bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood pressure lability is associated with subcortical atrophy in early Parkinson's disease
Authors: Yoo Sang-Won , Yun Eunkyeong , Bang Mirim , Yoon Uicheul , Yoo Ji-Yeon , Lee Kwang-Soo , Shin Na-Young , Kim Joong-Seok 
Published: July 2020

Objective:
Increased cerebral white matter intensities associated with blood pressure (BP) lability were reported in patients with Parkinson's disease. However, this type of cardiovascular dysautonomia has seldom been associated with disruptions in deep gray matter structures in Parkinson's disease. In the present study, the associations between BP lability and subcortical deep gray matter structures in early Parkinson's disease were evaluated.

Methods:
The present study included 98 early nondemented Parkinson's disease patients. Supine and orthostatic BPs were measured using head-up tilt tests. BP variabilities, measured as standard deviations of 24-h daytime and nighttime BPs, were assessed using 24-h ambulatory BP monitoring. Every patient underwent brain MRI and measurement of deep gray matter volumes. The associations between BP lability and deep gray matter structures were analyzed.

Results:
Parkinson's disease patients with orthostatic hypotension had smaller volumes of striatum, particularly caudate, than patients without OH after adjusting for covariates of age, sex, disease duration, and Mini-Mental Status Examination score. Nocturnal BP variability was inversely associated with thalamus, hippocampus, and globus pallidus volumes.

Conclusion:
The results from the present study showed that BP lability was adversely associated with structural changes in early Parkinson's disease. Different forms of BP fluctuations influenced distinct deep gray matter structures.
The associations of blood pressure parameters with all-cause and cardiovascular mortality in peritoneal dialysis patients: a cohort study in China
Authors: Xie Xishao , Lv Duo , Zheng Haiyan , Zhang Xiaohui , Han Fei , Chen Jianghua 
Published: July 2020

Background:
It remains controversial to claim blood pressure (BP) as a leading risk factor for high risk of death in peritoneal dialysis patients, and less is known about the relationship between BP and mortality in Chinese peritoneal dialysis patients.

Methods:
From Zhejiang Renal Data System in China, we collected data on patients treated and followed up at 98 peritoneal dialysis centres from 2008 to 2016. The associations of BP parameters [SBP, DBP, mean arterial pressure (MAP) and pulse pressure (PP)] with all-cause and cardiovascular mortality were examined. We fitted Cox models for mortality with penalized splines using nonparametric smoothers. Several sensitivity analyses were performed to confirm the robustness of our primary findings.

Results:
A total of 7335 Chinese peritoneal dialysis patients were included. During a median follow-up of 35.8 months, 1281 (17.5%) patients died. SBP, DBP, MAP follow a U-shaped pattern of both all-cause and cardiovascular mortality. PP presents a reverse L-shaped association with all-cause mortality. Either a higher (SBP >141, DBP >85 or MAP >102 mmHg) or lower (SBP <119, DBP <67 or MAP <88 mmHg) BP tends to have a significantly higher all-cause and cardiovascular mortality risk. Higher PP (>60 mmHg) is related to a higher risk of all-cause mortality, but not cardiovascular mortality. These associations remain the same in our competing risk analysis and subgroup analyses.

Conclusion:
These data indicate U-shaped associations of SBP, DBP and MAP with all-cause mortality and cardiovascular mortality, respectively, and a reverse L-shaped association of PP with all-cause mortality. Further studies are needed to reliably establish the optimal BP targets for better hypertension control in peritoneal dialysis patients.
A speckle tracking echocardiographic study on right ventricular function in primary aldosteronism
Authors: Chen Yi-Lin , Xu Ting-Yan , Xu Jian-Zhong , Zhu Li-Min , Li Yan , Wang Ji-Guang 
Published: July 2020

Objective:
We investigated right ventricular function using speckle tracking echocardiography (STE) in patients with primary aldosteronism.

Methods:
Our study included 51 primary aldosteronism patients and 50 age and sex-matched primary hypertensive patients. We performed two-dimensional echocardiography to measure cardiac structure and function. We performed STE offline analysis on right ventricular four-chamber (RV4CLS) and free wall longitudinal strains (RVFWLS).

