bluuebunny/crossref_metadata_2025 huggingface dataset:
Left ventricular hypertrophy predicts poorer cardiovascular outcome in normotensive normoglycemic patients with rheumatoid arthritis
Authors: Cioffi Giovanni , Viapiana Ombretta , Orsolini Giovanni , Ognibeni Sonographer Federica , Dalbeni Andrea , Gatti Davide , Adami Giovanni , Fassio Angelo , Rossini Maurizio , Giollo Alessandro
Published: March 2021

Introduction

Patients with rheumatoid arthritis (RA) develop early changes in left ventricular (LV) geometry and experience cardiovascular events in excess than in the general population. This study was designed to assess prevalence, predictors and prognostic role of LV hypertrophy (LVH) in a selected group of RA patients with normal blood pressure and glycemia who should be at low risk for LVH.

Methods

We prospectively analyzed 241 normotensive normoglycemic RA patients (mean age 53 ± 12 years, 61% women) involved in a primary prevention program for cardiovascular diseases who were followed‐up for 40 (24‐56) months. LVH was detected by echocardiography and defined as LV mass ≥49.2 g/m2.7 for men and ≥46.7 g/m2.7 for women. Primary outcome was a composite of cardiovascular death/hospitalization.

Results

LVH was detected in 39 patients (16%). Older age (>53 years), greater body mass index (BMI > 25 kg/m2), longer duration of RA disease, anti‐cyclic citrullinated peptide antibody (ACPA) positivity and concentric LV geometry were the variables associated with LVH. During the follow‐up, a cardiovascular event occurred in 12 of 39 (31%) patients with LVH and in 22 of 202 (11%; P < .001) patients without LVH. LVH independently predicted cardiovascular events (hazards ratio 3.28 [95% CI 1.03‐9.20], P = .03) at Cox regression analysis together with C‐reactive protein and ACPA positivity.

Conclusions

Nearly one‐sixth of normotensive normoglycemic RA patients analyzed in a primary prevention program for cardiovascular diseases has LVH which is associated with obesity and older age, and strongly predicts cardiovascular event in these subjects.
PA28α overexpressing female mice maintain exploratory behavior and capacity to prevent protein aggregation in hippocampus as they age
Authors: Adelöf Julia , Wiseman John , Zetterberg Madeleine , Hernebring Malin
Published: March 2021

With age, protein damage accumulates and increases the risk of age‐related diseases. The proteasome activator PA28αβ is involved in protein damage clearance during early embryogenesis and has demonstrated protective effects against proteinopathy. We have recently discovered that adult female mice overexpressing PA28α (PA28αOE) have enhanced learning and memory, and protein extracts from their hippocampi prevent aggregation more efficiently than wild type. In this study, we investigated the effect of overexpressing PA28α on aging using C57BL/6N×BALB/c F2 hybrid mice. We found that the hippocampal anti‐aggregation effect was maintained in young adult (7 months) to middle‐aged (15 months) and old (22 months) PA28αOE females. While the PA28αOE influence on learning and memory gradually decreased with aging, old PA28αOE females did not display the typical drop in explorative behavior—a behavioral hallmark of aging—but were as explorative as young mice. PA28αOE lowered PA28‐dependent proteasome capacity in both heart and hippocampus, and there was no indication of lower protein damage load in PA28αOE. The life span of PA28αOE was also similar to wild type. In both wild type and PA28αOE, PA28‐dependent proteasome capacity increased with aging in the heart, while 26S and 20S proteasome capacities were unchanged in the timepoints analyzed. Thus, PA28αOE females exhibit improved hippocampal ability to prevent aggregation throughout life and enhanced cognitive capabilities with different behavioral outcomes dependent on age; improved memory at early age and a youth‐like exploration at old age. The cognitive effects of PA28αβ combined with its anti‐aggregation molecular effect highlight the therapeutical potential of PA28αβ in combating proteinopathies.
Skin shop: long‐term management and follow‐up of narrowly and incompletely excised non‐melanomatous skin cancer
Authors: Lee Young , Yang Cliff , Adams Brandon
Published: March 2021

Background

‘Skin Shop’ is a model of care at a high‐volume tertiary centre that describes a registrar‐lead skin cancer service under consultant supervision. Ninety‐two percent of lesions are completely excised, 4.2% are narrowly excised and 3.2% are incompletely excised. Current international guidelines suggest re‐excision of incompletely excised non‐melanomatous skin cancer (NMSC); however, there is a lack of robust evidence to suggest how these lesions should be optimally managed. We describe how narrow and incompletely excised NMSC are managed in the ‘Skin Shop’ and present rates of recurrence.

Methods

Retrospective analysis of all lesions excised between December 2014 and June 2019. Lesion type, histological margin, presence of high‐risk features, management, presence of residual tumour in re‐excision and follow‐up duration were recorded. Rates of clinical recurrence were documented.

Results

From 5821 lesions excised, a total of 394 NMSC (245 basal cell carcinoma (BCC), 128 squamous cell carcinoma (SCC) and 21 Basosquamous cell carcinoma) were narrowly or incompletely excised. A total of 135 (34.3%) lesions were observed in clinic for recurrence, 133 (33.8%) lesions underwent re‐excision, 81 (20.6%) lesions underwent GP surveillance and 14 (3.6%) lesions received radiotherapy. Mean specialist clinic follow‐up was 12.4 months. Fourteen lesions recurred (3.5%, 10 BCC, 3 SCC, 1 basosquamous) of which 12 underwent re‐excision. The risk of recurrence for narrow and incompletely excised BCC was 2.9% and 10%, respectively. The corresponding rates for SCC were 2.2% and 3.3%, respectively.

