bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond Description: The Predictive Role of Affect, Memory, and Context in the Decision to Donate or Not Donate Blood
Authors: Masser Barbara , Ferguson Eamonn , Merz Eva-Maria , Williams Lisa
Published: September 2019

Background: Research on the recruitment and retention of blood donors has typically drawn on a homogeneous set of descriptive theories, viewing the decision to become and remain a donor as the outcome of affectively cold, planned, and rational decision-making by the individual. While this approach provides insight into how our donors think about blood donation, it is limited and has not translated into a suite of effective interventions. In this review, we set out to explore how a broader consideration of the influences on donor decision-making, in terms of affect, memory, and the context in which donation takes place, may yield benefit in the way we approach donor recruitment and retention. Summary: Drawing on emerging research, we argue for the importance of considering the implications of both the positive and the negative emotions that donors experience and we argue for the importance of directly targeting affect in interventions to recruit nondonors. Next, we focus on the reconstructed nature of memory and the factors that influence what we remember about an event. We discuss how these processes may impact the retention of donors and the potential to intervene to enhance donors’ recollections of their experiences. Finally, we discuss how our focus on the individual has led us to neglect the influence of the context in which donation takes place on donor behavior. We argue that the amassing of comprehensive large data sets detailing both the characteristics of the individuals and the context of their giving will ultimately allow for the more effective deployment of resources to improve recruitment and retention. Key Messages: In suggesting these directions for future research, our want is to move beyond the ways in which we have traditionally described blood donation behavior with the aim of improving our theorizing about donors while improving the translational value of our research.
Prognostic Value of Cysteine-Rich Protein 61 Combined with N-Terminal Pro-B-Type Natriuretic Peptide for Mortality in Acute Heart Failure Patients with and without Chronic Kidney Disease
Authors: Liu Chen , Liang Weihao , He Xin , Owusu-Agyeman Marvin , Wu Zexuan , Zhou Yuanyuan , Cao Yalin , Zhang Chongyu , Liu Jian , Jiang Jingzhou , Dong Bin , Xue Ruicong , Wu Dexi , Dong Yugang , Zhao Jingjing
Published: September 2019

Background: The ability of most biomarkers, such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), to predict prognosis in heart failure can be affected by the state of renal function; therefore, there is the need for a biomarker that can predict prognosis accurately without the influence of renal function. The prognostic value of cysteine-rich protein 61 (CYR61/CCN1) in acute heart failure (AHF) patients has been proven. Methods: A total of 248 patients hospitalized with AHF were recruited in this study, and serum CCN1 levels, NT-proBNP levels, and other necessary data of patients were collected upon admission. The correlation of serum CCN1 with estimated glomerular filtration rate (eGFR) was investigated, and the logistic regression model was used to investigate the prognostic value of serum CCN1 for 3-month mortality. Results: Fifty-four of 248 patients died (21.8%) during a 3-month follow-up. Serum CCN1 had no significant correlation with eGFR (rho = –0.088, p = 0.167). In the overall population and patients without chronic kidney disease, results showed that both serum CCN1 and NT-proBNP were significantly associated with 3-month mortality. In patients with chronic kidney disease, serum CCN1 was significantly associated with 3-month mortality in logistic regression analysis (odds ratio = 2.40, p = 0.002) while NT-proBNP was not. Further in tertile group comparison, in patients with chronic kidney disease, higher tertile levels of serum CCN1 had a significantly higher risk of 3-month mortality compared to the lower tertile ones (odds ratio = 4.17, p = 0.013), but that of NT-proBNP did not. Conclusion: Serum CCN1 level is not associated with eGFR, and it maintains the prognostic value in AHF patients with chronic kidney disease. CCN1 could be a potential novel prognostic biomarker in AHF patients with chronic kidney disease.
Sex Assignment and Diagnostics in Infants with Ambiguous Genitalia - A Single-Center Retrospective Study
Authors: van Zoest Martine , Bijker Else M. , Kortmann Barbara B.M. , Kempers Marlies , van Herwaarden Antonius E. , van der Velden Janiëlle , Claahsen-van der Grinten Hedi L.
Published: September 2019

Ambiguous genitalia affect 1 in 5,000 live births. Diagnostic procedures can be time-consuming, and often the etiology cannot be established in this group of individuals with differences/disorders of sex development (DSD). We aimed to evaluate the clinical presentation, sex assignment, and diagnostic workup in these patients. In this retrospective observational study, we included infants who presented with ambiguous genitalia from 2006 to 2016 at the Radboudumc (Radboud University Medical Center) DSD expert center. Relevant data were collected from patient records. Sixty-two 46,XY and fourteen 46,XX individuals were included. Sex was assigned in the first days of life and based on the combination of presence or absence of a uterus on ultrasound, AMH level, palpable gonads, and the karyotype (corresponded in 96% of the patients). In 86% of the 46,XX DSD subjects, a diagnosis was made, whereas in only 15/62 (24%) of the 46,XY DSD individuals, etiology was determined. In 52 individuals, genetic testing was performed resulting in a diagnosis in 24 patients (46%). AMH, hCG-stimulated testosterone, and dihydrotestosterone levels contributed to determining etiology, whilst basal testosterone and basal dihydrotestosterone did not. Establishing a diagnosis in infants with ambiguous genitalia is complex and challenging; this study aids to enhance this process and improve current practice.
A Diagnostic Approach to Endometrial Cytology by Means of Liquid-Based Preparations
Authors: Norimatsu Yoshiaki , Yanoh Kenji , Hirai Yasuo , Kurokawa Tetsuji , Kobayashi Tadao K. , Fulciniti Franco
Published: September 2019

