bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical activity and menopausal symptoms in women who have received menopause-inducing cancer treatments: results from the Women's Wellness After Cancer Program
Authors: Bailey Tom G. , Mielke Gregore I. , Skinner Tina S. , Anderson Debra , Porter-Steele Janine , Balaam Sarah , Young Leonie , McCarthy Alexandra L.
Published: November 2020

Objective:

This randomized controlled trial tested a digitally-delivered whole-of-lifestyle program for women previously treated for cancer. We investigated (1) associations between self-reported physical activity (PA) and menopausal symptoms and (2) if the intervention was associated with beneficial changes in PA and menopausal symptoms.

Methods:

Women were randomized to intervention (n = 142) or control (n = 138). The intervention targeted lifestyle behavior including PA. Self-reported PA (International Physical Activity Questionnaire – Short Form) and menopausal symptom (Green Climacteric Scale, GCS) data were collected at baseline, with measures repeated at 12 weeks (end of intervention) and 24 weeks (to assess sustainability). Generalized estimating equation models explored associations between PA and GCS scores. Mixed-effects generalized equation models analyzed changes within and between groups in PA and GCS scores.

Results:

Total GCS scores were 1.83 (95% CI: 0.11-3.55) and 2.72 (95% CI: 1.12-4.33) points lower in women with medium and high levels of PA, respectively, than in women with low levels of PA. Total average GCS scores were 1.02 (0.21-2.26) and 1.61 (0.34-2.87) points lower in those undertaking moderate or vigorous intensity PA, respectively. Time spent walking, and performing moderate and vigorous PA were not different between intervention and control. The average GCS decrease of 0.66 points (95% CI: 0.03-1.29; p time = 0.03) over 24 weeks was not different between groups.

Conclusion:

This exploratory study established a stepwise association between moderate and vigorous PA and a lower total menopausal symptom score. The intervention did not appear to increase self-reported PA in women treated for early stage breast, reproductive, and blood cancers.
The ewe as an animal model of vaginal atrophy and vaginal Er:YAG laser application
Authors: Hympanova Lucie , Rynkevic Rita , Mori Da Cunha Marina G. M. C. , Diedrich Chantal M. , Blacher Silvia , De Landsheere Laurent , Mackova Katerina , Krofta Ladislav , Roovers Jan-Paul , Deprest Jan
Published: November 2020

Objective:

In sheep of reproductive age, we aimed to document decrease in epithelial thickness, glycogen amount, and other vaginal changes after castration and the effect of Er:YAG laser as used clinically.

Methods:

On day 0, 16 sheep underwent ovariectomy. They were randomized to sham or three vaginal Er:YAG laser applications at monthly intervals. Primary outcome was vaginal epithelial thickness (d60, d71, d73, d77, and d160). Secondary outcomes included indicators of atrophy (vaginal health index = VHI), pH, cytology, morphology at the above time points, microcirculation focal depth (FD; d70 and d160), and at sacrifice (d160) vaginal dimensions and active and passive biomechanical testing.

Results:

Menopausal changes between 60 and 160 days after ovariectomy included a progressive decrease in epithelial thickness, in VHI, FD, glycogen, elastin content and vasculature, and an increase in pH and collagen content. In lasered animals, the first day a few white macroscopic foci were visible and an increase in pH was measured. Both disappeared within 3 days. Seven days after laser the epithelial thickness increased. At sacrifice (d160), there were no differences between sham and laser group in vaginal dimensions, morphometry, mitotic and apoptotic activity, active contractility, vaginal compliance, except for a lower blood vessel density in the lamina propria of the midvagina in the laser group.

Conclusions:

In reproductive sheep, ovariectomy induces vaginal atrophy evidenced in different outcome measurements. Vaginal Er:YAG laser induced visual impact, a short-term increase in epithelial thickness yet no long-term changes compared to sham therapy in menopausal controls.

Video Summary:
http://links.lww.com/MENO/A672.
Relationship between number of menopausal symptoms and work performance in Japanese working women
Authors: Hashimoto Keiko , Yoshida Mikako , Nakamura Yasuka , Takeishi Yoko , Yoshizawa Toyoko
Published: November 2020

Objective:

The presence of various menopausal symptoms could decrease work performance because symptom management strategies differ, and it is difficult to control all symptoms at work. The aim of this study was to examine the relationship between the number of menopausal symptoms experienced and work performance in working women.

Methods:

An online cross-sectional study was conducted with 599 working Japanese women aged 45 to 65 years. To represent work performance, absolute presenteeism was measured using the Japanese version of the World Health Organization and Work Performance Questionnaire short form, and menopausal symptoms were measured using the Greene Climacteric Scale. The total number of subscales on which a participant scored more than one point represented the number of menopausal symptoms.

Results:

Participants’ mean age was 54.2 years, and 60.6% were postmenopausal. Their mean Greene Climacteric Scale score and mean absolute presenteeism score were 10.5 ± 10.6 and 61.7 ± 17.9, respectively. The proportions of participants who provided care for a family member, who had chronic disease, and who undertook regular exercise were significantly different among the four groups. After adjusting for other factors, absolute presenteeism was negatively correlated with the number of menopausal symptoms experienced (β = −0.13, P < 0.001).