Conclusion

Skin Shop is an effective model with low rates of narrow and incompletely excised NMSC. Risk of recurrence of these lesions is low with our current practice.
Female genital mutilation/cutting, timing of deinfibulation, and risk of cesarean section
Authors: Taraldsen Sølvi , Vangen Siri , Øian Pål , Sørbye Ingvil K.
Published: March 2021

Introduction

The impact of female genital mutilation/cutting on obstetric outcomes in high‐income countries is not clear. In general, women with female genital mutilation/cutting type 3 (infibulation) seem to be most at risk of adverse outcomes such as cesarean section. Deinfibulation is recommended to prevent obstetric complications. Whether the timing of this procedure affects the complication risk is not known. The aims of this study were, first, to examine the association between female genital mutilation/cutting and the risk of cesarean section in Norway, and, second, whether the timing of deinfibulation affected the cesarean section risk.

Material and methods

This was a historical cohort study of nulliparous Somali‐born women who gave birth in Norway between 1990 and 2014. The Medical Birth Registry of Norway identified the women. Data were collected from medical records at 11 participating birth units. The exposures were female genital mutilation/cutting status and deinfibulation before pregnancy, during pregnancy, or no deinfibulation before labor onset. The main outcome was odds ratio (OR) of cesarean section. Type of cesarean section, primary indications, and neonatal outcomes were secondary outcomes.

Results

Women with female genital mutilation/cutting type 3 had lower risk of cesarean section compared with women with no female genital mutilation/cutting (OR 0.54, 95% CI 0.33‐0.89 P = .02). Among the 1504 included women, the cesarean section rate was 28.0% and the proportion of emergency operations was 92.9%. Fetal distress was the primary indication in approximately 50% of cases, across the groups with different female genital mutilation/cutting status. Women who had no deinfibulation before labor onset had lower risk of cesarean section compared with those who underwent deinfibulation before or during pregnancy (OR 0.64, 95% CI 0.46‐0.88 P = .01).

Conclusions

High risk of cesarean section in Somali nulliparous women was not related to the type of female genital mutilation/cutting in the present study. Deinfibulation before labor did not protect against cesarean section. Our findings indicate that nulliparous Somali women are at high risk of intrapartum complications. Future research should focus on measures to reduce maternal morbidity and on how timing of deinfibulation affects the outcomes of vaginal births.
The incidence of brain lesions in central precocious puberty: The main cause for Chinese boys was idiopathic
Authors: Wang Jinling , Zhan Shumin , Yuan Jinna , Ullah Rahim , Dong Guanping , Wu Wei , Huang Ke , Fu Junfen
Published: March 2021

Objective

Many studies show that brain lesions are the main cause of central precocious puberty (CPP) in males. However, the association rate has not been reported in China. This study aimed to assess the frequency of both abnormal and likely pathologic brain lesions by magnetic resonance imaging (MRI) in Chinese boys with CPP.

Design

This is a retrospective cross‐sectional single‐centre study.

Patients

396 CPP boys were recruited from 2011 to 2019 in Children's Hospital, Zhejiang University School of Medicine, and 129 were eligible for our study.

Measurements

Diagnosis age, bone age, weight (kg), height (cm), puberty stage, MRI results and levels of sexual hormone were analysed.

Results

The number of CPP boys is increasing from 2011 to 2019 in China. Brain MRI findings were normal in 83.7% of CPP boys. Only 21 (16.3%) CPP boys were found with abnormal MRI findings including hamartoma, pineal cyst and other minor changes.

Conclusion

In China, there is an increasing trend of male CPP over the last decade and the main cause is idiopathic, rather than pathogenic brain lesions. Further investigations about the aetiology for CPP with pathological brain lesions are needed.
Surgical anatomy of the accessory middle colic artery: a meta‐analysis with implications for splenic flexure cancer surgery
Authors: Cheruiyot Isaac , Cirocchi Roberto , Munguti Jeremiah , Davies R Justin , Randolph Justus , Ndung’u Bernard , Henry Brandon Michael
Published: March 2021

Aim

Surgical resection of splenic flexure cancers (SFCs) is technically demanding due to the complex regional anatomy, characterized by the presence of embryological adhesions, close proximity to the pancreas and spleen, and a highly heterogeneous arterial supply and lymphatic drainage. The accessory middle colic artery (AMCA) is increasingly being recognized as an important source of blood supply to the splenic flexure. The aim of this study is to determine the prevalence and anatomical features of the AMCA.

Method

A systematic search of the scientific literature was conducted on PubMed and Embase from inception to November 2020 to identify potentially eligible studies. Data were extracted and prevalence was pooled into a meta‐analysis using MetaXL and Meta‐Analyst software.

Results

A total of 16 studies (n = 2203 patients) were included. The pooled prevalence (PP) of the AMCA was 25.4% (95% CI 18.1–33.4). Its prevalence was higher in patients without a left colic artery (LCA) (PP = 83.2%; 95% CI 70.4–93.1). The commonest origin for the AMCA was the superior mesenteric artery (PP = 87.9%; 95% CI 86.4–90.7). The AMCA shared a common trunk/gave rise to pancreatic branches in 23.1% of cases (95% CI 15.3–31.9).

