bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone metabolism and fracture risk during and after critical illness
Authors: Rousseau Anne-Françoise , Kerschan-Schindl Katharina , Scherkl Mario , Amrein Karin 
Published: June 2020

Purpose of review
There is growing evidence that bone health is impacted during and after critical illness in multiple ways. In this review, we provide a practical update on postcritical care bone loss with an insight on identification of persons at risk, prevention and treatment strategies.

Recent findings
Critical illness is associated with an increase in bone turnover and with an uncoupling between bone resorption and bone formation. This results in loss of bone mass, as highlighted by changes in bone marker serum levels and in bone mineral density. Data suggest that ICU survivors are at an increased risk of bone fractures, but this is not completely quantifiable. A key driving factor for ICU-related bone loss, beside inflammation, undernutrition and vitamin D deficiency, is immobilization. Bone health and muscle health are closely related, through myokines and osteokines. Even if not completely proven in the context of critical care, it is likely that preserving muscle mass and strength helps reducing bone loss.

Summary
A history of critical illness should be considered as a strong risk factor for osteopenia and osteoporosis. ICU-related bone loss should be part of the postintensive care syndrome, and should be targeted by prevention and treatment strategies. Optimized and individualized protein and micronutrient provision (with specific attention to calcium, vitamin D and selenium), associated with physiotherapy and muscle training, should be implemented early after ICU admission and continued after ICU discharge. Antiresorptive agents such as biphosphonates should be considered on an individualized basis.
The best recipe: fat-based, protein-based, single amino acids?
Authors: Singer Pierre , Glass Yehuda D. , Kagan Ilya 
Published: June 2020

Purpose of review
Instead of comparing iso versus low energy or high versus low protein intake, the proportions between nutrients and the effects of specific amino or fatty acids may yield promising benefits for the nutritional therapy of critically ill patients.

Recent findings
Larger proportion of carbohydrates than lipids is usual in most of the commercial products. However, patients suffering from sepsis and from acute kidney injury preferentially utilize lipids. Parenteral omega-3-fatty acids, in particular, may be beneficial. Protein source and amount are important factors to achieve the best absorption and an improved nitrogen balance. Hydrolyzed whey protein reaches the highest amino acid plasma level if administered in large doses (35% of the measured energy expenditure). Muscle mass preservation may be achievable with large protein intake. β-Hydroxy-β-methylbutyrate has been shown to improve muscle strength in a large meta-analysis.

Summary
The nutritional therapy should take into account the fact that lipids are more oxidized. Intravenous lipid emulsions containing olive and fish oil are preferred, improving morbidity significantly in a recent meta-analysis. Enteral protein should be selected carefully according to protein source, origin and amount. Hydrolyzed whey protein improves nitrogen balance. The ultimate goal is to preserve muscle mass and muscle function. β-Hydroxy-β-methylbutyrate may improve muscle strength.
Trace element and vitamin deficiency: quantum medicine or essential prescription?
Authors: Berger Mette M. , Ben-Hamouda Nawfel 
Published: June 2020

Purpose of review
In critical care, micronutrients remain perceived as ‘quantum’ part, that is, a little pertinent component of therapy. Some micronutrients have attracted more attention because of their antioxidant properties. During the last decade, some large size trials have tested their therapeutic potential, generally as ‘single high-dose micronutrient intervention’, with variable success. This review aims at taking stock of most recent.

Recent findings
Micronutrient blood levels are generally low in ICU patients, which has prompted the concept of replenishing or compensating deficits, or even realizing a pharmacological action. Single micronutrient trials have been conducted in large cohorts with selenium (≥1000 μg/day), with limited success but no harm. Other trials have tested high-dose vitamin D (>400 000 IU), with nonconvincing results despite selecting patients with very low blood levels. High-dose vitamin C has been tested in septic shock (+/- thiamine, hydrocortisone) with variable results. A problem encountered in all studies is definition of deficiency based on blood levels as majority of the patients suffer inflammation, which causes redistribution of the micronutrients away from the circulating compartment in the absence of real deficiency.