Conclusions:

Higher numbers of menopausal symptoms were correlated with lower work performance. The maintenance of health and the provision of appropriate working environments would help working women and improve work performance by reducing menopausal symptoms.
Menopause, the gut microbiome, and weight gain: correlation or causation?
Authors: Becker Sarah L. , Manson JoAnn E.
Published: November 2020

The gut microbiome is a key regulator of metabolism and influences the metabolism of estrogens, however, the microbiome's role in the changes in body composition and metabolic risk factors experienced by menopausal women remains largely unexplored. Menopause has been shown to alter the gut microbiome, and rodent studies suggest that microbiome changes postovariectomy are associated with increased adiposity, decreased metabolic rate, and insulin resistance, changes attenuated by estrogen administration. Given these data, a deeper understanding of the gut microbiome's relationship to menopause-induced changes in body composition and metabolism is warranted and may offer opportunity for novel therapeutic interventions.

The microbiome is central to both systemic and estrogen metabolism, and is altered by the menopausal transition, suggesting an important role of the microbiome in the increased metabolic risk faced by menopausal women. Although additional research is needed to establish a causal link, the interrelationship between menopause and the gut microbiome may represent a new frontier to address menopause-related metabolic risk.
Internal Radiation Dose Evaluation for an Unruptured Post Release Tristructural Isotropic Fuel Particle for Advanced and Micro-reactor Applications
Authors: Condon Caitlin A. , Ivanusa Pavlo , Bunn Amoret L. , Jensen Philip J.
Published: November 2020

There are unique benefits from advanced/micro-reactor designs and fuel types that offer safety features in the case of an accident that may reduce environmental consequences compared to conventional reactors and fuels. Tristructural isotropic (TRISO) fuel particles are a robust advanced nuclear fuel type that leads to the unique question of how unruptured, activated TRISO particles will interact with humans. TRISO particles are 900 μm in size, and that particle size restricts internal dose assessment to the ingestion pathway. Activity of the TRISO particle was established by High Temperature Engineering Test Reactor simulations. The TRISO particle encapsulation was assumed to be perfect; exploration of internal dose contribution from radionuclides released from encapsulation was not included. The TRISO particle was assumed to be mixed actively within each alimentary tract compartment such that homogenous distribution could be assumed according to the International Commission on Radiological Protection publication 133. The dose assessment results indicate that the rectosigmoid colon had the highest internal organ dose for both reference male (2.1 Sv) and female (2.3 Sv). The internal dose from ingestion of the scenario-specific TRISO particle was 0.25 Sv for the reference male and 0.29 Sv for the reference female, which exceeds the annual occupational effective dose limit of 0.05 Sv in the Code of Federal Regulations, 10 CFR Part 20 Subpart C. Similarly, the annual occupational limit of 0.5 Sv to any one organ would be exceeded for the left colon, right colon, and rectosigmoid colon for both the reference male and female.
The Neutrophil to Lymphocyte Ratio as a Triage Tool in Criticality Accidents
Authors: Goans Ronald E. , Iddins Carol J.
Published: November 2020

During triage of possibly irradiated individuals after a criticality accident or nuclear weapon event, it is necessary to decide whether a patient has experienced a clinically significant dose (> 2 Gy) that would require referral for additional evaluation and medical treatment. This is a binary decision: yes or no. The neutrophil-to-lymphocyte ratio (NLR) is an appropriate decision parameter, is simple to obtain in field operations, and is recognized in clinical medicine as an independent marker of systemic inflammation. NLR is evaluated for usefulness in triage using data from the Radiation Accident Registry at the Radiation Emergency Assistance Center/Training Site (REAC/TS). A criticality accident data set has been prepared using historic complete blood counts from 12 criticality events with 33 patients. In addition, a cohort of 125 normal controls has been assembled for comparison with the radiation accident data. In the control set, NLR is found to be 2.1 ± 0.06 (mean ± SEM) and distributed consistent with a Gaussian distribution. A patient from the 1958 Y-12 criticality accident is presented as an example of the time dependence of NLR after an event. In this case, NLR is statistically elevated above controls from <4 h until ~20 d post-event, and for times >20 d post-event, NLR is less than the control value, returning to baseline > ~40 d. The latter result has been confirmed using late hematological data taken from patients at Hiroshima and Nagasaki, and this appears to be a general finding. Since triage is a binary decision, analyzing NLR with receiver operating characteristic (ROC) statistics is appropriate. Maximizing the Youden J statistic (sensitivity + specificity −1) determines an appropriate decision point. For this data set, the decision point for NLR is found to be 3.33, with area under the curve (AUC) 0.865, sensitivity 0.67, specificity 0.97, positive predictive value (PPV) 0.85, and negative predictive value (NPV) 0.92. Therefore, when a known criticality accident or nuclear weapon event has occurred and if the patient’s NLR is greater than 3.33 early post-event, then that person should be referred for further health physics and medical evaluation.
Intake Ratio of 131I to 137CS Derived from Thyroid and Whole-body Doses to Residents of Iwaki City in Japan's Fukushima Prefecture
Authors: Kim Eunjoo , Yajima Kazuaki , Igarashi Yu , Tani Kotaro , Hashimoto Shozo , Nakano Takashi , Akashi Makoto , Kurihara Osamu
Published: November 2020

