Autoimmune dysregulation and purine metabolism in adenosine deaminase deficiency.

Abstract: Genetic defects in the adenosine deaminase (ADA) gene are among the most common causes for severe combined immunodeficiency (SCID). ADA-SCID patients suffer from lymphopenia, severely impaired cellular and humoral immunity, failure to thrive, and recurrent infections. Currently available therapeutic options for this otherwise fatal disorder include bone marrow transplantation (BMT), enzyme replacement therapy with bovine ADA (PEG-ADA), or hematopoietic stem cell gene therapy (HSC-GT). Although varying degrees of immune reconstitution can be achieved by these treatments, breakdown of tolerance is a major concern in ADA-SCID. Immune dysregulation such as autoimmune hypothyroidism, diabetes mellitus, hemolytic anemia, and immune thrombocytopenia are frequently observed in milder forms of the disease. However, several reports document similar complications also in patients on long-term PEG-ADA and after BMT or GT treatment. A skewed repertoire and decreased immune functions have been implicated in autoimmunity observed in certain B-cell and/or T-cell immunodeficiencies, but it remains unclear to what extent specific mechanisms of tolerance are affected in ADA deficiency. Herein we provide an overview about ADA-SCID and the autoimmune manifestations reported in these patients before and after treatment. We also assess the value of the ADA-deficient mouse model as a useful tool to study both immune and metabolic disease mechanisms. With focus on regulatory T- and B-cells we discuss the lymphocyte subpopulations particularly prone to contribute to the loss of self-tolerance and onset of autoimmunity in ADA deficiency. Moreover we address which aspects of immune dysregulation are specifically related to alterations in purine metabolism caused by the lack of ADA and the subsequent accumulation of metabolites with immunomodulatory properties.

Sauer|Aisha Vanessa|AV|
Brigida|Immacolata|I|
Carriglio|Nicola|N|
Aiuti|Alessandro|A|

autoimmunity
adenosine deaminase
severe combined immunodeficiency
ADA-SCID
gene therapy


Xanthine oxidase functionalized Ta2O5 nanostructures as a novel scaffold for highly sensitive SPR based fiber optic xanthine sensor.

Abstract: Fabrication and characterization of a surface plasmon resonance based fiber optic xanthine sensor using entrapment of xanthine oxidase (XO) enzyme in several nanostructures of tantalum (v) oxide (Ta2O5) have been reported. Chemical route was adopted for synthesizing Ta2O5 nanoparticles, nanorods, nanotubes and nanowires while Ta2O5 nanofibers were prepared by electrospinning technique. The synthesized Ta2O5 nanostructures were characterized by photoluminescence, scanning electron microscopy, UV-Visible spectra and X-ray diffraction pattern. The probes were fabricated by coating an unclad core of the fiber with silver layer followed by the deposition of XO entrapped Ta2O5 nanostructures. The crux of sensing mechanism relies on the modification of dielectric function of sensing layer upon exposure to xanthine solution of diverse concentrations, reflected in terms of shift in resonance wavelength. The sensing probe coated with XO entrapped Ta2O5 nanofibers has been turned out to possess maximum sensitivity amongst the synthesized nanostructures. The probe was optimized in terms of pH of the sample and the concentration of XO entrapped in Ta2O5 nanofibers. The optimized sensing probe possesses a remarkably good sensitivity of 26.2nm/µM in addition to linear range from 0 to 3µM with an invincible LOD value of 0.0127µM together with a response time of 1min. Furthermore, probe selectivity with real sample analysis ensure the usage of the sensor for practical scenario. The results reported open a novel perspective towards a sensitive, rapid, reliable and selective detection of xanthine.

Kant|Ravi|R|
Tabassum|Rana|R|
Gupta|Banshi D|BD|

Xanthine
Xanthine oxidase
Nanostructures
Sensor
Surface plasmon resonance
Optical fiber
Ta(2)O(5)


Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy for Carotid Artery Stenosis.

Abstract:
OBJECTIVE
Patients undergoing carotid endarterectomy (CEA) are at risk of developing ipsilateral stroke or transient ischemic attacks (TIAs). In this study, we explored factors associated with development of these events following CEA in patients with long-term follow-up.

METHODS
We performed a retrospective analysis of all neurosurgical patients who underwent CEA and presented with ipsilateral ischemic stroke, TIA, or amaurosis fugax. Factors were compared against the outcome variable in univariate analysis. Multivariate logistic regression model was used to identify independent predictive variables. We used Kaplan-Meier analysis (log-rank test) to compare the effect of variables on long-term event-free survival.

RESULTS
Our study included 270 patients with an average age of 67.2 years. Two-hundred and forty-nine patients within our study cohort (92.2%) with 273 CEAs were followed at our institution. At presentation, 187 patients (68.5%) were symptomatic. The average follow-up was 50.2 months (113.2 lesion-years). Event-free survival was 91.6% and 89.9% at 2 years and 5 years, respectively. Family history of stroke (P = 0.002), cigarette smoking (P = 0.021), and atrial fibrillation (P = 0.005) significantly increased the risk of adverse events, whereas symptomatic presentation demonstrated a trend toward significance (P = 0.057). A higher risk for ischemic events was observed in female patients as compared with males with asymptomatic presentation (P = 0.005).

CONCLUSIONS
Our data suggest that family history of stroke, cigarette smoking, and atrial fibrillation are independent risk factors for developing ischemic events after CEA. In patients with asymptomatic presentation, female gender is also a risk factor. Identification of patients at risk is critical for tailored postoperative patient management and patient education.

Rong|Xiaoming|X|
Yang|Wuyang|W|
Garzon-Muvdi|Tomas|T|
Ye|Xiaobu|X|
Caplan|Justin M|JM|
Colby|Geoffrey P|GP|
Coon|Alexander L|AL|
Tamargo|Rafael J|RJ|
Huang|Judy|J|

Carotid endarterectomy
Stroke
Transient ischemic attack
Carotid stenosis


Chemical composition and antimicrobial activity of the essential oil of kumquat (Fortunella crassifolia Swingle) peel.

Abstract: The aim of this study was to determine the main constituents of the essential oil isolated from Fortunella crassifolia Swingle peel by hydro-distillation, and to test the efficacy of the essential oil on antimicrobial activity. Twenty-five components, representing 92.36% of the total oil, were identified by GC-MS analysis. The essential oil showed potent antimicrobial activity against both Gram-negative (E. coli and S. typhimurium) and Gram-positive (S. aureus, B. cereus, B. subtilis, L. bulgaricus, and B. laterosporus) bacteria, together with a remarkable antifungal activity against C. albicans. In a food model of beef extract, the essential oil was observed to possess an effective capacity to control the total counts of viable bacteria. Furthermore, the essential oil showed strongly detrimental effects on the growth and morphological structure of the tested bacteria. It was suggested that the essential oil from Fortunella crassifolia Swingle peel might be used as a natural food preservative against bacteria or fungus in the food industry.

Wang|Yong-Wei|YW| Zeng|Wei-Cai|WC| Xu|Pei-Yu|PY| Lan|Ya-Jia|YJ| Zhu|Rui-Xue|RX| Zhong|Kai|K| Huang|Yi-Na|YN| Gao|Hong|H|

chemical composition
antimicrobial activity
essential oil
Fortunella crassifolia
food-borne bacteria


HIV p17 enhances T cell proliferation by suppressing autophagy through the p17-OLA1-GSK3β axis under nutrient starvation.

Abstract: Nutrient starvation is a common phenomenon that occurs during T cell activation. Upon pathogen infection, large amounts of immune cells migrate to infection sites, and antigen-specific T cells are activated; this is followed by rapid proliferation through clonal expansion. The dramatic expansion of cells will commonly lead to nutrient shortage. Cellular autophagy is often upregulated as a way to sustain the body's energy requirements. During infection, human immunodeficiency virus (HIV) co-opts a series of host cell metabolic pathways for replication. Several HIV proteins, such as Env, Nef, and Vpr, have already been reported as being involved in autophagy-related processes. In this report, we identified that the HIV p17 protein acts as a major factor in suppressing the autophagic process in T cells, especially under glucose starvation condition. HIV p17 interacts with Obg-like ATPase 1 (OLA1) and disrupts OLA1-glycogen synthase kinase-3 beta (GSK3β) complex, leading to GSK3β hyperactivation. Consequently, a prior proliferation of HIV-infected T cells under glucose starvation will occur. The inhibition of autophagy also aids HIV replication by antagonizing the antiviral effect of autophagy. Our study shows a new cellular pathway that HIV can hijack for viral spreading by a prior proliferation of HIV-loaded T cells and may provide new therapeutic targets for acquired immunodeficiency syndrome intervention.

Lu|Jing|J|0000-0001-6741-6850 Jia|Jiayuan|J| Zhang|Jiahui|J| Liu|Xinqi|X|

D000071679:Glycogen Synthase Kinase 3 beta

D054301:gag Gene Products, Human Immunodeficiency Virus

HIV
autophagy
T cell survival
protein interaction
viral infection


Hyperfibrinolysis in severe isolated traumatic brain injury may occur without tissue hypoperfusion: a retrospective observational multicentre study.

Abstract:
BACKGROUND
Hyperfibrinolysis is a critical complication in severe trauma. Hyperfibrinolysis is traditionally diagnosed via elevated D-dimer or fibrin/fibrinogen degradation product levels, and recently, using thromboelastometry. Although hyperfibrinolysis is observed in patients with severe isolated traumatic brain injury (TBI) on arrival at the emergency department (ED), it is unclear which factors induce hyperfibrinolysis. The present study aimed to investigate the factors associated with hyperfibrinolysis in patients with isolated severe TBI.

