bluuebunny/crossref_metadata_2025 huggingface dataset:
Polypharmacy, functional outcome and treatment effect of intravenous alteplase for acute ischaemic stroke
Authors: Jensen M. , Boutitie F. , Cheng B. , Cho T.‐H. , Ebinger M. , Endres M. , Fiebach J. B. , Fiehler J. , Ford I. , Galinovic I. , Königsberg A. , Puig J. , Roy P. , Wouters A. , Thijs V. , Lemmens R. , Muir K. W. , Nighoghossian N. , Pedraza S. , Simonsen C. Z. , Gerloff C. , Thomalla G.
Published: October 2020

Background and purpose

Polypharmacy is an important challenge in clinical practice. Our aim was to determine the effect of polypharmacy on functional outcome and treatment effect of alteplase in acute ischaemic stroke.

Methods

This was a post hoc analysis of the randomized, placebo‐controlled WAKE‐UP trial of magnetic resonance imaging guided intravenous alteplase in unknown onset stroke. Polypharmacy was defined as an intake of five or more medications at baseline. Comorbidities were assessed by the Charlson Comorbidity Index (CCI). The primary efficacy variable was favourable outcome defined by a score of 0–1 on the modified Rankin Scale at 90 days. Logistic regression analysis was used to test for an association of polypharmacy with functional outcome, and for interaction of polypharmacy and the effect of thrombolysis.

Results

Polypharmacy was present in 133/503 (26%) patients. Patients with polypharmacy were older (mean age 70 vs. 64 years; p < 0.0001) and had a higher score on the National Institutes of Health Stroke Scale at baseline (median 7 vs. 5; p = 0.0007). A comorbidity load defined by a CCI score ≥ 2 was more frequent in patients with polypharmacy (48% vs. 8%; p < 0.001). Polypharmacy was associated with lower odds of favourable outcome (adjusted odds ratio 0.50, 95% confidence interval 0.30–0.85; p = 0.0099), whilst the CCI score was not. Treatment with alteplase was associated with higher odds of favourable outcome in both groups, with no heterogeneity of treatment effect (test for interaction of treatment and polypharmacy, p = 0.29).

Conclusion

In stroke patients, polypharmacy is associated with worse functional outcome after intravenous thrombolysis independent of comorbidities. However, polypharmacy does not interact with the beneficial effect of alteplase.
Coronavirus disease 2019 (COVID‐19) in two pediatric patients with kidney disease on chronic immunosuppression: A case series
Authors: Rawson Ashley , Wilson Amy C. , Schwaderer Andrew L. , Spiwak Elizabeth , Johnston Bethanne , Anderson Shannon , Nailescu Corina , Gupta Sushil , Christenson John C. , Hains David S. , Starr Michelle C.
Published: October 2020

Coronavirus disease 2019 (COVID‐19) is a highly infectious disease caused by the severe acute respiratory syndrome coronavirus 2 virus (SARS‐CoV‐2). While children appear to experience less severe disease than adults, those with underlying conditions such as kidney disease may be more susceptible to infection. Limited data are present for children with kidney disease, and there are limited prior reports of pediatric hemodialysis patients with COVID‐19. This report describes the mild clinical disease course of COVID‐19 in two pediatric patients with chronic kidney disease, one on hemodialysis and both on chronic immunosuppression. We review treatment in these patients, as well as our measures to reduce transmission among our hemodialysis patients and staff.
Headache in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Narrative Review
Authors: Tolebeyan Amir Soheil , Zhang Niushen , Cooper Vanessa , Kuruvilla Deena E.
Published: October 2020

Objective

To summarize available literature regarding headache as a manifestation of coronaviruses and to describe potential underlying mechanisms.

Review Methods

References for this review were identified by searches within PubMed without any date restrictions. The search terms used were coronavirus disease 2019 (COVID‐19) clinical manifestation, COVID‐19 epidemiology, neurologic findings in COVID‐19, headache in COVID‐19, neurologic manifestations of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), and headache in SARS‐CoV‐2.

Results

Headache is one of the most common neurologic complaints in patients with SARS‐CoV‐2. While the pathophysiological connection between headache and SARS‐CoV‐2 is unclear, inflammatory mechanisms may play a key role. One of the mechanisms cited in the literature of migraine and other headache disorders is the activation of nociceptive sensory neurons by cytokines and chemokines. A similar mechanism has been reported in SARS‐CoV‐2 with the release of cytokines and chemokines by macrophages throughout the course of infection. Other mechanisms for headache in SARS‐CoV‐2 include (1) viral neuroinvasion as seen with viral encephalitis; (2) hypoxemia due to the well‐described pulmonary manifestations of the disease; and (3) thrombosis secondary to COVID‐19 induced hypercoagulable states.

