bluuebunny/crossref_metadata_2025 huggingface dataset:
Parental Responsibility after Divorce: the Case of North Macedonia
Authors: Mickovik Dejan , Selmani-Bakiu Arta
Published: April 2021

In 2010 the Republic of North Macedonia began the process of drafting the Civil Code, which will be the most significant reform in the field of civil law since its independence in 1991. This reform is expected to include important amendments of the family law, including the regulation of the exercise of parental responsibilities after divorce. The authors in this article make a thorough analysis of the current legal framework in regard to the exercise of parental responsibilities after divorce in the Republic of North Macedonia (RNM). Their main purpose is to detect all legal solutions that are outdated and lead to a serious violation of the rights and interests of children. In the text, the authors provide an overview of the historical development of the legal regulation of the exercise of parental responsibilities after divorce, as well as an analysis of sociological research related to the consequences of divorce on the psychosocial development of children. In addition, the authors provide an overview of research on the impact of joint physical custody on children after divorce. Taking into consideration the importance of the best interest of the children, this article aims to point out the positive effect of joint physical custody on children. In the conclusion, the authors provide recommendations aiming towards a better regulation of the exercise of parental responsibilities after divorce in the new Civil Code of RNM which is now being drafted.
The origin of bulges and discs in the CALIFA survey – I. Morphological evolution
Authors: Méndez-Abreu J , de Lorenzo-Cáceres A , Sánchez S F
Published: April 2021

This series of papers aims at understanding the formation and evolution of non-barred disc galaxies. We use the new spectro-photometric decomposition code, c2d, to separate the spectral information of bulges and discs of a statistically representative sample of galaxies from the CALIFA survey. Then, we study their stellar population properties analysing the structure-independent datacubes with the Pipe3D algorithm. We find a correlation between the bulge-to-total (B/T) luminosity (and mass) ratio and galaxy stellar mass. The B/T mass ratio has only a mild evolution with redshift, but the bulge-to-disc (B/D) mass ratio shows a clear increase of the disc component since redshift z < 1 for massive galaxies. The mass–size relation for both bulges and discs describes an upturn at high galaxy stellar masses (log (M⋆/M⊙) > 10.5). The relation holds for bulges but not for discs when using their individual stellar masses. We find a negligible evolution of the mass–size relation for both the most massive ($\log {(M_{\star \rm ,b,d}/{\rm M}_{\odot })} \gt 10$) bulges and discs. For lower masses, discs show a larger variation than bulges. We also find a correlation between the Sérsic index of bulges and both galaxy and bulge stellar mass, which does not hold for the disc mass. Our results support an inside-out formation of nearby non-barred galaxies, and they suggest that (i) bulges formed early-on and (ii) they have not evolved much through cosmic time. However, we find that the early properties of bulges drive the future evolution of the galaxy as a whole, and particularly the properties of the discs that eventually form around them.
A novel approach to optimize the regularization and evaluation of dynamical models using a model selection framework
Authors: Lipka Mathias , Thomas Jens
Published: April 2021

Orbit superposition models are a non-parametric dynamical modelling technique to determine the mass of a galaxy’s central supermassive black hole (SMBH), its stars, or its dark matter halo. One of the main problems is how to decide which model out of a large pool of trial models based on different assumed mass distributions represents the true structure of an observed galaxy best. We show that the traditional approach to judge models solely by their goodness-of-fit can lead to substantial biases in estimated galaxy properties caused by varying model flexibilities. We demonstrate how the flexibility of the models can be estimated using bootstrap iterations and present a model selection framework that removes these biases by taking the variable flexibility into account in the model evaluation. We extend the model selection approach to optimize the degree of regularization directly from the data. Altogether, this leads to a significant improvement of the constraining power of the modelling technique. We show with simulations that one can reconstruct the mass, anisotropy, and viewing angle of an axisymmetric galaxy with a few per cent accuracy from realistic observational data with fully resolved line-of-sight velocity distributions (LOSVDs). In a first application, we reproduce a photometric estimate of the inclination of the disc galaxy NGC 3368 to within 5° accuracy from kinematic data that cover only a few sphere-of-influence radii around the galaxy’s SMBH. This demonstrates the constraining power that can be achieved with orbit models based on fully resolved LOSVDs and a model selection framework.
Numerical simulations of dark matter haloes produce polytropic central cores when reaching thermodynamic equilibrium
Authors: Sánchez Almeida Jorge , Trujillo Ignacio
Published: April 2021

Self-gravitating astronomical objects often show a central plateau in the density profile (core) whose physical origin is hotly debated. Cores are theoretically expected in N-body systems of maximum entropy, however, they are not present in the canonical N-body numerical simulations of cold dark matter (CDM). Our work shows that despite this apparent contradiction between theory and numerical simulations, they are fully consistent. Simply put, cores are characteristic of systems in thermodynamic equilibrium, but thermalizing collisions are purposely suppressed in CDM simulations. When collisions are allowed, N-body numerical simulations develop cored density profiles, in perfect agreement with the theoretical expectation. We compare theory and two types of numerical simulations: (1) when DM particles are self-interacting (SIDM) with enough cross-section, then the effective two-body relaxation time-scale becomes shorter than the Hubble time resulting in cored DM haloes. The haloes thus obtained, with masses from dwarf galaxies to galaxy clusters, collapse to a single shape after normalization, and this shape agrees with the polytropic density profile theoretically expected. (2) The inner radii in canonical N-body numerical simulations are always discarded because the use of finite-mass DM particles artificially increases the two-body collision rate. We show that the discarded radii develop cores which are larger than the employed numerical softening and have polytropic shape independently of halo mass. Our work suggests that the presence of cores in simulated (or observed) density profiles can used as evidence for systems in thermodynamic equilibrium.
Some glimpses of the plasma processes involved in power spectra of radio pulsars
Authors: Roy Tridib
Published: April 2021

