bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of free androgen index on blood pressure variability and target organ damage in postmenopausal hypertensive women: findings from a cross-sectional study
Authors: Chen Jianshu , Wang Qiongying , Pei Ying , Li Ningyin , Han Junchen , Yu Jing 
Published: August 2021

Abstract

Objective:
The present study investigated the effects of free androgen index (FAI) on ambulatory blood pressure (ABP) and target organ function in postmenopausal hypertensive women.

Methods:
A total of 285 postmenopausal hypertensive women (mean age 54.06 ± 3.61) were admitted to the Department of Hypertension of Lanzhou University Second Hospital between December 2018 and December 2020. According to the serum FAI level, the participants were divided into a low-FAI (<0.15) group, a medium-FAI (0.15-0.2) group, and a high-FAI (>0.2) group. The relationship of FAI with 24-hour ABP, left ventricular mass index (LVMI), and cardio-ankle vascular index (CAVI) was analyzed.

Results:
The LVMI, CAVI, 24-hour mean systolic blood pressure (SBP), 24-hour SBP coefficient of variation and 24-hour SBP standard deviation, 24-hour SBP average real variation (ARV), and 24-hour diastolic blood pressure (DBP) ARV in high-FAI group were significantly higher than those in low- and medium-FAI groups (P < 0.05). After adjusting for confounding factors, partial correlation analysis showed that FAI was positively correlated with LVMI (r = 0.728, P < 0.001), CAVI (left: r = 0.718, P < 0.001; right: r = 0.742, P < 0.001), 24-hour SBP ARV (r = 0.817, P < 0.001), and 24-hour DBP ARV (r = 0.747, P < 0.001). After adjusting for confounding factors, it was found that LVMI increased by 17.64 g/m2 for every 1 unit increase in FAI. CAVI also increased by 8.983 for every additional unit of FAI. In addition, the results also showed that LVMI and CAVI decreased respectively by 0.198 g/m2 and 0.009 for every 1 unit increase in sex hormone–binding globulin. Multivariable linear regression showed that FAI was an independent risk factor for 24-hour SBP ARV (OR: 20.416, 95% CI 8.143-32.688, P = 0.001) and 24-hour DBP ARV (OR: 16.539, 95% CI 0.472-32.607, P = 0.044). The results also showed that sex hormone–binding globulin was an independent factor of 24-hour SBP ARV (OR: −0.022, 95% CI −0.044 to 0.000, P = 0.048) and 24-hour DBP-ARV (OR: −0.018, 95% CI −0.029 to −0.008, P = 0.001).

Conclusion:
Higher serum FAI levels in postmenopausal hypertensive women indicate abnormal BP regulation and more serious target organ damage. FAI is closely related to 24-hour SBP ARV and 24-hour DBP ARV in postmenopausal hypertensive women.
Mediation of Anti-Keloid Effects of mTOR Inhibitors by Autophagy-Independent Machinery
Authors: Jiang Meng , Bu Wen-Bo , Chen Yu-Jie , Li Li , Xiao Ta , Gu Heng 
Published: August 2021

Abstract

Objective:
Blocking mechanistic target of rapamycin (mTOR) activation with mTOR inhibitors has promising therapeutic potential for keloids. However, the precise mechanism of mTOR inhibitors remains unclear. This study was aimed to investigate the role of autophagy machinery in the anti-keloid effects of mTOR inhibitors.

Methods:
We first validated the biological effects induced by the mTOR inhibitors rapamycin (100 nmol/L) and KU-0063794 (5 μmol/L) on the proliferation, apoptosis, migration, and collagen synthesis of keloid fibroblasts (KFs) derived from Han Chinese persons through a Cell Counting Kit-8 assay, 5-Bromo-2’-deoxyuridine incorporation, Annexin V/propidium iodide staining, migration, and western blotting. To explore whether autophagy machinery is involved in the anti-keloid effects of mTOR inhibitors, we first blocked the autophagy activation induced by rapamycin and KU-0063794 with a pharmacological autophagy inhibitor (wortmannin) or by silencing the key autophagy gene (ATG5), and we then re-evaluated these biological effects on KFs.

