bluuebunny/crossref_metadata_2025 huggingface dataset:
Leonurine Attenuates Myocardial Fibrosis Through Upregulation of miR-29a-3p in Mice Post-myocardial Infarction
Authors: Wang Ruiyu , Peng Linqian , Lv Dingyi , Shang Feifei , Yan Jianghong , Li Guoxing , Li Dan , Ouyang Jing , Yang Jiadan
Published: November 2020

Myocardial fibrosis (MF) is a pathological process that accelerates cardiac remodeling in myocardial infarction (MI), and miR-29 has become one of the foci of research into MF. As an alkaloid extracted from Herba leonuri, leonurine (LE) has been found to be an effective natural active ingredient for inhibiting fibrosis in many preclinical experiments. However, whether LE protects against MF after MI through modifying miR-29 remains unclear. The present study aimed to investigate the therapeutic effects of LE on MF, and to elucidate the underlying mechanisms involved. A mouse model of MI was established, followed by administration of LE for 4 weeks. We found that LE effectively improved cardiac function, and attenuated fibrosis and cardiac remodeling in mice post-MI. In vitro, LE simultaneously inhibited proliferation and migration of neonatal mouse cardiac fibroblasts (CFs) exposed to angiotensin II (Ang II), and the activation of collagen synthesis and myofibroblast generation was markedly suppressed by LE. Notably, we found that all mature miR-29 family members were downregulated in the myocardial tissues of mice post-MI, whereas LE significantly upregulated miR-29a-3p expression, and such upregulation was also detected in LE-treated CFs under Ang II stimulation. Knockdown of miR-29a-3p by a specific miRNA inhibitor upregulated the protein levels of TGF-β, collagen III, and collagen I in CFs, and completely reversed the antifibrotic effects of LE on CFs. Our study suggests that LE exerts cardioprotective effects against MF, possibly through the upregulation of miR-29a-3p.
Comparative Study of Metabolite Changes After Antihypertensive Therapy With Calcium Channel Blockers or Angiotensin Type 1 Receptor Blockers
Authors: Lu Jieyu , Tian Yunfan , Gu Jia , Qiu Ming , Lu Yan , Sun Wei , Kong Xiangqing
Published: November 2020

The high prevalence of hypertension contributes to an increased global burden of cardiovascular diseases. Calcium channel blockers (CCBs) and angiotensin type 1 receptor blockers (ARBs) are the most widely used antihypertensive drugs, and the effects of these drugs on serum metabolites remain unknown. Untargeted metabolomics has been proved to be a powerful approach for the detection of biomarkers and new compounds. In this study, we aimed to determine the changes in metabolites after single-drug therapy with a CCB or ARB in patients newly diagnosed with mild to moderate primary hypertension. We enrolled 33 patients and used an untargeted metabolomics approach to measure 625 metabolites associated with the response to a 4-week treatment of antihypertensive drugs. After screening based on P < 0.05, fold change > 1.2 or fold change < 0.83, and variable importance in projection > 1, 63 differential metabolites were collected. Four metabolic pathways—cysteine and methionine metabolism, phenylalanine metabolism, taurine and hypotaurine metabolism, and tyrosine metabolism—were identified in participants treated with ARBs. Only taurine and hypotaurine metabolism were identified in participants treated with CCBs. Furthermore, homocitrulline and glucosamine-6-phosphate were relevant to whether the blood pressure reduction achieved the target blood pressure (P < 0.05). Our study provides some evidence that changes in certain metabolites may be a potential marker for the dynamic monitoring of the protective effects and side effects of antihypertensive drugs.
Knockdown of H19 Attenuates Ox-LDL-induced Vascular Smooth Muscle Cell Proliferation, Migration, and Invasion by Regulating miR-599/PAPPA Axis
Authors: Lu Guoyong , Chu Yongxin , Tian Peng
Published: November 2020

Long noncoding RNAs could participate in the development of atherosclerosis (AS). However, the underlying mechanism by which long noncoding RNA H19 is implicated in AS remains largely unknown. In this study, we investigated the function of H19 on cell proliferation, migration, and invasion in oxidized low-density lipoprotein (ox-LDL)-treated human aortic vascular smooth muscle cells (HA-VSMCs), and on hyperlipidemia response in high-fat diet (HFD)-treated ApoE−/− mice. Moreover, we explored the target interaction among H19, microRNA (miR)-599, and pappalysin 1 (PAPPA). Our results showed that H19 expression was elevated in serum samples of patients with AS and ox-LDL-treated HA-VSMC. H19 silence mitigated ox-LDL-induced proliferation, migration, and invasion of HA-VSMCs. H19 acted as a sponge for miR-599, and miR-599 knockdown reversed the suppressive effect of H19 silence on proliferation, migration, and invasion of HA-VSMCs. PAPPA was a target of miR-599 and attenuated the inhibitive role of miR-599 in HA-VSMC processes. H19 knockdown repressed PAPPA expression by increasing miR-599. Moreover, H19 interference alleviated hyperlipidemia response in HFD-treated ApoE−/− mice. Collectively, knockdown of H19 inhibited proliferation, migration, and invasion of ox-LDL-treated HA-VSMCs and hyperlipidemia response in HFD-treated ApoE−/− mice by regulating miR-599/PAPPA axis, indicating H19 might act as a potential target for the treatment of AS.
A Systematic Review of Randomized Controlled Trials Comparing Renal Sympathetic Denervation Versus Sham Procedure for the Management of Uncontrolled Hypertension
Authors: Maqsood Muhammad H. , Rubab Kinza , Anwar Fazeel , Afzal Khan Muhammad T. , Maqsood Muhammad A. , Farooq Minaam , Tabaza Luai , Rangaswami Janani , Virk Hafeez ul H.
Published: November 2020