Summary
Micronutrients are essential in the ICU. Due to their antioxidant properties and to the high prevalence of low blood concentrations suggestive of deficiency, several large-size RCTs have been conducted with variable success. Further research must clarify the respective importance of deficiency and inflammation.
Evidence for improved survival with treatment of homozygous familial hypercholesterolemia
Authors: Bélanger Alexandre M. , Akioyamen Leo , Alothman Latifah , Genest Jacques 
Published: June 2020

Purpose of review
Homozygous familial hypercholesterolemia (HoFH) is an orphan disease caused by biallelic mutations at the LDL receptor (LDLR) gene, with a prevalence estimated at 1 : 250 000 to 1 : 630 000. HoFH is characterized by extremely elevated plasma levels of LDL-C greater than 10 mmol/l (>387 mg/dl), tendinous and cutaneous xanthomas in youth and premature atherosclerotic cardiovascular disease (ASCVD). The expected prevalence varies from country to country depending on the presence of founder effects, genetic probability and life expectancy. Untreated, HoFH is a fatal condition before age 30. Plasma levels of LDL-C are the major cause of mortality and the therapeutic target. Statin therapy led to a remarkable improvement in survival but is of limited use in loss-of-function LDLR gene variants or ‘null’ mutations. Inhibitors of PCSK9 are a useful adjunct in patients with LDLR mutations with residual activity. Extracorporeal LDL filtration has improved survival since its introduction three decades ago.

Recent findings
Novel therapies, not dependent on a functioning LDLR include lomitapide and mipomersen, which decrease hepatic apolipoprotein B secretion, and evinacumab, directed at the angiopoietin like-3 protein (ANGPLT-3).

Summary
Over the past 3–4 decades, the survival of patients with HoFH has increased markedly. New therapeutic options offer new hope.
Apolipoprotein F: a natural inhibitor of cholesteryl ester transfer protein and a key regulator of lipoprotein metabolism
Authors: Liu Yan , Morton Richard E. 
Published: June 2020

Purpose of review
The aim of this study is to highlight recent studies that have advanced our understanding of apolipoprotein F (ApoF) and its role in lipid metabolism.

Recent findings
Previous studies showed that ApoF hepatic mRNA levels are suppressed by fat-enriched diets. Recent studies show this downregulation is mediated by agonist-induced binding of liver X receptor (LXR) and PPARalpha to a regulatory element in the ApoF promoter. First-of-kind in-vivo studies show ApoF lowers low-density lipoprotein levels and enhances reverse cholesterol transport in fat-fed hamsters.

Summary
Diverse studies collectively provide compelling evidence that cholesteryl ester transfer protein (CETP) plays an important role in regulating lipid metabolism. Inhibiting CETP raises HDL cholesterol. However, considering the recent failures of pharmacological inhibitors of CETP in clinical trials, it does not seem likely that global inhibition of CETP will be beneficial. ApoF is a minor apolipoprotein that functions as a natural inhibitor of CETP. However, ApoF is not a general inhibitor of CETP, but rather it preferentially inhibits CETP activity with LDL. Therefore, ApoF tailors CETP activity so that less tissue-derived cholesterol traffics from HDL into the LDL compartment. Lower LDL cholesterol levels have recognized clinical benefit for reduced cardiovascular disease.
Can genetic testing help in the management of dyslipidaemias?
Authors: Lazarte Julieta , Hegele Robert A. 
Published: June 2020

Purpose of review
The aim of this study was to evaluate the potential role of genetic testing, particularly next-generation DNA sequencing, in diagnosing and managing dyslipidaemias, particularly monogenic dyslipidaemias.

Recent findings
Targeted DNA sequencing of the genes causing monogenic dyslipidaemias is becoming more accessible. Some societies’ position statements advise selective utilization of DNA testing in combination with clinical and biochemical assessment. However, high-quality peer-reviewed evidence showing that a DNA-based diagnosis impacts upon long-term patient outcomes is currently lacking. Nonetheless, we show anecdotal examples of tangible clinical actions following from a genetic diagnosis. In any event, care must be taken when interpreting genetic reports. We strongly feel that expertise in both genetics and dyslipidaemias is required to adequately interpret and report results to patients, as well as to make informed treatment decisions that can have a potential lifelong impact.