It is very important to determine the precise internal thyroid doses of Fukushima residents involved in the 2011 Fukushima nuclear disaster, particularly for small children. This has been challenging due to the lack of direct human measurements to identify 131I, the biggest contributor to the thyroid doses. We previously used a dataset of late whole-body counter (WBC) measurements targeting 134Cs and 137Cs for the thyroid dose estimation in comparison with the intake ratios of 131I to 137Cs (or 134Cs) derived from thyroid and whole-body doses individually obtained from different subject groups, assuming simultaneous acute intake via inhalation. Herein, we applied the same method to the doses of residents in Iwaki city (located south of the Fukushima Daiichi Nuclear Power Plant) with a relatively high activity ratio (131I/137Cs) for the ground deposition density. Our analyses revealed that the intake ratio (131I/137Cs) for the Iwaki residents was 4.2–4.3, which is relatively consistent with the values obtained in other studies (average 3.0–5.0). No regional difference in the intake ratios from other areas was observed, but further studies are required to determine the accurate intake ratio in the early phase of the accident, in particular focusing on the reasonable interpretation of results of the late WBC measurements to evaluate the actual Cs intake.
Virtual reality informative aids increase residents’ atrial fibrillation ablation procedures-related knowledge and patients’ satisfaction
Authors: Chang Shih-Lin , Kuo Ming-Jen , Lin Yenn-Jiang , Chen Shih-Ann , Yang Ying-Ying , Cheng Hao-Min , Yang Ling-Yu , Kao Shou-Yen , Lee Fa-Yauh
Published: November 2020

Background:

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and increasing numbers of patients receive AF ablation nowadays. Therefore, in the cardiology division, residents need to be familiar with the AF ablation procedure-related knowledge for primary care. This study evaluated the baseline residents and patients' self-efficacy to the AF ablation procedure-related knowledge, developed the specific virtual reality (VR) informative aids, and evaluated the effects of VR training and resident-led VR aids-based patient education on their self-efficacy, in the aspects of familiarity, confidence and anxiety, and satisfaction.

Methods:

From 2019, April to 2020, April, this 1-year prospective prestudy and poststudy was undergone in the cardiology division. Between 2019, April and 2019, December, the experienced physicians were invited to develop VR informative aids for AF ablation procedure-related knowledge. Between January 2020 and April 2020, newly developed VR informative aids were implemented in the educational program of training rotated residents for giving patient education.

Result:

A total of 20 residents and 32 patients were enrolled. The baseline self-reported self-efficacy and knowledge scores were relatively low among rotated residents and their patients. In addition to the high level of satisfaction, self-efficacy and knowledge scores of residents and their patients were increased after VR aids-based training and resident-led patient education. Higher degree of improvement in self-efficacy was noted among patients with depression/anxiety history than those without history. The follow-up assessments among residents showed that the positive effects of VR aids were sustained until 2 weeks later.

Conclusion:

Overall, residents and patients reported that the VR aids increase the effectiveness of patient education, achieve the purpose of a paperless environment, and motivate them to recommend it to others. The implementation of resident-to-patient education has a positive impact on trainees and patients understanding about AF ablation procedures-related knowledge.
Quality Changes Among Primary Care Clinicians Participating in the Transforming Clinical Practice Initiative
Authors: Dai Mingliang , Peterson Lars E. , Phillips Robert L.
Published: November 2020

The Transforming Clinical Practice Initiative (TCPI) was designed to provide technical assistance to clinicians and prepare practices to participate in value-based payment arrangements. In this longitudinal cohort study, we assessed whether clinician's participation in TCPI practice transformation networks (PTNs) was associated with changes in quality of care from 2016 to 2018. We extracted quarterly measure performance data from 2016 to 2018 on two NQF-endorsed measures, one for outcome (Controlling High Blood Pressure) and one for process (Use of Imaging Studies for Low Back Pain), from 1,981 primary care clinicians enrolled in the PRIME Registry. Clinicians participating in PTNs were identified and compared with their counterparts who did not participate in PTNs. We found that the performance of PTN clinicians on controlling high blood pressure and use of imaging studies for low back pain was equivalent to that of non-PTN clinicians during the first 3 years of the TCPI. Although PTNs provided assistance to help practices achieve their clinical outcomes, these findings suggest that the changes in quality of care, for the measures studied, among PTN clinicians in the first 3 years of the TCPI were attributable to temporal trends rather than participation in PTNs.
Using Focus Groups and Interviews to Inform the Design of a Workplace Exercise Programme
Authors: Burn Naomi L. , Weston Matthew , Atkinson Greg , Weston Kathryn L.
Published: November 2020

Objective:

Using a formative evaluation of a high-intensity interval training (HIIT) intervention, we illustrate how qualitative data can inform the development of workplace exercise interventions.

Method:

Eight focus groups and four interviews were conducted with employees (n = 38) and management (n = 4) from six office-based organisations before intervention implementation.

