bluuebunny/crossref_metadata_2025 huggingface dataset:
Pruritus and Malodour in Patients with Hidradenitis Suppurativa: Impact on Quality of Life and Clinical Features Associated with Symptom Severity
Authors: Molina-Leyva Alejandro , Cuenca-Barrales Carlos
Published: September 2019

Background: Patients with hidradenitis suppurativa (HS) suffer from symptoms such as pruritus and malodour which can significantly impair their quality of life. Objectives: (1) To analyse the impact of pruritus and malodour on the quality of life of patients with HS and (2) to explore the potential association between clinical features and the severity of these symptoms. Patients and Methods: This is a cross-sectional study. The Numeric Rating Scale (NRS) was used to assess pruritus and malodour. Quality of life was assessed by means of the Dermatology Life Quality Index (DLQI). Results: Two hundred and thirty-three patients were included in the study. Both pruritus and malodour positively correlated with worse quality of life (p < 0.05). Pruritus intensity was associated with the number of regions affected by HS, female sex, the intensity of suppuration, and the presence of comorbid Crohn’s disease. Statin use was associated with lower levels of pruritus. Malodour intensity was associated with higher body mass index, disease duration, the number of regions affected, Hurley stage, and intensity of suppuration. Conclusions: The results of our study show that pruritus and malodour are key symptoms in patients with HS which have a great impact on their quality of life. We have identified clinical features potentially associated with the intensity of these symptoms which could be useful to identify higher-risk patients and may influence treatment decisions.
Transcranial Magnetic Stimulation for Positive Symptoms in Schizophrenia: A Systematic Review
Authors: Marzouk Taylor , Winkelbeiner Stephanie , Azizi Heela , Malhotra Anil K. , Homan Philipp
Published: September 2019

Transcranial magnetic stimulation (TMS) has been proposed as a potential treatment add-on for positive symptoms in schizophrenia. To summarize the current evidence for its efficacy, we reviewed clinical trials from the last 20 years that investigated TMS for positive symptoms. We performed a search on the PubMed database for clinical trials that used TMS for the treatment of positive symptoms published in peer-reviewed journals. We excluded reviews, case reports, and opinion papers. Of the 30 studies included, the majority (n = 25) investigated auditory verbal hallucinations. Twelve studies found evidence for a positive treatment effect of TMS on positive symptoms, while 18 did not find enough evidence to conclude that TMS is effective for positive symptoms. However, the small sample size of the majority of studies is a limiting factor for the reliability of previous findings. In conclusion, evidence for an effect of TMS on positive symptoms was mixed. Since most of the studies were performed in patients with auditory verbal hallucinations, further research of TMS for other positive symptoms including thought disorder and delusions is warranted.
Human Leucocyte Antigen Sensitisation and Its Impact on Transfusion Practice
Authors: Weinstock Christof , Schnaidt Martina
Published: September 2019

Human leucocyte antigen (HLA) sensitisation, including the formation of antibodies against HLA, can cause serious effects in patients receiving blood. Under certain circumstances, donor HLA antibodies in the blood product can trigger the patient’s granulocytes to release mediators that cause transfusion-associated lung injury (TRALI), a serious complication of transfusion. The HLA systems of both donor and patient are involved in transfusion-associated graft-versus-host disease, which is a rare disease with a high mortality. Patient HLA antibodies can destroy incompatible platelets and may cause refractoriness to platelet transfusion. Identification of a patient’s HLA antibody specificities is necessary for issuing compatible platelets to overcome refractoriness. Many techniques for the detection and identification of HLA antibodies have been developed, including complement-dependent cytotoxicity assay, bead-based assays, the platelet adhesion immunofluorescence test, and the monoclonal antibody-specific immobilisation of platelet antigens assay. Different strategies for the selection of HLA-compatible platelets are applied. These strategies depend on the breadth of antibody reactivity and range from avoiding single HLA antigens in the platelet concentrates issued to apheresis of platelets from HLA-identical donors. The mechanisms of HLA sensitisation and the efforts made to provide compatible blood products to sensitised patients are reviewed in this article from the perspective of clinical transfusion medicine.
Incidence and Spectrum of Chromosome Abnormalities in Miscarriage Samples: A Retrospective Study of 330 Cases
Authors: Gug Cristina , Rațiu Adrian , Navolan Dan , Drăgan Ioan , Groza Iulia-Maria , Păpurică Marius , Vaida Monica-Adriana , Mozoș Ioana , Jurcă Maria C.
Published: September 2019

Embryonic chromosome abnormalities are the most important causes of early spontaneous abortions. The aim of this study was to evaluate the spectrum and the frequencies of chromosomal anomalies in spontaneous miscarriages and to correlate these with maternal and gestational age. A retrospective study was conducted based on data obtained from a single medical genetics laboratory that collects cases from Western Romania. Long-term cultures of chorionic villus samples were established for karyotype analysis by GTG banding. Additionally, we performed QF-PCR to detect aneuploidies for chromosomes 13, 18, 21, X, and Y. In total, chorionic villi samples of 330 miscarriages (from August 2007 to November 2018) were analyzed. Results were obtained for 90.6% (299/330) of the cases. The remaining 9.4% (31/330) were excluded from evaluation due to inconclusive results. An abnormal karyotype was found in 156 cases (47.27%), while in 143 cases (43.33%) a normal karyotype was present. Of the abnormal cases, 88 (56.4%) had trisomies, 25 (16.0%) presented polyploidies, 25 (16.0%) had monosomy X, and 19 (11.5%) chromosome rearrangements. QF-PCR analysis identified aneuploidy in 2 out of 8 samples (25%). Cytogenetic investigations of spontaneous abortions provide valid data as to the cause of the abortion. This information may also be helpful for genetic counseling and considering future pregnancies.
Psychological Adjustment of Aging Vietnam Veterans: The Role of Social Network Ties in Reengaging with Wartime Memories
Authors: Marini Christina M. , Fiori Katherine L. , Wilmoth Janet M. , Pless Kaiser Anica , Martire Lynn M.
Published: September 2019

