bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamical masses of brightest cluster galaxies I: stellar velocity anisotropy and mass-to-light ratios
Authors: Loubser S I , Babul A , Hoekstra H , Bahé Y M , O’Sullivan E , Donahue M
Published: June 2020

We investigate the stellar and dynamical mass profiles in the centres of 25 brightest cluster galaxies (BCGs) at redshifts of 0.05 ≤ z ≤ 0.30. Our spectroscopy enables us to robustly measure the Gauss–Hermite higher order velocity moments h3 and h4, which we compare to measurements for massive early-type galaxies, and central group galaxies. We measure positive central values for h4 for all the BCGs. We derive the stellar mass-to-light ratio ($\Upsilon _{\star \rm DYN}$), and velocity anisotropy (β) based on a multi-Gaussian expansion (MGE) and axisymmetric Jeans Anisotropic Methods (cylindrically and spherically aligned). We explicitly include a dark matter halo mass component, which is constrained by weak gravitational lensing measurements for these clusters. We find a strong correlation between anisotropy and velocity dispersion profile slope, with rising velocity dispersion profiles corresponding to tangential anisotropy and decreasing velocity dispersion profiles corresponding to radial anisotropy. The rising velocity dispersion profiles can also indicate a significant contribution from the intracluster light (ICL) to the total light (in projection) in the centre of the galaxy. For a small number of BCGs with rising velocity dispersion profiles, a variable stellar mass-to-light ratio can also account for the profile shape, instead of tangential anisotropy or a significant ICL contribution. We note that, for some BCGs, a variable βz(r) (from radial to tangential anisotropy) can improve the model fit to the observed kinematic profiles. The observed diversity in these properties illustrates that BCGs are not the homogeneous class of objects they are often assumed to be.
Magnesium abundances in cool metal-polluted white dwarfs
Authors: Blouin Simon
Published: June 2020

The accretion of rocky material is responsible for the presence of heavy elements in the atmospheres of a large fraction of white dwarf stars. Those objects represent a unique opportunity to infer the bulk composition of exoplanetesimals. This chemical characterization requires the use of detailed atmosphere models to determine the elemental abundances at the photospheres of white dwarfs. In this work, we use a state-of-the-art model atmosphere code to reanalyse the first large survey of metal-polluted white dwarfs for which abundances are found for multiple elements. We show that the improved constitutive physics of our models lead to systematically higher Mg abundances than previous analyses. We find an average $\log \, {\rm Mg/Ca}$ number abundance ratio of 1.5. This value is significantly above the reference abundance for chondrites, which is expected as current diffusion models predict that for the cool helium-atmosphere white dwarfs of our sample, Mg should remain in the atmosphere longer than Ca. This helps resolve a recently identified Mg depletion problem, where the planetesimals accreted by white dwarfs were reported to be Mg-deficient compared to the expected composition of their planetary systems.
The role of dietary fibre and prebiotics in the paediatric diet
Authors: Boctor Dana
Published: June 2020

Dietary fibres are resistant to digestion and absorption. Prebiotics are fermentable dietary fibres that confer health benefits through their effects on microbiome composition and activity. The range of physiological benefits from consuming dietary fibres is broad. Encouraging children to eat fibre-rich foods promotes a nutrient-dense diet. Introducing a variety of dietary fibre sources to young children helps establish future dietary choices and a more diverse intestinal microbiota. Low-fibre intake is associated with a higher prevalence of constipation and obesity.
LncRNA-H19 silencing suppresses synoviocytes proliferation and attenuates collagen-induced arthritis progression by modulating miR-124a
Authors: Fu Xiaohong , Song Guojing , Ni Rongrong , Liu Han , Xu Zhizhen , Zhang Dinglin , He Fengtian , Huang Gang
Published: June 2020

Objectives

Long non-coding RNA H19 (lncRNA-H19) is highly expressed in fibroblast-like synoviocytes (FLS) from patients with RA. The present study aimed to clarify the pathological significance and regulatory mechanisms of lncRNA-H19 in FLS.

Methods

Mice with CIA were locally injected with LV-shH19. The progression of CIA was explored by measuring arthritic index (AI), paw thickness (PT) and histologic analysis. The growth and cell cycle of human synoviocyte MH7A were assessed by CCK-8 and flow cytometric analysis. The putative binding sites between lncRNA-H19 and miR-124a were predicted online, and the binding was identified by luciferase assay. RT-qPCR, Western blot and luciferase assay were performed to explore the molecular mechanisms between liver X receptor (LXR), lncRNA-H19, miR-124a and its target genes.

Results

The expression of lncRNA-H19 was closely associated with the proliferation of synoviocytes and knockdown of lncRNA-H19 significantly ameliorated the progression of CIA, reflected by decreased AI, PT and cartilage destruction. Notably, lncRNA-H19 competitively bound to miR-124a, which directly targets CDK2 and MCP-1. It was confirmed that lncRNA-H19 regulates the proliferation of synoviocytes by acting as a sponge of miR-124a to modulate CDK2 and MCP-1 expression. Furthermore, the agonists of LXR inhibited lncRNA-H19-mediated miR-124a-CDK2/MCP-1 signalling pathway in synoviocytes. The ‘lncRNA-H19-miR-124a-CDK2/MCP-1’ axis plays an important role in LXR anti-arthritis.