The efficacy of renal sympathetic denervation (RSD) in the treatment of uncontrolled hypertension (HTN) remains uncertain. A systematic review of randomized controlled trials was performed to evaluate the efficacy and safety of RSD for resistant HTN. PubMed, EMBASE, MEDLINE, Cochrane, Directory of Open Access Journals, CINAHL, and Google Scholar were searched from January 01, 2001, through July 30, 2020. Randomized controlled trials comparing RSD with the sham procedure for uncontrolled HTN were selected. The primary efficacy outcome was the reduction in ambulatory systolic blood pressure. We used random-effects models. Nine prospective clinical trials met the inclusion criteria. The ReSet and Symplicity HTN-3 Trial showed no significant changes because of discrepancies in complete circumferential ablation during RSD. The Relief study, The Radiance HTN solo, and the SPYRAL HTN OFF medical trials showed a significant reduction in systolic blood pressure in the group that had undergone the intervention compared with the sham group attributed to rigorous trial design. In conclusion, our systematic review suggests that efficacy of RSD seems to be superior to sham-controlled interventions provided circumferential denervation is performed. However, difference in efficacy is marginal.
Plasma Concentrations and Safety of Lopinavir/Ritonavir in COVID-19 Patients
Authors: Chouchana Laurent , Boujaafar Sana , Gana Ines , Preta Laure-Hélène , Regard Lucile , Legendre Paul , Azoulay Celia , Canouï Etienne , Zerbit Jeremie , Carlier Nicolas , Terrier Benjamin , Kernéis Solen , Batista Rui , Treluyer Jean-Marc , Zheng Yi , Benaboud Sihem
Published: November 2020

Background:

Although the efficacy of lopinavir/ritonavir has not been proven, it has been proposed as an off-label treatment for COVID-19. Previously, it has been reported that the plasma concentrations of lopinavir significantly increase in inflammatory settings. As COVID-19 may be associated with major inflammation, assessing the plasma concentrations and safety of lopinavir in COVID-19 patients is essential.

Methods:

Real-world COVID-19 data based on a retrospective study.

Results:

Among the 31 COVID-19 patients treated with lopinavir/ritonavir between March 18, 2020 and April 1, 2020, higher lopinavir plasma concentrations were observed, which increased by 4.6-fold (interquartile range: 3.6–6.2), compared with the average plasma concentrations in HIV. Lopinavir concentrations in all except one patient were above the upper limit of the concentration range of HIV treatment. Approximately one to 5 patients prematurely stopped treatment mainly because of an ADR related to hepatic or gastrointestinal disorders.

Conclusions:

Lopinavir plasma concentrations in patients with moderate-to-severe COVID-19 were higher than expected, and they were associated with the occurrence of hepatic or gastrointestinal adverse drug reactions. However, a high plasma concentration may be required for in vivo antiviral activity against SARS-CoV-2, as suggested by previous studies. Therefore, in the absence of adverse drug reaction, lopinavir dosage should not be reduced. Caution is essential because off-label use can be associated with a new drug safety profile.
Developing and evaluating a patient decision aid for hormone therapy to manage symptoms of surgical menopause: the story behind the “SheEmpowers” patient decision aid
Authors: Siyam Tasneem , Shivji Alisha , Ross Sue , Eurich Dean T. , Lavasanifar Afsaneh , Yuksel Nesé
Published: November 2020

Objectives:

To develop and evaluate an evidence-based patient decision aid (PDA) that can support women making decisions on hormone therapy (HT) for the management of early surgical menopause.

Methods:

The PDA development was guided by the Ottawa Decision Support Framework and the International Patient Decision Aid Standards and involved three phases: an exploratory phase to identify women's decisional needs; a development phase to identify evidence related to treatment options and draft initial prototype; and an evaluation phase to evaluate the prototype and elicit views on acceptability in women (N = 12). All phases were driven by a multidisciplinary group of researchers, clinicians, and patient stakeholders to ensure women's priorities were met.

Results:

A prototype PDA was drafted based on needs identified from the exploratory phase. The PDA has five domains: information on surgical menopause and HT; HT outcome probabilities; patient stories; values clarification; and guidance in deliberation. Participants in the evaluation phase perceived the tool as acceptable and offered suggestions for modifications.

Conclusion:

Through our adopted, systematic approach the SheEmpowers PDA was developed to help women overcome deterrents to decision-making related to lack of knowledge, decision-making skills, and involvement in therapy decisions. The decisional effectiveness of the tool is to be assessed in future studies.
Estimation of Heights and Body Masses of Tuberculosis Patients in the Canadian Fluoroscopy Cohort Study for Use in Individual Dosimetry
Authors: Thiessen Kathleen M. , Apostoaei A. Iulian , Zablotska Lydia B.
Published: November 2020