The adoption of endometrial cytology as a diagnostic procedure has been hampered in the past by difficulties arising in interpreting the cellular findings due to a number of factors (such as excess blood, cellular overlapping, and the complex physiology of endometrium). Recently, the use of liquid-based cytology (LBC), with its ability to remove blood and mucus and to distribute cells uniformly in a thin layer on the slide, has provided an opportunity to reevaluate the role of endometrial cytology. LBC samples are easier to screen compared to conventional ones, due to a smaller screening area and an excellent quality of cell preparations. LBC by using peculiar cytoarchitectural features is a useful tool in the cellular diagnosis and follow-up of abnormalities, which, however, remains complementary to histopathology and to the emerging molecular diagnostic cytopathology. This review discusses these various entities and takes into consideration the ancillary techniques that may be useful in the diagnostic procedure. Herein, we also summarize the process and rationale by which updates were made to the standardized terminology in 2018 and outline the contents of the new Bethesda-style classification (the Yokohama system) for the endometrial cytology.
The Effect of Depression on Poor Glycemic Control in Adults with Type 2 Diabetes: The Mediating Roles of Self-Efficacy and Self-Management Behaviors
Authors: Azami Golnaz , Soh Kim Lam , Sazlina Shariff-Ghazali , Salmiah Md. Said , Khosravi Afra , Aazami Sanaz , Valizadeh Reza
Published: September 2019

Background: High levels of depression and poor self-efficacy and self-management are associated with worse glycemic control, but the linkage and pathway between these variables are poorly understood. We conducted this study to investigate the hypothesis that self-efficacy and self-management mediate the influence of depression on poor glycemic control. Methods: We studied a purposive sample of 142 adults with type 2 diabetes attending a public clinic in Ilam, Iran. Hierarchical linear regression analysis and structural equation modeling were used to explore the relationships among the variables of interest. Result: Depression directly and negatively affects self-efficacy and indirectly affects self-management behaviors, which in turn have direct effects on hemoglobin A1c (HbA1c). Self-efficacy mediates the relationship between depression and self-management behaviors. Self-efficacy and self-management behaviors partially mediate the effect of depression on HbA1c. These results confirmed that the data fit the hypothesized model very well. Conclusion: Careful monitoring of glycemic control might be important in those individuals who exhibit clinical signs of depression. Effective treatment programs should probably pay close attention to not only screening and treatment of depression but also skills training to enhance patient self-efficacy and self-management of diabetes to improve HbA1c.
SUMOylation in Neurodegenerative Diseases
Authors: Princz Andrea , Tavernarakis Nektarios
Published: September 2019

Posttranslational modifications are ubiquitous regulators of cellular processes. The regulatory role of SUMOylation, the attachment of a small ubiquitin-related modifier to a target protein, has been implicated in fundamental processes like cell division, DNA damage repair, mitochondrial homeostasis, and stress responses. Recently, it is gaining more attention in drug discovery as well. As life expectancy keeps rising, more individuals are at risk for developing age-associated diseases. This not only makes a person’s life uncomfortable, but it also places an economic burden on society. Therefore, finding treatments for age-related diseases is an important issue. Understanding the basic mechanisms in the cell under normal and disease conditions is fundamental for drug discovery. There is an increasing number of reports showing that the ageing process could be influenced by SUMOylation. Similarly, SUMOylation is essential for proper neuronal function. In this review we summarize the latest results regarding the connection between SUMOylation and neurodegenerative diseases. We highlight the significance of specific SUMO target proteins and the importance of SUMO isoform specificity.
Autosomal Recessive Alport Syndrome Unveiled by Pregnancy
Authors: Drury Erika R. , Stillman Isaac E. , Pollak Martin R. , Denker Bradley M.
Published: September 2019

Alport syndrome is a hereditary disease affecting Type IV collagen characterized by hematuria, progressive renal failure, sensorineural hearing loss, and ocular abnormalities. Most cases are X-linked and involve the COL4A5 gene with a minority of patients having autosomal recessive mutations in the COL4A3 or COL4A4 genes encoding the α3(IV) or α4(IV) chain respectively. Here, we describe the case of a 31-year-old woman who presented during pregnancy with hematuria and proteinuria and was diagnosed with autosomal recessive Alport syndrome (ARAS) post-partum. Her biopsy was notable for findings of segmental glomerulosclerosis with some collapsing features, in addition to thin basement membranes and rare “splitting”. Genetic testing identified 2 novel mutations in the COL4A4 gene: a truncating frame shift mutation c.3861delinsCTC and a missense mutation c.4708G>A (p.Glu1570Lys), both of which we assert to be pathogenic. She had normal full-term delivery without complications. This case has several unique features including the relatively mild disease phenotype and the findings of glomerular scarring with collapsing features on renal biopsy. The successful pregnancy outcome and her clinical presentation add to the growing body of evidence that ARAS can have a variable phenotype.
Nasalance in Arabic-Speaking Jordanians: A Comparative Study
Authors: Odeh Oruba M. , Madison Charles L. , Riski John E.
Published: September 2019