Results:
Blocking mTOR activation with either rapamycin or KU-0063794 completely inhibited proliferation, migration, and collagen synthesis of primary KFs but did not affect apoptosis. Incubating KFs with the autophagy inhibitor wortmannin or performing ATG5 silencing abrogated the subsequent activation of autophagic activity induced by rapamycin (rapamycin + E-64d + pepstatin vs. rapamycin + wortmannin + E-64d + pepstatin: 1.88 ± 0.38 vs. 1.02 ± 0.35, F = 6.86, P = 0.013), (non-sense control + rapamycin vs. ATG5 small interfering RNA + rapamycin: 1.46 ± 0.18 vs. 0.75 ± 0.20, respectively; F = 7.68, P = 0.01) or KU-0063794 (KU-0063794 + E-64d + pepstatin vs. KU-0063794 + wortmannin + E-64d + pepstatin: 1.65 ± 0.35 vs. 0.76 ± 0.17, F = 10.01, P = 0.004), (NC + KU-0063794 vs. ATG5 small interfering RNA + KU-0063794: 1.59 ± 0.50 vs. 0.77 ± 0.09, F = 5.93, P = 0.02) as evidenced by decreased accumulation of LC3-II. However, blockage of autophagy induction in mTOR inhibitor-treated KFs with both methods did not disturb their anti-keloid effects, such as inhibition of cell viability, cell migration, and collagen synthesis (P > 0.05 each).

Conclusion:
Blocking mTOR activation with the mTOR inhibitors rapamycin and KU-0063794 showed anti-keloid effects in KFs. Restoration of autophagy inhibition by mTOR inhibitors does not contribute to their anti-keloid effects.
An introduction to and review of cardiac neurodevelopment: the risks and recommended approaches
Authors: Ligsay Andrew , Goldberg Caren S. 
Published: August 2021

Purpose of review
To introduce the reader to the current understanding of the neurocognitive profile of congenital heart disease (CHD) survivors, the risk factors that may influence outcomes, and to the recommendations for cardiac neurodevelopmental care.

Recent findings
A growing body of literature has shown that survivors of CHD are at increased risk for neurodevelopmental impairments. Multiple elements influence each patient's risk, which likely begins in utero and extends to perioperative management, surgical considerations, and long-term clinical care. Additionally, sociodemographic factors may compound these risks. Serial developmental follow-up is recommended for children with critical CHD.

Summary
Though there are some clinical factors that increase risk, based on the high rate of developmental impairments for children with CHD, serial evaluations are recommended. Multidisciplinary and multicenter collaboration is ongoing and will facilitate moving this field forward to improve neurodevelopmental outcomes for children with CHD.
Improving Compliance and Quality of Documentation of Cerebral Function Monitoring in a Neonatal Neurocritical Care Unit
Authors: Goswami Ipsita , Chansarn Panadda , Aldana Aguirre Jose , Taher Floura , Wilson Diane , Hahn Cecil , ElShahed Amr , Lee Kyong-Soon 
Published: August 2021

Introduction:
Neonates admitted to neurocritical care units frequently undergo continuous bedside cerebral function monitoring (CFM). Documentation of CFM findings that are complete and accurate can augment the quality of care through improved communication. We aimed to increase the compliance with and quality of CFM documentation in the electronic medical records by 50% in our neonatal intensive care unit over 6 months.

Methods:
We used the Plan-Do-Study-Act methodology, process mapping, and fishbone analysis. We implemented interventions, including the development of standardized EMR templates, face-to-face reminders at staff meetings and clinical handover sessions, and teaching on CFM interpretation.

Results:
We evaluated 50 and 161 charts pre (August–October 2018) and postintervention (December 2018–July 2019), respectively. We improved compliance with documentation from 72% to 89% (P = 0.004); and the quality of documentation from 10% to 61% (P < 0.001). Multimodal reminders to document and educational sessions to increase familiarity with CFM interpretation effectively improved the quality of documentation.

Conclusions:
We improved the compliance with and the quality of CFM documentation using targeted quality improvement interventions with case-focused educational sessions, reference tools, and standardized templates. Barriers to compliance with documentation were adverse effects on the workflow that changes in the EMR system may address. A significant challenge to sustainability was the high frequency of rotating trainees. We addressed this challenge by developing mandatory electronic teaching modules that include reminders to document and a case-focused teaching curriculum; to increase awareness of the importance of CFM documentation and increase confidence in CFM interpretation.
Circulating microRNAs from the mouse tibia fracture model reflect the signature from patients with complex regional pain syndrome
Authors: Wickman Jason R. , Luo Xuan , Li Wenwu , Jean-Toussaint Renee , Sahbaie Peyman , Sacan Ahmet , Clark J. David , Ajit Seena K. 
Published: August 2021

Abstract

Introduction:
Complex regional pain syndrome (CRPS) often results from an initial trauma that later produces a disproportionate amount of pain. The mechanisms underlying CRPS have been studied using a tibia fracture model (TFM) in rodents because this model closely mimics symptoms and has several molecular correlates observed in patients with CRPS.

