bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acupuncture for knee osteoarthritis with sensitized acupoints: results from a pilot, feasibility randomized controlled trial
Authors: Jia Pengli , Liu Jiali , Li Ling , Luo Yanan , Li Ying , Zhao Ling , Liang Fanrong , Liu Zhibin , Zou Kang , Tang Li , Sun Xin 
Published: September 2020

Abstract
Background
Although previous clinical studies suggest possible benefits of acupuncture for knee osteoarthritis (KOA), the value of acupuncture at sensitized points is uncertain. We aimed to preliminarily assess the feasibility of performing a definitive randomized controlled trial to explore the effectiveness of acupuncture for KOA with highly sensitized acupoints.

Methods
In this randomized, single-blind, parallel, pilot trial, 36 participants with KOA were randomly assigned to receive acupuncture at highly sensitized acupoints (high-sensitization group) or at low/non-sensitized points (low/non-sensitization group) by a computer-generated random sequence. Both groups received three treatment sessions per week for four consecutive weeks (12 sessions in total). Assessments were performed at screening and at 4, 8, 12, and 16 weeks after randomization. Primary feasibility outcomes were patient recruitment, retention rate, and adherence to group treatment. Secondary outcomes included the change of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score from baseline to 16 weeks, the change of Short Form (SF)-12 health survey score, and safety outcomes.

Results
Patient recruitment of 36 patients took 2 months, achieving the recruitment target. Retention rates were similar between the treatment groups, 14 (77.8%) patients in the high-sensitization group completed the 16-week follow-up and compared to 14 (77.8%) patients in low/non-sensitization group, but the result was lower than expected. All patients received at least ten treatment sessions in total. The WOMAC total score and the pain, stiffness, and physical function score in the high-sensitization group were lower or very close to those in the control group at each assessment point. Similar results were observed on quality of life. No adverse events occurred.

Conclusion
This trial has presented preliminary data on the feasibility of conducting a large trial to test the effectiveness of acupuncture at sensitized points in KOA patients.

Trial registration
ClinicalTrials.gov, NCT03008668. Registered on 26 December 2016—retrospectively registered.
Single arm prospective multicenter case series on the use of burst stimulation to improve pain and motor symptoms in Parkinson’s disease
Authors: Chakravarthy Krishnan V. , Chaturvedi Rahul , Agari Takashi , Iwamuro Hirokazu , Reddy Rajiv , Matsui Ayano 
Published: September 2020

Abstract
Background
In this study we analyze new clinical data in the use of spinal cord stimulation (SCS) for the treatment of pain and motor symptoms in patients with Parkinson’s Disease (PD), as both a singular bioelectric therapy and as a salvage therapy after deep brain stimulation (DBS).

Methods
Fifteen patients were recruited and had percutaneous electrodes implanted at the level of the thoracic or cervical spine. Participants were set to one of three stimulation modes: continuous tonic stimulation, continuous Burst stimulation (40 Hz, 500 Hz, 1000 μs), or cycle mode (on time of 10–15 s, off time of 15–30 s) with Burst (40 Hz, 500 Hz, 1000 μs). Patients completed the Visual Analogue Scale (VAS), Unified Parkinson’s Disease Rating Scale, Self-Rating Depression Scale, Hamilton Depression Rating Scale, Profile of Mood State, 10-meter walking test, and the Timed Up and Go (TUG).

Results
All patients experienced significant improvement in VAS scores with a mean reduction of 59% across all patients. Patients who chose the cycling burst stimulation parameter had an average 67% reduction in VAS scores, as compared to the continuous burst parameter group, which had an average 48% reduction in VAS scores. Seventy-three percent of patients experienced improvement in the 10-meter walk, with an average improvement of 12%. Sixty-four percent of patients experienced clinically relevant improvements in the TUG, with an average improvement of 21%.

Conclusions
This study points to the potential utility of SCS to address both pain and certain aspects of motor symptoms in PD patients who have and have not received DBS therapy.
Predicting implementation: comparing validated measures of intention and assessing the role of motivation when designing behavioral interventions
Authors: Fishman Jessica , Lushin Viktor , Mandell David S. 
Published: September 2020

Abstract
Background
Behavioral intention (which captures one’s level of motivation to perform a behavior) is considered a causal and proximal mechanism influencing the use of evidence-based practice (EBP). Implementation studies have measured intention differently, and it is unclear which is most predictive. Some use items referring to “evidence-based practice” in general, whereas others refer to a specific EBP. There are also unresolved debates about whether item stems should be worded “I intend to,” “I will,” or “How likely are you to” and if a single-item measure can suffice. Using each stem to refer to either a specific EBP or to “evidence-based practice,” this study compares the ability of these commonly used measures to predict future EBP implementation. The predictive validity is important for causal model testing and the development of effective implementation strategies.