Objective: This investigation sought to establish nasalance scores for Jordanian Arabic (JA) speakers, to develop nasalance speech stimuli for JA speakers, and to compare JA adult nasalance scores with those of Standard American English (SAE) speakers. Subjects and Methods: Participants included normal native JA speakers (n = 100; males/females and adults/children) and adult SAE speakers (n = 49). Four speech tasks for JA speakers were developed, which included repetition of vowels, syllables, words, and sentences. Parallel speech tasks were also developed for SAE speakers. A nasometer (Nasometer II 6400; PENTAX Medical, Montvale, NJ, USA) was used to establish nasalance scores for all speakers across all speech tasks. Results: Nasalance values were established for adult and child JA speakers. The nasalance values were higher for Jordanian adults than for Jordanian children. No differences in nasalance were found between male and female Arabic speakers for nonnasal elements. JA speakers were significantly more nasal than SAE speakers on selected speech tasks. Conclusions: Nasalance values for JA speakers were established for both adults and children, and Arabic speech materials were developed. The results of this investigation add to the growing body of research documenting differences in nasalance scores for normal speakers across different languages.
Comparison of Mannequin Training Satisfaction with a Conventional Box Trainer and a Low-Fidelity Fetoscopic Surgical Simulator for Selective Fetoscopic Laser Photocoagulation
Authors: Wataganara Tuangsit , Viboonchart Sommai , Chumthup Wangcha , Chuenwattana Prakong , Pooliam Julaporn , Nawapun Katika , Phithakwatchara Nisarat
Published: September 2019

Background: A low-fidelity fetoscopic surgical simulator (FSS) for training of selective fetoscopic laser photocoagulation (SFLP) was developed. Objective: To evaluate and compare training satisfaction with an FSS and with a conventional box trainer (BT). Methods: The BT consisted of a cleaned human placenta attached to the inside of a plastic storage box with a watertight lock cover and an ultrasound-transparent rubber skin. The FSS consisted of the replica of a monochorionic twin placenta attached to the inside of a spherically shaped, ultrasound-transparent phantom. Tap water was used as an ultrasound conduction agent. Evaluation of the mannequin trainings was conducted on 8 junior maternal-fetal medicine (MFM) attending physicians and 22 MFM fellows. Training satisfaction was scored from 0 to 10 on 8 different domains. Results: The mean satisfaction score (±SD) with the FSS was higher than with the BT in all domains (p < 0.05). The fellows’ training satisfaction with the BT was greater than that of the attending physicians in 4 domains: tactile feedback, demonstration of chorionic vessels, feedback on performance, and overall value as learning aid (p < 0.05). Conclusions: As evaluated by a small group of trainees, our FSS is superior to the BT in mannequin training of SFLP. However, the BT may be more useful for trainees with limited clinical experience.
2019 European Thyroid Association Guidelines for the Treatment and Follow-Up of Advanced Radioiodine-Refractory Thyroid Cancer
Authors: Fugazzola Laura , Elisei Rossella , Fuhrer Dagmar , Jarzab Barbara , Leboulleux Sophie , Newbold Kate , Smit Jan
Published: September 2019

The vast majority of thyroid cancers of follicular origin (TC) have a very favourable outcome, but 5–10% of cases will develop metastatic disease. Around 60–70% of this subset, hence less than 5% of all patients with TC, will become radioiodine refractory (RAI-R), with a significant negative impact on prognosis and a mean life expectancy of 3–5 years. Since no European expert consensus or guidance for this challenging condition is currently available, a task force of TC experts was nominated by the European Thyroid Association (ETA) to prepare this document based on the principles of clinical evidence. The task force started to work in September 2018 and after several revision rounds, prepared a list of recommendations to support the treatment and follow-up of patients with advanced TC. Criteria for advanced RAI-R TC were proposed, and the most appropriate diagnostic tools and the local, systemic and palliative treatments are described. Systemic therapy with multikinase inhibitors is fully discussed, including recommendations on how to start it and at which dosage, on the duration of treatment, and on the management of side effects. The appropriate relationship between the specialist and the patient/family as well as ethical issues are covered. Based on the available studies and on personal experience, the experts provided 39 recommendations aimed to improve the management of advanced RAI-R TCs. Above all of them is the indication to treat and follow these patients in a specialized setting which allows the interaction between several specialists in a multidisciplinary team.
Effects of Weight Loss on Sweet Taste Preference and Palatability following Cognitive Behavioral Therapy for Women with Obesity
Authors: Nishihara Tomoe , Nozaki Takehiro , Sawamoto Ryoko , Komaki Gen , Miyata Noriyuki , Hosoi Masako , Sudo Nobuyuki
Published: September 2019