Conclusion

Regulation of the miR-124a-CDK2/MCP-1 pathway by lncRNA-H19 plays a crucial role in the proliferation of FLS. Targeting this axis has therapeutic potential in the treatment of RA and may represent a novel strategy for RA treatment.
Axial and peripheral spondyloarthritis: does psoriasis influence the clinical expression and disease burden? Data from REGISPONSER registry
Authors: López-Medina Clementina , Ortega-Castro Rafaela , Castro-Villegas M Carmen , Font-Ugalde Pilar , Puche-Larrubia M Ángeles , Gómez-García Ignacio , Arias-de la Rosa Iván , Barbarroja Nuria , Schiotis Ruxandra , Collantes-Estévez Eduardo
Published: June 2020

Objective

To evaluate whether the presence of psoriasis influences the clinical expression, disease activity and disease burden in both axial and peripheral phenotypes of spondyloarthritis (SpA).

Methods

Patients from the Spanish REGISPONSER registry classified as having SpA according to the ESSG criteria were included. Patients were classified as psoriatic or non-psoriatic depending on the presence of cutaneous or nail psoriasis; thereafter, they were classified as having either axial [presence of radiographic sacroiliitis OR inflammatory back pain (IBP)] or peripheral phenotype (absence of radiographic sacroiliitis AND absence of IBP AND presence of peripheral involvement). Pair-wise univariate and multivariate analyses among the four groups (psoriatic/non-psoriatic axial phenotypes and psoriatic/non-psoriatic peripheral phenotypes) were performed with adjustment for treatment intake.

Results

A total of 2296 patients were included in the analysis. Among patients with axial phenotype, psoriasis was independently associated (P < 0.05) with HLA-B27+ [odds ratio (OR) 0.27], uveitis (OR 0.46), synovitis (ever) (OR 2.59), dactylitis (OR 2.78) and the use of conventional synthetic DMARDs (csDMARDs) (OR 1.47) in comparison with non-psoriatic patients. Among patients with peripheral phenotype and adjusting for csDMARD intake, psoriasis was independently associated with higher age at disease onset (OR 1.05), HLA-B27+ (OR 0.14) and heel enthesitis (OR 0.22). Higher scores for patient-reported outcomes and greater use of treatment at the time of the study visit were observed in psoriatic patients with either axial or peripheral phenotype.

Conclusion

These findings suggest that, among all patients with SpA, psoriasis is associated with differences in clinical expression of SpA, a greater disease burden and increased use of drugs.
Neural synchrony in mother–child conversation: Exploring the role of conversation patterns
Authors: Nguyen Trinh , Schleihauf Hanna , Kayhan Ezgi , Matthes Daniel , Vrtička Pascal , Hoehl Stefanie
Published: June 2020

Conversations are an essential form of communication in daily family life. Specific patterns of caregiver–child conversations have been linked to children’s socio-cognitive development and child-relationship quality beyond the immediate family environment. Recently, interpersonal neural synchronization has been proposed as a neural mechanism supporting conversation. Here, we present a functional near-infrared spectroscopy (fNIRS) hyperscanning study looking at the temporal dynamics of neural synchrony during mother–child conversation. Preschoolers (20 boys and 20 girls, M age 5;07 years) and their mothers (M age 36.37 years) were tested simultaneously with fNIRS hyperscanning while engaging in a free verbal conversation lasting for 4 min. Neural synchrony (using wavelet transform coherence analysis) was assessed over time. Furthermore, each conversational turn was coded for conversation patterns comprising turn-taking, relevance, contingency and intrusiveness. Results from linear mixed-effects modeling revealed that turn-taking, but not relevance, contingency or intrusiveness predicted neural synchronization during the conversation over time. Results are discussed to point out possible variables affecting parent–child conversation quality and the potential functional role of interpersonal neural synchronization for parent–child conversation.
The Self and Its Prolonged Intrinsic Neural Timescale in Schizophrenia
Authors: Northoff Georg , Sandsten Karl Erik , Nordgaard Julie , Kjaer Troels Wesenberg , Parnas Josef
Published: June 2020

Schizophrenia (SCZ) can be characterized as a basic self-disorder that is featured by abnormal temporal integration on phenomenological (experience) and psychological (information processing) levels. Temporal integration on the neuronal level can be measured by the brain’s intrinsic neural timescale using the autocorrelation window (ACW) and power-law exponent (PLE). Our goal was to relate intrinsic neural timescales (ACW, PLE), as a proxy of temporal integration on the neuronal level, to temporal integration related to self-disorder on psychological (Enfacement illusion task in electroencephalography) and phenomenological (Examination of Anomalous Self-Experience [EASE]) levels. SCZ participants exhibited prolonged ACW and higher PLE during the self-referential task (Enfacement illusion), but not during the non-self-referential task (auditory oddball). The degree of ACW/PLE change during task relative to rest was significantly reduced in self-referential task in SCZ. A moderation model showed that low and high ACW/PLE exerted differential impact on the relationship of self-disorder (EASE) and negative symptoms (PANSS). In sum, we demonstrate abnormal prolongation in intrinsic neural timescale during self-reference in SCZ including its relation to basic self-disorder and negative symptoms. Our results point to abnormal relation of self and temporal integration at the core of SCZ constituting a “common currency” of neuronal, psychological, and phenomenological levels.
Effect of energy source and level, animal age, and sex on the flavor profile of sheep meat12
Authors: Jaborek Jerad R , Zerby Henry N , Wick Macdonald P , Fluharty Francis L , Moeller Steven J
Published: June 2020

