bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infrequent Monitoring of the Effects of Valproate and Carbamazepine Therapy in Patients With Epilepsy in Nigeria
Authors: Eshiet Unyime Israel , Ubaka Chukwuemeka Michael , Ukwe Chinwe Victoria 
Published: June 2020

Background:Carbamazepine and valproate are widely used in the treatment of epileptic seizures. However, these agents exhibit certain adverse effects including hematopoietic disorders (carbamazepine) and severe hepatotoxicity (valproate).Purpose:To determine the extent of monitoring of the hematologic effects of carbamazepine as well as the extent of monitoring of the hepatic effects of valproate in patients with epilepsy receiving treatment with these agents.Method:A cross-sectional antiepileptic drug use study using case notes of patients with epilepsy managed at the neurologic clinics of 2 tertiary medical facilities in Nigeria between January and December 2017.Results:Carbamazepine was the most frequently prescribed antiepileptic drug (48.24%), followed by valproate (29.34%) and levetiracetam (9.24%). Pretreatment monitoring of hematologic effect was carried out in only 61.11% of patients placed on carbamazepine therapy while follow-up monitoring was done in 3.7% of these patients. Also, in patients placed on valproate therapy, pretreatment and follow-up monitoring of the hepatic effect was done in only 33.71% and 19.0% of the patients, respectively.Conclusions:The extent of monitoring of the hematologic effects of carbamazepine, as well as the hepatic effects of valproate in the cohort studied, is poor.
Recruiting African American parents of school-aged children in a physical activity study: Lessons learned
Authors: Webber-Ritchey Kashica J , Taylor-Piliae Ruth E , Loescher Lois J 
Published: June 2020

Objectives To describe the recruitment strategies and lessons learned when enrolling African American parents/caregivers of school-aged children (ages 6–12 years) in an online survey of physical activity. With physical activity serving as a modifiable behavioral risk factor for several chronic diseases (obesity and cardiovascular diseases), little is understood regarding the influences on African Americans’ physical activity participation to develop culturally appropriate physical activity interventions. Gaining a better understanding of physical activity influences is possible through research, yet recruiting and enrolling African Americans in health research is a challenge. Methods Over a three-month period, a multidimensional approach (distribution of flyers, community partnerships, network sampling, African American researcher, effective communication, and data collection procedures) was used for study recruitment. Results We exceeded our recruitment goal of 105 participants. A total of 127 African American parent/caregivers of school-aged children enrolled, which included both females/mothers ( n = 87, 69%) and males/fathers ( n = 40, 31%). Network sampling was the single most effective recruitment strategy for reaching this population. Lessons learned in this study includes considering participant burden and their comfort with technology, as well as gaining community trust. Discussion Lessons learned in recruiting African American parents provides a guide for future research. Efforts are needed to further increase the representation of African American males in health research.
Downregulation of GRK6 in arcuate nucleus promotes chronic visceral hypersensitivity via NF-κB upregulation in adult rats with neonatal maternal deprivation
Authors: Li Xin , Xu Yu-Cheng , Tian Yuan-Qin , Zhang Ping-An , Hu Shu-Fen , Wang Lin-Hui , Jiang Xing-Hong , Xu Guang-Yin 
Published: June 2020

Aims The arcuate nucleus is a vital brain region for coursing of pain command. G protein-coupled kinase 6 (GRK6) accommodates signaling through G protein-coupled receptors. Studies have demonstrated that GRK6 is involved in inflammatory pain and neuropathic pain. The present study was designed to explore the role and the underlying mechanism of GRK6 in arcuate nucleus of chronic visceral pain. Methods Chronic visceral pain of rats was induced by neonatal maternal deprivation and evaluated by monitoring the threshold of colorectal distension. Western blotting, immunofluorescence, real-time quantitative polymerase chain reaction techniques, and Nissl staining were employed to determine the expression and mutual effect of GRK6 with nuclear factor κB (NF-κB). Results Expression of GRK6 in arcuate nucleus was significantly reduced in neonatal maternal deprivation rats when compared with control rats. GRK6 was mainly expressed in arcuate nucleus neurons, but not in astrocytes, and a little in microglial cells. Neonatal maternal deprivation reduced the percentage of GRK6-positive neurons of arcuate nucleus. Overexpression of GRK6 by Lentiviral injection into arcuate nucleus reversed chronic visceral pain in neonatal maternal deprivation rats. Furthermore, the expression of NF-κB in arcuate nucleus was markedly upregulated in neonatal maternal deprivation rats. NF-κB selective inhibitor pyrrolidine dithiocarbamate suppressed chronic visceral pain in neonatal maternal deprivation rats. GRK6 and NF-κB were expressed in the arcuate nucleus neurons. Importantly, overexpression of GRK6 reversed NF-κB expression at the protein level. In contrast, injection of pyrrolidine dithiocarbamate once daily for seven consecutive days did not alter GRK6 expression in arcuate nucleus of neonatal maternal deprivation rats. Conclusions Present data suggest that GRK6 might be a pivotal molecule participated in the central mechanisms of chronic visceral pain, which might be mediated by inhibiting NF-κB signal pathway. Overexpression of GRK6 possibly represents a potential strategy for therapy of chronic visceral pain.
Switching from omalizumab to mepolizumab: real-life experience from Southern Italy
Authors: Carpagnano Giovanna Elisiana , Pelaia Corrado , D’Amato Maria , Crimi Nunzio , Scichilone Nicola , Scioscia Giulia , Resta Onofrio , Calabrese Cecilia , Pelaia Girolamo , Quarato Carla Maria Irene , Foschino Barbaro Maria Pia 
Published: June 2020