Objective: Current evidence suggests that obesity is associated with alteration of sweet taste perception. The purpose of this study was to determine if nonsurgical cognitive behavioral therapy (CBT)-based weight loss can cause a change in sweet taste perception. Methods: This case-control study consisted of 51 women aged 21–64 years. Twenty-seven with obesity or overweight were assigned to an obesity (OB) group (BMI: 29.8 ± 0.5 kg/m2) and 24 to a normal control (NC) group (BMI: 20.9 ± 0.3 kg/m2). The OB group underwent a 30-week weight loss intervention using CBT-based group therapy. The results of measurement of detection threshold, suprathreshold perceived intensity, preference, and palatability, elements of sweet taste perception, were compared before and after the intervention. Psychological variables and appetite-related hormonal levels were measured. Results: Twenty-three patients and 22 controls completed the study. The OB group showed a 14.6% weight loss after the intervention. At baseline, the OB group preferred significantly higher sucrose concentrations than did the NC group; however, this difference was no longer significant after intervention. In the OB group, persistent pleasure and reduced desire for other taste, measured by repeated exposure to sweetness, normalized after weight loss to levels comparable to those seen in the NC group. No significant difference in discriminative perception of the threshold concentration or the suprathreshold sensory value was found between the two groups before or after intervention. A significant correlation was found between the basal preferred sucrose concentration and the serum leptin level of the OB group after adjusting for confounding factors, such as BMI, depressive symptom score, and trait-anxiety scores. Conclusions: Weight loss induced by CBT-based nonsurgical intervention resulted in the normalization of the sucrose preference and palatability of women with obesity. Leptin activity may be associated with the altered sweet taste preference of people with obesity.
Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery
Authors: Barbara Maurizio , Talamonti Rita , Benincasa Anna Teresa , Tarentini Silvia , Filippi Chiara , Covelli Edoardo , Monini Simonetta
Published: September 2019

Introduction: Cochlear implantation (CI) has been reported to negatively affect vestibular function. The study of vestibular function has variably been conducted using different types of diagnostic tools. The combined use of modern, rapidly performing diagnostic tools could prove useful for standardization of the evaluation protocol. Methods: In a group of 28 subjects undergoing CI, the video head impulse test (vHIT), the cervical vestibular evoked myogenic potentials (cVEMP) and the short form of the Dizziness Handicap Inventory (DHI) questionnaire were investigated preoperatively and postoperatively (implant on and off) in both the implanted and the contralateral, nonimplanted ear. All surgeries were performed with a round window approach (RWA), except for 3 otosclerosis cases in which the extended RWA (eRWA) was used. Results: The vHIT of the lateral semicircular canal showed preoperative vestibular involvement in nearly 50% of the cases, while the 3 canals were contemporarily affected in only 14% of the cases. In all the hypofunctional subjects, cVEMP were absent. A low VOR gain in all of the investigated superior semicircular canals was found in 4 subjects (14%). In those subjects (21.7%) in whom cVEMP were preoperatively present and normal on the operated side, the absence of a response was postoperatively recorded. Discussion/Conclusion: The vestibular protocol applied in this study was found to be appropriate for distinguishing between the CI-operated ear and the nonoperated ear. In this regard, cVEMP was found to be more sensitive than vHIT for revealing a vestibular sufferance after CI, though without statistical significance. Finally, the use of RWA surgery apparently did not reduce the occurrence of signs of vestibular impairment.
Aneurysm Architecture: First in vivo Imaging of Human Cerebral Aneurysms with Extravascular Optical Coherence Tomography
Authors: Hartmann Karl , Stein Klaus-Peter , Neyazi Belal , Sandalcioglu I. Erol
Published: September 2019

Objective: The present study was conducted to explore the value of 3-dimensional microscope integrated extravascular optical coherence tomography (OCT) as the first suitable intraoperative imaging modality of cerebral aneurysm (CA) and parent vessel wall morphology. Methods: Incidental CAs (n = 16) of the anterior circulation with indication for microsurgical clipping were scanned. Results: Analysis revealed that intraoperative OCT achieved to delineate the microstructural composition of the parent vessel in all cases and the CA wall in 68.8%. Clinical relevant characteristics such as thickness, calcification, residual tunica media, and atherosclerotic plaque of CA wall could be demonstrated with high image quality approaching the spatial resolution of histopathology. Conclusion: Our findings demonstrate that intraoperative OCT may hold promise as an additional imaging tool during neurovascular procedures.
Costs Attributable to Arteriovenous Fistula and Arteriovenous Graft Placements in Hemodialysis Patients with Medicare coverage
Authors: Nordyke Robert J. , Reichert Heidi , Bylsma Lauren C. , Jackson Jenny J. , Gage Shawn M. , Fryzek Jon , Roy-Chaudhury Prabir , Lithgow Theodore
Published: September 2019

Introduction: Hemodialysis (HD) in end-stage renal disease (ESRD) patients requires vascular access (VA) through an arteriovenous fistula (AVF), a prosthetic arteriovenous graft (AVG), or a central venous catheter. While AVF or AVG is commonly used for HD, the economic implications of AVF versus AVG use have not been fully established. We describe the healthcare resource utilization and costs of AVF and AVG use for incident ESRD patients in the United States. Methods: This observational cohort study of AVF and AVG placements used data from the United States Renal Data System to identify and follow access placements. AVF and AVG placements after ESRD onset for incident patients from 2012 to 2014 with continuous Medicare primary coverage were included. All-cause and access-related Medicare costs were averaged over the placement lifetime and expressed as per dialysis-month costs. Results: The analysis included 38,035 AVF placements and 12,789 AVG placements. Total all-cause monthly costs for AVF averaged USD 8,508; mean monthly costs were USD 3,027 for inpatient (IP), USD 3,139 for outpatient (OP), USD 1,572 for physician services, and USD 770 for other care settings. Access-related monthly costs averaged USD 1,699 and represented 20% of all-cause charges for AVFs. Mean all-cause monthly costs for AVG were USD 9,605; by setting monthly costs were USD 3,811 for IP, USD 3,034 for OP, USD 1,881 for physician services and USD 879 for other care settings. Access-related monthly costs averaged USD 2,656 and represented 28% of all-cause charges for AVGs. Discussion/Conclusions: This study indicates that costs due to VA are a significant burden on Medicare budgets and on patients. The factors driving access-related utilization and costs merit attention in future research. Both optimizing process of care and discovery innovation may significantly accelerate better stewardship of available healthcare resources.
Lymphovascular Invasion Predicts Lymph Node Involvement in Small Pancreatic Neuroendocrine Tumors
Authors: Blakely Andrew M. , Lafaro Kelly J. , Li Daneng , Kessler Jonathan , Chang Sue , Ituarte Philip H.G. , Lee Byrne , Singh Gagandeep
Published: September 2019

