bluuebunny/crossref_metadata_2025 huggingface dataset:
Voice Morphing
Authors: Skuk Verena G. , Kawahara Hideki
Published: October 2019

Voice morphing is a framework to generate a new sound which has the mixed attribute of given voice examples. It provides a flexible tool for investigating perceptual attributes in voice communication, especially for quantifying paralinguistic and extralinguistic cues. Recent advances in parametric representation of speech sounds have made the morphing-based approach a practical alternative or complementary strategy to procedures using speech-production models. Stimulus continuum spanning between two typical voice recordings having different perceptual attributes provides an external reference to quantify subjective responses. Generalized morphing, which enables extrapolation as well as interpolation of arbitrarily many numbers of voices, provides a unique strategy for investigating speaker identity. Its ability to selectively manipulate any combination of fundamental parameters facilitates the development of technology to intervene and mediate paralinguistic and extralinguistic communication channels.
Acoustic Patterning of Emotion Vocalizations
Authors: Scherer Klaus R.
Published: October 2019

Starting with evolutionary considerations, this chapter provides a comprehensive overview of vocal emotion communication. On the production/encoding side, the effects of the physiological changes accompanying different emotions is described, highlighting the functional aspects of the acoustic patterns that are determined by emotion-antecedent appraisals and the consequent behavioural tendencies. Special efforts are made to examine the stability of the acoustic patterning for different emotions based on the available reports in the literature, with some attention to the underlying phonatory-articulatory mechanisms. A brief excursion examines the acoustic parameters characterizing emotions in singing. Next, the transmission of vocal signals from sender/encoder to receiver/decoder is briefly described and the literature on emotion inference by receivers (vocal emotion recognition) is reviewed. In this context, the use of path models to obtain a comprehensive investigation of the communication process as a whole is discussed and illustrated. The important issue of language and cultural differences in vocal emotion encoding and decoding is considered in the light of recent evidence. The discussion of applied aspects of the acoustic analysis of vocal emotion expression and recognition concludes the chapter. Specific attention is paid to the role of voice analysis in clinical diagnostics, for example in the case of depression, and for the detection of stress.
Reconsidering the Nature of Voice
Authors: Kreiman Jody , Gerratt Bruce R.
Published: October 2019

Voices play essential roles in human experience, and carry many kinds of meaning. At present, voice production, acoustics, and perception are treated as separate, independently-studied stages, creating a situation where voice comprises something different to everyone who studies it. This chapter presents arguments for an alternative approach, wherein voice is viewed as a single, integral process. According to this view, voice production, acoustics, aeroacoustics, biomechanics, perception, and all the rest, are conceptually inseparable, and none can be understood without knowing how its relationship to the others contributes to its structure and function. The authors of this chapter submit that development of a comprehensive theory of these interactions and dependencies should be the primary goal of voice research, because such a theory would form a basis on which to build realistic explanations of how voice functions socially and communicatively, how it has evolved, and how it conveys meanings of all sorts, leading to a deeper understanding of what it means to be human and to communicate.
Voice Perception in Newborns and Infants
Authors: Paquette Natacha , Dionne-Dostie Emmanuelle , Lassonde Maryse , Gallagher Anne
Published: October 2019

Human voice perception plays a significant role in day-to-day interactions. However, little is known about how newborns and infants perceive and process this information. Yet the ability to perceive vocal cues is crucial, not only for speech and language learning, but also for the development of key social skills such as perceiving other people’s emotions. It is therefore important to understand how, typically, developing infants perceive and process this information in the first few months of life. The aim of this chapter is to provide a better understanding of the early development of these abilities as well as an overview of the key recent behavioural and neuroimaging studies in fetuses, newborns, and infants. The chapter describes and discusses how newborns and infants perceive human voices; how they extract and learn social cues from vocalizations; and how they use this information to learn language.
Eastern Christianity and Meditation
Authors: Hovorun Cyril
Published: October 2019

Eastern Orthodox Christianity has developed a wide variety of theories and practices of meditation. Among these, this chapter covers the contemplation of sins, the recitation of the Jesus prayer, hesychasm, and the contemplation of Divine Light. This latter form of meditation, where God’s uncreated Light is revealed to the individual, is particularly important in the Eastern Christian tradition, as it is linked to theosis, the human capacity to seek and reach divinization. This is not only important as an individual goal but also a key theological notion in Eastern Christianity. The chapter ends by considering the present interest in meditation practices within this tradition.
G−0.02−0.07, the compact H ii region complex nearest to the galactic center with ALMA
Authors: Tsuboi Masato , Kitamura Yoshimi , Uehara Kenta , Miyazaki Atsushi , Miyawaki Ryosuke , Tsutsumi Takahiro , Miyoshi Makoto
Published: October 2019