Objective:
Here, we determined whether the TFM has alterations in circulating microRNAs (miRNAs) and cytokines transported by small extracellular vesicles (sEVs) that faithfully model previously reported miRNA alterations from patients with CRPS.

Methods:
We isolated and characterized serum-derived sEVs from mice 3 weeks after fracture when symptoms such as pain hypersensitivity develop. Whole-transcriptome profiling was used to determine sEV miRNAs, and Bio-Plex Pro Mouse Cytokine 23-plex assay was used to measure cytokines. Differentially expressed miRNAs from TFM were compared with previously reported circulating miRNA alterations from patients with CRPS.

Results:
Although sEV cytokine levels were unchanged, there were significant changes in sEV miRNA profiles. Differentially expressed miRNAs from TFM sEVs significantly overlapped with those previously reported in patients with CRPS. Of the 57 sEV miRNAs dysregulated in the TFM, 30 were previously reported in patients with CRPS compared with healthy control donors both in sEVs and 23 in whole blood.

Conclusions:
These findings enhance the validity of TFM as a model for CRPS and suggest that specific miRNA dysregulation may be a shared feature of CRPS and the TFM. These dysregulated miRNAs could help identify mechanistic targets or serve as biomarker candidates for both diagnosis and treatment responses in clinical trials.
The Anatomical Basis of Cellulite Dimple Formation: An Ultrasound-Based Examination
Authors: Whipple Lauren A. , Fournier Craig T. , Heiman Adee J. , Awad Amanda A. , Roth Malcolm Z. , Cotofana Sebastian , Ricci Joseph A. 
Published: August 2021

Background:
Cellulite is a common aesthetic condition that affects the majority of women. It is characterized by the inhomogeneous appearance of the skin overlying the gluteal and the posterior thigh region. Despite a wide array of treatment options, little has been done to evaluate the anatomical basis of cellulite formation. This study used ultrasound to visualize subcutaneous changes of cellulite to aid with treatment guidance and complication avoidance.

Methods:
Cellulite dimples were examined on the bilateral thigh and buttock regions of 50 consecutive women and each dimple was scored with the Hexsel Cellulite Scoring System based on severity. Cellulite dimples were then analyzed by ultrasound to identify the presence, orientation, and origination of subcutaneous fibrous bands and the presence of associated vascular structures.

Results:
Two hundred total sites were examined, with 173 dimples identified. Of these, 169 demonstrated the presence of fibrous bands (97.6 percent). The majority of bands demonstrated an oblique (versus perpendicular) orientation to the skin (84.4 percent), with the majority (90.2 percent) taking origin from the superficial fascia (versus the deep fascia). Overall, 11 percent of bands had an associated vascular structure. When stratified by body mass index, overweight and obese patients had a higher likelihood of having an associated blood vessel visualized (p = 0.01). Results were similar for dimples in the thigh compared to those located in the buttock region.

Conclusions:
Ultrasound appears to be a valid technique to image the subcutaneous architecture of cellulite. This technology can help guide surgeons in real time to improve outcomes and minimize complications while performing cellulite treatments.
Epidemiology of Upper Extremity Firearm Injuries among Major Trauma Hospitals in the United States
Authors: Hooper Rachel C. , Shauver Melissa J. , Chou Ching-Han , Chen Jung-Shen , Chung Kevin C. 
Published: August 2021

Background:
As many as 34 percent of nonfatal firearm injuries involve the upper extremity. Although not lethal, these injuries cause substantial morbidity. The authors conducted an epidemiologic study characterizing upper extremity firearm-related injuries presenting to U.S. trauma centers over a 10-year period.

Methods:
The authors used the National Trauma Databank from 2007 to 2017 to identify isolated upper extremity firearm-related injuries. Descriptive statistics were performed to characterize patient demographic data, firearm type, extremity injury patterns, treatments received, hospital length of stay, and regional variation.