Introduction: Pancreatic neuroendocrine tumors (p-NETS) are increasing in incidence, and prognostic factors continue to evolve. The benefit of lymphadenectomy for p-NETS ≤2 cm remains unclear. We sought to determine the significance of lymphovascular invasion (LVI) for small p-NETS. Methods: The National Cancer Database was queried for patients with p-NETS ≤2 cm and with ≥1 evaluated lymph node (LN), years 2004–2015. Demographic, clinical, and treatment characteristics were analyzed. Multivariate logistic regression was performed to identify predictors of LN positivity. Results: Among 2,499 patients identified, tumor location was delineated as the head (26%), body (18%), tail (38%), or unspecified (18%); 74% were well-differentiated versus 10% moderate, 2% poor, and 14% unknown. LVI occurred in 11%. A median of 9 LNs were evaluated; overall positivity was 18%. Mean survival was significantly longer in node-negative patients (115 vs. 95 months, log-rank p < 0.0001). LVI was the strongest predictor of node involvement (OR 10.4, p < 0.0001) when controlling for tumor size, grade, and location. Subset analysis of patients with known LVI status, grade, location, and mitoses found that LVI was more likely in the setting of moderate-to-high tumor grade, 1–2 cm size, pancreatic head location, and high mitotic rate. Among patients with ≥2 of these 4 factors, 25% were node-positive. Conclusions: Presence of LVI was the strongest predictor of node positivity. LVI on endoscopic biopsy should prompt resection and regional LN dissection to fully stage patients with small p-NETS. Patients with other high-risk factors should also be considered for resection and regional lymphadenectomy.
An Integrated Kidney Care eConsult Practice Model: Results from the iKinect Project
Authors: Ong Stephanie W. , Kaushal Amit , Pariser Pauline , Chan Christopher T.
Published: September 2019

Background: Collaborative management of kidney disease relies on coordinated and effective partnerships between multiple provider teams. Siloed care contributes to limited access between physicians, resulting in delays in the diagnosis and treatment of kidney disease and inappropriate use of healthcare resources. These gaps contribute to dissatisfied and disempowered providers and patients. Digital systems such as eConsult can support collaborative management and address these gaps, thereby streamlining the consultation and referral process between primary care physicians (PCPs) and nephrologists. In this study, we evaluated an established eConsult platform integrated with a central triage process for a network of PCPs and nephrologists. The study aimed to assess the acceptability, feasibility, and impact on access to nephrology when using eConsult integrated into the management of kidney disease between PCPs and nephrologists. Methods: We conducted a 1-year pilot study and used mixed methods to measure the acceptability and feasibility of using eConsult for the management of kidney disease. We compared eConsult and traditional referrals with respect to types of consultation, referrals, and times to response to determine impact on access to kidney care. We conducted semi-structured interviews of PCPs and nephrologists to assess physician experience. Results: From January 8, 2018, to January 11, 2019, 52 PCPs and 23 nephrologists participated in the study, with 250 traditional referrals and 106 eConsults submitted during that period. The median response time for eConsult was 15 (3–64) h, with 25% originating outside the central Toronto region. The median time to first clinic appointment from a traditional referral was 4 months (111 [61–163] days). PCP and nephrologist interviews revealed high user satisfaction, citing efficiency and timely response as key facilitators. Conclusion: The eConsult platform was acceptable, feasible, and facilitated access to nephrology care compared to traditional referrals. Physicians report improvements in physician care delivery, nephrology care gaps, patient experience, and healthcare utilization.
Prostate Volume Index Is Able to Differentiate between Prostatic Chronic Inflammation and Prostate Cancer in Patients with Normal Digital Rectal Examination and Prostate-Specific Antigen Values <10 ng/mL: Results of 564 Biopsy Naïve Cases
Authors: Porcaro Antonio B. , Tafuri Alessandro , Sebben Marco , Novella Giovanni , Processali Tania , Pirozzi Marco , Amigoni Nelia , Rizzetto Riccardo , Shakir Aliasger , Panunzio Andrea , De Michele Mario , Brunelli Matteo , Cerruto Maria Angela , Migliorini Filippo , Siracusano Salvatore , Artibani Walter
Published: September 2019