We have observed the compact H ii region complex nearest to the dynamical center of the Galaxy, G−0.02−0.07, using ALMA in the H42α recombination line, CS J = 2–1, H13CO+J = 1–0, and SiO v = 0, J = 2–1 emission lines, and the 86 GHz continuum emission. The H ii regions HII-A to HII-C in the cluster are clearly resolved into a shell-like feature with a bright half and a dark half in the recombination line and continuum emission. The analysis of the absorption features in the molecular emission lines show that H ii-A, B, and C are located on the near side of the “Galactic center 50 km s−1 molecular cloud” (50MC), but HII-D is located on the far side of it. The electron temperatures and densities ranges are Te = 5150–5920 K and ne = 950–2340 cm−3, respectively. The electron temperatures in the bright half are slightly lower than those in the dark half, while the electron densities in the bright half are slightly higher than those in the dark half. The H ii regions are embedded in the ambient molecular gas. There are some molecular gas components compressed by a C-type shock wave around the H ii regions. From the line width of the H42α recombination line, the expansion velocities of HII-A, HII-B, HII-C, and HII-D are estimated to be Vexp = 16.7, 11.6, 11.1, and 12.1 km s−1, respectively. The expansion timescales of HII-A, HII-B, HII-C, and HII-D are estimated to be tage ≃ 1.4 × 104, 1.7 × 104, 2.0 × 104, and 0.7 × 104 yr, respectively. The spectral types of the central stars from HII-A to HII-D are estimated to be O8V, O9.5V, O9V, and B0V, respectively. These derived spectral types are roughly consistent with the previous radio estimation. The positional relation among the H ii regions, the SiO molecule enhancement area, and Class-I maser spots suggest that a shock wave caused by a cloud–cloud collision propagated along the line from HII-C to HII-A in the 50MC. The shock wave would have triggered the massive star formation.
Feasibility and Effectiveness of an Individualized 12-Week “Uptime” Participation (U-PART) Intervention in Girls and Women With Rett Syndrome
Authors: Stahlhut Michelle , Downs Jenny , Wong Kingsley , Bisgaard Anne-Marie , Nordmark Eva
Published: October 2019

Background

Girls and women with Rett Syndrome (RTT) have low levels of daily physical activity and high levels of sedentary time. Reducing sedentary time and enhancing “uptime” activities, such as standing and walking, could be an important focus for interventions to address long-term health and quality of life in RTT.

Objective

The aim of the study was to evaluate the feasibility and health-related effects of an individualized 12-week uptime participation (U-PART) intervention in girls and women with RTT.

Design

The study used a single-group pretest-posttest design with 4 assessments (2 baseline, postintervention, and follow-up).

Methods

A participation-based intervention employing a whole-day approach was used. During a 12-week intervention period, individualized programs focused on participation in enjoyable uptime activities in home, school/day center, and community settings. Feasibility was assessed with a study-specific questionnaire. Primary outcome measures were sedentary time and daily step count. Secondary outcomes were gross motor skills, walking capacity, quality of life, and goal attainment scaling.

Results

Fourteen girls and women who were 5 to 48 years old and had RTT participated. The U-PART intervention was perceived as feasible by caregivers. Similar scores were observed at baseline assessments in all outcomes. Positive effects with small to medium effect sizes (0.27–0.54) were seen in sedentary time (− 4%), daily step count (+ 689 steps/d), walking capacity (+ 18.8 m), quality of life (+ 2.75 points), and goal attainment scaling after the intervention. Positive effects were maintained in sedentary time (− 3.2%) and walking capacity (+ 12.1 m) at short-term follow-up.

Limitations

This study was limited by the lack of a control group. However, participants acted as their own control, and the stable baseline period partially mitigated this issue.

Conclusions

The U-PART intervention was found to be feasible and effective in the short term in girls and women with RTT.
Hepatitis C virus media coverage favorably impacts on antibody testing in the non-interferon era
Authors: Morales-Arraez Dalia , Hernandez-Guerra Manuel , Diaz-Flores Felicitas , Nieto-Bujalance Yolanda , Garcia-Dopico Jose , Jimenez Alejandro , Quintero Enrique
Published: October 2019

Background

In the non-interferon era, many patients still remain untested for hepatitis C virus (HCV) infection. Our aim was to determine if media coverage, number and type of news, can influence the rate of HCV testing.

Methods

For each calendar year we searched from national, regional and local newspapers for articles published related to HCV between 2001 and 2013 (interferon era) and 2014–2018 (non-interferon era) and the HCV tests performed. Demographics, provider data and test result were collected from patients tested.

Results

During the studied period, 21 913 press articles were found, and we identified a total of 293 226 HCV tests. A total of 9778 HCV tests from 5237 patients tested positive (1.88%). An inverse correlation was found between media coverage and the number of HCV tests during the interferon era (r2 = −0.558, P = 0.024), where news concerning epidemiology and burden of the disease were more frequent. By contrast, in the non-interferon era a strong correlation was observed (r2 = 0.900, P = 0.019), where news related to treatment prevailed.

Conclusion

Our results show that media coverage on HCV fluctuate so the type of news. It remains to be prospectively evaluated if well designed publicity campaigns about the benefits of HCV screening and treatment influences on HCV testing.
Wealth Taxation and Wealth Accumulation: Theory and Evidence From Denmark*
Authors: Jakobsen Katrine , Jakobsen Kristian , Kleven Henrik , Zucman Gabriel
Published: October 2019

Using administrative wealth records from Denmark, we study the effects of wealth taxes on wealth accumulation. Denmark used to impose one of the world’s highest marginal tax rates on wealth, but this tax was greatly reduced starting in 1989 and later abolished. Due to the specific design of the wealth tax, the 1989 reform provides a compelling quasi-experiment for understanding behavioral responses among the wealthiest segments of the population. We find clear reduced-form effects of wealth taxes in the short and medium run, with larger effects on the very wealthy than on the moderately wealthy. We develop a simple life cycle model with utility of residual wealth (bequests) allowing us to interpret the evidence in terms of structural primitives. We calibrate the model to the quasi-experimental moments and simulate the model forward to estimate the long-run effect of wealth taxes on wealth accumulation. Our simulations show that the long-run elasticity of taxable wealth with respect to the net-of-tax return is sizable at the top of the distribution.
Long-term outcomes of patients who rate symptoms of rheumatoid arthritis as ‘satisfactory’
Authors: Gwinnutt James M , Hyrich Kimme L , Lunt Mark ,   RAMS Co-Investigators, Barton Anne , Verstappen Suzanne M M
Published: October 2019

Objectives

To describe outcomes of patients with early RA in a patient acceptable symptom state (PASS) at treatment initiation and to identify clusters of symptoms associated with poor outcomes.