The effects of dietary energy source, energy level, sheep age, and sheep sex on flavor and off-flavor intensity were evaluated. Consumer panelists, with previous lamb-eating experience, assessed lamb flavor and off-flavor intensity on a 100-point, end-anchored scale (0 = very mild to 100 = very intense), with off-flavor being defined as anything different than lamb flavor. Lamb longissimus thoracis (LT) and whole, boneless ground shoulder (GS) formed into patties were evaluated. Trial 1 was a randomized complete block design with a 3 × 2 factorial arrangement of treatments. Sheep age (ewe lambs, yearling ewes, and mature ewes; n = 16/age) and ad libitum access to diets [alfalfa pellets (AP) or whole-shelled corn (WSC100)] were treatments. The LT from mature ewes had a greater (P ≤ 0.02) off-flavor intensity when compared with yearling ewes and ewe lambs. Ground shoulder from sheep raised on AP had a greater lamb flavor (P ≤ 0.04) and off-flavor (P ≤ 0.04) intensity than GS from sheep consuming WSC100. Trial 2 was a randomized complete block design with a 3 × 2 × 2 factorial arrangement of treatments. Three dietary treatments [AP, WSC100, and restricted intake of whole-shelled corn to 85% of ad libitum (WSC85)], lamb sex (ewes and wethers; n = 48/sex), and lamb age [short fed, 177 ± 16.6 d of age and 93 ± 20.5 d on feed (DOF); long fed, 294 ± 7.0 d of age and 219 ± 3.8 DOF]. Flavor intensity of the LT was greater (P ≤ 0.05) from lambs offered AP when compared with lambs offered WSC85, whereas lamb flavor of the LT from lambs fed WSC100 was intermediate and not different from the lamb flavor of the LT of lambs fed AP or WSC85. The LT of long-fed lambs had a greater (P ≤ 0.01) lamb flavor and off-flavor intensity when compared with short-fed lambs. Lambs offered AP resulted in a GS with greater lamb flavor intensity (P ≤ 0.01) when compared with lambs offered WSC85 and WSC100, with no diet influence on GS off-flavor intensity. Long-fed lambs produced GS with a greater lamb flavor (P ≤ 0.01) and off-flavor (P ≤ 0.01) intensity when compared with GS from short-fed lambs. Results from the two trials indicate lamb flavor and off-flavor intensity were greater from sheep offered a high-forage (AP) diet when compared with a high-concentrate (WSC) diet. Lamb flavor intensity increased as age of the sheep at harvest increased, suggesting dietary management and associated age-related effects at harvest will influence consumer perception of lamb flavor.
Increased resolution of African swine fever virus genome patterns based on profile HMMs of protein domains
Authors: Masembe Charles , Phan My V T , Robertson David L , Cotten Matthew
Published: June 2020

African swine fever virus (ASFV), belonging to the Asfarviridae family, was originally described in Africa almost 100 years ago and is now spreading uncontrolled across Europe and Asia and threatening to destroy the domestic pork industry. Neither effective antiviral drugs nor protective vaccines are currently available. Efforts to understand the basis for viral pathogenicity and the development of attenuated potential vaccine strains are complicated by the large and complex nature of the ASFV genome. We report here a novel alignment-free method of documenting viral diversity based on profile hidden Markov model domains on a genome scale. The method can be used to infer genomic relationships independent of genome alignments and also reveal ASFV genome sequence differences that determine the presence and characteristics of functional protein domains in the virus. We show that the method can quickly identify differences and shared patterns between virulent and attenuated ASFV strains and will be a useful tool for developing much-needed vaccines and antiviral agents to help control this virus. The tool is rapid to run and easy to implement, readily available as a simple Docker image.
Identification and Characterization of a Pear Chlorotic Leaf Spot-Associated Virus, a Novel Emaravirus Associated with a Severe Disease of Pear Trees in China
Authors: Liu Huazhen , Wang Guoping , Yang Zuokun , Wang Yanxiang , Zhang Zhe , Li Longhui , Waqas Muhammad , Hong Ni , Liu Huazhen , Wang Guoping , Hong Ni , Hong Jian , Zhang Jinguo , Xu Lei , Qi Liying
Published: June 2020

Pear chlorotic leaf spot (PCLS) is a recently emerged disease of commercially cultivated sandy pear (Pyrus pyrifolia) trees in central and southern China. By integrating high-throughput sequencing and conventional Sanger sequencing of reverse-transcription (RT)-PCR products, a novel emaravirus infecting pear trees was identified and molecularly characterized. The virus was provisionally named pear chlorotic leaf spot-associated virus (PCLSaV). PCLSaV shows the typical molecular features of members of the genus Emaravirus in the family Fimoviridae. It has a genome composed of at least five negative-sense RNA segments, with each containing a single open reading frame and two complementary 13-nucleotide stretches at the 5′ and 3′ termini. PCLSaV shows a close phylogenetic relationship with recognized emaraviruses but forms a separate clade. Moreover, double-membrane-bound bodies were observed in PCLSaV-infected tissues and in extracts of PCLSaV-infected leaves. For the first time, our study revealed the profile distribution of viral RNA reads from the RNA-seq libraries of three samples along the RNA1 to RNA5 of an emaravirus. Field surveys combined with specific RT-PCR assays revealed the presence of PCLSaV in almost all PCLS-diseased pear samples, strongly supporting the association of the virus with the PCLS disease. This study revealed the first emaravirus infecting pear trees and its association with a severe pear chlorotic leaf disease.
Remimazolam for anaesthesia or sedation
Authors: Sneyd J. Robert , Rigby-Jones Ann E.
Published: June 2020

Purpose of review

Anaesthesia and sedation are ubiquitous in contemporary medical practice. Developments in anaesthetic pharmacology are targeted on reducing physiological disturbance whilst maintaining or improving titrateability, recovery profile and patient experience. Remimazolam is a new short-acting benzodiazepine in the final stages of clinical development.

Recent findings

Clinical experience with remimazolam comprises volunteer studies and a limited number of clinical investigations. In addition, laboratory investigations explore the implications of its ‘soft drug’ pharmacology.