Introduction: To assess the association of prostate volume index (PVI), defined as the ratio of the central transition zone volume to the peripheral zone volume, and prostatic chronic inflammation (PCI) as predictors of prostate cancer (PCA) risk in patients presenting with normal digital rectal exam and prostate-specific antigen (PSA) ≤10 ng/mL at baseline random biopsies. Methods: We evaluated patients with a negative digital rectal examination (DRE) and a PSA ≤10 ng/mL who underwent initial baseline prostate biopsy from 2010 to 2017. Parameters evaluated included age, PSA, total prostate volume (TPV), PSA density (PSAD), PVI and PCI. All patients underwent 14 core trans-perineal standard biopsies. The association of factors with the risk of PCA was evaluated by logistic regression analysis, utilizing 2 multivariate models: model I included age, TPV, PVI and PCI; model II included age, PSAD, PVI and PC. Results: Overall, 564 Caucasian patients were included. PCA and PCI were detected in 242 (42.9%) and 129 (22.9%) cases respectively. In patients with PCA, the median PVI was 0.83 (interquartile range [IQR] 0.62–1.04). In patients with PCI, the median PVI was 1.12 (IQR 0.81–1.47). In model I, age (OR 1.080) TPV (OR 0.961), PVI (OR 0.517) and PCI (OR 0.249) were associated with PCA risk. In model II, the age (OR 1.074), PSAD (OR 3.080), PVI (OR 0.361) and PCI (OR 0.221) were associated with PCA risk. Conclusions: Higher PVI and PCI predicted decreased PCA risk in patients presenting with normal DRE, and a PSA ≤10ng/mL at baseline random biopsy. In this subset of patients, PVI is able to differentiate patients with PCI or PCA.
Urodynamic Differences between Complete and Incomplete Spinal Cord Injuries with Neurogenic Detrusor Overactivity
Authors: García Fadrique Gonzalo , Gallego Daniel , Ordaz Domingo , Climent Laura
Published: September 2019

Objective: To analyze if there are urodynamic differences in patients with neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI) depending on whether the SCI is complete or incomplete according to the American Spinal Injury Association (ASIA) classification. Methods: A retrospective and comparative study was carried out, including 194 patients with suprasacral SCI and NDO. Maximum cystometric capacity (MCC), volume at first involuntary contraction (VIC), compliance, maximum pressure of the detrusor during filling cystometry (MaxDetP), detrusor leak point pressure (LeakDetP) and postvoid residual urine volume (PVR) were analysed. Means were compared with Student t test for independent samples, with statistical significance p < 0.05. Results: SCI was complete (ASIA A) in 51 patients (26.3%) and incomplete (ASIA B–E) in 143 (73.7%). The comparison of means showed significant differences regarding MCC (278.5 ± 102.6 mL in ASIA A vs. 321.6 ± 127.1 mL in ASIA B–E; p = 0. 018) and VIC (161 ± 85.1 and 210 ± 114.4 mL ­respectively; p = 0.006). There were no differences regarding MaxDetP (58.8 ± 26.9 vs. 49.3 ± 35.6 cm H2O), LeakDetP (44.6 ± 25.3 vs. 48.3 ± 26.7 cm H2O), PVR (155.3 ± 94.2 vs. 118.5 ± 129.8) or compliance (29.9 ± 25.3 vs. 48.3 ± 26.7 cm H2O). Conclusions: In our serie incomplete SCI (ASIA B–E) showed differences from complete ones (ASIA A) regarding MCC and VIC, but not regarding LeakDetP, MaxDetP, PVR or compliance.
Intravesical Treatment with Electro-Mediated Administration of Mytomicin C as Prophylaxis for Intermediate and High-Risk Nonmuscle-Invasive Bladder Cancer: A Retrospective Multicenter Study
Authors: Carando Roberto , Zazzara Michele , Cotrufo Simone , Ludovico Giuseppe M.
Published: September 2019

Background: Topical therapy of nonmuscle-invasive bladder cancer (NMIBC) is based on immunotherapy with Bacillus Calmette-Guerin and chemotherapy administered by passive instillation, but an active drug administration achieves a better concentration of the drugs in the bladder. Aim: This study aimed to investigate the effectiveness of electromotive drug administration (EMDA) of mitomycin C (EMDA/MMC) in intermediate- and high-risk NMIBC patients 6 months after the end of induction treatment. Materials and Methods: Sixty-five patients diagnosed with histologically confirmed NMIBC, with a complete transurethral resection of all visible tumors underwent EMDA/MMC. Primary endpoint was the proportion of responders at 3 or 6 months. Results: Data on follow-up were available for 62 subjects at 3 months and 45 at 6 months. EMDA was effective in intermediate- and high-risk patients: because of the small number of cases no conclusions can be drawn on the efficacy in the low-risk group. No difference in the response to treatment between intermediate- (83.3%) and high-risk (84%) patients could be seen. Conclusions: EMDA/MMC is a useful technique for an effective and safe treatment of primary and recurrent NMIBC, and a valuable therapeutic option in intermediate- and high-risk NMIBC patients.
Chemotherapy in Resected Neuroendocrine Carcinomas of the Digestive Tract: A National Study from the French Group of Endocrine Tumours
Authors: Pellat Anna , Walter Thomas , Augustin Jérémy , Hautefeuille Vincent , Hentic Olivia , Do Cao Christine , Lievre Astrid , Coriat Romain , Hammel Pascal , Dubreuil Olivier , Cohen Romain , Couvelard Anne , André Thierry , Svrcek Magali , Baudin Eric , Afchain Pauline
Published: September 2019