Results:

Some participants thought workplace-based HIIT would be practical, given the limited time required. Others perceived it may not be acceptable for all individuals, given the exercise intensity. With consideration of identified barriers (workload/family commitments effecting time availability) and facilitators (flexible working conditions) participants’ perspectives were incorporated into the intervention protocol. A short-term group-based intervention was preferred, with a choice of exercise modes (based on stair climbing, stepping or boxing).

Conclusion:

This study provides a framework to incorporate stakeholders’ perspectives into the development of workplace exercise interventions.
Impacts of Working From Home During COVID-19 Pandemic on Physical and Mental Well-Being of Office Workstation Users
Authors: Xiao Yijing , Becerik-Gerber Burcin , Lucas Gale , Roll Shawn C.
Published: November 2020

Objective:

To understand impacts of social, behavioral and physical factors on well-being of office workstation users during COVID-19 work from home (WFH).

Methods:

A questionnaire was deployed from April 24 to June 11, 2020 and 988 responses were valid. Linear regression, multinomial logistic regression and chi-square tests were used to understand factors associated with overall physical and mental health statuses and number of new physical and mental health issues.

Results:

Decreased overall physical and mental well-being after WFH were associated with physical exercise, food intake, communication with coworkers, children at home, distractions while working, adjusted work hours, workstation set-up and satisfaction with workspace indoor environmental factors.

Conclusion:

This study highlights factors that impact workers’ physical and mental health well-being while WFH and provides a foundation for considering how to best support a positive WFH experience.
Clinical Resources for Assessing Mobility of People with Lower-Limb Amputation: Interviews with Rehabilitation Clinicians
Authors: Morgan Sara J. , Balkman Geoffrey S. , Gaunaurd Ignacio A. , Kristal Anat , Amtmann Dagmar , Hafner Brian J.
Published: November 2020

Introduction

Mobility tests are increasingly used in prosthetic rehabilitation to evaluate patient outcomes. Knowledge of the space, equipment, and time resources available to clinicians who work in different settings can guide recommendations for which tests are most clinically feasible and promote coordination of mobility testing among members of the rehabilitation team. The primary aim of this study was to characterize the different resources available to clinicians for measuring mobility of people with lower-limb amputation. A secondary aim was to identify performance tasks that clinicians use to evaluate prosthetic mobility.

Materials and Methods

Semistructured interviews were conducted with prosthetists, physical therapists, and physiatrists who treat people with lower-limb amputation. Researchers used convenience and snowball sampling to identify participants. Interviews included questions about the resources available for conducting mobility tests, as well as questions about which tasks clinicians deemed valuable to assessing mobility of patients with lower-limb amputation. Interviews were audio recorded and transcribed. Summary and frequency statistics were calculated for quantitative data; explanatory comments were summarized.

Results

Interviews were conducted with 25 clinicians (eight prosthetists, nine physical therapists, and eight physiatrists). Participants had access to multiple spaces and basic measurement equipment. The maximum time participants were willing to spend on performance tests varied. Physiatrists reported less time available (median, 10 minutes; range, 5–30 minutes) than prosthetists and physical therapists (median, 30 minutes; range, 5–60 minutes for both professions). Mobility tasks commonly used to evaluate patients with lower-limb amputation included sit-to-stand, standing balance, walking, and varying speed. Participant comments suggested that mobility tests need to be quick, simple, and add value; existing mobility tests are beneficial but challenging to incorporate into practice; mobility tests should reflect real-world activities; and technological advancements could improve mobility testing.

Conclusions

Clinicians generally had small-to-medium spaces, basic measurement equipment, and sufficient training to administer mobility tests in their clinics. A limiting factor was time, which can be addressed through selection of efficient measures and collaboration within the rehabilitation team.
Surgical Affirmation for Gender-Diverse Youth
Authors: Oles Norah , Ganor Oren , Aquino Nelson J. , Boskey Elizabeth R.
Published: November 2020

Gender affirmation surgeries have become increasingly accessible over the past decade, and more youth and young adults are seeking surgical solutions to align their physical characteristics with their gender identity. This article describes several major types of gender affirming surgeries, reviews the guidelines outlined by the World Professional Association for Transgender Health, and covers practical surgical care concerns. It is addressed to the healthcare provider taking care of gender-diverse youth with emphasis on best practice guidelines, informed consent, and ethical issues in transgender medicine.
Pharmacological Prevention of Noise-induced Hearing Loss: A Systematic Review
Authors: Gupta Avigeet , Koochakzadeh Sina , Nguyen Shaun A. , Brennan Emily A. , Meyer Ted A. , Lambert Paul R.
Published: November 2020

Objective:

This study aims to explore and determine the effectiveness of current pharmacologic agents for the prevention of noise-induced hearing loss (NIHL) via a systematic review.

Databases Reviewed:

The PubMed, Scopus, ClinicalTrials.gov, and Cochrane Library databases were searched from inception through February 6, 2020.

Methods:

Full-text, English-language articles detailing prospective randomized and nonrandomized clinical trials with pharmacological interventions administered to prevent NIHL were included in accordance with PRISMA guidelines. The detailed search terms are included in the Appendix, http://links.lww.com/MAO/B67.