Conclusion

The AMCA contributes to the vascularization of the splenic flexure in approximately 25% of individuals, and may be an important feeder artery to SFCs, especially in the absence of a LCA. Preoperative identification of this artery is important to ensure optimal surgery for SFC and minimize complications.
Organ transplantation and outcomes in patients with a past history of melanoma: A systematic review and meta‐analysis
Authors: Williams Gabrielle Jean , Webster Angela C. , Thompson John F.
Published: March 2021

Background

The incidence of melanoma is steadily rising around the world. There is uncertainty about the safety of solid organ transplantation in patients with a prior history of melanoma.

Aim

To review studies reporting patients with a history of melanoma before solid organ transplantation.

Methods

Electronic searches of Medline, Embase, and the Cochrane library up to March 2020. All study designs, in any language and without sample size restriction, were eligible for inclusion. Risk of bias was assessed using established tools, and meta‐analysis was performed using a random‐effects model.

Results

We identified 41 studies reporting 703 100 transplant recipients and 1692 had pre‐transplantation melanomas. Risk of death, expressed as a hazard ratio, in patients with pre‐transplantation melanoma relative to those without prior melanoma, was 1.32 (95% CI: 1.09–1.59). After transplantation, 13.1% of patients with pre‐transplantation melanoma developed new or recurrent melanoma (IQR: 4.8%–18.2%).

Conclusions

Around 1‐in‐400 transplant recipients had a prior history of melanoma. This was associated with a greater than 1‐in‐10 risk of new or recurrent melanoma after transplantation and an increased risk of death. A 5‐year waiting time between a melanoma diagnosis and transplantation has been recommended based on historic registry data, but very little additional information is available to justify or revise this.
Safer local injection of triamcinolone acetonide for preventing post‐endoscopic submucosal dissection esophageal stenosis
Authors: Misumi Yoshitsugu , Nonaka Kouichi , Kishino Maiko
Published: March 2021

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Parent perspective on powered wheelchair standing devices
Authors: Lyman Jennifer
Published: March 2021

This commentary is on the original article by Kenyon et al. on pages 969–975 of this issue.
Creative Leadership: Design Meets Neuroscience to Transform Leadership
Authors: Gheerawo Rama , Flory Melanie , Ivanova Ninela
Published: March 2021

Creative Leadership (CL) is a tripartite leadership model that has been developed and pioneered by Rama Gheerawo, Director of The Helen Hamlyn Centre for Design at London’s Royal College of Art. It evolved over the last decade through observation and experience of the limitations of hierarchical models of leadership across a diverse range of sectors. During this time, the three Creative Leadership attributes of empathy, clarity, and creativity have been explored through a range of primary and secondary research methods. The next stage of research and development involves a multidisciplinary convergence of design thinking with neuroscience that relates to brain plasticity, neural connectivity, and emotional intelligence theory. The aim is to develop a comprehensive grid of key performance indicators of CL. Dr. Melanie Flory, neuroscience project partner, explains that the three attributes are learnable and correlate positively with well‐being‐sustaining values and behaviors in individuals and groups. When the cognitive, emotional, and behavioral aspects of these traits are identified and understood, a three‐dimensional complementary feedback loop of learn–retain–apply can ensue through experiential learning and development. This positioning paper presents the evolution, scope, and applications of CL alongside a discussion of the emerging opportunities for novel design–neuroscience intersection relating to personal, leadership, and organizational development, growth, and transformation. It also reflects on the pandemic context of 2020.
Quantification of soil structure via synchrotron X‐ray tomography after 22 years of fertilization
Authors: Wang Weipeng , Zhang Yufa , Li Hua
Published: March 2021

Applying fertilizers on a long‐term basis can promote the accumulation of soil organic matter and increase soil aggregation. The effects of organic and inorganic fertilizers on soil structure have manifested as different morphological characteristics for different soil types. To quantify the three‐dimensional (3D) pore structure of soil cores after long‐term fertilization, we collected cinnamon soil (Chromic Luvisol) aggregates and 2 cm × 2 cm × 2 cm soil cores from a long‐term fertilization field trial beginning in 1989. The treatment groups included no fertilization (CK), inorganic fertilization (NPK) and organic fertilization (OF). Synchrotron radiation‐based X‐ray microcomputer tomography (SR‐μCT) and digital image analysis were used to determine the soil core structure. The results showed that the long‐term practices of OF treatment increased the stability of wet aggregates. Combined visualization of the soil structure and morphological parameters consistently revealed that the soil pore systems under OF treatment were more connected and multilevel than those under the CK treatment after 22 years. The soil pore structures under the CK and NPK treatments were similar but significantly different from the structure under the OF treatment.

Highlights

Effect of long‐term organic and inorganic fertilization on soil structure was explored.

SR‐μCT and digital image analysis techniques were applied to visualise the soil 3D pore structure.

Long‐term application of organic fertilizers promoted the number of pores in soil aggregates.

