bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Evaluation of Spontaneous Olfactory Discrimination in Two Nocturnal Primates (Microcebus murinus and M. lehilahytsara)
Authors: Kollikowski Annika , Jeschke Selina , Radespiel Ute
Published: July 2020

Solitary species often employ chemocommunication to facilitate mate localization. In the solitarily foraging, nocturnal mouse lemurs (Microcebus spp.), females advertise their short period of estrus acoustically and by increased scent marking, whereas males search widely for receptive females. Both sexes can be trained by operant conditioning to discriminate conspecific from heterospecific urine scent. However, it is not known, if males during and outside the reproductive season show different spontaneous interest in conspecific female urine, and if urine from estrous females elicits a higher investigation response than that from diestrous females. We established a spontaneous discrimination paradigm and quantified olfactory investigation responses of 21 captive male mouse lemurs of M. lehilahytsara and M. murinus when presenting 1 conspecific and 1 heterospecific female urine odor sample simultaneously. Overall, M. murinus investigated stimuli significantly longer than M. lehilahytsara. Moreover, males of M. murinus showed significantly longer olfactory investigation at conspecific urine samples during but not outside the reproductive season. This indicates that female urinary cues are spontaneously discriminated by male M. murinus and that this discrimination is more relevant during the reproductive season. However, males of both species did not show different responses toward urine samples from estrous versus diestrous females. Finally, male age did not correlate with the overall duration of olfactory investigation, and investigation levels were similar when testing with fresh or frozen urine samples. In conclusion, this new spontaneous discrimination paradigm provides a useful additional tool to study olfactory communication of nocturnal primates from the receiver’s perspective.
Management of COVID-19 myopericarditis with reversal of cardiac dysfunction after blunting of cytokine storm: a case report
Authors: Li Angela , Garcia-Bengochea Youssef , Stechel Richard , Azari Bani M
Published: July 2020

Background

Coronavirus disease 2019 (COVID-19) is a syndrome that has been associated with multiple cardiac complications including myopericarditis. The pathophysiology and treatment for myopericarditis in the setting of COVID-19 infection is still under investigation.

Case summary

We present a case of a 60-year-old male admitted for dyspnoea due to COVID-19. He developed new ST-segment elevation, elevated cardiac enzymes, severe left ventricular dysfunction, and high inflammatory markers in the setting of haemodynamic and respiratory collapse from the viral illness. He was diagnosed with COVID-19-induced myopericarditis. He showed rapid clinical improvement with a rapid wean off pressure support, resolution of electrocardiogram (ECG) findings, and recovery of left ventricular systolic function following treatment with intravenous immunoglobulin (IVIG) and methylprednisolone.

Discussion

COVID-19’s complex and devastating complications continue to create new challenges for clinicians. Cardiac complications, specifically, have been shown to be a signal for worse prognosis in these patients. IVIG and steroids can inhibit the inflammatory cascade and decrease myocardial injury, with implications in treatment of severe myopericarditis.
Prevalence of Undiagnosed Diabetes in 2004 and 2012: Evidence From the English Longitudinal Study of Aging
Authors: Huang Yun-Ting , Steptoe Andrew , Zaninotto Paola
Published: July 2020

Background

In light of recent publicity campaigns to raise awareness of diabetes, we investigated changes in the prevalence of diabetes and undiagnosed diabetes in adults age 50 and older in England between 2004 and 2012, and explored risk factors for undiagnosed diabetes.

Method

In total, 7666 and 7729 individuals were from Wave 2 (2004–2005, mean age 66.6) and Wave 6 (2012–2013, mean age 67.6) of the English Longitudinal Study of Ageing. Diagnosed diabetes was defined as either self-reported diabetes or taking diabetic medications. Undiagnosed diabetes was defined as not self-reporting diabetes and not taking diabetic medications, but having a glycated hemoglobin measurement ≥48 mmol/mol (6.5%).

Results

There were increases in both diagnosed diabetes (7.7%–11.5%) and undiagnosed diabetes (2.4%–3.4%) between 2004 and 2012. However, a small decrease in the proportion of people with diabetes who were unaware of this condition (24.5%–23.1%, p < .05) was observed. Only men aged 50–74 showed a stable prevalence of undiagnosed diabetes, with better recognition of diabetes. Age, non-white ethnicity, manual social class, higher diastolic blood pressure, and cholesterol level were factors associated with higher risks of undiagnosed diabetes, whereas greater depressive symptoms were related to lower risks.

Conclusion

This study suggests that the greater awareness of diabetes in the population of England has not resulted in a decline in undiagnosed cases between 2004 and 2012. A greater focus on people from lower socioeconomic groups and those with cardiometabolic risk factors may help early diagnosis of diabetes for older adults.
Selective Reshaping: China’s Paradigm Shift in International Economic Governance
Authors: Wang Heng
Published: July 2020

In contrast with the selective adaptation approach toward external norms seen in its accession to the World Trade Organization, China increasingly plays a proactive role on the international stage, with the Belt and Road Initiative at the center of these activities. How can we understand this new approach by China toward international economic governance? What is responsible for China’s shifting approach, and what are the implications of this shift? The paper presents selective reshaping as a new theoretical framework, and argues that China is shifting toward the selective reshaping of institutions and rules within the global economic order. Within this theoretical framework, perception and conception, complementarity and legitimacy are influencing components that affect selective reshaping, and which manifest substantially differently in this context, when compared with selective adaptation. Selective reshaping is likely to transform the institutions and rules within the international economic order, and carry long-term implications.
Illness Uncertainty Longitudinally Predicts Distress Among Caregivers of Children Born With DSD
Authors: Roberts Caroline M , Sharkey Christina M , Bakula Dana M , Perez Megan N , Delozier Alexandria J , Austin Paul F , Baskin Laurence S , Chan Yee-Ming , Cheng Earl Y , Diamond David A , Fried Allyson J , Kropp Bradley , Lakshmanan Yegappan , Meyer Sabrina Z , Meyer Theresa , Nokoff Natalie J , Palmer Blake W , Paradis Alethea , Reyes Kristy J Scott , Tishelman Amy , Williot Pierre , Wolfe-Christensen Cortney , Yerkes Elizabeth B , Aston Christopher , Wisniewski Amy B , Mullins Larry L
Published: July 2020