This paper documents the estimation of mean heights and body masses, by age and sex, used in development of organ-specific dose conversion coefficients for external radiation for a historical cohort of about 64,000 patients from the Canadian Fluoroscopy Cohort Study. Patients were exposed to repeated fluoroscopy and chest radiography examinations in the course of treatment for tuberculosis in residential medical facilities throughout Canada between 1930 and 1969. Using Canadian national survey data and extensive literature review, mean heights and masses were obtained for the White population of Canada during the time period of interest, and the differences in mean body mass between tuberculosis patients and the general population were estimated. Results in terms of mean height and body mass of Canadian tuberculosis patients, with uncertainties, are reported for selected age groups (children of ages 1, 5, 10, and 15 y and adults age 20+) and for both sexes. Use of estimated average heights and body masses by age and sex permits the adjustment of computerized phantoms for body mass for a given age, thereby increasing the relevance of the organ-specific dose conversion coefficients for the cohort and improving the accuracy of the resulting estimated organ doses.
Identification of Volume of Distribution for 239Pu in Rats
Authors: Cook Madeline C. , Brey Richard R.
Published: November 2020

The work within identifies the volume of distribution (VD) of plutonium using data from studies in which rats were administered an intravenous bolus injection of 239Pu4+-citrate. The research investigated two separate datasets. Data published by Durbin and colleagues in “Plutonium Deposition Kinetics in Rats” and studies conducted by Lovelace Respiratory Research Institute (LRRI) were examined. The goal of this research was to identify a value of VD consistent with the known biological behavior of plutonium. The identified VD is necessary to develop a physiologically-based pharmacokinetic (PBPK) model. The creation of a PBPK model describing the behavior of plutonium in the body enables the comparison of transfer rates to validate the biokinetic models currently in use for internal dosimetry purposes. The VD of a substance describes the distribution between intracellular and extracellular fluid compartments, providing information such as cellular uptake and protein binding. The VD time profiles and values found using the Durbin data were consistent with known behavior of plutonium. The VD values found using data provided by LRRI were not consistent with known behavior of plutonium; however, the VD time profiles generated may still be of use for PBPK modeling.
Systemic Cat-Scratch Disease: a “Troublesome” Diagnosis
Authors: Sarno Marco , Rosanio Francesco Maria , De Brasi Daniele , Santoro Claudio , Lo Vecchio Andrea , Esposito Francesco , Siani Paolo , Vajro Pietro , Mandato Claudia
Published: November 2020

Diagnosis of systemic cat scratch disease may be challenging. Here, we describe a case of an immunocompetent girl exhibiting fever and multifocal hepatosplenic abscesses. Diagnostic tests for Bartonella henselae infection (enzyme immunoassay and polymerase chain reaction) were found steadily negative and the diagnosis, suspected on the basis of the Margilet’s criteria, was finally confirmed by indirect immunofluorescent antibodies.
Invasive Bacterial and Fungal Infections After Pediatric Cardiac Surgery: A Single-center Experience
Authors: Tönz Gian Maria , Kadner Alexander , Pfammatter Jean-Pierre , Agyeman Philipp Kwame Abayie
Published: November 2020

Background:

Discrimination of infectious and noninfectious complications in children with inflammatory signs after cardiac surgery is challenging. Given the low prevalence of infectious complications after heart surgery, there might be a risk of excessive antibiotic usage. We performed this study to determine the rate of invasive bacterial or fungal infections in children after cardiac surgery at our institution and to evaluate our postoperative management.

Methods:

This single-center retrospective observational cohort study included children 16 years of age or younger who underwent cardiac surgery at our institution between January 2012 and December 2015.

Results:

We analyzed 395 surgical procedures. Thirty-five postoperative invasive bacterial or fungal infections were detected in 29 episodes (7%, 0.42 per 100 admission days). Among bacterial infections, the most common infection sites were bacteremia and pneumonia, accounting for 37% (13/35) and 23% (8/35) of infections respectively. The rate of postoperative infections was associated with surgical complexity score and length of postoperative pediatric intensive care unit (PICU) stay. In 154 (43%) of 357 episodes without microbiologically documented infection, uninterrupted postoperative antibiotic administration was continued for more than 3 days and in 80 (22%) for more than 5 days.

Conclusions:

The rate of postoperative bacterial or fungal infection at our institution is comparable to current literature. High surgical complexity score and prolonged length of PICU stay were risk factors for bacterial or fungal infections in this patient population.
Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID-19-Associated Acute Respiratory Distress Syndrome
Authors: Mekonnen Zesemayat K. , Ashraf Davin C. , Jankowski Tyler , Grob Seanna R. , Vagefi M. Reza , Kersten Robert C. , Simko Jeffry P. , Winn Bryan J.
Published: November 2020

Acute invasive fungal rhinosinusitis is a rare, although highly morbid, infection primarily affecting immunosuppressed individuals. The same population is at particularly high risk of complications and mortality in the setting of SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome. The authors present a case of acute invasive fungal rhino-orbital mucormycosis in a patient with COVID-19 and discuss the prevalence, diagnosis, and treatment of fungal coinfections in COVID-19. Prompt recognition, initiation of therapy, and consideration of the challenges of rapidly evolving COVID-19 therapy guidelines are important for improving patient survival.
Translation and validation of the traditional Chinese version of the Constipation Severity Instrument
Authors: Tsai Yi-Jian , Yang Yi-Wen , Lan Yuan-Tzu
Published: November 2020

Background:

The Constipation Severity Instrument (CSI) is a well-validated measure for assessing constipation severity. At present, no translated traditional Chinese version of the scale is available. We aimed to develop a traditional Chinese version of the CSI and to validate the translated version.

Methods:

The CSI questionnaire was translated into traditional Chinese language, followed by linguistic validation. It was tested on 45 constipated patients and 55 controls from colorectal outpatient clinics and volunteers. A retest was performed in a subgroup of 39 patients 2 weeks later. Convergent validation was assessed using the Cleveland constipation scoring system (CSS) and quality of life was assessed with the 12-item short-form health survey (SF-12). The reliability and validity were assessed using Cronbach’s α coefficient, intraclass correlation coefficient (ICC), and the Spearman correlation test.