Methods

Data came from the Rheumatoid Arthritis Medication Study, a UK multicentre cohort study of RA patients starting MTX. The HAQ, DAS28 and other patient-reported outcome measures (PROMs) were collected at baseline, and at 6 and 12 months. Patients answering yes to the question ‘Is your current condition satisfactory, when you take your general functioning and your current pain into consideration?’ were defined as PASS; patients answering no were defined as N-PASS. Symptom clusters in the baseline PASS group were identified using K-medians cluster analysis. Outcomes of baseline PASS vs N-PASS patients and each cluster are compared using random effects models.

Results

Of 1127 patients, 572 (50.8%) reported being in PASS at baseline. Over one year, baseline PASS patients had lower DAS28 (mean difference = −0.71, 95% CI −0.83, −0.59) and HAQ scores (mean difference = −0.48, 95% CI −0.56, −0.41) compared with N-PASS patients. Within the baseline PASS group, we identified six symptom clusters. Clusters characterized by high disease activity and high PROMs, or moderate disease activity and high PROMs, had the worst outcomes compared with the other clusters.

Conclusion

Despite reporting their condition as ‘satisfactory’, early RA patients with high PROM scores are less likely to respond to therapy. This group may require increased vigilance to optimize outcomes.
Evaluation of Resmethrin Toxicity to Neonatal Testes in Organ Culture
Authors: Park Hyun-Jung , Lee Won-Young , Zhang Mingtian , Hong Kwon-Ho , Park Chankyu , Kim Jin-Hoi , Song Hyuk
Published: October 2019

Resmethrin is a widely used pyrethroid insecticide, which causes low toxicity in mammals. However, its toxicity in testes has not been fully investigated. Therefore, we evaluated the toxicity of resmethrin in mouse testes using an in vitro organ culture. Mouse testicular fragments (MTFs) derived from neonates were cultured in medium containing resmethrin for 30 days. Effects on spermatogenesis in the cultured testes were investigated as functions of both time and dose. Resmethrin significantly downregulated the transcription levels of marker genes for spermatogonia and the number of spermatogenic germ cells relative to those of the controls, according to quantitative PCR and immunostaining. In addition, spermatocyte was observed in the control, but not in 50 μM resmethrin-exposed cultures. Levels of the SYCP3 meiotic marker and phosphorylated H2AX decreased by resmethrin treatment, as observed by Western blotting. Toxic or apoptotic effects of resmethrin in Sertoli and Leydig cells from MTFs were not observed by immunostaining and Tunnel assay. No changes in the expression of steroidogenic enzymes were noted. Apoptosis was only detected in the germ cells of resmethrin-treated MTFs. Thus, the highest dose of resmethrin tested (50 μM) completely inhibited spermatogenesis, because of apoptosis of germ cells and spermatocytes. Although the in vivo toxicity of resmethrin has not yet been studied in detail, significant evidence for cytotoxicity was observed in our organ cultures. This methodological approach is useful for the study of reproductive toxicity before proceeding to animal models, as it greatly reduces the use of laboratory animals.
Modular nature of simian foamy virus genomes and their evolutionary history
Authors: Aiewsakun Pakorn , Richard Léa , Gessain Antoine , Mouinga-Ondémé Augustin , Vicente Afonso Philippe , Katzourakis Aris
Published: October 2019

Among all known retroviruses, foamy viruses (FVs) have the most stable virus–host co-speciation history, co-diverging in concert with their vertebrate hosts for hundreds of millions of years. However, detailed molecular analyses indicate that different parts of their genome might have different evolutionary histories. While their polymerase gene displays a robust and straightforward virus–host co-speciation pattern, the evolutionary history of their envelope (env) gene, is much more complicated. Here, we report eleven new FV env sequences in two mandrill populations in Central Africa, geographically separated by the Ogooué River into the North and the South populations. Phylogenetic reconstruction of the polymerase gene shows that the two virus populations are distinct, and each contains two variants of env genes co-existing with one another. The distinction between the two env variants can be mapped to the surface domain, flanked by two recombination hotspots, as previously reported for chimpanzee and gorilla FVs. Our analyses suggest that the two env variants originated during the diversification of Old World monkeys and apes, ∼30 million years ago. We also show that this env gene region forms two phylogenetically distinct clades, each displaying a host co-divergence and geographical separation pattern, while the rest of the genome of the two strains is phylogenetically indistinguishable in each of the host-specific groups. We propose possible evolutionary mechanisms to explain the modular nature of the FV genome.
The Emperor’s Cadlina, hidden diversity and gill cavity evolution: new insights for the taxonomy and phylogeny of dorid nudibranchs (Mollusca: Gastropoda)
Authors: Korshunova Tatiana , Fletcher Karin , Picton Bernard , Lundin Kennet , Kashio Sho , Sanamyan Nadezhda , Sanamyan Karen , Padula Vinicius , Schrödl Michael , Martynov Alexander
Published: October 2019

