bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remnant lipoproteins: are they equal to or more atherogenic than LDL?
Authors: Salinas Carlos A. Aguilar , Chapman M. John 
Published: April 2020

Purpose of review
To critically appraise new insights into the biology of remnant lipoproteins and their putative role in the pathophysiology of atherosclerotic cardiovascular disease, and to compare the atherogenicity of remnant particles with that of low-density lipoproteins (LDL).

Recent findings
New in-vivo stable isotope tracer studies of the kinetics of apoB48 and apoB100-containing lipoproteins in postprandial conditions have revealed that apoB48-containing very low-density lipoproteins (VLDL) accumulated markedly in hypertriglyceridemic patients. These intestinally-derived particles were cleared slowly, and represented up to 25% of circulating VLDL; as part of the remnant particle population, they may increase cardiovascular risk. Importantly, the PCSK9 inhibitor, evolocumab, was shown to reduce remnant levels (−29%) during the postprandial period in diabetic patients on statin therapy – an effect which may be additive to that of LDL-cholesterol reduction in conferring cardiovascular benefit. In recent Mendelian randomization studies, the effect of lowering triglyceride-rich lipoproteins or LDL-cholesterol translated to similar clinical benefit per unit of apoB. Finally, in randomized trials involving statin-treated patients with atherosclerotic cardiovascular disease, remnant cholesterol levels were associated with coronary atheroma progression independently of LDL-cholesterol.

Summary
Overall, data from observational studies in large cohorts, Mendelian randomization studies, meta-regression analyses, and post-hoc analyses of randomized trials are consistent with the contention that remnants are highly atherogenic particles and contribute to the atherosclerotic burden in an equivalent manner to that of LDL.
Prediction of Cognitive Ability With Social Determinants in Children of Low Birth Weight
Authors: Blair Lisa M. , Ford Jodi L. , Gugiu P. Cristian , Pickler Rita H. , Munro Cindy L. , Anderson Cindy M. 
Published: April 2020

Background
Despite strong prevention efforts and advances in neonatal care in recent decades, low birth weight remains a serious public health problem in the United States, and survivors remain at increased risk for lifelong problems including cognitive deficits. Current regional and local strategies for referral often rely on variable thresholds for birth weight and gestational age that may be poor analogues to cognitive risk. Improving early referral criteria offers many benefits, including improved cognitive outcomes for children and improved cost-effectiveness and resource utilization in resource-limited communities.

Objectives
We hypothesized that social determinants measurable at birth or at birth hospital discharge, when combined with birth weight and gestational age, would offer an improvement over birth weight and gestational age alone in predicting cognitive test scores in school-aged children with low birth weight.

Methods
We conducted a secondary analysis using a birth cohort of children from the Fragile Families and Child Wellbeing Study. We created a panel of maternal, familial, and community-level social determinant indicators from the data and examined associations with cognitive measures assessed at age of 9 years.

Results
The final social determinant model was statistically significant and explained 35% of the total variance in composite test scores. The “standard care” model (birth weight and gestational age) only explained 9% of the variance.

Discussion
Assessment of social determinants may offer improvement over traditional referral criteria to identify children most at risk of cognitive deficits after low birth weight.
Self-Reported Sensory Gating and Stress-Related Hypertension
Authors: Peters Rosalind M. , El-Masri Maher , Cassidy-Bushrow Andrea E. 
Published: April 2020

BackgroundIncreasing evidence views hypertension as a stress-induced disorder. Stressors must be “gated” by the brain before any inflammatory or immune processes that contribute to hypertension are initiated. No studies were found that examined sensory gating in relation to hypertension.ObjectivesThe aim of the study was to determine if disturbances in self-reported sensory gating could differentiate normotensive from hypertensive young adults.MethodsA nonmatched, case–control design was used. We administered an online survey to 163 young adult participants. Participants were predominantly female, in their mid-20s, well educated, and approximately evenly distributed by race and hypertension status. The Sensory Gating Inventory (SGI) measured gating disturbances.ResultsThe mean SGI scores were significantly higher among persons diagnosed with hypertension, reflecting a moderate effect size of sensory gating. After adjusting for confounders, however, the normotensive and hypertensive groups were not significantly different on their SGI scores.DiscussionWith an observed moderate effect size of 0.35, but low power, more research is warranted regarding the role of gating disturbances in the development of stress-induced hypertension. Clinically, the SGI may be important for screening patients who would benefit from ambulatory blood pressure monitoring to identify persons with masked hypertension.
Evaluation of Text Message Reminders to Encourage Retesting for Chlamydia and Gonorrhea Among Female Patients at the Municipal Sexually Transmitted Disease Clinic in Seattle, Washington
Authors: Unutzer Anna , Dombrowski Julia C. , Katz David A. , Barbee Lindley A. , Golden Matthew R. , Khosropour Christine M. 
Published: April 2020