METHODS
We conducted a multicentre retrospective review of data for adult trauma patients with an injury severity score ≥ 16, and selected patients with isolated TBI (TBI group) and extra-cranial trauma (non-TBI group). The TBI group included patients with an abbreviated injury score (AIS) for the head ≥ 4 and an extra-cranial AIS < 2. The non-TBI group included patients with an extra-cranial AIS ≥ 3 and head AIS < 2. Hyperfibrinolysis was defined as a D-dimer level ≥ 38 mg/L on arrival at the ED. We evaluated the relationships between hyperfibrinolysis and injury severity/tissue injury/tissue perfusion in TBI patients by comparing them with non-TBI patients.

RESULTS
We enrolled 111 patients in the TBI group and 126 in the non-TBI group. In both groups, patients with hyperfibrinolysis had more severe injuries and received transfusion more frequently than patients without hyperfibrinolysis. Tissue injury, evaluated on the basis of lactate dehydrogenase and creatine kinase levels, was associated with hyperfibrinolysis in both groups. Among patients with TBI, the mortality rate was higher in those with hyperfibrinolysis than in those without hyperfibrinolysis. Tissue hypoperfusion, evaluated on the basis of lactate level, was associated with hyperfibrinolysis in only the non-TBI group. Although the increase in lactate level was correlated with the deterioration of coagulofibrinolytic variables (prolonged prothrombin time and activated partial thromboplastin time, decreased fibrinogen levels, and increased D-dimer levels) in the non-TBI group, no such correlation was observed in the TBI group.

CONCLUSIONS
Hyperfibrinolysis is associated with tissue injury and trauma severity in TBI and non-TBI patients. However, tissue hypoperfusion is associated with hyperfibrinolysis in non-TBI patients, but not in TBI patients. Tissue hypoperfusion may not be a prerequisite for the occurrence of hyperfibrinolysis in patients with isolated TBI.

Hayakawa|Mineji|M| Maekawa|Kunihiko|K| Kushimoto|Shigeki|S| Kato|Hiroshi|H| Sasaki|Junichi|J| Ogura|Hiroshi|H| Matsuoka|Tetsuya|T| Uejima|Toshifumi|T| Morimura|Naoto|N| Ishikura|Hiroyasu|H| Hagiwara|Akiyoshi|A| Takeda|Munekazu|M| Kaneko|Naoyuki|N| Saitoh|Daizoh|D| Kudo|Daisuke|D| Kanemura|Takashi|T| Shibusawa|Takayuki|T| Furugori|Shintaro|S| Nakamura|Yoshihiko|Y| Shiraishi|Atsushi|A| Murata|Kiyoshi|K| Mayama|Gou|G| Yaguchi|Arino|A| Kim|Shiei|S| Takasu|Osamu|O| Nishiyama|Kazutaka|K|

Hyperfibrinolysis
Traumatic brain injury
Hypoperfusion
Coagulopathy
Disseminated intravascular coagulation


Fetal bronchopulmonary malformations.

Abstract:
INTRODUCTION
Fetal body tumors are rare, but the ability to diagnose them has improved over recent years. Most masses discovered in the chest results from fetal bronchopulmonary malformations, such as congenital cystic adenomatoid malformation and bronchopulmonary sequestration. Congenital cystic adenomatoid malformation and bronchopulmonary sequestration have a reported incidence of 50% and 33% of all prenatally diagnosed lung lesions, respectively.

MATERIAL AND METHODS
Retrospective analysis of the congenital cystic adenomatoid malformation and bronchopulmonary sequestration cases diagnosed or surveilled at our department, between January 2003 and March 2013. Prenatal examination, evolution, management and patient outcome were analyzed.

RESULTS
A total of 918 fetal malformations were diagnosed at our hospital, 17 of them representing fetal bronchopulmonary malformations. The majority were diagnosed during the second trimester and stabilized or regressed during the third trimester of pregnancy. The pregnancies and deliveries had no other relevant findings or complications, except in three cases. Nine children required surgery. All of the children are healthy and have a normal development, with regular surveillance by the pediatricians.

DISCUSSION
The majority of these fetal lung masses are isolated findings that partially regress during intrauterine life. With adequate postnatal surveillance and eventual surgery the prognosis is good.

Nunes|Carla|C|
Pereira|Isabel|I|
Araújo|Cláudia|C|
Santo|Susana Ferreira|SF|
Carvalho|Rui Marques|RM|
Melo|Antonieta|A|
Graça|Luís Mendes|LM|

D015615:Cystic Adenomatoid Malformation of Lung, Congenital

cystic adenomatoid malformation
Bronchopulmonary sequestration
prenatal diagnosis


Assessment of shoulder external rotation range-of-motion on throwing athletes: the effects of testing end-range determination (active versus passive).

Abstract: The purpose of this study was to compare the effects of active or passive end-range determination (supine position) for external rotation range of motion (ROM) in overhead throwing athletes and verify if athletes' ROM is similar to non-athletes. Kinematic data from the dominant shoulder of 24 healthy male subjects, divided into two groups (12 athletes and 12 non-athletes) were recorded at end-range external rotation, thoracohumeral and glenohumeral external rotation angles were compared and a 2-way repeated-measures ANOVA was used to calculate the effects of end-range determination (passive versus active) across groups (athlete and non-athlete). A significant main effect (p < 0.001) on both thoracohumeral and glenohumeral external end-range angles was observed while the highest end-range determination values were associated with passive motion. No differences were observed between the athletic or non-athletic groups for either thoracohumeral (p = 0.784) or glenohumeral (p = 0.364) motion.

D000328:Adult
D000704:Analysis of Variance
D053587:Arthrometry, Articular
D056352:Athletes
D054874:Athletic Performance
D001696:Biomechanical Phenomena
D006801:Humans
D008297:Male
D016059:Range of Motion, Articular
D012785:Shoulder Joint
D016683:Supine Position
D055815:Young Adult

shoulder external rotation
overhead throwing athletes
Clinical assessment


Total Reconstruction of the Afferent Loop for Treatment of Radiation-Induced Afferent Loop Obstruction with Segmental Involvement after Pancreaticoduodenectomy with Roux-en-Y Reconstruction.

Abstract: As the literature on afferent loop obstruction (ALO) after pancreaticoduodenectomy (PD) is very limited, standardized rules for its management do not exist. Herein, we report the case of a 65-year-old male patient with chronic ALO who had undergone PD with single Roux-en-Y limb reconstruction and adjuvant chemoradiation therapy for pancreatic head adenocarcinoma 2 years earlier. The patient was brought to the operating room with the diagnosis of radiation enteritis of the afferent loop with segmental involvement and concurrent hepaticojejunostomy (HJ) and pancreaticojejunostomy (PJ) stricture. Complete mobilization of the afferent loop, removal of the affected segment and reconstruction were performed. Reconstruction of the afferent loop was a one-way option for the surgeons because the Roux-en-Y reconstruction limited endoscopic access to the afferent loop, and the segmental radiation injury of the afferent loop ruled out bypass surgery. However, mobilization of the affected segment through a field of dense adhesions and revision of the HJ and PJ were technically demanding.

Blouhos|Konstantinos|K|
Boulas|Konstantinos A|KA|
Salpigktidis|Ilias I|II|
Konstantinidou|Anna|A|
Ioannidis|Konstantinos|K|
Hatzigeorgiadis|Anestis|A|

Afferent loop obstruction
Pancreaticoduodenectomy
Roux-en-Y reconstruction
Radiation enteritis
Surgery


BCR-ABL mutations in chronic myeloid leukemia treated with tyrosine kinase inhibitors and impact on survival.

Abstract: This is the largest Latin American study of BCR-ABL mutations in chronic myeloid leukemia (CML) patients, resistant to imatinib (IM). In 195/467 (41%) patients, mutations were detected. The most frequent mutation was T315I (n = 31, 16%). Progression-free (PFS) and overall survival (OS) at 5 years were lower in patients with BCR-ABL mutations (43% vs. 65%, p = 0.07 and 47% vs. 72%, p = 0.03, respectively) and in those with the T315I mutation (p = 0.003 and p = 0.03). OS and PFS were superior in subgroup who switched to second generation inhibitors (SGIs) after IM failure (OS: 50% vs. 39% p = 0.01; PFS: 48% vs. 30% p = 0.02). BCR-ABL mutations conferred a significant poor prognosis in CML patients.

Pagnano|Katia Borgia Barbosa|KB|
Bendit|Israel|I|
Boquimpani|Carla|C|
De Souza|Carmino Antonio|CA|
Miranda|Eliana C M|EC|
Zalcberg|Ilana|I|
Larripa|Irene|I|
Nardinelli|Luciana|L|
Silveira|Rosana Antunes|RA|
Fogliatto|Laura|L|
Spector|Nelson|N|
Funke|Vaneuza|V|
Pasquini|Ricardo|R|
Hungria|Vania|V|
Chiattone|Carlos Sérgio|CS|
Clementino|Nelma|N|
Conchon|Monika|M|
Moiraghi|Elena Beatriz|EB|
Lopez|Jose Luis|JL|
Pavlovsky|Carolina|C|
Pavlovsky|Miguel A|MA|
Cervera|Eduardo E|EE|
Meillon|Luis Antonio|LA|
Simões|Belinda|B|
Hamerschlak|Nelson|N|
Bozzano|Alicia Helena Magarinos|AH|
Mayta|Ernesto|E|
Cortes|Jorge|J|
Bengió|Raquel M|RM|
|||

D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive

BCR-ABL mutations
Chronic myeloid leukemia
Tyrosine kinase inhibitors
Resistance
Imatinib


Mobile applications in peripheral arterial disease (PAD): a review and introduction of a new innovative telemonitoring application: JBZetje.