OF‐treated soil had more macropores and better continuity between the pores with longer path lengths.
Resilience and vulnerability in adolescents with primary headaches: A cross‐sectional population‐based study
Authors: Arruda Marco Antônio , Arruda Renato , Landeira‐Fernandez J. , Anunciação Luis , Bigal Marcelo Eduardo
Published: March 2021

Background

A scarcity of studies on the role of resilience resources (RRs) and vulnerability risk (VR) in children and adolescents with primary headache hampers the development of a risk‐resilience model for pediatric headaches.

Objective

To examine the extent to which headache frequency and diagnosis are associated with RRs and VR and explore possible predictors of low RRs and high VR in a cross‐sectional population‐based study in adolescents.

Methods

This is a cross‐sectional population study conducted in a small city in Brazil (Delfinópolis). Consents and analyzable data were obtained from 339/378 adolescents (89.7%). RRs and VR were assessed using the validated Brazilian version of the Resiliency Scales for Children and Adolescents, completed by the adolescents. Parents filled a structured questionnaire assessing sociodemographic and headache characteristics, as well as the Brazilian‐validated version of the Strengths and Difficulties Questionnaire added to the impact supplement to evaluate the adolescent's psychosocial adjustment skills. Teachers completed a structured questionnaire about the students’ school performance.

Results

A higher frequency of headache was associated with lower RRs (F3,335 = 2.99, p = 0.031) and higher VR (F3,335 = 4.05, p = 0.007). Headache diagnosis did not significantly influence the risk of having lower RRs or higher VR. In the exploratory analyses, females (OR 3.07; 95% CI: 1.16–9.3) and individuals with psychosocial adjustment problems (OR 7.5; 95% CI: 2.51–22.4) were predictors of low RRs, and prenatal exposure to tobacco (OR 5.6; 95% CI: 1.57–20.9) was a predictor of high VR in adolescents with primary headache.

Conclusions

The risk of low RRs and high VR was associated with a higher headache frequency, but not with headache diagnosis. These findings may contribute to the development of a risk‐resilience model of headaches in the pediatric population and help identify novel targets and develop effective resources for successful interventions.
Outcomes associated with treatment change from tenofovir disoproxil fumarate to tenofovir alafenamide in HIV‐1‐infected patients: a real‐world study in Japan
Authors: Kanda Naoki , Okamoto Koh , Okumura Hisatoshi , Mieno Makiko , Sakashita Kentaro , Sasahara Teppei , Hatakeyama Shuji
Published: March 2021

Objectives

To investigate the impact of switching from tenofovir disoproxil fumarate (TDF)‐ to tenofovir alafenamide (TAF)‐containing regimens on bone, kidney, serum lipids and body weight among Asian patients.

Methods

A prospective, multicentre, observational cohort study was conducted at three centres for HIV infection in Japan during 2017–2019. HIV‐infected adults previously treated with TDF‐containing regimens and scheduled to switch to TAF‐containing regimens were included. Bone mineral density (BMD), renal markers, lipids and weight were measured consecutively from 12 months before to 12 months after the switch.

Results

Among 118 patients evaluated, the mean percentage change to spine BMD during 1 year of TAF treatment was higher than that during 1 year of TDF treatment (mean difference = 1.9%; 95% confidence interval (CI): 0.8–3.1). Urine protein and β2‐microglobulin levels decreased significantly after the switch, while low‐density lipoprotein cholesterol and triglycerides increased. During the TDF and TAF periods, the mean weight gains were 0.2 and 1.9 kg, respectively (mean difference = 1.6 kg; 95% CI: 0.9–2.3). Subgroup analysis revealed a significant difference between the mean body weight change associated with an integrase inhibitor (INSTI) (+2.8 kg) and that associated with a non‐INSTI (+1.2 kg) third agent treatment only during the TAF period.

Conclusions

Among predominantly Japanese HIV‐infected patients, BMD and renal tubular markers improved, while lipid profiles worsened significantly after the switch. Weight gain during the TAF period was larger than that during the TDF period. Concurrent use of INSTI with TAF may act synergistically to gain body weight.
The interplay between liminality and consumption: A systematic literature review with a future research agenda
Authors: Darveau Jessica , Cheikh‐Ammar Mustapha
Published: March 2021

During the last three decades, the concept of liminality has been used by consumer researchers to examine consumption‐related phenomena associated with ambiguous transitions and meaningful transformative events. Inspired by the richness of this concept, researchers have continuously applied and extended the theoretical lens it affords to new and emerging contexts. However, the literature on liminality remains fragmented, and it is sometimes confusing because of the complex relationship between liminality and consumption. To dispel this confusion, this study builds on the findings of a systematic literature review to clarify the interplay between liminality and consumption and to develop a comprehensive framework for examining their relationship with each other. This framework offers a theoretical lens for the conceptual investigation of this interplay and, ultimately, for the development of a theory of liminal consumption. Four different conceptual associations between liminality and consumption are identified: liminal products, liminal consumption, consumption‐caused liminality, and liminality‐caused consumption, and their unique manifestations are theorized. Using the notion of lifeworld existentials, this study also examines various types of liminal experiences and shows that they have four overarching modes: time, space, position, and the body. Important avenues for future research are also discussed.
Workplace universalism and the integration of migrant workers and refugees in Germany
Authors: Schmidt Werner , Müller Andrea
Published: March 2021