Background
United States guidelines recommend retesting for chlamydia (CT) and gonorrhea (GC) approximately 3 months after treatment, but adherence to these guidelines is poor.

Methods
In May 2016, the municipal sexually transmitted disease (STD) Clinic in Seattle, WA, integrated opt-in short message system (SMS) (text message) retesting reminders for female patients into our clinic's routine electronic intake. Women were asked if they wanted to receive an SMS reminder for retesting for GC/CT in 3 months. We used Fisher exact tests to compare the proportion who returned to the clinic for retesting and the proportion who retested GC/CT positive 3 to 6 months after their initial diagnosis. We used sexually transmitted disease surveillance data to ascertain repeat GC/CT diagnoses.

Results
From May 2016 to December 2017, 743 (36%) of 2067 women opted to receive an SMS reminder. Overall, 95 of these women tested positive for GC or CT and provided a valid phone number; 31 (33%) had opted into SMS reminders. The percentage of women who returned to the clinic 3 to 6 months after their initial GC/CT diagnosis did not significantly differ for women who did and did not opt in to receive SMS reminders (23% vs 9%; P = 0.11). Repeat GC/CT diagnosis 3 to 6 months after the initial GC/CT diagnosis was not significantly different between women who did and did not opt in (7% vs 3%; P = 0.58).

Conclusions
Uptake of automated SMS reminders among women was low, and most women who received reminders did not return for retesting. Despite this, SMS reminders integrated into an existing clinic infrastructure may somewhat increase retesting among women with GC/CT.
The Early Effects of COVID-19 on Plastic Surgery Residency Training: The University of Washington Experience
Authors: Cho Daniel Y. , Yu Jenny L. , Um Grace T. , Beck Christina M. , Vedder Nicholas B. , Friedrich Jeffrey B. 
Published: April 2020

Summary:
Plastic surgeons have the unique perspective of working with all types of patients and care teams from almost all specialties in surgery and medicine, which creates unique challenges in times of distress. As the initial epicenter of coronavirus disease 2019 cases in the United States, the University of Washington program was required to rapidly develop strategies to deal with the escalating crisis. All aspects of the program were affected, including the need to triage the urgency of plastic surgery care, safe staffing of plastic surgery teams, and the role of plastic surgery in the greater hospital community. In addition, as a residency training program, limiting the impact of resident education and maintaining a sense of community and connection among members of the program developed into important considerations. The authors hope that the narrative of their experience will provide insight into the decisions made in the University of Washington health care system but also remind others that they are not alone in dealing with the challenges of this pandemic.
Intestinal Oxygenation and Survival After Surgery for Necrotizing Enterocolitis
Authors: Kuik Sara J. , van der Heide Martin , Bruggink Janneke L. M. , Bos Arend F. , Verhagen A. A. Eduard , Kooi Elisabeth M. W. , Hulscher Jan B. F. 
Published: April 2020

Objective:
To assess whether regional intestinal oxygen saturation (rintSO2) and regional cerebral oxygen saturation (rcSO2) measurements aid in estimating survival of preterm infants after surgery for NEC.

Summary of Background Data:
Predicting survival after surgery for NEC is difficult yet of the utmost importance for counseling parents.

Methods:
We retrospectively studied prospectively collected data of preterm infants with surgical NEC who had available rintSO2 and rcSO2 values measured via near-infrared spectroscopy 0–24 hours preoperatively. We calculated mean rintSO2 and rcSO2 for 60–120 minutes for each infant. We analyzed whether preoperative rintSO2 and rcSO2 differed between survivors and non-survivors, determined cut-off points, and assessed the added value to clinical variables.

