bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequent drinking is a more important risk factor for new-onset atrial fibrillation than binge drinking: a nationwide population-based study
Authors: Kim Yun Gi , Han Kyung-Do , Choi Jong-Il , Boo Ki Yung , Kim Do Young , Lee Kwang-No , Shim Jaemin , Kim Jin Seok , Kim Young-Hoon
Published: September 2019

Aims

Heavy consumption of alcohol is a known risk factor for new-onset atrial fibrillation (AF). We aimed to evaluate the relative importance of frequent drinking vs. binge drinking.

Methods and results

A total of 9 776 956 patients without AF who participated in a national health check-up programme were included in the analysis. The influence of drinking frequency (day per week), alcohol consumption per drinking session (grams per session), and alcohol consumption per week were studied. Compared with patients who drink twice per week (reference group), patients who drink once per week showed the lowest risk [hazard ratio (HR) 0.933, 95% confidence interval (CI) 0.916–0.950] and those who drink everyday had the highest risk for new-onset AF (HR 1.412, 95% CI 1.373–1.453), respectively. However, the amount of alcohol intake per drinking session did not present any clear association with new-onset AF. Regardless of whether weekly alcohol intake exceeded 210 g, the frequency of drinking was significantly associated with the risk of new-onset AF. In contrast, when patients were stratified by weekly alcohol intake (210 g per week), those who drink large amounts of alcohol per drinking session showed a lower risk of new-onset AF.

Conclusion

Frequent drinking and amount of alcohol consumption per week were significant risk factors for new-onset AF, whereas the amount of alcohol consumed per each drinking session was not an independent risk factor. Avoiding the habit of consuming a low but frequent amount of alcohol might therefore be important to prevent AF.
Health literacy and hypertension outcomes in a multi-ethnic population: the HELIUS study
Authors: Miranda R , Meeks K A C , Snijder M B , van den Born B J , Fransen M P , Peters R J , Stronks K , Agyemang C
Published: September 2019

Background

Hypertension disproportionately affects ethnic minority groups. Although health literacy may play role in these ethnic inequalities, little is known about the extent to which health literacy affects hypertension prevalence, awareness, treatment and control in different ethnic groups. Therefore, we assessed these associations in a multi-ethnic population.

Methods

Baseline data from the HELIUS study were used including participants of Dutch (n = 1948), South-Asian Surinamese (n = 2054) and African Surinamese (n = 1932) origin aged 18–70 years, who lived in Amsterdam, the Netherlands, were fluent in Dutch and underwent health literacy assessment through the Rapid Estimate of Adult Literacy in Medicine–Dutch (REALM-D). The REALM-D was categorized either as low (<60 sumscore) or adequate (≥60 sumscore) health literacy. Participants completed questionnaires and underwent physical examination.

Results

After adjusting for confounding variables, Dutch [odds ratio (OR) 2.02; 95% confidence interval (CI), 1.11–3.64] and African Surinamese (OR 1.36; 1.03–1.79) with low health literacy were more likely than those with adequate health literacy to have hypertension, whereas in South-Asian Surinamese this association was not significant. No significant associations were found between health literacy and hypertension awareness, treatment and control in any of the ethnic groups.

Conclusion

Findings indicate that health literacy is associated with hypertension prevalence in selected ethnic groups, but not with hypertension awareness, treatment and control. Targeting health literacy might be an entry point for tackling ethnic inequalities in hypertension prevalence. To substantially reduce these inequalities, further research is needed to explore other factors and pathways through which health literacy may impact hypertension outcomes in different ethnic groups.
Jurassic location of the Yukon-Tanana Terrane from paleomagnetism of the folded Mississippian Tatlmain Batholith and Ragged Stock
Authors: Symons D T A , Kawasaki K
Published: September 2019

The extensive Yukon-Tanana terrane of the northern Canadian Cordillera has been considered controversially to be part of the allochthonous ‘Baja B.C.’ microcontinent or of the para-autochthonous North American cratonic margin during the Mesozoic. Paleomagnetic methods have isolated a very-stable Early Jurassic thermochemical remanent remagnetization in the terrane's felsic Tatlmain batholith and mafic Ragged stock after correction for: 1) rotation from northeast-plunging anticlinal deformation; 2) northerly dipping tectonic tilt of the host rocks; and, 3) northwestward regional translation on the adjacent Tintina transcurrent fault zone. The resulting 196 ± 6 Ma Tatlmain and Ragged paleopoles are 64.9° N, 44.8° E (A95 = 5.9°) and 64.2° N, 58.5° E (A95 = 7.7°), respectively. The YTT paleopoles support para-autochthonous tectonic models that have the YTT: 1) accreting to North America by the Early Jurassic; 2) undergoing non-significant orogen-perpendicular shortening by mid-Early Cretaceous from thrust-faulting; and, then 3) undergoing significant orogen-parallel northward translation of ∼500 km from mid-Early Cretaceous to the Eocene. In contrast, the paleopoles for Stikinia and Quesnellia of the Intermontane Belt show progressive northwestward translation relative to North America by ∼1000 km and a rotation of ∼55° cw since mid-Early Cretaceous. We speculate that ∼500 km of the northward translation is related to dextral motion on the Tintina and Northern Rocky Mountain Trench fault in British Columbia, and that the clockwise rotation is related to upper crustal tectonics in both Yukon and southern British Columbia.
Estimation of frictional properties and slip evolution on a long-term slow slip event fault with the ensemble Kalman filter: numerical experiments
Authors: Hirahara Kazuro , Nishikiori Kento
Published: September 2019