Objective

A subset of parents of children with disorders/differences of sex development (DSD) including ambiguous genitalia experience clinically elevated levels of anxious and depressive symptoms. Research indicates that uncertainty about their child’s DSD is associated with parent psychosocial distress; however, previous studies have been cross-sectional or correlational in nature. The current study is the first to examine the longitudinal trajectory of the relationship between caregiver-perceived uncertainty about their child’s DSD and caregiver anxious and depressive symptoms across the first 12 months following genital surgery in young children, or if surgery was not performed, the first 12 months following study entry.

Methods

One hundred and thirteen caregivers (Mage = 32.12; 57.5% mothers; 72.6% Caucasian) of children (N = 70; Mage = 9.81 months; 65.7% female) with DSD were recruited from 12 DSD specialty clinics in the United States. Caregivers completed psychosocial measures at baseline, 6 and 12 months following genitoplasty, or study entry if parents elected not to have surgery for their child.

Results

Caregiver illness uncertainty and both anxious and depressive symptoms were highest at baseline and decreased over time (ps < .05). Caregiver illness uncertainty predicted symptoms of anxious and depressive symptoms across all time points (ps < .05).

Conclusions

Caregivers’ perceptions of uncertainty about their child’s DSD are highest soon after diagnosis, and uncertainty continues to predict both anxious and depressive symptoms across time. Thus, the initial diagnostic period is a critical time for psychological assessment and intervention, with parent illness uncertainty being an important clinical target.
Agreement Between Ti-RADS Classification and Bethesda Cytopathological Findings from Thyroid Nodules in Young Adults
Authors: Zloczower Elchanan , Atas Ofir , London Daniel , Elharar Limor , Jacobe-Levy Maayan , Marom Tal
Published: July 2020

Introduction

Thyroid nodules are common in young adults. We sought to compare the sonographic characteristics (thyroid imaging reporting and data system [Ti-RADS] classification) with the reported cytological results (Bethesda categories) from thyroid nodules in young recruits and examine the efficiency of our unique multidisciplinary clinic.

Materials and Methods

In this retrospective cohort, we identified young recruits (18–25 years) who underwent needle biopsies for asymptomatic thyroid nodule(s), with cytology reports of Bethesda categories II-V, performed in our “Rapid Diagnostic Service” at a large Israeli Defense Forces Medical Corps healthcare facility, between 2013 and 2018. We studied the concordance rates between their Ti-RADS and Bethesda grades, and the preoperative Bethesda grades accuracy versus final pathology results, and the time period needed for their thyroid nodules workup.

Results

A total of 81 patients were included who contributed 91 nodules. A fair agreement was found between the Ti-RADS classifications and the Bethesda grades (Cohen’s κ = 0.238) that was more noticeable in males than in females. The agreement rate was 87.5% in males (21 of 24), but only 77.6% in females (59 of 67) [P = .029]. Of the 5 operated benign cases, all had low Ti-RADS, and 2 had low Bethesda. Of the 8 operated malignant cases, 6 had high Ti-RADS, and 5 had high Bethesda. On average, 37.64 days elapsed between the first visit to the ultrasound study, and 24.2 days elapsed until biopsy was performed.

Conclusions

Despite an overall fair agreement between the sonographic features and cytological findings in young adults, we recommend a more aggressive approach and repeated biopsies despite reported benign pathology, because of a high false-negative rate.
Toxicogenetic and antiproliferative effects of chrysin in urinary bladder cancer cells
Authors: Lima Ana Paula Braga , Almeida Tamires Cunha , Barros Tatiane Martins Barcelos , Rocha Lorrana Cachuite Mendes , Garcia Camila Carriao Machado , da Silva Glenda Nicioli
Published: July 2020

The antitumour activity of chrysin have been studied in several types of cancer cells. In urinary bladder cancer, its cytotoxic effects have already demonstrated; however, its mechanism of action is not completely understood and the role of tumour protein p53 (TP53) gene in these effects is unclear. In this study, we investigated the role of chrysin (10, 20, 40, 60 80 and 100 µM) in progression of bladder tumour cells with different status of the TP53 gene and different degrees of tumour (RT4, grade 1, TP53 wild type; 5637, grade 2, TP53 mutated and T24, grade 3, TP53 mutated). Results demonstrated that chrysin inhibited cell proliferation by increasing reactive oxygen species and DNA damage and inhibited cell migration in all cell lines. In TP53 wild-type cells, a sub-G1 apoptotic population was present. In mutated TP53 cells, chrysin caused arrest at the G2/M phase and morphological changes accompanied by downregulation of PLK1, SRC and HOXB3 genes. In addition, in Grade 2 cells, chrysin induced global DNA hypermethylation and, in the highest-grade cells, downregulated c-MYC, FGFR3 and mTOR gene expression. In conclusion, chrysin has antiproliferative and toxicogenetic activity in bladder tumour cells independently of TP53 status; however, the mechanisms of action are dependent on TP53 status.
A 16 deg2 survey of emission-line galaxies at z < 1.6 from HSC-SSP PDR2 and CHORUS
Authors: Hayashi Masao , Shimakawa Rhythm , Tanaka Masayuki , Onodera Masato , Koyama Yusei , Inoue Akio K , Komiyama Yutaka , Lee Chien-Hsiu , Lin Yen-Ting , Yabe Kiyoto
Published: July 2020