It is projected that by 2020 there will be 8.7 million veterans over the age of 65 years, more than half (64%) of whom served during the Vietnam War. The effects of military service on mental health and well-being may be more pronounced later in life among those who served in Vietnam than prior cohorts of veterans. Many veterans confront and rework their wartime memories later in life in an attempt to find meaning and coherence, engaging in a process referred to as Later-Adulthood Trauma Reengagement (LATR). LATR often occurs in the context of other stressors that are a normative part of aging, such as role transitions (e.g., retirement), declines in physical health, and the death of close others (e.g., spouses), perhaps because these events trigger reminiscence. Importantly, LATR may result in either positive (e.g., acceptance) or negative (e.g., distress) psychological outcomes. It has been suggested that the presence of social/environmental resources, including socioemotional support, may aid veterans in successfully navigating LATR. We, therefore, review relevant areas of research to delineate the role that various layers of social context may play in ­helping – or hindering – aging Vietnam veterans as they navigate LATR in the context of normative late-life stressors. We conclude by offering fruitful directions for future research and applied implications for intervention efforts.
Association of Estrogen Receptor α Gene Polymorphism and its Expression with Gestational Diabetes Mellitus
Authors: Li Chao , Qiao Binglong , Zhou Yubin , Qi Weihong , Ma Chunling , Zheng Lin
Published: September 2019

Background:The estrogen receptor α (ERα) gene is a potential candidate gene of gestational diabetes mellitus (GDM). Objectives: The purpose of the study was to investigate the relationship of ERα gene polymorphism (single nucleotide polymorphism [SNP]) and its expression in placental tissues with the development of GDM. Methods: The SNPs of PvuII and Xba I in the ERα gene of 175 pregnant women with GDM and 240 healthy pregnant women were detected by polymerase chain reaction-restriction fragment length polymorphism. Immunohistochemistry and western blotting were used to analyze the expression of the ERα gene in placental tissues. Results: The results showed that the frequency of the CC + CT genotype and the C allele frequency of PvuII in the GDM group was significantly higher than that of the control group (p < 0.05). There was no significant difference in the genotype distribution and allele frequency of Xba I between the GDM group and control group. The expression of ERα in placental tissues of pregnant women with GDM was higher than that in the control group (p < 0.05). The participants with the PvuII CC + CT genotype had elevated levels of fasting blood glucose, homeostasis model assessment of insulin resistance (IR), and ERα expression in placental tissues compared with those with the TT genotype in the GDM group (p < 0.05). The SNP of Xba I of ERα gene had no correlation with clinical biochemical indicators of GDM and the expression of ERα in placental tissues (p > 0.05). Conclusions: This study suggested that SNP of the ERα gene and abnormal expression of ERα in placenta tissues were associated with GDM. The C allele of PvuII may be associated with GDM. In addition, SNP of the PvuII site in pregnant women with GDM was related to the degree of IR and to the upregulation of ERα expression in placental tissues, which may play an important role in the pathogenesis of GDM.
HLA Matching in Pediatric Stem Cell Transplantation
Authors: Eyrich Matthias , Schulze Harald
Published: September 2019

For several malignant and nonmalignant disorders such as leukemias, lymphomas, or inborn errors of hematopoiesis, stem cell transplantation is the only curative option. Depending on the underlying cause of the disease, the conditioning regimens, source of the stem cells, and graft composition may vary. Possible stem cell donors are selected from databases considering existing major histocompatibility genes of the donor and the recipient. This is currently performed by matching human leukocyte antigen (HLA)-A, -B, and -C for class I, as well as HLA-DRB1 and -DQB1 for class II. Stem cell transplantation for nonmalignant disorders is a specialty of pediatrics. While algorithms for donor selection in these cases are generally similar, the objective of optimizing a possible graft-versus-leukemia effect is less important. In this article, we aim to provide an overview on the current methods for HLA typing and the algorithms for HLA matching. We also address ethical aspects regarding children and minors as stem cell donors.
Cheek Microbial Communities Vary in Young Children with Atopic Dermatitis in China
Authors: Song Liya , Wang Qian , Zheng Yumei , Ma Laiji , Chen Yuanyuan , Gao Ying , Zhang Gaolei , Cui Shumei , He Keke , He Congfen
Published: September 2019

Background: Atopic dermatitis (AD) is a chronic, recurrent skin condition with recently increased incidence in younger children. AD development has been correlated with the skin microbiome, and Staphylococcus aureus enrichment causes significant increases in skin lesions. Objective: Our objectives were to compare the microbial diversity of the cheek skin of children with or without AD aged 0–1 years in China, and to determine whether 4 types of skin-isolated bacteria could inhibit S. aureus in vitro. Methods: The skin microbial samples of cheek skin of children were sequenced by 16S rRNA V1-V2 region. Four skin isolated bacterial fermentation supernatants were tested for effects on S. aureus growth, membrane formation, and induction of cytokine secretion from HaCaT cells. Results: Bacterial diversity decreased significantly in skin with severe AD compared to healthy skin (p < 0.01). Seven phyla had content >1%, 4 of which differed in AD (p < 0.05). 38 genera had content >1%, 15 differed (p < 0.05). Differences in 8 species were observed (p < 0.05). In vitro antibacterial and cellular experiments showed that S. aureus growth, biofilm formation, and induction of interleukin (IL)-1α and IL-6 secretion from HaCaT cells were significantly inhibited by Klebsiella oxytoca, Kocuria rhizophila, and Staphylococcus epidermidis culture supernatants (p < 0.05). Conclusion: Skin microbiome changes in children varied with age and with AD. There were complex interactions between skin isolated bacteria and S. aureus which could inhibit S. aureus growth and biofilm formation in vitro, suggesting that these microorganisms could be used in AD treatment.
Clinical Features of Patients with an Epidermal Growth Factor Receptor T790M Mutation Detected in Circulating Tumor DNA
Authors: Ikushima Hiroaki , Sakatani Toshio , Usui Kazuhiro
Published: September 2019