Although more than a half-century since pulsar discovery, the field of pulsar astronomy has attained an unprecedented level of success and has opened several windows in astronomy, very few theories have been put forwarded to investigate the nature of power spectra and emission properties of radio pulsars. There has been a copious amount of observation dedicated to investigating the nature and shape of radio pulsar’s power spectra. In this paper, I have suggested some alternative plasma processes in the frame of general parametric instability, such as Stimulated Raman Scattering (SRS) and Stimulated Compton Scattering (SCS) as a potential probe to generate power spectra theoretically. There are basically three prominent processes in which electromagnetic waves can undergo scattering in an ambient plasma medium. First, one is very well-known Compton scattering; it is when the scattering of radiation occurs by a single electron. The second and third ones are SRS and SCS, which are the relatively less known plasma phenomena. By definition, SRS is a process where the scattering of radiation occurs by longitudinal electron plasma mode, whereas SCS occurs by highly damped electron plasma mode. I have explored the possibility of explaining the radio power spectra of pulsar under different circumstances of plasma. I have computed the growth rates of SRS and SCS instabilities numerically. Thereafter, I have produced full radio power spectra of the pulsars PSRB 2111+46, PSRB 0329+54 theoretically by assuming typical pulsar parameters, dispersion relation associated with the plasma of three-wave interacting parametric instability process and the spatial variation associated with different plasma parameters like plasma density, Lorentz factor of electrons, frequency, and input flux of the pump wave.
Dark acoustic oscillations: imprints on the matter power spectrum and the halo mass function
Authors: Schaeffer Timothée , Schneider Aurel
Published: April 2021

Many non-minimal dark matter scenarios lead to oscillatory features in the matter power spectrum induced by interactions either within the dark sector or with particles from the standard model. Observing such dark acoustic oscillations would therefore be a major step towards understanding dark matter. We investigate what happens to oscillatory features during the process of non-linear structure formation. We show that at the level of the power spectrum, oscillations are smoothed out by non-linear mode coupling, gradually disappearing towards lower redshifts. In the halo mass function, however, the oscillatory features remain visible until the present epoch. As a consequence, dark acoustic oscillations could be detectable in observations that are either based on the halo mass function or on the high-redshift power spectrum. We investigate the effect of such features on different observables, namely the cluster mass function, the stellar-to-halo mass relation, and the Lyman α flux power spectrum. We find that oscillatory features remain visible in all of these observables, but they are very extended and of low amplitude, making it challenging to detect them as distinct features in the data.
Genetic Architecture Underlying Nascent Speciation—The Evolution of Eurasian Pigs under Domestication
Authors: Xie Hai-Bing , Wang Li-Gang , Fan Chen-Yu , Zhang Long-Chao , Adeola Adeniyi C , Yin Xue , Zeng Zhao-Bang , Wang Li-Xian , Zhang Ya-Ping
Published: April 2021

Speciation is a process whereby the evolution of reproductive barriers leads to isolated species. Although many studies have addressed large-effect genetic footprints in the advanced stages of speciation, the genetics of reproductive isolation in nascent stage of speciation remains unclear. Here, we show that pig domestication offers an interesting model for studying the early stages of speciation in great details. Pig breeds have not evolved the large X-effect of hybrid incompatibility commonly observed between “good species.” Instead, deleterious epistatic interactions among multiple autosomal loci are common. These weak Dobzhansky–Muller incompatibilities confer partial hybrid inviability with sex biases in crosses between European and East Asian domestic pigs. The genomic incompatibility is enriched in pathways for angiogenesis, androgen receptor signaling and immunity, with an observation of many highly differentiated cis-regulatory variants. Our study suggests that partial hybrid inviability caused by pervasive but weak interactions among autosomal loci may be a hallmark of nascent speciation in mammals.
LZerD webserver for pairwise and multiple protein–protein docking
Authors: Christoffer Charles , Chen Siyang , Bharadwaj Vijay , Aderinwale Tunde , Kumar Vidhur , Hormati Matin , Kihara Daisuke
Published: April 2021

Protein complexes are involved in many important processes in living cells. To understand the mechanisms of these processes, it is necessary to solve the 3D structures of the protein complexes. When protein complex structures have not yet been determined by experiment, protein-protein docking tools can be used to computationally model the structures of these complexes. Here, we present a webserver which provides access to LZerD and Multi-LZerD protein docking tools. The protocol provided by the server have performed consistently among the top in the CAPRI blind evaluation. LZerD docks pairs of structures, while Multi-LZerD can dock three or more structures simultaneously. LZerD uses a soft protein surface representation with 3D Zernike descriptors and explores the binding pose space using geometric hashing. Multi-LZerD performs multi-chain docking by combining pairwise solutions by LZerD. Both methods output full-atom docked models of the input proteins. Users can also input distance constraints between interacting or non-interacting residues as well as residues that locate at the interface or far from the interface. The webserver is equipped with a user-friendly panel that visualizes the distribution and structures of binding poses of top scoring models. The LZerD webserver is available at https://lzerd.kiharalab.org.
Carbon monoxide exposures reported to the UK National Poisons Information Service: a 4-year study
Authors: Gentile Daniela , Adams Richard , Klatka Michal , Bradberry Sally , Gray Laurence , Thanacoody Ruben , Jackson Gillian , Sandilands Euan A
Published: April 2021