Remimazolam provides effective procedural sedation with superior success rates and recovery profile when compared to midazolam. Comparisons with propofol are required. Preliminary studies suggest potential for using remimazolam as the hypnotic component of general anaesthesia. Definitive studies are awaited. As a benzodiazepine, remimazolam could be evaluated as an anticonvulsant and for intensive care sedation.
Urinary Buprenorphine, Norbuprenorphine and Naloxone Concentrations and Ratios: Review and Potential Clinical Implications
Authors: Warrington Jill S. , Warrington Gregory S. , Francis-Fath Samuel , Brooklyn John
Published: June 2020

Objectives:

Treatment with medications for opioid use disorder such as buprenorphine improves patient morbidity and mortality as well as treatment adherence, an important component of patient care. Buprenorphine is combined with naloxone to reduce misuse; and, when taken sublingually, naloxone is poorly absorbed. Urine testing for buprenorphine is a common way to monitor adherence. Some patients who want to appear adherent may directly tamper with their urine by adding buprenorphine to their urine to allow for the detection without ingestion. Practitioners may rely upon the concentration of buprenorphine and the metabolite, norbuprenorphine, and utilize the ratio of metabolite to parent compound (norbuprenorphine:buprenorphine – N:B ratio) to discern possible evidence of tampering; however, there remains debate as to what specific ratio may signify this practice. Testing for naloxone may also help determine if urine tampering occurred as only low naloxone concentrations are found in the urine when taken by a sublingual route.

Methods:

To determine a reliable N:B ratio that may be used to identify possible urine tampering by adding parent drug directly to urine, we examined 136,605 urine samples for quantitative concentrations of buprenorphine and norbuprenorphine by LC-MS/MS performed at a commercial laboratory. After identifying abnormal ratios (<0.02), we then compared them with naloxone concentrations and specimen validity testing, other markers that may coincide with specimen tampering of this type.

Results:

Correlating urinary buprenorphine and norbuprenorphine concentrations, we found 2 distinct patient populations, which could be distinguished by N:B ratios ranging from 0.01 to 0.2. In addition, while the distribution of urine naloxone concentrations itself did not demonstrate distinct populations, naloxone was able to further flag potential tampered specimens when combined with N:B ratios. Abnormal specimen validity testing was additionally found more commonly in cases with N:B ratios <0.02.

Conclusions:

This comprehensive study compared N:B ratios with naloxone concentrations and specimen validity testing. This study suggests that a N:B ratio of <0.02 in concert with high naloxone concentrations (>1000 ng/ml) can help to identify potential cases of tampered urine samples.
Wrong-Patient Ordering Errors in Peripartum Mother–Newborn Pairs
Authors: Kern-Goldberger Adina R. , Adelman Jason , Applebaum Jo R. , Manzano Wilhelmina , Goffman Dena
Published: June 2020

Because maternal morbidity and mortality remain persistent challenges to the U.S. health care system, efforts to improve inpatient patient safety are critical. One important aspect of ensuring patient safety is reducing medical errors. However, obstetrics presents a uniquely challenging environment for safe ordering practices. When mother–newborn pairs are admitted in the postpartum setting with nearly identical names in the medical record (for example, Jane Doe and Janegirl Doe), there is a potential for wrong-patient medication ordering errors. This can lead to harm from the wrong patient receiving a medication or diagnostic test, especially a newborn receiving an adult dose of medication, as well as delaying treatment for the appropriate patient. We describe two clinical scenarios of wrong-patient ordering errors between mother–newborn pairs. The first involves an intravenous labetalol order that was placed for a postpartum patient but was released from the automated dispensing cabinet under the newborn's name. The medication was administered correctly, but an automatic order for labetalol was generated in the neonate's chart. Another scenario involves a woman presenting in labor with acute psychotic symptoms. The psychiatry service placed a note and orders for antipsychotic medications in the neonate's chart. These orders were cancelled shortly thereafter and replaced for the mother. These scenarios illustrate this specific patient-safety concern inherent in the treatment of mother–newborn pairs and highlight that perinatal units should evaluate threats to patient safety embedded in the unique mother–newborn relationship and develop strategies to reduce risk.
Postmenopausal Pregnancy in the Era of Assisted Reproductive Technologies
Authors: Moutos Christopher P. , Rasouli Melody A. , Phelps John Y.
Published: June 2020

Assisted reproductive technologies allow women to achieve pregnancy at ages beyond the limits of their natural reproductive lifespans. As women seek pregnancy later in life, physicians are challenged with balancing their professional autonomy against patient autonomy. Increased parental age increases risk to mother and fetus. Legal aspects of postmenopausal women desiring fertility services will vary by location. Ethically, the principles of beneficence, nonmaleficence, and justice become important factors in a physician's evaluation process. This article aims to highlight current guidelines for postmenopausal women desiring fertility services and address medical, legal, and ethical concerns that may arise when assessing these patients.
Early Pregnancy Blood Pressure Elevations and Risk for Maternal and Neonatal Morbidity
Authors: Sutton Elizabeth F. , Rogan Sarah C. , Lopa Samia , Sharbaugh Danielle , Muldoon Matthew F. , Catov Janet M.
Published: June 2020

OBJECTIVE:

To investigate whether women with early pregnancy elevated blood pressure (BP) or stage 1 hypertension exhibit increased risk of preeclampsia and maternal or neonatal morbidity.