Results:

Eleven articles were included in this review with 701 patients receiving a pharmacologic prevention for various noise exposures. Various regimens included administration of alpha-lipoic acid, ambient oxygen, beta-carotene, carbogen, ebselen, Mg-aspartate, N-acetylcysteine, and vitamins C, E, and B12. A number of studies demonstrated statistically significant amelioration of NIHL with pharmacologic intervention. Two studies demonstrated significantly better hearing outcomes for pharmacological prophylaxis with carbogen or ebselen as compared with placebo for the 4 kHz frequency, where the noise-notch is most likely to be encountered. Given the considerable heterogeneity in agents and methodologies, however, it was not possible to conduct a meta-analysis.

Conclusions:

While several heterogenous articles demonstrated promising results for Mg-aspartate, carbogen, vitamin B12, and alpha-lipoic acid, the clinical significance of these pharmaceuticals remains unclear. Initial data from this study alongside future clinical trials might potentially contribute to the generation of clinical practice guidelines to prevent NIHL.

Level of Evidence: 2
A Comparison of Dizziness Handicap Inventory Scores by Categories of Vestibular Diagnoses
Authors: Graham Madison K. , Staab Jeffrey P. , Lohse Christine M. , McCaslin Devin L.
Published: November 2020

Objective:

The Dizziness Handicap Inventory (DHI) is a 25-item self-report quantifying dizziness-related physical and emotional symptoms and restrictions in daily activities. DHI scores do not correlate with severity of structural vestibular deficits; thus, high DHI scores may reflect other causes of morbidity. This study investigated the relationship between total DHI scores and the presence of structural, functional, and psychiatric disorders in tertiary neurotology patients.

Study Design:

Retrospective.

Setting:

Tertiary center.

Patients:

Eighty-five patients who underwent multidisciplinary neurotologic evaluations.

Intervention:

Diagnostic.

Main Outcome Measure(s):

Active illnesses identified by a multidisciplinary neurotology team were abstracted from medical records, cataloged as structural, functional, or psychiatric disorders, and used to group patients into diagnostic categories: structural (structural disorders only), functional (functional disorders with/without structural disorders), and psychiatric (psychiatric disorders with/without other conditions). DHI scores were compared across diagnostic categories. Sensitivities and specificities of DHI scores for identifying structural versus functional or psychiatric disorders were calculated.

Results:

Mean DHI scores differed significantly by diagnostic category (structural 35 ± 18, functional 64 ± 15, and psychiatric 65 ± 19), before and after adjusting for age and sex (p < 0.001, Hedges’ g>1.62 for structural versus functional and psychiatric categories). DHI≤30 (mild handicap) had specificity = 0.98 for structural disorders alone, whereas DHI>60 (severe handicap) had specificity = 0.88 for functional or psychiatric disorders.

Conclusions:

In this tertiary cohort, categories of illnesses had large effects on total DHI scores. Patients with scores ≤30 were likely to have structural disorders alone, whereas those with scores >60 were likely to have functional or psychiatric disorders, with or without coexisting structural conditions.
Prevalence of aberrant blood pressure readings across two automated intraoperative blood pressure monitoring systems among patients undergoing caesarean delivery
Authors: Schonberger Robert B. , Gonzalez-Fiol Antonio , Fardelmann Kristen L. , Bardia Amit , Michel George , Dai Feng , Banack Trevor , Alian Aymen
Published: November 2020

Objectives

Aberrant automated blood pressure (BP) readings during caesarean delivery may lead to disruptions in monitoring. The present study compared the frequency of aberrant BP readings across two types of commercially available BP monitoring systems in use during caesarean delivery.

Methods

This was a retrospective observational study using two comparable patient cohorts that resulted from simultaneous introduction of two types of monitors into a single obstetric surgical center in which similar patients were treated for the same surgical procedure by the same set of clinicians during the same year. Our primary hypothesis was that aberrant readings were significantly associated with the type of monitor being used for BP measurement, controlling for a variety of relevant covariates as specified in the analytic plan

Results

A total of 1418 cesarean delivery patients met inclusion criteria. Gaps of at least 6 min in machine-captured BP readings occurred in 159 (21.1%) of cases done in the operating room using a Datex-Ohmeda monitor vs. 183 (27.5%) of cases in the operating rooms using Phillips monitors (P = 0.005). In multivariable logistic regression analysis, the relative odds of the occurrence of monitoring gaps was 35% higher in rooms with the Phillips BP monitors as compared to the Datex-Ohmeda monitor while controlling for pre-specified covariates (odds ratio = 1.35, 95% confidence interval = 1.04–1.74, P = 0.02).

Conclusion

The present analysis suggests that aberrant BP readings for parturients undergoing caesarean delivery are significantly different between the two types of automated BP monitoring systems used in the operating rooms at our institution.
Association of vitamin D deficiency with arterial stiffness in newly diagnosed hypertension
Authors: Cakal Sinem , Çakal Beytullah , Karaca Oguz
Published: November 2020

Objective

Vitamin D has beneficial effects on vascular endothelial function, blood pressure (BP) and arterial stiffness. Arterial stiffness increases in early-stage hypertensive patients and it is a strong predictor of cardiovascular morbidity and mortality. The purpose of this study was to assess the association between serum 25-hydroxyvitamin D (25-OH D) levels and arterial stiffness in patients with newly diagnosed hypertension.