Conclusion

According to the Centers for Disease Control, common symptoms of human coronavirus include fever, cough, runny nose, sore throat, and headache. In the case of SARS‐CoV‐2, there are limited reports about headaches, one of the most common clinical manifestations. There are currently no studies that focus specifically on headache among patients with SARS‐CoV‐2 infection.
Effectiveness of patient‐oriented education and medication management intervention in people with decompensated cirrhosis
Authors: Hayward Kelly L. , Valery Patricia C. , Patel Preya J. , Horsfall Leigh U. , Wright Penny L. , Tallis Caroline J. , Stuart Katherine A. , David Michael , Irvine Katharine M. , Cottrell W. Neil , Martin Jennifer H. , Powell Elizabeth E.
Published: October 2020

People with chronic disease often have poor comprehension of their disease and medications, which can negatively affect health outcomes. In a randomised‐controlled trial, we found that patients with decompensated cirrhosis who received a pharmacist‐led, patient‐oriented education and medication management intervention (n = 57) had greater knowledge of cirrhosis and key self‐care tasks compared with usual care (n = 59). Intervention patients also experienced improved quality of life. Dedicated resources are needed to support implementation of evidence‐based measures at local centres to improve outcomes.
Infliximab‐related weight gain in inflammatory bowel disease: associations and financial impacts
Authors: Kaazan Patricia , Tan Zhi , Bednarz Jana , Hughes Julie , Grafton Rachel , Andrews Jane M.
Published: October 2020

Association between tumour necrosis alpha inhibitors and weight gain has been reported. We examined weight change in our cohort of inflammatory bowel disease patients treated with infliximab (IFX) for over 12 months, its associations and financial implications. Two‐thirds of patients gained weight during the course of therapy. The mean change in weight after 12 months of IFX therapy was 3.3 (±6.5) kg.
Understanding the ethical implications of the rituals of medicine
Authors: Arnold Mark H. , Komesaroff Paul , Kerridge Ian
Published: October 2020

Rituals may be understood broadly as stereotyped behaviours carrying symbolic meanings, which play a crucial role in defining relationships, legitimating authority, giving meaning to certain life events and stabilising social structures. Despite intense interest in the subject, and an extensive literature, relatively little attention has been given to the nature, role and function of ritual in contemporary medicine. Medicine is replete with ritualistic behaviours and imperatives, which play a crucial role in all aspects of clinical practice. Rituals play multiple, complex functions in clinical interactions and have an important role in shaping interactions, experiences and outcomes. Longstanding medical rituals have been disrupted in the wake of coronavirus disease 2019 (COVID‐19). Medical rituals may be evident or invisible, often overlap with or operate alongside instrumentalised practices, and play crucial roles in establishing, maintaining and guaranteeing the efficacy of clinical practices. Rituals can also inhibit progress and change, by enforcing arbitrary authority. Physicians should consider when they are undertaking a ritual practice and recognise when the exigencies of contemporary practice are affecting that ritual with or without meaning or intention. Physicians should reflect on whether aspects of their ritual interactions are undertaken on the basis of sentiment, custom or evidence‐based outcomes, and whether rituals should be defended, continued in a modified fashion or even abandoned in favour of new behaviours suitable for and salient with contemporary practice in the interests of patient care.
Nursing discharge teaching for hospitalized older people: A rapid realist review
Authors: Pellet Joanie , Weiss Marianne , Rapin Joachim , Jaques Cecile , Mabire Cedric
Published: October 2020

Aim

To develop, refine and put forward a programme theory that describes configurations between context, hidden mechanisms and outcomes of nursing discharge teaching.

Design

Rapid realist review guided by Pawson's recommendations and using the Realist and Meta‐narrative Evidence Syntheses: Evolving Standards.

Data Sources

We performed searches in MEDLINE, Embase, CINAHL Full text, Google Scholarand supplementary searches in Google. We included all study designs and grey literature published between 1998‐2019.

Review Methods

We followed Pawson's recommended steps: initial programme theory development; literature search; document selection and appraisal; data extraction; analysis and synthesis process; presentation and dissemination of the revised programme theory.

Results

We included nine studies and a book to contribute to the synthesis. We developed 10 context–mechanisms–outcome configurations which cumulatively refined the initial programme theory. These configurations between context, mechanisms and outcome are classified in four categories as follows: relevancy of teaching content; patients’ readiness to engage in the teaching–learning process; nurses’ teaching skills and healthcare team approach to discharge teaching delivery. We also found that some of the same contexts generated similar outcomes, but through different mechanisms, highlighting interdependencies between context–mechanisms–outcome configurations.

Conclusion

This rapid realist review resulted in an explanatory synthesis of how discharge teaching works to improve patient‐centred outcomes. The proposed programme theory has direct implications for clinical practice by giving meaning to the ‘hidden’ mechanisms used by nurses when they prepare patients to be discharged home and can inform curricula for nursing education.

Impact

The essential components, process mechanisms, contexts and impacts of the nursing discharge teaching are not consistently or clearly described, explained or evaluated for effectiveness. This review uncovers underlying contexts and mechanisms in the teaching/learning process between patients and nurses. The resulting programme theory can guide nurse clinicians and managers towards improvements in conducting discharge teaching.
Systematic review: What is the impact of self‐scheduling on the patient, nurse and organization?
Authors: Wynendaele Herlinde , Gemmel Paul , Pattyn Eva , Myny Dries , Trybou Jeroen
Published: October 2020

Aim

To systematically review and evaluate the literature on the impact of self‐scheduling on patient, nurse and organization‐related outcomes.

Design

A systematic review.

Data sources

PubMed, Embase, Web of Science, Cinahl, Scopus, Google Scholar, ERIC and Cochrane Library were screened until October 2019 (week 40) for peer‐reviewed, empirical articles, written in English, Dutch or French.

Review methods

Two reviewers screened title and abstract using predetermined eligibility criteria and one reviewer screened the full texts of relevant hits. Quality was assessed with the Mixed Methods Appraisal Tool.