A variety of slow slip events at subduction zones have been observed. They can be stress meters for monitoring the stress state of megathrust faults during their earthquake cycles. In this study, we focus on long-term slow slip events (LSSEs) recurring at downdip portions of megathrust faults among such slow earthquakes. Data analyses and simulation studies of LSSEs have so far been executed independently. In atmosphere and ocean sciences, data assimilations that optimally combine data analyses and simulation studies have been developed. We develop a method for estimating frictional properties and monitoring slip evolution on an LSSE fault, with a sequential data assimilation method, the ensemble Kalman filter (EnKF). We executed numerical twin experiments for the Bungo Channel LSSE fault in southwest Japan to validate the method. First, based on a rate- and state-dependent friction law, we set a rate-weakening circular LSSE patch on the rate-strengthening flat plate interface, whose critical nucleation size is larger than that of the patch, and reproduced the observed Bungo Channel LSSEs with recurrence times of approximately 7 yr and slip durations of 1 yr. Then, we synthesized the observed data of surface displacement rates at uniformly distributed stations with noises from the simulated slip model. Using our EnKF method, we successfully estimated the frictional parameters and the slip rate evolution after a few cycles. Secondly, we considered the effect of the megathrust fault existing in the updip portion of the LSSE fault, as revealed by kinematic inversion studies of Global Navigation Satellite System (GNSS) data and added this locked region with a slip deficit rate in the model. We estimated the slip rate on the locked region only kinematically, but the quasi-dynamic equation of motion in each LSSE fault cell includes the stress term arising from the locked region. Based on this model, we synthesized the observed surface displacement rate data for the actual distribution of GNSS stations and executed EnKF estimations including the slip rate on the locked region. The slip rate on the locked region could be quickly retrieved. Even for the actual distribution of GNSS stations, we could successfully estimate frictional parameters and slip evolution on the LSSE fault. Thus, our twin numerical experiments showed the validity of our EnKF method, although we need further studies for actual GNSS data analyses.
Analysis of random walks on a hexagonal lattice
Authors: Di Crescenzo Antonio , Macci Claudio , Martinucci Barbara , Spina Serena
Published: September 2019

We consider a discrete-time random walk on the nodes of an unbounded hexagonal lattice. We determine the probability generating functions, the transition probabilities and the relevant moments. The convergence of the stochastic process to a two-dimensional Brownian motion is also discussed. Furthermore, we obtain some results on its asymptotic behaviour making use of large deviation theory. Finally, we investigate the first-passage-time problem of the random walk through a vertical straight line. Under suitable symmetry assumptions, we are able to determine the first-passage-time probabilities in a closed form, which deserve interest in applied fields.
Tedizolid is a promising antimicrobial option for the treatment of Staphylococcus aureus infections in cystic fibrosis patients
Authors: Roch Melanie , Varela Maria Celeste , Taglialegna Agustina , Rosato Adriana E
Published: September 2019

Background

Tedizolid is a protein synthesis inhibitor in clinical use for the treatment of Gram-positive infections. Pulmonary MRSA infections are a growing problem in patients with cystic fibrosis (CF) and the efficacy of tedizolid-based therapy in CF pulmonary infections is unknown.

Objectives

To evaluate the in vitro and in vivo activity of tedizolid and predict the likelihood of tedizolid resistance selection in CF-background Staphylococcus aureus strains.

Methods

A collection of 330 S. aureus strains (from adult and paediatric patients), either of normal or small colony variant (SCV) phenotypes, gathered at three CF centres in the USA was used. Tedizolid activity was assessed by broth microdilution, Etest and time–kill analysis. In vivo tedizolid efficacy was tested in a murine pneumonia model. Tedizolid in vitro mutants were obtained by 40 days of exposure and progressive passages. Whole genome sequencing of clinical S. aureus strains with reduced susceptibility to tedizolid was performed.

Results

MRSA strain MIC90s were tedizolid 0.12–0.25 mg/L and linezolid 1–2 mg/L; for MSSA strains, MIC90s were tedizolid 0.12 mg/L and linezolid 1–2 mg/L. Two strains, WIS 441 and Seattle 106, with tedizolid MICs of 2 mg/L and 1 mg/L, respectively, had MICs above the FDA tedizolid breakpoint (0.5 mg/L). Tedizolid at free serum concentrations exhibited a bacteriostatic effect. Mean bacterial burdens in lungs (log10 cfu/g) for WIS 423-infected mice were: control, 11.2±0.5; tedizolid-treated (10 mg/kg), 3.40±1.87; linezolid-treated (40 mg/kg), 4.51±2.1; and vancomycin-treated (30 mg/kg), 5.21±1.93. For WIS 441-infected mice the (log10 cfu/g) values were: control, 9.66±0.8; tedizolid-treated, 3.18±1.35; linezolid-treated 5.94±2.19; and vancomycin-treated, 4.35±1.7.