Dorids are one of the largest nudibranch groups, encompassing more than 2000 species. One of the crucial problems with tracing the evolution of dorids is the relationship between cryptobranch dorids (gill cavity present) and phanerobranch dorids (gill cavity absent). Integrative morphological and molecular studies of the enigmatic Japanese dorid species of the cryptobranch genus Cadlina, C. japonica and ‘C.’ sagamiensis, which were collected by the Emperor of Japan (Shōwa era), are presented here for the first time. It is shown that while C. japonica does belong to the Cadlina clade, another Japanese species ‘C.’ sagamiensis is not part of the cryptobranch dorids of the family Cadlinidae, but is related to both the phanerobranch dorid family, Hexabranchidae, and to the cryptobranch family Cadlinellidae stat. nov. A new genus, Showajidaia gen. nov., and new family, Showajidaiidae fam. nov., are proposed for ‘C.’ sagamiensis, and four new species of the genus Cadlina are described based on a dorid-wide molecular phylogenetic analysis, which is the first substantial update of the dorid family system since 2010. Integration of phylogenetic data with an ontogenetic model of dorid evolution suggests that cryptobranch organization can be most reliably assessed as the ancestral state for the majority of dorids.
Incidental Acantholysis in Hailey–Hailey Disease (Microscopic Nikolsky Sign): An Underappreciated Histologic Sign
Authors: Saggini Andrea , Cota Carlo , Cerroni Lorenzo
Published: October 2019

Identification of subtle disease-specific histologic changes may be of significant help in early diagnosis of acantholytic skin diseases. Hailey–Hailey disease (HHD) is an autosomal dominant genodermatosis characterized by vesiculoerosive lesions favoring the intertriginous areas. Histologically, HHD is characterized by full-thickness acantholysis of the spinous layer in association with dyskeratosis of individual keratinocytes; a pemphigus vulgaris-like suprabasal pattern of acantholysis may be observed in the earliest stages of disease. HHD is characterized by highly variable expressivity regarding the age at onset and severity of the disease. Patients may present with late-onset and/or only mild disease. We report the recurrent presence of incidental foci of variably extensive, subclinical acantholysis in multiple bioptic specimens taken from a patient with known HHD for dermatologic conditions other than HHD. Such histologic finding has gone underappreciated in the literature, despite being a likely frequent occurrence in skin biopsies from HHD patients; recognition of this finding might represent a valuable diagnostic clue in selected cases of HHD.
The opposing contribution of neurotrophin-3 and nerve growth factor to orofacial heat hyperalgesia in rats
Authors: dos Reis Renata Cristiane , Kopruszinski Caroline Machado , Nones Carina Fernanda Mattedi , Aguiar Débora Assunção , Chichorro Juliana Geremias
Published: October 2019

It has been proposed that neurotrophin-3 acts in a manner that is opposed to nerve growth factor, especially in the modulation of heat hyperalgesia. Injury to the constriction of the infraorbital nerve (CION) is a well-established model of trigeminal neuropathic pain that leads to robust heat, cold, and mechanical hyperalgesia. Here, we assessed the effect of local neurotrophin-3 treatment on CION-induced hyperalgesia, and we examined some mechanisms related to the effect of neurotrophin-3. Neurotrophin-3 (1 µg/50 µl) injected into the upper lip of CION rats caused a significant and long-lasting reduction of CION-induced heat hyperalgesia, but failed to affect cold and mechanical hyperalgesia. Increased levels of neurotrophin-3 were detected in the injured nerve at the time point that represents the peak of heat hyperalgesia. The anti-hyperalgesic effect of neurotrophin-3 was markedly reduced in the presence of an antagonist of TrkA receptors (K-252a, 1 μg/50 μl). Moreover, association of lower doses of neurotrophin-3 with an antibody anti-nerve growth factor resulted in a synergistic anti-hyperalgesic effect in CION rats. Local injection of nerve growth factor (3 µg/50 µl) or the TRPV1 agonist capsaicin (1 μg/50 μl), but not neurotrophin-3 injection (1 µg/50 µl), resulted in long-lasting facial heat hyperalgesia, which was both significantly reduced by previous neurotrophin-3 local treatment. In conclusion, we suggest that neurotrophin-3 is a potent modulator of facial heat hyperalgesia, which may exert an inhibitory influence on the trkA pathway. Neurotrophin-3 treatment may represent a promising approach, especially in pain conditions associated with increased levels of nerve growth factor.
Statin therapy is associated with better ambulatory blood pressure control: a propensity score analysis
Authors: Spannella Francesco , Filipponi Andrea , Giulietti Federico , Di Pentima Chiara , Bordoni Valentina , Sarzani Riccardo
Published: October 2019

Objective:

Statin therapy was associated with lower blood pressure (BP) in some but not all studies. We evaluated the association between statin therapy and ambulatory BP in a large hypertensive population using ‘propensity score matching’.

Methods:

Retrospective observational study on 1827 consecutive essential hypertensive patients evaluated with 24-h ambulatory BP monitoring. Antihypertensive treatment intensity (ATI) was calculated to compare different drug associations. We used a propensity score matching to compare two equally-sized cohorts of patients with similar characteristics according to statin therapy. Matching was performed on log-transformed propensity score in a 1 : 1 fashion with a caliper of 0.1, in order to account for the different baseline characteristics between statin and no-statin group.