Abstract: Introduction:Peripheral arterial disease (PAD) is an occlusive vascular disease of the lower extremities with increasing incidence and prevalence numbers and therefore rising health care costs. Mobile applications have great potential to improve health system efficiency and can assist in overcoming the increasing health care costs. In this review all available mobile applications developed for PAD are summarized and a new innovative application is introduced.Areas covered:Available applications for PAD are scarce and currently aim at prevention, teleconsultation and telemonitoring via questionnaires and activity tracking. Integration in the daily workflow of the physician is an overlooked aspect of these applications. JBZetje is an innovative mobile application that provides remote care, information services and self-service tools, and enables connection with the electronic health record (EHR).Expert opinion:Connection of the application with the EHR generates a complete overview of a patient's current health status. This will reinforce the tendency toward personalized medicine and will probably lead to reduced health care costs and increase the quality of care. Future feasibility studies should answer the question whether the use of mobile applications is feasible in the PAD population.

D006801:Humans
D035002:Lower Extremity
D063731:Mobile Applications
D058729:Peripheral Arterial Disease
D011795:Surveys and Questionnaires
D017216:Telemedicine

mobile applications
peripheral arterial disease
review
Coaching
intermittent claudication
prom
telemedicine
wearables


Urinary steroid profile in relation to the menstrual cycle.

Abstract: The interpretation of the steroidal module of the Athlete Biological Passport (ABP) in female athletes is complex due to the large variation of the endogenous urinary steroids. The menstrual cycle seems to be one of the largest confounders of the steroid profile. The duration of the different phases in the menstrual cycle differs between women and is difficult to predict only by counting days after menstruation. Here, we have determined the follicle, ovulation, and luteal phases, by assessing the menstrual hormones in serum samples collected from 17 healthy women with regular menses. Urine samples were collected three times per week during two consecutive cycles to measure the urinary steroid concentrations used in the ABP. The metabolite that was mostly affected by the menstrual phases was epitestosterone (E), where the median concentration was 133% higher in the ovulation phase compared to the follicle phase (p < 0.0001). The women with a large coefficient of variation (CV) in their first cycle also had a large CV in their second cycle and vice versa. The inter-individual difference was extensive with a range of 11%-230% difference between the lowest and the highest T/E ratio during a cycle. In conclusion, E and ratios with E as denominator are problematic biomarkers for doping in female athletes. The timing of the sample collection in the menstrual cycle will have a large influence on the steroid profile. The results of this study highlight the need to find additional biomarkers for T doping in females.

steroid profile
menstrual cycle
ABP
T/E
doping in sports


Lipohypertrophy Monitoring Study (LIMO): Effect of single use of 4 mm pen needles combined with education on injection site rotation on glycaemic control: Confirmation of an unpleasant truth.

Abstract:
AIMS
To investigate whether single use of 4 mm needles combined with education about injection technique and lipohypertrophy affects HbA1c, hypoglycaemia and glucose variability.

METHODS
Insulin-injecting people with diabetes recruited from nine Belgian diabetes centres were prospectively followed for 6 months. They were provided 4 mm pen needles and education concerning injection technique using an online platform (BD and Me™) based on the international Forum for Injection Technique & Therapy Recommendations focused on avoidance of lipohypertrophy zones and reduction of needle reuse.

RESULTS
A total of 171 people with diabetes were included of which 146 completed the study. At baseline, lipohypertrophy was present in 63.0% of those who completed the study, with 51.4% injecting in zones of lipohypertrophy, 37.0% incorrectly rotating and 95.9% reusing needles. After the intervention, 7.5% still injected in a lipohypertrophy zone, 4.1% rotated incorrectly and needle reuse decreased to 21.2%. The number of participants with severe hypoglycaemias (from 15.8% to 4.1%, p < 0.001), unexplained hypoglycaemias (from 46.6% to 16.4%, p < 0.001) and high glucose variability (from 64.4% to 29.5%, p < 0.001) was significantly reduced. HbA1c and total daily insulin dose remained stable.

CONCLUSION
The combination of 4 mm pen needles and online education on injection techniques significantly reduced the number of people with severe hypoglycaemic episodes, unexplained hypoglycaemia and high glucose variability but did not improve HbA1c control nor lower insulin needs.

TRIAL REGISTRATION
ClinicalTrials.gov NCT04659330.

lipohypertrophy
injection technique
hypoglycaemia
glucose variability
needle reuse


Open Access and Article Processing Charges in Cardiology and Cardiac Surgery Journals: a Cross-Sectional Analysis.

Abstract:
INTRODUCTION
Open access (OA) publishing often requires article processing charges (APCs). While OA provides opportunities for broader readership, authors able to afford APCs are more commonly associated with well-funded, high-income country institutions, skewing knowledge dissemination. Here, we evaluate publishing models, OA practices, and APCs in cardiology and cardiac surgery.

METHODS
The InCites Journal Citation Reports 2019 directory by Clarivate Analytics was searched for "Cardiac and Cardiovascular Systems" journals. Sister journals of included journals were identified. All journals were categorized as predominantly cardiology or cardiac surgery. Publishing models, APCs, and APC waivers were defined for all journals.

RESULTS
One hundred sixty-one journals were identified (139 cardiology, 22 cardiac surgery). APCs ranged from $244 to $5,000 ($244-5,000 cardiology; $383-3,300 cardiac surgery), with mean $2,911±891 and median $3,000 (interquartile range [IQR]: $2,500-3,425) across 139 journals with non-zero available APCs ($2,970±890, median $3,000, IQR: $2,573-3,450, cardiology; $2,491±799, median $2,740, IQR: $2,300-3,000, cardiac surgery). Average APCs were $3,307±566 and median $3,250 (IQR: $3,000-3,500) for hybrid journals ($3,344±583, median $3,260, IQR: $3,000-3,690, cardiology; $2,983±221, median $2,975, IQR: $2,780-3,149, cardiac surgery) and $1,997±832 and median $2,100 (IQR: $1,404-2,538) for fully OA journals ($2,039±843, median $2,100, IQR: $1,419-2,604, cardiology; $1,788±805, median $2,000, IQR: $1,475-2,345, cardiac surgery). Waivers were available for 51 (86.4%) fully OA and 37 (37.4%) hybrid journals. Seventeen journals were fully OA without APCs, one journal did not yet release APCs, and four journals were subscription-only.

CONCLUSION
OA publishing is common in cardiology and cardiac surgery with substantial APCs. Waivers remain limited, posing barriers for unfunded and lesser-funded researchers.

Vervoort|Dominique|D|
Luc|Jessica G Y|JGY|
Sá|Michel Pompeu B O|MPBO|
Etchill|Eric W|EW|

D022126:Access to Information
D006348:Cardiac Surgical Procedures
D002309:Cardiology
D003430:Cross-Sectional Studies
D006801:Humans
D010506:Periodicals as Topic

Cardiology
Publishing
Access to Information
Cardiac Surgical Procedures
Open Access Publishing
Periodicals as Topic


Cuticular hydrocarbons corroborate the distinction between lowland and highland Natal fruit fly (Tephritidae, Ceratitis rosa) populations.

Abstract: The cuticular hydrocarbons (CHs) and morphology of two Ceratitis rosa Karsch (Diptera: Tephritidae) populations, putatively belonging to two cryptic taxa, were analysed. The chemical profiles were characterised by two-dimensional gas chromatography with mass spectrometric detection. CHs of Ceratitis rosa that originated from the lowlands and highlands of Kenya comprised of n-alkanes, monomethylalkanes, dimethylalkanes and unsaturated hydrocarbons in the range of the carbon backbone from C14 to C37. Hydrocarbons containing C29, C31, C33 and C35 carbon atoms predominated in these two populations. 2-Methyltriacontane was the predominant compound in both populations. Quantitative differences in the distribution of hydrocarbons of different chain lengths, mainly the C22, C32, C33 and C34 compounds of these two populations, were observed despite indistinct qualitative differences in these hydrocarbons. Morphological analyses of male legs confirmed that the flies belong to different morphotypes of Ceratitis rosa previously labelled as R1 and R2 for lowland and highland populations, respectively. A statistical analysis of the CH compositions of the putative R1 and R2 species showed distinct interspecific identities, with several CHs specific for each of the lowland and highland populations. This study supports a hypothesis that the taxon Ceratitis rosa consists of at least two biological species.

Vaníčková|Lucie|L|
Břízová|Radka|R|
Pompeiano|Antonio|A|
Ekesi|Sunday|S|
Meyer|Marc De|MD|

Ceratitis rosa
GC×GC/MS
chemotaxonomy
cryptic species
integrative taxonomy


An experimental study on eco-friendly and cost-effective natural materials for productivity enhancement of single slope solar still.

Abstract: The proposed research study aims to improve the productivity of solar still (SS) by using low-cost and eco-friendly materials. The aforementioned objective was achieved by enhancing the evaporation rate of seawater in the absorber basin and the condensation rate over the glass cover of the solar still. In this study, the low-cost and eco-friendly materials used for enhancing the evaporation rate in the solar still were molasses powder (MP), sawdust (SD) and rice husk (RH). In addition to these materials, bamboo straw (BS), banana leaf stem (BL) and rice straw (RS) were used as absorbing materials over the glass cover for enhancing the condensation rate. The experiments were carried out under similar meteorological conditions, and the results of the modified solar still were compared with the conventional solar still (CSS). The productivities of CSS, SSMP, SSRH, SSSD, SSBS, SSBL and SSRS were about 2250 mL/m2, 2383 mL/m2, 2467 mL/m2, 3033 mL/m2, 2700 mL/m2, 2683 mL/m2 and 3367 mL/m2, respectively. The results of the experimental investigation highlighted that the SSSD had a comparatively better evaporation rate and 34.81% higher yield than CSS. Besides, SSRS had a comparatively better condensation rate and a 51.88% higher yield than CSS. Furthermore, the combination of sawdust (SD) and rice straw (RS) was investigated for the combined enhancement of evaporation and condensation. The solar still with sawdust and rice straw (SSSDRS) showed a 62.88% improvement in productivity with 3633 mL/m2 when compared to CSS. Also, the economic analysis showed that the cost per litre (CPL) of freshwater obtained from SSSDRS was about ₹ 1.9 ($ 0.025) with a payback period of 4.4 months which was the least when compared to all the considered cases.