Method

Our study included 100 newly diagnosed hypertensive patients (63 male, 37 female and mean age: 51.7 ± 10.3 years) without cardiovascular disease, malignancy, chronic kidney disease and diabetes mellitus. Patients were divided into two groups: vitamin D deficiency group (<20 ng/ml) and normal vitamin D group (≥20 ng/ml). Twenty-four-hour, daytime and nighttime ambulatory BP readings were recorded. Mobil-O-Graph ARC solver algorithm was used to evaluate arterial stiffness parameters of pulse wave velocity (PWV) (m/s), augmentation index normalized with 75/min heart rate (Alx@75).

Results

Patients with vitamin D deficency had higher values of Alx@75 and PWV values (20.9 ± 9 vs. 16.8 ± 6.9, P = 0.018 and 8.37 ± 1.16 vs. 6.9 ± 0.9, P = 0.001, respectively) despite similar 24-hour ambulatory BP monitoring in both groups. Level of serum calcium was significantly higher in vitamin D deficiency group (9.5 ± 0.23 vs. 9.3 ± 0.12, P = 0.007). Nighttime SBP was higher in vitamin D deficiency group (133.2 ± 14.3 mmHg vs. 126.3 ± 17.2 mmHg; P = 0.03) and also, vitamin D deficiency group had non-dipping SBP pattern compared to normal Vitamin D group (P = 0.013).

Conclusion

Vitamin D deficiency is associated with increased arterial stiffness in newly diagnosed hypertensive patients in terms of increased PWV and Alx@75 values.
Could aortic arch calcification help in detection of hypertensive retinopathy?
Authors: Adar Adem , Onalan Orhan , Sevik Ozge , Turgut Yeliz , Cakan Fahri
Published: November 2020

Objective

Hypertension-induced end-organ damage is one of the important determinants of morbidity and mortality in patients with hypertension. All types of hypertension-induced end-organ damages start with vascular damage. Vascular calcification is a marker of vascular damage and aortic arch calcification (AAC) is one of the easily identifiable types of vascular calcification. We hypothesized that AAC predicts retinopathy in hypertensive patients.

Methods

Consecutive hypertensive patients without diabetes mellitus were included. Chest radiography in the posterior-anterior was used to assess the presence of AAC. All patients underwent ophthalmologic examination for retinopathy.

Results

We included 495 hypertensive patients in this study. Of these, 306 (62%) had hypertensive retinopathy. Patients with hypertensive retinopathy had significantly higher prevalence of AAC as compared to the patients without hypertensive retinopathy (88% vs. 22%, P < 0.001). We found a strong and positive correlation between hypertensive retinopathy and AAC grades (r = 639, P < 0.001). Receiver operator characteristics curve analysis yielded a strong predictive ability of AAC for the presence of hypertensive retinopathy [area under curve = 0.814, 95% confidence interval (CI): 0.775–0.853, P < 0.0001]. In multivariate logistic regression analysis, presence of AAC [odds ratio (OR) 13.128; CI: 7.894–21.832] and serum glucose levels (OR 1.020; CI: 1.003–1.037) were strongly and independently associated with hypertensive retinopathy.

Conclusion

Presence of AAC on chest radiograph is strongly and independently associated with retinopathy in nondiabetic hypertensive patients. This simple, inexpensive and widely available tool may help in early detection of retinopathy in patients with hypertension.
Evaluation of cuff deflation and inflation rates on a deep learning-based automatic blood pressure measurement method: a pilot evaluation study
Authors: Pan Fan , He Peiyu , Chen Fei , Xu Yuhang , Zhao Qijun , Sun Ping , Zheng Dingchang
Published: November 2020

Objective

The aim of this study was to evaluate the performance of using a deep learning-based method for measuring SBPs and DBPs and the effects of cuff inflation and deflation rates on the deep learning-based blood pressure (BP) measurement (in comparison with the manual auscultatory method).

Methods

Forty healthy subjects were recruited. SBP and DBP were measured under four conditions (i.e. standard deflation, fast deflation, slow inflation and fast inflation) using both our newly developed deep learning-based method and the reference manual auscultatory method. The BPs measured under each condition were compared between the two methods. The performance of using the deep learning-based method to measure BP changes was also evaluated.

Results

There were no significant BP differences between the two methods (P > 0.05), except for the DBPs measured during the slow and fast inflation conditions. By applying the deep learning-based method, SBPs measured from fast deflation, slow inflation and fast inflation decreased significantly by 3.0, 3.5 and 4.7 mmHg (all P < 0.05), respectively, in comparison with the standard deflation condition. Whereas, corresponding DBPs measured from the slow and fast inflation conditions increased significantly by 5.0 and 6.8 mmHg, respectively (both P < 0.05). There were no significant differences in BP changes measured by the two methods in most cases (all P > 0.05, except for DBP change in the slow and fast inflation conditions).