Results:

Mean age: 58.1 ± 13.8 years; male sex: 55%. Patients on statin therapy: 402 (22%). These patients showed lower 24-h BP (−2.8/−7.1 mmHg), daytime (−3.3/−7.6 mmHg) and night-time BP (−2.5/−6.0 mmHg, all P < 0.001). They also showed better ambulatory BP control, even after adjustment for confounding factors. The analyses on the groups derived from the ‘propensity score matching’ (369 patients in each group) confirmed these results (OR 1.8 for 24-h BP control; OR = 1.6 for daytime BP control; OR = 1.7 for night-time BP control, all P < 0.001).

Conclusion:

Statin therapy is associated with better ambulatory BP control in essential hypertensive patients. This result is not affected by the intensity of the antihypertensive treatment or by the several cofactors analyzed.
INVESTIGATING A GROWTH PREDICTION MODEL IN ADVANCED AGE-RELATED MACULAR DEGENERATION WITH SOLITARY GEOGRAPHIC ATROPHY USING QUANTITATIVE AUTOFLUORESCENCE
Authors: Reiter Gregor S. , Told Reinhard , Baumann Lukas , Sacu Stefan , Schmidt-Erfurth Ursula , Pollreisz Andreas
Published: October 2019

Purpose:

To investigate geographic atrophy (GA) progression using quantitative autofluorescence (qAF) in eyes with solitary GA.

Methods:

Forty-three eyes of 26 patients (age 79.7 ± 7.2 years; 28 women; 16 pseudophakic) underwent spectral-domain optical coherence tomography and qAF imaging at baseline and after 12 months. The junctional zone (AJZ) and a nonaffected 300-µm-wide control area (AC) were delineated on spectral-domain optical coherence tomography scans and transferred to the qAF image. Linear mixed models were calculated to investigate the association between GA progression and qAF, age, and baseline GA area. Mixed model analyses of variance were used to investigate differences in qAF between areas.

Results:

Quantitative autofluorescence of the three inferior sections of both the AJZ (P = 0.028; P = 0.014 and P = 0.032) and the AC (P = 0.043; P = 0.02 and P = 0.028) were significantly associated with GA progression after 12 months. However, qAF measurements were not associated with GA progression in the overall model (P > 0.05). Mean qAF was significantly lower in the AJZ and growth area (AG12) than in the AC (both P ≤ 0.001).

Conclusion:

The authors report a statistically significant association between GA growth area and qAF measurements at specific retinal locations and a significant difference in qAF between the GA border and unaffected areas outside the lesion. Quantitative autofluorescence measurements may be limitedly useful for predicting GA progression.
The Impact on Work Patterns of Implementing the Save Sight Keratoconus Registry in the Hospital Setting
Authors: Ferdi Alex C. , Nguyen Vuong , Samarawickrama Chameen , Hamilton Alex , Yeung Season , Watson Stephanie L.
Published: October 2019

Purpose:

The adoption of clinical registries has the potential to improve outcomes, while reducing the costs of health care. We sought to evaluate the changes in workflow that occurred with implementation of the Save Sight Keratoconus Registry (SSKR) in corneal clinics.

Methods:

A prospective time–motion study and a clinician survey were conducted. The timing of clinic consultations was recorded before and after implementation of the SSKR. The activities were assigned into 3 main categories: 1) direct patient care (eg, talking to, examining), 2) indirect patient care (record keeping), and 3) indirect patient care (reading).

Results:

Overall, there was no change in average time spent per patient with or without the SSKR; 12.3 (5.3 SD) versus 12.1 (5.3 SD) minutes, respectively, P = 0.84. There was no change in time spent providing direct care with or without the SSKR; 5.4 (2.8 SD) versus 5.9 (2.8 SD) minutes, respectively, P = 0.51. Within direct patient care, there was no impact with or without the SSKR on the time spent examining (1.9 [1.0 SD] vs. 1.9 [1.4 SD] minutes, respectively, P = 0.58) or talking to patients (3.5 [2.3 SD] vs. 4.1 [2.3 SD] minutes, respectively, P = 0.21). Indirect care time was unchanged overall for record keeping (3.2 [2.2 SD] vs. 4.6 [2.9 SD], respectively, P = 0.16) and reading tasks (3.1 [1.8 SD] vs. 2.0 [1.3 SD], respectively, P = 0.09).

Conclusions:

The SSKR was implemented into clinical practice without affecting the total consultation time, time spent directly interacting with patients, or use of patient records. Our findings support that registries requiring data entry could be widely adopted into routine clinical practice.
The Independent Effect of Various Cross-Linking Treatment Modalities on Treatment Effectiveness in Keratoconus
Authors: Godefrooij Daniel A. , Roohé Suzanna L. , Soeters Nienke , Wisse Robert P.L.
Published: October 2019

Purpose:

To investigate the 1-year outcomes of using various corneal cross-linking (CXL) techniques for treating keratoconus.

Methods:

Setting: This is a prospective longitudinal cohort study performed at a tertiary academic medical center. Patient population: Six hundred seventy eyes of 461 patients with progressive keratoconus who underwent CXL were followed up for 1 year. Intervention: Eight combinations of CXL modalities were assessed, including 2 different CXL techniques (transepithelial or epithelium-off), 7 riboflavin formulations, and 2 ultraviolet-A protocols (conventional 3 mW/cm2 or accelerated 9 mW/cm2). Patients treated using the Dresden protocol were used as the reference group.Main outcome measures: Primary outcomes were maximum keratometry and mean keratometry 1 year after treatment. Multivariable linear regression was used which provides β coefficients (β). Secondary outcomes were uncorrected and corrected distance visual acuity, manifest refractive spherical equivalent, and corneal thickness 1 year after treatment.