Results:

Cronbach’s α coefficient for the CSI total score and its three subscale scores were all above 0.93. Test–retest reliability was good for the CSI total score (ICC = 0.865) and its three subscale scores (ICC = 0.709–0.882). The constipated participants could be effectively differentiated from the controls based on the CSI total score and its three subscales. The convergent validation was good between the CSI and CSS (Spearman’s ρ = 0.711, p < 0.001). The CSI score correlated negatively with the physical composite score and mental composite score of the SF-12 quality of life scale, indicating poorer quality of life in constipated patients.

Conclusion:

We demonstrated the reliability and validity of the traditional Chinese version of the CSI, which could be a standardized tool for future studies on constipation.
Omeprazole vs famotidine for the prevention of gastroduodenal injury in high-risk users of low-dose aspirin: A randomized controlled trial
Authors: Tseng Zhi-Fu , Hsu Ping-I , Peng Nan-Jing , Kao Sung-Shuo , Tsay Feng-Woei , Cheng Jin-Shiung , Chen Wen-Chi , Tsai Kun-Feng , Tang Sheng-Yeh , Chuah Seng-Kee , Shie Chang-Bih
Published: November 2020

Background:

Low-dose aspirin is widely used in the prevention of cardiovascular diseases. However, the use of aspirin is associated with an increased risk of gastrointestinal injury.

Methods:

Low-dose aspirin users with a history of peptic ulcers who did not have gastroduodenal mucosal breaks at initial endoscopy were randomly assigned to receive famotidine (20 mg bid) or omeprazole (20 mg qd) for 6 months. Follow-up endoscopy was performed at the end of the sixth month and whenever epigastric discomfort, hematemesis, or melena occurred. The primary end point was the occurrence of gastroduodenal mucosal breaks. The secondary end points were (1) the occurrence of gastroduodenal ulcers and (2) the occurrence of gastroduodenal bleeding.

Result:

Between November 2013 and June 2018, 170 patients were randomly assigned to receive either famotidine (n = 84) or omeprazole (n = 86). The incidence of gastroduodenal mucosal breaks was 33.8% among the patients receiving famotidine, and 19.8% among those receiving omeprazole (95% CI: 0.4%-27.5%; p = 0.045). The two patient groups had comparable incidence rates of gastroduodenal ulcers (20.0% vs 9.8%; p = 0.071), and gastroduodenal bleeding (2.5% vs 0%; p = 0.243). Multivariate analysis showed that use of the proton pump inhibitor was an independent protective factor (odds ratio: 0.47; 95% CI: 0.23-0.99; p = 0.047), and that smoking was a risk factor for mucosal breaks (odds ratio: 3.84; 95% CI: 1.52-9.71; p = 0.004).

Conclusion:

Proton pump inhibitor was superior to histamine-2 receptor antagonist in the prevention of gastroduodenal mucosal breaks in high-risk users of low-dose aspirin, and smoking was an independent risk factor for developing gastroduodenal mucosal breaks.
Role of Preoperative Patient Expectations in Adult Cochlear Implant Outcomes
Authors: McRackan Theodore R. , Reddy Priyanka , Costello Mark S. , Dubno Judy R.
Published: November 2020

Objective:

Preoperative expectations affect patient outcomes in many health conditions, but expectations are rarely assessed in adult cochlear implant (CI) users. This study is a first step in assessing the contribution of preoperative expectations to postoperative CI outcomes, including speech recognition, CI quality of life (CIQOL), and CI satisfaction.

Study Design:

Cross-sectional study.

Setting:

Tertiary medical center.

Patients:

Fourty one adult CI patients.

Interventions/Main Outcome Measures:

Preoperative expectation questionnaire results, pre- and postoperative speech recognition (CNC and AzBio) scores, postoperative CIQOL domain scores and global scores, and CI satisfaction scores using a visual analog scale (VAS). Cohen's d was used to express effect size.

Results:

Overall, patients with lower preoperative CI performance expectations showed higher postoperative QOL. This effect was large for the emotional, entertainment, and social domains (d = 0.85–1.02) of the CIQOL-35 and medium for the communication, listening effort domains, and the Global score (d = 0.55–0.63). Preoperative performance expectations showed minimal associations with preoperative versus postoperative change in CNC (d = –0.26; –0.69–0.18) or AzBio scores (d = –0.28; –0.72–0.15). Determining the extent to which preoperative expectations played a role in postoperative satisfaction with CIs was limited by the clustering of satisfaction scores in the upper range of the scale (VAS mean 81.1).

Conclusions:

This study provides preliminary evidence that patients’ expectations before cochlear implantation may influence their postoperative quality of life and other outcomes, but not postoperative speech recognition. This suggests that an increased emphasis should be placed on measuring and counseling expectations in CI candidates. This assumption needs to be confirmed with additional research with larger sample sizes, more sensitive satisfaction measures, and a prospective design.
Do Patients Benefit From a Cochlear Implant When They Qualify Only in the Presence of Background Noise?
Authors: Lundberg Emily M. H. , Strong Darcy , Anderson Melinda , Kaizer Alexander M. , Gubbels Samuel
Published: November 2020

Objective:

To compare the difference in pre- to postoperative speech performance of patients qualifying for a cochlear implant (CI) in quiet, +10 dB signal-to-noise ratio (SNR), and +5 dB SNR.

