bluuebunny/crossref_metadata_2025 huggingface dataset:
Nest cavity reuse by the cooperatively breeding Acorn Woodpecker
Authors: Koenig Walter D , Hallock Eve M , Weber David J , Walters Eric L
Published: May 2021

Although primary cavity-nesting species are capable of excavating new cavities, they often reuse old ones. To determine potential factors driving such reuse, we studied nest-cavity reuse in the Acorn Woodpecker (Melanerpes formicivorus), a cooperatively breeding species that reuses old cavities for 57.2% of nests at Hastings Reservation in central coastal California, USA. We found no evidence for significant fitness costs or benefits of cavity reuse compared to using newly constructed cavities. In contrast, several lines of evidence supported a role for constraints on both cavity reuse and on new cavity construction. The main constraint on reuse was cavities failing to survive from one year to the next, usually because the limb fell apart, filled with water, or was usurped by another species. Evidence that constraints on new cavity construction may be important included more frequent cavity reuse when groups renested and use of artificial cavities when they were experimentally provided. Nest-cavity reuse in this population appears to be driven primarily by constraints, including the energetic costs and time required to excavate a new cavity, rather than fitness consequences, even though Acorn Woodpeckers regularly excavate small holes in trees for acorn storage and the energetic costs of new cavity construction are apparently insufficient to significantly depress reproductive success. Constraints play a significant role in cavity reuse and may affect both the intraspecific and interspecific frequency of cavity reuse among facultative excavating species.
Current favourable 10-year outcome of patients with early rheumatoid arthritis: data from the ESPOIR cohort
Authors: Combe Bernard , Rincheval Nathalie , Berenbaum Francis , Boumier Patrick , Cantagrel Alain , Dieude Philippe , Dougados Maxime , Fautrel Bruno , Flipo René-Marc , Goupille Philippe , Mariette Xavier , Saraux Alain , Schaeverbeke Thierry , Sibilia Jean , Vittecoq Olivier , Daurès Jean-Pierre
Published: May 2021

Objective

To report the 10-year outcome of an inception cohort of patients with early rheumatoid arthritis (RA), the ESPOIR cohort, and predictors of outcome.

Methods

From 2003 to 2005, 813 patients were included if they had early arthritis (<6 months) with a high probability of RA and had never been prescribed DMARDs. Multivariate analysis was used to evaluate predictors of outcome.

Results

In total, 521 (64.1%) RA patients were followed up for 10 years; 35 (4.3%) died, which appears to be similar to the French general population. Overall, 480 (92.1%) patients received a DMARD; 174 (33.4%) received at least one biologic DMARD, 13.6% within 2 years. At year 10, 273 (52.4%) patients were in DAS28 remission, 40.1% in sustained remission, 14.1% in drug-free remission, 39.7% in CDAI remission. Half of the patients achieved a health assessment questionnaire-disability index (HAQ-DI) < 0.5. SF-36 physical component and pain were well controlled. Structural progression was weak, with a mean change from baseline in modified Sharp score of 11.0  (17.9). Only 34 (6.5%) patients required major joint surgery. A substantial number of patients showed new comorbidities over 10 years. Positivity for anti-citrullinated peptides antibodies (ACPA) was confirmed as a robust predictor of long-term outcome.

Conclusions

We report a very mild 10-year outcome of a large cohort of patients with early RA diagnosed in the early 2000s, which was much better than results for a previous cohort of patients who were recruited in 1993. This current favourable outcome may be related to more intensive care for real-life patients.
Drug survival of anakinra and canakinumab in monogenic autoinflammatory diseases: observational study from the International AIDA Registry
Authors: Sota Jurgen , Rigante Donato , Cimaz Rolando , Cattalini Marco , Frassi Micol , Manna Raffaele , Sicignano Ludovico Luca , Verrecchia Elena , Aragona Emma , Maggio Maria Cristina , Lopalco Giuseppe , Emmi Giacomo , Parronchi Paola , Cauli Alberto , Wiesik-Szewczyk Ewa , Hernández-Rodríguez José , Gaggiano Carla , Tarsia Maria , Mourabi Mariam , Ragab Gaafar , Vitale Antonio , Fabiani Claudia , Frediani Bruno , Lamacchia Vittoria , Renieri Alessandra , Cantarini Luca
Published: May 2021

Objectives

To investigate survival of IL-1 inhibitors in monogenic autoinflammatory disorders (mAID) through drug retention rate (DRR) and identify potential predictive factors of drug survival from a real-life perspective.

Patients and methods

Multicentre retrospective study analysing patients affected by the most common mAID treated with anakinra or canakinumab. Survival curves were analysed with the Kaplan-Meier method. Statistical analysis included a Cox-proportional hazard model to detect factors responsible for drug discontinuation.

Results

Seventy-eight patients for a total of 102 treatment regimens were enrolled. The mean treatment duration was 29.59 months. The estimated DRR of IL-1 inhibitors at 12, 24 and 48 months of follow-up was 75.8%, 69.7% and 51.1%, respectively. Patients experiencing an adverse event had a significantly lower DRR (P=0.019). In contrast, no significant differences were observed between biologic-naïve patients and those previously treated with biologic drugs (P=0.985). Patients carrying high-penetrance mutations exhibited a significantly higher DRR compared with those with low-penetrance variants (P=0.015). Adverse events were the only variable associated with a higher hazard of treatment withdrawal [hazard ratio (HR) 2.573 (CI: 1.223, 5.411), P=0.013] on regression analysis. A significant glucorticoid-sparing effect was observed (P<0.0001).