Background

Unintentional carbon monoxide (CO) poisoning poses a public health challenge. The UK National Poisons Information Service (NPIS) provides advice to healthcare professionals via the online database, TOXBASE®, and a 24-hour telephone line. Our aim was to analyse all CO-related enquiries to the NPIS.

Methods

We analysed enquiries regarding unintentional CO exposure (1st July 2015-30th June 2019). Information on patient demographics, CO source and location, clinical features and poisoning severity was collected from telephone enquiries and TOXBASE accesses.

Results

2970 unintentional non-fire-related CO exposures were reported. Exposures occurred commonly in the home (60%) with faulty boilers frequently implicated (27.4%). Although five fatalities were reported, 68.7% of patients experienced no or minor symptoms only (headache most frequently reported). Despite being the gold standard measurement, blood carboxyhaemoglobin concentration was only recorded in 25.6% patients, with no statistically significant correlation with severity.

Conclusions

Unintentional CO exposures in the UK commonly occur in domestic settings and although are generally of low severity, fatalities continue to occur. Carboxyhaemoglobin measurement is important to confirm exposure but further work is required to assess its validity as a prognostic indicator in CO exposure. Public health policy should continue to focus on raising awareness of the dangers of CO.
Uncertainty in the Hot Hand Fallacy: Detecting Streaky Alternatives to Random Bernoulli Sequences
Authors: Ritzwoller David M , Romano Joseph P
Published: April 2021

We study a class of permutation tests of the randomness of a collection of Bernoulli sequences and their application to analyses of the human tendency to perceive streaks of consecutive successes as overly representative of positive dependence—the hot hand fallacy. In particular, we study permutation tests of the null hypothesis of randomness (i.e. that trials are i.i.d.) based on test statistics that compare the proportion of successes that directly follow $k$ consecutive successes with either the overall proportion of successes or the proportion of successes that directly follow $k$ consecutive failures. We characterize the asymptotic distributions of these test statistics and their permutation distributions under randomness, under a set of general stationary processes, and under a class of Markov chain alternatives, which allow us to derive their local asymptotic power. The results are applied to evaluate the empirical support for the hot hand fallacy provided by four controlled basketball shooting experiments. We establish that substantially larger data sets are required to derive an informative measurement of the deviation from randomness in basketball shooting. In one experiment, for which we were able to obtain data, multiple testing procedures reveal that one shooter exhibits a shooting pattern significantly inconsistent with randomness—supplying strong evidence that basketball shooting is not random for all shooters all of the time. However, we find that the evidence against randomness in this experiment is limited to this shooter. Our results provide a mathematical and statistical foundation for the design and validation of experiments that directly compare deviations from randomness with human beliefs about deviations from randomness and thereby constitute a direct test of the hot hand fallacy.
Cortical monitoring of cardiac activity during rapid eye movement sleep: the heartbeat evoked potential in phasic and tonic rapid-eye-movement microstates
Authors: Simor Péter , Bogdány Tamás , Bódizs Róbert , Perakakis Pandelis
Published: April 2021

Sleep is a fundamental physiological state that facilitates neural recovery during periods of attenuated sensory processing. On the other hand, mammalian sleep is also characterized by the interplay between periods of increased sleep depth and environmental alertness. Whereas the heterogeneity of microstates during non-rapid-eye-movement (NREM) sleep was extensively studied in the last decades, transient microstates during rapid-eye-movement (REM) sleep received less attention. REM sleep features two distinct microstates: phasic and tonic. Previous studies indicate that sensory processing is largely diminished during phasic REM periods, whereas environmental alertness is partially reinstated when the brain switches into tonic REM sleep. Here, we investigated interoceptive processing as quantified by the heartbeat evoked potential (HEP) during REM microstates. We contrasted the HEPs of phasic and tonic REM periods using two separate databases that included the nighttime polysomnographic recordings of healthy young individuals (N = 20 and N = 19). We find a differential HEP modulation of a late HEP component (after 500 ms post-R-peak) between tonic and phasic REM. Moreover, the late tonic HEP component resembled the HEP found in resting wakefulness. Our results indicate that interoception with respect to cardiac signals is not uniform across REM microstates, and suggest that interoceptive processing is partially reinstated during tonic REM periods. The analyses of the HEP during REM sleep may shed new light on the organization and putative function of REM microstates.
Pathogenicity of Phytopythium chamaehyphon: A New Player in Kiwifruit Vine Decline Syndrome of Actinidia chinensis var. deliciosa ‘Hayward’ in Italy
Authors: Savian F. , Prencipe S. , Filippini N. , Nari L. , Martini M. , Ermacora P. , Spadaro D.
Published: April 2021