METHODS:

We conducted a clinical cohort study of 18,162 women who delivered a singleton neonate from 2015 to 2018 and attended at least two prenatal appointments before 20 weeks of gestation. Data were collected within the Magee Obstetric Maternal and Infant database, an aggregate of prenatal and delivery health records. Early pregnancy BP was defined as average BP before 20 weeks of gestation, and women were classified with normal, elevated BP, stage 1 or 2 hypertension according to current guidelines. The primary outcome was preeclampsia. Secondary outcomes were severe maternal morbidity, placental abruption, gestational diabetes, and composite neonatal morbidity.

RESULTS:

Overall, 75.2% of the women were categorized with normal BP, 13.9% with elevated BP, 5.4% with stage 1 hypertension, and 5.5% with stage 2 hypertension. Risk of preeclampsia increased in a stepwise fashion with increasing BP category, adjusted for covariates (normal BP, 4.7%, referent; elevated BP, 7.3%, adjusted odds ratio [aOR] 1.29, 95% CI 1.07–1.56; stage 1, 12.3%, aOR 2.35, 95% CI 1.86–2.96), and stage 2, 30.2%, aOR 6.49, 95% CI 5.34–7.89). Results were similar among black and white women. Gestational diabetes was more prevalent among women with stage 1 (11.4%; aOR 1.50, 95% CI 1.18–1.91] and stage 2 hypertension (14.2%; aOR 1.65, 95% CI 1.30–2.10). Severe maternal morbidity and neonatal morbidity were increased only among women with stage 2 hypertension (aOR 2.99, 95% CI 2.26–3.99, and aOR 2.67, 95% CI 2.28–3.12, respectively).

CONCLUSION:

Women with elevated BP, and stage 1 and 2 hypertension in early pregnancy are at increased risk for preeclampsia. These findings emphasize the importance of applying the 2017 BP guidelines to reproductive-aged women. Strategies to incorporate these guidelines into obstetric care may also be warranted.
Higher serum angiopoietin 2 levels are independently associated with coronary microvascular dysfunction in patients with angina in the absence of obstructive coronary artery disease
Authors: Chen Shao-Min , Li Dan , Xing Xing , Li Zhao-Ping
Published: June 2020

Background

Angiopoietin-2 (Ang-2) is a type of endothelial growth factor involved in angiogenesis and vascular remodeling. Circulating Ang-2 levels are elevated in patients with obstructive coronary artery disease (CAD). This study aimed to evaluate the association between serum Ang-2 levels and coronary microvascular dysfunction in patients without obstructive CAD.

Methods

A total of 125 patients with angina in the absence of obstructive CAD were included in this cross-sectional study. Coronary flow reserve (CFR) was measured in the distal left anterior descending coronary artery by trans-thoracic Doppler echocardiography. The patients were divided into the following two sub-groups according to CFR: the impaired CFR group with CFR values <2.5 and the preserved CFR group with CFR values ≥2.5. Serum Ang-2 levels were determined using enzyme-linked immunosorbent assay. Independent predictors for impaired CFR were identified by binary logistic regression analysis. The receiver-operating characteristic curve was determined to evaluate the ability of serum Ang-2 in predicting impaired CFR.

Results

We found that age, percentage of female sex, N-terminal pro-B-type natriuretic peptide levels, Ang-2 levels (763.3 ± 264.9 vs. 579.7 ± 169.3 pg/mL, P < 0.001), and the left atrial volume index were significantly higher in patients with impaired CFR than in patients with preserved CFR. Serum Ang-2 levels were negatively correlated with CFR (r = −0.386, P < 0.001). Binary logistic regression analysis showed that Ang-2 (odds ratio: 1.004, 95% confidence interval [CI]: 1.001–1.006, P = 0.003) and age (odds ratio: 1.088, 95% CI: 1.023–1.156, P = 0.007) were independently associated with impaired CFR. Furthermore, Ang-2 was a significant predictor of impaired CFR on the receiver-operating characteristic curve (P < 0.001). The area under the curve was 0.712 (95% CI: 0.612–0.813).

Conclusions

High serum Ang-2 levels are independently associated with impaired CFR in patients with angina in the absence of obstructive CAD.
Pancreatic Insufficiency in Patients Under Sorafenib Treatment for Hepatocellular Carcinoma
Authors: Díaz-González Álvaro , Belmonte Ernest , Sapena Víctor , Sanduzzi-Zamparelli Marco , Darnell Anna , Díaz Alba , Gomes da Fonseca Leonardo , Llarch Neus , Iserte Gemma , Ayuso Carmen , Forner Alejandro , Feu Faust , Bruix Jordi , Rimola Jordi , Reig María
Published: June 2020

Goals:

To describe the occurrence of malabsorption (MA) in hepatocellular carcinoma (HCC) patients under sorafenib, the potential relationship with pancreatic insufficiency (PI), and the role of pancreatic enzymes supplementation.

Background:

With the increasing options of second-line systemic therapies for HCC, the recognition of drug intolerance using practical tools is crucial. It has been proposed that a MA syndrome could be due to sorafenib-induced pancreatic dysfunction.

Study:

All sorafenib-treated patients with suspicion of MA (defined as decreased stool consistency lasting >4 wk or presenting ≥10% body weight loss without HCC progression) were prospectively evaluated by serum markers, endoscopy, and imaging techniques.

Results:

We evaluated 81 sorafenib-treated patients and 21 developed MA suspicion (85.7% male, 81.5% Child-Pugh A, 52.4% BCLC-B, and 47.6% BCLC-C) within a median 5.9 months after starting sorafenib. The median treatment duration, follow-up, and overall survival after MA suspicion were 5.9, 20.3, and 20.3 months, respectively. Nine of them (42.9%) presented hyperparathyroidism secondary to vitamin D deficiency and 8 with PI. A gradual decrease in pancreatic volume of up to 19% was observed among patients with PI. Six of the 8 patients with PI received pancreatic enzymes, with complete recovery from MA symptoms and stabilization of pancreatic volume.