Background: Neuroendocrine carcinomas (NECs) of the digestive tract are rare and aggressive tumours. In localised disease the treatment is surgery. Based on expert consensus, international guidelines recommend the administration of adjuvant chemotherapy combining etoposide and platinum derivatives, justified by the high risk of metastatic relapse. However, no clinical study has proven the benefit of neoadjuvant or adjuvant chemotherapy. Objectives: We aimed to evaluate the effect of neoadjuvant +/– adjuvant and adjuvant therapy in this indication. Methods: We performed a retrospective observational French study to evaluate overall survival (OS) and disease-free survival (DFS), prognostic factors for survival, and chemotherapy toxicity. Results: Seventy-three patients had surgical resection of a localised digestive NEC between January 1, 2000 and December 31, 2016. The majority of patients presented colorectal (35%) tumours and the median Ki-67 value was 70%. Forty-three patients received chemotherapy, either perioperative (neoadjuvant +/– adjuvant) or adjuvant. The median OS and DFS for the whole population was 24 and 9 months, respectively. The median OS and DFS for patients receiving chemotherapy was 62 and 13 months, respectively. Positive postoperative node status and Ki-67 ≥80% had a negative prognostic impact on OS and DFS. Administration of chemotherapy had a positive prognostic impact on OS and DFS. Sixteen grade 3/4 toxicities were reported without toxic death. Conclusions: Our results suggest a positive effect on survival of chemotherapy in resected digestive NECs, but further studies are needed to confirm these results.
Capecitabine and Temozolomide in Patients with Advanced Pulmonary Carcinoid Tumours
Authors: Papaxoinis George , Kordatou Zoe , McCallum Lynne , Nasralla Magdy , Lamarca Angela , Backen Alison , Nonaka Daisuke , Mansoor Wasat
Published: September 2019

Background: Temozolomide and capecitabine (CAPTEM) chemotherapy is known to be active in patients with pancreatic neuroendocrine tumours. Objective: This retrospective analysis set out to describe the efficacy and toxicity of CAPTEM in patients with advanced pulmonary carcinoids (PCs). Methods: Patients were included with advanced PC who had been treated with a maximum of 6 cycles of oral temozolomide 200 mg/m2 on days 10–14 and capecitabine 750 mg/m2 b.i.d. on days 1–14, repeated every 28 days, ­followed by monthly intramuscular injection of octreotide 30 mg long-acting release as maintenance treatment. Results: Of the 33 patients, all with well-differentiated PC, 61% had atypical carcinoid, 36% had Ki-67 index >10% and 42% had ≥3 organs involved by metastasis. CAPTEM was administered as first-line treatment in 42% of patients, and 17% had received prior somatostatin analogue treatment. Six patients (18%) achieved a partial response, 19 (58%) had stable disease and 8 (24%) developed progressive disease. After a median time of follow-up of 34.8 months, median progression-free survival (PFS) was 9.0 months and median overall survival 30.4 months. Median duration of disease response was 21.7 months and median duration of disease control 9.7 months. Patients with multi-organ metastasis had shorter PFS, but only when treated as second or third line with CAPTEM (p = 0.023). Conclusions: CAPTEM induced a modest response and PFS rate, comparable to other studies with temozolomide in patients with advanced PC. The efficacy of CAPTEM should be compared to that of monotherapy with temozolomide in a prospective clinical trial.
Estradiol Enables Chronic Corticosterone to Inhibit Pulsatile Luteinizing Hormone Secretion and Suppress Kiss1 Neuronal Activation in Female Mice
Authors: Kreisman Michael J. , McCosh Richard B. , Tian Katherine , Song Christopher I. , Breen Kellie M.
Published: September 2019

Introduction: Two common responses to stress include elevated circulating glucocorticoids and impaired luteinizing hormone (LH) secretion. We have previously shown that a chronic stress level of corticosterone can impair ovarian cyclicity in intact mice by preventing follicular-phase endocrine events. Objective: This study is aimed at investigating if corticosterone can disrupt LH pulses and whether estradiol is necessary for this inhibition. Methods: Our approach was to measure LH pulses prior to and following the administration of chronic corticosterone or cholesterol in ovariectomized (OVX) mice treated with or without estradiol, as well as assess changes in arcuate kisspeptin (Kiss1) neuronal activation, as determined by co-expression with c-Fos. Results: In OVX mice, a chronic 48 h elevation in corticosterone did not alter the pulsatile pattern of LH. In contrast, corticosterone induced a robust suppression of pulsatile LH secretion in mice treated with estradiol. This suppression represented a decrease in pulse frequency without a change in amplitude. We show that the majority of arcuate Kiss1 neurons contain glucocorticoid receptor, revealing a potential site of corticosterone action. Although arcuate Kiss1 and Tac2 gene expression did not change in response to corticosterone, arcuate Kiss1 neuronal activation was significantly reduced by chronic corticosterone, but only in mice treated with estradiol. Conclusions: Collectively, these data demonstrate that chronic corticosterone inhibits LH pulse frequency and reduces Kiss1 neuronal activation in female mice, both in an estradiol-dependent manner. Our findings support the possibility that enhanced sensitivity to glucocorticoids, due to ovarian steroid milieu, may contribute to reproductive impairment associated with stress or pathophysiologic conditions of elevated glucocorticoids.
Epigenetic Modifications as Outcomes of Exercise Interventions Related to Specific Metabolic Alterations: A Systematic Review
Authors: Barrón-Cabrera Elisa , Ramos-Lopez Omar , González-Becerra Karina , Riezu-Boj Jose Ignacio , Milagro Fermin I. , Martínez-López Erika  , Martínez Jose Alfredo
Published: September 2019