Conclusions

These results suggest that tedizolid represents a promising therapeutic option for the treatment of CF-associated MRSA/MSSA infections, having potent in vivo activity and low resistance potential.
Gaussian beam velocity tomography based on azimuth-opening angle domain common imaging gathers
Authors: Cai Jiexiong , Zheng Hao
Published: September 2019

Ray-based tomography in the imaging domain, implemented with seismic migration, is currently widely used in industrial applications. However, conventional ray-based tomography has some inherent problems, such as shadow area, multi-path problem and so on, which limit the inversion accuracy. To alleviate these problems, we proposed Gaussian beam velocity tomography (GBT) based on azimuth-opening angle domain common imaging gathers (ADCIGs). According to the first-order Born and Rytov approximations, we derived a linear relationship between travel-time perturbation and velocity perturbation in the imaging domain, by which we construct the explicit expression of the sensitivity kernel function and use a Gaussian beam operator to compute the kernel. Furthermore, by introducing the preconditioned model regularization, a method of GBT under the constraint of a structure-guided filter is derived. Iterative applications of migration and tomography, both based on a Gaussian beam propagator, embody the idea of integrating velocity inversion and imaging. Numerical tests on both synthetic data and field data demonstrate that Gaussian beam propagator-based travel-time tomography in the imaging domain is effective.
Reducing West Nile Virus Risk Through Vector Management
Authors: Nasci Roger S , Mutebi John-Paul
Published: September 2019

Over 50,000 human West Nile virus (WNV) (Flaviviridae: Flavivirus) clinical disease cases have been reported to the CDC during the 20 yr that the virus has been present in the United States. Despite the establishment and expansion of WNV-focused mosquito surveillance and control efforts and a renewed emphasis on applying integrated pest management (IPM) principles to WNV control, periodic local and regional WNV epidemics with case reports exceeding 2,000 cases per year have occurred during 13 of those 20 yr in the United States. In this article, we examine the scientific literature for evidence that mosquito control activities directed at either preventing WNV outbreaks or stopping those outbreaks once in progress reduce WNV human disease or have a measurable impact on entomological indicators of human WNV risk. We found that, despite a proliferation of research investigating larval and adult mosquito control effectiveness, few of these studies actually measure epidemiological outcomes or the entomological surrogates of WNV risk. Although many IPM principles (e.g., control decisions based on surveillance, use of multiple control methodologies appropriate for the ecosystem) have been implemented effectively, the use of action thresholds or meaningful public health outcome assessments have not been used routinely. Establishing thresholds for entomological indicators of human risk analogous to the economic injury level and economic thresholds utilized in crop IPM programs may result in more effective WNV prevention.
Simulation of Chemotherapy Effects in Older Breast Cancer Patients With High Recurrence Scores
Authors: Chandler Young , Jayasekera Jinani C , Schechter Clyde B , Isaacs Claudine , Cadham Christopher J , Mandelblatt Jeanne S
Published: September 2019

Background

Tumor genomic expression profile data are used to guide chemotherapy choice, but there are gaps in evidence for women aged 65 years and older. We estimate chemotherapy effects by age and comorbidity level among women with early-stage, hormone receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative breast cancers and Oncotype DX scores of 26 or higher.

Methods

A discrete-time stochastic state transition simulation model synthesized data from population studies and clinical trials to estimate outcomes over a 25-year horizon for subgroups based on age (65–69, 70–74, 75–79, and 80–89 years) and comorbidity levels (no or low, moderate, severe). Outcomes were discounted at 3%, and included quality-adjusted life-years (QALYs), life-years, and breast cancer and other-cause mortality with chemoendocrine vs endocrine therapy. Sensitivity analysis tested the effect of varying uncertain parameters.

Results

Women aged 65–69 years with no or low comorbidity gained 0.16 QALYs with chemo-endocrine and reduced breast cancer mortality from 34.8% to 29.7%, for an absolute difference of 5.1%; this benefit was associated with a 12.8% rate of grade 3–4 toxicity. Women aged 65–69 years with no or low or moderate comorbidity levels, and women aged 70–74 years with no or low comorbidity had small chemotherapy benefits. All women aged 75 years and older experienced net losses in QALYs with chemo-endocrine therapy. The results were robust in sensitivity analyses. Chemotherapy had greater benefits as treatment effectiveness increased, but toxicity reduced the QALYs gained.

Conclusion

Among women aged 65–89 years whose tumors indicate a high recurrence risk, only those aged 65–74 years with no or low or moderate comorbidity have small benefits from adding chemotherapy to endocrine therapy. Genomic expression profile testing (and chemotherapy use) should be reserved for women aged younger than 75 years without severe comorbidity.
Contraception in female travellers: challenges and solutions
Authors: Borwein Sarah T
Published: September 2019

Contraception is an important issue for female travelers, but one that is often neglected in the pre-travel consult. Options have expanded in the 21st century. Travel medicine practitioners should have a basic understanding of the choices available to their female patients, as well as the advantages and disadvantages of each. This paper will review the contraceptive methods available to female travelers, including newer methods, and discuss emergency contraception options.
Long-term variability of a black widow’s eclipses – A decade of PSR J2051$-$0827
Authors: Polzin E J , Breton R P , Stappers B W , Bhattacharyya B , Janssen G H , Osłowski S , Roberts M S E , Sobey C
Published: September 2019