Methods
A longitudinal study enrolled 70 teachers to track their use of two EBPs and compare the predictive validity of six different items measuring teachers’ intention. The measures differ by whether an item refers to a specific EBP, or to “evidence-based practices” in general, and whether the stem is worded in one of the three ways: “I intend to,” “I will,” or “How likely are you to.” For each item, linear regressions estimated the variance in future behavior explained. We also compared the predictive validity of a single item versus an aggregate of items by inter-correlating the items using different stems and estimating the explained variance in EBP implementation.

Results
Depending on the EBP and how intention was measured, the explained variance in implementation ranged from 3.5 to 29.0%. Measures that referred to a specific EBP, rather than “evidence-based practices” in general, accounted for more variance in implementation (e.g., 29.0% vs. 8.6%, and 11.3% vs. 3.5%). The predictive validity varied depending on whether stems were worded “I intend to,” “I will,” or “How likely are you to.”

Conclusions
The observed strength of the association between intentions and EBP use will depend on how intention is measured. The association was much stronger if an item referred to a specific EBP, rather than EBP in general. To predict implementation, the results support using an aggregate of two or three intention items that refer to the specific EBP. An even more pragmatic measure of intention consisting of a single item can also predict implementation. As discussed, the relationship will also vary depending on the EBP, which has direct implications for causal model testing and the design of implementation strategies.
Pyloric stenosis at a tertiary hospital in Uganda
Authors: Okello Innocent , Naluyimbazi Rovine , Massenga Alicia , Ullrich Sarah , Kakembo Nasser , Kisa Phyllis , Sekabira John , Nimanya Stella 
Published: September 2020

Abstract
Background
Worldwide, infantile hypertrophic pyloric stenosis has an incidence of 3 in 1000 livebirths, with an unknown etiology. Even when babies present with characteristic symptoms, it is often misdiagnosed leading to late referral for appropriate surgical care. The purpose of this study was to document our experience in management of pyloric stenosis within our setting.

Results
A total of 33 patient records were reviewed. All the patients presented with non-bilious vomiting. The ratio of males to females was 4.5:1. Of these patients, 76% had electrolyte imbalance with low chloride count in the majority of patients. All the patients underwent an open Ramstedt pyloromyotomy, and 91% had a good outcome.

Conclusion
Management of IHPS has very good outcomes in our setting. Earlier referral of patients leads to improved outcomes.
New Horizons: Circadian Control of Metabolism Offers Novel Insight Into the Cause and Treatment of Metabolic Diseases
Authors: Deota Shaunak , Panda Satchidananda 
Published: September 2020

Abstract
Metabolic homeostasis is achieved by endocrine factors, signaling cascades, and metabolic pathways that sense and respond to metabolic demands in different organs. However, the recent discovery that almost every component of this regulatory system is also modulated by circadian rhythm highlights novel etiology and prognosis of metabolic diseases. First, chronic circadian rhythm disruption, as in shiftwork or shiftwork-like lifestyle, can increase the risk for metabolic diseases. Second, by understanding factors that affect circadian rhythm, we can implement new behavioral or pharmacological interventions for the prevention and management of metabolic disorders. One of these novel circadian-based interventions is time-restricted eating (TRE) in which all daily caloric intake is restricted to a consistent window of 8 to 12 hours. In preclinical animal models, TRE can prevent or reverse many metabolic diseases. Circadian research has also catalyzed attempts to optimally time the dosing of existing drugs to treat metabolic diseases or develop new drugs that target the circadian clock to treat metabolic disorders.
The Vitamin D Receptor in Osteoblast-Lineage Cells Is Essential for the Proresorptive Activity of 1α,25(OH)2D3 In Vivo
Authors: Mori Tomoki , Horibe Kanji , Koide Masanori , Uehara Shunsuke , Yamamoto Yoko , Kato Shigeaki , Yasuda Hisataka , Takahashi Naoyuki , Udagawa Nobuyuki , Nakamichi Yuko 
Published: September 2020