Results:
We included 22 infants, median gestational age 26.9 weeks [interquartile range (IQR): 26.3–28.4], median birth weight 1088 g [IQR: 730–1178]. Eleven infants died postoperatively. Preoperative rintSO2, but not rcSO2, was higher in survivors than in non-survivors [median: 63% (IQR: 42–68) vs 29% (IQR: 21–43), P < 0.01), with odds ratio for survival 4.1 (95% confidence interval, 1.2–13.9, P = 0.02) per 10% higher rintSO2. All infants with rintSO2 values of >53% survived, whereas all infants with rintSO2 <35% died. Median C-reactive protein [138 mg/L (IQR: 83–179) vs 73 mg/L (IQR: 12–98), P < 0.01), lactate [1.1 mmol/L (IQR: 1.0–1.6) vs 4.6 mmol/L (IQR: 2.8–8.0), P < 0.01], and fraction of inspired oxygen [25% (IQR: 21–31) vs 42% (IQR: 30–80), P < 0.01] differed between survivors and non-survivors. Only rintSO2 remained significant in the multiple regression model.

Conclusions:
Measuring rintSO2, but not rcSO2, seems of added value to clinical variables in estimating survival of preterm infants after surgery for NEC. This may help clinicians in deciding whether surgery is feasible and to better counsel parents about their infants’ chances of survival.
Breakthrough cancer pain in 2020
Authors: Løhre Erik T. , Thronæs Morten , Klepstad Pål 
Published: April 2020

Purpose of review
An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options.

Recent findings
The estimated prevalence of BTCP is dependent on the defined cutoffs for controlled background pain and the magnitude of the pain flare. In addition, pain flares outside the definition of BTCP are prevalent. In the 11th Revision of the International Classification of Diseases, the temporal characteristics of cancer pain are described as continuous background pain and intermittent episodic pain. BTCP should be assessed by validated methods, and the patient perspective should be included. The pain may be related to neoplastic destruction of bone, viscera, or nerve tissue and is characterized by rapid onset, high intensity, and short duration. Treatment directed towards painful metastases must be considered. Due to pharmacological properties mirroring the pain characteristics, transmucosal fentanyl formulations are important for the treatment of BTCP. Oral immediate release opioids can be used for slow-onset or predictable BTCP. For more difficult pain conditions, parenteral, or even intrathecal pain medication, may be indicated.

Summary
All clinically relevant episodic pains must be adequately treated in accordance with the patient's preferences. Transmucosal fentanyl formulations are effective for BTCP.
Innate lymphoid cells in treatment-induced gastrointestinal pathogenesis
Authors: Omar Saïd Z. , Blom Bianca , Hazenberg Mette D. 
Published: April 2020

Purpose of review
Tissue injury often occurs as collateral damage after chemotherapy and radiotherapy and is associated with significant comorbidity and mortality. The arsenal of options to prevent tissue injury other than dose reduction is limited, and treatment is mostly aimed at symptom relief and prevention of complications, such as bacterial translocation and malnourishment. Novel approaches directed at prevention and early repair of damaged tissues are highly anticipated.

Recent findings
Innate lymphoid cells (ILC) are important in tissue homeostasis and wound healing. Most knowledge of ILC is based on studies in mice, and the contribution of ILC to repair therapy-induced tissue damage in humans is relatively understudied. A picture is nevertheless emerging, suggesting that ILC have several means to maintain tissue homeostasis. Subsets of ILC produce, for example, interleukin (IL)-22 or amphiregulin (AREG) that induce epithelial tissue repair and the release of microbiome modulating proteins. In addition, ILC have immune-regulatory capacities given that adoptive transfer of ILC in a mouse model of graft versus host disease (GvHD) attenuated tissue inflammation.