Results

Studies (N = 23) were retained and classified into explanatory and descriptive studies. The articles reported on a range of outcomes: patient‐ and nurse‐reported quality of care, job satisfaction, satisfaction with scheduling, work/life balance, planning involvement, interaction with colleagues, health and well‐being, psychosocial factors, professional development, nurse manager's scheduling time, general working conditions, turnover, temporary employment agency use and absenteeism, recruitment and retention.

Conclusion

The evidence base is limited. Several studies confirmed the positive impact of self‐scheduling on the nurse and the organization. However, other studies found negative outcomes or no change. These outcomes should be interpreted in the light of contextual factors and the implementation process, which was often not without difficulties. Future research should use a multimethod longitudinal design, bear in mind the possibilities of quantitative research (e.g. for studying psychosocial factors) and employ a theoretical framework.

Impact

This review informs about the inconsistent evidence on the association between self‐scheduling and patient, nurse and organization‐related outcomes and includes enablers and barriers to a successful implementation. These outcomes are influenced by the implementation process and the sustainability of the self‐scheduling system, which are still major challenges for healthcare management. This demonstrates the urgent need for further research.
Evolutionary history and eco‐climatic diversification in southern African dung beetle Sisyphus
Authors: Daniel Gimo M. , Davis Adrian L. V. , Sole Catherine L. , Scholtz Clarke H.
Published: October 2020

Aim

The high diversity of species in southern Africa has been attributed to geological and palaeoclimatic factors. The timing of radiations in some groups is held to be linked to these geoclimatic trends. Using the Scarabaeinae dung beetle genus, Sisyphus, as a model system, we investigate how geological uplift and climatic changes in the late Cenozoic affected its diversification patterns in southern Africa.

Location

Southern Africa.

Taxon

The dung beetle genus, Sisyphus Latreille, 1807 (Coleoptera: Scarabaeidae: Scarabaeinae).

Methods

A dated molecular phylogeny of southern African Sisyphus was compared with a factor analysis of species distribution data that statistically defined groups of species according to current climatic distribution. We used these climatic clusters to estimate ancestral ranges using the “BioGeoBEARS” R package. A lineage through time plot was calculated using the R package ‘APE’. We used Bayesian diversification models (compound Poisson process on mass extinction times) to test hypotheses on how late Cenozoic uplift and climatic changes affected speciation and extinction of Sisyphus. Furthermore, we implemented ecological niche modelling in MaxEnt to predict the habitat suitability of species under present climatic conditions.

Results

Four species groups defined from factor analysis of current climatic distribution data are primarily restricted to the moist summer rainfall region in the northeast. Species diversification occurred from the mid‐Miocene until the Pleistocene, during which the central southern African plateau was uplifted in tandem with the advent of winter rainfall and arid climatic zones to the southwest. The ancestor of Sisyphus was centred in eastern low to mid‐altitude areas. Speciation rates were higher in the Miocene to Pliocene, followed by a dramatic drop during the transition to the Pleistocene.

Main conclusions

The taxonomic and eco‐climatic diversification of sisyphines is coincident with geological uplift and changes in climate in east‐central southern Africa. However, phylogenetic relationships of southern African Sisyphus species are not homogenously distributed with respect to geography and climate.
How to check whether a blood pressure monitor has been properly validated for accuracy
Authors: Picone Dean S. , Padwal Raj , Campbell Norm R. C. , Boutouyrie Pierre , Brady Tammy M. , Olsen Michael Hecht , Delles Christian , Lombardi Cintia , Mahmud Azra , Meng Yaxing , Mokwatsi Gontse G. , Ordunez Pedro , Phan Hoang T. , Pucci Giacomo , Schutte Aletta E. , Sung Ki‐Chul , Zhang Xin‐Hua , Sharman James E. ,   for the Accuracy in Measurement of Blood Pressure (AIM‐BP) Collaborative
Published: October 2020

Hypertension guidelines recommend that blood pressure (BP) should be measured using a monitor that has passed validation testing for accuracy. BP monitors that have not undergone rigorous validation testing can still be cleared by regulatory authorities for marketing and sale. This is the situation for most BP monitors worldwide. Thus, consumers (patients, health professionals, procurement officers, and general public) may unwittingly purchase BP monitors that are non‐validated and more likely to be inaccurate. Without prior knowledge of these issues, it is extremely difficult for consumers to distinguish validated from non‐validated BP monitors. For the above reasons, the aim of this paper is to provide consumers guidance on how to check whether a BP monitor has been properly validated for accuracy. The process involves making an online search of listings of BP monitors that have been assessed for validation status. Only those monitors that have been properly validated are recommended for BP measurement. There are numerous different online listings of BP monitors, several are country‐specific and two are general (international) listings. Because monitors can be marketed using alternative model names in different countries, if a monitor is not found on one listing, it may be worthwhile cross‐checking with a different listing. This information is widely relevant to anyone seeking to purchase a home, clinic, or ambulatory BP monitor, including individual consumers for use personally or policy makers and those procuring monitors for use in healthcare systems, and retailers looking to stock only validated BP monitors.
Identifying patterns of diurnal blood pressure variation among ELSA‐Brasil participants
Authors: Paula Daniela P. , Lopes Leidjaira J. , Mill José G. , Fonseca Maria J. M. , Griep Rosane H.
Published: October 2020