Abstract
We previously reported that daily administration of a pharmacological dose of eldecalcitol, an analog of 1α,25-dihydroxyvitamin D3 [1α,25(OH)2D3], increased bone mass by suppressing bone resorption. These antiresorptive effects were found to be mediated by the vitamin D receptor (VDR) in osteoblast-lineage cells. Using osteoblast-lineage-specific VDR conditional knockout (Ob-VDR-cKO) mice, we examined whether proresorptive activity induced by the high-dose 1α,25(OH)2D3 was also mediated by VDR in osteoblast-lineage cells. Administration of 1α,25(OH)2D3 (5 μg/kg body weight/day) to wild-type mice for 4 days increased the number of osteoclasts in bone and serum concentrations of C-terminal crosslinked telopeptide of type I collagen (CTX-I, a bone resorption marker). The stimulation of bone resorption was concomitant with the increase in serum calcium (Ca) and fibroblast growth factor 23 (FGF23) levels, and decrease in body weight. This suggests that a toxic dose of 1α,25(OH)2D3 can induce bone resorption and hypercalcemia. In contrast, pretreatment of wild-type mice with neutralizing anti-receptor activator of NF-κB ligand (RANKL) antibody inhibited the 1α,25(OH)2D3-induced increase of osteoclast numbers in bone, and increase of CTX-I, Ca, and FGF23 levels in serum. The pretreatment with anti-RANKL antibody also inhibited the 1α,25(OH)2D3-induced decrease in body weight. Consistent with observations in mice conditioned with anti-RANKL antibody, the high-dose administration of 1α,25(OH)2D3 to Ob-VDR-cKO mice failed to significantly increase bone osteoclast numbers, serum CTX-I, Ca, or FGF23 levels, and failed to reduce the body weight. Taken together, this study demonstrated that the proresorptive, hypercalcemic, and toxic actions of high-dose 1α,25(OH)2D3 are mediated by VDR in osteoblast-lineage cells.
Glycemic Response to Oral Dexamethasone Predicts Incident Prediabetes in Normoglycemic Subjects With Parental Diabetes
Authors: Nyenwe Ebenezer , James Deirdre , Wan Jim , Dagogo-Jack Sam 
Published: September 2020

Abstract

Background
Prediabetes, an often unrecognized precursor of type 2 diabetes (T2DM), is associated with cardiometabolic complications. Here, we investigated the utility of dexamethasone challenge in predicting incident prediabetes among normoglycemic subjects with parental T2DM enrolled in the prospective Pathobiology of Prediabetes in a Biracial Cohort study.

Design and Methods
After documenting normoglycemic status with an oral glucose tolerance test (OGTT), participants ingested dexamethasone (2 mg) at 10:00 pm, and fasting plasma glucose (FPG-Dex) and cortisol were measured at 8:00 am the next day. Subjects were followed quarterly for 5 years, the primary outcome being incident prediabetes. Serial assessments included body composition, blood chemistry, OGTT, insulin sensitivity, and secretion.

Results
We analyzed data from 190 participants (107 Black, 83 white; mean age 44.7 ± 10.0 years; body mass index [BMI] 29.8 ± 6.8 kg/m2; fasting plasma glucose [FPG] 90.9 ± 5.7 mg/dL). Following dexamethasone ingestion, plasma cortisol was &lt; 5 µg/dL; FPG-Dex levels displayed marked variability (81-145 mg/dL) as did delta FPG (–7 to +48 mg/dL). During 5 years of follow-up, 58 of 190 subjects (30.5%) progressed to prediabetes. FPG-Dex (116.8 ± 10.9 vs 106.9 ± 10.8 mg/dL, P &lt; 0.0001) and delta FPG (23.4 ± 10.1 vs 17.0 ± 10.2 mg/dL, P &lt; 0.0001) were higher in progressors than nonprogressors. FPG-Dex (P = 0.007) was an independent predictor of incident prediabetes in a multivariate model that included age, race, gender, BMI, waist circumference, FPG, insulin sensitivity, and secretion. In further analyses, an FPG-Dex level ≥ 107 mg/dL predicted incident prediabetes with 88% sensitivity and 49% specificity.