In this paper we report on $\sim 10$  yr of observations of PSR J2051$-$0827, at radio frequencies in the range 110–4032 MHz. We investigate the eclipse phenomena of this black widow pulsar using model fits of increased dispersion and scattering of the pulsed radio emission as it traverses the eclipse medium. These model fits reveal variability in dispersion features on time-scales as short as the orbital period, and previously unknown trends on time-scales of months–years. No clear patterns are found between the low-frequency eclipse widths, orbital period variations, and trends in the intrabinary material density. Using polarization calibrated observations we present the first available limits on the strength of magnetic fields within the eclipse region of this system; the average line of sight field is constrained to be $10^{-4}$ G $\lesssim B_{||} \lesssim 10^2$ G, while for the case of a field directed near-perpendicular to the line of sight we find $B_{\perp } \lesssim 0.3$ G. Depolarization of the linearly polarized pulses during the eclipse is detected and attributed to rapid rotation measure fluctuations of $\sigma _{\text{RM}} \gtrsim 100$ rad m$^{-2}$ along, or across, the line of sights averaged over during a subintegration. The results are considered in the context of eclipse mechanisms, and we find scattering and/or cyclotron absorption provide the most promising explanation, while dispersion smearing is conclusively ruled out. Finally, we estimate the mass-loss rate from the companion to be $\dot{M}_{\text{C}} \sim 10^{-12}\, \mathrm{M}_\odot$ yr$^{-1}$, suggesting that the companion will not be fully evaporated on any reasonable time-scale
Hypertrophic Interstitial Neuropathy of the Trigeminal Nerve: Case Report and Literature Review
Authors: Wang Alick P , Catana Dragos , Provias John P , Reddy Kesava K V
Published: September 2019

BACKGROUND AND IMPORTANCE

Hypertrophic interstitial neuropathy (HIN) is an uncommon, non-neoplastic lesion typically affecting peripheral nerves. Cranial nerve (CN) involvement is exceedingly rare. We present a case of isolated trigeminal nerve HIN manifesting with V3 distribution neuralgia.

CLINICAL PRESENTATION

A 50-yr-old male presented with left sided trigeminal neuralgia refractory to medical management. The patient underwent retromastoid craniectomy for possible microvascular decompression. Intra-operatively, the trigeminal nerve appeared to be focally enlarged with a sausage-like configuration. We selectively resected 1 fascicle which was predominantly involved. Histopathological examination revealed onion bulb formations composed of Schwann cells around centrally placed axons. A diagnosis of HIN was made. Postoperatively, the patient experienced complete resolution of symptoms.

CONCLUSION

This is the third case of isolated trigeminal nerve HIN in the literature. We performed a selective resection in a patient presenting with trigeminal neuralgia, resulting in complete resolution of symptoms. It is reported here with intraoperative microscope images, along with a review and analysis of this topic as it related to CN.
Fermion mass and mixing in a low-scale seesaw model based on the S4 flavor symmetry
Authors: Vien V V , Long H N , Hernández A E Cárcamo
Published: September 2019

We construct a low-scale seesaw model to generate the masses of active neutrinos based on $S_4$ flavor symmetry supplemented by the $Z_2 \times Z_3 \times Z_4 \times Z_{14}\times U(1)_L$ group, capable of reproducing the low-energy Standard Model (SM) fermion flavor data. The masses of the SM fermions and the fermionic mixing parameters are generated from a Froggatt–Nielsen mechanism after spontaneous breaking of the $S_4\times Z_2 \times Z_3 \times Z_4 \times Z_{14}\times U(1)_L$ group. The obtained values for the physical observables of the quark and lepton sectors are in good agreement with the most recent experimental data. The leptonic Dirac CP-violating phase $\delta _\mathrm{CP}$ is predicted to be $259.579^\circ$ and the predictions for the absolute neutrino masses in the model can also saturate the recent constraints.
Oscillopsia in Bilateral Vestibular Hypofunction: Not Only Gain But Saccades Too
Authors: Batuecas-Caletrio Angel , Trinidad-Ruiz Gabriel , Rey-Martinez Jorge , Matiño-Soler Eusebi , Martin Sanz Eduardo , Perez Fernandez Nicolás
Published: September 2019

Objectives:

Oscillopsia is a disabling condition for patients with bilateral vestibular hypofunction (BVH). When the vestibulo-ocular reflex is bilaterally impaired, its ability to compensate for rapid head movements must be supported by refixation saccades. The objective of this study is to assess the relationship between saccadic strategies and perceived oscillopsia.

Design:

To avoid the possibility of bias due to remaining vestibular function, we classified patients into two groups according to their gain values in the video head impulse test. One group comprised patients with extremely low gain (0.2 or below) in both sides, and a control group contained BVH patients with gain between 0.2 and 0.6 bilaterally. Binary logistic regression (BLR) was used to determine the variables predicting oscillopsia.

Results:

Twenty-nine patients were assigned to the extremely low gain group and 23 to the control group. The BLR model revealed the PR score (saccades synchrony measurement) to be the best predictor of oscillopsia. Receiver operating characteristic analysis determined that the most efficient cutoff point for the probabilities saved with the BLR was 0.518, yielding a sensitivity of 86.6% and specificity of 84.2%.

Conclusions:

BVH patients with higher PR values (nonsynchronized saccades) were more prone to oscillopsia independent of their gain values. We suggest that the PR score can be considered a useful measurement of compensation.
Impact of Prolonged Skeletal Traction in Patients With Acetabular Fractures
Authors: Boissonneault Adam R. , Schenker Mara , Wilson Jake , Schwartz Andrew , Staley Christopher , Maceroli Michael
Published: September 2019

Objectives:

To explore the association between increased time in traction and in-hospital pulmonary complications in patients with acetabular fractures.

Design:

Retrospective.

Setting:

Level I trauma center.

Patients/Participants:

One hundred ninety consecutive patients.

Intervention:

Application of skeletal traction before fixation of acetabular fracture.

Main Outcome Measurements:

The primary outcome measure was pulmonary complication as defined by pulmonary embolism, pneumonia, and acute respiratory distress syndrome. Secondary outcome measures included length of intensive care unit stay (in days), total length of hospital stay (in days), deep hardware-associated infection, subsequent conversion to total hip arthroplasty, urinary tract infection, and lower-extremity deep venous thrombosis.