Ambulatory blood pressure monitoring (ABPM) is the gold standard method for the diagnosis of hypertension. ABPM provides a set of repeated measurements for blood pressure (BP), usually over 24 h. Traditional approaches characterize diurnal BP variation by single ABPM parameters such as average and standard deviation, regardless of the temporal nature of the data. In this way, information about the pattern of diurnal BP variation and relationship between parameters is lost. The objective of this study was to identify and characterize daily BP patterns considering the set of repeated measures from 24‐h ABPM. A total of 859 adult participants of the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil) performed a 24‐h ABPM record. Hypertension, sex, age, race/color, education, marital status, smoking, alcohol, physical activity, and BMI were the covariables analyzed. Techniques for longitudinal clustering, multinomial models, and models with mixed effects were used. Three daily BP patterns were identified. Daily BP patterns with high BP presented higher standard deviation and morning surge and lower nocturnal dipping. They showed greater systolic BP variability and faster rise than fall in diastolic BP during sleep. Hypertensive, “pardos,” and men had greater odds to present these patterns. Daily BP patterns with high BP presented the worst profile concerning ABPM parameters associated with cardiovascular risk. The daily BP patterns identified contribute to the characterization of diurnal BP variation.
Predatory arthropod community composition in apple orchards: Orchard management, landscape structure and sampling method
Authors: Hambäck Peter A. , Porcel Mario , Tasin Marco , Samnegård Ulrika
Published: October 2020

Studies on predatory arthropods in agricultural areas seldom include Diptera other than hoverflies, partly because common sampling methods are less effective for capturing species that easily fly off when disturbed. To study the effect from this bias when describing the predator community, we compared traditional beat sampling of branches and suction sampling for describing the community of predatory arthropods in Swedish apple orchards, both organic orchards and orchards using integrated pest management (IPM). Our results indicate that the proportion of both predatory dipterans and parasitic hymenopterans increase dramatically when using suction sampling (Diptera: 32% vs. 20%, Hymenoptera: 25% vs. 7%). In fact, predatory dipterans were the most abundant predatory group when using suction sampling, in contrast to beat sampling where spiders were the most abundant group. One group of predatory flies that was particularly rich in both species and individuals in the surveyed apple orchards was dance flies in the family Hybotidae. Even though the bias of sampling method was evident, it was encouraging that the method choice did not affect the conclusions concerning management on predatory arthropod communities. With both methods, dipteran and coleopteran predators were more abundant in organic apple orchards whereas opilionids were more abundant in orchards managed according to IPM. The inclusion of landscape variables further indicated effects of landscape diversity and of deciduous forest cover, but the response varied in sign between predatory groups. Whereas both Coleoptera and Heteroptera were more abundant in orchards surrounded by more complex landscapes (high landscape diversity and/or high deciduous forest cover), spiders, opilionids and dipterans were rather less abundant in these orchards. To conclude, our study points to the potential importance of predatory dipterans in apple orchards, and we highly recommend future studies of arthropod predators in apple and other crops to actively include predatory Diptera.
Homeowner mitigation decision‐making: Exploring the theory of planned behaviour approach
Authors: Slotter Rachel , Trainor Joseph , Davidson Rachel , Kruse Jamie , Nozick Linda
Published: October 2020

During hurricanes, flooding and wind cause property damage and loss of life. Increased coastal development and recent economic impacts of hurricanes has increased stakeholders' interest in coastal mitigation. Through the use of the Theory of Planned Behaviour, this study focuses on factors that impact the intention of homeowners to mitigate. Methodologically, surveys were sent to a random sample of 2,500 coastal North Carolina homeowners who provided insights about their hurricane and mitigation experiences. The sample was purchased from Genesys, which utilises the postal service's database to randomly select addresses. Binary logistic regression was used to compute homeowners' intention to adopt eight separate mitigation actions for their homes. The findings show limited support on the influence of emotion and risk perception on intention to mitigate. However, the findings clearly support the relationships between intention to mitigate and the influence of others and perceptions of the characteristics of the mitigation actions. The significance of the findings indicates the importance of utilising these factors in future studies to better understand mitigation decision‐making and to inform future mitigation policies and programs.
Psychological Reactivity to Daily Family Experiences During Adolescence: Individual Differences and Developmental Stability
Authors: Kim Joanna J. , Fuligni Andrew J.
Published: October 2020

The current study examined adolescent psychological reactivity to daily family experiences, an important feature of emotion regulation that could have significant implications for psychopathology. A total of 428 Mexican‐heritage adolescents (Mage = 15.02 years, range: 13–18 years) completed daily diary checklists for 14 days and again 1 year later. Results revealed that adolescents’ family experiences were associated with negative mood, positive mood, and role fulfillment on a daily basis. Only role fulfillment reactivity was stable across 1 year, suggesting instability in individual differences in positive and negative mood reactivity. Sex moderated the relation between positive and negative mood reactivity during the second year of study, with males exhibiting broad psychological reactivity to daily family experiences. However, females who experienced higher negative mood reactivity exhibited less positive mood reactivity. Implications for possible sex differences in depression risk during the high school years are discussed.
Availability of public dental care service and dental caries increment in children: a cohort study
Authors: Moraes Renita Baldo , Menegazzo Gabriele Rissotto , Knorst Jessica Klöckner , Ardenghi Thiago Machado
Published: October 2020

Objective

Evaluate the impact of the availability of public dental care service on the increment of dental caries in children.