Conclusion

This study demonstrated that the deep learning-based method can achieve accurate BP measurement under the deflation and inflation conditions with different rates.
Hemodynamic response to heated water immersion in older individuals with hypertension
Authors: Marçal Isabela R. , Ngomane Awassi Y. , Souza Fernanda B. , Ciolac Emmanuel G.
Published: November 2020

The aim of this study was to evaluate blood pressure (BP), heart rate, arterial stiffness and endothelial reactivity responses to heated water immersion in older individuals with hypertension. Thirty-five sedentary individuals (67 ± 5 years) under treatment for hypertension were randomly assigned to water-based [n = 20; 30 min of seated resting in a heated swimming pool (30–32 °C)] or land-based group [n = 15; 30 min of seated resting in a quiet room with controlled temperature (21–23 °C)]. BP, heart rate, arterial stiffness and endothelial reactivity were measured before, immediately after (post) and 45 min after (recovery) each session. Heart rate reduced (P < 0.05) during the land-based session, and the reduction was maintained at post (~7 bpm) and recovery (~9 bpm), but no heart rate changes occurred during and after the water-based session. Systolic/diastolic BP increased (P = <0.001) at post (~29/10 mmHg) and recovery (~10/7 mmHg) in the water-based group, but not in the land-based group. No significant changes in pulse wave velocity and endothelial reactivity occurred in both groups. These results suggest that the hemodynamic response to heated water immersion should be taken into account when assessing the effect of heated water-based exercise on postexercise hypotension in older individuals with hypertension.
Expanding the phenotype of PURA-related neurodevelopmental disorder: a close differential diagnosis of infantile hypotonia with psychomotor retardation and characteristic facies
Authors: Mishra Shivani , Girisha Katta Mohan , Shukla Anju
Published: November 2020

Purine-rich element-binding protein A (PURA) encodes Pur-alpha, a transcriptional activator protein is crucial for normal brain development. Pathogenic variants in PURA are known to cause mental retardation, autosomal dominant 31, characterized by psychomotor delay, absent or poor speech, hypotonia, feeding difficulties, seizures or ‘seizure-like’ movements, and dysmorphism. PURA-related neurodevelopmental disorder (PURA-related NDD) result either from heterozygous pathogenic sequence variants in PURA or microdeletions spanning PURA. Singleton whole-exome sequencing (WES) was performed for the proband after a clinical diagnosis of infantile hypotonia with psychomotor retardation and characteristic facies (IHPRF) was made. The pathogenic variant was validated by Sanger sequencing in the proband and parents. Comparison of PURA-related NDD and IHPRF was carried out. WES identified a novel, de-novo stop-gain variant c.178G>T in PURA. In addition to typical phenotype, subject also had hypersensitivity to various stimuli which was not reported in PURA-related NDD. Significant phenotypic overlap was observed in subjects with PURA-related NDD and IHPRF especially with IHPRF2, caused by biallelic pathogenic variants in UNC80. This study expands the phenotypic and mutational spectrum of PURA-related NDD. We propose PURA-related NDD to be considered as a close differential diagnosis of IHPRF.
WGO Guidance for the Care of Patients With COVID-19 and Liver Disease
Authors: Hamid Saeed , Alvares da Silva Mario R. , Burak Kelly W. , Chen Tao , Drenth Joost P.H. , Esmat Gamal , Gaspar Rui , LaBrecque Douglas , Lee Alice , Macedo Guilherme , McMahon Brian , Ning Qin , Reau Nancy , Sonderup Mark , van Leeuwen Dirk J. , Armstrong David , Yurdaydin Cihan
Published: November 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as “bystander hepatitis,” myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19—such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection.
Probiotics for the Prevention of Antibiotic-associated Diarrhea in Adults
Authors: Liao Wanqian , Chen Chongxiang , Wen Tianmeng , Zhao Qingyu
Published: November 2020

Objective:

This meta-analysis aims to combine the latest research evidence to assess the effect of probiotics on preventing antibiotic-associated diarrhea (AAD) in adults.

Methods:

PubMed, Cochrane Library, EMBASE, and Web of Science were searched for randomized placebo-controlled trials on probiotics preventing AAD. A random or fixed effect model was used to combine the incidence of AAD (primary outcome) and the adverse event rates. The authors performed subgroup analyses to explore the effects of different participants population, probiotics species, and dosage.

Results:

Thirty-six studies were included with 9312 participants. Probiotics reduced the incidence of AAD by 38% (pooled relative risk, 0.62; 95% confidence interval, 0.51-0.74). The protective effect of probiotics was still significant when grouped by reasons for antibiotics treatment, probiotic duration, probiotic dosage, and time from antibiotic to probiotic. However, there were no statistically significant increased adverse events in the probiotics group (relative risk, 1.00; 95% confidence interval, 0.87-1.14).