Results:

The mean time in traction for patients who developed a pulmonary complication was 210 hours compared with 62 hours for those who did not (P < 0.001). After controlling for Injury Severity Score, chest injury, and concomitant long bone injury requiring intramedullary nailing, the odds of developing a pulmonary complication for patients who spent longer than 120 hours in traction were over 40 times higher than those treated within 5 days (P < 0.001). The mean intensive care unit stay for patients who spent at least 120 hours in traction was 17 days compared with 5 days for those treated in less than 120 hours (P < 0.001).

Conclusion:

Early definitive fixation and decreased time in skeletal traction is associated with a lower rate of complications in patients with acetabular fractures. Our results would suggest that fixation of acetabular fractures before 120 hours (5 days) confers a significant risk-reduction benefit.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Suture Suspension Arthroplasty With Trapeziectomy for Thumb Carpometacarpal Arthritis Using a Wide-awake Approach
Authors: Takagi Takehiko , Weiss Arnold-Peter C.
Published: September 2019

Despite the introduction of various techniques for ligament reconstruction in the treatment of thumb carpometacarpal (CMC) arthritis, complications, including proximal migration, dorsal subluxation of the first metacarpal base, hyperextension of the thumb metacarpophalangeal joint, and impingement between the first and second metacarpal bases, have been reported. Even suture button suspensionplasty with Arthrex Mini TightRope may be unable to correct the adduction contracture deformity and does not effectively tether the trapeziometacarpal toward the base of the index metacarpal, thus potentially leaving patients with persistent decreased first web space angle, proximal migration, and collapse deformity. Hence, suture suspension arthroplasty with abductor pollicis longus (APL)-flexor carpi radialis (FCR) tendon suture after trapeziectomy, a simpler technique, was applied. This simple surgical reconstruction abducts the first metacarpal bone. Abduction of the CMC joint improves metacarpophalangeal joint hyperextension. However, strong tension of the APL-FCR causes abduction contracture of the first CMC joint and difficulty of pinch motion of the thumb to the other fingers. Therefore, we have modified the arthroplasty with a wide-awake approach. The procedure is performed with the patient fully awake under local anesthesia, without a tourniquet to allow the patient to actively move and pinch the thumb, which allows the surgeon to confirm the tension of the APL-FCR suture. A fiber wire is connected to the APL-FCR with proper tension. The patient and surgeon can ensure pinch motion and thumb opposition with satisfaction during surgery.
Feasibility of Hidden Markov Models for the Description of Time-Varying Physiologic State After Severe Traumatic Brain Injury
Authors: Asgari Shadnaz , Adams Hadie , Kasprowicz Magdalena , Czosnyka Marek , Smielewski Peter , Ercole Ari
Published: September 2019

Objectives:

Continuous assessment of physiology after traumatic brain injury is essential to prevent secondary brain insults. The present work aims at the development of a method for detecting physiologic states associated with the outcome from time-series physiologic measurements using a hidden Markov model.

Design:

Unsupervised clustering of hourly values of intracranial pressure/cerebral perfusion pressure, the compensatory reserve index, and autoregulation status was attempted using a hidden Markov model. A ternary state variable was learned to classify the patient’s physiologic state at any point in time into three categories (“good,” “intermediate,” or “poor”) and determined the physiologic parameters associated with each state.

Setting:

The proposed hidden Markov model was trained and applied on a large dataset (28,939 hr of data) using a stratified 20-fold cross-validation.

Patients:

The data were collected from 379 traumatic brain injury patients admitted to Addenbrooke’s Hospital, Cambridge between 2002 and 2016.

Interventions:

Retrospective observational analysis.

Measurements and Main Results:

Unsupervised training of the hidden Markov model yielded states characterized by intracranial pressure, cerebral perfusion pressure, compensatory reserve index, and autoregulation status that were physiologically plausible. The resulting classifier retained a dose-dependent prognostic ability. Dynamic analysis suggested that the hidden Markov model was stable over short periods of time consistent with typical timescales for traumatic brain injury pathogenesis.

Conclusions:

To our knowledge, this is the first application of unsupervised learning to multidimensional time-series traumatic brain injury physiology. We demonstrated that clustering using a hidden Markov model can reduce a complex set of physiologic variables to a simple sequence of clinically plausible time-sensitive physiologic states while retaining prognostic information in a dose-dependent manner. Such states may provide a more natural and parsimonious basis for triggering intervention decisions.
Association Between Perceived Skin Cancer Risk Reduction and Sunscreen Use
Authors: Sharma Timmie R. , Yeh Vanessa , Debanne Sara M. , Bordeaux Jeremy S.
Published: September 2019

BACKGROUND

Understanding factors that influence people to use sunscreen would allow clinicians to counsel patients in a way that is influential. Perceived efficacy of sunscreen has been associated with sunscreen use, but it is unclear whether the degree of efficacy is important.

OBJECTIVE

To determine whether larger perceived efficacy of sunscreen (larger skin cancer risk reduction) is associated with increased sunscreen use.

MATERIALS AND METHODS

A cohort of 131 patients with a history of skin cancer visiting a Mohs micrographic surgery center were surveyed.