Background: Current availability of several biologic treatments for severe asthma makes it possible to choose the most appropriate for each patient. Sometimes a good percentage of patients with severe asthma may be eligible for biologics that target either the allergic phenotype or the eosinophilic one, but not all respond to that selected as first choice. The aim of our real-life study was to assess whether, for patients with severe eosinophilic allergic asthma, not previously controlled by the anti-IgE omalizumab, the shift to another biologic targeting interleukin-5, such as mepolizumab, may represent a good therapeutic choice. Methods: A total of 41 consecutive patients with severe, persistent allergic, eosinophilic asthma, uncontrolled despite treatment with omalizumab, were enrolled in seven certified Clinical Respiratory Units of Southern Italy (Catania, Catanzaro, Foggia, Bari, Palermo, and two University Respiratory Units of Naples) and shifted to mepolizumab without a wash-out period. Data at baseline, after at least 12 months of therapy with omalizumab, and after at least 12 months of treatment with mepolizumab were collected. Results: After at least 12 months of therapy with mepolizumab, patients experienced a significant decrease in the number of exacerbations/year (5.8 ± 1.8 versus 0.7 ± 0.9, p < 0.0001), an increment of asthma control test score (12 ± 2.7 versus 21.9 ± 2.7, p < 0.0001), an increase in pre-bronchodilator forced expiratory volume in 1 s (1.56 ± 0.45 l versus 1.86 ± 0.52 l, p < 0.0001), and a reduction of blood eosinophils (584 ± 196 cells/µl versus 82 ± 56 cells/µl, p < 0.0001). The percentage of patients who were dependent on corticosteroids significantly decreased from 46% at baseline to 5% during treatment with mepolizumab. Conclusion: Results of our real-life multicentric experience confirms that the shift to mepolizumab could be a good therapeutic strategy in severe eosinophilic allergic asthma not previously controlled by omalizumab. The reviews of this paper are available via the supplemental material section.
Mechanical heart valves and pregnancy: Issues surrounding anticoagulation. Experience from two obstetric cardiac centres
Authors: Dos Santos Francois , Baris Lucia , Varley Alice , Cornette Jerome , Allam Joanna , Steer Philip , Swan Lorna , Gatzoulis Michael , Roos-Hesselink Jolien , Johnson Mark R 
Published: June 2020

Background Pregnant women with mechanical heart valves are at significant risk of obstetric/cardiac complications. This study compares the anticoagulation management in two obstetric cardiac centres. Methods Retrospective case-note review from Chelsea and Westminster/Royal Brompton Hospitals (CR) and Erasmus Medical Centre (EMC). Main outcome measure was mechanical heart valve thrombosis. Results Nineteen pregnancies from CR and 25 pregnancies from EMC were included. Most women were on low-molecular-weight heparin (LMWH) throughout pregnancy at CR, whereas at EMC most had LMWH in the first trimester and vitamin K antagonists in subsequent trimesters. Peak anti-factor Xa were performed monthly at CR, levels 0.39–1.51 IU/mL (mean 0.82 IU/mL). Anticoagulation management peri-partum was inconsistent. Delivery was mainly by caesarean section at CR (74%) and vaginal delivery at EMC (64%). No maternal deaths and only one mechanical heart valve thrombosis at CR. Two mechanical heart valve thromboses and one maternal death at EMC. Conclusion Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.
Body mass index and outcomes in ischaemic versus non-ischaemic heart failure across the spectrum of ejection fraction
Authors: Gentile Francesco , Sciarrone Paolo , Zamora Elisabet , De Antonio Marta , Santiago Evelyn , Domingo Mar , Aimo Alberto , Giannoni Alberto , Passino Claudio , Codina Pau , Bayes-Genis Antoni , Lupon Josep , Emdin Michele , Vergaro Giuseppe 
Published: June 2020