Results:
Primary aldosteronism patients, compared with primary hypertensive patients, had a significantly (P ≤ 0.045) greater left ventricular mass index (112.0 ± 22.6 vs. 95.8 ± 18.5 g/m2) and left atrial volume index (26.9 ± 6.0 vs. 24.7 ± 5.6 ml/m2) and higher prevalence of left ventricular concentric hypertrophy (35.3 vs. 12.0%), although they had similarly normal left ventricular ejection fraction (55–77%). Primary aldosteronism patients also had a significantly (P ≤ 0.047) larger right atrium and ventricle, lower tricuspid annular plane systolic excursion, and higher E/E’t (the peak early filling velocity of trans-tricuspid flow to the peak early filling velocity of lateral tricuspid annulus ratio), estimated pulmonary arterial systolic pressure and right ventricular index of myocardial performance. On the right ventricular strain analysis, primary aldosteronism patients had a significantly (P < 0.001) lower RV4CLS (−18.1 ± 2.5 vs. −23.3 ± 3.4%) and RVFWLS (−21.7 ± 3.7 vs. −27.9 ± 4.5%) than primary hypertensive patients. Overall, RV4CLS and RVFWLS were significantly (r = −0.58 to −0.41, P < 0.001) correlated with plasma aldosterone concentration and 24-h urinary aldosterone excretion. After adjustment for confounding factors, the associations for RV4CLS and RVFWLS with 24-h urinary aldosterone excretion remained significant (P < 0.001), with a standardized coefficient of −0.48 and −0.55, respectively.

Conclusion:
In addition to left ventricular abnormalities, primary aldosteronism patients also show impaired right ventricular function, probably because of hyperaldosteronism.
Monte Carlo simulation of uncertainty to identify barriers to optimizing blood pressure control
Authors: Zanisi Lorenzo , Floyd Christopher N. , Barrett James E. , Bunce Catey , Frohmaier Chris , Shankar Francesco , Chowienczyk Phil J. 
Published: July 2020

Objectives:
To assess the impact of variable drug response and measurement error on SBP control.

Methods:
We simulated a treat-to-target strategy for populations with different pretreatment SBP, whereby medications were added sequentially until measured SBP (mSBP) less than 140 mmHg. Monte Carlo simulations determined variability of both drug response (drugeff ± σdrug; 10 ± 5 mmHg base case) and measurement error (σmeas; 10 mmHg base case) of true SBP (tSBP). The primary outcome measure was the proportion of individuals who achieved target less than 140 mmHg.

Results:
Decision-making based on mSBP resulted in 35.0% of individuals with initial tSBP 150 mmHg being either inappropriately given, or inappropriately denied a second drug. When the simulation was run for multiple drug titrations, measurement error limited tSBP control for all populations tested. A strategy of drug titration based on a second measurement for individuals at risk of incorrect decisions (mSBP 120–150 mmHg; σmeas 15 mmHg) reduced the proportion above target from 40.1 to 30.0% when initial tSBP 160 mmHg. When the measurement variability for the second reading was reduced below that usually seen in clinical practice (σmeas 5 mmHg), the proportion above target decreased further to 17.4%.

Conclusion:
In this simulation, measurement error had the greatest impact on the proportion of individuals achieving their SBP target. Efforts to reduce this error through repeated measures, alternative measurement techniques or changing thresholds, are promising strategies to reduce cardiovascular morbidity and mortality and should be investigated in clinical trials. Here we have shown that Monte Carlo simulations are a useful technique to investigate the influence of uncertainty for different hypertension management strategies.
A Case of Rapidly Progressive Neurological Decline
Authors: Rishi Abdul R. , Garland Katherine , Logan William 
Published: July 2020

Abstract
Creutzfeldt-Jakob disease is the most common human prion disease. Because of rarity and heterogeneous clinical presentation, the diagnosis is difficult. We describe a very intriguing case of progressive neurological decline where the patient initially presented to the primary care physician and was ultimately diagnosed with Creutzfeldt-Jakob disease in a community hospital setting. We have highlighted the difficulties in diagnosing this uniformly fatal condition and its potential transmission from animals.
A Novel Case of Life-Threatening Thrombocytopenia Secondary to Anaplasmosis
Authors: Keltner Case 
Published: July 2020