Conclusions

IL-1 inhibitors display an excellent long-term effectiveness in terms of DRR, and their survival is not influenced by the biologic line of treatment. They display a favourable safety profile, which deserves, however, a close monitoring given its impact on treatment continuation. Special attention should be paid to molecular diagnosis and mutation penetrance, as patients carrying low-penetrance variants are more likely to interrupt treatment.
Comparison of a traditional bovine respiratory disease control regimen with a targeted program based upon individualized risk predictions generated by the Whisper On Arrival technology
Authors: Nickell Jason S , Hutcheson John P , Renter David G , Amrine David A
Published: May 2021

The study objective was to determine if cattle health and performance comparing a targeted bovine respiratory disease (BRD) control program based on individualized risk prediction generated by a novel technology (Whisper On Arrival) was superior to a negative control (no metaphylaxis) yet no different than a positive control (conventional BRD control; 100% application). Across four study sites, auction market-derived beef calves were randomly allocated to one of four BRD control treatment groups: 1) Negative control (Saline), 2) Positive control (Tildipirosin [TIL] to 100% of the group), 3) Whisper-high (±TIL based on conservative algorithm threshold), and 4) Whisper-low (±TIL based on aggressive algorithm threshold). Within either Whisper On Arrival group, only calves predicted to be above the algorithm threshold by the technology (determined a priori) were administered TIL leaving the remainder untreated. Cattle were followed to either a short-term timepoint (50 or 60 d; health outcomes, all sites; feed performance outcomes, two sites) or to closeout (two sites). Data were analyzed as a completely randomized block design separately at each site. Across all sites, BRD control antibiotic use was reduced by 11% to 43% between the two Whisper On Arrival treatment groups compared to the positive control. The positive control and both Whisper On Arrival groups reduced (P ≤ 0.05) BRD morbidity compared to negative controls at both the short-term timepoint at three of the four sites and at closeout at one of two sites. The positive control and both Whisper-managed groups had improved (P ≤ 0.05) average daily gain (ADG), dry-matter intake (DMI), and feed efficiency compared to negative controls at the short-term timepoint at one of two sites. At closeout, the positive control and both Whisper-managed groups improved (P ≤ 0.05) ADG (deads-in) compared to the negative control at one of the two sites. At one of two sites, the positive control and the Whisper-high group displayed an improvement (P ≤ 0.05) in hot carcass weight compared to the negative control. The Whisper On Arrival technology maintained the benefits of a conventional BRD control program yet reduced BRD control antibiotic use by 11% to 43%. This technology maintained the benefits of a conventional BRD control program while reducing antibiotic costs to the producer and supporting judicious antimicrobial use.
Isoflurane Suppresses Hippocampal High-frequency Ripples by Differentially Modulating Pyramidal Neurons and Interneurons in Mice
Authors: Zhao Wenling , Zhao Shuai , Zhu Tao , Ou Mengchan , Zhang Donghang , Sun Huaiqiang , Liu Jin , Chen Xiangdong , Hemmings Hugh C. , Zhou Cheng
Published: May 2021

Background

Isoflurane can induce anterograde amnesia. Hippocampal ripples are high-frequency oscillatory events occurring in the local field potentials of cornu ammonis 1 involved in memory processes. The authors hypothesized that isoflurane suppresses hippocampal ripples at a subanesthetic concentration by modulating the excitability of cornu ammonis 1 neurons.

Methods

The potencies of isoflurane for memory impairment and anesthesia were measured in mice. Hippocampal ripples were measured by placing recording electrodes in the cornu ammonis 1. Effects of isoflurane on the excitability of hippocampal pyramidal neurons and interneurons were measured. A simulation model of ripples based on the firing frequency of hippocampal cornu ammonis 1 neurons was used to validate the effects of isoflurane on neuronal excitability in vitro and on ripples in vivo.

Results

Isoflurane at 0.5%, which did not induce loss of righting reflex, impaired hippocampus-dependent fear memory by 97.4 ± 3.1% (mean ± SD; n = 14; P < 0.001). Isoflurane at 0.5% reduced ripple amplitude (38 ± 13 vs. 42 ± 13 μV; n = 9; P = 0.003), rate (462 ± 66 vs. 538 ± 81 spikes/min; n = 9; P = 0.002) and duration (36 ± 5 vs. 48 ± 9 ms; n = 9; P < 0.001) and increased the interarrival time (78 ± 7 vs. 69 ± 6 ms; n = 9; P < 0.001) and frequency (148.2 ± 3.9 vs. 145.0 ± 2.9 Hz; n = 9; P = 0.001). Isoflurane at the same concentration depressed action potential frequency in fast-spiking interneurons while slightly enhancing action potential frequency in cornu ammonis 1 pyramidal neurons. The simulated effects of isoflurane on hippocampal ripples were comparable to recordings in vivo.

Conclusions

The authors’ results suggest that a subanesthetic concentration of isoflurane can suppress hippocampal ripples by differentially modulating the excitability of pyramidal neurons and interneurons, which may contribute to its amnestic action.

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Effects of preoperative serum vitamin D levels on early clinical function outcomes and the moderate-to-severe pain prevalence in postmenopausal women after primary total knee arthroplasty
Authors: Song Yu , Liu Sheng-Fu , Wu Zhong , Wang Miao , Cong Rui-Jun , Tao Kun
Published: May 2021

Objective:

To investigate the impact of vitamin D levels on early clinical function outcomes and the potential risk factors of moderate-to-severe pain prevalence in postmenopausal women after primary total knee arthroplasty (TKA).