Study Design:

Retrospective.

Setting:

Tertiary referral center.

Patients:

Fifty-eight post-lingually deafened, unilateral CI recipients from three Groups were included: 1) those who met CI candidacy criteria with AzBio sentences in quiet, 2) in noise at +10 dB SNR but not in quiet, 3) and in noise at +5 dB SNR but not in quiet or +10 dB SNR.

Intervention:

Unilateral CI.

Main Outcome Measures:

Pre- and 1 year postoperative speech recognition scores.

Results:

Best-aided AzBio speech recognition of individuals in Group 1 improved significantly for all test conditions and improved significantly for Groups 2 and 3 in the +10 and +5 dB SNR test conditions postoperatively. When tested with their CI alone however, while AzBio speech recognition of individuals in Group 1 and Group 2 improved significantly in the quiet and +10 dB SNR conditions, speech recognition was not significantly changed postoperatively under any testing condition for individuals in Group 3.

Conclusions:

While individuals qualifying for a CI only in the +5 dB SNR condition may derive significant benefit from implantation in best aided conditions, speech understanding outcomes can be more variable thus warranting additional counseling before implantation and case-by-case consideration of listening needs and goals.
Nystagmus and Vertigo in Acute Vestibular Migraine Attacks: Response to Non-Invasive Vagus Nerve Stimulation
Authors: Beh Shin C.
Published: November 2020

Objective:

Vestibular migraine (VM) is the most common neurologic cause of vertigo in adults, but there are no currently-approved rescue therapies. This study describes the benefits of non-invasive vagus nerve stimulation (nVNS) on vertigo, headache, and nystagmus during VM attacks.

Methods:

Case series of four VM patients who were evaluated during acute VM episodes in a tertiary referral neurology clinic between February 2019 and January 2020. They underwent bedside neuro-otologic examination, and graded the severity of vertigo and headache using a 10-point visual-analog scale (VAS; 0—no symptoms, 10—worst ever symptoms), before and 15 minutes after nVNS.

Results:

Average vertigo severity was 5 (median 4.5) before, and 1.5 (median 0.5) after nVNS. Mean headache severity (three patients) before treatment was 4 (median 4), and 0.7 (median 0) after. Spontaneous right-beating nystagmus (Patient 1) nystagmus, upbeat nystagmus (Patient 2), and positional nystagmus (Patient 3) resolved with nVNS. Baseline left-beating nystagmus in Patient 4 from previous vestibular neuritis damped during acute VM but returned to baseline following nVNS. In all four patients, ictal nystagmus resolved, and examination findings returned to baseline.

Conclusions:

This study suggests nVNS may ameliorate vertigo and headache, as well as nystagmus associated with VM attacks. Larger, sham device-controlled studies are needed to elucidate the benefits of nVNS in VM.
Vestibular Screening Before Cochlear Implantation: Clinical Implications and Challenges in 409 Cochlear Implant Recipients
Authors: West Niels , Klokker Mads , Cayé-Thomasen Per
Published: November 2020

Objective:

Cochlear implantation (CI) carries a risk of loss of vestibular function following surgery. Thus, vestibular assessment presurgery is used to identify vestibulopathy that may contraindicate implantation and guide in selecting the candidate ear. The aim of this study was to evaluate the clinical implications of preoperative vestibular assessment, and to identify challenges in performing vestibular testing in patients with profound hearing loss, i.e., CI candidates.

Study Design:

Retrospective study of all CI recipients implanted since the introduction of a vestibular screening program.

Setting:

Tertiary referral center in 2013.

Patients and Intervention:

CI candidates routinely underwent testing with the video head impulse test (VHIT) and the cervical vestibular evoked myogenic potential (cVEMP) test as a part of the CI work up.

Results:

Three hundred thirty-five individuals were screened before the first CI and 74 individuals before the second CI. In 301 cases (73.6%), the vestibular function was considered normal and consequently carried no contraindications for surgery or implications for choice of ear to be implanted. Bilateral vestibular loss was found in 43 cases (10.5%) and unilateral vestibular loss was found in 62 cases (15.2%). In the latter cases, evaluation of multiple variables was indicated to select candidate ear. In nine implanted patients (2.2%), a relative contraindication to operate based on an “only balancing” ear was overruled by other factors. Vestibular testing was challenged by various factors (e.g., neck immobility, eye tracking issues, communication, and other patient issues), limiting the vestibular data output. This resulted in omittance, testing failure, or interpretation uncertainty 24 times (5.9%) for VHIT and 65 times (15.9%) for cVEMP.

Conclusion:

Vestibular screening is an important part of the clinical workup with respect to selection of candidate ear for cochlear implantation, as 15.2% of CI candidates present with unilateral vestibulopathy. Challenges in performing the vestibular tests are not uncommon, as test failure occurred in 15.9% of cases for the cVEMP and 5.9% for the VHIT. The most common reasons for test failure were neck immobility, communication issues, and problems of pupil tracking.
Abnormal diurnal blood pressure profile and hypertension-mediated organ damage in nondiabetic chronic kidney disease G1-G3b patients
Authors: Stróżecki Paweł , Pluta Agnieszka , Donderski Rafał , Włodarczyk Zbigniew , Manitius Jacek
Published: November 2020

Objective

Chronic kidney disease (CKD) is associated with high cardiovascular risk. Prevalence of hypertension and hypertension-mediated organ damage (HMOD) increases with CKD progression. Nocturnal blood pressure (BP) is a strong predictor of cardiovascular complications. This cross-sectional study investigated the link between the diurnal BP profile and HMOD in nondiabetic CKD G1-G3b patients.