Results:

Four treatment modalities differed significantly from the reference group regarding both maximum keratometry and mean keratometry: the transepithelial CXL (TE-CXL) group (β = 1.422; P = 0.001), 1 riboflavin formulation (Meran β = 1.210; P = 0.02), and both the 9 mW/cm2 protocols (Vibex Rapid β = 1.751; P < 0.001 and Collagex β = 1.170, P < 0.001). Overall, the visual outcome, manifest refractive spherical equivalent, and corneal thickness were similar among the treatment modalities. Infections were rare (1.6% of cases); however, re-treatment was required for 33.3% of cases that underwent TE-CXL.

Conclusions:

TE-CXL, the use of Meran riboflavin, and applying the accelerated irradiation protocol appeared to be associated with reduced efficacy regarding controlling keratoconus progression. One-third of cases treated using TE-CXL required re-treatment.
Musical Ear Syndrome and Cochlear Explantation: Case Report and Proposal for a Theoretical Framework
Authors: Kompis Martin , Mantokoudis Georgios , von Gunten Benjamin , Schmid Christoph , Blaser Daniela , Caversaccio Marco
Published: October 2019

Objective:

To report an unusual case of musical ear syndrome, and to present a theoretical framework for this condition, merging information from the presented case and from former case reports.

Patient:

A 67-year-old semi-professional musician, who underwent bilateral cochlear implantation and experienced musical ear syndrome, i.e., hearing music, where none was present.

Interventions:

Cochlear implantation with a bilateral cochlear implant, and cochlear explantation 17 months later.

Main Outcome Measure:

Report of presence or absence of musical ear syndrome by the patient.

Results:

Musical ear syndrome started 1 day after implantation. It ceased immediately after cochlear explantation, but reappeared 3 months later.

Conclusions:

Several types of factors seem to determine whether a musical ear syndrome is present or not. We propose to differentiate between triggers, modifiers, and conditions, which determine a base vulnerability. Vulnerability seems to be increased by auditory deprivation and by habitual retrieval of music from memory. Cochlear implantation or explantation seems to act as triggers. The proposed framework may help to stimulate reporting of more potentially relevant factors in future case reports on musical ear syndrome, and ultimately to help to understand this condition better.
Optimizing Postcardiac Transplantation Outcomes in Children with Ventricular Assist Devices: How Long Should the Bridge Be?
Authors: Riggs Kyle W. , Zafar Farhan , Lorts Angela , Villa Chet R. , Bryant Roosevelt , Morales David L.S.
Published: October 2019

Ventricular assist devices (VADs) decrease waitlist mortality and improve end-organ function. Therefore, we sought to determine the duration of VAD support that could allow for optimal posttransplant outcomes. Pediatric transplant recipients were identified from the United Network for Organ Sharing database. Inflection points were determined using hazard of mortality associated with support time fitted by cubic spline method. Of 685 patients, those supported for >2 months had a significant decrease in inotrope use and mechanical ventilation and an increase in functional status compared with those supported for <2 months (all p < 0.001). Those supported for 2–4 months experienced better posttransplant survival than <2 months (p = 0.031). In durable pulsatile devices, similar improvement was seen in mechanical ventilation and functional status for the 2–4 month group with superior survival compared with <2 months (p = 0.008) and >4 months (p = 0.012). In continuous flow devices, used in patients overall less ill, the inflection point was >3 weeks with improvement in most end-organ function (p < 0.001) and posttransplant survival (p = 0.014) compared with <3 weeks. In general, a period of VAD support is associated with improvement in pretransplant risk factors and better posttransplant survival. This suggests that most patients bridged to transplantation by VADs should be supported for some time before listing to optimize posttransplant outcomes.
Silent coronary artery disease in asymptomatic patients with severe aortic stenosis and normal exercise testing
Authors: Banovic Marko , Iung Bernard , Brkovic Voin , Nikolic Serge , Mitrovic Predrag , Van Camp Guy , Penicka Martin , Simic Dragan , Kockova Radka , Aleksandric Srdjan , Asanin Milika , Nedeljkovic Ivana , Popovic Dejana , Putnik Svetozar , Jaukovic Milena , Bartunek Jozef
Published: October 2019

Objective:

There are no data about the prevalence of silent coronary artery disease in asymptomatic severe aortic stenosis patients with normal exercise testing. Importantly, unmasking significant coronary artery disease in patients with aortic stenosis could influence the choice/timing of treatment in these patients.

Method:

Exercise testing was performed on semi-supine ergobicycle. Cardiopulmonary analysis during exercise testing, echocardiography, and laboratory analysis at rest was done. Standard clinical/electrocardiography criteria were assessed for symptoms/signs of ischemia during/after exercise testing. In patients with normal exercise testing coronary angiography was performed using standard femoral/radial percutaneous approach. Coronary stenosis was considered significant if >70% of vessel diameter or 50%–70% with fractional flow reserve ≤0.8.

Results:

Total of 96 patients with normal exercise testing were included (67.6 years, 50.6% males). No patient had any complication or adverse event. The P
mean was 52.7 mmHg, mean indexed aortic valve area was 0.36 cm2/m2 and left ventricular ejection fraction, 69.5%. 19/96 patients (19.8%) had significant coronary artery disease on coronary angiography. Multivariate logistic regression analysis revealed brain natriuretic peptide and blood glucose as independent predictors of silent coronary artery disease. Brain natriuretic peptide value of 118 pg/ml had sensitivity/specificity of 63%/73% for predicting coronary artery disease (area under the curve 0.727, P = 0.006).