Kiwifruit vine decline syndrome (KVDS) is a serious soil-borne disease that degrades the fine roots of both Actinidia chinensis var. deliciosa and var. chinensis. The disease seems to be the result of an interaction between several soil-borne pathogens, mostly oomycetes, and waterlogging. This work investigates the pathogenicity of the oomycete Phytopythium chamaehyphon recently isolated from roots of diseased plants. Pathogenicity was tested in 6-month-old and 1-year-old plants that, after inoculation, were flooded up to three times to induce symptom appearance. Leaf wilting and root rot typical of KVDS was observed in all the plants inoculated with P. chamaehyphon strain KD-15 (PCHA) and in all the positive controls potted in a mix of peat and soils collected in KVDS-affected orchards, while negative controls remained symptomless. Disease development on 6-month-old plants was characterized by unusual degradation of the not-lignified collar, occurring even in absence of flooding. Conversely, on 1-year-old plants, symptoms faithfully reproduced KVDS dynamics observed in orchard. This work confirmed the pathogenicity of P. chamaehyphon and raised new questions about the actual role of waterlogging in KVDS etiology.
Complete Genome Sequence Resource for the Endophytic Burkholderia sp. Strain MS389 Isolated from a Healthy Soybean Growing Adjacent to Charcoal Rot Disease Patch
Authors: Jia Jiayuan , Ford Emerald , Baird Sonya M. , Lu Shi-En
Published: April 2021

Burkholderia sp. strain MS389, an endophytic bacterium, was isolated from a healthy soybean plant growing adjacent to a patch of plants affected by charcoal rot disease, caused by the fungal pathogen Macrophomina phaseolina. Preliminary studies demonstrated that strain MS389 possesses antimicrobial activities against multiple plant pathogens. Burkholderia sp. strain MS389 was found to have three circular chromosomes of 3,563,380 bp, 3,002,449 bp, and 1,180,421 bp in size, respectively. The 7,746,250-bp genome, with 66.73% G+C content, harbors 6,756 protein coding genes in the predicted 6,985 genes. In total, 18 rRNAs, 68 tRNAs, and four ncRNAs were identified and 139 pseudogenes were annotated as well. The findings of this study will provide valuable data to explore the antimicrobial mechanisms of the endophytic bacterial strain.
A Look Back at the Year of the Nurse and the Midwife
Authors: McSpedon Corinne
Published: April 2021

An unprecedented year highlighted the essential care nurses provide.
The First Injection
Authors: Kelly Tracy
Published: April 2021

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog is a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.
Poor Air Quality in Subway Systems Poses Health Risks
Authors: Rosenberg Karen
Published: April 2021

According to this study:

High levels of airborne particulate matter in large urban subway systems during rush hour can expose commuters and transit workers to health risks.
Built for This
Authors: Kottler Janey Eden
Published: April 2021

A volunteer during the pandemic gains insight into her role as an NP.
Virtual Twelve Step Meeting Attendance During the COVID-19 Period: A Study of Members of Narcotics Anonymous
Authors: Galanter Marc , White William L. , Hunter Brooke
Published: April 2021

Objectives:

Face-to-face meetings are key components of Twelve Step (TS) fellowships’ support of members’ abstinence. Home confinement during COVID-19 made this less feasible. Our objective was to ascertain whether a transition to virtual online meetings among TS members took place, and whether it was potentially effective.

Methods:

Two thousand one hundred fifty-two long-standing USA members of Narcotics Anonymous (NA) were surveyed to ascertain their recovery-related experiences and their relation to the transition to virtual meetings.

Results:

During the previous week (ie, ‘during COVID-19’) respondents attended more virtual meetings (

 = 4.13[SD4.64]) than they had attended both face-to-face meetings before COVID-19 (

 = 3.35[SD2.05]), and also face-to-face meetings during COVID-19 (

 = 0.75[SD1.8]). Many of the meetings were accessed from sites remote from their homes (44.4%), even overseas (21.5%). The majority (64.9%) found virtual meetings at least as effective in promoting their abstinence as were face-to-face meetings, and 41.8% estimated the same for newcomers. A shorter period of antecedent abstinence from drugs and increased loneliness were associated with increased craving during the transition period. Relative to Whites, Black respondents were less distressed, with a lesser increase in craving, and currently attended more virtual meetings. Data provided by a national program reflected a large increase in virtual TS attendance since the onset of the pandemic.

Conclusions:

In a survey of well-established NA members, most had made a successful transition from face-to-face to virtual meetings, relative to their antecedent characteristics. This successful transition suggests the possibility of an enhanced opportunity for stabilizing TS membership.
Clinical Case Conference: Strategies for Transferring From Methadone to Buprenorphine
Authors: Hill Duncan , Hayes Victoria , Demirkol Apo , Lintzeris Nicholas
Published: April 2021

The mainstay of treatment for opioid use disorder are medications, methadone (a full opioid agonist), or buprenorphine (a partial opioid agonist), in conjunction with psychosocial interventions. Both treatments are effective but safety, efficacy, and patient preference can lead to a decision to change from one treatment to the other. Transfer from buprenorphine to methadone is not clinically challenging; however, changing from methadone to buprenorphine is more complex. Published reports describe varied approaches to manage this transfer to both minimize patient symptoms associated with withdrawal from methadone and reduce risk of precipitating withdrawal symptoms with introduction of the partial agonist buprenorphine [Lintzeris et al. J Addict Med. 2020; in press]. There is no single approach for methadone to buprenorphine that is superior to others and no approach that is suitable for all case presentations. This case conference describes three different approaches to achieve a successful methadone to buprenorphine transfer and provides commentary on how the case may be managed based on published transfer “strategies.”
Predictors of Medical Malpractice Outcomes After Spine Surgery
Authors: Park Howard Y. , Hwang Richard , Sheppard William L. , Blumstein Gideon , Shah Akash A. , Medina Jesus A. , Cargle Melani N. , Bugarin Amador , Hamad Christopher D. , Proal Joshua D. , Smith Ryan , Bernthal Nicholas M. , Shamie A. Nick , Park Don Y.
Published: April 2021

Study Design:

Retrospective review of spine surgery malpractice cases.

