TAA procedures (1,960 total) covered by Medicare. Of these surgeons, 66% practice in metropolitan areas with a population >1 million. Fifty-one percent of US major metropolitan areas contained no surgeon who submitted >10 traditional Medicare claims for TAA. Areas with an AOFAS fellowship had nominally more TAA claims submitted.

Conclusions

The distribution of high-volume TAA surgeons among major metropolitan areas in the United States is highly unequal. Analyzing the data with this method aids in targeting TAA surgeons to currently underserved areas.

Levels of Evidence

Level IV: Retrospective-comparative study
The impact of the COVID-19 pandemic on patients awaiting spinal cord stimulation surgery in the United Kingdom: a multi-centre patient survey
Authors: Baranidharan Ganesan , Bretherton Beatrice , Eldabe Sam , Mehta Vivek , Thomson Simon , Sharma Manohar Lal , Vajramani Girish , Bojanic Stana , Gulve Ashish , FitzGerald James , Hall Samuel , Firth Julie
Published: August 2020

Introduction:

Spinal cord stimulation (SCS) is a recommended treatment for chronic refractory neuropathic pain. During the COVID-19 pandemic, elective procedures have been postponed indefinitely both to provide capacity to deal with the emergency caseload and to avoid exposure of elective patients to COVID-19. This survey aimed to explore the effect of the pandemic on chronic pain in this group and the views of patients towards undergoing SCS treatment when routine services should resume.

Methods:

This was a prospective, multi-centre telephone patient survey that analysed data from 330 patients with chronic pain who were on an SCS waiting list. Questions focussed on severity of pain, effect on mental health, medication consumption and reliance on support networks during the COVID-19 pandemic. Views towards undergoing SCS therapy were also ascertained. Counts and percentages were generated, and chi-square tests of independence explored the impact of COVID-19 risk (very high, high, low) on survey responses.

Results:

Pain, mental health and patient’s ability to self-manage pain deteriorated in around 47%, 50% and 38% of patients, respectively. Some patients reported increases in pain medication consumption (37%) and reliance on support network (41%). Patients showed a willingness to attend for COVID-19 testing (92%), self-isolate prior to SCS (94%) and undergo the procedure as soon as possible (76%).

Conclusion:

Our findings suggest that even during the COVID-19 pandemic, there remains a strong clinical need for patients with chronic pain identified as likely SCS responders to be treated quickly. The current prioritisation of new SCS at category 4 (delayed more than 3 months) is challenged judging by this national survey. These patients are awaiting SCS surgery to relieve severe intractable neuropathic pain. A priority at category 3 (delayed up to 3 months) or in some selected cases, at category 2 are the appropriate priority categories.
Refractory scleroderma renal crisis precipitated after high-dose oral corticosteroids and concurrent intravitreal injection of bevacizumab
Authors: Hanna Ramy M , Abdelnour Lama , Zuckerman Jonathan E , Ferrey Antoney J , Pai Alex , Vahabzadeh Kambiz , Wilson James , Torres Everado A , Kalantar-Zadeh Kamyar , Kurtz Ira B
Published: August 2020

Scleroderma renal crisis is a serious complication that can develop in certain patients with systemic sclerosis. Some risks have been identified as potential triggers of scleroderma renal crisis, including the high-dose oral corticosteroids. Here, we present a patient who developed clinically severe systemic sclerosis and scleroderma renal crisis after exposure to oral corticosteroids and intravitreal vascular endothelial growth factor blockade with bevacizumab for cotton wool spots. The patient’s scleroderma renal crisis was severe, progressive, and refractory to the standard of care therapy: oral captopril. Biopsy showed a diffuse thrombotic microangiopathy and findings consistent with scleroderma renal crisis. We hypothesize that depletion of systemic vascular endothelial growth factor with intravitreal anti–vascular endothelial growth factor injections likely contributed to the particularly severe presentation seen in this case. Though the finding of a monoclonal gammopathy of undetermined significance is another complicating factor, this case suggests that vascular endothelial growth factor inhibition may be a newly recognized trigger of scleroderma renal crisis.
Laypeople Can Predict Which Social-Science Studies Will Be Replicated Successfully
Authors: Hoogeveen Suzanne , Sarafoglou Alexandra , Wagenmakers Eric-Jan
Published: August 2020