Conclusions:

We validated the association between MA and PI in 10% of sorafenib-treated patients. Pancreatic enzymes supplementation successfully led to symptomatic recovery. Awareness of this adverse event can help in the management of sorafenib irrespective of cancer type and likely, of other tyrosine kinase inhibitors for HCC patients.
Rapid Review
Authors: Ehrenpreis Eli D. , Kruchko David H.
Published: June 2020

In the current COVID-19 pandemic, there has been concern regarding the use of ibuprofen and other nonsteroidal anti-inflammatory agents by COVID-19 infected patients. Aminosalicylates (5-ASAs) are structurally similar and have anti-inflammatory functions that resemble those of nonsteroidal anti-inflammatory agents. Since 5-ASAs are a mainstay treatment for inflammatory bowel disease, the authors review the pharmacology of both classes of drugs and discuss the potential relevance of 5-ASAs in the ongoing discussion of medication use in patients infected with COVID-19.
The efficacy and safety of daunorubicin versus idarubicin combined with cytarabine for induction therapy in acute myeloid leukemia
Authors: Wang Hanyu , Xiao Xueting , Xiao Qirong , Lu Yanhong , Wu Yong
Published: June 2020

Objective:

To ascertain the efficacy and safety of daunorubicin combined with cytarabine comparing with idarubicin combined with cytarabine as a standard induction therapy for acute Myeloid leukemia by a meta-analysis.

Methods:

The randomized controlled trials included were retrieved from PubMed, Embase, and Cochrane library. We evaluated and cross-checked the randomized clinical trials (RCTs) comparing daunorubicin combined with cytarabine (DA) and idarubicin combined with cytarabine (IA) by two reviewers independently according to Cochrane Handbook for Systematic Reviewers of Interventions. The data of meta-analysis was conducted using Review Manager 5.3 and Stata 12.0 software.

Results:

A total of 6 studies containing 3140 patients were included. The primary outcomes were complete remission (CR), CR in one course (CR1), CR in two courses (CR2), overall survival (OS), and relapse rate. The secondary outcomes included adverse events and cytogenetic risk in subgroup analyses. IA showed a statistically significant in CR (RR = 1.05; 95%CI = 1.00–1.09, P = .03) and CR1 (RR = 1.11; 95%CI = 1.04–1.18, P = .003), but not in CR2 (RR = 0.97; 95%CI = 0.77–1.24, P = .83), and relapse rate (RR = 1.08; 95%CI = 0.98–1.43, P = .08). In high dose daunorubicin group, OS was significantly improved with IA compared to DA (HR = 0.89, 95%CI = 0.8–1.0, P = .041, I
2 = 0). At grade 3/4 adverse events, the difference between IA and DA was not statistically significant (infection, P = .28; cardiac toxicity, P = .15; bleeding, P = .29). In the subgroup analysis, the genotypes of the IA and DA groups were not statistically significant for comparison of CR between the two groups (P = .07).

Conclusion:

This meta-analysis showed that IA had a better efficacy in the treatment of acute myeloid leukemia than DA, even with increased doses of DA. The OS of a standard dose of IA patients was longer than that of DA patients. Our research shows that anthracycline dose intensification of daunorubicin is of no clinically relevant benefit in AML patients comparing with a standard dose of IA. When it comes to adverse drug reactions, it is not a significant difference. Therefore, in clinical practice, IA should be the first choice for induction regimen in patients with acute myeloid leukemia.
Interbody fusion in degenerative lumbar spinal stenosis with additional posterolateral fusion using Escherichia coli-derived bone morphogenetic protein-2
Authors: Choi Sung Hoon , Koo Ja Wook , Choe DaeHyun , Hur Jeong Min , Kim Dong-Hong , Kang Chang-Nam
Published: June 2020

This case series investigated the efficacy and optimal dose of Escherichia coli-derived bone morphogenetic protein-2 (E.BMP-2) as a bone graft substitute for additional posterolateral spinal fusion, accompanying interbody fusion procedures, for treating lumbar degenerative spinal stenosis. This study focused on the optimal dose for each segment and the efficacy of E.BMP-2 as a substitute for autogenous iliac bone graft.

Ten patients were enrolled from January 2015 to December 2015, and underwent an additional posterolateral fusion procedure, with 2.5 mg of E.BMP-2 followed by decompression, transpedicular fixation, and interbody fusion. The mean follow-up period was 13.9 months, and regular radiological examinations were performed in every case. Clinical outcomes were measured with a visual analog scale for back pain (VAS-BP), and leg pain (VAS-LP) and the Korean Oswestry Disability Index (K-ODI). All parameters were assessed preoperatively and postoperatively at 12 months.

All 18 segments treated with E.BMP-2 completely fused in 6 months as observed on both simple radiography and computed tomography. The mean fusion period was 4.5 months on simple radiography. At 12 months follow-up, VAS-BP, VAS-LP, and K-ODI scores (1.9 ± 1.5, 1.9 ± 1.9, 11.0 ± 6.6, respectively) had improved significantly compared to preoperative scores (5.5 ± 1.9, 6.5 ± 1.9, and 49.9 ± 11.5, respectively, P < .05). There were no postoperative wound infections, neurological symptoms, or complications associated with the use of E.BMP-2 during the follow-up period.