Methods:

From April 2017 to December 2019, 226 women were retrospectively recruited. The women were divided into two groups based on their preoperative serum 25-hydroxyvitamin D levels: (1) vitamin D-sufficient group (≥30 ng/mL); (2) vitamin D-deficient group (<30 ng/mL). The visual analog scale, Western Ontario and McMaster Arthritis Index score, and Knee Society Score were used to evaluate clinical outcomes. Risk factors for developing postoperative moderate-to-severe knee pain were studied using multivariate binary logistic regression analyses.

Results:

There was no significant difference in preoperative clinical function assessment between the two groups. The difference in postoperative Western Ontario and McMaster Arthritis Index score between the two groups was statistically significant (15.3 ± 0.7 vs 15.6 ± 0.7: P = 0.02). However, the differences in postoperative visual analog scale and Knee Society Score scores between the two groups were not significant (P > 0.05). The incidence of postoperative moderate-to-severe pain was 16.4% (95% CI 11.8%-21.9%). Multivariate logistic regression analysis revealed that vitamin D deficiency, smoking, and high body mass index were potential risk factors for moderate-to-severe knee pain in postmenopausal women early after TKA (P < 0.05).

Conclusion:

Preoperative vitamin D deficiency may adversely affect early functional outcomes in postmenopausal women after TKA. In addition, vitamin D deficiency, smoking, and high body mass index were independent risk factors for moderate-to-severe knee pain after surgery.
Leisure-Time Physical Activity and General Health Mitigate Effects of Job Demands on Nonrestorative Sleep
Authors: Rusch Lisa M. , Swede Helen , Dugan Alicia G. , Cherniack Martin G. , Barnes-Farrell Janet , Cavallari Jennifer M.
Published: May 2021

Objective:

We sought to determine if leisure-time physical activity (LTPA) modified the adverse relationship between high job demands and nonrestorative sleep (NRS).

Methods:

We conducted a multivariate logistic regression analysis among workers from the cross-sectional National Healthy Worksite Project (n = 4683) using self-report Likert-Scale data on psychological and physical demands of jobs, LTPA and general health in relation to NRS.

Results:

Not engaging in LTPA was associated with NRS for workers with jobs at the lowest or highest levels of the physical demand scale (OR 1.64, 95% CI: 0.96–2.81, OR 2.06, 95% CI: 0.95–4.45; respectively) in comparison to those who met LTPA recommendations. When assessing psychological demands, poor general health was associated with NRS at all levels of the scale independent of LTPA.

Conclusions:

LTPA may reduce NRS for workers with jobs at either extreme of physical demands.
Analysis of related risk factors of lung metastasis after laparoscopic radical hysterectomy of cervical cancer
Authors: Henglian Liu , Jiajun Wang , Caixia Wang , Gang Lu , Min Xia
Published: May 2021

To explore the risk factors of lung metastasis in patients after laparoscopic radical hysterectomy (LRH) of cervical cancer (CC).

The clinical data of CC patients with clinical stage of IA1–IIA2 diagnosed in our hospital from April 2007 to October 2015 were collected. According to the situation of metastasis, the patients were divided into lung metastasis (n = 73) and non-lung metastasis group (n = 2076). The clinical data were compared between 2 groups, and logistic stepwise regression model was used to analyze the risk factors of lung metastasis in patients with CC after LRH.

The incidence of lung metastasis after LRH of CC was 3.39%, and 67.13% of patients with lung metastases had no obvious clinical symptoms. 15.06% patients had lung metastasis in the first year, 38.35% in the second year, 43.83% in the third year and later. The postoperative lung metastasis of CC was related to tumor diameter (P < .001), pathological type (P < .001), interstitial invasion depth (P < .001), pelvic lymph node metastasis (PLNM, P < .001), vascular tumor thrombus (P = .011), tumor uterine invasion (P = .002), and abnormal preoperative tumor markers (P = .015). However, it was not related to age, clinical stage, tumor growth pattern, tumor differentiation, and para-aortic lymph node metastasis (P > .05). Logistic regression analysis revealed non-squamous cell carcinoma (P = .022), tumor diameter ≥4 cm (P = .008), interstitial invasion depth >2/3 (P = .003), PLNM (P = .007), and tumor uterine invasion (P = .037) is an independent risk factor for lung metastasis after LRH of CC.

Non-squamous cell carcinoma, tumor diameter ≥4 cm, tumor interstitial invasion depth >2/3, PLNM, and tumor uterine invasion are independent risk factors for lung metastasis after LRH of CC.
Comparisons between Locomat and Walkbot robotic gait training regarding balance and lower extremity function among non-ambulatory chronic acquired brain injury survivors
Authors: Lee Hoo Young , Park Jung Hyun , Kim Tae-Woo
Published: May 2021

Lower limb rehabilitation exoskeleton robots connect with the human body in a wearable way and control the movement of joints in the gait rehabilitation process. Among treadmill-based lower limb rehabilitation exoskeleton robots, Lokomat (Hocoma AG, Volketswil, Switzerland) has 4 actuated joints for bilateral hips and knees whereas Walkbot (P&S Mechanics, Seoul, Korea) has 6 bilateral actuated joints for bilateral hips, knees, and ankles. Lokomat and Walkbot robotic gait training systems have not been directly compared previously. The present study aimed to directly compare Lokomat and Walkbot robots in non-ambulatory chronic patients with acquired brain injury (ABI).

The authors conducted a single-center, retrospective, cross-sectional study of 62 subjects with ABI who were admitted to the rehabilitation hospital. Patients were divided into 2 groups: Lokomat (n = 28) and Walkbot (n = 34). Patients were subjected to robot-assisted gait training (RAGT) combined with conventional physical therapy for a total of 14 (8–36) median (interquartile range) sessions. Baseline characteristics, including age, sex, lag time post-injury, ABI type, paralysis type, intervention sessions, lower extremity strength, spasticity, and cognitive function were assessed. Functional ambulation category (FAC) and Berg balance scale (BBS) were used for outcome measures.