Productivity enhancement
Solar still
Evaporation
Condensation
Sawdust
Rice straw


Delayed entry to care by men with HIV infection in Kumasi, Ghana.

Abstract:
INTRODUCTION
In resource-limited settings, men may face considerable barriers to accessing HIV care as early interventions tend to focus on antenatal care settings.

METHODS
We performed a retrospective chart review of all adult patients referred to Komfo Anokye Teaching Hospital HIV clinic in Kumasi, Ghana in 2011 to identify the differences in clinical and demographic variables by gender at presentation to care using two-sample t tests with adjusted variance and Wilcox rank sum tests for continuous variables and Pearson chi-squared tests for categorical variables. We also compared differences in clinical and demographic variables among men stratified by CD4 count at initiation of care in order to identify variables associated with later entry to care.

RESULTS
Demographically, men were more likely to be older (men age 42 vs. 37, p<0.01), have a greater number of dependent children (1.8 v. 1.5, p = 0.04), to be living with or married to their partner (65.4% vs. 49.0%, p<0.01), and to have a higher level of education (tertiary education, 45.8% vs. 25.4%, p<0.01) than women. Clinically, men were more likely to have a lower CD4 count at entry to care (260 v. 311 cells/µL, p<0.01), to report clinical symptoms to the nurse during intake (p<0.01), and to have any history of alcohol use (p<0.01).

CONCLUSION
Men in Ghana are accessing treatment at a later stage of their disease than women. Efforts to test and link men to care early should be intensified.

Kumar|Natasha|N| Reece|Rebecca|R| Norman|Betty|B| Kwara|Awewura|A| Flanigan|Timothy|T| Rana|Aadia|A|

D010342:Patient Acceptance of Health Care

entry to care
men
HIV
Ghana
Gender disparities
access to care


Breeding system and bumblebee drone pollination of an explosively pollen-releasing plant, Meliosma tenuis (Sabiaceae).

Abstract: Explosive pollen release is a mechanism used by some angiosperms that serves to attach pollen to a pollinator's body. It is usually adopted by species with zygomorphic tubular flowers and pollinated by birds and bees. The tree genus Meliosma (Sabiaceae, Proteales) has unique disc-like flowers that are externally actinomorphic, but internally zygomorphic, and release pollen explosively. To elucidate the adaptive significance of explosive pollen release, we observed flowering behaviour, the breeding system and pollinator visits to flowers of the Japanese species Meliosma tenuis in a temperate forest. Flowers bloomed in June and were nectariferous and protandrous. Explosive pollen release was triggered by slight tactile stimuli to anther filaments or staminodes in male-stage flowers. Because pollen cannot come into contact with the pistils enclosed by staminodes, M. tenuis is functionally protandrous. Artificial pollination treatments revealed that M. tenuis is allogamous. The dominant flower visitors were nectar-seeking drones of the bumblebee species Bombus ardens (Apidae). The drones' behaviour, pollen attachment on their bodies and fruit set of visit-restricted flowers suggest that they are the only agent triggering the explosive pollen release mechanism, and are the main pollinator of M. tenuis. The finding that bumblebee workers rarely visit these flowers suggests that the explosive pollen release has another function, namely to discourage pollen-harvesting bumblebee workers.

Sabiaceae
explosive pollen release
Dichogamy
male bumblebee
protandry
tactile stimulus


Electroacupuncture pretreatment prevents ischemic stroke and inhibits Wnt signaling-mediated autophagy through the regulation of GSK-3β phosphorylation.

Abstract: Electroacupuncture (EA), a traditional Chinese replacement therapy, is widely accepted to treat ischemic stroke. Increasing evidence show that autophagy is involved in the process of cerebral ischemia injury and the Wnt/GSK3β pathway, playing an important role in protecting central nervous system. In this study, rats were treated with EA prior to focal ischemia by middle cerebral artery occlusion (MCAO). Deficit score, infarct volumes and levels of autophagy markers, such as LC3I, LC3II and p62, were assessed with either PI3K inhibitor wortmannin or a GSK-3β inhibitor LiCl. Oxygen-glucose deprivation/re-oxygenation (OGD/R) was made in the primitive neuron in vitro, and was respectively treated with autophagy inhibitors 3-MA, LiCl, GSK3β siRNA, or mTOR inhibitor rapamycin. The results indicated that EA pretreatment increased the levels of autophagy marker LC3-II and reduced the levels of p62. Meanwhile, deficit outcome was improved, and infarct volumes were reduced by EA pretreatment. Furthermore, the beneficial effects of EA pretreatment were reversed by wortmannin. LiCl and GSK3β siRNA can mimic the neuroprotective effects of EA pretreatment by downregulating autophagy, and increasing protein levels of p-mTOR, p-GSK3β and β-catenin in OGD/R neurons. However, the protective effects of GSK3β siRNA were blocked by rapamycin. These results suggest that EA pretreatment induces tolerance to cerebral ischemia by inhibiting autophagy via the Wnt pathway through the inhibition of GSK3β.

Chen|Chengyu|C|
Yu|Qimin|Q|
Xu|Kaiwei|K|
Cai|Libin|L|
Felicia|Balelang Meita|BM|
Wang|Lu|L|
Zhang|Anqi|A|
Dai|Qinxue|Q|
Geng|Wujun|W|
Wang|Junlu|J|
Mo|Yunchang|Y|

Autophagy
Wnt/GSK3β
Cerebral ischemia/reperfusion
Electroacupuncture(EA)


Lunar phase does not influence perioperative complications in total hip arthroplasty.

Abstract:
INTRODUCTION
Lunar calendars, publishing recommendations for daily life, are gaining more and more attention in Germany, where 10.5% of the population believe in lunar effects on disease. A widespread and often heard belief is that a full moon has the most negative effects on surgical outcome. The present study evaluates the effects of lunar phase on perioperative complications in total hip arthroplasty.

MATERIAL AND METHODS
We performed a retrospective study with 305 patients being provided with a primary hip arthroplasty. To identify possible influences of the lunar phase on perioperative complications we investigated data such as operation length, blood loss and course of C-reactive protein that were collected during the patients' stay in the hospital and allocated them to moon illumination.

RESULTS
There were no significant differences in all collected data concerning the lunar phase (p > 0.05). Although not statistically significant, there were fewer operations during the full moon phase.

CONCLUSIONS
Therefore there is no evidence that lunar phase has an effect on perioperative complications in total hip arthroplasty. Fewer, though not significantly fewer, operations were performed during the full moon phase. Although this was not a prospective randomized trial, the statistical magnitude of the results does not support any recommendations for scheduling patients for total hip arthroplasty at any particular day of the lunar phase.

Ficklscherer|Andreas|A| Angermann|Alexander|A| Weber|Patrick|P| Wegener|Bernd|B| Pietschmann|Matthias|M| Müller|Peter|P|

lunar phase
perioperative complications
hip arthroplasty


Practical two-photon-absorption cross sections and spectra of eosin and hematoxylin.

Abstract: We experimentally investigate the two-photon absorption cross sections and spectra of eosin and hematoxylin for applications in nonlinear microscopy. The experiments are carried out on pure samples of the two dyes in DI-water solvent with different concentrations, in the typical range employed in standard staining procedures. Nonlinear fluorescence is excited by a line-shaped beam emitted by a Ti:Sapphire mode-locked laser in the wavelength range from 740 to 880 nm and is detected through a microscope setup. The two-photon absorption spectral response is systematically analyzed and discussed. Finally, the staining is applied on biological tissue samples, which are imaged by two-photon microscopy. Our results show that the employed dyes are fully suitable for applications in nonlinear imaging.

eosin
hematoxylin
two-photon absorption
microscopy
dyes
nonlinear fluorescence


Polyamines cause elevation of steroid 5α-reductase mRNA levels by suppressing mRNA degradation in C6 glioma cells.

Abstract: Polyamines are widely distributed in living organisms, and considered to play a potential role in various cellular processes. The effects of polyamines on gene expression as well as cell proliferation have been suggested to be closely associated with the physiological and pathological functions. However, it seems necessary to investigate their potential roles in the regulation of cellular metabolism and functions. Previously, glial cells have been suggested to be involved in the protection and preservation of neuronal functions, probably through the production of neurotrophic factors in the brain. On the other hand, neuroactive 5α-reduced steroids promote glial cell differentiation, resulting in enhancement of their ability to produce brain-derived neurotrophic factor (BDNF). Based on these findings, polyamines are assumed to stimulate the expression of the gene encoding steroid 5α-reductase (5α-R), which can induce the production of neuroactive 5α-reduced steroids in glial cells. The effects of polyamines on 5α-R mRNA levels in C6 glioma cells were examined as a model experiment. In consequence, spermine (SPM) and spermidine (SPD), but not putrescine (PUT), have been shown to elevate 5α-R mRNA levels without activating the 5α-R promoter. Furthermore, SPM increased 5α-R mRNA levels under the conditions in which the mRNA biosynthesis was inhibited. Therefore, it can be speculated that polyamines increase 5α-R mRNA levels as a consequence of suppressing the degradation of mRNA.