Abstract
This case report discusses an atypical presentation of anaplasmosis characterized by severe, potentially life-threatening thrombocytopenia. From the case and the ensuing discussion, medical professionals should appreciate the growing incidence of anaplasmosis across the country, as well as its potential to provoke profound hematologic disturbances in humans.
Physicians' Counseling on Toxoplasma gondii Prepregnancy Screening Tests
Authors: Sanei Zahra , Sheybani Fereshte , Eslami Saeid , Naderi HamidReza , Taherzadeh Zhila , Vatanchi Atiyeh Mohammadzadeh , Varzandeh Marjan 
Published: July 2020

Objective
The aim of the study was to evaluate the ability of obstetrics and gynecologists about interpretation and counseling regarding Toxoplasma gondii prepregnancy screening tests.

Methods
This research was a simulation-based study that was conducted using simulated patients from April 2018 to March 2019 in Mashhad, Iran. Cluster sampling of practicing obstetricians and gynecologists (OBGYNs) was performed by municipal districts. In this study, 2 scenarios were constructed to address the approach to a T. gondii seronegative (both IgG and IgM were negative) and seropositive (IgG was positive, and IgM was negative) women who are planning to become pregnant in scenario 1 and scenario 2, respectively.

Results
With regard to scenario 1, T. gondii serological tests in seronegative individuals were correctly interpreted by approximately 90% of OBGYNs. However, in less than 10% of cases, counseling regarding Toxoplasma infection prevention was performed, most of which were not performed appropriately. With regard to scenario 2, the interpretation of test results was performed correctly by 80% of OBGYNs of whom almost 80% followed by appropriate counseling. Except for the relationship between T. gondii infection and cats as well as risk of abortion, level of physicians' knowledge regarding toxoplasmosis was estimated to be inadequate.

Conclusions
Although it has been shown that physicians play an important role in raising awareness of toxoplasma-seronegative pregnant women about appropriate preventive measures, according to the results of our study, most T. gondii seronegative women who plan to become pregnant do not receive any consultation about the importance of following preventive measures, and in a minority of them, only avoidance of cat exposure is emphasized. Insufficient knowledge of providers was identified regarding immunopathogenesis of toxoplasmosis, preventive measures, interpretation of T. gondii serological test results, and optimal approach to the T. gondii prepregnancy serological test results that emphasizes on the importance of more effective education in these areas of knowledge and practice.
Antidepressant Augmentation
Authors: Catalano Glenn , Robeel Rhonda A. , Cheney Grace A. , Spurling Benjamin C. , Catalano Maria C. , Schultz Susan K. , Sanchez Deborah L. 
Published: July 2020

Purpose
Antidepressant augmentation strategies for treatment-resistant depression (TRD) are discussed here with an analysis of patient out-of-pocket costs for various medications. The choice of agent ranges from newer atypical antipsychotics (aripiprazole, brexpiprazole, quetiapine) to older agents including buspirone, liothyronine (T3), and lithium. We sought to better understand the differences among these agents to aid in clinical decision making.

Methods
We conducted a focused review of the support for each of the aforementioned agents in antidepressant augmentation. We then compared the approximate out-of-pocket cost for each medication during a typical augmentation trial using the typical prescription costs on ClinCalc.com derived from the Medical Expenditure Panel Survey. We calculated the cost to achieve response for one patient with TRD based on the number needed to treat (NNT).

Findings
We observed significant variance in cost to achieve response based on the NNT derived from our review of each of the medications. For example, the overall out-of-pocket cost for one patient to achieve response with aripiprazole (the costliest generic agent) could cover lithium prescriptions for 4 to 5 patients with TRD to achieve response. Although brexpiprazole was estimated separately because of its brand name cost, we estimated that 324 patients receiving lithium could achieve response for same cost of single patient receiving brexpiprazole.