Summary
There are some examples of monogenic dyslipidaemias for which having a molecular diagnosis might beneficially affect patient outcomes, for example certain cases of suspected familial hypercholesterolemia, familial chylomicronemia syndrome, sitosterolemia or lysosomal acid lipase deficiency. In general, we recommend limiting genetic testing to selected cases of monogenic dyslipidaemias. Finally, we advise that there is currently no proven clinical benefit in testing for polygenic dyslipidaemias.
Mycoplasma genitalium and Trichomonas vaginalis: addressing disparities and promoting public health control of two emerging sexually transmitted infections
Authors: Korich Faye , Reddy Neha G. , Trent Maria 
Published: June 2020

Purpose of review

Mycoplasma genitalium (M. genitalium) and Trichomonas vaginalis (T. vaginalis), sexually transmitted infections that remain non-reportable in the United States, may lead to pelvic inflammatory disease (PID) and adverse pregnancy outcomes if left untreated. Prevalence estimates have highlighted socioeconomic and racial/ethnic disparities in rates of infection. This review summarizes the recent literature on M. genitalium and T. vaginalis with a focus on the epidemiology, screening, and treatment of M. genitalium and T. vaginalis.

Recent findings
The burden of T. vaginalis testing remains on women. Antimicrobial resistance is of great concern for M. genitalium. Comprehensive screening and treatment guidelines present an opportunity to address these public health concerns.

Summary

M. genitalium and T. vaginalis infections disproportionately affect sexual and racial/ethnic minorities and those facing socioeconomic disparities. The availability of nucleic acid amplification test testing has facilitated accurate diagnosis of both disorders. Safe and efficacious treatments are available for treatment of both disorders. Integrating macrolide resistance testing into treatment algorithms for M. genitalium and dual antibiotic therapy may prove a useful strategy for future US-based guidance. Public health reporting and increased public awareness campaigns are key next steps to addressing the observed reproductive health disparities.
Pediatric Wilson Disease Presenting as Acute Liver Failure
Authors: Vandriel Shannon M. , Ayoub Mohammed D. , Ricciuto Amanda , Hansen Bettina E. , Ling Simon C. , Ng Vicky L. , Roberts Eve A. , Kamath Binita M. 
Published: June 2020

ABSTRACTObjectives:Wilson disease (WD) presenting as acute liver failure (ALF) is rare and typically fatal without liver transplantation (LT). Its rarity has hindered comprehensive studies. We undertook an individual patient data meta‐analysis to characterize a cohort of pediatric patients presenting with ALF whose final diagnosis was WD to examine outcomes and identify predictors of poor outcomes.Methods:Database searches were conducted in PubMed, ScienceDirect, and Google Scholar, restricted to English‐language articles published between January 1984 and May 2018. Articles were excluded if pediatric (<18 years old) data were not extractable or if LT was not readily available at reporting institutions. Extracted data included clinical and biochemical characteristics, genotype, treatment, and outcome.Results:Data were available on 249 subjects from 52 articles, plus 7 additional subjects identified from our institution's WD database (N = 256). Females represented 69% (n = 170/245). Median age at presentation was 13.4 years (n = 204, range 4.0–17.9). Of the total 256 subjects, 87% underwent LT, 11% achieved spontaneous recovery and 2% died before LT. International normalized ratio >2.0 at presentation was a predictor of LT/death (odds ratio 7.6, 95% confidence interval 1.5–28), with a trend observed for hepatic encephalopathy (HE) (odds ratio 4.18, 95% confidence interval 0.99–18). Arithmetic diagnostic scores proved inferior in the pediatric age‐bracket compared to adults.Conclusions:This large international pediatric cohort has permitted an individual patient data analysis of WD presenting as ALF. Notably, 11% of subjects achieved spontaneous survival; the rest required LT. Coagulopathy (international normalized ratio >2:0) and HE at presentation heralded poor outcomes. Further prospective studies may identify additional early predictors of outcomes.
Safety of Thiopurine Use in Paediatric Gastrointestinal Disease
Authors: Miele Erasmo , Benninga Marc A. , Broekaert Ilse , Dolinsek Jernej , Mas Emmanuel , Orel Rok , Pienar Corina , Ribes‐Koninckx Carmen , Thomassen Rut A. , Thomson Mike , Tzivinikos Christos , Thapar Nikhil 
Published: June 2020