RESULTS

Participants believed sunscreen would reduce their risk of basal cell carcinoma (BCC) by 61.1% (95% confidence interval [CI] = 56.4–65.9), squamous cell carcinoma (SCC) by 59.4% (95% CI = 54.6–64.2), and melanoma by 59.5% (95% CI = 54.8–64.3). Perceived magnitude of risk reduction of BCC, SCC, and melanoma was significant independent predictors of sunscreen use (BCC: odds ratio [OR] 3.5, 95% CI 1.1–11.2, p = .04. Squamous cell carcinoma: OR 2.8, 95% CI 1.0–7.6, p = .05. Melanoma: OR 5.0, 95% CI 1.8–14.2, p = .002).

CONCLUSION

Larger perceived skin cancer (BCC, SCC, and melanoma) risk reduction was associated with increased sunscreen use.
Nonsurgical Rhinoplasty With Polydioxanone Threads and Fillers
Authors: Kang Seung H. , Moon Seok H. , Kim Hei S.
Published: September 2019

BACKGROUND

Absorbable wedge-shaped polydioxanone (PDO) sutures are currently available for facial rejuvenation, and they are extremely popular in the aesthetic clinics in Korea. Other than face lifting, threads also can be used for nonsurgical rhinoplasty. The Asian nose is typified by a flat nasal bridge, indistinct nasal dorsum, underprojected and broad nasal tip, and a short columella. In the past, Asian rhinoplasty mainly focused on dorsal augmentation. At present, augmentation of the nasal tip is very popular and is considered an important aspect of achieving a natural and balanced nose.

OBJECTIVE

To describe a novel technique with PDO threads in nonsurgical rhinoplasty. In addition, the authors aimed to assess the overall safety and efficacy of nonsurgical rhinoplasty combining both fillers and threads.

METHODS

A retrospective analysis was performed on Korean patients who received rhinoplasty with PDO threads and fillers. All participants underwent a single treatment session. The results were assessed objectively by 2 independent dermatologists using serial photography and subjectively based on the patients' satisfaction scores at 6-month follow-up.

RESULTS

A total of 31 patients were evaluated, and 93.5% considered the results satisfactory. Consensus ratings at the 6-month follow-up were largely categorized as very much improved (38.7%), much improved (35.5%), and improved (25.8%). An average increase of 6.3° (percentage increase by 7.6) in the nasolabial angle (p < .05) was measured at follow-up. The incidence of the complications was low, and the ones reported were minor.

CONCLUSION

Nonsurgical rhinoplasty combining PDO threads and fillers can be safe and effective, maintaining good results at 6 months after the procedure. Threads are especially useful for lifting-up the nasal tip, contributing to a more harmonious and pleasing nasal appearance by modifying the columella-labial angle.
Disease Severity and Quality of Life Outcome Measurements in Patients With Keloids: A Systematic Review
Authors: Lyons Alexis B. , Peacock Anjelica , Braunberger Taylor L. , Viola Kate V. , Ozog David M.
Published: September 2019

BACKGROUND

Keloids have been assessed by numerous methods and severity indices resulting in a lack of standardization across published research.

OBJECTIVE

This study aims to evaluate published keloid randomized controlled trials (RCTs) and identify the need for a gold standard of assessment.

METHODS and MATERIALS

PubMed, MEDLINE, and Embase were searched for human RCTs on keloid treatment during a 10-year period. Eligible studies were English language RCTs reporting disease severity outcome measures after keloid treatments.

RESULTS

A total of 40 disease outcome measures were used in 41 included RCTs. Twenty-four (59%) of the included studies used more than one disease severity scale. The most frequently used outcome measures were the Vancouver Scar Scale (34%) (n = 14), followed by serial photography (24%) (n = 10). These were followed by adverse events and complications (20%) (n = 8), Visual Analogue Scale (12%) (n = 5), keloid dimensions (12%) (n = 5), and Patient and Observer Scar Assessment Scale (10%) (n = 4). Only one study reported quality of life outcomes.

CONCLUSION

There is wide variation in keloid outcome measures in the published literature. A standardized method of assessment should be implemented to reduce the disparities between studies and to better be able to compare the numerous treatment modalities.
Intrinsic Adaptation of SHR Right Atrium Reduces Heart Rate
Authors: Rodrigues Juliano Quintella Dantas , Camara Henrique , da Silva Junior Edilson Dantas , Godinho Rosely Oliveira , Jurkiewicz Aron
Published: September 2019

Hypertension represents an autonomic dysfunction, characterized by increased sympathetic and decreased parasympathetic cardiovascular tone leading to resting tachycardia. Therefore, studies assessing hypertension-associated changes in isolated cardiac tissues were conducted under electric field stimulation to stimulate the neurons. Herein, we characterize the influence of the autonomic neurotransmitter on the baseline atrial chronotropism of unpaced isolated right atria of normotensive Wistar rats (NWR) and spontaneously hypertensive rats (SHR). Our results revealed a resting bradycardia in tissues from SHR in comparison to NWR. The release of autonomic neurotransmitters, acetylcholine or norepinephrine, still occurs in the electrically unstimulated right atrium, after excision of the sympathetic nerve, which could explain differences in basal heart rate between NWR and SHR. Nicotine and the acetylcholinesterase inhibitor physostigmine reduced the chronotropism of right atria from either NWR or SHR. Conversely, the muscarinic receptor antagonist atropine did not affect the basal chronotropism of tissues from both strains. Furthermore, tyramine increased the chronotropism of NWR and SHR atria indicating availability of the neuronal stocks of noradrenaline. Although the monoamine uptake inhibitor cocaine increased right atrium chronotropism in both strains, the basal heart rate was not affected by the β-adrenoceptor antagonist propranolol. In summary, after acute section of the sympathetic nerve, autonomic neurotransmitters are still released either in resting conditions or upon pharmacological stimulation of right atria from both strains. Nevertheless, autonomic neurotransmission does not affect resting chronotropism, nor is the responsible for reduced basal heart rate of the isolated right atrium of hypertensive rats.
The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN)
Authors: El Khoudary Samar R. , Greendale Gail , Crawford Sybil L. , Avis Nancy E. , Brooks Maria M. , Thurston Rebecca C. , Karvonen-Gutierrez Carrie , Waetjen L. Elaine , Matthews Karen
Published: September 2019

Objective:

Our initial understanding of the menopause transition (MT) has been framed by clinical samples of women seeking treatment rather than by population-based studies. The Study of Women's Health Across the Nation (SWAN) initiated in 1996 with an overall goal to define the MT, to characterize its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women.