This article looks into differences and similarities between former labour migrants' and today's refugees' workplace integration and asks what role German industrial relations play in integration processes. Drawing on more than 150 interviews, document analysis and three employee attitude surveys, conducted in the course of three research projects, a crucial finding is that despite some differences between labour migrants and refugees in terms of labour market access, education and support programmes, in both cases, workplace integration often works better than integration in German society in general. The integration of both groups is fostered by ‘pragmatic cooperation’ of workers, which is based on everyday encounters and promotes collegiality, and by universal rules for all workers, including the active and passive right to elect works councils. German industrial relations provide the institutional frame for this ‘workplace universalism’. However, workplace integration is under pressure due to polarized societal discourses and eroding industrial relations.
Differential outcomes of tonic and phasic irritability in adolescent girls
Authors: Silver Jamilah , Carlson Gabrielle A. , Olino Thomas M. , Perlman Greg , Mackin Daniel , Kotov Roman , Klein Daniel N.
Published: March 2021

Background

Irritable mood is a transdiagnostic clinical feature that is present in multiple psychiatric disorders. Although irritability is frequently examined as a unitary construct, two dimensions of irritability, tonic (i.e., irritable mood) and phasic (i.e., temper outbursts), have been hypothesized. However, few studies have examined whether tonic and phasic irritability are empirically separable and predict different forms of psychopathology.

Methods

We utilized data from a longitudinal study of a community sample of 550 girls (age 13.5–15.5 years) followed at 9‐month intervals for 3 years. We conducted exploratory factor analysis (EFA) using items from three self‐report inventories: the International Personality Item Pool Anger scale, Temperament and Affectivity Inventory Anger scale, and Buss‐Perry Aggression Questionnaire Anger scale.

Results

The EFA identified dimensions that were consistent with tonic and phasic irritability. Tonic irritability at baseline independently predicted the development of depressive disorders and generalized anxiety disorder (GAD) in subsequent waves. Phasic irritability independently predicted a decreased probability of GAD, but an increased probability of oppositional defiant, conduct, and substance use disorder, and greater risky sexual behavior and relational aggression during the follow‐up.

Conclusions

Tonic and phasic irritability appear to be separable constructs with unique implications for later psychopathology and related behavior among adolescent girls. It is important to consider this distinction in research on the etiology and pathophysiology of irritability and developing effective treatments.
A novel RFX6 heterozygous mutation (p.R652X) in maturity‐onset diabetes mellitus: A case report
Authors: Imaki Sakiho , Iizuka Katsumi , Horikawa Yukio , Yasuda Megumi , Kubota Sodai , Kato Takehiro , Liu Yanyan , Takao Ken , Mizuno Masami , Hirota Takuo , Suwa Tetsuya , Hosomichi Kazuyoshi , Tajima Atsushi , Fujiwara Yuuka , Yamazaki Yuji , Kuwata Hitoshi , Seino Yutaka , Yabe Daisuke
Published: March 2021

Heterozygous RFX6 mutation has emerged as a potential cause of maturity‐onset diabetes mellitus of the young (MODY). A 16‐year‐old female was diagnosed with diabetes by her family doctor and was referred to our institution for genetic examination. Genetic testing revealed a novel RFX6 heterozygous mutation (NM_173560: exon17: c.1954C>T: p.R652X) in the patient and in her mother and brother. She had no islet‐specific autoantibodies and showed a reduced meal‐induced response of insulin, glucose‐dependent insulinotropic polypeptide, and glucagon‐like peptide‐1, which is consistent with the phenotype of MODY due to heterozygous RFX6 mutation. In conclusion, we report a case of MODY due to a novel heterozygous mutation, p.R652X.
Randomized, double‐blind, active‐controlled, multicentre, phase III clinical trial with two stages to assess the safety and efficacy of letibotulinum toxin a vs. onabotulinum toxin a for subjects with moderate to severe crow's feet
Authors: Yoo K.H. , Park S.J. , Han H.S. , Won C.H. , Lee Y.W. , Kim B.J.
Published: March 2021

Background

Letibotulinum toxin A (LeBA) was approved by the Ministry of Food and Drug Safety (known as the Korea Food & Drug Administration) for cosmetic indications in 2012. However, the efficacy and safety of this newly introduced LeBA have not been investigated in crow's feet lines (CFL) treatment and standardization before its universal use.

Objective

The aim of this multicentre, double‐blind, randomized, parallel, active‐controlled Phase III clinical trial with two stages (ClinicalTrials.gov identifier: NCT03408236) was to investigate the non‐inferiority of LeBA vs. the existing onabotulinum toxin A (OnBA) for the treatment of CFL.

Methods

A total of 240 subjects were randomized to either the test (LeBA) or control (OnBA) group. At the baseline and at weeks 4 while maximum smiling (primary efficacy assessment), 8, 12 and 16, investigator's on‐site evaluation, independent evaluator, evaluation by the subjects, subjects' satisfaction assessment and safety assessment were performed.

Results

At week 4, the response rate of primary efficacy assessment was 69.75% and 68.33% in the test (LeBA) and control (OnBA) groups, respectively, without a significant difference. Other minor secondary evaluation results showed significant differences suggesting that LeBA offered better improvement than OnBA, but the overall results did not show significant differences between the two groups.