Large-scale collaborative projects recently demonstrated that several key findings from the social-science literature could not be replicated successfully. Here, we assess the extent to which a finding’s replication success relates to its intuitive plausibility. Each of 27 high-profile social-science findings was evaluated by 233 people without a Ph.D. in psychology. Results showed that these laypeople predicted replication success with above-chance accuracy (i.e., 59%). In addition, when participants were informed about the strength of evidence from the original studies, this boosted their prediction performance to 67%. We discuss the prediction patterns and apply signal detection theory to disentangle detection ability from response bias. Our study suggests that laypeople’s predictions contain useful information for assessing the probability that a given finding will be replicated successfully.
Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy
Authors: Ford Jon J. , Kaddour Omar , Gonzales Michael , Page Patrick , Hahne Andrew J.
Published: August 2020

Background

An understanding of the clinical features of inflammation in low back pain with or without leg symptoms may allow targeted evaluations of anti-inflammatory treatment in randomised-controlled-trials and clinical practice.

Purpose

This study evaluated the diagnostic accuracy of clinical features to predict the presence/absence of histologically confirmed inflammation in herniated disc specimens removed at surgery in patients with lumbar disc herniation and associated radiculopathy (DHR).

Study design

Cohort Study.

Methods

Disc material from patients with DHR undergoing lumbar discectomy was sampled and underwent histological/immunohistochemistry analyses. Control discs were sampled from patients undergoing surgical correction for scoliosis. Baseline assessment comprising sociodemographic factors, subjective examination, physical examination and psychosocial screening was conducted and a range of potential clinical predictors of inflammation developed based on the existing literature. Multi-variate analysis was undertaken to determine diagnostic accuracy.

Results

Forty patients with DHR and three control patients were recruited. None of the control discs had evidence of inflammation compared to 28% of patients with DHR. Predictors of the presence of histologically confirmed inflammation included back pain < 5/10, symptoms worse the next day after injury, lumbar flexion range between 0 and 30° and a positive clinical inflammation score (at least 3 of: constant symptoms, morning pain/stiffness greater than 60-min, short walking not easing symptoms and significant night symptoms). The model achieved a sensitivity of 90.9%, a specificity of 92.9%, and a predictive accuracy of 92.3%.

Conclusion

In a sample of patients with lumbar DHR a combination of clinical features predicted the presence or absence of histologically confirmed inflammation.

Clinical relevance

These clinical features may enable targeted anti-inflammatory treatment in future RCTs and in clinical practice.
Two weeks of western diet disrupts liver molecular markers of cholesterol metabolism in rats
Authors: St-Amand Roxane , Ngo Sock Émilienne T. , Quinn Samantha , Lavoie Jean-Marc , St-Pierre David H.
Published: August 2020

Background

The present study was designed to test the hypothesis that in the liver, excessive fat accumulation impairs cholesterol metabolism mainly by altering the low-density lipoprotein-receptor (LDL-R) pathway.

Method

Young male Wistar rats were fed standard (SD), high fat (HFD; 60% kcal) or Western (WD; 40% fat + 35% sucrose (17.5% fructose)) diets for 2 or 6 weeks.