Conclusions:

This updated meta-analysis suggested that using probiotics as early as possible during antibiotic therapy has a positive and safe effect on preventing AAD in adults. Further studies should focus on the optimal dosage and duration of probiotics to develop a specific recommendation.
Decision making for transjugular intrahepatic portosystemic stent shunt in refractory ascites and variceal bleeding: MELD, or not MELD, that is the question
Authors: Pitton Michael B. , Zimmermann Tim , Mildenberger Philipp , Weinmann Arndt , Kloeckner Roman , Düber Christoph , Mittler Jens , Hoppe-Lotichius Maria , Otto Gerd
Published: November 2020

Purpose

The model of end-stage liver disease (MELD) score has been shown to predict 3-month prognosis following transjugular intrahepatic portosystemic stent shunt (TIPS) in liver cirrhosis; however, that score was derived from a mixed cohort, including patients with refractory ascites and variceal bleeding. This study re-evaluates the role of the MELD score and focuses on differences between both groups of patients.

Methods

A total of 301 patients (192 male and 109 female) received TIPS, 213 because of refractory ascites and 88 because of variceal bleeding. Univariate and multivariate Cox analyses were performed to identify predictors of mortality and area under the receiver operator characteristics (AUROC) were used to assess the prognostic capacity of the MELD score and of the results of predictors of the multivariate analyses.

Results

In refractory ascites, age, bilirubin and albumin were independent predictors of mortality. In variceal bleeding, emergency TIPS during ongoing bleeding, concomitant grade III ascites, history of hepatic encephalopathy, spontaneous bacterial peritonitis, bilirubin and platelet count proved significant. AUROCs of the MELD score for 3-month survival yielded 0.543 and 0.836 for refractory ascites and variceal bleeding, respectively (P < 0.001). For 1-year survival, the respective AUROCs yielded 0.533 and 0.767 (P < 0.001). In contrast to MELD, the AUROCs based on the calculated risk scores of this study resulted in 0.660 and 0.876 for 3-month survival, and 0.665 and 0.835 for 1-year survival in patients with ascites and variceal bleeding, respectively.

Conclusion

In refractory ascites, the prognostic capability of MELD is significantly inferior compared to variceal bleeding. The results of our multivariate analyses and AUROC calculations corroborate the impact of different prognostic variables in patients undergoing TIPS for ascites and variceal bleeding.
A Systematic Review of Surveys for Measuring Patient-centered Care in the Hospital Setting
Authors: Handley Sara C. , Bell Sydney , Nembhard Ingrid M.
Published: November 2020

Background:

Patient-centered care (PCC) is a core component of quality care and its measurement is fundamental for research and improvement efforts. However, an inventory of surveys for measuring PCC in hospitals, a core care setting, is not available.

Objective:

To identify surveys for assessing PCC in hospitals, assess PCC dimensions that they capture, report their psychometric properties, and evaluate applicability to individual and/or dyadic (eg, mother-infant pairs in pregnancy) patients.

Research Design:

We conducted a systematic review of articles published before January 2019 available on PubMed, Web of Science, and EBSCO Host and references of extracted papers to identify surveys used to measure “patient-centered care” or “family-centered care.” Surveys used in hospitals and capturing at least 3 dimensions of PCC, as articulated by the Picker Institute, were included and reviewed in full. Surveys’ descriptions, subscales, PCC dimensions, psychometric properties, and applicability to individual and dyadic patients were assessed.

Results:

Thirteen of 614 articles met inclusion criteria. Nine surveys were identified, which were designed to obtain assessments from patients/families (n=5), hospital staff (n=2), and both patients/families and hospital staff (n=2). No survey captured all 8 Picker dimensions of PCC [median=6 (range, 5–7)]. Psychometric properties were reported infrequently. All surveys applied to individual patients, none to dyadic patients.

Conclusions:

Multiple surveys for measuring PCC in hospitals are available. Opportunities exist to improve survey comprehensiveness regarding dimensions of PCC, reporting of psychometric properties, and development of measures to capture PCC for dyadic patients.
Research progress of sirtuins in renal and cardiovascular diseases
Authors: Wang Wanning , Li Jia , Cai Lu
Published: November 2020

Purpose of review

Sirtuins are a family of nicotinamide adenine dinucleotide+-dependent enzymes catalyzing target protein deacetylation to modulate cellular metabolism, response to oxidative stress and inflammation, senescence, autophagy and apoptosis. In this review, we provide an overview of recent studies regarding the alterations and roles of sirtuins in a variety of renal and cardiovascular diseases. We are also going to highlight activators and inhibitors of sirtuins in the prevention of these diseases. This will help us to understand how this field may change in the future.

Recent finding

Recent studies have elucidated how physical or diseased conditions alter the expressions and enzyme activity of sirtuins and expounded sexual differences in sirtuins functions. In addition, interventions by targeting sirtuins have been applied in preclinical and clinical studies to prevent or slow the development of related diseases.

The advantages of female sex in renal and cardiovascular diseases are partially due to the expression and function of sirtuins. Estrogen activates sirtuins and in turn sirtuins promote estrogen receptor signaling. In addition, the hypoglycemic agents, sodium-glucose cotransporter 2 inhibitors protect against diabetic nephropathy at least in part via activating SIRT-1. Although several compounds targeted sirtuins are promising drug candidates in a variety of renal and cardiovascular diseases, well designed large clinical trials are still required to identify their efficacy and safety.