Methods

This is a 2‐year cohort study that followed preschool children from southern Brazil. Dental caries was measured at baseline and follow‐up evaluation, considering the number of surfaces with untreated dental caries. Demographic and socioeconomic characteristics as well as the use and availability of dental services were assessed. Multilevel Poisson regression analysis through a hierarchical approach and considering a random effect for repeated measures was used to explore the influence of exploratory variables in the increase in the outcome.

Results

A total of 419 cases were evaluated at follow‐up (91.3% cohort retention rate). The increase in the untreated dental caries was associated with living in places where there is no regular presence of dentists in the public health system. In addition, the increment of dental caries was influenced by age, household income, and dental attendance.

Conclusion

The results suggest that the availability of dentists in the public health system have an impact the increment of dental caries among children. The integration of the dentist in the primary healthcare can contribute to decrease the barriers that lead to children's oral health.
Melatonin attenuates diabetic cardiomyopathy and reduces myocardial vulnerability to ischemia‐reperfusion injury by improving mitochondrial quality control: Role of SIRT6
Authors: Yu Li‐Ming , Dong Xue , Xue Xiao‐Dong , Xu Shu , Zhang Xu , Xu Yin‐Li , Wang Zhi‐Shang , Wang Yang , Gao Hao , Liang Yan‐Xiao , Yang Yang , Wang Hui‐Shan
Published: October 2020

Targeting mitochondrial quality control with melatonin has been found promising for attenuating diabetic cardiomyopathy (DCM), although the underlying mechanisms remain largely undefined. Activation of SIRT6 and melatonin membrane receptors exerts cardioprotective effects while little is known about their roles during DCM. Using high‐fat diet‐streptozotocin‐induced diabetic rat model, we found that prolonged diabetes significantly decreased nocturnal circulatory melatonin and heart melatonin levels, reduced the expressions of cardiac melatonin membrane receptors, and decreased myocardial SIRT6 and AMPK‐PGC‐1α‐AKT signaling. 16 weeks of melatonin treatment inhibited the progression of DCM and the following myocardial ischemia‐reperfusion (MI/R) injury by reducing mitochondrial fission, enhancing mitochondrial biogenesis and mitophagy via re‐activating SIRT6 and AMPK‐PGC‐1α‐AKT signaling. After the induction of diabetes, adeno‐associated virus carrying SIRT6‐specific small hairpin RNA or luzindole was delivered to the animals. We showed that SIRT6 knockdown or antagonizing melatonin receptors abolished the protective effects of melatonin against mitochondrial dysfunction as evidenced by aggravated mitochondrial fission and reduced mitochondrial biogenesis and mitophagy. Additionally, SIRT6 shRNA or luzindole inhibited melatonin‐induced AMPK‐PGC‐1α‐AKT activation as well as its cardioprotective actions. Collectively, we demonstrated that long‐term melatonin treatment attenuated the progression of DCM and reduced myocardial vulnerability to MI/R injury through preserving mitochondrial quality control. Melatonin membrane receptor‐mediated SIRT6‐AMPK‐PGC‐1α‐AKT axis played a key role in this process. Targeting SIRT6 with melatonin treatment may be a promising strategy for attenuating DCM and reducing myocardial vulnerability to ischemia‐reperfusion injury in diabetic patients.
The association of bacteriuria with survival and disease progression in cats with azotemic chronic kidney disease
Authors: Hindar Camilla , Chang Yu‐Mei , Syme Harriet M. , Jepson Rosanne E.
Published: October 2020

Background

Cats with chronic kidney disease (CKD) have an increased prevalence of positive urine cultures (PUC). Limited information is available regarding the prognosis of cats with CKD and concurrent PUC.

Objective

To determine the association of PUC with survival time and disease progression in cats with CKD.

Animals

Medical records of 509 cats diagnosed with azotemic CKD between 1997 and 2018.

Methods

Cats were classified as having “no‐PUC” or “PUC.” The PUC cats were further classified as having 1 or multiple PUC, and also were classified based on the presence or absence of clinical signs of urinary tract infection (UTI). Progression of CKD was defined as a plasma creatinine concentration increase of ≥25% within 365 days of CKD diagnosis; PUC also must have occurred within this time frame. Survival time and frequency of CKD progression were compared between groups.

Results

No significant difference in survival time was found between cats with no‐PUC and cats with any number of PUC (P= .91), or between cats with no‐PUC, 1 PUC or multiple PUC (P= .37). Also, no significant difference was found in the frequency of CKD progression between PUC and no‐PUC cats (P= .5), or among no‐PUC, 1 PUC and multiple PUC cats (P= .22). When assessing cats with clinical signs of lower UTI, no significant difference was found in the frequency of CKD progression between cats with true UTI, subclinical bacteriuria or no‐PUC (P= .8).

Conclusions and Clinical Importance

When treated with antibiotics, PUC in cats with CKD do not affect disease progression or survival time.
Treatment of Complex Proximal Humeral Fractures in the Elderly with Reverse Shoulder Arthroplasty
Authors: Tian Xu , Xiang Ming , Wang Guangyu , Zhang Bo , Liu Junyang , Pan Chao , Liu Lintao , Dong Jingming
Published: October 2020

Objective

To assess the short‐term efficacy of reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly.