Summary
ILC are important in tissue maintenance and damage repair and as such have the potential to be developed as (adoptive) therapy to prevent and repair therapy-induced tissue damage.
How soon is too soon?: Optimal timing of split-thickness skin graft following polyglactin 910 mesh closure of the open abdomen
Authors: Lewis Richard H. , Sharpe John P. , Croce Martin A. , Fabian Timothy C. , Magnotti Louis J. 
Published: April 2020

BACKGROUND
Various management strategies exist for the abdomen that will not close. At our institution, these patients are managed with polyglactin 910 mesh followed 14 days later (LATE) by split-thickness skin graft (STSG) or, in some cases, earlier (EARLY, <14 days), if the wound is judged to be adequately granulated. The purpose of this study was to evaluate the impact of STSG timing for wounds felt ready for grafting on STSG failure.

METHODS
Consecutive patients over a 3-year period managed with polyglactin 910 mesh followed by STSG were identified. Patient characteristics, severity of injury and shock, time to STSG, and outcomes, including STSG failure, were recorded and compared. Multivariable logistic regression analysis was performed to identify predictors of graft failure.

RESULTS
Sixty-one patients were identified: 31 EARLY and 30 LATE. There was no difference in severity of injury or shock between the groups. Split-thickness skin graft failure occurred in 11 patients (9 EARLY vs. 2 LATE, p < 0.0001). Time to STSG was significantly less in patients with graft failure (11 days vs. 15 days, p = 0.012). In fact, after adjusting for age, injury severity, severity of shock, and time to STSG, multivariable logistic regression identified EARLY STSG (odds ratio, 1.4; 95% confidence interval, 1.1–1.8, p = 0.020) as the only independent predictor of graft failure.

CONCLUSION
Appearance of the open abdomen can be misleading during the first 2 weeks following polyglactin 910 mesh placement. EARLY STSG was the only modifiable risk factor associated with graft failure. Thus, for optimal results, STSG should be delayed at least 14 days after polyglactin 910 mesh placement.

LEVEL OF EVIDENCE
Prognostic study, level IV.
One-Leg Standing and Y-Balance Test Performance in Elderly Fallers and Nonfallers
Authors: Park Kyue-nam , Yang Mi , Yoo Tae-gi , Kim Si-hyun 
Published: April 2020

Background:
Falls are one of the severe causes of injury and death in older adults.

Objectives:
The aims of this study were to compare the 1-leg standing time and Y-balance test score between older adults with and without a history of falls, and to examine the association between 1-leg standing and Y-balance test performance in older adults.

Design:
A cross-sectional study.

Methods:
Twelve older adults who had fallen in the past year and 27 who had not experienced falls participated. One-leg standing and Y-balance tests were used to assess balance.

Results:
There were no significant differences in 1-leg standing time or Y-balance test distance and percentage scores between fallers and nonfallers. One-leg standing showed a fair correlation with Y-balance test in excursion distance of posterolateral reach and scores of the posteromedial and posterolateral reach.

Conclusions:
One-leg standing and Y-balance tests are useful and easy-to-apply tools for assessing balance, and a significant correlation between performance on the 2 tests was demonstrated in the older adults in this study. However, additional evaluation with 1-leg standing and Y-balance test may be needed to identify differences in balance and fall risk between older fallers and nonfallers.
Change in Estimated GFR and Risk of Allograft Failure in Patients Diagnosed With Late Active Antibody-mediated Rejection Following Kidney Transplantation
Authors: Irish William , Nickerson Peter , Astor Brad C. , Chong Edward , Wiebe Chris , Moreso Francesc , Seron Daniel , Crespo Marta , Gache Larry , Djamali Arjang 
Published: April 2020

Background.
There are challenges in designing adequate, well-controlled studies of patients with active antibody-mediated rejection (AMR) after kidney transplantation (KTx).

Methods.
We assessed the functional relationship between change in estimated glomerular filtration rate (eGFR) following the diagnosis of AMR and the risk of subsequent death-censored graft failure using the joint modeling framework. We included recipients of solitary KTx between 1995 and 2013 at 4 transplant centers diagnosed with biopsy-proven active AMR at least 1 year post-KTx, who had a minimum of 3-year follow-up.