We have conducted a comprehensive survey of emission-line galaxies at z ≲ 1.6 based on narrow-band (NB) imaging data taken with Hyper Suprime-Cam (HSC) on the Subaru telescope. In this paper, we update the catalogs of Hα, [O iii], and [O ii] emission-line galaxies using the data from the second Public Data Release (PDR2) of the Subaru Strategic Program (SSP) of the HSC and Cosmic HydrOgen Reionization Unveiled with Subaru (CHORUS) survey along with the spectroscopic redshifts for 2019 emission-line galaxies selected with the PDR1 data. The wider effective coverage of NB816 and NB921, 16.3 deg2 and 16.9 deg2, respectively, are available in the Deep and UltraDeep layers of HSC-SSP from the PDR2. The CHORUS survey provides us with data with additional three NBs (NB527, NB718, and NB973) in the COSMOS field in the UltraDeep layer (1.37 deg2). The five NB datasets allow us to investigate the star-forming galaxies presenting emission-lines at 14 specific redshifts ranging from z ∼ 1.6 down to z ∼ 0.05. We revisit the distribution of large-scale structures and luminosity functions (LFs) for the emission-line galaxies with the large samples of 75377 emission-line galaxies selected. The redshift revolution of LFs shows that the star formation rate densities (SFRDs) decreases monotonically from z ∼ 1.6, which is consistent with the cosmic SFRD known to-date. Our samples of emission-line galaxies covering a sufficiently large survey volume are useful to investigate the evolution of star-forming galaxies since the cosmic noon in a wide range of environments including galaxy clusters, filaments, and voids.
Evidentiary function of the provisions on the form of wills in the contemporary succession law: is the complete abandonment of formalism possible?
Authors: Załucki Mariusz
Published: July 2020

In succession law, the formalism of legal acts has grown to its limits. There is a rule in all democratic legal systems according to which only a will created in accordance with the framework set by the legislator can cause legal effects. The task of such regulations is described by the doctrine in four functions: evidentiary, protective, cautionary and channelling. The significance of each of these functions is different, as is its place in individual legislation. The author examines the evidentiary function, commonly mentioned as the most important, and explains that this function can be constructed differently in individual countries’ legislation on succession since legislators can shape their own legal reality according to their own discretion and needs. This creates, among other things, doubts as to whether diverse solutions of the last wills’ formalities in various legal systems influence the execution of the aforementioned function in any way, and whether the formalism in succession law is still necessary and the evidentiary function continues to fulfil its role.
Alteration of DNA methylation induced by PM2.5 in human bronchial epithelial cells
Authors: Wang Bingyu , Li Runbing , Cai Ying , Li Boru , Qin Shuangjian , Zheng Kai , Zeng Ming , Xiao Fang , Zhang Zhaohui , Xu Xinyun
Published: July 2020

This current study explored the effects of fine particulate matter (PM2.5) on deoxyribonucleic acid methylation in human bronchial epithelial cells. Human bronchial epithelial cells were exposed to PM2.5 for 24 h after which, deoxyribonucleic acid samples were extracted, and the differences between methylation sites were detected using methylation chips. Subsequent gene ontology functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed for the differential methylation sites. Functional epigenetic modules analysis of the overall differential methylation site interactions was also conducted. A total of 127 differential methylation sites in 89 genes were screened in the PM2.5 10 μg/ml group, of which 55 sites demonstrated increased methylation, with methylation levels decreasing in a further 72 sites. Following an exposure of 50 μg/ml PM2.5, a total of 238 differentially methylated sites were screened in 168 genes, of which methylation levels increased in 127 sites, and decreased in 111. KEGG analysis showed that the top 10 enrichment pathways predominantly involve hepatocellular carcinoma pathways and endometrial cancer pathways, whereas functional epigenetic modules analysis screened eight genes (A2M, IL23A, TPIP6, IL27, MYD88, ILE2B, NLRC4, TNF) with the most interactions. Our results indicate that exposure to PM2.5 for 24 h in human bronchial epithelial cells induces marked changes in deoxyribonucleic acid methylation of multiple genes involved in apoptosis and carcinogenesis pathways, these findings can provide a new direction for further study of PM2.5 carcinogenic biomarkers.
How coronavirus disease 2019 entered Africa and the Middle East: a case study from Egypt
Authors: Khattab Nourhan M , Vermund Sten H , Hu Yifei
Published: July 2020

Background

We report the first person with SARS-CoV-2 in Egypt.

Methods

We interviewed the index case and contacts.

Results

The 36-year old man was healthy when he traveled on business to Wuhan, China in January 2020. Upon his return to Cairo, he became ill, went to work, and subsequent autochthonous viral spread occurred.