There were no significant differences in baseline characteristics between the groups. Baseline FAC score was 1 (0–2) in Lokomat and 1 (0–1) in Walkbot group. After the intervention, FAC scores improved significantly to 2 (1–3) in both groups (P < .05). Lokomat and Walkbot groups showed significantly enhanced BBS from 5 (2.75–24.25) and 15 (4–26.5) to 15 (4–26.5) and 22 (12–40), respectively (P < .05). Degree of improvements in both group were not significantly different with regard to balance (P = .56) and ambulatory ability (P = .74).

This study indicates that both Locomat and Walkbot robotic gait training combined with conventional gait-oriented physiotherapy are promising intervention for gait rehabilitation in patients with chronic stage of ABI who are not able to walk independently.
Evaluation of the efficiency of corticosteroids in treating adult with sepsis
Authors: Li Ke-Peng , Zeng Yan-Yan , Li Li-Li , Wang Wan-Peng
Published: May 2021

Background:

Sepsis is a worldwide health problem that is a leading cause of mortality due to infection. Sepsis is prevalent in infections that are complicated with organ failure. Generally, sepsis is intricate and impaired corticosteroid metabolism leads to complex outcomes. Therefore, the provision of corticosteroids could lead to improved clinical outcomes. The effect of corticosteroids therapy in adult patients with sepsis is not well studied. Therefore, this study is an attempt to evaluate the efficacy of corticosteroids for treating adult cases of sepsis.

Methods:

We will systematically search the randomized controlled trials for potential eligible studies from online databases, which includes 5 English databases (PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Library) and 4 Chinese databases (China National Knowledge Infrastructure, WanFang Database, VIP information database, and China Biomedical Database) from their origin to March 2021. Languages were restricted to English and Chinese. Two independent authors will be screening the literature, collect, and perform data extraction and quality assessment. Data will be synthesized using appropriate statistical methods.

Results:

This study will summarize present evidence to evaluate the efficacy of corticosteroids for the treatment of adult cases of sepsis.

Conclusion:

The results of the present study will provide the latest, reliable, superior quality evidence for the clinical application of corticosteroids for treating sepsis patients.

Ethics and dissemination:

The present study will use published data and does not require ethics approval.

Protocol registration number:

March 28, 2021.osf.io/tm6sw. (https://osf.io/tm6sw/)
Advancing research for HIV prevention among African, Caribbean and Black men
Authors: Husbands Winston , Etowa Josephine , Oakes Wesley , Omorodion Francisca , Luginaah Isaac , Etowa Egbe , Ghose Bishwajit , Wong Josephine Pui-Hing
Published: May 2021

In Ontario, African, Caribbean, and Black (ACB) men account for almost 60% of the estimated number of HIV-positive people (through heterosexual contact), although they constitute less than 5% of the province's population. However, current HIV research, programming and policy in Ontario are not aligned with heterosexual ACB men's healthcare needs and interests, and fail to engage them in community responses to HIV.

weSpeak is a multisite (Ottawa, Toronto, London, and Windsor) project that is aims to:

This will be a mixed method study comprising focus groups, in-depth interviews, and a survey to meet the data objectives. All data collection activities will take place at the same time in 4 cities in 3 sequential phases:

Service providers will participate in the concept mapping exercise to review the research findings and develop program, policy, and community-based initiatives to promote resilience and meaningfully engage heterosexual ACB men in community responses to HIV survey.

This study will provide evidence on:

This study will lead to better understanding of the structural determinants and the psychosocial risk factors of HIV transmission among ACB men in Ontario which will aid in designing evidence-based intervention programs, and thereby reduce their higher vulnerability to HIV and its associated consequences.
Complications of permanent makeup procedures for the eyebrow and eyeline
Authors: Tomita Shoichi , Mori Katsuya , Yamazaki Hitomi , Mori Kaori
Published: May 2021

Japan is one of the few countries that consider the application of permanent makeup a medical procedure, and only doctors and nurses are allowed to perform this procedure. Studies on the safety and esthetic outcomes of permanent makeup procedures are not available, although there are studies that report allergies and other complications associated with permanent makeup. Thus, we aimed to study the complications and esthetic outcomes of permanent makeup.

We surveyed clients who underwent permanent eyebrow or eyeline makeup procedures at the Shibuya Mori Clinic between November 2016 and March 2020 using a paper-based questionnaire. The permanent makeup procedures involved inorganic pigments, such as iron oxide and titanium dioxide. The questionnaire consisted of 2 parts: the first part asked whether the clients had experienced persistent redness, itching, swelling, infection, or any other complications (multiple answers possible). The second part used a 5-point Likert scale to rate the clients’ satisfaction with the color, shape, and overall appearance of their permanent makeup. We retrospectively studied the clients’ responses to survey items.

A total of 1352 clients participated in the survey. The median period between the procedure and survey response was 15 days. Overall, complications were reported in 12.1% of cases. The most common complication for each type of procedure was itching for eyebrow procedures (8.2%) and swelling for eyeline procedures (13.2%). Infections were reported in 3 cases (0.2%). None of the post-procedure symptoms persisted until the time of this study. The Likert scale measurements revealed that 89.6% of subjects were satisfied with the aesthetic outcome of their permanent makeup procedure(s).