Abstract

Aims
Obesity is related to better prognosis in heart failure with either reduced (HFrEF; left ventricular ejection fraction (LVEF) &lt; 40%) or preserved LVEF (HFpEF; LVEF ≥50%). Whether the obesity paradox exists in patients with heart failure and mid-range LVEF (HFmrEF; LVEF 40–49%) and whether it is independent of heart failure aetiology is unknown. Therefore, we aimed to test the prognostic value of body mass index (BMI) in ischaemic and non-ischaemic heart failure patients across the whole spectrum of LVEF.

Methods
Consecutive ambulatory heart failure patients were enrolled in two tertiary centres in Italy and Spain and classified as HFrEF, HFmrEF or HFpEF, of either ischaemic or non-ischaemic aetiology. Patients were stratified into underweight (BMI &lt; 18.5 kg/m2), normal-weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), mild-obese (BMI 30–34.9 kg/m2), moderate-obese (BMI 35–39.9 kg/m2) and severe-obese (BMI ≥40 kg/m2) and followed up for the end-point of five-year all-cause mortality.

Results
We enrolled 5155 patients (age 70 years (60–77); 71% males; LVEF 35% (27–45); 63% HFrEF, 18% HFmrEF, 19% HFpEF). At multivariable analysis, mild obesity was independently associated with a lower risk of all-cause mortality in HFrEF (hazard ratio, 0.78 (95% confidence interval (CI) 0.64–0.95), p = 0.020), HFmrEF (hazard ratio 0.63 (95% CI 0.41–0.96), p = 0.029), and HFpEF (hazard ratio 0.60 (95% CI 0.42–0.88), p = 0.008). Both overweight and mild-to-moderate obesity were associated with better outcome in non-ischaemic heart failure, but not in ischaemic heart failure.

Conclusions
Mild obesity is independently associated with better survival in heart failure across the whole spectrum of LVEF. Prognostic benefit of obesity is maintained only in non-ischaemic heart failure.
Impact of environmental pollution and weather changes on the incidence of ST-elevation myocardial infarction
Authors: Biondi-Zoccai Giuseppe , Frati Giacomo , Gaspardone Achille , Mariano Enrica , Di Giosa Alessandro D , Bolignano Andrea , Dei Giudici Angela , Calcagno Simone , Scappaticci Massimiliano , Sciarretta Sebastiano , Valenti Valentina , Casati Rebecca , Visconti Giuseppe , Penco Maria , Giannico Maria B , Peruzzi Mariangela , Cavarretta Elena , Budassi Simone , Cosma Joseph , Federici Massimo , Roever Leonardo , Romeo Francesco , Versaci Francesco 
Published: June 2020

Abstract

Background
Environmental pollution and weather changes unfavorably impact on cardiovascular disease. However, limited research has focused on ST-elevation myocardial infarction (STEMI), the most severe yet distinctive form of acute coronary syndrome.

Methods and results
We appraised the impact of environmental and weather changes on the incidence of STEMI, analysing the bivariate and multivariable association between several environmental and atmospheric parameters and the daily incidence of STEMI in two large Italian urban areas. Specifically, we appraised: carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NOX), ozone, particulate matter smaller than 10 μm (PM10) and than 2.5 μm (PM2.5), temperature, atmospheric pressure, humidity and rainfall. A total of 4285 days at risk were appraised, with 3473 cases of STEMI. Specifically, no STEMI occurred in 1920 (44.8%) days, whereas one or more occurred in the remaining 2365 (55.2%) days. Multilevel modelling identified several pollution and weather predictors of STEMI. In particular, concentrations of CO (p = 0.024), NOX (p = 0.039), ozone (p = 0.003), PM10 (p = 0.033) and PM2.5 (p = 0.042) predicted STEMI as early as three days before the event, as well as subsequently, and NO predicted STEMI one day before (p = 0.010), as well as on the same day. A similar predictive role was evident for temperature and atmospheric pressure (all p &lt; 0.05).