Methods

Forty‐three elderly patients treated operatively for complex proximal humeral fractures with reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively reviewed. To be specific, 12 males and 31 females were reviewed with an average age of 72.0 years (range, 66–78 years). All fractures were attributed to trauma and treated for 8.0 days on average (range, 6–11 days). As suggested from Neer classification, 21 cases (48.8%, 21/43) were three‐part fractures, and 22 (51.2%, 22/43) were four‐part fractures. To assess the postoperative efficacy, Visual Analog Scale (VAS), American Society of Shoulder and Elbow Surgery Shoulder Joint Score (ASES), Constant–Murley score and radiological examination were adopted. The Neer three‐part fracture group and the Neer four‐part fracture group were compared.

Results

There was no significant difference in age, gender, operation time, and follow‐up period between Neer three‐part fracture group and Neer four‐part fracture group. All operations were successfully performed, and the average operation time was 120–170 min, with an average of 141.3 min. Besides, the mean blood loss was 407.0 mL (250–700 mL), and the average intraoperative blood transfusion reached 446.5 mL (400–800 mL). All patients received the follow‐up for 6 to 16 months, that is for 10.9 months on average. All patients were discharged in 7 days after operation, and no wound‐related complications were identified. In 8 weeks, the greater and lesser tuberosities of all patients healed completely. During the last follow‐up, no loosening or dislocation of prosthesis was detected, and the forward elevation of 133.0 (100°‐ 165°), the external rotation of 29.5° (20°–35°), the internal rotation of 46.7°(30°–60°), the VAS score of 0.8(0–3), the ASES score of 89.1(78.8–100.0) were achieved. Constant‐Murley score reached 88.7 (range, 70–98). There was no significant difference between Neer three‐part fracture group and Neer four‐part fracture group (P > 0.05). A 71‐year‐old patient developed the symptoms of axillary nerve injury after operation; he recovered completely at 6 weeks after the operation, which had not adversely affected the functional rehabilitation exercise or the stability of the prosthesis. At the follow‐up, no other complications (e.g., infection, acromial stress fracture, and scapular notching) were identified in all patients.

Conclusion

The short‐term efficacy of one‐stage reverse shoulder arthroplasty to treat complex proximal humeral fractures in the elderly is satisfactory.
Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems
Authors: Dai Junxi , Zhang Guofeng , Li Shulin , Xu Jianguang , Lu Jiuzhou
Published: October 2020

Objectives

To evaluate the effectiveness of arthroscopic management of posttraumatic elbow stiffness due to soft tissue problems.

Methods

A retrospective review of 30 consecutive arthroscopic elbow releases for posttraumatic stiff elbow from November 2011 to December 2019 was conducted. Stiff elbows with bony problems, such as heterotopic ossification, intraarticular nonunion or malunion, and cartilage lesions were excluded from this study. Contracture and adhesion of soft tissue around the elbow were identified. Surgical treatments included arthroscopic capsulectomy, ligaments and muscle release, and ulnar nerve release. The results were evaluated using the Mayo elbow performance score (MEPS) and range of motion of the elbow. Surgery‐related complications were assessed.

Results

Patients who underwent arthroscopic release were followed up for between 6 and 35 months, with a mean follow‐up time of 10.1 months. The postoperative elbow ROM was 123.2° ± 19°, which was significantly different compared to the preoperative value of 68° ± 32°. In addition, the MEPS score improved from 71.2 ± 10.3 preoperatively to 93.7 ± 6.6 at the final follow‐up, a mean improvement of 22.5 (range, 0–55; P < 0.05). Postoperative complications included five cases of prolonged drainage from the portal site, three transient nerve palsies, and one hematoma in the medial elbow.

Conclusion

With full recognition by the surgeon of the pathologic changes of the soft tissue around the elbow, arthroscopic release is usually safe and effective for posttraumatic elbow stiffness without symptomatic bony problems.
Shoulder Osteonecrosis: Pathogenesis, Causes, Clinical Evaluation, Imaging, and Classification
Authors: Hernigou Philippe , Hernigou Jacques , Scarlat Marius
Published: October 2020

The humeral head is the second most common site for nontraumatic osteonecrosis after the femoral head, yet it has attracted relatively little attention. Osteonecrosis is associated with many conditions, such as traumatism, corticosteroid use, sickle cell disease, alcoholism, dysbarism (or caisson disease), and Gaucher's disease. The diagnosis is clinical and radiographic with MRI, with radiographs being the basis for staging. Many theories have been proposed to decipher the mechanism behind the development of osteonecrosis, but none have been proven. Because osteonecrosis may affect patients with a variety of risk factors, it is important that caregivers have a heightened index of suspicion. Early detection may affect prognosis because prognosis is dependent on the stage and location of the disease. In particular, the disease should be suspected in patients with a history of fractures, steroid usage, or sickle cell disease, and in divers. This report reviews osteonecrosis of the humeral head, with an emphasis on causes, clinical evaluation, imaging, and classification.
Installation of C4 photosynthetic pathway enzymes in rice using a single construct
Authors: Ermakova Maria , Arrivault Stéphanie , Giuliani Rita , Danila Florence , Alonso‐Cantabrana Hugo , Vlad Daniela , Ishihara Hirofumi , Feil Regina , Guenther Manuela , Borghi Gian Luca , Covshoff Sarah , Ludwig Martha , Cousins Asaph B. , Langdale Jane A. , Kelly Steven , Lunn John E. , Stitt Mark , von Caemmerer Susanne , Furbank Robert T.
Published: October 2020