Morita|Kyoji|K| Lee|Mi-Sook|MS| Her|Song|S| Nishibori|Naoyoshi|N|

actinomycin D
mRNA stabilization
neuroactive steroids
promoter activity


Expression of αvβ6 integrin and collagen fibre in oral squamous cell carcinoma: association with clinical outcomes and prognostic implications.

Abstract:
BACKGROUND
This study aims to investigate the expression and significance of the αvβ6 integrin, collagen fibres and matrix metalloproteinases (MMP)-3 in oral squamous cell carcinoma (OSCC) and to analyse the possible regulatory relationships between αvβ6, collagen fibres and MMP-3.

MATERIALS AND METHODS
A series of 80 patients (mean age 56.4 years) diagnosed with OSCC were enrolled. Associations between αvβ6, MMP-3, collagen fibre expression levels and clinicopathological parameters were evaluated using the Fisher exact test. Survival analysis was performed with Kaplan-Meier curves. Spearman rank correlation was used to analyse interactions between αvβ6, MMP-3 and collagen fibres.

RESULTS
αvβ6 and MMP-3 were strongly expressed in human OSCC, especially at the peripheral borders of invasive tumour islands, and collagen fibres were generally disrupted and degraded in the same areas. The expression intensity of αvβ6 was associated with the differentiation state of cells. β6 mRNA was expressed in almost all cancer cells. In carcinomas, αvβ6 and MMP-3 expression were correlated with the distribution of collagen fibres.

CONCLUSIONS
Tumour cells highly expressing αvβ6 have a strong capability for invasion and migration, due to concomitant protease production and the destruction and remodelling of collagen fibres. Increased αvβ6 integrin and MMP-3 expression and collagen fibre changes in human OSCCs are related to unfavourable clinical prognostic factors and decreased survival.

Li|Hai-Xia|HX| Zheng|Jin-Hua|JH| Fan|Hai-Xia|HX| Li|Hui-Ping|HP| Gao|Zhong-Xiuzi|ZX| Chen|Dong|D|

D015972:Gene Expression Regulation, Neoplastic

αvβ6 integrin
collagen fibre
oral squamous cell carcinoma
MMP-3
prognosis


Elastodynamic image forces on dislocations.

Abstract: The elastodynamic image forces on edge and screw dislocations in the presence of a planar-free surface are derived. The explicit form of the elastodynamic fields of an injected, quiescent screw dislocation are also derived. The resulting image forces are affected by retardation effects: the dislocations experience no image force for a period of time defined by the arrival and reflection at the free surface of the dislocation fields. For the case of injected, stationary dislocations, it is shown that the elastodynamic image force tends asymptotically to the elastotatic prediction. For the case of injected, moving dislocations, it is shown that the elastodynamic image force on both the edge and the screw dislocations is magnified by inertial effects, and becomes increasingly divergent with time; this additional effect, missing in the elastostatic description, is shown to be substantial even for slow moving dislocations. Finally, it is shown that the elastodynamic image force of an edge dislocation moving towards the surface at the Rayleigh wave speed becomes repulsive, rather than attractive; this is suggestive of instabilities at the core of the dislocation, and likely resonances with the free surface.

Gurrutxaga-Lerma|Beñat|B|
Balint|Daniel S|DS|
Dini|Daniele|D|
Sutton|Adrian P|AP|

elastodynamic
image force
dislocation
screw dislocation
edge dislocation


The impact of soil erosion on soil-related ecosystem services: development and testing a scenario-based assessment approach.

Abstract: The ecosystem service (ES) approach usually addresses soil erosion as the regulating service control of erosion rates or soil retention. In addition to the assessment of this regulating ES, mitigated impacts on soil-related ES by preventing soil erosion can be assessed. This study presents a scenario-based approach for the assessment of the impact of soil erosion on soil-related ES. The assessment approach was tested in agricultural landscapes in Northern Germany, combining mapping and assessment of soil-related ES. In six scenarios, the degradation of soils due to soil erosion was simulated by the calculation of soil profile reductions. The scenarios represent two levels of impact with three time steps (+50, +100, +150 years). In the scenarios for the structural impact, the potential soil erosion rates were extrapolated into the future to generate spatially explicit information on degraded soils. In the scenarios for the mitigated impact, the actual soil erosion rates were extrapolated. Four soil-related ES were assessed for the initial state and the scenarios crop provision, water filtration, water flow regulation and fresh water provision. The comparison of the potential service supply of the four soil-related ES in the scenarios enabled the assessment of the long-term effect of the ES control of erosion rates. The mitigated reduction in the potential service supply for three of the considered ES (crop provision, water filtration, water flow regulation) is large and highlights the importance of sustainable soil management. Contrary to this, the ES fresh water provision benefits of erosion-induced soil profile reductions.

D003247:Conservation of Natural Resources

Control of erosion rates
Soil retention
Landscape
CICES
Soil natural capital
Water erosion


Installation of pedal-operated alcohol gel dispensers with behavioral nudges and changes in hand hygiene behaviors during the COVID-19 pandemic: A hospital-based quasi-experimental study.

Abstract: We conducted a quasi-experimental study and compared hand hygiene behaviors at potential pathogen transmission events among outpatient visitors (according to structured observations a trained enumerator) before and after installation of 12 pedal-operated alcohol gel dispensers with behavioral nudges (signs attached to the dispensers) at a tertiary hospital in southern Thailand during the COVID-19 pandemic. The enumerator observed 243 events during the pre-intervention period and 223 events during the postintervention period. Prevalence of hand hygiene was significantly different between the pre-intervention and post-intervention periods (0 vs 24 events, or 0% vs 11%, respectively; p-value <0.001). However, 21 of 24 hand hygiene events were of participants who came from outside the observation area, used the dispensers, then left. Nonetheless, the intervention might have helped to increase access to hand hygiene materials and created opportunities for hand hygiene among hospital visitors in general.

Wichaidit|Wit|W| Naknual|Sommanas|S| Kleangkert|Nanta|N| Liabsuetrakul|Tippawan|T|

hand hygiene
COVID-19
hospital
intervention
patients


Does scrolling affect measurement equivalence of electronic patient-reported outcome measures (ePROM)? Results of a quantitative equivalence study.

Abstract:
BACKGROUND
Scrolling is a perceived barrier in the use of bring your own device (BYOD) to capture electronic patient reported outcomes (ePROs). This study explored the impact of scrolling on the measurement equivalence of electronic patient-reported outcome measures (ePROMs) in the presence and absence of scrolling.

METHODS
Adult participants with a chronic condition involving daily pain completed ePROMs on four devices with different scrolling properties: a large provisioned device not requiring scrolling; two provisioned devices requiring scrolling - one with a "smart-scrolling" feature that disabled the "next" button until all information was viewed, and a second without this feature; and BYOD with smart-scrolling. The ePROMs included were the SF-12, EQ-5D-5L, and three pain measures: a visual analogue scale, a numeric response scale and a Likert scale. Participants completed English or Spanish versions according to their first language. Associations between ePROM scores were assessed using intraclass correlation coefficients (ICCs), with lower bound of 95% confidence interval (CI) > 0.7 indicating comparability.

RESULTS
One hundred fifteen English- or Spanish-speaking participants (21-75y) completed all four administrations. High associations between scrolling and non-scrolling were observed (ICCs: 0.71-0.96). The equivalence threshold was met for all but one SF-12 domain score (bodily pain; lower 95% CI: 0.65) and two EQ-5D-5L item scores (pain/discomfort, usual activities; lower 95% CI: 0.64/0.67). Age, language, and device size produced insignificant differences in scores.

CONCLUSIONS
The measurement properties of PROMs are preserved even in the presence of scrolling on a handheld device. Further studies that assess scrolling impact over long-term, repeated use are recommended.

Scrolling
Measurement equivalence
Patient-reported outcome
Patient-reported outcome measures
ePROM
BYOD
ePRO
Intraclass correlation
Latin Square crossover design


Schistosomiasis and liver disease: Learning from the past to understand the present.

Abstract: To diagnose schistosomiasis, past medical history review should include recent travel to or from an endemic area, a history of elevated liver enzymes as well as contact with contaminated sources of water or farm animals.

schistosomiasis
liver diseases
gastroenterology
hepatology
infectious diseases
schistosoma


Ethics and the facial plastic surgeon.

Abstract: The facial plastic surgeon potentially has a conflict of interest when confronted with the patients requesting surgery, due to the personal gain attainable by agreeing to perform surgery. The aim of this review is to discuss the potential harm the surgeon can inflict by carrying out facial plastic surgery, beyond the standard surgical complications of infection or bleeding. It will discuss the desire for self-improvement and perfection and increase in the prevalence facial plastic surgery. We address the principles of informed consent, beneficence and non-maleficence, as well as justice and equality and how the clinician who undertakes facial plastic surgery is at risk of breaching these principles without due care and diligence.

Ethics
Facial plastic surgery
Aesthetic surgery
Cosmetic surgery
Rhinoplasty


Phenylobacterium deserti sp. nov., isolated from desert soil.