E.BMP-2 could be used to enhance the outcomes in posterolateral spinal fusion following interbody fusion surgery. In the present study, 2.5 mg of the E.BMP-2 per segment was sufficient to obtain bony union in posterolateral fusion surgery. Further large-scale trials with long-term follow-up are necessary to evaluate the various complications related to the use of E.BMP-2.
Withdrawing mycophenolate mofetil in treating a young kidney transplant recipient with COVID-19
Authors: Chen Dong , Yang Bo , Zhang Yan , Chen Liang , Wei Lai , Zhang Weijie , Wang Xinqiang , Tong Xiaolin , Chen Zhishui
Published: June 2020

Rationale:

Coronavirus disease 2019 (COVID-19) is a novel infectious disease and became a global issue. Treatment of COVID-19 especially in solid organ transplant recipients is empirical and controversial, especially the adjustment of the immunosuppressants.

Patient concerns:

A 29-year-old kidney transplant recipient with the symptoms of COVID-19 pneumonia.

Diagnoses:

COVID-19 pneumonia after kidney transplantation.

Interventions:

He was treated with modified immunosuppressants (unchanged dose of tacrolimus and oral corticosteroids while discontinuing mycophenolate mofetil (MMF)), antibiotics, interferon α-2b inhalation and traditional Chinese medicine.

Outcomes:

He recovered from COVID-19 pneumonia after 29 days of hospitalization. And the renal function (measured as blood urea nitrogen, serum creatinine, and urine protein) returned to normal.

Lessons:

In certain group of COVID-19 (e.g., mild to moderate cases, young patients without comorbidities), a reduction instead of an overall withdrawal of immunosuppressant in kidney transplant recipients is feasible.
Interstitial pneumonia as the initial presentation in an infant with a novel mutation of CD40 ligand-associated X-linked hyper-IgM syndrome
Authors: Li Jian , Miao Hongjun , Wu Lihui , Fang Yongjun
Published: June 2020

Introduction:

X-linked hyper-IgM syndrome is a type of primary combined immunodeficiency disorder caused by mutations in CD40 ligand. Opportunistic infections caused by P jirovecii, cytomegalovirus (CMV), or fungi are frequently the first presenting symptom of the patients with X-linked hyper-IgM syndrome.

Patient concerns:

Here, we report a 10-month-old infant who presented with cyanosis and shortness of breath. The infant exhibited no medical or birth history indicating a primary immune deficiency and was first diagnosed with interstitial pneumonia and acute respiratory failure on admission.

Diagnoses:

The infant was diagnosed with Pneumocystis jirovecii pneumonia combined with CMV and fungal infection through gene sequencing by nasopharyngeal swab and G-test. Whole-exome sequencing from a blood sample was performed and identified a functional mutation across the CD40 ligand gene (NM_000074;exon1;C.86_87del) resulting in an amino acid change (P.T29Sfl∗18) attributed to X-linked hyper IgM syndrome.

Interventions:

The infant received continuous positive airway pressure ventilation treatment combined with trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia, ganciclovir for CMV, voriconazole for fungal infection and substitution of high-dose immunoglobulin.

Outcomes:

Six months after discharge from our hospital, the infant remained well.

Conclusion:

Opportunistic infections should be suspected in infants presenting with severe interstitial pneumonia. Primary immune deficiency diseases should also be considered in infants diagnosed with opportunistic infections.
Corticosteroids or immunosuppressants were not superior to supportive care in IgA nephropathy patients with mild proteinuria
Authors: Pei Gaiqin , Tan Jiaxing , Tang Yi , Tan Li , Zhong Zhengxia , Zhou Ling , Chen Changyun , Qin Wei
Published: June 2020

Background:

We aimed to evaluate the effect of immunosuppressant therapy for immunoglobulin A nephropathy (IgAN) patients with mild proteinuria (<1 g/d).

Methods:

We recruited patients with biopsy-proven IgAN from 4 study centers. Patients were followed for more than 1 year or up to the study end point. Clinical indexes, renal pathological data, and treatment information were collected during the follow-up period. IgAN patients with mild proteinuria (<1 g/d at biopsy) were included. Patients were divided into a supportive care group (SC) and an immunosuppressant group (IT). Patients in the SC group received the optimal dose of renin angiotensin system inhibitors (RASi). Patients in the IT group received corticosteroids or immunosuppressant therapy plus RASi. Responses to therapy included complete remission (CR), partial remission (PR), no response (NR), and end stage renal disease (ESRD). A 50% decline in estimated glomerular filtration rate (eGFR) and/or ESRD was the primary end point of this study.

Results:

295 patients (36.3% male and 63.7% female) were included in this study and were followed for 49.46 ± 24.35 months. We found a significant difference in estimated glomerular filtration rate, urine protein, mesangial hypercellularity, segmental glomerulosclerosis, cellular or fibrocellular crescents, and glomerulosclerosis between the 2 treatment groups at baseline. At the final follow-up, 224 patients (75.9%) achieved CR, 7 patients (2.4%) achieved PR, 55 patients (18.6%) had NR, and 9 patients (3.1%) reached ESRD. However, no significant differences were observed between the SC and IT groups with respect to CR (76.4% vs 73.5%, P = .659), PR (2.0% vs 4.1%, P = .329), NR (18.3% vs 20.4%, P = .728), and ESRD (3.3% vs 2.0%, P = 1.000). Kidney survival rates were also comparable between the SC and IT groups (93.7% vs 94.1%, P = .808). We observed similar results after subgroup analysis according to chronic kidney disease stages or pathological manifestations. A multivariate model showed that segmental sclerosis (HR 9.55, 95% CI 1.04–88.16, P = .047) and glomerulosclerosis (HR 21.09, 95% CI 1.39–320.53, P = .028) were independent predictors of poor renal survival.