Introduction of a C4 photosynthetic mechanism into C3 crops offers an opportunity to improve photosynthetic efficiency, biomass and yield in addition to potentially improving nitrogen and water use efficiency. To create a two‐cell metabolic prototype for an NADP‐malic enzyme type C4 rice, we transformed Oryza sativa spp. japonica cultivar Kitaake with a single construct containing the coding regions of carbonic anhydrase, phosphoenolpyruvate (PEP) carboxylase, NADP‐malate dehydrogenase, pyruvate orthophosphate dikinase and NADP‐malic enzyme from Zea mays, driven by cell‐preferential promoters. Gene expression, protein accumulation and enzyme activity were confirmed for all five transgenes, and intercellular localization of proteins was analysed. 13CO2 labelling demonstrated a 10‐fold increase in flux though PEP carboxylase, exceeding the increase in measured in vitro enzyme activity, and estimated to be about 2% of the maize photosynthetic flux. Flux from malate via pyruvate to PEP remained low, commensurate with the low NADP‐malic enzyme activity observed in the transgenic lines. Physiological perturbations were minor and RNA sequencing revealed no substantive effects of transgene expression on other endogenous rice transcripts associated with photosynthesis. These results provide promise that, with enhanced levels of the C4 proteins introduced thus far, a functional C4 pathway is achievable in rice.
The nature of attachment systems
Authors: Barbaro Nicole
Published: October 2020

Attachment theory is an enduring and generative framework for understanding infant and romantic relationships. As a lifespan phenomenon, attachment research has focused largely on developmental processes and how to link the infant attachments with later close relationships, but there has been comparably less scholarly attention targeted at the evolutionary origins and functionality of romantic attachments, in particular. Here, I advance a two‐system approach to attachment, proposing that infant attachments and romantic attachments constitute etiologically distinct systems that evolved in response to different selection pressures, serve different evolutionary functions, and are fundamentally different in nature with regard to operation and necessity toward their respective evolutionary goals. This two‐system approach has downstream implications for future attachment research, most notably with regard to how the romantic attachment system develops over the lifespan, and the extent to which romantic attachments guide the formation of relationships in adulthood.
Introducing data science with data moves and CODAP
Authors: Erickson Tim , Chen Ernest
Published: October 2020

This paper describes a short module [3] for introducing data science to senior school students or other data‐science beginners. The design focuses on “data moves.” Students use CODAP [5] to do their work.
Topical treatment of equine sarcoids with imiquimod 5% cream or Sanguinaria canadensis and zinc chloride – an open prospective study
Authors: Pettersson Carina M. , Broström Hans , Humblot Patrice , Bergvall Kerstin E.
Published: October 2020

Contexte

Les sarcoïdes équins sont la tumeur cutanée la plus prévalente chez le cheval dans le monde entier. Bien que plusieurs traitements soient disponibles, aucun n’est totalement efficace et les récidives sont fréquentes.

Objectifs

Déterminer l’efficacité et l’innocuité de la crème imiquimod 5% et Sanguinaria canadensis + chloride de zinc dans le traitement de sarcoïdes équins et étudier les effets systémiques potentiels sur les sarcoïdes distants non traités.

Sujets/tumeurs

Vingt‐cinq chevaux de propriétaires avec un total de 164 tumeurs ont été inclus dans l’étude. Cinquante‐sept tumeurs ont été traitées et 107 non traitées.

Matériels et méthodes

Des biopsies ont été prélevées, au moins une par cheval, les autres étaient diagnostiquées comme probablement des sarcoïdes à partir de l’aspect clinique. L’imiquimod 5% (A) a été appliquée trois fois par semaine, tandis que Sanguinaria canadensis + chloride de zinc (X) a été appliqué tous les quatre jours après une phase d’initiation d’une fois par jour pendant six jours. Le traitement a été poursuivi jusqu’à rémission clinique ou pendant 45 semaines maximum, avec une période de suivi longue (34 mois en moyenne). Des biopsies des sarcoïdes ont été renouvelées après la fin du traitement et en suivi si le propriétaire donnait son consentement.

Résultats

Une rémission complète a été enregistrée dans 84.4% (A) et 75.0% (X) des tumeurs. Une récidive a été observée dans 7.3% (A) et 21.4% (X). Une rémission spontanée a été observée dans 1,9% des tumeurs non traitées. Aucun effet systémique indésirable sur les tumeurs non traitées n’a été détecté. Au cours du traitement des degrés variables d’inflammation locale étaient fréquents.

Conclusion et importance clinique

Les deux traitements sont considérés comme surs et efficaces. Les plus petites tumeurs répondaient plus favorablement au traitement. Le taux de récidive était faible et non observée au sein des biopsies répétées après la fin du traitement.
Do females and males exhibit a similar sarcopenic response as a consequence of normoxic and hypoxic bed rest?
Authors: Mekjavic Igor B. , Eiken Ola , Mekjavic Polona Jaki , McDonnell Adam C.
Published: October 2020

New Findings

What is the central question of this study?

Do females and males exhibit a similar sarcopenic response as a consequence of normoxic and hypoxic bed rest?

What is the main finding and its importance?

During 10‐day bed rest, exposure to a simulated (normobaric hypoxia) altitude of ∼4000 m does not exert additional significant structural or functional effect on the weight‐bearing muscles in females compared to those noted under normoxic conditions. Whereas males and females exhibit decrements in muscle cross‐sectional area and mass during normoxic and hypoxic bed rest, a concomitant strength decrement was only observed in males.