We believe that all symptoms observed in this study were due to needle insertion. No allergies were observed, and the infection rate was quite low (0.2%). Thus, our results suggest that permanent makeup procedures are safe and are associated with high client satisfaction. We must note that the appropriate environment, equipment, and techniques are important prerequisites.
Uracil-tegafur vs fluorouracil as postoperative adjuvant chemotherapy in Stage II and III colon cancer
Authors: Chen Po-Huang , Wu Yi-Ying , Lee Cho-Hao , Chung Chi-Hsiang , Chen Yu-Guang , Huang Tzu-Chuan , Yeh Ren-Hua , Chang Ping-Ying , Dai Ming-Shen , Lai Shiue-Wei , Ho Ching-Liang , Chen Jia-Hong , Chen Yeu-Chin , Hu Je-Ming , Yang Sung-Sen , Chien Wu-Chien
Published: May 2021

We conducted a population-based cohort study enrolling patients with Stage II and III colon cancer receiving postoperative adjuvant chemotherapy with uracil and tegafur (UFT) or fluorouracil (5-FU) from the Taiwan National Health Insurance Research Database from 2000 to 2015. The outcomes of the current study were disease-free survival (DFS) and overall survival (OS). Hazard ratios (HRs) were calculated by multivariate Cox proportional hazard regression models. We compared our effectiveness results from the literature by meta-analysis, which provided the best evidence. Severe adverse events were compared in meta-analysis of reported clinical trials. In the nationwide cohort study, UFT (14,486 patients) showed DFS similar to postoperative adjuvant chemotherapy (adjusted HR 1.037; 95% confidence interval [CI] 0.954–1.126; P = .397) and OS (adjusted HR 0.964; 95% CI 0.891–1.041; P = .349) compared with the 5-FU (866 patients). Our meta-analysis confirmed the similarity of effectiveness and found the incidence of leucopaenia was statistically significantly reduced in UFT (risk ratio 0.12; 95% CI 0.02–0.67; I

2
 = 0%). Through our analysis, we have confirmed that UFT is a well-tolerated adjuvant therapy choice, and has similar treatment efficacy as 5-FU in terms of DFS and OS in patients with Stage II and III colon cancer.
A breastfeeding woman with spontaneous coronary artery dissection and possible takotsubo syndrome
Authors: Takeuchi Makoto , Okada Takenori , Ikegami Yuki , Nakamoto Yumiko , Idei Naomi , Ohashi Norihiko
Published: May 2021

Rationale:

The relationship between spontaneous coronary artery dissection (SCAD) and takotsubo syndrome (TTS) remains unclear. Coexistence of SCAD and TTS has been reported in the literature. However, the relationship between these two diseases has not yet been elucidated.

Patient concerns:

A 36-year-old breastfeeding woman was brought to our hospital 52 days after cesarean section because of discomfort in her left arm and convulsions.

Diagnoses:

She was diagnosed of acute myocardial infarction (AMI). The convulsions were attributed to lethal arrhythmia.

Interventions:

An immediate coronary angiography revealed that her left anterior descending artery (LAD) was Type 2a SCAD, but with no flow limitation. In addition, a 12-lead electrocardiogram (ECG) revealed improvement in ST-elevation. We chose the conservative treatment according to the patient's needs.

Outcomes:

Conservative treatment was unsuccessful. She developed another acute myocardial infarction requiring another percutaneous coronary intervention (PCI) during hospitalization. From the course of hospitalization, we suspected the coexistence of SCAD and TTS.

Lessons:

When we treat patients with SCAD, we should consider the possibility of coexistence of TTS and confirm left ventricular wall motion. Patients with SCAD may require invasive treatment, hence, should be monitored for a while. An urgent strategy for managing patients with SCAD who require PCI should be established.
Hypopharyngeal spindle cell lipoma
Authors: Liang Zheng , Zang Yiqing , Jing Zhibin , Zhang Yujie , Cao Hui , Zhou Huifang
Published: May 2021

Rationale:

Spindle cell lipoma is a rare, uncommon type of benign lipomatous tumor, a distinct group of lipomas composed of mature adipocytes, uniform spindle cells, and multinucleated giant cells associated with ropey collagen. Immunohistochemically, spindle cell lipoma is characterized by the diffuse expression of CD34.

Patient concerns:

We present a rare case of a 56-year-old man who complained of vomiting out of a smooth and giant mass in the oral cavity provoked by an intra-abdominal pressure increase. Oral examination revealed an elongated mass protruding from the mouth. Computed tomography of the patient showed a mass from left pyriform to oral cavity, with 2.38 × 2.78 × 16.86 cm in size. The flexible fiberscope showed that the pedicle of the elongated mass originated from the posterior wall of the hypopharynx, corresponding to the left pyriform fossa.

Diagnosis:

Histopathologically, the tumor was mainly composed of hyperplastic adipocytes, admixed with small blood vessels, and scattered inside adipose tissue spindle cells. The immunohistochemical profile revealed positivity of spindle cells for CD34, negativity for S100, and low proliferation with Ki67, which confirmed the diagnosis of spindle cell lipoma and revealed its benign behavior.

Interventions:

The patient underwent hypopharyngeal mass resection using transoral suspension laryngoscopy.

Outcomes:

No recurrence was found after 5 months of follow-up.

Lessons:

Spindle cell lipoma is difficult to diagnose early because of slow growth and subtle symptomatology. This entity should be differentiated from several benign or malignant subtypes of lipomas, including liposarcomas. In this case, the spindle cell lipoma is large and originates from the hypopharynx, which is a rare entity and presents with atypical symptoms. This case gave rise to further studies on the clinical and pathologic characteristics of this tumor in the future.
Application and side effects of blood flow restriction technique
Authors: de Queiros Victor Sabino , Dantas Matheus , Neto Gabriel Rodrigues , da Silva Luiz Felipe , Assis Marina Gonçalves , Almeida-Neto Paulo Francisco , Dantas Paulo Moreira Silva , Cabral Breno Guilherme de Araújo Tinôco
Published: May 2021

The physiological benefits of applying blood flow restriction (BFR) in isolation or in the presence of physical exercise have been widely documented in the scientific literature. Most investigations carried out under controlled laboratory conditions have found the technique to be safe. However, few studies have analyzed the use of the technique in clinical settings.