Objectives:

The aim was to compare medical malpractice outcomes among different types of spine surgery and identify predictors of litigation outcomes.

Summary of Background Data:

Spine surgery is highly litigious in the United States with data suggesting favorable outcomes for defendant surgeons. However, factor specific data and explanations for plaintiff verdicts are lacking.

Methods:

Westlaw legal database was queried for spine surgery malpractice outcomes from 2010 to 2019. Clinical data, reasons for litigation, and legal outcomes were tabulated. Statistical analysis was performed to identify factors associated with litigation outcomes.

Results:

A total of 257 cases were identified for inclusion. There were 98 noninstrumented and 148 instrumented cases; 110 single-level and 99 multilevel; 83 decompressions, 95 decompression and fusions, and 47 fusion only. In all, 182 (71%) resulted in a defendant verdict, 44 (17%) plaintiff verdict, and 31 (12%) settlement. Plaintiff verdicts resulted in payouts of $2.03 million, while settlements resulted in $1.11 million (P=0.34). Common reasons for litigation were intraoperative error, hardware complication, and improper postoperative management. Cases were more likely to result for the plaintiff if postoperative cauda equina syndrome (55% vs. 26%, P<0.01), a surgical site infection (46% vs. 27%, P=0.03), or other catastrophic injury (40% vs. 26%, P=0.03) occurred. Higher monetary awards were associated with multi versus single-level (median: $2.61 vs. $0.92 million, P=0.01), improper postoperative management cited (median: $2.29 vs. $1.12 million, P=0.04), and permanent neurological deficits ($2.29 vs. $0.78 million, P<0.01). Plaintiff payouts were more likely if defendant specialty was neurosurgery versus orthopedic surgery (33% vs. 18%, P=0.01).

Conclusions:

Spine surgery is a litigious field with multiple factors associated with outcomes. Efforts to reduce intraoperative errors and complications may improve patient care and decrease the risk of litigation.
Acute Cardiac Injury in Coronavirus Disease 2019 and Other Viral Infections—A Systematic Review and Meta-Analysis
Authors: Cheng Matthew P. , Cau Alessandro , Lee Todd C. , Brodie Daniel , Slutsky Arthur , Marshall John , Murthy Srin , Lee Terry , Singer Joel , Demir Koray K. , Boyd John , Ohm Hyejee , Maslove David , Goffi Alberto , Bogoch Isaac I. , Sweet David D. , Walley Keith R. , Russell James A. ,   on behalf of Angiotensin Receptor Blocker Coronavirus Study (ARBs) CORONA I
Published: April 2021

OBJECTIVES:

Severe acute respiratory syndrome–related coronavirus-2 binds and inhibits angiotensin-converting enzyme-2. The frequency of acute cardiac injury in patients with coronavirus disease 2019 is unknown. The objective was to compare the rates of cardiac injury by angiotensin-converting enzyme-2–binding viruses from viruses that do not bind to angiotensin-converting enzyme-2.

DATA SOURCES:

We performed a systematic review of coronavirus disease 2019 literature on PubMed and EMBASE.

STUDY SELECTION:

We included studies with ten or more hospitalized adults with confirmed coronavirus disease 2019 or other viral pathogens that described the occurrence of acute cardiac injury. This was defined by the original publication authors or by: 1) myocardial ischemia, 2) new cardiac arrhythmia on echocardiogram, or 3) new or worsening heart failure on echocardiogram.

DATA EXTRACTION:

We compared the rates of cardiac injury among patients with respiratory infections with viruses that down-regulate angiotensin-converting enzyme-2, including H1N1, H5N1, H7N9, and severe acute respiratory syndrome–related coronavirus-1, to those with respiratory infections from other influenza viruses that do not bind angiotensin-converting enzyme-2, including Influenza H3N2 and influenza B.

DATA SYNTHESIS:

Of 57 studies including 34,072 patients, acute cardiac injury occurred in 50% (95% CI, 44–57%) of critically ill patients with coronavirus disease 2019. The overall risk of acute cardiac injury was 21% (95% CI, 18–26%) among hospitalized patients with coronavirus disease 2019. In comparison, 37% (95% CI, 26–49%) of critically ill patients with other respiratory viruses that bind angiotensin-converting enzyme-2 (p = 0.061) and 12% (95% CI, 7–22%) of critically ill patients with other respiratory viruses that do not bind angiotensin-converting enzyme-2 (p < 0.001) experienced a cardiac injury.