Conclusion

This study showed that LeBA was as effective and safe as OnBA for the treatment of CFL at the same doses.
“It’s splendid once you grow into it:” Client experiences of relational teletherapy in the era of COVID‐19
Authors: Maier Candice A. , Riger Dana , Morgan‐Sowada Heather
Published: March 2021

The novel Coronavirus pandemic (COVID‐19) and subsequent social distancing practices have altered the way we move through the world and access physical and mental healthcare. While researchers and clinicians have begun to explore the impact of telehealth delivery on psychotherapy and treatment outcomes, the purpose of this study was to explore the lived experiences of individuals in teletherapy, specifically those engaging in teletherapy with a romantic partner or family member. Using a thematic analysis of open‐ended online survey questions, we explored the experiences of 25 individuals who engaged in couple or family teletherapy after social distancing began. The resulting themes included “making do,” safe therapeutic space, convenience, logistical challenges, and therapist accommodation. We discuss the clinical implications of these themes to support effective couple and family teletherapy and offer suggestions and considerations for remote clinical interventions and practices. [Correction added on 22 March 2021, after first online publication: The term '19' has been changed to '(COVID‐19)' in the first line of the Abstract section, in this version.]
Split‐face comparative study of fractional Er:YAG laser versus microneedling radiofrequency in treatment of atrophic acne scars, using optical coherence tomography for assessment
Authors: Emam Amira A.M. , Nada Hesham A. , Atwa Mona A. , Tawfik Noha Z.
Published: March 2021

Background

Efficacy and safety of ablative fractional laser used for treatment of acne scars have been described in several studies. Recently, microneedling radiofrequency treatment has been showing promising results with low risk of side effects and rapid healing time.

Objective

To study efficacy and safety of ablative fractional Er:YAG laser 2940 nm and microneedling radiofrequency for facial atrophic acne scar.

Methods

21 patients with atrophic postacne scars were randomized to MRF for one half of the face and laser for the other half. Four sessions were performed monthly. For evaluation, the validated scale “Quantitative Global Grading System for Postacne Scarring” and patient's satisfaction were used before and 3 months after treatment. Optical coherence tomography imaging of the skin was used as an objective tool for assessment.

Results

Both sides showed significant improvement on clinical evaluation with no significant difference. Optical coherence tomography assessment showed significant increase of both epidermal and dermal thickness compared to baseline.

Conclusion

Both MRF and ablative fractional Er. YAG laser 2940 nm are effective in the treatment of post acne scars. Microneedling radiofrequency is better tolerated, with lower downtime and fewer side effects.
Thrombotic thrombocytopenic purpura and acquired immunodeficiency syndrome diagnosed in pregnancy: Case report
Authors: Marins Lina R. , da Rocha Oppermann Maria L.
Published: March 2021

Thrombotic thrombocytopenic purpura (TTP) is a medical emergency that demands prompt diagnosis to allow lifesaving treatment: plasmapheresis. TTP during pregnancy is rare, with estimated prevalence of 1/200 000, and even rarer in association with acquired immunodeficiency syndrome, with only two cases reported. Differential diagnosis includes HELLP syndrome (hemolysis elevated liver enzymes and low platelets), sepsis, intravascular‐disseminated coagulation, and acquired autoimmune diseases, each one with its unique treatment and prognosis. A case of a pregnant woman at 26th week with sudden onset of left hand paresthesia and purpura is reported. PLASMIC score showed high risk for ADAMTS‐13 deficiency and diagnosis of TTP was made. Human immunodeficiency virus screening test was positive on admission. Plasmapheresis and antiretroviral therapy were initiated and the delivery of a healthy newborn at full‐term gestation was achieved, unlike other cases in literature. No obstetric complications were observed and the follow‐up shows no signs of disease recurrence.
Adverse retention: Strategic renewal of guaranteed renewable term life insurance policies
Authors: Lai Gene C. , Nakamura Hisashi , Yamamoto Shinichi , Yoneyama Takau
Published: March 2021

This study examines adverse retention using guaranteed renewable level term life insurance policies as a sample. No additional underwriting or physical examination is performed at the time of renewal. Our results show adverse retention exists in retention decisions. Further, we also find that the degree of adverse retention increases with age and policy amount and decreases with time elapses. Our results are robust with respect to the trend of before and after the renewal. During the prerenewal period, we find the prerenewal mortality rate is not higher than the nonrenewal mortality rate which is opposite to the evidence of postrenewal period. We also find correlation between “residuals of lapse” and “residuals of fatalities” is positive, also implying adverse retention exists. Most empirical studies on adverse selection often face problems such as the role of underwriting, entanglement of adverse selection, moral hazard, and regulations. Our study is free of these problems.
Maternal exposure to iron oxide nanoparticles is associated with ferroptosis in the brain: A chicken embryo model analysis
Authors: Basaki Mehdi , Keykavusi Kamran , Sahraiy Nazila , Ali Shahbazfar Amir
Published: March 2021