Results:
The authors identified 48,254 upper extremity firearm-related injuries. The patients were largely male patients (85 percent), and over half were between the ages of 20 and 39 years. Handguns (34 percent) were the most frequently used firearm. Shoulder and upper arm were the most frequently injured areas (54 percent); however, 18 percent of patients injured two or more areas. Patients were most often treated at university hospitals (59 percent) with Level I or II trauma designation. Seventy percent were admitted and/or taken directly to the operating room. The mean hospital length of stay was 3 days. Payer mix among these patients was variable: Medicaid, 20 percent; private insurance, 20 percent; and self-pay, 29 percent.

Conclusions:
Upper-extremity firearm injuries are resource intensive, with three-quarters of patients requiring operative intervention and/or hospitalization. Level I and II trauma centers were the site of care for the majority of patients. Targeted gun policy reform and prevention measures directed toward at-risk groups have the potential to limit the unnecessary morbidity and costs associated with these injuries.
Understanding the Evidence and Improving Outcomes with Implant-Based Prepectoral Breast Reconstruction
Authors: Campbell Chris A. , Losken Albert 
Published: August 2021

Learning Objectives:
After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of prepectoral breast reconstruction. 2. Have knowledge of primary immediate and delayed prepectoral breast reconstruction techniques and secondary procedures required. 3. Describe data on outcomes of prepectoral breast reconstruction.

Summary:
Once considered to have an unacceptable complication profile, prepectoral breast reconstruction is increasing in popularity because of decreased surgical invasiveness and postoperative pain and the absence of animation deformity. Short-term outcomes studies comparing prepectoral breast reconstruction to partially submuscular techniques demonstrate similarly acceptable rates of postoperative complications. Aesthetic outcomes demonstrate similar rates of capsular contracture but increased rippling and implant palpability of the upper pole. Postoperative functional data are limited but overall show decreased pain and more rapid return of function but equivalent satisfaction on the BREAST-Q. Long-term aesthetic data and rates of revision are lacking.
High rate of long-term clinical events after antiretroviral therapy resumption in HIV-positive patients exposed to antiretroviral therapy interruption
Authors: Richart Valèria , Fernández Irene , de Lazzari Elisa , Berrocal Leire , Fehér Csaba , Plana Montserrat , Leal Lorna , García Felipe 
Published: August 2021

Objective:
We analyzed the incidence rate of long-term events in patients on antiretroviral therapy (ART) previously exposed to therapy interruption.

Design:
A single-center cohort study involving participants in ART interruptions (ARTI) clinical trials (n = 10) was conducted.

Methods:
Non-AIDS events after ART resumption were analyzed. A control group not exposed to ARTI was randomly selected from the same cohort and a propensity score of belonging to ARTI group was estimated based on age, sex, CD4+ nadir value, time from HIV diagnosis to ARTI, time from HIV diagnosis to starting ART and time of suppressed viral load, and used to adjust effect estimates.

Results:
One hundred and eighty-one patients were included, 136 in ARTI and 45 in the control arm. Median time of known HIV-1 infection was 21 years and median time from ART resumption to first non-AIDS event was 5.2 years. A significantly higher proportion of patients with ARTI had an event as compared with control group [raw percentages: 43% (n = 53) vs. 23% (n = 10), P = 0.015]. These differences were confirmed when only the non-AIDS events occurring after ART resumption were analyzed [adjusted hazard ratio (aHR) = 2.43, 95% confidence interval (CI) 1.15–5.12]. The logistic model adjusted for the propensity score indicated that patients with an ARTI had a four-fold higher risk of having at least one non-AIDS event (P = 0.002).

Conclusion:
We found a higher risk of having at least one non-AIDS event years after ART resumption in HIV-infected patients exposed to ARTI as compared with controls. These data should be taken into consideration for future functional cure clinical trials.
Evaluation of the relationship between quantitative PCR results and cell culturing of SARS2-CoV with respect to symptoms onset and Viral load – a systematic review
Authors: Gilad Rozenberg , Oran Erster , Itai Ghersin , Michal Mandelboim , Ami Neuberger , Eli Schwartz 
Published: August 2021