This study investigated the effects of hypoxia on the known processes of adaptation of body composition and muscle function to normoxic inactivity. Females (n = 12) and males (n = 11) took part in the following interventions: hypoxic ambulation (HAMB; ∼4000 m); hypoxic bed rest (HBR; ∼4000 m) and normoxic bed rest (NBR). Prior to and immediately following each intervention, body composition, thigh and lower leg cross‐sectional area (CSA) and isometric muscular strength were recorded. Participants lost body mass (HAMB: male −1.5 ± 0.9 kg, female −1.9 ± 0.7 kg; HBR: male −2.0 ± 1.8 kg, female −2.4 ± 0.8 kg; NBR: male −1.4 ± 1.3 kg, female −1.4 ± 0.9 kg) and lean mass (HAMB: male −3.9 ± 3.0%, female −3.4 ± 2.0%; HBR: male −4.0 ± 4.4%, female −4.1 ± 2.0%; NBR: male −4.0 ± 3.4%, female −2.2 ± 2.7%) with no between‐condition or sex differences. Knee extension decreased for males in NBR compared to HAMB (HAMB: male −0.2 ± 9.1%, female 1.3 ± 4.9%; HBR: male −7.8 ± 10.3%, female −3.3 ± 10.9%; NBR: male −14.5 ± 11%, female −3.4 ± 6.9%). Loss of force during maximal voluntary contraction (MVC) in the knee extensors was significantly different between males and females following NBR. There were no other significant changes noted following the experimental interventions. There were no differences recorded between sexes in maximal MVC for elbow or ankle joints. Female lower leg CSA decreased following bed rest (HAMB: ‐4.5 ± 2.0%; HBR: ‐9.9 ± 2.6%; NBR: ‐8.0 ± 1.6%). These findings indicate that a 10‐day hypoxic bed rest does not exert any significant additional effect on muscle atrophy when compared to NBR, except for female thigh CSA. In contrast to males, who exhibited a significant loss of muscle strength, no such decrement in strength was observed in the female participants.
Influence of cuff‐occlusion duration on contrast‐enhanced ultrasound assessments of calf muscle microvascular blood flow responsiveness in older adults
Authors: Young Grace Marie , Krastins Digby , Chang David , Lam Jeng , Quah Jing , Stanton Tony , Russell Fraser , Greaves Kim , Kriel Yuri , Askew Christopher David
Published: October 2020

New Findings

What is the central question of the study?

Cuff‐occlusion duration may influence contrast‐enhanced ultrasound (CEUS) assessments of skeletal muscle microvascular blood flow responsiveness: what are the effects of 1, 3 and 5 min cuff‐occlusion on the magnitude and reliability of calf muscle microvascular blood flow responsiveness in older adults?

What is the main finding and its importance?

Calf muscle microvascular blood flow responsiveness was enhanced following 5 min cuff‐occlusion compared with 1 min. The reliability of post‐occlusion CEUS measurements was also improved following 5 min occlusion. The use of a standardized 5 min occlusion period should therefore be considered in future studies and clinical practice.

Contrast‐enhanced ultrasound (CEUS) is increasingly used in assessments of skeletal muscle microvascular blood flow responsiveness. In response to limb cuff‐occlusion, some studies have reported significant impairments in CEUS measurements of microvascular blood flow in older adults with cardiovascular or metabolic disease, whereas others have failed to detect significant between‐group differences, which has brought the reliability of the technique into question. In the absence of a standardized CEUS protocol, there is variance in the duration of cuff‐occlusion used, which is likely to influence post‐occlusion measurements of muscle microvascular blood flow. We aimed to determine the effect of cuff‐occlusion duration by comparing the magnitude and reliability of CEUS measurements of calf muscle microvascular blood flow responsiveness in older adults (n = 15, 67 ± 11 years) following 1, 3 and 5 min occlusion periods. Microvascular blood flow (= microvascular volume × microvascular velocity) within the calf muscle was measured using real‐time destruction–replenishment CEUS. Measurements were made following thigh cuff‐occlusion (200 mmHg) periods of 1, 3 and 5 min in a random order. Microvascular blood flow was higher following 3 min (3.71 ± 1.46 aU s−1) and 5 min (3.47 ± 1.48 aU s−1) compared with 1 min (2.42 ± 1.27 aU s−1, P = 0.002), which corresponded with higher microvascular volumes after 3 and 5 min compared with 1 min. Reliability was good following 5 min (intraclass correlation coefficient (ICC) 0.49) compared with poor following 1 min (ICC 0.34) and 3 min (ICC 0.35). This study demonstrates that the magnitude and reliability of calf muscle microvascular responsiveness is enhanced using a 5 min cuff‐occlusion protocol compared with 1 min in older adults.
On-chip heralded single photon sources
Authors: Signorini S. , Pavesi L.
Published: October 2020

Time correlated photon pairs are used to produce heralded single photon states for quantum integrated circuits. These states are generated by photon sources, which are called heralded single photon sources. They are based on the detection of one photon which heralds the presence of the other. In this way, pure single photon states can be probabilistically generated and, subsequently, manipulated in complex photonic circuits. Heralded single photon sources are the topic of this review. The authors detail the main parameters and the experiments involved in their characterization, with a focus on their use in integrated photonic circuits. Different geometries and technological platforms are compared, and an assessment of their performances is performed. The final result is that nearly perfect single photon sources are possible and feasible in an integrated platform. A few open issues are also underlined.