To analyze how the BFR technique has been applied by professionals working in the clinical area and the prevalence of side effects (SEs) resulting from the use of this technique.

This is a cross-sectional study. A total of 136 Brazilian professionals who perform some function related to physical rehabilitation, sports science, or physical conditioning participated in this study. Participants answered a self-administered online questionnaire consisting of 21 questions related to the professional profile and methodological aspects and SEs of the BFR technique.

Professionals reported applying the BFR technique on individuals from different age groups from youth (≤18 years; 3.5%) to older adults (60–80 years; 30.7%), but mainly on people within the age group of 20 to 29 years (74.6%). A total of 99.1% of the professionals coupled the BFR technique with resistance exercise. Their main goals were muscle hypertrophy and physical rehabilitation. The majority (60.9%) of interviewees reported using BFR in durations of less than 5 minutes and the pressure used was mainly determined through the values of brachial blood pressure and arterial occlusion. Moreover, 92% of professionals declared observing at least 1 SE resulting from the BFR technique. Most professionals observed tingling (71.2%) and delayed onset of muscle soreness (55.8%). Rhabdomyolysis, fainting, and subcutaneous hemorrhaging were reported less frequently (1.9%, 3.8%, and 4.8%, respectively).

Our findings indicate that the prescription of blood flow restriction technique results in minimal serious side effects when it is done in a proper clinical environment and follows the proposed recommendations found in relevant scientific literature.
Correlation between 25-hydroxyvitamin D level and arterial elasticity in middle-aged and elderly cadres in Guiyang, China
Authors: Shi Lan , Zhang Qiao , Song Sai-Nan , Ma Lin , Chang Qing , Zhang Shuang-Yun
Published: May 2021

There is evidence that serum 25-hydroxyvitamin D [25-(OH) D] levels may be associated with cardiovascular disease and its risk factors. This study aimed to investigate the relationship between 25-(OH) D levels and blood pressure (BP), blood lipids, and arterial elasticity in middle-aged and elderly cadres in China.

In this retrospective study, we included 401 civil servants and cadres aged >42 years who underwent medical examinations at Guiyang Municipal First People's Hospital, China in 2018. The participants were assigned to deficiency (≤20 ng/mL), insufficiency (20–30 ng/mL), and sufficiency (≥30 ng/mL) groups according to 25-(OH) D levels in their blood. Demographics, brachial–ankle pulse wave velocity (baPWV), BP, ankle–brachial index (ABI), and blood lipids were compared among groups. The associations between 25-(OH) D and other parameters were evaluated using linear regression analysis.

Median (range) 25-(OH) D levels in the deficiency (n = 162), insufficiency (n = 162), and sufficiency (n = 77) groups were 15.32 (2.93–19.88), 25.12 (20.07–29.91), and 33.91 (30.23–82.42) ng/mL, respectively. There were significant differences in systolic BP, pulse pressure, baPWV (left and right sides), ABI (left side), high-density lipoprotein-cholesterol, and triglycerides (TGs; all P < .05) among groups. Multivariate linear regression revealed that TG, left baPWV, and right baPWV were significantly negatively correlated with 25-(OH) D levels (all P < .05).

In this study, 25-(OH) D levels were found to be associated with TG, left baPWV, and right baPWV values. 25-(OH) D deficiency may be associated with reduced arterial elasticity.
Bacterial extracellular vesicles affect endocrine therapy in MCF7 cells
Authors: An Jeongshin , Kim Jong Bin , Yang Eun Yeol , Kim Hye Ok , Lee Won-Hee , Yang Jinho , Kwon Hyungju , Paik Nam Sun , Lim Woosung , Kim Yoon-Keun , Moon Byung-In
Published: May 2021

Background

: The microbiome is important in the development and progression of breast cancer. This study investigated the effects of microbiome derived from Klebsiella on endocrine therapy of breast cancer using MCF7 cells. The bacterial extracellular vesicles (EVs) that affect endocrine therapy were established through experiments focused on tamoxifen efficacy.

Methods

: The microbiomes of breast cancer patients and healthy controls were analyzed using next-generation sequencing. Among microbiome, Klebsiella was selected as the experimental material for the effect on endocrine therapy in MCF7 cells. MCF7 cells were incubated with tamoxifen in the absence/presence of bacterial EVs derived from Klebsiella pneumoniae and analyzed by quantitative real-time polymerase chain reaction and Western blot.

Results

: Microbiome derived from Klebsiella is abundant in breast cancer patients especially luminal A subtype compared to healthy controls. The addition of EVs derived from K pneumoniae enhances the anti-hormonal effects of tamoxifen in MCF7 cells. The increased efficacy of tamoxifen is mediated via Cyclin E2 and p-ERK.

Conclusion

: Based on experiments, the EVs derived from K pneumoniae are important in hormone therapy on MCF7 cells. This result provides new insight into breast cancer mechanisms and hormone therapy using Klebsiella found in the microbiome.
Breast surgery for young women with early-stage breast cancer
Authors: Sun Zhi-Hong , Chen Chuang , Kuang Xin-Wen , Song Jun-Long , Sun Sheng-Rong , Wang Wei-Xing
Published: May 2021

Whether breast-conserving therapy (BCT) should be chosen as a local treatment for young women with early-stage breast cancer is controversial. This study compared the survival benefits of BCT or mastectomy in young women under 40 with early-stage breast cancer and further explored age-stratified outcomes. This study investigated whether there is a survival benefit when young women undergo BCT compared with mastectomy.