Ferroptosis is a form of cell death associated with iron‐dependent lipid peroxidation. We used a chicken embryo model to investigate if ferroptosis was implicated in the molecular mechanism underlying the potential effects of maternal exposure to iron oxide nanoparticles (IONPs) on the developing brain. One hundred and eighty fertilized eggs were randomly divided into six groups (30 eggs/group; 10 eggs/replicate). Groups I and II received maghemite (γ‐Fe2O3) NPs (MGMNPs), while groups III and IV received magnetite (Fe3O4) NPs (MGTNPs). Both MGMNP and MGTNP were administrated at the concentrations of 100 and 250 ppm. One group (placebo) received saline, and the other remained untreated (control). The compounds were given by in ovo method (0.3 ml/egg) only once on the first day of the embryonic period. Samples from cerebral tissue were collected on day 20 for histopathological, biochemical and gene expression analyses. Total antioxidant capacity (TAC) and malondialdehyde (MDA) increased; glutathione peroxidase (GPX) expression and activity decreased in IONPs‐treated groups. Ferroptotic cells appeared in the cerebral tissue following exposure to the low dose of MGMNP and MGTNP. Oxidative stress and ferroptotic cells were more evident for MGMNP compared to MGTNP. The low dose of MGMNP and MGTNP induced more severe oxidative stress in the cerebral tissue. According to the results, maternal exposure to IONPs is associated with ferroptosis in the brain. This work could encourage future researches to investigate inhibitors of ferroptosis as a protective strategy against iron‐induced cell injuries and cell death.
The bidirectional relationship between sleep and physical activity following traumatic brain injury
Authors: Bruijel Jessica , van Heugten Caroline M. , Murray Jade , Grima Natalie , Ymer Lucy , Walters Elizabeth M. , Sinclair Kelly , Stapert Sven Z. , Vermeeren Annemiek , Ponsford Jennie L.
Published: March 2021

Sleep and physical activity are both modifiable behavioural factors that are associated with better health and are potentially related. Following traumatic brain injury, damage to the brain caused by an external force, sleep disturbances are common. Exploring bidirectional relationships between sleep and physical activity might provide insight into whether increasing physical activity could decrease these sleep disturbances. The current study, therefore, examined inter‐ and intra‐individual temporal associations between sleep and daytime physical activity in 64 people with traumatic brain injury reporting sleep problems or fatigue (47 males; mean age, 40 years). Sleep and physical activity were measured using actigraphy with corroborating sleep diaries over 14 consecutive days. Multilevel models were used to examine inter‐ and intra‐individual associations between physical activity and sleep. Inter‐individual variations showed that earlier bedtimes, earlier wake‐up times and lower sleep efficiency were associated with more physical activity. Intra‐individual temporal variations showed no significant association of daytime physical activity with sleep duration or continuity. However, shorter sleep time and less wake after sleep onset than usual were associated with more time spent in light‐intensity activity the next day. Therefore, sleep may have more of an influence on physical activity than physical activity has on sleep in people with traumatic brain injury. In conclusion, the results do not confirm a potential beneficial effect of physical activity on sleep but suggest that improving sleep quality might be relevant to support of a physically active lifestyle in people with traumatic brain injury. Further research is necessary to confirm these results.
‘Meritocracy’ and ‘fairness’ in medical student selection: Comparing UK and Australia
Authors: Razack Saleem
Published: March 2021

Razack compares the discourse of widening access in the UK and Australia, raising incisive questions about the nature of meritocracy and constructs of fairness in student selection.
Drones and marine mammals in Svalbard, Norway
Authors: Palomino‐González Albert , Kovacs Kit M. , Lydersen Christian , Ims Rolf A. , Lowther Andrew D.
Published: March 2021

The impact of remotely piloted aircraft systems (RPAS) on marine mammals remains poorly documented despite their increasing use. In the high‐Arctic Archipelago of Svalbard, where marine mammals face increasing pressure from climate change and expanding tourism, the use of RPAS remains largely unregulated. In this study we assessed the impacts of RPAS across a range of species to provide science‐based management advice, using a variety of aircraft sizes and approach strategies. We explored RPAS sound levels and animal behavior prior to and after flights. Preexperimental alertness influenced sensitivity to disturbance notably. Harbor seals were more sensitive during prebreeding than during molting, reacting at distances of 80 m, whereas walruses responded at distances <50 m. Polar bears reacted to the sound of RPAS during take‐off at 300 m, although response levels were relatively low. White whales reacted to the sight of RPAS when flown ahead of the pod, below 15 m. Variations in sound levels typical in overhead descents and manual flights increased disturbance potential more than RPAS size; preprogrammed flight paths are advised. Our study highlights factors that can influence sensitivity to RPAS including tidal state and swell, the presence of young individuals, ambient noise levels, and RPAS approach strategies.
The impact of obesity on immune response to infection: Plausible mechanisms and outcomes
Authors: Muscogiuri Giovanna , Pugliese Gabriella , Laudisio Daniela , Castellucci Bianca , Barrea Luigi , Savastano Silvia , Colao Annamaria
Published: March 2021

Emerging data suggest an association between obesity and infectious diseases. Although the mechanisms underlying this link are not well established, a number of potential factors may be involved. Indeed, the obesity‐related vulnerability to infectious diseases could be due to chronic low‐grade inflammation, hyperglycemia, hyperinsulinemia, and hyperleptinemia, which lead to a weakening of both the innate and adaptive immune responses. In addition, obesity results in anatomical–functional changes by the mechanical obstacle of excessive adipose tissue that blunt the respiratory mechanisms and predisposing to respiratory infections. Subjects with obesity are also at risk of skin folds and sweat more profusely due to the thick layers of subcutaneous fat, favoring the proliferation of microorganisms and slowing the repair of wounds down. All these factors make subjects with obesity more prone to develop nosocomial infections, surgical site, skin and soft tissue infections, bacteremia, urinary tract infections, and mycosis. Furthermore, infections in subjects with obesity have a worse prognosis, frequently prolonging hospitalization time as demonstrated for several flu viruses and recently for COVID‐19. Thus, the aim of this manuscript is to provide an overview of the current clinical evidence on the associations between obesity and infectious diseases highlighting physio pathological insights involved in this link.
The effect of the Brexit Referendum Result on Subjective Well-being
Authors: Kavetsos Georgios , Kawachi Ichiro , Kyriopoulos Ilias , Vandoros Sotiris
Published: March 2021