Conclusions
The glycemic response to dexamethasone significantly predicted incident prediabetes among offspring of parents with T2DM, and may be a tool for uncovering latent risk of dysglycemia.
Reevaluation of the Effect of Iodine on Thyroid Cell Survival and Function Using PCCL3 and Nthy-ori 3-1 Cells
Authors: Kurashige Tomomi , Shimamura Mika , Nagayama Yuji 
Published: September 2020

AbstractThe appropriate amount of iodine is critical for normal function of thyroid cells synthesizing thyroid hormones. Although normal thyroid cell lines such as rat PCCL3 and FRTL5 and human Nthy-ori 3-1 have been widely used for in vitro studies on physiological and pathophysiological effects of iodine on thyroid cells, we have recently pointed out the critical differences between FRTL5/PCCL3 cells and Nthy-ori 3-1 cells. Therefore, we here directly compared some of the cellular characteristics—iodine uptake, differentiated status, iodine-induced cytotoxicity, and iodine-regulation of autophagy—between PCCL3 and Nthy-ori 3-1 cells. PCCL3 cells express messenger RNAs for thyrotropin receptor and sodium/iodine symporter and incorporate iodine in a thyrotropin-dependent manner, whereas Nthy-ori 3-1 cells do not either. Nevertheless, both cells were comparably resistant to iodine cytotoxicity: Only far excess iodine (5 × 10–2 M) killed 20% to 40% cells in 24 hours with perchlorate exhibiting no effect, suggesting this cytotoxic effect is due to extracellular iodine. In contrast, a wide range of iodine (5 × 10–9 to 5 × 10–2 M) induced autophagy in PCCL3 cells, which was abolished by perchlorate, indicating intracellular iodine-induction of autophagy, but this effect was not observed in Nthy-ori 3-1 cells. In conclusion, it is critical to discriminate the effect of iodine incorporated into cells from that of extracellular iodine on thyroid cells. Iodine-uptake competent thyroid cells such as PCCL3 and FRTL5 cells, not Nthy-ori 3-1 cells, should be used for studies on iodine effect on thyroid cells.
Peripheral Neuropathies Associated With Monoclonal Gammopathies
Authors: Naddaf Elie , Mauermann Michelle L. 
Published: September 2020

ABSTRACTPURPOSE OF REVIEWNeurologists commonly evaluate patients with a monoclonal gammopathy and peripheral neuropathy. As both monoclonal gammopathy and peripheral neuropathy are common in the general population, their coexistence may, in some instances, be purely coincidental. However, monoclonal gammopathies or underlying lymphoplasmacytic disorders can affect the peripheral nervous system by various mechanisms. This article discusses how to approach patients with monoclonal gammopathy and peripheral neuropathy, highlighting clinical and laboratory clues that may aid in establishing a diagnosis in a timely manner.RECENT FINDINGSFrom a hematologic standpoint, a monoclonal gammopathy may be of undetermined significance or can be associated with an underlying myeloma, lymphoplasmacytic lymphoma, or amyloidosis. Each of these conditions can cause peripheral neuropathy, with varying clinical and electrodiagnostic profiles. Treatment usually consists of treating the underlying hematologic disorder. IgM-associated peripheral neuropathy may not require treatment from a hematologic standpoint, and only anecdotal evidence exists for the use of immunotherapy in such patients. Therefore, treatment should be determined on a case-by-case basis.SUMMARYEvaluating for an association between a monoclonal gammopathy and a peripheral neuropathy in a patient depends on the monoclonal gammopathy subtype and the clinical and electrodiagnostic characteristics of the peripheral neuropathy.
A Structured Approach to the Diagnosis of Peripheral Nervous System Disorders
Authors: London Zachary N. 
Published: September 2020

ABSTRACT

PURPOSE OF REVIEW
Neuroanatomic localization and pattern recognition can be used to diagnose both focal lesions and generalized disorders of the peripheral nervous system. This article describes the nature and pattern of sensory and motor deficits associated with lesions of specific spinal nerve roots, plexus, or peripheral nerves. It also describes the patterns of sensory and motor deficits that suggest multifocal or generalized disorders of the motor neurons, sensory neurons, and peripheral nerves.

RECENT FINDINGS
The pattern of sensory and motor deficits may be used to distinguish lesions of the peripheral nervous system from those of the central nervous system. The spinal roots, nerve plexus, and peripheral nerves supply specific muscles and receive sensory input from distinctive cutaneous regions. Focal lesions of these structures therefore produce characteristic patterns of sensory and motor deficits. Multifocal or generalized disorders of the peripheral nervous system may be distinguished by categorizing their sensory and motor involvement, proximal and distal predominance, and degree of symmetry. Serum tests, CSF analysis, electrodiagnostic studies, MRI, ultrasound, nerve biopsy, and skin biopsy have unique roles in the diagnosis of suspected neuromuscular disorders.