AbstractBackgroundViral culture is currently the most accurate method to demonstrate viability and infectivity of Severe acute respiratory syndrome Coronavirus (SARS-2 CoV). Routine clinical diagnosis, however, is mostly performed by PCR – based assays that do not discriminate between infectious and non-virus. Herein, we aimed to determine the correlation between positive viral cultures and either PCR positivity, the Cycle Threshold (Ct) or the number of viral copies.MethodsA systematic electronic literature search was performed and studies that reported both viral SARS-CoV-2 culture and PCR–based assays were included. A separate search for samples from blood, urine, stool, breast milk and tears were performed. To convert Ct values reported in the reviewed studies were to viral genomic copies, calibration experiments with four different reaction performed, using quantified RNA molecules.ResultsA total 540 articles were reviewed, and 38 studies were included in this review. Out of 276 positive-culture of non-severe patients, 272 (98.55%) were negative ten days after symptoms onset, while PCR assays remained positive for up to 67 days. In severely ill or immunocompromised patients positive-culture was obtained up to 32 days and out of 168 cultures, 31 (18.45%) stayed positive after day 10. In non-severe patients, in Ct value greater than 30 only 10.8% were still culture-positive while in Ct >35 it was nearly universally negative. The minimal calculated number of viral genome copies in culture-positive sample was 2.5 × 103 copies / mL. These findings were similar in immunocompromised patients. Recovering positive culture from non-respiratory samples was sporadically obtained in stool or urine samples. Conversion of Ct values to viral genome copies showed variability between different PCR assays and highlighted the need to standardize reports to correctly compare results obtained in different laboratories.ConclusionDuring the pandemic phase, non-severe COVID-19 patients who are recovering and are not immuno-suppressed, can be regarded as non-infectious, within 10 days from symptom onset, or with Ct value greater than 35 (or a calculated viral load lower than 1.2×103 copies / mL). These findings have important implications for recovering patients and asymptomatic patients, with respect to isolation criteria. The conversion of Cq values to viral genome copies described herein may be useful in future work, enabling a more standardized comparison between results reported in different studies from different laboratories.
HLA Class I and Plasma Viral Load of HIV-1 in Sexually Transmitted and Reproductive Tract Infections among Heterosexual Serodiscordant couples in Nigeria
Authors: Otuonye NM , Ma Luo , Chinweokwu Chris , Aniedobe MN , Okoye RN , Enya VN , Ogbonna FN , Audu R , Uwandu M , Adedeji A , Ponmak J , Nduaga S , Akindele SK , Liboro GO , Odewale EO , Adesesan AA , Musa AZ , Ezechi O , Ojetunde MM , Odunukwe NN 
Published: August 2021

ABSTRACTBackgroundThis study investigated HLA Class I in Long Term Non-progressors (LTNPs) and plasma viral load in Sexually Transmitted and Reproductive Tract Infections (STIs/RTIs) associated with Heterosexual HIV-1 transmission among serodiscordant couples in Nigeria.MethodsA total of 271 serodiscordant and concordant couples (HIV positive and negative) were enrolled, blood samples were collected from the subjects by venipuncture. HLA class I (with specific primers), plasma viral load, CD4+ analysis was done. Endocervical/urethral swabs and early morning urine samples were collected by standard microbiological methods. These were screened by microscopy, culture, antibiogram, and biochemical tests with a view to identify aetiologic agents of co-infections with HIV.ResultsThe Participants age ranged from ≥ 21- < 50years. The index whose plasma viral loads were 10,001-100,000 copies/ml had STIs/RTIs 32(60.9% p=0.059). Staphylococcus aureus and Escherichia coli (22.1%) were isolated from the index (HIV positive subject) while 14.5% of Staphylococcus aureus and 27.2% of E coli were isolated from their partners (HIV negative subject). Staphylococcus aureus and E coli are normal flora but because the patients are Immunocompromised as a result of positivity to HIV, Staphylococcus aureus and E. coli in this context becomes opportunistic thereby, causing genital tract infections. Staphylococcus from the index showed more sensitivity to Amoxicillin/clavulanate (95.4%/90.4%) compared to the partners (55.1%/73.5%) and more resistant to Ceftazidime (81.4%) compared to the partners (68.9%). LTNPs were 28(8.51%) among the index. HLA-B alleles: B*5701 (9.2%), B*5703 (4.6%) and B*5801(12.5%) were identified for viral control at late stage of HIV infection while A*1 (4.6%), and C*0701 (29.1%) were protective alleles observed. HLA-B*0702 (33.3%), B*4201/A*2301(4.6%) respectively were susceptible alleles associated with seroconversion among LTNPs.ConclusionThe microorganisms isolated from the index were associated with high viral loads and are independent makers to HIV-1 transmission among serodiscordant couples. Individuals associated with HLA class I alleles identified among LTNPs were those significantly associated with resistance and susceptible to HIV-1 infections.