Methods

We investigated 109 CKD patients and 41 apparently healthy persons as controls. All subjects underwent 24-ambulatory blood pressure monitoring (ABPM), echocardiography with left ventricular mass index (LVMI) calculation and pulse wave velocity (PWV) measurement.

Results

Hypertension was present in 84% of CKD patients. SBP-24 and DBP-24, SBP-day and DBP-day did not differ between CKD and controls. Significant differences were found in SBP-night and DBP-night. The nondipping BP profile (SBP-night/SBP-day ratio ≥0.9) was found in 62% of CKD patients and 32% of controls (P < 0.005). Nocturnal hypertension was found in 56% of CKD patients. LVMI was higher in CKD compared to controls, higher in nondipping than dipping CKD patients, and higher in patients with nocturnal hypertension than without nocturnal hypertension. Abnormal left ventricular geometry was found in 72% nondipping and 43% dipping CKD patients. PWV was higher in CKD than in controls, in patients with nocturnal hypertension than without nocturnal hypertension but did not differ between CKD nondippers and dippers.

Conclusion

The nondipping BP profile and nocturnal hypertension are associated with HMOD in G1-G3b CKD patients. Hence, there is a need for more extensive use of ABPM for individual risk assessment and personalization of antihypertensive treatment in CKD patients.
The impact of chronic kidney disease on long-term outcomes following semi-urgent and elective percutaneous coronary intervention
Authors: Soh Rodney Yu-Hang , Sia Ching-Hui , Lau Rui-Huai , Ho Pei-Ying , Timothy Ng Yi-Ming , Ho Jamie Sin-Ying , Kaur Harsharon , Sim Hui-Wen , Yeo Tiong-Cheng , Tan Huay-Cheem , Chan Mark Yan-Yee , Loh Joshua Ping-Yun
Published: November 2020

Introduction

The effects of chronic kidney disease (CKD) on outcomes in patients undergoing semi-urgent and elective percutaneous coronary intervention (PCI) are unclear. This study aims to investigate impact of CKD on long-term outcomes of this population.

Methods

This was a retrospective cohort study of patients who underwent semi-urgent and elective PCI from 1 January 2014 to 31 December 2015 at a tertiary academic center. They were stratified into five groups – group 1 [estimated glomerular filtration rate (eGFR) ≥90 ml/min/1.73m2], group 2 (eGFR 60–89 ml/min/1.73m2), group 3 (eGFR 30–59 ml/min/1.73 m2), group 4 (eGFR <30 ml/min/1.73m2), and group 5 (dialysis). Demographics, risk factors in relation to endpoints of all-cause mortality, contrast-induced nephropathy (CIN), three-point major adverse cardiac events (MACE) (cardiac death, subsequent myocardial infarction, subsequent stroke), and four-point MACE (including target lesion revascularization) were analyzed.

Results

One thousand six hundred nine patients were included. Advanced CKD patients were more likely to be female and older, with higher prevalence of co-morbidities. Compared to group 1, group 4 patients were associated with increased risk of three-point [adjusted hazard ratio (aHR) 1.94, 95% confidence interval (CI): 1.06–3.55; P = 0.031] and four-point MACE (aHR 2.15, 95% CI: 1.21–3.80; P = 0.009). However, higher contrast volume usage [odds ratio (OR) 2.20, 95% CI: 1.04–4.68; P = 0.040) was associated with increased CIN risk but not reduced eGFR (OR 1.62, 95% CI: 0.57–4.65; P = 0.369).

Conclusion

Advanced CKD patients undergoing PCI were associated with higher co-morbid burden. Despite adjustments for co-morbidities, these patients had higher mortality and worse cardiovascular outcomes at 3 years following contemporary PCI.
Apolipoprotein B: the Rosetta Stone of lipidology
Authors: Glavinovic Tamara , Sniderman Allan D.
Published: November 2020

Purpose of review

This review summarizes the evidence that apolipoprotein B (apoB) integrates the conventional lipid markers – total cholesterol, triglycerides, LDL-cholesterol, and non-HDL-cholesterol – into a single index that accurately and simply quantitates the atherogenic risk due to the apoB lipoprotein particles.

Recent findings

Marked hypertriglyceridemia remains the essential signal for hyperchylomicronemia and potential pancreatitis. However, with the exception of Lp(a) and the abnormal cholesterol-enriched remnant particles that are the hallmark of type III hyperlipoproteinemia, recent evidence from discordance analyses and Mendelian randomization indicate that apoB integrates the risk due to the atherogenic lipoprotein particles because all LDL particles are, within the limits of our ability to measure any differences, equally atherogenic and all, except the largest VLDL particles are, within the limits of our ability to measure any differences, equally atherogenic.