Implications
These findings suggest that among augmentation agents, there are differences in cost that may be highly important in clinical decision making. Other issues of medication monitoring may incur additional costs, and brand name medications offer significantly greater complexity and potential out-of-pocket costs to patients. The use of lithium as a first-line agent for TRD should be considered based on low cost, lowest NNT, and data in support of its efficacy.
Vortioxetine on Cognition in Schizophrenia
Authors: Bruno Antonio , Zoccali Rocco Antonio , Troili Giulia Maria , Scala Loredana , Pandolfo Gianluca , Cedro Clemente , Mento Carmela , Santoro Vincenza , Spina Edoardo , Muscatello Maria Rosaria Anna 
Published: July 2020

Background
Given the wide implications of cognitive impairment for prognosis and outcome in schizophrenia, the research on pharmacological approaches aimed at addressing dysfunctional cognition has been extensive; nevertheless, there are no currently available licensed drugs, and the evidence in this field is still unimpressive. Vortioxetine is a multimodal antidepressant, which has been proposed as a suitable treatment option for cognitive symptoms in depression.

Methods
Twenty schizophrenia outpatients (mean age ± SD, 40.7 ±10.6 years) on stable clozapine treatment, assessed by neuropsychological (Wisconsin Card Sorting Test, Verbal Fluency, and Stroop task) and psychodiagnostic instruments (Positive and Negative Syndrome Scale [PANSS] and Calgary Depression Scale for Schizophrenia), received vortioxetine at the single daily dose of 10 mg/d until week 12; the dose was increased at 20 mg/d afterward, and this dosage was maintained unchanged until week 24. A physical examination, electrocardiogram with QTc measurement, and laboratory tests were also performed.

Results
Vortioxetine supplementation significantly improved Stroop test (P = 0.013) at week 12 and Stroop test (P = 0.031) and Semantic Fluency (P = 0.002) at end point. Moreover, a significantly reduction of PANSS domains “positive” (P = 0.019) at week 12 and of PANSS domains positive (P = 0.019) and total score (P = 0.041) and of depressive symptoms (Calgary Depression Scale for Schizophrenia, P = 0.032) at end point. There was no significant change in clinical, metabolic, and safety parameters, and no subject spontaneously reported adverse effects.

Conclusions
Despite the limitations (open design, lack of a control group, small sample size, and short intervention period), our findings suggest for the first time that vortioxetine augmentation of clozapine may be a promising therapeutic strategy for addressing cognitive deficits in patients with schizophrenia.
Machine learning methods in organ transplantation
Authors: Guijo-Rubio David , Gutiérrez Pedro Antonio , Hervás-Martínez César 
Published: July 2020

Purpose of review
Machine learning techniques play an important role in organ transplantation. Analysing the main tasks for which they are being applied, together with the advantages and disadvantages of their use, can be of crucial interest for clinical practitioners.

Recent findings
In the last 10 years, there has been an explosion of interest in the application of machine-learning techniques to organ transplantation. Several approaches have been proposed in the literature aiming to find universal models by considering multicenter cohorts or from different countries. Moreover, recently, deep learning has also been applied demonstrating a notable ability when dealing with a vast amount of information.

Summary
Organ transplantation can benefit from machine learning in such a way to improve the current procedures for donor--recipient matching or to improve standard scores. However, a correct preprocessing is needed to provide consistent and high quality databases for machine-learning algorithms, aiming to robust and fair approaches to support expert decision-making systems.
Fumarate Hydratase–Deficient Renal Cell Carcinoma: A Review
Authors: Chen Diane A. , Virk Renu K. 
Published: July 2020

Abstract
Fumarate hydratase (FH)–deficient renal cell carcinoma (RCC) has emerged in recent years as a subtype of renal tumors that show diverse morphologic patterns with predominance of papillary architecture. Most of these tumors show high-grade cytologic features and at least focally prominent eosinophilic macronucleoli with perinuclear halos. Infrequently, these tumors show low-grade oncocytic cytologic features. Fumarate hydratase–deficient RCCs are characterized by inactivating FH gene mutations resulting in FH loss and 2-succinocysteine [2SC] accumulation, demonstrable by immunohistochemistry. A vast majority of these tumors occur in the setting of hereditary leiomyomatosis and RCC syndrome. Fumarate hydratase–deficient RCCs show slight male preponderance and present at relatively younger age. These tumors are often locally advanced at the time of presentation. Prospective recognition of these tumors upon histologic examination is of paramount importance not only for the appropriate management of the patient but also for a potential to detect undiagnosed hereditary leiomyomatosis and RCC syndrome in at-risk family members.
Efficacy of Botulinum Toxin in Treating Lateral Epicondylitis—Does Injection Location Matter?
Authors: Song Bo , Day Derek , Jayaram Prathap 
Published: July 2020