We study the effect of the Brexit referendum result on subjective well-being in the United Kingdom. Using a quasi-experimental design, we find that the referendum’s outcome led to an overall decrease in subjective well-being in the United Kingdom compared to a control group. The effect is driven by individuals who hold an overall positive image of the European Union and shows little signs of adaptation during the Brexit transition period. Economic expectations are potential mechanisms of this effect.
Fundamental Rights as Constraints to and Triggers for Differentiated Integration
Authors: Bertolini Elena , Dawson Mark
Published: March 2021

When looking for possible constraints on Differentiated Integration, the fundamental values of the European Union (EU) seem an obvious starting point. Both the Charter of Fundamental Rights and the values articulated in Art. 2 TEU are cross‐cutting across EU states. However, while fundamental values have acted as centralising devices in other federal settings, in an EU context marked by extensive value disagreement, they may also act as pathways for differentiation. Insofar as national constitutional orders disagree on the scope of EU rights, attempts to ground EU law in fundamental values trigger inevitable interpretive conflicts across states. This paper will use the examples of asylum and the European Arrest Warrant to demonstrate this argument: while EU law may use fundamental values as a reason to harmonise EU law across states, such values may also be invoked to question the principle of mutual trust underlying the EU legal order, thereby causing rather than limiting differentiation.
French Guiana margin evolution: From Gondwana break‐up to Atlantic opening
Authors: Derycke Alexis , Gautheron Cécile , Barbarand Jocelyn , Bourbon Pierre , Aertgeerts Geoffrey , Simon‐Labric Thibaud , Sarda Philippe , Pinna‐Jamme Rosella , Boukari Claire , Haurine Frederic
Published: March 2021

Knowledge of the Guiana Shield evolution during the Gondwana break‐up is key to a better understanding of craton dynamics and margin response to transtensional opening. To improve this knowledge, we investigated the dynamics and thermal evolution of French Guiana, using several low‐temperature thermochronology methods applied to basement rocks, including apatite and zircon (U‐Th)/He and apatite fission tracks. Inverse modelling of results allows us to reconstruct the Phanerozoic thermal history of French Guiana margin and to give a preview of the Guiana Shield evolution. Three main events are inferred: firstly, a long‐term period of relative stability since ~1.2 Ga, with no strong evidence for any erosional or burial event (>5–7 km); secondly, a heating phase between ~210 and ~140 Ma consistent with the Central Atlantic Magmatic Province‐related event. Finally, an exhumation phase between ~140 and ~90 Ma, triggered by the Equatorial Atlantic opening, brought samples close to the surface (<40°C).
Geography and film music: Musicology, gender, and the spatiality of instrumental music
Authors: Kirby Philip
Published: March 2021

Film and music are key concerns in human geography. But rarely has film music been considered. Here, the scores of James Horner (1953–2015), one of the most successful Hollywood composers of recent decades, are used to explore future directions in the geographies of music. Through engagement with the fields of musicology and film music studies, the paper calls for greater engagement with instrumental, in addition to lyrical, music. Hitherto, the latter has encountered the overwhelming majority of attention in human geography. But instrumental music’s style, form, and structure convey distinctly spatial knowledge and thought. As such, instrumental music represents a crucial addition to the topics considered by musical geographies. Through attention to such music, the conceptualisation of music in musical geographies is expanded.
How do we implement pathogen reduction technology, while maintaining an adequate platelet inventory for our patients?
Authors: Nguyen Jennifer T. , Rioveros Jowin , Ziman Alyssa , McGonigle Andrea M. , Ward Dawn C.
Published: March 2021

Despite the significantly reduced infectious disease risk through robust and sensitive laboratory assays, comprehensive donor screening and good manufacturing practices, new and emerging infectious agents and bacterial contamination continue to pose a threat to the blood supply. Pathogen Reduction (PR) technology is an option to mitigate the risk of platelet transfusion transmitted infections. Here we describe our structure and strategies to implement PR technology. Pre‐implementation and phased approach implementation processes from our hospital‐based donor center, components processing laboratory, transfusion service, clinicians, nursing, and patient perspectives are described. Communication and reassessment of collection settings occurred between the donor center and components processing laboratory (CPL). During Phase 1, CPL consistently processed approximately 56% of monthly apheresis platelets (AP) collections by PR and the remaining 44% as conventional platelets (CP). Phase 2 increased the amount of AP undergoing PR from 56% to approximately 78%. A phased implementation and maintenance of a dual inventory may provide flexibility to blood collection, blood manufacturing, and transfusion service processes. Our dual inventory of PR and CP allows our transfusion service a readily available platelet inventory. A collaborative hospital‐based donor center, component processing laboratory, and transfusion service are essential to the productivity and maintenance of the dual platelet inventory.