Results

Weight gain (~ 40 g) was observed only following 6 weeks of the obesogenic diets (P < 0.01). Compared to the 2-week treatment, obesogenic diets tripled fat pad weight (~ 20 vs 7 g) after 6 weeks. Hepatic triglyceride (TG) levels were greater in response to both the WD and HFD compared to the SD (P < 0.01) at 2 and 6 weeks and their concentrations were greater (P < 0.05) in WD than HFD at 2 weeks. Plasma total cholesterol levels were higher (P < 0.05) in animals submitted to WD. After 2 and 6 weeks, liver expression of LDL-R, proprotein convertase subtilisin/kexin 9 (PCSKk9) and sterol regulatory element binding protein 2 (SREBP2), involved in LDL-cholesterol uptake, was lower in animals submitted to WD than in others treated with HFD or SD (P < 0.01). Similarly, low-density lipoprotein-receptor-related protein 1 (LRP1) and acyl-CoA cholesterol acyltransferase-2 (ACAT-2) mRNA levels were lower (P < 0.01) among WD compared to SD-fed rats. Expression of the gene coding the main regulator of endogenous cholesterol synthesis, 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMGCoAR) was reduced in response to WD compared to SD and HFD at 2 (P < 0.001) and 6 (P < 0.05) weeks. Being enriched in fructose, the WD strongly promoted the expression of carbohydrate-response element binding protein (ChREBP) and acetyl-CoA carboxylase (ACC), two key regulators of de novo lipogenesis.

Conclusion

These results show that the WD promptly increased TG levels in the liver by potentiating fat storage. This impaired the pathway of hepatic cholesterol uptake via the LDL-R axis, promoting a rapid increase in plasma total cholesterol levels. These results indicate that liver fat content is a factor involved in the regulation of plasma cholesterol.
Effectiveness of switching between TNF inhibitors in patients with axial spondyloarthritis: is the reason to switch relevant?
Authors: Manica Santiago Rodrigues , Sepriano Alexandre , Pimentel-Santos Fernando , Gouveia Nélia , Barcelos Anabela , Branco Jaime C. , Bernardes Miguel , Ferreira Raquel Miriam , Vieira-Sousa Elsa , Barreira Sofia , Vinagre Filipe , Roque Raquel , Santos Helena , Madeira Nathalie , Rovisco João , Daniel Alexandra , Ramiro Sofia
Published: August 2020

Background

To investigate whether the reason to discontinue the first TNF inhibitor (TNFi) affects the response to the second TNFi in axial spondyloarthritis (axSpA).

Methods

Patients with axSpA from the Rheumatic Diseases Portuguese Register (ReumaPt), who discontinued their first TNFi and started the second TNFi between June 2008 and May 2018, were included. Response was assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS) clinically important improvement (ASDAS-CII), major important improvement (ASDAS-MI), low disease activity (ASDAS-LDA), and inactive disease (ASDAS-ID). The reason for discontinuation of the first TNFi was defined, according to ASDAS-CII as primary failure (no response ≤ 6 months), secondary failure (response ≤ 6 months but lost thereafter), adverse events, and others. The association between the reason for discontinuation of the first TNFi and response to the second TNFi over time was assessed in multivariable generalized equation (GEE) models.

Results

In total, 193 patients were included. The reason for discontinuation of the first TNFi did not influence the response to the second TNFi, according to the ASDAS-CII. However, a difference was found with more stringent outcomes, e.g., there was a higher likelihood to achieve ASDAS-ID with the second TNFi for patients discontinuing the first TNFi due to secondary failure (OR 7.3 [95%CI 1.9; 27.7]), adverse events (OR 9.1 [2.5; 33.3]), or other reasons (OR 7.7 [1.6; 37.9]) compared to primary failure.

Conclusion

Patients with axSpA with secondary failure to their first TNFi, compared to those with primary failure, have a better response to the second TNFi according to stringent outcomes.
Hemato-oncology Tourism in Israel: A Retrospective Review
Authors: Hod Keren , Bronstein Yotam , Chodick Gabriel , Shpilberg Ofer
Published: August 2020

PURPOSE

Despite the significant increase in medical tourism worldwide, data on medical tourist (MT) clinical characteristics and treatment outcomes are lacking. Many MTs who choose Israel to receive medical services are individuals diagnosed with hematologic malignancies. The purpose of this study was to describe hemato-oncology MTs and to compare their disease characteristics and treatment outcomes to a control group of local (Israeli) hemato-oncology patients.

MATERIALS AND METHODS

In this retrospective review, we analyzed hospital records of all hemato-oncology tourists and Israeli patients diagnosed and/or treated at the Institute of Hematology, Assuta Medical Center, between 2014 and 2016. MT and local patient demographics, clinical characteristics, and treatment outcomes were compared. MT data were also analyzed according to their commitment to treatment in Israel.