Conclusions:

Corticosteroids or immunosuppressants were not superior to supportive care in IgA nephropathy patients with mild proteinuria.
The effect of the reconstruction algorithm for the pulmonary nodule detection under the metal artifact caused by a pacemaker
Authors: Kikuchi Noriko , Yanagawa Masahiro , Enchi Yukihiro , Nakayama Akiko , Yoshida Yuriko , Miyata Tomo , Hata Akinori , Tsubamoto Mitsuko , Honda Osamu , Tomiyama Noriyuki
Published: June 2020

The aim was to compare the effects of metal artifacts from a pacemaker on pulmonary nodule detection among computed tomography (CT) images reconstructed using filtered back projection (FBP), single-energy metal artifact reduction (SEMAR), and forward-projected model-based iterative reconstruction solution (FIRST).

Nine simulated nodules were placed inside a chest phantom with a pacemaker. CT images reconstructed using FBP, SEMAR, and FIRST were acquired at low and standard dose, and were evaluated by 2 independent radiologists.

FIRST demonstrated the most significantly improved metal artifact and nodule detection on low dose CT (P < .0032), except at 10 mA and 5-mm thickness. At standard-dose CT, SEMAR showed the most significant metal artifact reduction (P < .00001). In terms of nodule detection, no significant differences were observed between FIRST and SEMAR (P = .161).

With a pacemaker present, FIRST showed the best nodule detection ability at low-dose CT and SEMAR is comparable to FIRST at standard dose CT.
Radial extracorporeal shock wave therapy: a novel approach for the treatment of Dupuytren's contractures
Authors: Brunelli Stefano , Bonanni Cinzia , Traballesi Marco , Foti Calogero
Published: June 2020

Introduction:

While the efficacy of focused Extracorporeal Shock Wave Therapy (ESWT) in the treatment of Dupuytren's disease (DD) is supported by one positive trial, the effects of radial ESWT is unclear.

Patient concerns:

A 79-year-old man with a 4-year history of impairment of left-hand function and pain due to DD with weakness and flexion deformities of middle and ring fingers. He has not been treated before for this impairment.

Diagnosis:

The diagnosis of DD was based on clinical features and ultrasound images.

Interventions:

Four weekly sessions of radial ESWT with 1400 impulses 3 bar each, 12 Hz.

Outcomes:

The limitations in activities of daily living were analyzed through the Disabilities of Arm Shoulder and Hand Questionnaire (DASH) and Michigan Hand Outcome Questionnaire (MHQ) at baseline, after four sessions of radial ESWT and at 4-months follow-up. Data analysis showed a significant reduction of hand deformities and an improvement of daily living performance. The effects continued at the 4-months follow-up.

Conclusion:

This case report demonstrates the feasibility of radial ESWT. Radial ESWT sessions may be carried out by a physiotherapist in outpatient clinics with cost reduction compared with surgical treatment and focused ESWT. Radial ESWT is a non-invasive, well tolerated therapy, so it should be considered in the DD treatment.
Can respiratory muscle training therapy effectively manage obstructive sleep apnea syndrome after stroke?
Authors: Guo Shu-wen , Dai Chang-fei , Yu Liang , Zhao Xiong-fei
Published: June 2020

Background:

This study will explore the effectiveness and safety of respiratory muscle training therapy (RMTT) for the treatment of patients with obstructive sleep apnea syndrome (OSAS) after stroke.

Methods:

In this study, we will systematically and comprehensively search Cochrane Library, PubMed, EMBASE, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for relevant literature from their inception to March 1, 2020 without any limitations to language and publication status. We will consider any randomized controlled trials focusing on the effectiveness and safety of RMTT for the treatment of patients with OSAS after stroke. The study quality will be checked using Cochrane risk of bias tool, and statistical analysis will be performed utilizing RevMan 5.3 software.

Results:

This study will summarize and synthesize the current evidence of RMTT for the treatment of patients with OSAS following stroke.

Conclusion:

The findings of this study will assess the present evidence for the benefits and harms of RMTT for treating OSAS after stroke, and will inform clinical practice and future research.

PROSPERO registration number:

PROSPERO CRD42020170355.
The adverse skin reactions of health care workers using personal protective equipment for COVID-19
Authors: Hu Kaihui , Fan Jing , Li Xueqin , Gou Xin , Li Xinyuan , Zhou Xiang
Published: June 2020

In December 2019, a new coronavirus was found in Wuhan, Hubei Province, China, and spread rapidly throughout the country, attracting global attention. On February 11, the World Health Organization (WHO) officially named the disease caused by 2019-nCoV coronavirus disease 2019 (COVID-19). With the increasing number of cases, health care workers (HCWs) from all over China volunteered to work in Hubei Province. Because of the strong infectivity of COVID-19, HCWs need to wear personal protective equipment (PPE), such as N95 masks, latex gloves, and protective clothing. Due to the long-term use of PPE, many adverse skin reactions may occur. Therefore, the purpose of this study is to explore the adverse skin reactions among HCWs using PPE.

Questionnaires were used for the research; a quantitative study was carried out to determine the incidence of adverse skin reactions among HCWs using PPE.

A total of 61 valid questionnaires were collected. The most common adverse skin reactions among HCWs wearing N95 masks were nasal bridge scarring (68.9%) and facial itching (27.9%). The most common adverse skin reactions among HCWs wearing latex gloves were dry skin (55.7%), itching (31.2%), and rash (23.0%). The most common adverse skin reactions among HCWs wearing protective clothing were dry skin (36.1%) and itching (34.4%).

When most HCWs wear PPE for a long period of time, they will experience adverse skin reactions. The incidence of adverse skin reactions to the N95 mask was 95.1%, that to latex gloves was 88.5%, and that to protective clothing was 60.7%.