Conclusions
The risk of STEMI is strongly associated with pollution and weather features. While causation cannot yet be proven, environmental and weather changes could be exploited to predict STEMI risk in the following days.
Educating for Comprehensive Well-being
Authors: Wortham Stanton , Love-Jones Renata , Peters William , Morris Stacy , García-Huidobro Juan Cristóbal 
Published: June 2020

Purpose: Educational approaches that advocate “well-being,” the “whole child,” “social and emotional learning,” “character,” and the like emphasize human development beyond the acquisition of knowledge and skills. These approaches vary widely in their views of human nature, their visions of a good life, and their prescriptions for educational practice. This article maps out heterogeneous contemporary approaches to “well-being” and related constructs, thereby allowing researchers, educators, and policymakers to understand the divergent assumptions made by the proliferating approaches to education that go beyond academics. Design/Approach/Methods: This article presents results from a 2-year project, which included interviews with advocates of different approaches and review of key literature about eleven educational approaches to “well-being,” the “whole child,” “social and emotional learning,” “character,” and similar noncognitive ends. Findings: The article argues that any educational approach to “well-being” and related constructs must respond to four questions: whether humans are bundles of discrete competencies or integrated wholes, what the appropriate relation is between individuals and society, the relative importance of instrumental and intrinsic goals, and the importance of an overarching purpose for one’s life. The analysis reviews how eleven contemporary approaches address these four questions. Originality/Value: Despite the global proliferation of divergent approaches to “well-being,” the “whole child,” “social and emotional learning,” “character,” and related constructs in education, there are no comprehensive frameworks for understanding the alternatives and their key assumptions. This article organizes the globally proliferating educational movements that promote “well-being,” making sense of a confusing set of alternatives. We also argue that any comprehensive approach to education that goes beyond academics must consider the four questions that we identify.
Somatotype of Santal Tribal Women of West Bengal in India
Authors: Adhikari Anup , Dash Keya 
Published: June 2020

Sixty-four Santal tribal women from Paschim Medinipur district, West Bengal, India, were studied for their somatotype. The studied women were with an average age of 32.5 ± 11.6 years with a wide age range of 16–70. Average height was 150.2 (±5.2) cm. Heath–Carter method (1967) was followed for somatotyping. Average somatotype of the studied Santal women was 3.9 (±1.5) – 4.1 (1.1) – 2.9 ± (1.7). A total of 16–20 year age group had an average somatotype of 3.7 (±1.0) – 3.3 (±0.7) – 3.4 (±1.5), whereas that of 21–30 had an average somatotype of 3.4 (±1.2) – 3.7 (±1.0) – 3.9 (±1.5). A total of 31–40 year age group were more mesomorphic with an average somatotype of 4.4 (±1.6) – 4.4 (±1.2) – 2.1 (±1.7). Mesomorphy component increased as the Santal women grew up. The women from age group 41 to 50 year had an average somatotype of 4.0 (±1.6) – 4.6 (±1.1) – 1.9 (±1.3), whereas that of older women of 51–70 year age group were more mesomorphic with an average value of 5.0 (±1.9) – 5.1 (±0.7) – 1.7 (±0.7). Thus, muscularity of the Santal women increased as age increased. This was due to their changed lifestyle from young age to older age where older had to do more physical work than the young adults. Thus, well-built muscular body type of Santal women was an adaptation for hard physical work for survival.
Thoracic lymphadenopathy as possible predictor of the onset of interstitial lung disease in systemic sclerosis patients without lung involvement at baseline visit: A retrospective analysis
Authors: Rotondo Cinzia , Urso Livio , Praino Emanuela , Cacciapaglia Fabio , Corrado Addolorata , Cantatore Francesco Paolo , Iannone Florenzo 
Published: June 2020