ABSTRACTThiopurines, alone or in combination with other agents, have a pivotal role in the treatment of specific gastrointestinal and hepatological disorders. In inflammatory bowel disease and autoimmune hepatitis thiopurines have proven their value as steroid sparing agents for the maintenance of remission and may be considered for preventing postoperative Crohn disease recurrence where there is moderate risk of this occurring. Their use with infliximab therapy reduces antibody formation and increases biologic drug levels. The routine clinical use of thiopurines has, however, been questioned due to a number of potential adverse effects. The aim of this article is to provide information regarding the use, and in particular, safety of these agents in clinical practice in the light of such potentially severe, albeit rare, effects.
Empathy, Alexithymia, and Theory of Mind in Borderline Personality Disorder
Authors: Kılıç Faruk , Demirdaş Arif , Işık Ümit , Akkuş Merve , Atay İnci Meltem , Kuzugüdenlioğlu Duru 
Published: June 2020

Abstract
The purpose of this research was to determine the differences in empathy, alexithymia features, and theory of mind between healthy controls and patients with borderline personality disorder (BPD). Thirty-five patients with BPD and 35 healthy controls were included in the study. To measure the clinical variables, the Empathy Quotient (EQ), Reading the Mind in the Eyes Test (RMET), Toronto Alexithymia Scale (TAS-20), Barratt Impulsivity Scale-11 (BIS-11), and Beck Depression Inventory (BDI) were applied. We found that the BPD group had significantly worse total RMET and neutral RMET scores than the control group. There were no differences in the EQ scores between the BPD and control groups. The patients with BPD were more alexithymic than the controls, and alexithymia and depression scores predicted BPD status. Patients with BPD who have difficulty identifying their own emotions tend to display deficits in perceptions of facial emotions, which, in turn, may lead to misperceptions of social signals and thus contribute to excessive emotional intensity and tension in social situations. The study results reveal that alexithymia and depression are important variables in predicting BPD traits.
The Cost of Being Apart
Authors: Kinory Dana , Aisenberg Daniela , Levi-Belz Yossi 
Published: June 2020

Abstract
Older adults have the highest suicide rates of all age groups in most industrialized countries. However, research concerning psychological risk factors for suicide among older adults is sparse. Thus, our study aimed to examine the contribution of perceived burdensomeness (PB) and thwarted belongingness (TB) to suicide ideation (SI) among older adults. Participants included 160 Israeli older adults (aged 65–91 years), who completed measures of suicide risk, PB, and TB as well as hopelessness and depression. Using hierarchical regression, we found that PB and TB accounted for 9.8% of the variance in SI and that the interaction of PB and TB had a significant unique contribution to SI among the participants, beyond the effect of hopelessness and depression. The study's findings highlight the contribution of interpersonal variables to SI among older adults and suggest that mental health professionals should be aware of PB and TB levels when assessing suicide risk among older adults.
Genotyping of Treponema pallidum in Cuba (2018–2019): Increased Circulation of Recombinant Genotype and No New Treponema pallidum Subspecies endemicum Infection Among Syphilis Patients
Authors: Noda Angel A. , Rodríguez Islay , Šmajs David 
Published: June 2020

Objectives
This study aimed to determine the allelic profiles of Treponema pallidum in patients confirmed with syphilis in Cuba (2018–2019) and to explore mutations leading to macrolide and tetracycline resistance.

Methods
Multilocus sequence typing and polymerase chain reaction of rrn loci (23S and 16S rDNA), followed by Sanger sequencing, were used to define the allelic profile of TPA and resistance mutations, respectively.

Results
Allelic profile 1.3.1 and the recombinant profile were identified, with 15.7.3 having an increased frequency. We did not detect the presence of the T. pallidum subspecies endemicum among syphilis patients, as in previous reports. A high frequency of macrolide-resistant strains and the absence of mutations potentially causing tetracycline resistance were found.