Abstract: A novel bacterial strain, designated YIM 73061T, was isolated from the Cholistan desert in Punjab, Pakistan, and characterized by using a polyphasic taxonomic approach. 16S rRNA gene sequence analysis revealed the highest levels of sequence similarity with respect to Phenylobacterium conjunctum FWC21T (97.6 %), Phenylobacterium lituiforme FaiI3T (97.4 %), Phenylobacteriumcomposti 4T-6T (97.0 %) and Phenylobacterium aquaticum W2-3-4T (96.8 %). Cells were Gram-stain-negative, aerobic and motile rods that formed orange colonies. The strain was oxidase- and catalase-positive. Growth occurred at 20-40 °C (optimum, 30-37 °C) at pH 5.0-8.0 (optimum, pH 7.0) and with 0-1 % (w/v) NaCl (optimum, 0-0.5 %). The major cellular fatty acids (>10 %) were summed feature 8 (comprising C18 : 1ω7c and/or C18 : 1ω6c) and C16 : 0. The polar lipid profile consisted of phosphatidylglycerol and four unidentified glycolipids. The major isoprenoid quinone was ubiquinone-10 (Q-10). The G+C content of the genomic DNA was 66.8 mol%. Strain YIM 73061T showed low levels of DNA-DNA relatedness to P. conjunctum FWC21T (27.2±2.6 %), P. lituiforme FaiI3T (24.6±1.1 %) and P.composti 4T-6T (18.4±3.1 %). On the basis of phylogenetic inference, chemotaxonomic characteristics and phenotypic data, strain YIM 73061T should be classified as representing a novel species, for which the name Phenylobacterium deserti sp. nov. is proposed. The type strain is YIM 73061T (=DSM 103871T=CCTCC AB 2016297T).

Khan|Inam Ullah|IU|
Hussain|Firasat|F|
Habib|Neeli|N|
Wadaan|Mohammed A M|MAM|
Ahmed|Iftikhar|I|
Im|Wan-Taek|WT|
Hozzein|Wael N|WN|
Zhi|Xiao-Yang|XY|
Li|Wen-Jun|WJ|

Phenylobacterium deserti sp. nov.
Cholistan desert
Pakistan
polyphasic taxonomy


Truth even unto its innermost parts.

Abstract: Challenging anyone who spreads falsehoods is an important part of respecting the truth in both science and the wider world.

disinformation
living science
public attitudes to science
scientific integrity


Differences in the Complexity of Office Visits by Physician Specialty: NAMCS 2013-2016.

Abstract:
BACKGROUND
Specialty-to-specialty variation in use of outpatient evaluation and management service codes could lead to important differences in reimbursement among specialties.

OBJECTIVE
To compare the complexity of visits to physicians whose incomes are largely dependent on evaluation and management services to the complexity of visits to physicians whose incomes are largely dependent on procedures.

DESIGN, SETTING, AND PARTICIPANTS
We analyzed 53,670 established patient outpatient visits reported by physicians in the National Ambulatory Medical Care Survey (NAMCS) from 2013 to 2016. We defined high complexity visits as those with an above average number of diagnoses (> 2) and/or medications (> 3) listed We based our comparison on time intervals corresponding to typical outpatient evaluation and management times as defined by the Current Procedural Terminology Manual and specialty utilization of evaluation and management codes based on 2015 Medicare payments.

MAIN OUTCOME AND MEASURES
Proportion of complex visits by specialty category.

KEY RESULTS
We found significant differences in the content of similar-length office visits provided by different specialties. For level 4 established outpatient visits (99214), the percentage involving high diagnostic complexity ranged from 62% for internal medicine, 52% for family medicine/general practice, and 41% for neurology (specialties whose incomes are largely dependent on evaluation and management codes), to 34% for dermatology, 42% for ophthalmology, and 25% for orthopedic surgery (specialties whose incomes are more dependent on procedure codes) (p value of the difference < 0.001). High medication complexity was found in the following proportions of visits: internal medicine 56%, family medicine/general practice 49%, and neurology 43%, as compared with dermatology 33%, ophthalmology 30%, and orthopedic surgery 30% (p value of the difference < 0.001).

CONCLUSION
Within the same duration visits, specialties whose incomes depend more on evaluation and management codes on average addressed more clinical issues and managed more medications than specialties whose incomes are more dependent on procedures.

Goodson|John D|JD|0000-0002-8847-1653
Shahbazi|Sara|S|
Rao|Karthik|K|
Song|Zirui|Z|

NAMCS
evaluation and management services
duration of visit
outpatient visit complexity


Impact of patient characteristics on efficacy and safety of once-weekly semaglutide versus dulaglutide: SUSTAIN 7 post hoc analyses.

Abstract:
OBJECTIVE
In SUSTAIN 7, once-weekly semaglutide demonstrated superior glycated haemoglobin (HbA1c) and body weight (BW) reductions versus once-weekly dulaglutide in subjects with type 2 diabetes (T2D). This post hoc analysis investigated the impact of clinically relevant subject characteristics on treatment effects of semaglutide versus dulaglutide.

DESIGN
Analyses by baseline age (<65, ≥65 years), sex (male, female), diabetes duration (≤5, >5-10, >10 years), HbA1c (≤7.5, >7.5-8.5, >8.5% (≤58, >58-69, >69 mmol/mol)) and body mass index (BMI) (<30, 30-<35, ≥35 kg/m2).

SETTING
194 sites; 16 countries.

PARTICIPANTS
Subjects with T2D (n=1199) exposed to treatment.

INTERVENTIONS
Semaglutide 0.5 mg versus dulaglutide 0.75 mg (low-dose comparison); semaglutide 1.0 mg versus dulaglutide 1.5 mg (high-dose comparison), all subcutaneously once weekly.

PRIMARY AND SECONDARY OUTCOME MEASURES
Change in HbA1c (primary endpoint) and BW (confirmatory secondary endpoint) from baseline to week 40; proportion of subjects achieving HbA1c targets (<7%, ≤6.5% (<53, ≤48 mmol/mol)) and weight-loss responses (≥5%, ≥10%) at week 40; and safety.

RESULTS
HbA1c and BW reductions (estimated treatment difference ranges: -0.22 to -0.70%-point; -1.76 to -3.84 kg) and proportion of subjects achieving HbA1c targets and weight-loss responses were statistically significantly greater for the majority of comparisons of semaglutide versus dulaglutide within each subgroup category and, excepting glycaemic control within the low-dose comparison in HbA1c subgroups, this was irrespective of subgroup or dose comparison. Gastrointestinal adverse events, the most common with both treatments, were reported by more women than men and, with semaglutide, decreased with increasing BMI.

CONCLUSIONS
Consistently greater improvements in HbA1c and BW with semaglutide versus dulaglutide, regardless of age, sex, diabetes duration, glycaemic control and BMI, support the efficacy of semaglutide across the continuum of care in a heterogeneous population with T2D.

TRIAL REGISTRATION NUMBER
NCT02648204.

clinical trials
diabetes & endocrinology
general diabetes


Fostering reproducibility, reusability, and technology transfer in health informatics.

Abstract: Computational methods can transform healthcare. In particular, health informatics with artificial intelligence has shown tremendous potential when applied in various fields of medical research and has opened a new era for precision medicine. The development of reusable biomedical software for research or clinical practice is time-consuming and requires rigorous compliance with quality requirements as defined by international standards. However, research projects rarely implement such measures, hindering smooth technology transfer into the research community or manufacturers as well as reproducibility and reusability. Here, we present a guideline for quality management systems (QMS) for academic organizations incorporating the essential components while confining the requirements to an easily manageable effort. It provides a starting point to implement a QMS tailored to specific needs effortlessly and greatly facilitates technology transfer in a controlled manner, thereby supporting reproducibility and reusability. Ultimately, the emerging standardized workflows can pave the way for an accelerated deployment in clinical practice.

Hauschild|Anne-Christin|AC| Eick|Lisa|L| Wienbeck|Joachim|J| Heider|Dominik|D|

health informatics
Bioinformatics
software engineering
software robustness


Radiofrequency Irradiation Attenuates High-Mobility Group Box 1 and Toll-like Receptor Activation in Ultraviolet B-Induced Skin Inflammation.

Abstract: Ultraviolet B (UVB) exposure activates various inflammatory molecules of keratinocytes in the epidermis layer. Such UVB-mediated skin inflammation leaves post-inflammatory hyperpigmentation (PIH). Reports show a close relationship between PIH and high-mobility group box 1 (HMGB1) and its receptors. General clinical treatments of PIH, such as oral medication and laser treatment, have reported side effects. Recent studies reported the effects of radiofrequency (RF) irradiation on restoring dermal collagen, modulating the dermal vasculature, and thickening the basement membrane. To validate how RF regulates the inflammatory molecules from UVB-irradiated keratinocytes, we used UVB-radiated keratinocytes and macrophages, as well as animal skin. In addition, we examined two cases of RF-irradiated skin inflammatory diseases. We validated the effects of RF irradiation on keratinocytes by measuring expression levels of HMGB1, Toll-like receptors (TLRs), and other inflammatory factors. The results show that the RF modulates UVB-radiated keratinocytes to secrete fewer inflammatory factors and also modulates the expression of macrophages from HMGB1, TLRs, and inflammatory factors. RF irradiation could alleviate inflammatory skin diseases in patients. RF irradiation can regulate the macrophage indirectly through modulating the keratinocyte and inflammatory molecules of macrophages reduced in vitro and in vivo. Although the study is limited by the low number of cases, it demonstrates that RF irradiation can regulate skin inflammation in patients.

Kim|Hyoung Moon|HM|
Oh|Seyeon|S|
Yoon|Jung Hyun|JH|
Kang|Donghwan|D|
Son|Myeongjoo|M|0000-0002-9104-3991
Byun|Kyunghee|K|

skin inflammation
PIH
HMGB1
TLR
micro needling radiofrequency


Evaluation of reproductive function in women treated for bipolar disorder compared to healthy controls.

Abstract:
OBJECTIVES
The purpose of the present study was to investigate the reproductive function of women with bipolar disorder (BD) compared to healthy controls.

METHODS
Women diagnosed with BD and healthy controls with no psychiatric history, aged 18-45 years, were recruited from a university clinic and surrounding community. Participants completed a baseline reproductive health questionnaire, serum hormone assessment, and ovulation tracking for three consecutive cycles using urine luteinizing hormone (LH)-detecting strips with a confirmatory luteal-phase serum progesterone.