Background: Osimertinib, a third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI), is effective against EGFR-mutated non-small cell lung carcinoma resistant to first- or second-generation EGFR-TKIs in patients in whom an EGFR T790M mutation has been detected. Detection of the T790M mutation using circulating tumor DNA (ctDNA) is less invasive than a tissue re-biopsy, including a transbronchial lung biopsy; however, the prognostic implications of the T790M mutation in ctDNA have not been fully elucidated. Methods: We retrospectively reviewed the clinical features of non-small cell lung carcinoma patients in whom an EGFR T790M mutation had been detected at our hospital and assessed the clinical outcomes of osimertinib for these patients in terms of detection sites. Results: An EGFR T790M mutation was detected in 32 non-small cell lung carcinoma patients, of whom 21 (65.6%) underwent osimertinib treatment after detection of the mutation. The mutation was detected using plasma samples in 10 patients (47.6%; liquid biopsy group), while it was detected using tissue samples in 11 patients (52.4%; tissue biopsy group). Liver and bone metastases were more frequently observed in patients in the liquid biopsy group than in the tissue biopsy group (30.0 vs. 0% and 60.0 vs. 18.2%, respectively). The median progression-free survival time was significantly shorter in the liquid biopsy group (132.0 days) than in the tissue biopsy group (682.0 days). The median overall survival time in the liquid biopsy group was 376.0 days, whereas that in the tissue biopsy group was not reached during our observation period. Conclusions: Non-small cell lung carcinoma patients in whom an EGFR T790M mutation was detected in plasma samples demonstrated a poorer response to osimertinib than those in whom the mutation was detected in tissue specimens.
Prognostic Role of Hyponatremia in Heart Failure Patients Depending on Renal Disease: Clinical Evidence
Authors: Arévalo-Lorido José Carlos , Carretero-Gómez Juana , Robles Nicolás Roberto , Llácer Pau , Carrera Margarita , Suárez-Pedreira Iván , Álvarez-Rocha Pablo , Manzano-Espinosa Luis , Cepeda-Rodrigo José Maria , Montero-Pérez-Barquero Manuel ,   on behalf of the RICA Investigators Group
Published: September 2019

Aim: Hyponatremia is very often associated with renal disease in patients with heart failure (HF) and, when present, determines a poor outcome. We investigated the role of hyponatremia in HF patients in whom the presence or absence renal insufficiency was accurately predefined. Methods: This was a cohort study based on the Spanish National Registry on Heart Failure (RICA), a multicenter, prospective registry that enrolls patients admitted for decompensated HF who were subsequently followed up for 1 year. We classified patients into 4 groups according to the presence or absence of renal disease defined by the hematocrit, urea, and gender formula (HUGE) and then according to the presence of hyponatremia (Na ≤135 mEq/L). Results: A total of 3,478 patients were included. Hyponatremia was more prevalent in the group with renal disease (22.1%) than without (18.4%). During admission, both groups with hyponatremia had more complications than those with normal serum sodium. During the 1-year follow-up, patients with hyponatremia and renal disease had a significantly worse outcome (HF mortality and readmission), HR 1.87, 95% CI 1.54–2.29, p < 0.001, compared to those with hyponatremia without renal disease, HR 1.01, 95% CI 0.79–1.3, p = 0.94. Conclusions: Hyponatremia is more prevalent in patients with renal insufficiency, and outcome is poorest when both renal disease and hyponatremia coexist. Patients with hyponatremia without renal disease show no differences in outcome compared to those without hyponatremia.
A Nationwide Study of Incidence and Mortality Due to Traumatic Brain Injury in Ecuador (2004–2016)
Authors: Ortiz-Prado Esteban , Mascialino Guido , Paz Clara , Rodriguez-Lorenzana Alberto , Gómez-Barreno Lenin , Simbaña-Rivera Katherine , Diaz Ana Maria , Coral-Almeida Marco , Espinosa Patricio S.
Published: September 2019