CONCLUSIONS:

Acute cardiac injury may be associated with whether the virus binds angiotensin-converting enzyme-2. Acute cardiac injury occurs in half of critically ill coronavirus disease 2019 patients, but only 12% of patients infected by viruses that do not bind to angiotensin-converting enzyme-2.
Real-world healthcare costs of localized and regionally advanced cutaneous melanoma in the Netherlands
Authors: Leeneman Brenda , Blommestein Hedwig M. , Coupé Veerle M.H. , Hendriks Mathijs P. , Kruit Wim H.J. , Plaisier Peter W. , van Ruth Serge , ten Tije Albert J. , Wouters Michel W.J.M. , Franken Margreet G. , Uyl - de Groot Carin A.
Published: April 2021

The aim of this study was to provide insight into real-world healthcare costs of patients initially diagnosed with localized or regionally advanced melanoma in three Dutch hospitals between 2003 and 2011. Patients were stratified according to their stage at diagnosis and recurrence status. Costs were calculated by applying unit costs to individual patient resource use and reported for the full disease course, the initial treatment episode, and treatment episodes for disease recurrence (stratified by type of recurrence). We included 198 patients with localized melanoma and 98 patients with regionally advanced melanoma. Total costs were much higher for patients with disease recurrence than for patients without disease recurrence: €20 007 versus €3032 for patients with localized melanoma and €19 519 versus €5951 for patients with regionally advanced melanoma. This was owing to the costs of disease recurrence because the costs of the initial treatment were comparable between patients with and without disease recurrence. Costs of disease recurrence were dependent on the type of recurrence: €4414, €4604, €8129 and €10 393 for a local recurrence, intralymphatic metastases, regional lymph node metastases and distant metastases, respectively. In conclusion, healthcare costs of patients with localized and regionally advanced melanoma were rather low for the initial treatment. Costs became, however, more substantial in case of disease recurrence. In the context of a rapidly changing treatment paradigm, it remains crucial to monitor treatment outcomes as well as healthcare expenditures.
Multistage Rectal Polypectomy: An Alternative to Proctectomy in Patients With Familial Adenomatous Polyposis
Authors: Sommovilla Joshua , Liska David , Church James
Published: April 2021

INTRODUCTION:

When patients with familial adenomatous polyposis have a severely affected rectum, it is usually assumed that endoscopic control is impossible or unwise. The standard approach is proctectomy with either an end ileostomy or an IPAA. Here we show that application of aggressive, multistage snare polypectomy to this situation can be effective and allow the patient to avoid surgery, at least in the short term.

TECHNIQUE:

Standard polypectomy using snare excision with coagulation is used, taking 2 or 3 sessions, and beginning with the largest polyps. The procedures are performed with the patient under general anesthesia. Endoscopic mucosal resection technique with fluid injection to lift polyps is not necessary.

RESULTS:

Complete control of the rectal polyps, sustained for at least 2 years, is possible without functional sequelas.

CONCLUSIONS:

Patients with familial adenomatous polyposis with severe rectal polyposis can be offered multistage rectal polypectomy and safely avoid proctectomy.
Taurine Alleviates Sympathetic Innervation by Inhibiting NLRP3 Inflammasome in Postinfarcted Rats
Authors: Lee Cheng-Che , Chen Wei-Ting , Chen Syue-yi , Lee Tsung-Ming
Published: April 2021

The NLRP3 inflammasome is activated by myocardial infarction and then induces the activation of inflammatory caspase-1 activation and maturation of IL-1β, a regulator of synthesis of the nerve growth factor (NGF). Here, we studied whether taurine, 2-aminoethanesulphonic acid, can attenuate cardiac sympathetic reinnervation by modulating NLRP3 inflammasome-mediated NGF in a rat model of myocardial infarction. Male Wistar rats were subjected to coronary ligation and then randomized to either saline or taurine for 3 days or 4 weeks. Postinfarction was associated with activation of NF-κB (p65) and NLRP3 inflammasome component and increased the protein and expression of IL-1β. Macrophages at the border zone were shown to be positive for IL-1β 3 days postinfarction. Compared with vehicle, infarcted rats treated with taurine significantly attenuated myocardial messenger RNA and protein levels of NF-κB, NLRP3 inflammasome, mature caspase-1, and IL-1β. Immunofluorescent analysis, real-time quantitative reverse transcription polymerase chain reaction, and Western blotting of NGF showed that sympathetic hyperinnervation was blunted after administering taurine. Arrhythmia vulnerability in the taurine-treated infarcted rats was significantly improved than those in vehicle. Ex vivo studies showed that taurine infusion reduced myocardial IL-1β level at the extent similar to either pyrrolidine dithiocarbamate or CP-456,773, inhibitors of NF-κB and NLRP3 inflammasome, implying the key axis of NF-κB/NLRP3 inflammasome in mediating taurine-related anti-inflammation. Furthermore, administration of anti-IL-1β antibody reduced NGF levels. Taurine attenuated sympathetic innervation mainly by NLRP3 inflammasome/IL-1β–dependent pathway, which downregulated expression of NGF in infarcted rats. These findings may provide a new insight into the anti-inflammation effect of taurine.
An Liquid Chromatography–Tandem Mass Spectrometry Method for the Simultaneous Determination of Afatinib, Alectinib, Ceritinib, Crizotinib, Dacomitinib, Erlotinib, Gefitinib, and Osimertinib in Human Serum
Authors: Mukai Yuji , Wakamoto Azusa , Hatsuyama Tae , Yoshida Tatsunari , Sato Hideki , Fujita Akihisa , Inotsume Nobuo , Toda Takaki
Published: April 2021

Background:

Routine therapeutic drug monitoring is a promising approach for the rational use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and anaplastic lymphoma kinase (ALK) inhibitors. The purpose of this study was to develop and validate a liquid chromatography–tandem mass spectrometry (LC-MS/MS) method for the simultaneous determination of 5 EGFR-TKIs (afatinib, dacomitinib, erlotinib, gefitinib, and osimertinib) and 3 ALK inhibitors (alectinib, ceritinib, and crizotinib).