RESULTS
Women with BD (n = 103) did not differ from controls (n = 36) in demographics, rates of menstrual abnormalities (MAs), or number of ovulation-positive cycles. Of the women with BD, 17% reported a current MA and 39% reported a past MA. Dehydroepiandrosterone sulfate and 17-hydroxyprogesterone levels were higher in controls (p = 0.052 and 0.004, respectively), but there were no other differences in biochemical levels. Medication type, dose, or duration was not associated with MA or biochemical markers, although those currently taking an atypical antipsychotic agent indicated a greater rate of current or past MA (80% versus 55%, p = 0.013). In women with BD, 22% reported a period of amenorrhea associated with exercising or stress, versus 8% of controls (p = 0.064). Self-reported rates of bulimia and anorexia nervosa were 10% and 5%, respectively.

CONCLUSIONS
Rates of MA and biochemical levels did not significantly differ between women with BD and controls. Current atypical antipsychotic agent use was associated with a higher rate of current or past MA and should be further investigated. The incidence of stress-induced amenorrhea should be further investigated in this population, as should the comorbid incidence of eating disorders.

Reynolds-May|Margaret F|MF|
Kenna|Heather A|HA|
Marsh|Wendy|W|
Stemmle|Pascale G|PG|
Wang|Po|P|
Ketter|Terence A|TA|
Rasgon|Natalie L|NL|

reproductive function
women
bipolar disorder
hormones
menstrual abnormalities
eating disorder
polycystic ovary syndrome


Fast-Folding Kinetics Using Nanosecond Laser-Induced Temperature-Jump Methods.

Abstract: The development of ultrafast kinetic methods is one of the factors that allowed the research on protein folding to flourish over the last 20 years. The introduction of new optical triggering techniques enabled to experimentally investigate the protein dynamics at the nanosecond to millisecond timescale, allowing researchers to test theoretical predictions and providing experimental benchmarks for computer simulations. In this work, the details of how to perform kinetic experiments by the laser-induced temperature-jump technique, using the two most commonly used probing techniques (namely infrared absorption and fluorescence spectroscopy) are given, with a strong emphasis on the practical details.

Protein folding
Infrared absorption
Fluorescence
Folding kinetics
Förster resonance energy transfer
Pump and probe
Temperature jump


Are Reallocations between Sedentary Behaviour and Physical Activity Associated with Better Sleep in Adults Aged 55+ Years? An Isotemporal Substitution Analysis.

Abstract: Physical activity has been proposed as an effective alternative treatment option for the increasing occurrence of sleep problems in older adults. Although higher physical activity levels are associated with better sleep, the association between specific physical activity intensities and sedentary behaviour (SB) with sleep remains unclear. This study examines the associations of statistically modelled time reallocations between sedentary time and different physical activity intensities with sleep outcomes using isotemporal substitution analysis. Device-measured physical activity data and both objective and subjective sleep data were collected from 439 adults aged 55+ years. Replacing 30 min of SB with moderate to vigorous intensity physical activity (MVPA) was significantly associated with an increased number of awakenings. Moreover, a reallocation of 30 min between light physical activity (LPA) and MVPA was significantly associated with increased sleep efficiency. Furthermore, reallocating 30 min of SB to LPA showed a significant association with decreased sleep efficiency. There were no significant associations of time reallocations for wake time after sleep onset, length of awakenings, and sleep quality. These results improve our understanding of the interrelationships between different intensities of movement behaviours and several aspects of sleep in older adults.

Vanderlinden|Julie|J|
Biddle|Gregory J. H.|GJH|
Boen|Filip|F|0000-0002-5295-4776
van Uffelen|Jannique G Z|JGZ|

sedentary behaviour
physical activity
sleep
isotemporal substitution analysis
older adults
public health


Unusual gastrointestinal manifestations of COVID-19: two case reports.

Abstract: As of December 2019, a new strain of coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was discovered in Wuhan, China, following an epidemic of a fast-spreading viral respiratory disease, later called Coronavirus Disease 2019 (COVID-19), which then lead to the present pandemic the world has come to know. Patients who tested positive for COVID-19 are mostly asymptomatic or present with mild self-limiting symptoms. While GI symptoms occur with less prevalence, they are increasingly being reported. A diagnosis of Covid-19 has increased dramatically in patients presenting with gastrointestinal symptoms suggesting that GI symptoms should be taken into serious consideration with patient diagnosis. Case 1: A 65-year-old man presented to the hospital emergency room with abdominal pain, Murphy's sign and chills without fever, subsequently diagnosed as acute acalculous cholecystitis with a positive COVID-19 rRT-PCR. Case 2: A 78-year-old woman presented to the hospital emergency room complaining of severe positional epigastric pain precipitated by lying supine, chills with no fever, being later diagnosed as acute pancreatitis and a positive COVID-19 rRT-PCR. It has become evident that the ACE2 receptor plays a significant role as the entry site into human cells for the virus. This receptor is generally expressed in respiratory cells, as well as the gastrointestinal tract, corresponding with extrapulmonary manifestations of COVID-19. Studies concluded that the origin of gastrointestinal symptoms could be caused by the interaction of the SARS-CoV-2 virus with cells through the ACE2 receptor. The findings of the present study support this theory, as both patients presented with symptoms regarding tissues with high ACE2 expression.

Hassani|Amir Hossein|AH|
Beheshti|Alireza|A|
Almasi|Faezeh|F|
Ketabi Moghaddam|Pardis|P|
Azizi|Mohammadreza|M|
Shahrokh|Shabnam|S|

Gastrointestinal manifestations
COVID-19
Case reports


Comparison of systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized patients with malignancy, and their influence on mortality from COVID-19.

Abstract:
INTRODUCTION
We evaluated several biological indicators based on inflammation and/or nutritional status, such as systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized COVID-19 patients with and without malignancies for a prognostic significance.

METHODOLOGY
This is a retrospective and observational study on 186 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 75 patients had various malignancies, and the rest (111), having a similar age and comorbidity profile based on propensity score matching, had no malignancy.

RESULTS
None of the measures as neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to lymphocyte ratio, SII, PNI or ANDC was found to be significantly different between two groups. Odds ratio for the mortality, OR 2.39 (%95 CI 1.80-3.16) was found to be significantly higher for the malignancy group, even though the duration of hospitalization was statistically similar for both groups. PNI was found to be significantly lower for deceased patients compared with survivors in the malignancy group. Contrarily, ANDC was found to be significantly higher for deceased patients in the malignancy group.

CONCLUSIONS
PNI and ANDC have independent predictive power on determining the in-hospital death in COVID-19 malignancy cases. It is suggested that ANDC seems to be a more sensitive score than SII in COVID-19 cases with malignancies.

SII
ANDC
PNI
Malignancy
COVID-19 pneumonia


Transfusion Medicine.

Abstract: Transfusion of various blood components can provide relief from symptomatic anemia and reduce the bleeding risks associated with low platelet counts or presence of coagulopathy. Blood components are collected from volunteer donors and processed into separate components to maximize efficient utilization of a scarce resource while also providing maximum clinical benefit. Tests including blood type and screening for clinically significant alloantibodies increase the likelihood of successful transfusion. Risks of transfusion include hypersensitivity and hemolytic transfusion reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, and transmission of infection. Indications for transfusion are reviewed along with various products available for transfusion.

D001803:Blood Transfusion
D006402:Hematologic Diseases
D006403:Hematologic Tests
D006801:Humans
D011320:Primary Health Care
D012307:Risk Factors
D064826:Transfusion Medicine
D065227:Transfusion Reaction

Transfusion medicine
Platelets
Blood transfusion
FFP
Red cells


Prevalence of hypothyroidism and thyroid nodule in chronic hemodialysis Iranian patients.

Abstract:
INTRODUCTION
End stage renal disease (ESRD) reasons several changes in the function of thyroid gland as; lower levels of thyroid hormones, altered hormone metabolism, and increased iodine storage. The aim of this study was to evaluate the prevalence of nodular goiter and hypothyroidism in hemodialysis (HD) patients compared with normal population.

METHODS
This cross-sectional study was conducted among HD patients and healthy people as the control group for thyroid function evaluation. Thyroid gland was evaluated by physical examination and ultrasonography. Blood level of FT3, FT4, TSH, TPO Ab, and urinary iodine excretion were checked in both groups. Data were analyzed using SPSS-17 and P-value less than 0.05 was considered as the significance level.

FINDINGS
Eighty six HD patients (57.2 ± 17.2 mean age, 48 men) and 86 healthy people (56.6 ± 16.8 mean age, 48 men) were enrolled in this study. Goiter was confirmed by physical examination in 29.0% of the HD patients and 12.8% of the control group (P = 0.04). Nodular goiter that was shown by ultrasonography was found in 27.9% and 3.5% of the HD and control groups, respectively (P = 0.01). HD patients had a higher frequency of reduced FT3 (40.9% vs. 4.6%, P < 0.01) and increased TSH (18.6% vs. 8.1%, P < 0.03(. TPO Ab was positive in 15.1% of the HD and 11.6% of the control groups (P = 0.14).

DISCUSSION
The high incidence of nodular goiter and hypothyroidism in ESRD patients shows that screening for thyroid dysfunction and goiter, using appropriate laboratory tests, should be considered in evaluations of ESRD patients.