Objective: To evaluate clinical, laboratory, or radiographic predictors of the onset of interstitial lung disease in systemic sclerosis. Methods: Sixty-five out of 220 systemic sclerosis outpatients, without interstitial lung disease at baseline and with ⩾3 chest high resolution computed tomography scans during follow-up were recruited. Thoracic lymphadenopathy and interstitial lung disease were assessed by chest high resolution computed tomography. Hazard ratio (95% confidence interval) of interstitial lung disease occurrence was assessed by Cox regression models, adjusting patient’s demographics and disease characteristics. Sensitivity, specificity, and accuracy of the interstitial lung disease predictors were evaluated by receiver operating characteristic analysis. Results: The development of interstitial lung disease was observed in 44/65 (68%) patients. Thoracic lymphadenopathies was detected in 40/65 (61%) patients, of whom 36 (82%) developed interstitial lung disease, but only four patients with thoracic lymphadenopathies did not develop ILD at last visit of follow-up (19%) (p = 0.0001). Adjusted hazard ratio of systemic sclerosis-interstitial lung disease onset was 5.8 (95% confidence interval, 2.0–16.5) for thoracic lymphadenopathy, which preceded by 108 ± 98 weeks the systemic sclerosis-interstitial lung disease detection. Thoracic lymphadenopathy had 84% specificity, 81% sensitivity, and 0.82 accuracy to predict interstitial lung disease. In particular, anticentromere antibodies or limited cutaneous subset of systemic sclerosis patients with thoracic lymphadenopathy showed earlier interstitial lung disease onset than those without lymphadenopathy. In addition, patients who developed interstitial lung disease had higher frequency of anti-Scl-70 (57% vs 19%; p = 0.009) and diffuse cutaneous subset (29% vs 3%; p = 0.02) than those who did not. Conclusions: Thoracic lymphadenopathy was the strongest independent predictor of systemic sclerosis-interstitial lung disease, mostly in anticentromere antibodies and limited cutaneous subset of systemic sclerosis patients. Further prospective studies are needed to confirm our preliminary data and to understand whether thoracic lymphadenopathies may have a pathogenetic role in interstitial lung disease development.
Ultrasound‐Guided Fine‐Needle Biopsy of First 1000 Consecutive Thyroid Nodules: Single‐Surgeon Experience
Authors: Dhingra Jagdish K. 
Published: June 2020

ObjectiveTo study the feasibility, safety, and learning curve of ultrasound‐guided fine‐needle biopsy (USGFNB) performed by a newly trained otolaryngologist in a community office in a setting.Study DesignCollect USGFNB data of all thyroid nodules in a prospective manner.SettingA dedicated ultrasound clinic in a large community‐based practice, operated by a single surgeon with the purpose of providing office‐based point‐of‐care diagnostic ultrasonography and USGFNB.Subjects and MethodsData on the first 1000 unselected consecutive thyroid nodules that underwent USGFNB over a 3‐year period were analyzed. Chi‐square analysis was used to assess the statistical significance of characteristics of diagnostic vs nondiagnostic nodules. A multivariate regression analysis was conducted to determine nodule characteristics predictive of adequate sampling. Diagnostic yield and time efficiency data were plotted over a 3‐year period to study the learning curve for the USGFNB procedure performed by an operator with no previous experience.ResultsA total of 1000 nodules in 734 patients including 142 males and 592 females (age range, 17‐87 years) were studied. Of the patients, 188 of 734 had more than 1 nodule biopsied, with a maximum of 4 nodules biopsied in 1 setting. The procedure was successfully completed in all patients, with no major complications. A steep learning curve was observed, and adequate samples were obtained in 91.9% of the patients on the first attempt. The cystic nature of the nodule was the biggest predictor of a nondiagnostic yield.ConclusionsOtolaryngologist‐performed USGFNB of the thyroid is safe, effective, and desirable.
New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2019
Authors: Rameau Anais , Hong Robert Stephen , Djalilian Hamid , Erbele Isaac David , Phillips Katie M. , Capasso Robson , Rose Austin S. , Brenner Michael Joel , Santa Maria Peter Luke 
Published: June 2020

ObjectiveTo review new devices and drugs relevant to otolaryngology–head and neck surgery that were approved by the US Food and Drug Administration (FDA) in 2019.Data SourcesApproval notifications for 2019 were extracted from the ENT (ear, nose, and throat) and general and plastic surgery sections of the FDA’s medical devices and therapeutics listings.Review MethodsNew therapeutics and medical devices identified from the query were analyzed by members of the American Academy of Otolaryngology–Head and Neck Surgery’s Medical Devices and Drugs Committee. Technologies were assessed by 2 independent reviewers to ascertain relevance to otolaryngology, prioritized, and classified to subspecialty field with critical review based on extant scientific literature.ConclusionsQuery of the FDA drug and device database returned 105 ENT devices (50 cleared, 55 with premarket approval, and 0 de novo), 543 general and plastic surgery devices (372 cleared, 170 with premarket approval, and 1 de novo), and 46 new otolaryngology‐relevant drug approvals that occurred in 2019. Advances spanned all subspecialty areas with otology predominating, primarily due to hearing‐related technologies. While scientific evidence was available for all new devices, there was significant heterogeneity in rigor of supporting scientific data.Implications for PracticeTechnological and pharmaceutical innovation is an important catalyst for advances in the surgical specialties. Familiarity with new devices and therapeutics in otolaryngology–head and neck surgery ensures that clinicians keep abreast of developments with potential to improve prevailing standards of care.