Conclusion:

Our results are the first to show that in patients with severe aortic stenosis, normal left ventricular ejection fraction,, and normal exercise testing, significant coronary artery disease is present in as many as 1/5 patients. In such patients, further prospective studies are warranted to address the diagnostic value of brain natriuretic peptide in detecting silent coronary artery disease.
Dissociation of coronary computed tomography and stress myocardial scintigraphy: a case of vasospasm
Authors: Yoshida Ruka , Takagi Kensuke , Morita Yasuhiro , Furui Koichi , Morishima Itsuro
Published: October 2019

Exercise-induced vasospastic angina (VSA) is an uncommon entity of coronary artery disease. Here, we report a case of exercise-induced VSA, which was detected by exercise stress myocardial perfusion imaging.
Low serum level of sirtuin 1 predicts coronary atherosclerosis plaques during computed tomography angiography among an asymptomatic cohort
Authors: He Xiang , Zheng Jing , Liu Chao
Published: October 2019

Objectives:

Whether in asymptomatic populations levels of serum sirtuin 1 (Sirt1) are associated with coronary atherosclerosis plaque characteristics remains unclear. This article aims to evaluate the possibility of Sirt1 serum levels predicting high-risk coronary plaques revealed through computed tomography angiography (CTA).

Methods:

The current cross-sectional investigation was performed on patients from non high-risk plaque (HRP) group (control group) as well as HRP group. CTA was conducted and the Framingham Risk Score (FRS) was generated each patient. Serum Sirt1 level was determined through ELISA. Univariate analysis and receiver-operating characteristic curve were used to examine the role of Sirt1 to predict HRP.

Results:

Lower Sirt1 serum levels were observed in patients in the HRP group in comparison with those in the control group. Gender, hyperlipidemia, age, the total cholesterol to high-density lipoproteincholesterol (HDL-C) ratio, HDL-C, apolipoprotein B and Sirt1 displayed independent association with HRP as revealed by the univariate analysis. Area under curve of the univariate model for HRP was 0.848 (95% confidence interval: 0.798–0.899); 75.4% specificity, 75.2% sensitivity, the negative predictive value was 83.0%, and the positive predictive value was 66.2%.

Conclusion:

Low serum level of Sirt1 predicted HRP in individuals with low–intermediate FRS, implying that Sirt1 may play a predictive role in the plaque screening before coronary CTA.
Klippel-Feil syndrome: a review of the literature
Authors: Frikha Rim
Published: October 2019

Klippel-Feil syndrome is a congenital defect in the formation or segmentation of the cervical spine. A wide spectrum of associated anomalies may be present. This heterogeneity has complicated clarification of the genetic causes and management of patient’s with congenital vertebral fusion. In this review, we focussed on clinical heterogeneity; radiographic abnormalities and genetic etiology in Klippel-Feil syndrome. We insist on comprehensive evaluation and delineation of diagnostic and prognostic classes.
Prognostic role of S100A9 expression in patients with clear cell renal cell carcinoma
Authors: Koh Hyun Min , An Hyo Jung , Ko Gyung Hyuck , Lee Jeong Hee , Lee Jong Sil , Kim Dong Chul , Song Dae Hyun
Published: October 2019

S100A9 was originally regarded as a regulator of immune response and a mediator of the inflammatory process. Recent studies have suggested that S100A9 expression plays an important role during tumor development, progression and metastasis in various cancers. The present study aimed to investigate the expression and prognostic role of S100A9 in clear cell renal cell carcinoma (ccRCC).

S100A9 expression was examined by immunohistochemical staining in 152 patients who underwent surgical resection due to ccRCC. The correlation between S100A9 expression and clinicopathological data and its prognostic role were evaluated in patients with ccRCC.

S100A9 revealed high expression in 37 cores (12.6%) of ccRCC. S100A9 expression was significantly associated with T stage (P < .001) and Fuhrman nuclear grade (P < .001), but not with patient age (P = .821) and sex (P = .317). Survival analysis revealed that high S100A9 expression is an independent factor for unfavorable disease-free survival (hazard ratio, 2.423; 95% confidence interval, 1.044–5.621; P = .039) and disease-specific survival (hazard ratio, 2.428; 95% confidence interval, 1.130–5.214; P = .023) in patients with ccRCC.

S100A9 expression can be a useful prognostic factor in patients with ccRCC.
The risk of stroke and associated risk factors in a health examination population
Authors: Li Rui-Cen , Xu Wang-Dong , Lei Ya-Li , Bao Ting , Yang Han-Wei , Huang Wen-Xia , Tang Huai-Rong
Published: October 2019

Health examination is an important method for early detection of people with different risk of stroke. This study estimates the risk of stroke and identify risk factors for people who underwent health examinations at the Health Examination Center at West China Hospital, Sichuan University from July 2014 to February 2018.

A total of 31,464 people were recruited in this study and divided into 3 groups (low risk, moderate risk, and high risk) according to risk of stroke. We explored possible factors associated with the risk of stroke by using multivariable stepwise logistic regression analysis.