Objective: Traumatic brain injury (TBI) is a public health problem worldwide. Information regarding TBI from low- and middle-income countries is scarce. The objectives of this study are to determine the incidence, mortality and geodemographic distribution of TBI in Ecuador. Methods: A population-based analytical study from 2004 to 2016 was conducted in Ecuador. Men and women with a diagnosis of TBI from all ages (0–110 years) were included. Data was obtained from official hospital-discharges records and retrieved from the National Institute of Statistics and Census (INEC) Database. We analyzed data by region, province and canton with a monthly resolution. The incidence, mortality, case fatality rates and the risk of developing TBI within the population were calculated based on the last 13 years of available data. Results: A total of 124,576 hospital admissions and 5,264 deaths due to TBI were registered in Ecuador from 2004 to 2016. The overall TBI-related hospital admission rate was 70.68 per 100,000. The sex- and age-specific rate was 90.1 per 100,000 for men and 64.1 per 100,000 for women. Mestizos’ population has the highest adjusted incidence rate of 195.6 per 100,000, followed by the indigenous with 61.4 per 100,000 and Afro-Americans with 14.2 per 100,000. The overall annual mortality rate during the study ranged from 2.11 to 3.35 per 100,000. Case fatality rates were significantly higher in older populations, becoming fatal in up to 27% of men >90 years/old and in 15% of women older than 90 years/old. Conclusion: This is the first recorded epidemiological study of the socio-demographic distribution of TBI in Ecuador to date. The study found that young men were almost 4 times more likely to be hospitalized due to TBI than women of this age. Fatalities due to TBI were less likely to occur among younger age groups, increasing significantly among the elderly population. The national incidence rate of TBI has been decreasing since 2011, which coincides with the introduction of stricter alcohol regulation, suggesting that this measure might have played a role in this reduction.
Association of Serum Testosterone at 12 Years with a Subsequent Increase in Bone Mineral Apparent Density at 18 Years: A Longitudinal Study of Boys in Puberty
Authors: Tamme Reeli , Jürimäe Jaak , Mäestu Evelin , Remmel Liina , Purge Priit , Mengel Eva , Tillmann Vallo
Published: September 2019

Background: Cross-sectional studies have associated serum testosterone with bone mineral density (BMD). However, there is a shortage of prospective longitudinal studies in this domain, leaving it unclear whether changes in testosterone level precede changes in BMD. Objectives: To examine the association between serum testosterone concentration at the age of 12 years and a subsequent increase in BMD by the age of 18 years. Methods: Eighty-eight boys with a mean age of 12.1 ± 0.7 (time point 1 [T1]) and 18.0 ± 0.7 (T2) were investigated. For both time points, serum testosterone was measured from venous blood samples. Total body (TB) and lumbar spine (LS) BMD and bone mineral apparent density (BMAD) were measured. As different brands of DEXA machines were used at T1 and T2, we calculated SD scores (SDS) from samples at T1 and T2 and their change (Δ). As covariates, bone age at T1 and physical activity (PA) by accelerometer at T1 and T2 were measured. Results: Serum testosterone at T1 was positively correlated with TB BMD at T2 (r = 0.28; p < 0.01), Δ TB BMAD SDS (r = 0.47; p < 0.0001) and Δ LS BMAD SDS (r = 0.23; p < 0.05). When additionally controlling for bone age and total PA at T1, the correlation between testosterone at T1 and Δ TB BMAD SDS remained significant (r = 0.32; p < 0.05). Conclusions: Serum testosterone concentration at the age of 12 years is associated with a subsequent increase in TB BMAD by the age of 18 years. This supports the inference that testosterone levels in early puberty may influence subsequent bone mineral accrual.
Resveratrol Pretreatment Ameliorates p53-Bax Axis and Augments the Survival Biomarker B-Cell Lymphoma 2 Modulated by Paracetamol Overdose in a Rat Model of Acute Liver Injury
Authors: Al Humayed Suliman , Al-Hashem Fahaid , Haidara Mohamed A. , El Karib Abbas O. , Kamar Samaa S. , Amin Shaimaa N. , Al-Ani Bahjat
Published: September 2019

Background: The potential protective effects of resveratrol (RES) on the modulation of hepatic biomarkers of apoptosis and survival, p53-Bax axis, and B-cell lymphoma 2 (Bcl-2) in an animal model of paracetamol-induced acute liver injury have not been investigated before. Methods: The model group of rats received a single dose of paracetamol (2 g/kg, orally), whereas the protective group of rats were pretreated for 7 days with RES (30 mg/kg, i.p.) before they were given a single dose of paracetamol. All rats were then sacrificed 24-h post paracetamol ingestion. Results: Histology images showed that paracetamol overdose induced acute liver injury, which was substantially protected by RES. Paracetamol significantly (p < 0.05) modulated p53, apoptosis regulator Bax, Bcl-2, tumor necrosis factor-alpha, interleukin-6, inducible nitric oxide synthase, malondialdehyde, superoxide dismutase, glutathione peroxidase, alanine aminotransferase, and aspartate aminotransferase, which were significantly protected by RES. We further demonstrated a significant (p< 0.01) correlation between either p53 or Bcl-2 scoring and the levels of inflammatory, nitrosative stress, and liver injury biomarkers. Conclusion: We demonstrate a substantial protection by RES pretreatment against paracetamol-induced modulation of p53-Bax axis, Bcl-2, and other acute liver injury biomarkers in rats.
MEFV Gene-Related Enterocolitis Account for Some Cases Diagnosed as Inflammatory Bowel Disease Unclassified
Authors: Saito Daisuke , Hibi Noritaka , Ozaki Ryo , Kikuchi Oki , Sato Taro , Tokunaga Sotaro , Minowa Shintaro , Ikezaki Osamu , Mitsui Tatsuya , Miura Miki , Sakuraba Akihito , Hayashida Mari , Miyoshi Jun , Matsuura Minoru , Nakase Hiroshi , Hisamatsu Tadakazu
Published: September 2019