Background: Chronic diseases arise as a consequence of an unhealthy lifestyle primarily characterized by physical inactivity and unbalanced diets. Regular physical activity can improve health, and there is consistent evidence that these improvements may be the result of epigenetic modifications. Objective: To identify epigenetic modificationsas outcomes of exercise interventions related to specific metabolic alterations. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) methodology for manuscript research and preparation was followed using PubMed and EBSCO databases for literature review. Out of 2,638 articles identified, only 34 articles met the inclusion criteria. Results: The sections of the review were organized by metabolic alterations in which studies were grouped according to healthy, diseased, and trained individuals. Resistance exercise in humans induced epigenetic changes in pathways associated with energy metabolism and insulin sensitivity, contributing to healthy skeletal muscle. Endurance exercise also caused modifications in biomarkers associated to metabolic alterations through changes in DNA methylation and the expression of specific miRNAs. However, both resistance and endurance exercise are necessary to obtain a better physiological adaptation and a combination of both seems to be needed to properly tackle the increasing prevalence of non-communicable pathologies. Conclusion: Given the heterogeneity and complexity of the existing literature, it is currently not possible to propose a specific recommendation about the type, intensity, or duration of exercise that could be beneficial for different subsets of the population (healthy, diseased, and/or trained). Nevertheless, this review highlights the importance of exercise for health and shows the need to perform more research in this emerging area to identify epigenetic biomarkers that could serve as indicators of exercise adaptations.
Anatomia cardíaca aplicada à medicina veterinária
Authors:   Universidade de São Paulo, Faculdade de Medicina Veterinária e Zootecnia, Massari Catia Helena de Almeida Lima , Miglino Maria Angélica ,   Universidade de São Paulo, Faculdade de Medicina Veterinária e Zootecnia
Published: September 2019

A disciplina de Anatomia Animal é uma das matérias mais esperadas pelos estudantes de Medicina Veterinária, ao mesmo tempo em que pode ser uma das mais temidas pelo desafio imenso que é aprender seu extenso conteúdo. Neste livro as autoras abordam alguns temas muito pertinentes aos alunos da área: Aprendendo a Aprender Anatomia Animal; História da Anatomia Cardiovascular; Etimologia para Anatomia Cardíaca; Angiotécnicas anatômicas; Anatomia do Desenvolvimento do Sistema Cardiovascular; Circulação fetal em mamíferos; Anatomia Funcional do coração dos mamíferos; Vasos sanguíneos; Sistema Linfático; Anatomia Cardíaca aplicada ao Diagnóstico por Imagem; Insuficiência Cardíaca Congestiva (ICC); Coração de animais vertebrados não-mamíferos: peixes, anfíbios, répteis e aves; e Bioengenharia do tecido cardíaco.
60/70: da participação ao comportamental
Authors: Favaretto Celso Fernando
Published: September 2019

No período 1965-68, ocorreu uma reconfiguração das relações entre arte e política, resultante do tensionamento das proposições em curso entre radicalidade experimental e significação política. A categoria de participação, que já adquirira especial relevo nas atividades artísticas, passou a admitir o aspecto comportamental, a corporalidade, como constitutivo dessa nova posição estética. A eficácia política de tal mudança estendeu-se até meados da década seguinte, no horizonte das variadas atividades contraculturais, apesar da pressão e censura agravadas pelo AI-5.
Papa Highirte, de Oduvaldo Vianna Filho: apontamentos de análise dramatúrgica
Authors: Betti Maria Silvia
Published: September 2019

Este artigo analisa alguns dos expedientes dramatúrgicos utilizados na peça Papa Highirte, de Oduvaldo Vianna Filho.
Literatura e vida pública. Eça e Mário de Carvalho
Authors: Sequeira Rosa Maria , Vieira Maria Cecília
Published: September 2019

Este artigo analisa a relação entre a literatura e a vida pública em Portugal em dois autores representativos da literatura portuguesa, Eça de Queirós e Mário de Carvalho. Eça de Queirós é provavelmente o escritor português do século XIX com mais projeção internacional. Mário de Carvalho possui atualmente uma vasta obra de mais de trinta anos que tem merecido a atribuição de vários prémios literários, nacionais e estrangeiros e é um leitor entusiástico de Eça que frequentemente menciona. Têm em comum a intenção formadora e reformadora através de uma ironia impiedosa e crítica acutilante das respetivas sociedades. Este artigo analisa algumas vertentes e instituições da sociedade portuguesa que merecem a sua crítica, nomeadamente o jornalismo, a política, as igrejas e a cultura dominante. A responsabilidade de trazer os cidadãos da apatia em que estão quanto à cultura e à política é evidente nestes dois autores que não apenas dão um testemunho da sociedade portuguesa, mas transmitem a indignação moral contra todas as formas de submissão aos poderes instituídos.
História de um distanciamento: a memória de Piglia nos Diários de Renzi
Authors: Pinto Júlio Pimentel
Published: September 2019

O texto explora o primeiro volume de Los diarios de Emilio Renzi (1957-1967), de Ricardo Piglia, seus mecanismos de construção da memória, sua problematização da figura do autor — também narrador e personagem — e seu exercício crítico.