Conclusion

We linked SARS-CoV-2 importation to global business travel. The extent to which physical distancing, hand/face/surface hygiene, mask use, viral testing/contact tracing, restricted travel, small gatherings, and/or stay-in-residence mandates will be implemented and limit further spread in the Middle East and North Africa remains to be seen.
Diversity and circulation of Jingmen tick virus in ticks and mammals
Authors: Guo Jing-Jing , Lin Xian-Dan , Chen Yan-Mei , Hao Zong-Yu , Wang Zhao-Xiao , Yu Zhu-Mei , Lu Miao , Li Kun , Qin Xin-Cheng , Wang Wen , Holmes Edward C , Hou Wei , Zhang Yong-Zhen
Published: July 2020

Since its initial identification in ticks in 2010, Jingmen tick virus (JMTV) has been described in cattle, rodents, and primates. To better understand the diversity, evolution, and transmission of JMTV, we sampled 215 ticks, 104 cattle bloods, 216 bats, and 119 rodents in Wenzhou city, Zhejiang Province, China as well as 240 bats from Guizhou and Henan Provinces. JMTV was identified in 107 ticks (from two species), 54 bats (eleven species), 8 rodents (three species), and 10 cattle, with prevalence levels of 49.8, 11.8, 6.7, and 9.6 per cent, respectively, suggesting that bats may be a natural reservoir of JMTV. Phylogenetic analyses revealed that all the newly identified JMTVs were closely related to each other and to previously described viruses. Additionally, all tick and mammalian JMTV sampled in Wenzhou shared a consistent genomic structure, suggesting that the virus can cocirculate between ticks and mammals without observable variation in genome organization. All JMTVs sampled globally could be divided into two phylogenetic groups, Mantel tests suggested that geographic isolation, rather than host species, may be the main driver of JMTV diversity. However, the exact geographical origin of JMTV was difficult to determine, suggesting that this virus has a complex evolutionary history.
Opinions of supervisors of clinical associates in South African district hospitals
Authors: Smalley Scott , Mlambo Motlatso Gladys , Gibbs Audrey , Couper Ian
Published: July 2020

Objective:

To determine the opinions of supervising physicians about the introduction of clinical associates at South African district hospitals in 2012.

Methods:

Twenty-four healthcare professionals in Gauteng and North West provinces were selected to participate in cross-sectional qualitative interviews exploring their opinions on the clinical practice of clinical associates, the effect of the new cadre, their achievements, and the concerns of the supervisors. The inductive content analysis process generated several themes.

Results:

Three positive themes related to clinical associate practice were identified: professionalism, skill level, and efficiencies in patient management. Themes of concern included overtime and calls, writing prescriptions, and supervision.

Conclusions:

Interview results highlighted acceptance and appreciation for the introduction of clinical associates. Baseline opinions enhanced curriculum development and will inform further research on the effect of clinical associates on healthcare delivery in South Africa.
Understanding the most commonly billed diagnoses in primary care
Authors: Rogers Julia , Baker Manisa
Published: July 2020

This installment in the series on the most commonly billed diagnoses in primary care focuses on hyperlipidemia. This article discusses the pathophysiologic processes of hyperlipidemia as well as how the clinical manifestations and treatments are linked to the pathogenesis of disease.
Treatment of type III supracondylar humerus fractures: adherence and limitations of American Academy of Orthopedic Surgeons Appropriate Use Criteria App
Authors: Emanuelli Elisa , Stevanovic Ognjen , Klott Jeffrey , Uvodich Mason , Sherman Ashley , Schwend Richard M.
Published: July 2020

The American Academy of Orthopedic Surgeons (AAOS) published Appropriate Use Criteria (AUC) in 2014 to aid physicians in the management of pediatric supracondylar humerus fractures. AUC should be evaluated in real practice, and if necessary modified based on identified problems. This study compares AAOS AUC recommendations with actual treatment performed in a cohort of patients treated for type III supracondylar humerus fractures. Medical record review of patients treated for type III supracondylar humerus fractures at our hospital from 2009 to 2016. Criteria required by the AAOS AUC were collected and entered into the AAOS AUC web-based application to determine the ‘appropriateness’ and score of each treatment. These were compared with the actual treatment the patient received. Over the study period, 585 patients (mean age: 6.5 years, 51% male, 49% female) were treated for type III supracondylar humerus fractures. Of the 585 cases, 561 (95.9%) were classified as ‘appropriate’, 24 (4.1%) as ‘maybe appropriate’, and 0 (0%) as ‘rarely appropriate’. Of the ‘maybe appropriate’ cases there was a significant decrease in the proportion that deviated from the AUC over time (P = 0.0076). The main reasons for deviation were that an open reduction was performed due to difficulty with closed reduction (75% of deviations) or the surgery was not performed emergently (25% of deviations). The vague definition of ‘emergent’ and not allowing for open reduction if needed are limitations of the AUC that should be clarified or improved by the AAOS.
‘Does compliance with BOAST guidelines matter for displaced supracondylar fractures in children?’: the experience of a tertiary referral major trauma centre over a 3.5-year period
Authors: Tzatzairis Themistoklis , Firth Gregory , Loke Wei Jie , Serlis Athanasios , Ramachandran Manoj
Published: July 2020

Supracondylar fractures are the most frequently occurring paediatric fractures about the elbow and can be associated with neurovascular injury. For that reason, the British Orthopaedic Association has published the British Orthopaedic Association Standards for Trauma (BOAST) 11 guidelines, aiming to the best management of supracondylar fractures. The aim of this study was to assess adherence to the BOAST 11 guidelines for displaced supracondylar fractures at a Major Trauma Centre in London, UK between 2015 and 2018 and to see whether adherence to guidelines affected the outcomes. A retrospective review was carried out between January 2015 and August 2018 of all paediatric patients who underwent either closed reduction and percutaneous pinning or open reduction and fixation for a displaced supracondylar fracture of the humerus. One hundred nine patients between 1 and 16 years of age with isolated displaced extension type supracondylar fractures (Gartland II, III and IV) were included in the study. The current study did not manage to achieve complete compliance with the BOAST 11 guidelines. K-wire size, fixation technique and pre-, intra-, postoperative documentation were the most important points of lack of compliance. However, deviating from specific guidelines did not cause any adverse clinical outcomes. Lack of correct documentation either preoperatively or postoperatively could be detrimental to patient outcome, especially with respect to neurovascular status. Implementation of a clerking template for use in the electronic medical records for all children with displaced supracondylar fractures is of value in order to improve our documentation.
Clinical outcomes of selective fusion for the thoracolumbar-lumbar curve in patients with Lenke type 6C adolescent idiopathic scoliosis: a preliminary study
Authors: Chang Sam Yeol , Son Jongyeon , Zheng Guang Bin , Chang Bong-Soon , Lee Choon-Ki , Kim Hyoungmin
Published: July 2020