Background and Aims: Familial mediterranean fever (FMF), an autoinflammatory disease, is characterized by periodic fever and serositis. An MEFV gene mutation has been identified as the cause of FMF. Recently, patients with MEFV gene mutations and chronic gastrointestinal mucosal inflammation mimicking inflammatory bowel disease (IBD) have been reported. In this retrospective study, we analyzed the clinical characteristics of patients with IBD unclassified (IBDU) with MEFV gene mutations. Methods: MEFV gene analysis was performed on 8 patients with IBDU among 710 patients with IBD who had been treated at Kyorin University Hospital from April 2016 to December 2018. Clinical manifestations, endoscopic findings, and serological markers were also analyzed. Results: The average of the 8 patients with IBDU (3 men, 5 women) was 32.7 ± 6.4 years (range 26–76 years). Their symptoms comprised diarrhea (n = 8, 100%), hematochezia (n = 3, 37.5%), abdominal pain (n = 3, 37.5%), high fever (n = 2, 16.5%), and other periodic symptoms (n = 2, 16.5%). MEFV gene mutation was confirmed in 4/8 of these patients. Colonoscopy showed various mucosal lesions, rectal sparing, right side dominant colitis, pseudopolyposis, and granular protrusions. Colchicine was administered to 5 of the 8 patients (4 with and 1 without MEFV mutation) who were resistant to conventional treatment for ulcerative colitis. Clinical and endoscopic improvement was observed in all of 5 patients treated with colchicine. Conclusions: Some patients diagnosed as having IBDU have enterocolitis related to MEFV gene mutation and respond to colchicine therapy.
Sodium Knowledge, Beliefs, and Behaviors in Patients on Chronic Hemodialysis
Authors: Kauric-Klein Zorica
Published: September 2019

Introduction: There is a clear relationship between sodium intake and blood pressure in patients on chronic hemodialysis (HEMO). To date, there are few studies that assess sodium knowledge, beliefs, and behaviors in patients on chronic HEMO. The purpose of this research study was to determine sodium knowledge, beliefs and behaviors in patients on chronic HEMO. Methods: A descriptive correlational study was conducted using an investigator developed online sodium knowledge, beliefs, and behaviors survey. Participants were recruited via nephrology social media websites. Findings: One hundred and fourteen participants completed the survey, the majority of participants (n = 39, 34.2%) were between the ages of 36 and 50 years, 55.3% (n = 63) were female, and 70% (n = 80) were white. Fifty-four participants (47%) could not identify their recommended salt intake limit. Participants answered an average of 4 out of 7 questions pertaining to sodium knowledge correctly (SD 1.5). Increased age was associated with total sodium knowledge (r = 0.33, p= 0.01) and length of time on HEMO was related to total sodium knowledge (r = –0.20, p = 0.04). In terms of beliefs, 38% (n = 44) were unsure or did not believe that salt intake was related to blood pressure and 30% (n = 33) did not feel it was related to fluid gains. Forty-two participants (37%) responded that they were not informed by a health care provider to cut down their salt intake. Discussion: Knowledge about sodium levels is lacking in patients on chronic HEMO. Patients may be more likely to decrease their sodium intake if they know their recommended sodium levels. Health care providers are not doing enough to educate patients on the need to decrease sodium intake and reinforce the relationship between sodium intake, fluid gains, and blood pressure. Findings from this study are useful to help develop educational programs to target these knowledge needs.
“Radiologically Isolated” Spinal Cavernoma Associated with Familial Cerebral Cavernomatosis
Authors: Bakirtzis Christos , Koutroulou Ioanna , Nikolaidis Ioannis , Karapanayiotides Theodoros , Grigoriadis Nikolaos
Published: September 2019

We describe a 45 year-old woman with a randomly discovered cavernous malformation of the cervical cord following investigation for neck injury. She had multiple brain cavernomas increasing in number over the following two years. She was finally diagnosed with familial cavernomatosis due to a PDCD10 mutation (CCM3).
Protective Effect of Diphenhydramine against Traumatic Brain Injury in Rats via Modulation of Oxidative Stress and Inflammation
Authors: Pan Wenyong , Cao Zhigang , Liu Dongyang , Jiao Yingbin
Published: September 2019

Background: Traumatic brain injury (TBI) is considered a major burden across the globe affecting both individuals and their families. Therefore, the present study was conducted to determine the protective effect of diphenhydramine (DPM) against TBI in experimental rats. Methods: The effect of DPM was evaluated on the cerebral edema (CE) and neuronal degeneration after the induction of experimental brain injury in rats. The effect of DPM was also investigated on the inflammatory cytokines, for example, tumor necrosis factor-α and interleukin 1β and oxidative stress markers, such as malondialdehyde, superoxide dismutase, and glutathione peroxidase. Western blot analysis was used to investigate the effect of DPM on B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax) and cleaved caspase-3. Results: Results of the study suggest that DPM causes reduction in CE and prevents neuronal degeneration. It also causes reduction in inflammation and oxidative stress in a dose-dependent manner. The level of Bax was found to be elevated, together with reduction in the Bcl-2 level in the DPM-treated group. Conclusion: DPM exerts a neuroprotective effect after TBI via the attenuation of oxidative stress, inflammation, and mitochondrial apoptosis pathways.
Performance of Different Imaging Techniques for Detection of Para-Aortic Lymph Node Metastasis from Gynecological Malignancies: A Systematic Review and Meta-Analysis
Authors: Gong Yi , Guo Zhiyong , Tang Xiufa , Li Chunjie , Wang Qingming
Published: September 2019