Among the participants, 17,959 were at low risk, 11,825 were at moderate risk, and 1680 were at high risk. Age, smoking, alcohol consumption, body mass index, uric acid, diastolic pressure, systolic pressure, triglycerides, low-density lipoprotein cholesterol, glucose, and brachial-ankle pulse wave velocity (baPWV) were independent significant risk factors for stroke, whereas high-density lipoprotein cholesterol was an independent protective factor for stroke. Interestingly, with increasing age, the percentage of people at moderate or high risk of stroke was increased. The percentages of people at moderate and high risk of stroke were also increased with respect to the stages of baPWV.

This study showed that >40% of the participants were at moderate or high risk of stroke, especially the older participants. Several factors were related to the risk of stroke, especially baPWV. Some preventive action may be adopted early, and more attention can be paid to the health examination population.
Efficacy and safety of acupuncture therapy for urinary incontinence in women
Authors: Zhong Dan , Tang Wenjun , Geng Dan , He Chengshi
Published: October 2019

Background:

Urinary incontinence (UI), affects women more frequently than men, with a prevalence to 30–40% of perimenopausal women and almost 50% among women aged over 70 years. caused severe psychological burden and bringing negatively impact to the quality of life, increased caregiver burden and economic cost. Acupuncture is often used to treat them. We aim to conduct a systematic review to evaluate the efficacy of acupuncture for women experiencing UI.

Methods:

The following electronic databases will be searched from inception to Jan. 2020: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Traditional Chinese Medicine, Chinese Biomedical Literature Database (CBM), Wan-Fang Database and Chinese Scientific Journal Database (VIP database).All published randomized controlled trials in English or Chinese related to acupuncture for urinary incontinence in women will be included. The primary outcome will be the change from baseline in the amount of urine leakage measured by the 1-hour pad test. Adverse events will be the secondary outcome. Study selection, data extraction, and assessment of study quality will be performed independently by two reviewers. RevMan V.5.3.5 software will be used for the assessment of risk of bias and data synthesis.

Results:

This study will provide a high-quality synthesis of current evidence of acupuncture for UI from the 1-hour pad test.

Conclusion:

The conclusion of our study will provide an evidence to judge whether acupuncture is an effective intervention for patients suffered from UI.

PROSPERO registration number:

CRD42019133195
Prognostic and clinicopathological significance of kinesin family member C1 in various cancers
Authors: Sun Yuting , Zhang Yi , Lang Zhiquan , Huang Junfu , Zou Zhenhong
Published: October 2019

Background:

Kinesin family member C1 (KIFC1), a C-type kinesin motor protein, plays important roles in centrosome assembly and intracellular transport. Numerous studies have focused on the prognostic value of KIFC1 in malignant tumors and the relationship between KIFC1 expression and clinicopathological traits of cancer patients, but the studies remain controversial. And no meta-analysis has yet shown the association between KIFC1 and various cancers.

Methods:

Systematic retrieval was carried out within several databases, including PubMed, Embase, Web of Science, Wanfang and China National Knowledge Infrastructure (CNKI). In addition, hazard ratios (HR) and relative risks (RR) with 95% confidence intervals (CIs) were calculated to examine the risk or hazard correlation by Stata SE15.1.

Results:

Eleven studies with the overall 2424 participants were included in this research. High KIFC1 expression was remarkably correlated with worse OS (HR = 1.33, 95% CI = 1.07–1.60) and poorer relapse-free survival (HR = 2.28, 95% CI = 1.75–2.80). In subgroup analysis, high KIFC1 expression was a negative predictor for OS in patients with ovarian cancer (P < .001), breast cancer (P < .001), hepatocellular carcinoma (P < .001), and non-small cell lung cancer (P < .001), but not for esophageal squamous cell carcinoma (P = .246). Moreover, high levels of KIFC1 were related with positive lymph node metastasis (RR = 1.23, 95% CI = 1.01–1.50, P = .041) and advanced tumor node metastasis (TNM) stage (RR = 1.55, 95% CI = 1.27–1.89, P < .001).

Conclusions:

KIFC1 overexpression indicates poor prognosis and more serious clinicopathological characteristics in kinds of malignancies. Thus, we conclude that KIFC1 could be a target for clinical diagnosis and treatment of various cancers.
Association between palliative care and end-of-Life care for patients with hematological malignancies
Authors: Chiang Jui-Kun , Lee Yang-Cheng , Kao Yee-Hsin
Published: October 2019

To date, few studies have examined the end-of-life (EOL) care for patients with hematological malignancies (HMs). We evaluated the effects of palliative care on the quality of EOL care and health care costs for adult patients with HMs in the final month of life.

We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information for patient medical records, health care costs, and insurance system exit dates (our proxy for death) between 2000 and 2011.

A total of 724 adult patients who died of HMs were investigated. Of these patients, 43 (5.9%) had received only inpatient palliative care (i-Pal group), and 19 (2.6%) received home palliative care (h-Pal group). The mean health care costs during the final month of life were not significantly different between the non-Pal and Pal groups (p=0.315) and between the non-Pal, i-Pal, and h-Pal groups (p=0.293) either. By the multivariate regression model, the i-Pal group had lower risks of chemotherapy, ICU admission, and receipt of CPR, but higher risks of at least two hospitalizations and dying in hospital after adjustments. The h-Pal group had the similar trends as the i-Pal group but lower risk of dying in hospital after adjustments.

Patients with HMs who had received palliative care could benefit from less aggressive EOL cancer care in the final month of life. However, 8.6% patients with HMs received palliative care. The related factors of more hospitalizations and dying in hospital warrant further investigation.