Limited evidence is available in the literature regarding the fate of the unfused structural thoracic curve following selective thoracolumbar-lumbar curve fusion (SLF) in Lenke 6C adolescent idiopathic scoliosis (AIS) patients. Therefore, we compared the outcomes of SLF between Lenke 6C and 5C AIS patients. We retrospectively reviewed 31 patients Lenke 5C (n = 18) and Lenke 6C (n = 13) AIS patients who underwent SLF at a single institution. Multiple radiological parameters were measured using whole-spine radiographs taken before and after surgery and at the last follow-up visit. SRS-22 at the final follow-up was obtained for clinical assessment. A total of 31 patients with a mean age of 14.6 years at operation who were followed for a mean of 6.4 years were included in this study. The Cobb angle of the unfused thoracic curve was spontaneously corrected immediately following SLF and increased slightly but not significantly at the final follow-up in both groups (Lenke 5C: pre 33.0°, post 14.4°, final 19.4°, Lenke 6C: pre 46.1°, post 31.7°, final 34.2°). At every time point, the thoracic Cobb angle was significantly larger in the Lenke 6C. SRS-22 score at the final follow-up, including the self-image domain, did not differ between the two groups. In this study, SLF for Lenke 6C AIS achieved a significant spontaneous correction of the unfused thoracic curve and yielded a comparable SRS-22 result at the final follow-up to that of Lenke 5C. Our findings suggest that SLF is a viable treatment option for Lenke 6C AIS.
Determinants of caregiver satisfaction in pediatric orthopedics
Authors: Singleton Ian M. , Garfinkel Rachel J. , Malone Jason B. , Temkit M’hamed H. , Belthur Mohan V.
Published: July 2020

This study investigates determinants of pediatric orthopedic surgery patients’ parent or guardian (caregiver) satisfaction with the physician in an outpatient office setting. This was a cross-sectional survey study of 200 English-speaking caregivers of pediatric patients that checked into the pediatric orthopedic clinic at the authors’ institution from 1 March 2017 to 1 November 2018. Questionnaires given in clinic include the Newest Vital Sign and The Literacy in Musculoskeletal Problems survey to measure general and musculoskeletal health literacy, respectively, demographic information, expected/estimated wait time, Consultation and Relational Empathy Measure, and Consumer Assessment of Healthcare Providers and Systems Clinician and Group. After multivariate regression, only perceived physician empathy as measured by the Consultation and Relational Empathy Measure score was significantly correlated with caregiver satisfaction (P < 0.0001), accounting for 56% of the variability of caregiver satisfaction scores. The odds of a satisfaction score of at least 9 out of 10 were 21% higher for every unit increase of the Consultation and Relational Empathy Measure score [odds ratio = 1.21 (P < 0.0001)]. After logistic regression, the caregiver’s gender was also correlated with patient satisfaction and the odds of a patient satisfaction score ≥9 for males was less than 1/4th that of females [odds ratio = 0.16 (P = 0.040)]. The most important determinant of caregiver satisfaction with the physician in an outpatient pediatric orthopedic setting is perceived physician empathy. This accounts for the majority of the caregiver’s satisfaction. This is the first study to determine this relationship in pediatric orthopedic surgery.
Current use of patient-reported outcomes in pediatric limb deformity surgery
Authors: Amakoutou Kouami , Liu Raymond W.
Published: July 2020

Patient-reported outcome (PRO) instruments are critical to evaluate the natural history of conditions and treatment effects, but have not been well studied in pediatric limb deformity. The goal of this study was to identify and assess the most commonly used PROs in pediatric limb deformity surgery across a representative sample of the recent orthopedic literature. A review was performed from 1 January 2016 to 31 December 2018 in five orthopedic journals previously identified as having the greatest impact: Journal of Pediatric Orthopaedics, Journal of Pediatric Orthopaedics B, Journal of Children’s Orthopaedics, The Journal of Bone and Joint Surgery, and The Bone and Joint Journal. Clinical research studies involving pediatric population, operative management of limb deformity, and PRO measures were reviewed. The initial search of 3489 publications found 130 clinical articles involving operative management of pediatric limb deformity. Thirty-one studies (24%) met inclusion criteria, in which a total of 23 different PRO instruments were used. An average of 1.5 PRO instruments was reported per study (range 1–4). No outcome instrument was used by more than five different studies in this review, and no instrument validated in the pediatric population was used by more than three different studies. PROs currently used in pediatric limb deformity surgery are highly heterogeneous, as well as underutilized. Future research is necessary to either validate a current PRO in pediatric limb deformity or to develop a new instrument using pediatric Patient-Reported Outcomes Measurement Information System or Pediatric Outcomes Data Collection Instrument as a benchmark.
A novel multi-target tyrosine kinase inhibitor anlotinib combined with irinotecan has in-vitro anti-tumor activity against human small-cell lung cancer
Authors: Li Hui , Liu Yan , Liu Xianhong , Zhao Dandan , Liu Jingjing , Cheng Ying
Published: July 2020