Measuring apoB as well as the conventional lipids is essential for accurate diagnosis. For almost all follow-up, however, apoB is all that need be measured. ApoB is the Rosetta Stone of lipidology because dyslipoproteinemia cannot be understood unless apoB is measured.
Validation of the telephone-based assessment of locomotion ability after stroke
Authors: Avelino Patrick R. , Nascimento Lucas R. , Menezes Kênia K.P. , Tenório Ruani A. , Cândido Gabriela N. , Christovão Isabela S. , Teixeira-Salmela Luci F.
Published: November 2020

The aim of the study was to validate the telephone-based application of the ABILOCO questionnaire for the assessment of locomotion ability after stroke. Individuals after stroke answered the ABILOCO-Brazil questionnaire on two randomized occasions, face-to-face and by telephone, 5–7 days apart. The mean difference between the interviews was reported. Intraclass correlation coefficient (ICC) was calculated to investigate the agreement between the total scores, and weighted-Kappa statistics to investigate the agreement between the individual items. A total of 92 individuals were included. There was no significant difference in the mean scores between face-to-face and telephone-based applications of the ABILOCO [mean difference 0.17 logits; 95% confidence interval (CI), −0.88 to 0.54]. A high level of agreement was found between the ABILOCO total scores obtained between both applications (ICC = 0.90; 95% CI, 0.84–0.93), and most of the individual items had, on average, moderate agreement. The ABILOCO showed to be a reliable questionnaire for telephone assessment of locomotion ability after stroke.
Content Validation of the Quality and Safety Framed Clinical Evaluation for Nurse Practitioner Students
Authors: Altmiller Gerry , Dugan Mary Ann
Published: November 2020

Background

Clinical performance evaluation is a high-stakes assessment that requires a valid and reliable instrument. There appear to be no identified clinical evaluation instruments developed for nurse practitioner (NP) students that have undergone content validation.

Purpose

This study describes the process to develop, validate, and pilot a clinical evaluation instrument for NP students framed in the Quality and Safety Education of Nurses Competencies for advanced practice.

Methods

Six expert nurse educators were recruited for the purpose of rating items for relevance for inclusion in the Quality and Safety Framed Clinical Evaluation Instrument for NP Students using the content validity index. The instrument was pilot tested in a primary care clinical course.

Results

Two rounds of review yielded a 34-item content validated instrument.

Conclusions

Evidence suggests that the Quality and Safety Framed Clinical Evaluation for NP Students is a valid and reliable instrument to evaluate the clinical performance of NP students.
Virtual Education During COVID-19
Authors: Alqahtani Naji , Innab Adnan , Bahari Ghareeb
Published: November 2020

Background

Because of the COVID-19 pandemic, education and learning processes have been shifted to a completely virtual, online format. Students' satisfaction has been linked to better learning outcomes.

Purpose

The purpose was to determine factors associated with students' satisfaction with e-learning among Saudi nursing students.

Methods

A cross-sectional, correlational descriptive study was conducted among 139 nursing students from different nursing programs in Saudi Arabia using a self-reported online survey.

Results

Previous experience with and readiness for e-learning influenced students' overall satisfaction with e-learning and satisfaction with assessment. Only readiness for e-learning was associated with satisfaction with teaching and generic skills and learning experiences.

Conclusions

This study may enhance faculty members' understandings of factors influencing students' satisfaction with e-learning. Therefore, the urgent national distance education plan may need further development to meet students' needs.
Prevalence of and Factors Associated With Genital and Extragenital Chlamydia and Gonorrhea Among Transgender Women in HIV Care in the United States, 2005 to 2016
Authors: Van Gerwen Olivia T. , Tamhane Ashutosh , Westfall Andrew O. , Mugavero Michael J. , Crane Heidi M. , Moore Richard D. , Karris Maile , Christopoulos Katerina , Dombrowski Julia C. , Mayer Kenneth H. , Marrazzo Jeanne , Dionne-Odom Jodie
Published: November 2020

Background

Data on testing rates and prevalence of and factors associated with genital and extragenital chlamydia and gonorrhea among transgender women with HIV in the United States are limited.

Methods

This retrospective cohort analysis included transgender women living with HIV enrolled in the US Centers for AIDS Research Network of Integrated Clinical Systems cohort between January 2005 and December 2016 with chlamydia or gonorrhea testing performed in HIV clinic. The primary outcome was a positive test result for chlamydia or gonorrhea at urogenital or extragenital (rectal/pharyngeal) sites. Factors associated with infection were examined using logistic regression and generalized estimating equations to account for multiple tests per woman.

Results

Among 312 transgender women in HIV care, 252 (81%) were tested for chlamydia or gonorrhea at least once. Annual testing rates were low: 23% to 53% at genital sites and 24% to 47% at extragenital sites. A total of 88 infections were detected, and 22% of women (55/252) had at least one positive test result. Most infections occurred at extragenital sites (80% of chlamydia and 82% of gonorrhea positive test results). Factors associated with infection in an adjusted model were as follows: age 18 to 29 years compared with ≥50 years (adjusted odds ratio [aOR], 7.6; 95% confidence interval [CI], 1.8–31.2), CD4 count >350 compared with CD4 <200 (aOR, 5.5; 95% CI, 1.2–25.1), and higher engagement in HIV care (aOR, 2.2; 95% CI, 1.0–4.5).

Conclusions

Among transgender women living with HIV, testing rates for chlamydia and gonorrhea are inadequate, particularly at extragenital sites where most infections occur.
Variation Among Public Health Interventions in Initial Efforts to Prevent and Control the Spread of COVID-19 in the 50 States, 29 Big Cities, and the District of Columbia
Authors: Fraser Michael R. , Juliano Chrissie , Nichols Gabrielle
Published: November 2020

US states and big cities acted to protect the residents of their jurisdictions from the threat of SARS-CoV-2 infection and reduce COVID-19 transmission. As there were no known pharmacologic interventions to prevent COVID-19 at the outset of the pandemic, public health and elected leaders implemented a host of nonpharmaceutical interventions (NPIs) to slow the spread of the virus. This article discusses variation among states and cities in their implementation of 3 NPIs: stay-at-home/shelter-in-place orders, gathering restrictions, and mask mandates. We illustrate how frequently each was used by states and big cities, discuss state and local authorities to implement such interventions, and consider how these NPIs and accompanying public adherence to public health orders may vary considerably in different regions of the country and by local and state laws specific to state preemption of public health authority.
Supporting and Protecting Residents Experiencing Homelessness in the Nation's Largest Cities During COVID-19
Authors: Nichols Gabrielle , Mays Max
Published: November 2020