RESULTS

Data on 110 MTs (median age, 51.0 years; 53.6% women) and 122 local patients (median age, 65.0 years; 41.8% women) diagnosed with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, and multiple myeloma were analyzed. The most common hematologic malignancy in both MTs and local patients was NHL (54.5% and 73.0%, respectively). Among MTs, 32.7% were fully committed to treatment in Israel, 32.7% were partially committed, and 34.6% were not committed. In 25.9% of MTs, a review of their biopsy resulted in a more definitive or different diagnosis. The percentage of patients who achieved complete response to treatment was similar among MTs and local patients.

CONCLUSION

MTs often require a pathologic review of their initial diagnosis and are more likely to present with advanced stages of disease. Treatment of MTs according to the appropriate clinical parameters is expected to yield similar outcomes to those of local patients.
Subsequent Neoplasm Risk Associated With Rare Variants in DNA Damage Response and Clinical Radiation Sensitivity Syndrome Genes in the Childhood Cancer Survivor Study
Authors: Morton Lindsay M. , Karyadi Danielle M. , Hartley Stephen W. , Frone Megan N. , Sampson Joshua N. , Howell Rebecca M. , Neglia Joseph P. , Arnold Michael A. , Hicks Belynda D. , Jones Kristine , Zhu Bin , Dagnall Casey L. , Karlins Eric , Yeager Meredith S. , Leisenring Wendy M. , Yasui Yutaka , Turcotte Lucie M. , Smith Susan A. , Weathers Rita E. , Miller Jeremy , Sigel Byron S. , Merino Diana M. , Berrington de Gonzalez Amy , Bhatia Smita , Robison Leslie L. , Tucker Margaret A. , Armstrong Gregory T. , Chanock Stephen J.
Published: August 2020

PURPOSE

Radiotherapy for childhood cancer is associated with elevated subsequent neoplasm (SN) risk, but the contribution of rare variants in DNA damage response and radiation sensitivity genes to SN risk is unknown.

PATIENTS AND METHODS

We conducted whole-exome sequencing in a cohort of childhood cancer survivors originally diagnosed during 1970 to 1986 (mean follow-up, 32.7 years), with reconstruction of doses to body regions from radiotherapy records. We identified patients who developed SN types previously reported to be related to radiotherapy (RT-SNs; eg, basal cell carcinoma [BCC], breast cancer, meningioma, thyroid cancer, sarcoma) and matched controls (sex, childhood cancer type/diagnosis, age, SN location, radiation dose, survival). Conditional logistic regression assessed SN risk associated with potentially protein-damaging rare variants (SnpEff, ClinVar) in 476 DNA damage response or radiation sensitivity genes with exact permutation-based P values using a Bonferroni-corrected significance threshold of P < 8.06 × 10−5.

RESULTS

Among 5,105 childhood cancer survivors of European descent, 1,108 (21.7%) developed at least 1 RT-SN. Out-of-field RT-SN risk, excluding BCC, was associated with homologous recombination repair (HRR) gene variants (patient cases, 23.2%; controls, 10.8%; odds ratio [OR], 2.6; 95% CI, 1.7 to 3.9; P = 4.79 × 10−5), most notably but nonsignificantly for FANCM (patient cases, 4.0%; matched controls, 0.6%; P = 9.64 × 10−5). HRR variants were not associated with likely in/near-field RT-SNs, excluding BCC (patient cases, 12.7%; matched controls, 12.9%; P = .92). Irrespective of radiation dose, risk for RT-SNs was also associated with EXO1 variants (patient cases, 1.8%; controls, 0.4%; P = 3.31 × 10−5), another gene implicated in DNA double-strand break repair.

CONCLUSION

In this large-scale discovery study, we identified novel associations between RT-SN risk after childhood cancer and potentially protein-damaging rare variants in genes involved in DNA double-strand break repair, particularly HRR. With replication, these results could affect screening recommendations for childhood cancer survivors and risk-benefit assessments of treatment approaches.
EXERCISE DURING PREGNANCY
Authors: Davenport Margie H.
Published: August 2020

Apply It!Summary

•Pregnant women are recommended to engage in ≥150 minutes of moderate-intensity physical activity over three or more days per week.