Anlotinib is a multi-target tyrosine kinase inhibitor developed independently in China. Its biological effects remain unclear in small-cell lung cancer (SCLC). The current study aimed to evaluate the effects of anlotinib in combination with irinotecan on H446 and H2227 SCLC cell lines and provide new treatment strategy for SCLC. Cell growth of two cell lines was inhibited by anlotinib, irinotecan and the combination in a dose-dependent manner. After 72 h incubation, the inhibition rate was greater in the combination group than all single drug group. A similar result was found when apoptosis was assessed after 12 h, but not after 6 h of treatment. Compared with single drug, combination drug suppressed the migration and invasion abilities in two cell lines; however, there was no difference between individual anlotinib or irinotecan. The colony formation rate was obviously lower in the combination group. Vascular endothelial growth factor receptor, fibroblast growth factor receptor (FGFR) and platelet-derived growth factor receptor were expressed in two cell lines after treatment regardless single or combination, but FGFR was expressed more after combination treatment than anlotinib. The expression of phosphorylated (p) ERK was decreased with anlotinib alone or combination treatment and pAKT expression was impaired with combination treatment, but not with anlotinib or irinotecan alone. The biological function of anlotinib and irinotecan may be mediated through the AKT/ERK signaling pathway. Additional investigations on biomarker-guided patient-stratification and elucidating individualized targets in patients anlotinib are urgently needed.
Polycystic Ovary Syndrome: Menopause and Malignancy
Authors: MATEVOSSIAN KARINE , CARPINELLO OLIVIA
Published: July 2020

Polycystic ovary syndrome (PCOS) has been extensively studied in reproductive-aged women. However, accumulating research shows that PCOS can have lifelong effects on multiple aspects of women’s health. PCOS can affect the onset and course of menopause and cardiovascular health in perimenopausal and postmenopausal patients. Moreover, PCOS may increase a woman’s risk for both gynecologic and nongynecologic malignancies. When treating older PCOS patients, physicians should be cognizant of the syndrome’s long-term effects and consider the unique needs of these women.
Sodium–glucose cotransporter 2 inhibitors at the intersection of cardiovascular, renal and metabolic care: an integrated and multidisciplinary approach to patient-centered care
Authors: Verma Subodh , Klug Eric , Mareev Viacheslav Y. , Kobalava Zhanna D. , Connelly Kim A. , Arici Mustafa , Berwanger Otávio , Santoso Anwar , Mehta Roopa , Meglis Gus , Kosiborod Mikhail N.
Published: July 2020

Purpose of review

The management of individuals who live with type 2 diabetes requires an integrated and multifaceted approach.

Recent findings

Sodium–glucose cotransporter 2 inhibitors effectively prevent and treat cardiorenal complications in the presence of type 2 diabetes. They also reduce death and disease progression in those with established heart failure (with reduced ejection fraction) in the absence of diabetes.

Close collaborations between primary care physicians, cardiovascular specialists, endocrinologists and nephrologists are necessary to optimize cardiovascular, renal and metabolic risk reduction in their shared patients.
Effects of Behavioral Weight Loss and Weight Loss Goal Setting in Cardiac Rehabilitation
Authors: Barrett Kaitlyn V. , Savage Patrick D. , Ades Philip A.
Published: July 2020

Purpose:

Obesity is prevalent among participants in cardiac rehabilitation (CR). Establishing a weight loss goal is an important strategy for promoting weight loss. We evaluate the association between a pre-program weight loss goal and change in weight during CR.

Methods:

Body weight was measured at CR entry and at exit from CR. Overweight/obese participants were categorized as having: (1) established a weight loss goal and attended behavioral weight loss sessions (G + BWL); (2) set a weight loss goal but did not attend BWL (G); (3) and neither set a weight loss goal nor attended BWL (NoG).

Results:

The cohort consisted of 317 overweight/obese participants; 52 of whom set a weight loss goal and attended BWL, 227 patients set a goal but did not attend BWL, and 38 did neither. The G + BWL group lost more weight than the G group (−6.8 + 4.3 vs −1.1 + 3.5) (P < .0001). Both groups that established a weight loss goal lost more weight than the NoG group.

Conclusions:

For overweight/obese individuals in CR, participating in BWL classes and setting a weight loss goal leads to more weight loss than G alone. Setting a weight loss goal alone leads to greater weight loss than not setting a weight loss goal.
Twenty-four-hour ambulatory central blood pressure in adolescents and young adults: association with peripheral blood pressure and preclinical organ damage
Authors: Ntineri Angeliki , Kollias Anastasios , Bountzona Ioanna , Servos George , Moyssakis Ioannis , Destounis Antonios , Vazeou Andriani , Soldatou Alexandra , Stergiou George S.
Published: July 2020

Objectives:

To investigate the relationship of 24-h ambulatory central blood pressure (ABP) with preclinical organ damage in youth.

Methods:

Individuals aged 10–25 years referred for suspected hypertension and healthy volunteers had simultaneous 24-h peripheral and central ABP monitoring (Mobil-O-Graph 24 h PWA). Central BP was calculated using two different calibration methods (c1 using oscillometric systolic/diastolic ABP; c2 using mean arterial/diastolic ABP). Their association with preclinical organ damage [left ventricular mass index (LVMI), carotid intima–media thickness (IMT), 24-h pulse wave velocity (PWV)] was investigated.

Results:

A total of 136 participants were analyzed (age 17.9 ± 4.7 years, 54% adolescents, 77% males, 34% with elevated ABP). Twenty-four-hour peripheral systolic ABP (pSBP) was higher than c1 systolic ABP (c1SBP) by 14.1 ± 3.7 mmHg, but lower than c2SBP by 6.5 ± 7.6 mmHg (all P < 0.01). c2SBP quartiles provided better stratification of preclinical organ damage than pSBP. Both c1SBP/c2SBP were significantly associated with LVMI (r = 0.35/0.33) and IMT (r = 0.23/0.42; all P < 0.01; primary endpoint). These associations were stronger for c2SBP compared with those of pSBP in adolescents but not in adults. PWV was more closely associated with pSBP than c2SBP (r = 0.94/0.83, P < 0.01). LVMI variation was best determined by c2SBP in adolescents and pSBP in adults; IMT by c2SBP and PWV by pSBP in both subgroups.