Methods:

This review summarizes the central findings of SWAN to date that can inform women and their healthcare providers about the impact of the MT and midlife aging on overall health and well-being.

Results:

SWAN characterized changes in reproductive axis and menstrual cycle patterns that informed the development of the reproductive aging staging system Staging of Reproductive Aging Workshop+10; MT-related symptoms and mental health (vasomotor symptoms, sleep complaints, psychological symptoms, cognitive performance, and urogenital and sexual health); and physiological systems and functions (cardiovascular and cardiometabolic health, bone health, physical function performance) that are influenced by the MT. SWAN demonstrated substantial interrelations among these changes and significant racial/ethnic differences in the rate and magnitude of change in multiple health indictors in midlife women. The findings point to midlife as a critical stage for adopting healthy behavior and preventive strategies.

Conclusions:

Over the past 23 years, SWAN has advanced our understanding of the impact of the MT and midlife aging on health and well-being in women. SWAN will be instrumental to determine whether MT-related changes during midlife are related to unfavorable health and well-being in early old age.
Stage IV Breast Implant–associated Anaplastic Large-cell Lymphoma with Complete Pathologic Response to Neoadjuvant Chemotherapy
Authors: Thibodeau Renee , Fan Kenneth L. , Wehner Patricia B.
Published: September 2019

Breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare lymphoma that has been associated with textured breast implants. Most cases present as a delayed (>1 year) seroma, which can be aspirated for diagnosis. Fewer patients present with masses or skin signs. Surgical resection is the cornerstone of treatment for this form of lymphoma. For advanced disease, treatment is multidisciplinary and incorporates adjuvant chemotherapy, radiation therapy, and potentially, the immunotherapeutic agent brentuximab vedotin, an anti-CD30 antibody-drug conjugate. However, relapse rates are high among patients with peripheral ALCL. We present the case of a 39-year-old woman who developed BIA-ALCL 13 years after augmentation with silicone, textured implants and had a complete pathologic response to neoadjuvant cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine (Oncovin), etoposide, prednisolone (CHOEP) at time of bilateral removal of implants and capsules. CHOEP is a long-standing regimen for treatment of peripheral ALCL and is a suggested regimen for treatment of BIA-ALCL. This case report is the first to demonstrate the use of neoadjuvant chemotherapy in the treatment of BIA-ALCL and suggests a role for its use in advanced disease.
Not All Dry Eye in Contact Lens Wear Is Contact Lens–Induced
Authors: Molina Karen , Graham Andrew D. , Yeh Thao , Lerma Mariel , Li Wing , Tse Vivien , Lin Meng C.
Published: September 2019

Objectives:

To compare subjective and clinical outcomes in three study groups: (1) asymptomatic contact lens (CL) wearers (ASYM); (2) symptomatic CL wearers who become asymptomatic on lens removal; and (3) symptomatic CL wearers who do not resolve on lens removal.

Methods:

Ninety-two subjects completed the Berkeley Dry Eye Flow Chart with and without lenses, ocular surface examinations, and a battery of questionnaires.

Results:

Thirty-seven subjects (40%) were ASYM, 30 (33%) had contact lens–induced dry eye (CLIDE), and 25 (27%) had underlying physiological DE. Visual Analog Scale ratings, OSDI score, and SPEED score were significantly better for the ASYM group (P<0.001) but did not distinguish CLIDE from DE. The DE group was significantly worse than CLIDE and ASYM, which were similar, in precorneal noninvasive tear breakup time (8.2 sec DE vs. 12.3 sec CLIDE and 14.3 sec ASYM; P=0.002), anterior displacement of the Line of Marx (P=0.017), and superior conjunctival staining (P=0.001).

Conclusions:

Many CL wearers presenting with dryness symptoms have an underlying DE condition and will not respond to treatments aimed at changing lenses or solutions. Contradictory results from research studies of DE in CL wearers could be due in part to a failure to distinguish subjects with symptoms due specifically to CL wear from those whose symptoms have underlying causes unrelated to CL wear.
Comparison of Laser Platform Estimation and Objective Measurement of Maximum Ablation Depth Using Scheimpflug Pachymetry in Myopic Femtosecond Laser In Situ Keratomileusis
Authors: Febbraro Jean-Luc , Picard Hervé , Moran Sarah , Grise-Dulac Alice , Salomon Laurence , Gatinel Damien
Published: September 2019

Purpose:

To compare the preoperative estimation of maximum ablation depth provided by the laser platform with objective measurement using Scheimpflug pachymetry in myopic femtosecond laser-assisted in situ keratomileusis (FS-LASIK).