•This level of PA significantly reduces the odds of developing pregnancy complications (e.g., diabetes and hypertension) without increasing the odds of miscarriage, early delivery, or a small baby.

•Engaging in physical activity during pregnancy reduces the odds of developing depression by 67% and reduces the severity of depressive symptoms.

•Increasing the amount of weekly exercise concomitantly reduces the odds of developing pregnancy-related complications.

As exercise and health professionals, it’s important to consider a woman’s physical, mental, social, and spiritual health when prescribing exercise. Health and fitness professionals can encourage women during this period to be active and to include other areas of wellness by inviting friends to be active with them, or practicing mindfulness during PA, or joining group exercise session for increased social interactions. During pregnancy, there will be days where a woman feels tired or unwell, encouraging adequate rest and sleep to ensure recovery is as important as encouraging a resumption of activity after recovery. Consider the individual’s goal, whether it be disease prevention, stress reduction, or mood enhancement, in the design of an exercise plan or in making recommendations regarding PA. Although prescribing exercise during pregnancy requires additional considerations beyond nonpregnant women, such as time constraints, fatigue, and caring for other children, it is possible to develop effective strategies that increase PA while at the same time improving different aspects of wellness, particularly socioemotional well-being. And all of these can occur with as little as 10 minutes a day of PA.
MIDLIFE FUNCTIONAL FITNESS
Authors: Evans Ellen M. , Castillo-Hernández Isaura M.
Published: August 2020

Apply It!

After reading this article, the health and fitness professional will

Recognize that health behavior choices during midlife, that align with the dimensions of wellness and include exercise, can greatly affect one’s daily function and well-being and increase the chance for successful and active aging;

Conceptually reframe functional fitness, adding cognitive and psychosocial components to physical domains, and redefine it as functional well-being, which is operationalized as having adequate daily productivity with vitality and vigor while experiencing minimal stress that collectively enables optimal function;

Appreciate that midlife challenges often include changes in sex hormones and body composition, newly diagnosed chronic diseases/conditions, and complicated social roles, which together result in high stress levels and reduced sleep quality that can challenge multiple domains of one’s wellness;

When working with midlife individuals, understand that (a) an increased focus on strength training and exercise intensity is important to achieve benefits in less time; (b) daily movement is essential to both function and feeling better; (c) exercise is only one component of physical wellness; and (d) health behaviors are often interrelated.
KEEP ON: STAYING ACTIVE TO PROMOTE WELL-BEING DURING THE GOLDEN YEARS
Authors: Bushman Barbara , Goddard Stacy
Published: August 2020

Apply It!

• Incorporating balance and mobility exercises, in addition to muscular strength, aerobic activities, and flexibility, is needed to prevent falls among older adults.

• Functional activities can be added into any phase of a workout for older adults from warm-up to cool-down.

• Adequately addressing barriers while emphasizing motivators is key in promoting physical activity and well-being.

• Health and fitness professionals are in a pivotal position to take a holistic approach to wellness with well-designed programs that are physically and mentally stimulating.
Exercise Training Reverses Lipotoxicity-induced Cardiomyopathy by Inhibiting HMGCS2
Authors: LI SHENGCUN , QIAN XIAOLI , GONG JIAHONG , CHEN JIE , TU WENZHAN , CHEN XIAOLONG , CHU MAOPING , YANG GUANHU , LI LEI , JIANG SONGHE
Published: August 2020

Purpose

This study aimed to determine the effect of exercise training on preventing lipotoxic cardiomyopathy and to investigate the role of the 3-hydroxy-3-methylglutaryl-CoA synthase 2 (HMGCS2) and miR-344g-5p in cardiomyocytes.