SUMMARY
A structured approach to the diagnosis of nerve and motor neuron disorders can lead to hypothesis-driven diagnostic testing. Ancillary tests should be reserved for cases in which confirming or refuting a diagnosis will change patient management.
A Developing Nation’s Experience in Using Simulation-Based Training as a Preparation Tool for the Coronavirus Disease 2019 Outbreak
Authors: Loh P. S. , Chaw Sook-Hui , Shariffuddin Ina I. , Ng Ching-Choe , Yim Carolyn C. , Hashim Noorjahan Haneem Md. 
Published: September 2020

Background:
The coronavirus disease 2019 (COVID-19) pandemic affected and overwhelmed many health care systems around the world at an unprecedented speed and magnitude with devastating effects. In developing nations, smaller hospitals were unprepared to face this outbreak nor had strategies in place to do so at the beginning. Here, we describe the preparation in an anesthetic department using simulation-based training over 2 weeks, as the number of cases rose rapidly.

METHODS:
Three areas of priority were identified as follows: staff safety, patient movement, and possible clinical scenarios based on simulation principles in health care education. Staff was rostered and rotated through stations for rapid-cycle deliberate practice to learn donning and doffing of personal protective equipment (PPE) and powered air-purifying respirator (PAPR). For difficult airway management, Peyton’s 4 steps for skills training and Harden’s Three Circle model formed the structure in teaching the core skills. Several clinical scenarios used system probing to elicit inadequacies followed by formal debriefing to facilitate reflection. Finally, evaluation was both immediate and delayed with an online survey after 1 month to examine 4 levels of reaction, learning, behavior, and impact based on the Kirkpatrick Model. Frequency and thematic analysis were then conducted on the quantitative and qualitative data, respectively.

RESULTS:
A total of 15 of 16 (93%) consultants, 16 (100%) specialists, and 81 (100%) medical officers in the department completed training within 2 consecutive weeks. Reaction and part of the learning were relayed immediately to trainers during training. In total, 42 (39%) trained staff responded to the survey. All were satisfied and agreed on the relevance of training. A total of 41 respondents (98%; 95% confidence interval [CI], 87-99) answered 16 of 20 questions correctly on identifying aerosol-generating procedures (AGP), indications for PPE, planning and preparation for airway management to achieve adequate learning. About 43% (95% CI, 27-59) and 52% (95% CI, 36-68) recalled donning and doffing steps correctly. A total of 92 responses from 33 respondents were analyzed in the thematic analysis. All respondents reported at least 1 behavioral change in intended outcomes for hand hygiene practice (20%), appropriate use of PPE (27%), and airway management (10%). The emerging outcomes were vigilance, physical distancing, planning, and team communication. Finally, the impact of training led to the establishment of institutional guidelines followed by all personnel.

CONCLUSIONS:
Simulation-based training was a useful preparation tool for small institutions with limited time, resources, and manpower in developing nations. These recommendations represent the training experience to address issues of “when” and “how” to initiate urgent “medical education” during an outbreak.
The Gridlock transcriptional repressor impedes vertebrate heart regeneration by restricting expression of lysine methyltransferase
Authors: She Peilu , Zhang Huifang , Peng Xiangwen , Sun Jianjian , Gao Bangjun , Zhou Yating , Zhu Xuejiao , Hu Xueli , Lai Kaa Seng , Wong Jiemin , Zhou Bin , Wang Linhui , Zhong Tao P. 
Published: September 2020

ABSTRACT
Teleost zebrafish and neonatal mammalian hearts exhibit the remarkable capacity to regenerate through dedifferentiation and proliferation of pre-existing cardiomyocytes (CMs). Although many mitogenic signals that stimulate zebrafish heart regeneration have been identified, transcriptional programs that restrain injury-induced CM renewal are incompletely understood. Here, we report that mutations in gridlock (grl; also known as hey2), encoding a Hairy-related basic helix-loop-helix transcriptional repressor, enhance CM proliferation and reduce fibrosis following damage. In contrast, myocardial grl induction blunts CM dedifferentiation and regenerative responses to heart injury. RNA sequencing analyses uncover Smyd2 lysine methyltransferase (KMT) as a key transcriptional target repressed by Grl. Reduction in Grl protein levels triggered by injury induces smyd2 expression at the wound myocardium, enhancing CM proliferation. We show that Smyd2 functions as a methyltransferase and modulates the Stat3 methylation and phosphorylation activity. Inhibition of the KMT activity of Smyd2 reduces phosphorylated Stat3 at cardiac wounds, suppressing the elevated CM proliferation in injured grl mutant hearts. Our findings establish an injury-specific transcriptional repression program in governing CM renewal during heart regeneration, providing a potential strategy whereby silencing Grl repression at local regions might empower regeneration capacity to the injured mammalian heart.