Object: The purpose of this review is to assess the diagnostic performance of different imaging techniques for the detection of para-aortic lymph node (PALN) metastasis from gynecological malignancies. Methods: Six databases, from the earliest available date of indexing through July 22, 2018, were systematically searched. In addition, the reference lists of relevant articles were searched by hand. Study allocation, data extraction, and quality assessment were independently performed by 2 reviewers. The size effect, sensitivity (SEN), specificity (SPE), positive likelihood ratio, negative likelihood ratio, diagnostic OR, and 95% CIs were used in the meta-analysis. The area under the curve (AUC) and Q* were calculated to reflect the synthesized diagnostic accuracy. Statistical calculations of this meta-analysis were conducted using STATA version 14.0 software. Results: Across 41 eligible studies (1,615 participants), pooled SEN, SPE, and AUC of magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), PET-CT, and lymphangiography analyses were 25%, 93%, 0.7675; 60%, 94%, 0.9050; 83%, 96%, 0.9422; 66%, 97%, 0.9501; 77%, 75%, 0.8332, respectively. Analysis of combined summary receiver operating characteristic curves indicated that PET and PET-CT were superior to other imaging modalities. Conclusion: The present meta-analysis demonstrated that PET and PET-CT should be the first choice for detecting PALN metastasis in gynecological malignancies. CT was also suitable for confirmation. MRI was not recommended. Further studies are needed for PALN assessment.
Clinical and Humoral Determinants of Congestion in Heart Failure: Potential Role of Adiponectin
Authors: Monzo Luca , Kotrc Martin , Benes Jan , Sedlacek Kamil , Jurcova Ivana , Franekova Janka , Jarolim Petr , Kautzner Josef , Melenovsky Vojtech
Published: September 2019

Background: Some patients with heart failure (HF) are more prone to systemic congestion than others. The goal of this study was to identify clinical and humoral factors linked to congestion and its prognostic impact in HF patients. Methods: A total of 371 advanced HF patients underwent physical examination, echocardiography, right heart catheterization, blood samplings, and Minnesota Living with HF Questionnaire. Subjects were followed-up for adverse events (death, urgent transplantation, or assist device implantation without heart transplantation). Results: Thirty-one percent of patients were classified as prone to congestion. During a median follow-up of 1,093 days, 159 (43%) patients had an adverse event. In the Cox analysis, the congestion-prone (CP) status was associated with a 43% higher event risk. The CP status was strongly (p ˂ 0.001) associated with body weight loss, right ventricular dysfunction (RVD), dilated inferior vena cava (IVC), diuretics, and beta-blockers prescription and the majority of tested hormones in the univariate analysis. In the multivariate analysis, the only independent variables associated with the CP status were adiponectin, albumin, IVC diameter, and RVD. Adiponectin by itself was predictive of adverse events. In a multivariate model, CP status was no longer predictive of adverse events, in contrast to adiponectin. Conclusions: CP patients experienced more severe symptoms and had shorter survival. Potential role of adiponectin, a new independent predictor of CP status, should be further examined.
Intraoperative Flurbiprofen Treatment Alters Immune Checkpoint Expression in Patients Undergoing Elective Thoracoscopic Resection of Lung Cancer
Authors: Hu Ji-cheng , Chai Xiao-qing , Wang Di , Shu Shu-hua , Magnussen Costan G. , Xie Li-xia , Hu Shan-shan
Published: September 2019

Objectives: This study aimed to determine the effect of intraoperative administration of flurbiprofen on postoperative levels of programmed death 1 (PD-1) in patients undergoing thoracoscopic surgery. Materials and Methods: In this prospective double-blind trial, patients were randomized to receive intralipid (control group, n = 34, 0.1 mL/kg, i.v.) or flurbiprofen axetil (flurbiprofen group, n = 34, 50 mg, i.v.) before induction of anesthesia. PD-1 levels on T cell subsets, inflammation, and immune markers in peripheral blood were examined before the induction of anesthesia (T0) and 24 h (T1), 72 h (T2), and 1 week (T3) after surgery. A linear mixed model was used to determine whether the changes from baseline values (T0) between groups were significantly different. Results: The increases in the percentage of PD-1(+)CD8(+) T cells observed at T1 and T2 in the control group were higher than those in the flurbiprofen group (T1: 12.91 ± 1.65 vs. 7.86 ± 5.71%, p = 0.031; T2: 11.54 ± 1.54 vs. 8.75 ± 1.73%, p = 0.004), whereas no differences were observed in the changes in the percentage of PD-1(+)CD4(+) T cells at T1 and T2 between the groups. Moreover, extensive changes in the percentage of lymphocyte subsets and inflammatory marker concentrations were observed at T1 and T2 after surgery and flurbiprofen attenuated most of these changes. Conclusions: Perioperative administration of flurbiprofen attenuated the postoperative increase in PD-1 levels on CD8(+) T cells up to 72 h after surgery, but not after this duration. The clinical relevance of changes in PD-1 levels to long-term surgical outcome remains unknown.
Review of Factors Contributing to Nodular Goiter and Thyroid Carcinoma
Authors: Yildirim Simsir Ilgin , Cetinkalp Sevki , Kabalak Taylan
Published: September 2019

There is an increased incidence of thyroid nodules and cancer. In this article, the reasons for this increase are evaluated and discussed. The factors causing increases in the incidence of nodules are the same as those causing increases in thyroid cancer. There are publications from all over the world regarding the rising incidence of thyroid cancer; it is especially associated with papillary cancer. The literature was reviewed and evaluated with regard to this significant phenomenon. Thyroid-stimulating hormone (TSH) is the main mitotic factor. Any agent that elevates TSH will stimulate nodule formation. Therefore, the incidence of thyroid nodules is high in endemic goiter regions due to iodine deficiency. This paper has described many of the factors causing this higher incidence. Of note, metabolic syndrome and insulin resistance are important factors associated with the increased incidence of nodular goiter and papillary thyroid cancer today. However, these data must be confirmed by other studies in the future.
A prosa de Luiz Vilela
Authors: Vidal Ariovaldo
Published: September 2019

Este ensaio é formado de duas partes: a primeira analisa o romance Os novos (1971), romance de geração que trata de um grupo de universitários às voltas com a opressão do regime militar e as dúvidas diante dos caminhos possíveis. A segunda parte do ensaio trata dos contos de Luiz Vilela (também situados nesse período), mas procurando antes compreender alguns procedimentos do autor na construção da narrativa, bem como apontar o lirismo presente em muitas de suas histórias.
Mapping and Ablation of Ventricular Fibrillation Associated With Early Repolarization Syndrome
Authors: Nademanee Koonlawee , Haissaguerre Michel , Hocini Mélèze , Nogami Akihiko , Cheniti Ghassen , Duchateau Josselin , Behr Elijah R. , Saba Magdi , Bokan Ryan , Lou Qing , Amnueypol Montawatt , Coronel Ruben , Khongphatthanayothin Apichai , Veerakul Gumpanart
Published: September 2019

Background:

We conducted a multicenter study to evaluate mapping and ablation of ventricular fibrillation (VF) substrates or VF triggers in early repolarization syndromes (ERS) or J-wave syndrome (JWS).