Methods:

A 100-mL aliquot of serum was diluted with 100 μL of 1% aqueous ammonia containing internal standards and then purified using the supported liquid extraction method. LC-MS/MS was conducted in positive ionization mode, and the method was validated according to published guidelines.

Results:

Calibration curves were linear across concentration ranges examined. The intra- and interassay accuracies were 90.7%–110.7% and 94.7%–107.6%, respectively. All intra- and interassay imprecision values were ≤10.1%. The EGFR-TKIs and ALK inhibitors examined in this study, except osimertinib, which could be stored on ice for at least 5 hours, were stable at room temperature for 3 hours. For the internal standard–normalized matrix factors, the mean recovery and percent coefficient of variation values ranged between 54%–112% and 1.7%–11.7%, respectively. This method successfully determined serum concentrations of afatinib, alectinib, erlotinib, gefitinib, and osimertinib in clinical samples. Serum levels of kinase inhibitors consistently reflected those reported in previous studies.

Conclusions:

An LC-MS/MS method suitable for the simultaneous determination of 5 EGFR-TKIs and 3 ALK inhibitors in serum was developed and validated. The newly developed method enabled the determination of 5 of 8 target drugs examined in clinical samples. However, a large number of clinical samples need to be analyzed to verify the usefulness of the method.
Lens in Primary Congenital Glaucoma Eyes Treated by Combined Angle and Filtering Surgery
Authors: Bayoumi Nader , El Shakankiry Nihal , Fouad Mohamed , Elsayed Eman Nabil
Published: April 2021

Purpose:

To report on the changes in the natural crystalline lens in primary congenital glaucoma (PCG) eyes that had undergone previous combined angle-filtering surgery with antimetabolites.

Settings:

The pediatric ophthalmology unit of the ophthalmology department of Alexandria Main University Hospital.

Design:

A retrospective chart review.

Methods:

A retrospective chart review of patients presenting with and operated (by combined angle-filtering surgery with antimetabolites) for PCG in the period from 2005 to 2018. Any lens pathology was noted as well as the management and the outcome.

Results:

The records of 422 children (613 eyes) were reviewed. Lens pathology was noted in 54 (8.8%) eyes. Abnormalities in lens clarity (cataract) were detected in 31 (56%) eyes, and abnormalities in lens position (subluxation) were detected in 24 (44%) eyes. Management options included observation (in 28 eyes), lensectomy for aphakia (in 14 eyes), lensectomy with in the bag intraocular lens (IOL) implantation (in 11 eyes), and lensectomy with iris-fixated IOL (in 1 eye). Elevation of intraocular pressure (IOP) occurred in only 4 eyes (of 26 operated eyes, 15.3%) after lens extraction.

Conclusions:

Changes in the natural crystalline lens clarity and/or position occurred in 8.8% (54 of 613) of PCG eyes operated by combined angle-filtering surgery with antimetabolites. Lens extraction was a relatively safe procedure with only 15% (4 of 26) of eyes suffering an elevation of IOP after lens extraction.
Incidence of retinal detachment after lens surgery in children and young adults with nontraumatic ectopia lentis
Authors: Heo Hwan , Lambert Scott R.
Published: April 2021

Purpose:

To determine the incidence of retinal detachment after lens surgery in children and young adults with nontraumatic ectopia lentis.

Setting:

Population-based claims data.

Design:

Population-based retrospective cohort study.

Methods:

Patients with nontraumatic ectopia lentis aged 30 years or younger who had undergone lens surgery with or without intraocular lens (IOL) implantation and had 1 year or greater continuous enrollment after lens surgery were included in the Optum deidentified Clinformatics Data Mart Database (2003 to 2019) and IBM MarketScan Databases (2007 to 2016). Both databases were assessed for sex, age, etiology of ectopia lentis, IOL implantation, and postoperative retinal detachment separately. Univariate and multivariate analyses were conducted to identify the risk factors for postoperative retinal detachment.

Results:

Among a total of 298 eyes (210 patients), IOL implantation was coupled with lens surgery in 151 eyes (49.8%) that underwent lens surgery for nontraumatic ectopia lentis. The median follow-up was 32 months in aphakic eyes and 29 months in pseudophakic eyes. Patients undergoing IOL implantation were older at the time of lens surgery (median age: no IOL, 6 years; IOL, 16 years; P < .001). Retinal detachment developed in 13 patients (14 eyes [4.7%]) 14 eyes (4.7%). Older age was the baseline characteristic that correlated most closely with the risk for retinal detachment (P = .05).

Conclusions:

The rate of retinal detachment was similar with or without IOL implantation after lens surgery for nontraumatic ectopia lentis in children and young adults.
Prevalence and risk factors for keratoconus in a university-based population in Turkey
Authors: Özalp Onur , Atalay Eray , Yıldırım Nilgün
Published: April 2021

Purpose:

To determine the prevalence of keratoconus (KC) in the students and faculty members (aged ≥18 and ≤30 years) studying/working at the Medical and Health Sciences faculties of Eskişehir Osmangazi University.