The characteristics and prognosis of white women under 40 with stage I–II breast cancer from 1988 to 2016 were analyzed using the Surveillance, Epidemiology, and End Results (SEER) database. These women were either treated with BCT or mastectomy. The log-rank test of the Kaplan–Meier survival curve and Cox proportional risk regression model were used to analyze the data and survival. The analysis was stratified by age (18–35 and 36–40 years).

A total of 23,810 breast cancer patients were included, of whom 44.9% received BCT and 55.1% underwent mastectomy, with a median follow-up of 116 months. Patients undergoing mastectomy had a higher tumor burden and younger age. By the end of the 20th century, the proportion of BCT had grown from nearly 35% to approximately 60%, and then gradually fell to 35% into the 21st century. Compared with the mastectomy group, the BCT group had improved breast cancer-specific survival (BCSS) (hazard ratio [HR] 0.917; 95% CI, 0.846–0.995, P = .037) and overall survival (OS) (HR 0.925; 95% CI, 0.859–0.997, P = .041). In stratified analysis according to the different ages, the survival benefit of BCT was more pronounced in the slightly older (36–40 years) group while there was no significant survival difference in the younger group (18–35 years).

In young women with early-stage breast cancer, BCT showed survival benefits that were at least no worse than mastectomy, and these benefits were even better in the 36 to 40 years age group. Young age may not be a contraindication for BCT.
Guangdong's experience in defeating the COVID-19
Authors: Chen Haiqian , Shi Leiyu , Zhang Yuyao , Wang Xiaohan , Sun Gang
Published: May 2021

To provide valuable experience for other countries currently fighting the COVID-19 pandemic by systematically analyzing the effects of control policies on coping with COVID-19 in Guangdong Province of China.

Integrating qualitative and quantitative methods to systematically analyze the effects of control policies on fighting COVID-19 with official data in Guangdong Province.

Between January 19, 2020 and February 26, 2020, Guangdong Province issued 6 critical control policies to cope with COVID-19 and achieved effects in the following 3-phase.

Guangdong Province implemented 6 control policies in 3-phase and finally successfully defeated the COVID-19. In the first phase, the first 4 control policies showed initial effects on COVID-19 epidemic control. In the second phase, the last 2 control policies greatly contributed to containing the COVID-19 epidemic. In the third phase, the 6 control policies completely overcame the COVID-19 in Guangdong Province, China.
Age-adjusted Charlson comorbidity index score is the best predictor for severe clinical outcome in the hospitalized patients with COVID-19 infection
Authors: Kim Do Hyoung , Park Hayne Cho , Cho Ajin , Kim Juhee , Yun Kyu-sang , Kim Jinseog , Lee Young-Ki
Published: May 2021

Aged population with comorbidities demonstrated high mortality rate and severe clinical outcome in the patients with coronavirus disease 2019 (COVID-19). However, whether age-adjusted Charlson comorbidity index score (CCIS) predict fatal outcomes remains uncertain.

This retrospective, nationwide cohort study was performed to evaluate patient mortality and clinical outcome according to CCIS among the hospitalized patients with COVID-19 infection. We included 5621 patients who had been discharged from isolation or had died from COVID-19 by April 30, 2020. The primary outcome was composites of death, admission to intensive care unit, use of mechanical ventilator or extracorporeal membrane oxygenation. The secondary outcome was mortality. Multivariate Cox proportional hazard model was used to evaluate CCIS as the independent risk factor for death.

Among 5621 patients, the high CCIS (≥ 3) group showed higher proportion of elderly population and lower plasma hemoglobin and lower lymphocyte and platelet counts. The high CCIS group was an independent risk factor for composite outcome (HR 3.63, 95% CI 2.45–5.37, P < .001) and patient mortality (HR 22.96, 95% CI 7.20–73.24, P < .001). The nomogram showed that CCIS was the most important factor contributing to the prognosis followed by the presence of dyspnea (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.16–3.83), low body mass index < 18.5 kg/m2 (HR 2.36, CI 1.49–3.75), lymphopenia (<0.8 x109/L) (HR 2.15, CI 1.59–2.91), thrombocytopenia (<150.0 x109/L) (HR 1.29, CI 0.94–1.78), anemia (<12.0 g/dL) (HR 1.80, CI 1.33–2.43), and male sex (HR 1.76, CI 1.32–2.34). The nomogram demonstrated that the CCIS was the most potent predictive factor for patient mortality.

The predictive nomogram using CCIS for the hospitalized patients with COVID-19 may help clinicians to triage the high-risk population and to concentrate limited resources to manage them.
Degradation of the Endothelial Glycocalyx Contributes to Metabolic Acidosis in Children Following Cardiopulmonary Bypass Surgery
Authors: Bangalore Harish , Carter Michael J. , Parmar Kiran , Austin Conal , Shankar-Hari Manu , Hunt Beverley J. , Tibby Shane M.
Published: May 2021

OBJECTIVES:

Cardiopulmonary bypass surgery is complicated by metabolic acidosis, microvascular dysfunction, and capillary leak. The glycocalyx—a layer of proteins and sugars lining the vascular endothelium—is degraded during cardiopulmonary bypass. We aimed to describe the kinetics of glycocalyx degradation during and following cardiopulmonary bypass. We hypothesized that cleavage of negatively charged fragments of the glycocalyx would directly induce metabolic acidosis through changes in the strong ion gap (defined using Stewart's physicochemical approach to acid-base chemistry). We also investigated whether glycocalyx degradation was associated with failure of endothelial function and cardiovascular dysfunction.