Methods:

We studied 52 patients with ERS (4 women; median age, 35 years) with recurrent VF episodes. Body surface electrocardiographic imaging and endocardial and epicardial electroanatomical mapping of both ventricles were performed during sinus rhythm and VF for localization of triggers, substrates, and drivers. Ablations were performed on VF substrates, defined as areas that had late depolarization abnormalities characterized by low-voltage fractionated late potentials, and VF triggers.

Results:

Fifty-one of the 52 patients had detailed mapping that revealed 2 phenotypes: group 1 had late depolarization abnormalities predominantly at the right ventricular (RV) epicardium (n=40), and group 2 had no depolarization abnormalities (n=11). Group 1 can be subcategorized into 2 groups: Group 1A included 33 patients with ERS with Brugada electrocardiographic pattern, and group 1B included 7 patients with ERS without Brugada electrocardiographic pattern. Late depolarization areas colocalize with VF driver areas. The anterior RV outflow tract/RV epicardium and the RV inferior epicardium are the major substrate sites for group 1. The Purkinje network is the leading underlying VF trigger in group 2 that had no substrates. Ablations were performed in 43 patients: 31 and 5 group 1 patients had only VF substrate ablation and VF substrates plus VF trigger, respectively (mean, 1.4±0.6 sessions); 6 group 2 patients and 1 patient without group classification had only Purkinje VF trigger ablation (mean, 1.2±0.4 sessions). Ablations were successful in reducing VF recurrences (
P
<0.0001). After follow-up of 31±26 months, 39 (91%) had no VF recurrences.

Conclusions:

There are 2 phenotypes of ERS/J-wave syndrome: one with late depolarization abnormality as the underlying mechanism of high-amplitude J-wave elevation that predominantly resides in the RV outflow tract and RV inferolateral epicardium, serving as an excellent target for ablation, and the other with pure ERS devoid of VF substrates but with VF triggers that are associated with Purkinje sites. Ablation is effective in treating symptomatic patients with ERS/J-wave syndrome with frequent VF episodes.
Revisiting the Role of Aspirin for the Primary Prevention of Cardiovascular Disease
Authors: Marquis-Gravel Guillaume , Roe Matthew T. , Harrington Robert A. , Muñoz Daniel , Hernandez Adrian F. , Jones W. Schuyler
Published: September 2019

Aspirin is the cornerstone of the antithrombotic management of patients with established atherosclerotic cardiovascular disease, but major guidelines provide conflicting recommendations for its use in primary prevention. Findings from recent randomized trials totaling >47 000 patients called into question the net clinical benefits of aspirin in primary prevention for 3 key populations: patients with diabetes mellitus, community-dwelling elderly individuals, and patients without diabetes mellitus who are at intermediate risk for atherosclerotic events. In the context of increasing emphasis on the use of other treatments for primary prevention in patients with moderate-high future risk of developing atherosclerotic cardiovascular disease, the efficacy and safety of aspirin for primary prevention has become uncertain. Key unresolved questions regarding the role of aspirin in primary prevention include the optimal drug formulation, dosing schedule, weight-based dose selection, and interplay between sex and treatment response. In the current era, most patients without established atherosclerotic cardiovascular disease should not be prescribed aspirin. Rather, aggressive management of comorbidities tailored to the expected cardiovascular risk needs to be emphasized. In this context, informed shared decision making between clinicians and patients regarding the use of aspirin for primary prevention of cardiovascular events is a suitable and laudable approach. In this article, we revisit the role of aspirin for the primary prevention of cardiovascular diseases by critically reviewing the key scientific literature, highlight key areas of uncertainties for future research, and propose a decisional framework for clinicians to support prescription of aspirin in primary prevention.
Effect of Once-Weekly Exenatide in Patients With Type 2 Diabetes Mellitus With and Without Heart Failure and Heart Failure–Related Outcomes
Authors: Fudim Marat , White Jennifer , Pagidipati Neha J. , Lokhnygina Yuliya , Wainstein Julio , Murin Jan , Iqbal Nayyar , Öhman Peter , Lopes Renato D. , Reicher Barry , Holman Rury R. , Hernandez Adrian F. , Mentz Robert J.
Published: September 2019

Background:

Once-weekly exenatide (EQW) had a neutral effect on hospitalization for heart failure (HHF) in the EXSCEL study (Exenatide Study of Cardiovascular Event Lowering), with no differential treatment effect on major adverse cardiac events by baseline heart failure (HF) status. EQW’s effects on secondary end points based on HHF status have not been reported. The objective was to explore the effects of EQW on secondary end points in patients with and without baseline HF and test the effects of EQW on recurrent HHF events.

Methods:

The prespecified analysis of the randomized controlled EXSCEL trial, which enrolled patients with type 2 diabetes mellitus with and without additional cardiovascular disease, analyzed EQW effects on all-cause death, each major adverse cardiac event component, first HHF, and repeat HHF, by baseline HF status (regardless of ejection fraction). A subgroup analysis of the population stratified by preserved or reduced baseline ejection fraction was performed.