Large urban health departments developed and implemented various approaches to prevent COVID-19 outbreaks and promote the health and well-being of individuals experiencing homelessness and housing insecurity throughout the pandemic. Reviewing the approaches of several large urban health departments, the most frequent practices included increasing housing options, on-the-ground outreach and resource allocation, and integrated communications. Key steps necessary to develop and implement these policies and procedures are discussed, and innovative approaches are highlighted.
COVID-19 Case Investigation and Contact Tracing: Early Lessons Learned and Future Opportunities
Authors: Ruebush Elizabeth , Fraser Michael R. , Poulin Amelia , Allen Meredith , Lane J. T. , Blumenstock James S.
Published: November 2020

Context:

Case investigation and contact tracing are fundamental public health strategies for controlling and preventing the spread of infectious diseases. Although the principles behind these strategies are not new, the capacity and operational requirements needed to support disease investigation during the SARS-CoV-2 (COVID-19) pandemic are unprecedented. This article analyzes the implementation of case investigation and contact tracing in controlling COVID-19 transmission during the early stages of the US pandemic response (January 20 through August 31, 2020).

Program Implementation:

Governmental public health agencies mobilized to expand case investigation and contact tracing programs in the early months of the pandemic. In doing so, they encountered a range of challenges that included rapidly scaling up the workforce; developing and subsequently revising guidance and protocols specific to COVID-19 as more was learned about the virus over time; defining job functions; encouraging public acceptance of and participation in case investigation and contact tracing; and assessing the utility of these activities during both the containment and mitigation phases of outbreak response. COVID-19 case investigation and contact tracing programs presented an array of opportunities for health departments to innovate, especially around technology to support public health efforts, as well as opportunities to address health equity and advance community resilience.

Conclusion:

Lessons learned from disease intervention specialists, guidance and resources from federal agencies and national partners, and peer-to-peer exchange of promising practices can support jurisdictions encountering early implementation challenges. Further research is needed to assess COVID-19 case investigation and contact tracing program models and innovations, as well as strategies for implementing these activities during containment and mitigation phases.
Crisis Decision-Making at the Speed of COVID-19: Field Report on Issuing the First Regional Shelter-in-Place Orders in the United States
Authors: Aragón Tomás J. , Cody Sara H. , Farnitano Christopher , Hernandez Lisa B. , Morrow Scott A. , Pan Erica S. , Tzvieli Ori , Willis Matthew
Published: November 2020

Context:

In March, 2020, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causal agent of coronavirus disease 2019 (COVID-19), was spreading in the Bay Area, especially in Santa Clara County, causing increases in cases, hospitalizations, and deaths.

Program:

The Association of Bay Area Health Officials (ABAHO) represents 13 Bay Area health jurisdictions.

Implementation:

On March 15, 2020, the local health officers of 7 ABAHO members (counties of Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Santa Clara and the city of Berkeley) decided to issue legal orders on March 16 for 6.7 million residents to shelter in place to prevent the spread of SARS-CoV-2, the causal agent of COVID-19. The Bay Area was the first region in the United States to shelter in place, and within days, other regions in the United States followed.

Evaluation:

Subsequent comparative analyses have confirmed that acting early in issuing shelter-in-place orders prevented a large number of cases, hospitalizations, and deaths in the Bay Area throughout the United States. The quality of a decision—in this case, for crisis decision making—cannot be judged by the outcome. A good decision can have a bad outcome, and a bad decision can have a good outcome. The quality of a decision depends only on the quality of the decision-making process at the time the decision was made.

Discussion:

In this Field Report, we review how we made this collective decision. With the benefit of hindsight and reflection, we recount our story through the lens of public health legal authority, meta-leadership, and decision intelligence. Our purpose is to improve the crisis decision-making skills of public health officials by improving how we make high-stakes decisions each day in our continuing fight to contain the SARS-CoV-2 pandemic, to save lives, and to eliminate COVID-19 racial/ethnic inequities.
Public Health Across Partisan Lines: What Has Changed Since the Onset of COVID-19
Authors: Sellers Katie , Leider Jonathon P. , Gollust Sarah , Gendelman Moriah , Castrucci Brian
Published: November 2020

Two polls were conducted by an independent polling firm in September 2018 and July 2020 to assess public perceptions of public health departments and services among voters in the United States. The poll also sought to uncover changes in perception before and after the onset of COVID-19. A random sample was drawn from state voter files proportional to the national registered voter population by state, with quotas set by specific demographics to ensure representativeness. Overall, 1800 individuals participated between the 2 polls and weights were used in the analysis to adjust for nonresponse. From 2018 to 2020, respondents' familiarity with local public health departments rose 11% and their perception of the importance of the public health department to community health increased by 16%. In addition, support for public health departments and services differed significantly by political affiliation. In 2020, 85% of Democrats perceived the public health department to be very important while only 62% of their Republican counterparts felt similarly. Public health advocates have a unique opportunity to demand sustained funding for public health as American voters are more familiar and supportive of public health departments now than they were before the pandemic. In addition, policy makers, elected officials, and political candidates have the opportunity to leverage these data to fight for the health of their communities.