Methods:

This is a prospective study carried out at the Rothschild Foundation, Paris, France. In 89 consecutive myopic eyes (45 patients) treated with FS-LASIK, the maximum ablation depth was calculated by measuring the difference between preoperative and 3-month postoperative measurements in central corneal thickness using Scheimpflug pachymetry (Pentacam HR; Oculus Optikgeräte, Wetzlar, Germany). These values were compared with the preoperative estimation of the maximum ablation depth provided by the laser platform, without nomogram adjustment.

Results:

We found a strong linear correlation between laser platform estimation of maximum ablation depth and Scheimpflug pachymetry (P < 0.00001). The mean ablation depth measured using Scheimpflug pachymetry was greater than that predicted by the laser platform, with a mean overall difference of 2.15 μm (P < 0.05). Subgroup analysis revealed a difference in ablation depth measurements of 7.1 μm in the high myopia subgroup, which was the only subgroup where the difference remained statistically significant.

Conclusions:

In myopic FS-LASIK, laser platform estimation of maximum ablation depth correlates well with measurement of maximum ablation depth using Scheimpflug pachymetry and therefore can be used safely.
Effects of Massage and Acupressure on Relieving Labor Pain, Reducing Labor Time, and Increasing Delivery Satisfaction
Authors: GÖNENÇ Ilknur Munevver , TERZIOĞLU Füsun
Published: September 2019

Background:

Several recent studies have documented the effects of massage and acupressure in reducing labor pain and labor time and in satisfaction with the delivery. However, few studies have investigated the comparative effects of these two therapies.

Purpose:

The aim of this study was to compare the effects of massage and acupressure on labor-related pain management, duration, and satisfaction with delivery.

Methods:

This randomized controlled trial (n = 120) included three intervention groups (massage only, acupressure only, and massage + acupressure) and one control group, in which patients received no massage or acupressure treatment. A personal information form, Pregnant Watch Form, and Visual Analog Scale (VAS) were used to collect data. Frequency and percentage calculations, chi-square test, Student's t test, Tukey's honestly significant difference test, and one-way variance analysis were used for data analysis.

Results:

In the latent phase of labor, the mean VAS scores of the massage-only group and massage + acupressure group were lower (4.56 ± 1.36 and 4.63 ± 1.52, respectively) than that of the control group (6.16 ± 1.46; p < .01). In the active and transition phases, the mean VAS scores of the massage-only group, acupressure-only group, and massage + acupressure group were significantly lower than that of the control group (p < .01 and p < .001, respectively). During postpartum, the mean VAS score of the massage + acupressure group was lower (2.30 ± 0.70) than that of the control group (2.96 ± 0.72; p = .003). Cervical dilatation completion time and 1- and 5-minute Apgar scores were similar among all of the groups (p > .05). The three intervention groups reported relatively more positive feelings than the control group, and all three of the interventions were found to be effective in improving satisfaction.

Conclusions/Implications for Practice:

The results of this study indicate that the dual application of massage and acupressure is relatively more effective than either therapy applied alone and that massage is more effective than acupressure.
An exploratory study examining the relationship between performance status and systemic inflammation frameworks and cytokine profiles in patients with advanced cancer
Authors: Dolan Ross D. , Laird Barry J.A. , Klepstad Pål , Kaasa Stein , Horgan Paul G. , Paulsen Ørnulf , McMillan Donald C.
Published: September 2019

The role of cytokines in the systemic inflammatory response (SIR) is now well established. This is in keeping with the role of the SIR in tumorigenesis, malignant spread, and the development of cachexia. However, the relationship between performance status/systemic inflammation frameworks and cytokine profiles is not clear. The aim of the present study was to examine the relationship between the Eastern cooperative oncology group performance status/modified Glasgow prognostic score (ECOG-PS/mGPS) and cooperative oncology group performance status/neutrophil platelet score (ECOG-PS/NPS) frameworks and their cytokine profile in patients with advanced cancer.

This was a retrospective interrogation of data already collected as part of a recent clinical trial (NCT00676936). The relationship between the independent variables (ECOG-PS/mGPS and ECOG-PS/NPS frameworks), and dependent variables (cytokine levels) was examined using independent Mann–Whitney U and Kruskal Wallis tests where appropriate.

Of the 40 patients included in final analysis the majority had evidence of an SIR assessed by mGPS (78%) or NPS (53%). All patients died on follow-up and the median survival was 91 days (4–933 days). With increasing ECOG-PS there was a higher median value of Interleukin 6 (IL-6, P = .016) and C-reactive protein (CRP, P < .01) and lower albumin (P < .01) and poorer survival (P < .001). With increasing mGPS there was a higher median value of IL-6 (P = .016), Macrophage migration inhibitory factor (MIF, P = .010), erythrocyte sedimentation rate (ESR, P < .01) and poorer survival (P < .01). With increasing NPS there was a higher median value of TGF-β (P < .001) and C-reactive protein (P = .020) and poor survival (P = .001). When those patients with an ECOG-PS 0/1 and mGPS0 were compared with those patients with an ECOG-PS 2 and mGPS2 there was a higher median value of IL-6 (P = .017) and poorer survival (P < .001). When those patients with an ECOG-PS 0/1 and NPS0 were compared with those patients with an ECOG-PS 2 and NPS1/2 there was a higher median value of IL-6 (P = .002), TGF-β (P < .001) and poorer survival (P < .01).

In patients with advanced cancer IL-6 was associated with the ECOG-PS/mGPS and ECOG-PS/NPS frameworks and survival in patients with advanced cancer. Therefore, the present work provides supporting evidence that agents targeting IL-6 are worthy of further exploration.