Results:

Of 14 752 EXSCEL participants, 2389 (16.2%) had HF at baseline. Compared with those without HF at baseline, patients with preexisting HF were older, and more likely to be male and white, with a higher burden of other cardiovascular diseases. Overall, those assigned to EQW had a lower incidence of all-cause death (hazard ratio [HR], 0.86 [95% CI, 0.77–0.97]) and the composite outcome of all-cause death or HHF (HR, 0.89 [95% CI, 0.80–0.99]). When stratified by presence or absence of baseline HF, there was no observed reduction in all-cause death with EQW with baseline HF (HR, 1.05 [95% CI, 0.85–1.29]), while the risk of mortality was reduced with EQW in the no-HF group (HR, 0.79 [95% CI, 0.68–0.92]) with an interaction
P
value of 0.031. The reduction in all-cause death or HHF seen with EQW in patients without baseline HF (HR, 0.81 [95% CI, 0.71–0.93]) was not seen in patients with baseline HF (HR, 1.07 [95% CI, 0.89–1.29]; interaction
P
=0.015). First, plus recurrent, HHF was reduced in the exenatide group versus placebo (HR, 0.82 [95% CI, 0.68–0.99];
P
=0.038).

Conclusions:

In EXSCEL, the use of EQW in patients with or without HF was well tolerated, but benefits of EQW on reduction in all-cause death and first hospitalization for HF were attenuated in patients with baseline HF.

Clinical Trial Registration:

https://www.clinicaltrials.gov
. Unique identifier: NCT01144338.
Clinic Versus Ambulatory Blood Pressure in Resistant Hypertension: Impact of Antihypertensive Medication Nonadherence
Authors: Hamdidouche Idir , Gosse Philippe , Cremer Antoine , Lorthioir Aurelien , Delsart Pascal , Courand Pierre-Yves , Denolle Thierry , Halimi Jean-Michel , Girerd Xavier , Ormezzano Olivier , Rossignol Patrick , Pereira Helena , Azizi Michel , Amar L , Bobrie G , Monge M , Pagny JY , Sapoval M , Claisse G , Midulla M , Mounier-Vehier C , Dauphin R , Fauvel JP , Lantelme P , Rouvière O , Grenier N , Lebras Y , Trillaud H , Dourmap C , Heautot JF , Larralde A , Paillard F , Cluzel P , Rosenbaum D , Alison D , Popovic B , Zannad F , Baguet JP , Thony F , Bartoli JM , Vaïsse B , Drouineau J , Herpin D , Sosner P , Tasu JP , Velasco S , Ribstein J , Kovacsik H , Bouhanick B , Chamontin B , Rousseau H , Le Jeune S , Lopez-Sublet M , Mourad JJ , Bellmann L , Esnault V , Ferrari E , Chatellier G
Published: September 2019

Clinic-ambulatory blood pressure (BP) difference is influenced by patients- and device-related factors and inadequate clinic-BP measurement. We investigated whether nonadherence to antihypertensive medications may also influence this difference in a post hoc analysis of the DENERHTN trial (Renal Denervation for Hypertension). We pooled the data of 77 out of 106 evaluable patients with apparent resistant hypertension who received a standardized antihypertensive treatment and had both ambulatory BP and drug-screening results available at baseline after 1 month of standardized triple therapy and at 6 months on a median of 5 antihypertensive drugs. After drug assay samplings on study visits, patients took their antihypertensive treatment under supervision immediately after the start of the ambulatory BP recording, and supine clinic BP was measured 24 hours post-dosing; both allowed to calculate the clinic minus daytime ambulatory systolic BP (SBP) difference (clinic-SBP–day-SBP). A total of 29 (37.7%) were found nonadherent to medications at baseline and 38 (49.4%) at 6 months. At baseline, the mean clinic-SBP–day-SBP difference in the nonadherent group was 12.7 mm Hg (95% CI, 7.8–17.7 mm Hg,
P
<0.001). In contrast, clinic SBP was almost identical to day-SBP in the adherent group (clinic-SBP–day-SBP difference, 0.1 mm Hg; 95% CI, −3.3 to 3.5 mm Hg;
P
=0.947). Similar observations were made at 6 months. Using receiver operating characteristics curves, we found that a 6 mm Hg cutoff of clinic-SBP–day-SBP difference had 67% sensitivity and 69% specificity to predict nonadherence to the triple therapy at baseline. In conclusion, a large clinic-SBP–day-SBP difference may help discriminating between adherence and nonadherence to treatment in patients with resistant hypertension.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01570777.
Advances on the phylogenetic placement of the enigmatic octocoral Dendrobrachia Brook 1889
Authors: AURELLE DIDIER , PANTE ERIC , LEDOUX JEAN-BAPTISTE , SARTORETTO STÉPHANE
Published: September 2019

The monogeneric family Dendrobrachiidae has been a taxonomic curiosity since its original description in 1889. Using one nuclear (18S) and two mitochondrial (mtMutS and cox1) genes, the phylogenetic placement of Dendrobrachiidae within the Octocorallia was investigated based on recently-collected specimens and museum collections. In particular, the relationship between Dendrobrachia and its suspected close allies from the Chrysogorgiidae and Ifalukellidae was examined. Phylogenetic inferences based on nuclear 18S sequences were inconclusive. On the basis of mitochondrial cox1 and mtMutS, the hypothesis that Dendrobrachia is closely related to the Chrysogorgiidae or the Ifalukellidae could be rejected with confidence. Dendrobrachia appeared distantly related to all octocoral groups considered here. However, the phylogenetic placement of Dendrobrachia could not be further clearly resolved.