Conclusion:

These findings suggest that in young individuals, the calibration method for 24-h central ABP plays a major role in determining its association with preclinical organ damage. In adolescents, 24-h central ABP appears to be more strongly associated with early cardiac and carotid damage than peripheral BP.
Mean arterial pressure estimated by brachial pulse wave analysis and comparison with currently used algorithms
Authors: Grillo Andrea , Salvi Paolo , Furlanis Giulia , Baldi Corrado , Rovina Matteo , Salvi Lucia , Faini Andrea , Bilo Grzegorz , Fabris Bruno , Carretta Renzo , Benetos Athanase , Parati Gianfranco
Published: July 2020

Objective:

Mean arterial pressure (MAP) is usually calculated by adding one-third of pulse pressure (PP) to DBP. This formula assumes that the average value of pulse waveform is constant in all individuals and coincides with 33.3% of PP amplitude (MAP = DBP + PP × 0.333). Other formulas were lately proposed to improve the MAP estimation, adding to DBP an established percentage of PP: MAP = DBP + PP × 0.40; MAP = DBP + PP × 0.412; MAP = DBP + PP × 0.333 + 5 mmHg.

Methods:

The current study evaluated the integral of brachial pulse waveform recorded by applanation tonometry in 1526 patients belonging to three distinct cohorts: normotensive or hypertensive elderly, hypertensive adults, and normotensive adults.

Results:

The percentage of PP to be added to DBP to obtain MAP was extremely variable among individuals, ranging from 23 to 58% (mean: 42.2 ± 5.5%), higher in women (42.9 ± 5.6%) than men (41.2 ± 5.1%, P < 0.001), lower in the elderly cohort (40.9 ± 5.3%) than in the general population cohort (42.8 ± 6.0%, P < 0.001) and in the hypertensive patients (42.4 ± 4.8%, P < 0.001). This percentage was significantly associated with DBP (β = 0.357, P < 0.001) and sex (β = 0.203, P < 0.001) and significantly increased after mental stress test in 19 healthy volunteers (from 39.9 ± 3.2 at baseline, to 43.0 ± 4.0, P < 0.0001). The average difference between MAP values estimated by formulas, compared with MAP assessed on the brachial tonometric curve, was (mean ± 1.96 × SD): −5.0 ± 6.7 mmHg when MAP = DBP + PP × 0333; −1.2 ± 6.1 mmHg when MAP = DBP + PP × 0.40; −0.6 ± 6.1 mmHg when MAP = DBP + PP × 0.412; −0.4 ± 6.7 mmHg when MAP = DBP + PP × 0.333 + 5.

Conclusion:

Due to high interindividual and intraindividual variability of pulse waveform, the estimation of MAP based on fixed formulas derived from SBP and DBP is unreliable. Conversely, a more accurate estimation of MAP should be based on the pulse waveform analysis.
Association of clinic and ambulatory heart rate parameters with mortality in hypertension
Authors: Böhm Michael , Schwantke Igor , Mahfoud Felix , Lauder Lucas , Wagenpfeil Stefan , de la Sierra Alejandro , Vinyoles Ernest , Gorostidi Manuel , Segura Julián , Ruilope Luis M.
Published: July 2020

Objectives:

Resting heart rate (HR) taken in the office has been shown to be associated with cardiovascular outcomes in the general population, hypertension and heart failure. It is unknown whether 24-h oscillographic pulse rate measurement as an approximation of HR derived from ambulatory blood pressure monitoring (ABPM) associates with cardiovascular outcomes in hypertensive patients.

Methods:

We evaluated ABPM recordings from 56 901 patients with complete 3373 421 HR measures entering the final analysis from the Spanish Blood Pressure Monitoring Registry for a median follow-up time of 5.1 years. We explored the association of office HR, mean 24-h HR, mean day HR, mean night HR as well as day–night HR differences, morning mean HR, morning HR surge and night peak HR to all-cause death, cardiovascular death and noncardiovascular death. Data were analyzed by Cox regression analysis, analysis of variance and chi-square test.

Results:

The Spanish ABPM Registry recorded data in 223 primary care centers in Spain from 2004 until 31 December 2014 at the end of recruitment. Office HR was 3.5 bpm higher than mean 24-h HR, office mean HR versus mean night was 10.4 bpm higher and mean day versus mean night HR 9.3 bpm higher, while there were no relevant difference between office and mean day HR. Office mean, 24-h day and night HR more than 90 bpm were associated with an increased risk for all-cause and noncardiovascular death, whereas for cardiovascular death only mean night HR was predictive. The strongest association to all-cause death was observed with mean night HR [hazard ratio 3.80 (2.87–5.03)], mean 24-h HR [2.85 (2.30–3.54)] and mean day HR [2.22 (1.83–2.70)]. Day-night dipping of more than 8 bpm was associated with a 20% lesser risk on all-cause, cardiovascular and noncardiovascular death. Results were robust after adjusting for relevant risk indicators.