DESIGN:

Single-center prospective cohort study.

SETTING:

Twenty-two bed surgical/medical PICU.

PATIENTS:

Twenty-seven term infants and children requiring cardiopulmonary bypass surgery for the correction/palliation of congenital heart disease.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We recruited 27 patients, 5 days to 57 months old. We prospectively sampled plasma prior to, during, and following cardiopulmonary bypass at predefined time points. We measured plasma concentrations of interleukin-6 (inflammatory marker), heparan sulfate (negatively charged glycocalyx glycosaminoglycan), and syndecan-1 (neutrally charged glycocalyx protein). We defined the following outcome measures: metabolic acidosis (strong ion gap), renal dysfunction (fold change in creatinine), capillary leak (fluid bolus volume), cardiovascular dysfunction (Vasoactive Inotropic Score), and length of ventilation. In linear regression models, maximum measured heparan sulfate concentration (negatively charged) was associated with metabolic acidosis (p = 0.016), renal dysfunction (p = 0.009), and length of ventilation (p = 0.047). In contrast, maximum measured syndecan-1 concentration (neutrally charged) was not associated with these clinical endpoints (p > 0.30 for all).

CONCLUSIONS:

Our data show that metabolic acidosis (increased strong ion gap) is associated with plasma concentration of heparan sulfate, a negatively charged glycosaminoglycan cleaved from the endothelial glycocalyx during cardiopulmonary bypass. In addition, cleavage of heparan sulfate was associated with renal dysfunction, capillary leak, and global markers of cardiovascular dysfunction. These data highlight the importance of designing translational therapies to protect the glycocalyx in cardiopulmonary bypass.
Effects of Mindfulness Training on Emotion Regulation in Patients With Depression: Reduced Dorsolateral Prefrontal Cortex Activation Indexes Early Beneficial Changes
Authors: Barnhofer Thorsten , Reess Tim J. , Fissler Maria , Winnebeck Emilia , Grimm Simone , Gärtner Matti , Fan Yan , Huntenburg Julia M. , Schroeter Titus A. , Gummersbach Marie , Bajbouj Malek , Hölzel Britta K.
Published: May 2021

Objective

Mindfulness-based interventions (MBIs) have been found to be a promising approach for the treatment of recurrent courses of depression. However, little is known about their neural mechanisms. This functional magnetic resonance imaging study set out to investigate activation changes in corticolimbic regions during implicit emotion regulation.

Methods

Depressed patients with a recurrent lifetime history were randomized to receive a 2-week MBI (n = 16 completers) or psychoeducation and resting (PER; n = 22 completers). Before and after, patients underwent functional magnetic resonance imaging while labeling the affect of angry, happy, and neutral facial expressions and completed questionnaires assessing ruminative brooding, the ability to decenter from such thinking, and depressive symptoms.

Results

Activation decreased in the right dorsolateral prefrontal cortex (dlPFC) in response to angry faces after MBI (p < .01, voxel-wise family-wise error rate correction, T > 3.282; 56 mm3; Montreal Neurological Institute peak coordinate: 32, 24, 40), but not after PER. This change was highly correlated with increased decentring (r = −0.52, p = .033), decreased brooding (r = 0.60, p = .010), and decreased symptoms (r = 0.82, p = .005). Amygdala activation in response to happy faces decreased after PER (p < .01, family-wise error rate corrected; 392 mm3; Montreal Neurological Institute peak coordinate: 28, −4, −16), whereas the MBI group showed no significant change.

Conclusions

The dlPFC is involved in emotion regulation, namely, reappraisal or suppression of negative emotions. Decreased right dlPFC activation might indicate that, after the MBI, patients abstained from engaging in elaboration or suppression of negative affective stimuli; a putatively important mechanism for preventing the escalation of negative mood.

Trial Registration: The study is registered at ClinicalTrials.gov (NCT02801513; 16/06/2016).
A Systematic Review of Somatic Symptoms in School Refusal
Authors: Li Anne , Guessoum Sélim Benjamin , Ibrahim Nour , Lefèvre Hervé , Moro Marie Rose , Benoit Laelia
Published: May 2021

Objective

School refusers often display somatic symptoms that are temporally related to school attendance. The aim of this systematic review is to summarize characteristics and causes of somatic symptoms and their management in the context of school refusal. Findings of this review may help clinicians in their daily practice.

Methods

PubMed and PsycINFO databases were systematically searched (according to PRISMA guidelines) for articles mentioning somatic symptoms in school refusal by May 2020. Among 1025 identified studies, 148 were included.

Results

Unspecific somatic symptoms were frequently the first complaints in school refusal. Abdominal pain, headache, nausea, vomiting, muscular or joint ache, diarrhea, dizziness, fatigue, and palpitation were the most commonly encountered symptoms and were usually not accounted for by an identifiable physical disease. Anxiety was the most recurrent etiology found, but physicians’ lack of awareness about psychological comorbidities often delayed psychological/psychiatric referral. Successful therapies consisted of dialectical behavior therapy, anxiety management through relaxation/breathing training, and ignoring the somatic symptoms.

Conclusions

Somatic symptoms in school refusal are frequent but poorly understood. Their management could include interventions targeting anxiety, psychotherapies such as emotional awareness and expression therapy, third-wave behavioral therapies, and psychoeducation. A multidisciplinary approach through strengthened collaboration between school staff, physicians, and psychologists/psychiatrists is needed to improve well-being in children who experience somatic symptoms as related to school avoidance.