Conclusions
Understanding the current status of treponemal infection in Cuban patients provides insights into the syphilis epidemiology.
Injury and Illness Surveillance in Elite Para Athletes
Authors: Hirschmüller Anja , Fassbender Katharina , Kubosch Johanna , Leonhart Rainer , Steffen Kathrin 
Published: June 2020

Background
Longitudinal monitoring data of Para athletes are sparse.

Objective
The aim of the study was to describe the weekly prevalence and incidence of injuries and illnesses among German athletes preparing for the 2016 Rio de Janeiro Paralympic Games.

Methods
Athletes were invited to weekly report on medical problems, their severity/burden and training load, using the Oslo Sports Trauma Research Center Questionnaire on Health Problems. In case of any health problem, athletes were contacted and medical support offered. Data were analyzed with regard to impairment type. The acceptance of the monitoring program was evaluated.

Results
Fifty-eight athletes were followed for 29 wks, 10.927 athlete-days. At any given time, 28% (95% confidence interval = 26% to 30%) of athletes reported health problems, and 12% (11% to 14%) substantial health problems. The prevalence of health and illness problems diminished over time by 20.9 ± 4.1% and 16.1 ± 2.9%, P < 0.001, respectively, based on the means of the first and final 5 wks. Paraplegic athletes reported a significantly higher prevalence of all health problems (33%, 29% to 37%) than nonparaplegic athletes (26%, 23% to 29%; P = 0.007). Illnesses were in general more severe and resulted in more time loss days. Athletes reported a high satisfaction with the program.

Conclusions
At any given time, 28% of German Para athletes reported health problems, and 12% experienced substantial health problems. For a health team, illnesses seem to be more important to handle than injuries. The Oslo Sports Trauma Research Center Questionnaire on Health Problems is a suitable method for injury and illness surveillance in Para athletes.
The Relationship of Residency and Fellowship Sites to Academic Faculty and Leadership Positions
Authors: Egro Francesco M. , Beiriger Justin , Roy Eva , Nguyen Vu T. 
Published: June 2020

Background
After completion of training, a physician's training institution has a lasting and meaningful impact on career trajectory. Training program influence on first job placement and academic promotions remain uncertain in academic plastic surgery. The aim of this study was to determine the impact of training and internal bias in academic plastic surgery employment and promotion.

Methods
Academic plastic surgery faculty were identified through an internet search of all Accreditation Council for Graduate Medical Education–accredited residency training programs. Faculty demographics, training background, employment, and leadership status were gathered. The analysis examined the impact of internal recruitment bias on first job employment, the impact of training history on institutional leadership promotion (chair/chief, residency director, or fellowship director), and the impact of alumni effect on academic employment.

Results
A significant proportion of recent graduates (38.6%) are practicing at the same institution as where they received residency or fellowship training. Of the 229 institutional leaders, 31.5% of chairs/chiefs, 39.6% of residency directors, and 37.5% of fellowship directors were internal hires. Overall, 34% of plastic surgery faculty in the United States share a common training program with at least 1 colleague. The top 5 programs that have the most faculty who trained at their hiring institution are Harvard (30 faculty), University of Southern California (15 faculty), University of California Los Angeles (12 faculty), University of Michigan (12 faculty), and Albert Einstein (12 faculty). Overall, 54% of plastic surgery departments employ 2 or more faculty who share a common external training program. The top 5 programs that have the most faculty who share an external training program are (1) Methodist Houston, 8 faculty who trained at Baylor; (2) Hofstra, 7 faculty who trained at New York University; (3) Stanford, 6 faculty who trained at University of California, Los Angeles; (4) Wisconsin, 5 faculty who trained at University of Pittsburgh Medical Center; and (5) University of Southern California, 4 faculty who trained at New York University.

Conclusions
The study highlights that an internal bias exists in the recruitment for first jobs and leadership promotions. However, a clear bias of internal hiring exists at several institutions. In addition, an alumni effect was identified, where some programs have a bias of hiring faculty who trained at the same external institution.