Setting:

Eskişehir Osmangazi University, Eskişehir, Turkey.

Design:

Prevalence study.

Methods:

Subjects were randomly selected to undergo KC screening using a proportional stratified sampling method. Of the 648 invited subjects, 585 (90.3%) responded to the invitation. The demographic data, medical/family history, and habits of the subjects were collected using a standardized questionnaire. Subjects were classified as KC, ectasia susceptibility, and normal based on the corneal tomography. The chi-square and Kruskal-Wallis tests were used for the analysis of categorical variables and parametric values, respectively. Risk factors for KC were determined using logistic regression analysis.

Results:

Of the enrolled 585 subjects, the prevalence of KC was 2393/100 000 (2.4%, 95% CI: 1.3% to 4%), whereas that of ectasia susceptibility was 1538/100 000 (1.5%, 95% CI: 0.7% to 2.9%). Although the prevalence was much higher in males (4%, 95% CI: 1.7% to 7.7%) than in females (1.6%, 95% CI: 1.1% to 4.4%), the difference was not statistically significant (P = .09). Most (78.6%, n = 11) patients with KC were unaware of their disease. Eye rubbing (odds ratio [OR]: 3.53, P = .024) and consanguineous marriage (OR: 12.87, P = .032) were independent risk factors for KC.

Conclusions:

To the authors' knowledge, this is the first population-based KC prevalence study in a randomized sample conducted in Turkey. The prevalence of KC in Turkey was much higher than in European countries but similar to neighboring countries in the Middle East. Eye rubbing and history of consanguineous marriage were significant risk factors.
Inhibition of dual leucine zipper kinase prevents chemotherapy-induced peripheral neuropathy and cognitive impairments
Authors: Ma Jiacheng , Goodwani Sunil , Acton Paul J. , Buggia-Prevot Virginie , Kesler Shelli R. , Jamal Imran , Mahant Iteeben D. , Liu Zhen , Mseeh Faika , Roth Bruce L. , Chakraborty Chaitali , Peng Bo , Wu Qi , Jiang Yongying , Le Kang , Soth Michael J. , Jones Philip , Kavelaars Annemieke , Ray William J. , Heijnen Cobi J.
Published: April 2021

Chemotherapy-induced peripheral neuropathy (CIPN) and chemotherapy-induced cognitive impairments (CICI) are common, often severe neurotoxic side effects of cancer treatment that greatly reduce quality of life of cancer patients and survivors. Currently, there are no Food and Drug Administration-approved agents for the prevention or curative treatment of CIPN or CICI. The dual leucine zipper kinase (DLK) is a key mediator of axonal degeneration that is localized to axons and coordinates the neuronal response to injury. We developed a novel brain-penetrant DLK inhibitor, IACS′8287, which demonstrates potent and highly selective inhibition of DLK in vitro and in vivo. Coadministration of IACS′8287 with the platinum derivative cisplatin prevents mechanical allodynia, loss of intraepidermal nerve fibers in the hind paws, cognitive deficits, and impairments in brain connectivity in mice, all without interfering with the antitumor activity of cisplatin. The protective effects of IACS′8287 are associated with preservation of mitochondrial function in dorsal root ganglion neurons and in brain synaptosomes. In addition, RNA sequencing analysis of dorsal root ganglia reveals modulation of genes involved in neuronal activity and markers for immune cell infiltration by DLK inhibition. These data indicate that CIPN and CICI require DLK signaling in mice, and DLK inhibitors could become an attractive treatment in the clinic when coadministered with cisplatin, and potentially other chemotherapeutic agents, to prevent neurotoxicities as a result of cancer treatment.
The Affordable Care Act's young adult mandate was associated with a reduction in pain prevalence
Authors: Do Duy , Peele Morgan
Published: April 2021

Pain is a major health problem among U.S. young adults. The passage of the Affordable Care Act's young adult mandate in 2010 allowed individuals to remain on their parents' health insurance until age 26. Although studies have documented the positive effects of this mandate on various health outcomes, less is known about its association with self-reported pain among young adults. Using the 2002 to 2018 National Health Interview Survey (N = 48,053) and a difference-in-differences approach, we compared the probabilities of reporting pain at 5 sites (low back, joint, neck, headache/migraine, and facial/jaw) and the number of pain sites between mandate eligible (ages 20-25) and ineligible (ages 26-30) adults before and after the mandate. In fully adjusted models, the mandate was associated with a decline of 2 percentage points in the probability of reporting pain at any site (marginal effect, −0.02; 95% confidence interval [CI], −0.05 to −0.002; weighted sample proportion, 0.37) and in the number of pain sites (coefficient, −0.07; 95% CI, −0.11 to −0.01; weighted sample average, 0.62). These results were primarily driven by the association between the mandate and the probability of reporting low back pain (marginal effect, −0.03; 95% CI, −0.05 to −0.01; weighted sample proportion, 0.20). Additional analyses revealed that the mandate was associated with improvements in access to care and reductions in risk factors for pain—including chronic conditions and risky health behaviors. To the extent that the results are generalizable to other health insurance programs, removing financial barriers to medical care may help reduce pain prevalence.