Methods

Male C57BL/6 mice were fed a 60% high-fat diet (HFD) for 12 wk then began swimming exercise or remained sedentary for 8 wk. Thereafter, cardiac function was assessed by echocardiography, and heart tissue and plasma were collected for further measurements. The molecular mechanism of exercise was investigated after treating Hmgcs2 siRNA in palmitate-induced neonatal mouse cardiomyocytes.

Results

HFD induced myocardial hypertrophy and fibrosis and reduced coronary reserve and cardiac function. HMGCS2 levels increased, but junctophilin-2 (JPH2) levels decreased in HFD mice hearts. Such effects were attenuated by swimming exercise. Mechanistically, Hmgcs2 silencing prevented apoptosis and caspase-3 cleavage and elevated the expression of JPH2 in palmitate-stimulated cardiomyocytes. In addition, exercise promoted miR-344g-5p expression in HFD hearts. The overexpression of miR-344g-5p by chemical mimic reduced HMGCS2, apoptosis, and caspase-3 cleavage and elevated JPH2 expression in palmitate-induced cardiomyocytes.

Conclusion

Our results suggest that exercise limits lipid metabolic disorder, cardiac hypertrophy, and fibrosis and aids in the prevention of lipotoxic cardiomyopathy. Exercise-mediated cardioprotection by upregulating miR-344g-5p, which targets Hmgcs2 mRNA, prohibits HMGCS2 upregulation and thus lipotoxicity.
Studies of Twin Responses to Understand Exercise Therapy (STRUETH): Body Composition
Authors: THOMAS HANNAH J. , MARSH CHANNA E. , MASLEN BARBARA A. , SCURRAH KATRINA J. , NAYLOR LOUISE H. , GREEN DANIEL J.
Published: August 2020

Purpose

We studied individual variability in exercise responses in twins. We hypothesized that 1) endurance (END) training would reduce fat mass whereas resistance (RES) training would increase lean mass, 2) individuals who did not respond to one modality would respond to the other, and 3) cross-sectional heritability estimates would be higher than estimates based on training responses.

Methods

DXA was undertaken in 84 same-sex untrained twins (30 monozygotic [MZ], 12 dizygotic [DZ]). Participants underwent 3 months of END and RES training, separated by 3 months washout. Twins trained in pairs.

Results

RES (P < 0.001) and END (P = 0.002) increased lean mass, with a greater change in RES (P < 0.001). Similarly, RES (P = 0.04) and END (P = 0.006) decreased fat mass. Eighty-four percent of subjects responded positively to RES for lean mass and 58% to END (P < 0.001). For fat mass, RES and END induced 56% and 66% responder rates, respectively (P = 0.28). Cross-sectional intraclass correlations, used to assess the similarity in twin responses, were higher for MZ than DZ pairs for all variables. Following training, only MZ pairs were significantly correlated (P < 0.001) for change in lean mass to RES.

Conclusion

To our knowledge, this study is the first to report individual responsiveness in body composition to both RES and END in the same subjects. Although RES and END induced favorable changes in fat mass, RES was superior for lean mass. The frequency of lean mass responders to RES exceeded that for END, whereas response rates for fat mass were similar. Cross-sectional heritability estimates were higher than training response estimates, and shared environment had the largest influence on changes in body composition. This study suggests that exercise professionals should consider modality and environmental factors when optimizing exercise interventions.
Coingestion of Carbohydrate and Protein on Muscle Glycogen Synthesis after Exercise: A Meta-analysis
Authors: MARGOLIS LEE M. , ALLEN JILLIAN T. , HATCH-MCCHESNEY ADRIENNE , PASIAKOS STEFAN M.
Published: August 2020

Introduction/Purpose

Evidence suggests that carbohydrate and protein (CHO-PRO) ingestion after exercise enhances muscle glycogen repletion to a greater extent than carbohydrate (CHO) alone. However, there is no consensus at this point, and results across studies are mixed, which may be attributable to differences in energy content and carbohydrate intake relative to body mass consumed after exercise. The purpose of this study was determine the overall effects of CHO-PRO and the independent effects of energy and relative carbohydrate content of CHO-PRO supplementation on postexercise muscle glycogen synthesis compared with CHO alone.