Results.
A total of 91 patients across participating centers were included in the analysis. Of the 91 patients, n = 54 patients (59%) met the death-censored graft failure endpoint and n = 62 patients (68%) met the all-cause graft failure composite endpoint. Kaplan-Meier death-censored graft survival rates at 12, 36, and 60 months postdiagnosis of AMR pooled across centers were 88.9%, 58.9%, and 36.4%, respectively. Spaghetti plots indicated a linear trend in the change in eGFR, especially in the first 12 months postdiagnosis of active AMR. A significant change in eGFR was observed within the first 12 months postdiagnosis of active AMR, getting worse by a factor of −0.757 mL/min/1.73 m2 per month during the 12-month analysis period (a delta of −9.084 mL/min/1.73 m2 at 1 y). Notably, an extrapolated 30% improvement in the slope of eGFR in the first 12 months was associated with a 10% improvement in death-censored graft failure at 5 years.

Conclusions.
If prospectively validated, this study may inform the design of pivotal clinical trials for therapies for late AMR.
E-health and multiple sclerosis
Authors: Matthews Paul M. , Block Valerie J. , Leocani Letizia 
Published: April 2020

Purpose of review
To outline recent applications of e-health data and digital tools for improving the care and management of healthcare for people with multiple sclerosis.

Recent findings
The digitization of most clinical data, along with developments in communication technologies, miniaturization of sensors and computational advances are enabling aggregation and clinically meaningful analyses of real-world data from patient registries, digital patient-reported outcomes and electronic health records (EHR). These data are allowing more confident descriptions of prognoses for multiple sclerosis patients and the long-term relative benefits and safety of disease-modifying treatments (DMT). Registries allow detailed, multiple sclerosis-specific data to be shared between clinicians more easily, provide data needed to improve the impact of DMT and, with EHR, characterize clinically relevant interactions between multiple sclerosis and other diseases. Wearable sensors provide continuous, long-term measures of performance dynamics in relevant ecological settings. In conjunction with telemedicine and online apps, they promise a major expansion of the scope for patients to manage aspects of their own care. Advances in disease understanding, decision support and self-management using these Big Data are being accelerated by machine learning and artificial intelligence.

Summary
Both health professionals and patients can employ e-health approaches and tools for development of a more patient-centred learning health system.
Psychiatric Symptoms Related to the COVID-19 Pandemic
Authors: Rohde Christopher , Jefsen Oskar Hougaard , Nørremark Bettina , Aalkjær Danielsen Andreas , Østergaard Søren Dinesen 
Published: April 2020

The COVID-19 pandemic and the consequential societal changes are likely to have major health consequences way beyond those caused by the virus infection. One of the medical fields that may experience significant consequences of the pandemic is that of psychiatry. Importantly, individuals who already live with mental disorders may be particularly vulnerable to the psychological stress associated with the pandemic. However, data on how the COVID-19 pandemic affects this group of people is largely absent from the literature.Here, we report data from a quality development project conducted at the psychiatric services of the Central Denmark Region (CDR), which has a catchment area of approximately 1.3 million people covered by five psychiatric hospitals providing inpatient and outpatient treatment of all types of mental disorders. Based on a manual screening of all clinical notes from the period from February 1st to March 23rd 2020 that contained at least one of the following words: corona, COVID, virus, epidemic, pandemic, and contaminate/contamination (including compound words), we found 1357 notes from 918 adult patients that described pandemic-related psychopathology (symptoms that appeared to be caused/deteriorated by the pandemic and/or its societal consequences).To our knowledge, this is the first investigation of COVID-19 pandemic-related psychopathology from a large psychiatric treatment setting. The results clearly suggest that this phenomenon exists among individuals with mental illness. However, as the data from this investigation stems from standard clinical practice where the patients were not systematically assessed for pandemic-related psychopathology, we cannot speak to its overall prevalence. Nevertheless, we believe that our findings underline the necessity of taking urgent action to mitigate the negative effects of the COVID-19 pandemic on patients with mental disorders. A low-cost intervention would be to simply discuss the ongoing pandemic and its societal consequences with patients seeking care in psychiatric settings - as this may lead to relief of pandemic-related symptoms via general comforting, and clarification of misunderstandings/false beliefs regarding the pandemic.