Conclusion:

HR parameters derived from ABPM provide important information, in particular association with death by mean night HR, mean 24-h HR and reduced day–night HR dipping less than 8 bpm superior to office HR.
Accuracy of pulse rate derived from 24-h ambulatory blood pressure monitoring compared with heart rate from 24-h Holter-ECG
Authors: Lauder Lucas , Scholz Sean S. , Ewen Sebastian , Lettner Christine , Ukena Christian , Böhm Michael , Mahfoud Felix
Published: July 2020

Background:

Resting heart rate (HR) associates with cardiovascular outcomes in the general population and in patients with hypertension and heart failure. The accuracy of pulse rate acquired by 24-h ambulatory blood pressure monitoring (ABPM-PR) in comparison with Holter-ECG HR (Holter-HR) is unknown.

Objective:

We aimed at investigating the accuracy of ABPM-PR when compared with Holter-HR.

Methods and results:

The current study included 1500 patients of a general cardiology outpatient unit undergoing simultaneous Holter and ABPM recordings. ABPM-PR differed marginally from Holter-HR by 0.55 bpm for 24-h average [95% confidence interval (CI): 0.37–0.73, P < 0.001], 1.27 bpm for daytime (95% CI: −0.98–1.56, P < 0.001) and 0.63 bpm for night-time (95% CI: 0.40–0.86 bpm; P < 0.001). The absolute delta between 24-h Holter-HR and ABPM-PR was less than 5 and less than 10 bpm in 1363 (91%) and 1458 (97%) patients, respectively. 24-h ABPM-PR more commonly underestimated than overestimated (7 versus 2%) 24-h Holter-HR by at least 5 bpm. The mean difference between Holter-HR and ABPM-PR was higher (+1.9 bpm; 95% CI: 0.9–3.0; P < 0.001) in patients with than without atrial fibrillation. There was no significant difference between Holter-HR and ABPM-PR in patients without supraventricular or ventricular extrasystoles (both P ≥ 0.750).

Conclusion:

ABPM-PR did not differ clinically meaningful from Holter-HR recordings in most patients and might be useful for risk prediction in hypertension.
Creatinine increase following initiation of antihypertensives is associated with cardiovascular risk: a nationwide cohort study
Authors: Schytz Philip Andreas , Nissen Anders Bonde , Torp-Pedersen Christian , Gislason Gunnar H. , Nelveg-Kristensen Karl Emil , Hommel Kristine , Gerds Thomas A. , Carlson Nicholas
Published: July 2020

Objective:

Abrupt decline in renal function following initiation of renin–angiotensin system inhibitor is associated with increased risk of cardiovascular disease, but studies of other antihypertensive drugs are sparse. We investigated the risk of cardiovascular event associated with increased plasma creatinine after initiating first-line antihypertensive treatment.

Methods:

In a nationwide cohort study, we identified adult Danish primary care patients initiating either renin–angiotensin system inhibitor, calcium channel blocker or thiazide, between 2008 and mid-2018. Patients with prior end-stage renal disease, renal transplantation, or cardiovascular disease were excluded. Percentual plasma creatinine increase was calculated between the nearest creatinine measurement up to 1 year before redeeming the prescription (baseline), and the nearest measurement 90 days or less after (index). Multiple logistic regression and restricted cubic splines were applied to estimate the 6-month absolute risk of cardiovascular event (ischemic heart disease, heart failure or stroke) associated with this creatinine increase.

Results:

We included 20 789 patients. Within the first 6 months of follow-up, 283 (1.4%) cardiovascular events and 93 (0.4%) all-cause deaths were registered. With a creatinine increase of 0 and 30%, 6-month absolute risk [CI] of cardiovascular event was 1.4% [1.1–1.9] and 3.5% [2.4–5.2], respectively (in men aged 50–79 years with estimated glomerular filtration rate at least 60 ml/min per 1.73 m2 and no diabetes). Higher age and reduced renal function, but not the type of antihypertensive treatment, were associated with higher cardiovascular risk.

Conclusion:

In primary care, patients initiating first-line antihypertensive treatment, an increase in plasma creatinine above 30% was associated with increased absolute 6-month risk of cardiovascular event.
DENSIRON 68 HEAVY SILICONE OIL AS A SHORT-TERM INTRAOCULAR TAMPONADE FOR MACULA-ON INFERIOR RETINAL DETACHMENTS—A CASE SERIES
Authors: Hostovsky Avner , Yap Joel , Mandelcorn Mark S. , Mandelcorn Efrem D.
Published: July 2020

Purpose:

To describe our experience using short-term heavy silicone oil (Densiron 68) for macula-on inferior rhegmatogenous retinal detachments with inferior retinal breaks.

Methods:

Retrospective, consecutive, observational case series. Data were retrospectively collected from the medical records of patients who underwent pars plana vitrectomy and Densiron 68 endotamponade for macula-on rhegmatogenous retinal detachment repair.

Results:

Eight patients were included in the study. The mean patient age was 57.1 ± 12.3 (±SD) years. The mean time to Densiron 68 removal was 57.8 ± 17.8 (±SD) days (ranging from 24 to 83 days). One patient (12.5%) detached three weeks after Densiron 68 removal and required further surgery. All patients were attached at last follow-up with a mean follow-up of 192 days. The mean final best-corrected visual acuity was 20 of 40 (0.29 logarithm of the minimum angle of resolution) similar to the 20 of 45 preoperative best-corrected visual acuity (0.35 logarithm of the minimum angle of resolution, P = 0.501). No significant emulsification was noted before or during the removal of the Densiron 68. Two patients developed an increase in intraocular pressure before Densiron 68 removal that resolved after removal. One patient developed cystoid macular edema that resolved with a short course of topical medications, and one patient had persistent CME that required an intravitreal triamcinolone acetate 1% injection.

Conclusion:

The high anatomic success rate, good visual outcomes, and minimal complications suggest that Densiron 68 can be considered as a short-term tamponade for macula-on retinal detachments with inferior pathology.