Methods

Meta-analysis was conducted on crossover studies assessing the influence of CHO-PRO compared with CHO alone on postexercise muscle glycogen synthesis. Studies were identified in a systematic review from PubMed and Cochrane Library databases. Data are presented as effect size (95% confidence interval [CI]) using Hedges’ g. Subgroup analyses were conducted to evaluate effects of isocaloric and nonisocaloric energy content and dichotomized by median relative carbohydrate (high, ≥0.8 g·kg−1⋅h−1; low, <0.8 g·kg−1⋅h−1) content on glycogen synthesis.

Results

Twenty studies were included in the analysis. CHO-PRO had no overall effect on glycogen synthesis (0.13, 95% CI = −0.04 to 0.29) compared with CHO. Subgroup analysis found that CHO-PRO had a positive effect (0.26, 95% CI = 0.04–0.49) on glycogen synthesis when the combined intervention provided more energy than CHO. Glycogen synthesis was not significant (−0.05, 95% CI = −0.23 to 0.13) in CHO-PRO compared with CON when matched for energy content. There was no statistical difference of CHO-PRO on glycogen synthesis in high (0.07, 95% CI = −0.11 to 0.22) or low (0.21, 95% CI = −0.08 to 0.50) carbohydrate content compared with CHO.

Conclusion

Glycogen synthesis rates are enhanced when CHO-PRO are coingested after exercise compared with CHO only when the added energy of protein is consumed in addition to, not in place of, carbohydrate.
In vitro comparison of two types of digital X-ray sensors for proximal caries detection validated by micro-computed tomography
Authors: Heck Katrin , Litzenburger Friederike , Ullmann Verena , Hoffmann Lea , Kunzelmann Karl-Heinz
Published: August 2020

Objectives:

We aimed to compare the diagnostic accuracy of two intraoral digital X-ray sensors—the charged-coupled device (CCD) and complementary metal-oxide-semiconductor (CMOS)—for proximal caries detection in permanent molar and premolar teeth. Micro-CT served as the reference standard.

Methods:

250 samples were mounted in three-dimensional (3D)-printed phantoms, and their proximal surfaces were evaluated by ICDAS criteria directly to create a balanced sample. Bitewing radiography was conducted using 3D-constructed X-ray phantoms with a CCD sensor at a 0.08 s and a CMOS sensor at 0.12 and 0.16 s exposure time. Two examiners determined the diagnostic decisions twice at appropriate intervals. Three diagnostic thresholds for sound surfaces and enamel and dentin caries were defined and presented in a cross-table. Sensitivity and specificity values and overall accuracy were calculated, and receiver operating curves were generated and compared. Reliability assessment was performed using linear weighted κ statistics.

Results:

The overall accuracies between the reference standard and different sensors and exposure times were 63.1% (CCD), 67.1% (CMOS sensor at 0.12 s) and 70.7% (CMOS sensor at 0.08 s). High specificity but low sensitivity values were found for all examination conditions at all thresholds. The area under the curve comparison values revealed no significant difference between sensor types and exposure times. Linear-weighted κ analysis revealed almost perfect agreement for all assessments.

Conclusion:

No significant difference was found for diagnostic performance of proximal caries detection between the different sensors and exposure times. The increased exposure time did not lead to a significant diagnostic benefit.
Queue analysis of public healthcare system to reduce waiting time using flexsim 6.0
Authors: Amalia Putri , Cahyati Nur
Published: August 2020

Public healthcare is a health service facility from the government at a low cost. The problem is the long queue, which makes long patients’ waiting times. The patients are waiting for a maximum of more than 3 hours in the general polyclinic. Besides, the registration counter is almost busy all the time. The utilization is about 96.96%. Therefore, the objective of this research is to reduce the patients’ waiting time using the simulation method. Flexsim 6.0 software is employed to develop the public healthcare system and also develop some alternatives to improve the problem. The simulation model has been verified and validated. The result shows the waiting time is decreased by more than 80% by adding the resource in the registration counter. For managerial insight, this research could help the public healthcare system in satisfying the patients.