Objective
Clinical trials assessing the efficacy of botulinum toxin in treating recalcitrant lateral epicondylitis have demonstrated varied results and differed greatly in methodology. The objective of this systematic review was to demonstrate injection location as a significant contributor to outcome heterogeneity.

Design
Two reviewers independently conducted a systematic review using Scopus, Embase, and PubMed for randomized controlled trials assessing botulinum toxin in the treatment of lateral epicondylitis. After applying inclusion/exclusion criteria to abstracts and reviewing the full-text articles, seven studies were found representing six separate injection locations. Reduction in visual analog scale pain and change in grip strength were the principal outcomes of interest.

Results
The largest reduction in pain was seen in injection at 1/3 of the length of the forearm from the lateral epicondyle at 16-wk follow-up, whereas the smallest reduction was seen at 12-wk follow-up after injection at the 0-cm mark. Differences were also identified in grip strength, although all studies reported return to baseline strength by weeks 12–18.

Conclusions
This study demonstrates injection location as a potential source of heterogeneity. This clinical question warrants further evaluation with direct comparison of outcomes at different injection locations while controlling for dosage, toxin type, and ultrasound/electromyographic guidance.
A Rare Case of Nontraumatic Thoracic Compression Fracture in a 28-Year-Old Man
Authors: Donohue Nicholas K. , Braza Diane W. 
Published: July 2020

Abstract
A 28-yr-old African American man with a history of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome, tobacco use, and sickle cell trait was referred to a physiatrist at a multidisciplinary spine center with a 1-yr history of nontraumatic thoracic back pain that had significantly worsened over the previous 4 wks. In the context of recurrent infections requiring hospital admissions and the patient’s immunosuppressed status, magnetic resonance imaging of his thoracic spine was obtained, showing an acute or subacute anterior compression deformity of the T7 vertebral body. He was subsequently provided with a hyperextension brace, physical therapy referral, and a trial of intranasal calcitonin. The patient reported significant improvement in pain at his 3-mo follow-up appointment and continued to show pain and functional improvement in physical therapy sessions up to 6 mos later.
Peripheral Neuropathy in the Lower Limbs of Individuals With Spinal Cord Injury or Disease
Authors: Liang Jason , Furlan Julio C. 
Published: July 2020

Purpose
This study investigated the frequency and types of peripheral neuropathy in the lower limbs of patients undergoing rehabilitation after traumatic spinal cord injury or spinal cord disease.

Methods
This study included consecutive patients with spinal cord injury/spinal cord disease who had electrophysiological assessments during their admission in a rehabilitation center from October 2015 to July 2019. Patients with traumatic spinal cord injury were compared with patients with nontraumatic spinal cord disease.

Results
There were 67 patients (52 male patients, 15 female patients; mean age = 56.5 yrs) of whom 36 patients had spinal cord injury and 31 patients had spinal cord disease. Most of the patients were middle-aged men with at least one preexisting medical comorbidity, who were mostly admitted for rehabilitation of cervical, incomplete spinal cord injury/spinal cord disease. Most patients (86.6%) had abnormal electrophysiological studies representing 5.57% of all admissions. A length-dependent polyneuropathy was diagnosed in 0.77% of all admissions (n = 8). The group of patients with spinal cord injury was comparable with the group of patients with spinal cord disease regarding the other baseline data, clinical, and electrophysiological findings.

Conclusions
Diseases of the peripheral nervous system were similarly found among patients undergoing rehabilitation for either spinal cord injury or spinal cord disease. A length-dependent polyneuropathy was diagnosed in 0.77% of all admissions. Timely diagnosis and proper treatment of the cause of peripheral neuropathies in the lower limbs in these patients may potentially influence rehabilitation protocols and improve patient outcomes.