Pakfetrat|Maryam|M|
Dabbaghmanesh|Mohammad Hossein|MH|
Karimi|Zahed|Z|
Rasekhi|Alireza|A|
Malekmakan|Leila|L|
Hossein Nikoo|Mohammad|M|

ESRD
thyroid gland
nodular goiter
TSH
urinary iodine excretion


Successful endobronchial ultrasound-guided transbronchial needle aspiration of tumour thrombus in the left pulmonary vein to achieve histological diagnosis.

Abstract: A symptomatic 66-year-old gentleman presented with a large left upper lobe mass, thought likely to be malignant. Further imaging suggested direct tumour extension into the left pulmonary vein. During a subsequent EBUS (endobronchial ultrasound) histological diagnosis was not achieved from sampling higher order lymph nodes, thus intra-procedurally the decision to sample, by Transbronchial Needle Aspiration (TBNA), an area thought to relate to tumour thrombus in the left pulmonary vein was taken. A diagnosis of a non-small cell lung cancer was made on histological testing of the tumour thrombus sample. Considering the bleeding risk, direct probe contact with the endobronchial wall was maintained for several minutes but no bleeding was observed. There were no complications as a result of the procedure. It may be safe to sample tumour thrombus from within a pulmonary vein via EBUS-TBNA to achieve positive histology.

Braddy|Aaron|A|
Mogal|Rahul Janardan|RJ|
Maddox|Anthony John|AJ|
Timothy Barlow|Andrew Bryan|AB|

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)


Lymphatic Anatomy.

Abstract: Recent development of new lymphatic imaging and intervention techniques, such as intranodal lymphangiogram, dynamic contrast enhanced magnetic resonance lymphangiography and lymphatic embolization, have resulted in the resurgence of interest in the lymphatic anatomy. The lymphatic system is a continuous maze of interlacing vessels and lymph nodes and is extremely complex and variable. This presents a significant challenge for interpretation of imaging and performance of interventions on this system. There is an embryological reason for this complexity and variability; the lymphatic system sprouts off of primordia from several locations in the body, which later fuse together at different stages of development of the embryo. The lymphatic system can be divided in three distinct parts: soft tissue lymphatics, intestinal lymphatics, and liver lymphatics. Liver and intestinal lymphatics generate approximately 80% of the body lymph and are functionally the most important parts of the lymphatic system. However, their normal anatomy and pathological changes are relatively unknown. In this chapter we will explore the anatomy of these three systems relevant to lymphatic imaging and interventions.


Desmoid Tumor Causing Shoulder Pain in an Adolescent Male.

Abstract: A 17-year-old adolescent boy was referred by an orthopaedic physician to physical therapy for chronic left shoulder pain and a clinical diagnosis of labral tear. The physician ordered current radiographs, which were noncontributory. Findings during physical therapy examination warranted referral back to the physician, with a request for magnetic resonance imaging. Magnetic resonance imaging revealed a soft tissue abnormality in the infraclavicular and subcoracoid spaces. The patient was referred to orthopaedic oncology, where biopsy confirmed a desmoid tumor. J Orthop Sports Phys Ther 2020;50(8):467. doi:10.2519/jospt.2020.9596.

shoulder
adolescent
magnetic resonance imaging
radiography


Synergism between Angiotensin receptors ligands: Role of Angiotensin-(1-7) in modulating AT2 R agonist response on nitric oxide in kidney cells.

Abstract: Angiotensin-(1-7), an endogenous agonist for the MasR, has been shown to interact with ang-II AT1 R and AT2 R. Earlier we showed a physical and functional interaction between MasR and AT2 R in response to their respective agonists ang-(1-7) and C21. Moreover, ang-(1-7) is cardio-protective via AT1 R and alters ang-II function. Such complex nature of ang-(1-7) function is not clearly understood, particularly in relation to its functional interaction with these receptors. We tested how ang-(1-7) affects AT2 R function by utilizing HK-2 cells. The HK-2 cells were treated with a wide range of concentrations of angiotensin receptor agonists. The generation of NO• in response to agonists was determined as a readout and subjected to Bliss definition (δ score) to assess the nature of functional interaction between these receptors. Preincubation with ang-(1-7) followed by incubation with endogenous AT1 R/AT2 R agonist ang-II (δ = 162) or selective AT2 R agonist C21 (δ = 304) synergized NO• formation. The synergism was also observed when the order of incubation with ang-(1-7)/C21 was reversed (δ = 484), but not when the cells were simultaneously incubated with a mixture of ang-(1-7) and C21 (δ = 76). The synergism with nonpeptidic MasR agonist AVE0991 followed by C21 (δ = 45) was minimal. Ligand binding experiment suggested the binding of ang-(1-7) with these three receptors. However, the synergism observed with ang-(1-7) and ang-II/C21 was sensitive to the antagonists of AT2 R (PD123319) and AT1 R (candesartan), but not MasR (A779). Ang-(1-7) at lower concentrations synergies the AT2 R function in an AT1 R-dependent but MasR-independent manner. This phenomenon may have a physiological significance.

synergism
angiotensin receptor
nitric oxide
epithelial cells
receptor mas


Long term preservation of motion with artificial cervical disc implants: A comparison between cervical disc replacement and rigid fusion with cage.

Abstract:
BACKGROUND
With the advancement of technologies there is more interest in the maintenance of the spine's biomechanical properties focusing on the preservation of the functional motion segment. In present article we describe our experience with 25 cases managed with artificial cervical discs with 28 Solis cage following cervical discectomy with a mean follow-up period of 7.5 year.

MATERIALS AND METHODS
All surgeries were performed by single surgeon from March 2004 to June 2005 with a follow-up till date. Patients with symptomatic single or multiple level diseases that had no prior cervical surgery were candidates for the study. Cohort demographics were comparable. Standardized clinical outcome measures and radiographic examinations were used at prescribed post-operative intervals to compare the treatment groups. Relief in radicular pain, cervical spine motion, and degenerative changes at follow-up were noted.

RESULTS
In a total 53 cases, the mean age in prosthesis group was 47 years (age range: 30-63 years) and mean age in cage group was 44 years (32-62 years). Mean hospital stay was 2.7 days in both the groups. At 4 weeks complete cervical movements could be achieved in 19 cases in artificial disc group. Maintenance of movement after 7.5 years was in 76% of these patients. Lordosis was maintained in all cases till date. There was no mortality or wound infection in our series.

CONCLUSIONS
We conclude that artificial cervical disc could be an alternative to fixed spinal fusion as it represents the most physiological substitute of disc. However, there is need for further studies to support the use of artificial cervical disc prosthesis.

Cincu|Rafael|R|
Lorente|Francisco de Asis|Fde A|
Gomez|Joaquin|J|
Eiras|Jose|J|
Agrawal|Amit|A|

prosthesis
Arthrodesis
cervical arthroplasty
cervical disc herniation
cervical prosthesis
spondylosis


Thalamocortical Communication in the Awake Mouse Visual System Involves Phase Synchronization and Rhythmic Spike Synchrony at High Gamma Frequencies.

Abstract: In the neocortex, communication between neurons is heavily influenced by the activity of the surrounding network, with communication efficacy increasing when population patterns are oscillatory and coherent. Less is known about whether coherent oscillations are essential for conveyance of thalamic input to the neocortex in awake animals. Here we investigated whether visual-evoked oscillations and spikes in the primary visual cortex (V1) were aligned with those in the visual thalamus (dLGN). Using simultaneous recordings of visual-evoked activity in V1 and dLGN we demonstrate that thalamocortical communication involves synchronized local field potential oscillations in the high gamma range (50-90 Hz) which correspond uniquely to precise dLGN-V1 spike synchrony. These results provide evidence of a role for high gamma oscillations in mediating thalamocortical communication in the visual pathway of mice, analogous to beta oscillations in primates.

McAfee|Samuel S|SS|
Liu|Yu|Y|
Dhamala|Mukesh|M|
Heck|Detlef H|DH|

mouse
visual system
high gamma
gamma oscillations
neuronal synchronization


Experiences of care among individuals with opioid use disorder-associated endocarditis and their healthcare providers: Results from a qualitative study.

Abstract:
PURPOSE
Infectious complications of opioid use disorder (OUD), including endocarditis, are rising. Patients with OUD-associated endocarditis have poor clinical outcomes but their care is not well understood. We aimed to elucidate the prior experiences of care for patients with OUD-associated endocarditis and the healthcare providers who deliver that care.

STUDY DESIGN
This qualitative study was conducted through semi-structured interviews of patients and providers at a single academic hospital using a grounded theory approach. Patients meeting DSM-5 criteria for at least mild OUD who had previously completed an episode of care for OUD-associated endocarditis were recruited from inpatient and ambulatory settings. Multidisciplinary care providers who regularly care for patients with OUD-associated endocarditis were also recruited. Interviews were conducted until thematic saturation was achieved.

PRINCIPLE RESULTS
Of 11 patient participants, six were recruited from outpatient settings. Of 12 provider participants, seven cared for patients with OUD "almost always." Five major themes emerged across patient and provider interviews: stigma-related inequity and delays in care, the social and medical comorbidities of individuals with OUD-associated endocarditis, addiction as a chronic and relapsing disease, differing experiences of prolonged hospitalizations between patients and providers, and a lack of integration or discontinuity of care. Opportunities for care innovation and improvement were identified.

CONCLUSIONS
This qualitative analysis highlights multiple patient and health system factors that may explain poor clinical outcomes experienced by individuals with OUD-associated endocarditis. A sick, complex, stigmatized patient population was noted, with new physical and mental comorbidities often developing on top of pre-existing ones. Perceived barriers to effective treatment of OUD-associated endocarditis included the complexity of managing two life threatening illness simultaneously, external stigma towards individuals with OUD, and discontinuity in longitudinal care.

Bearnot|Benjamin|B|
Mitton|Julian A|JA|
Hayden|Margaret|M|
Park|Elyse R|ER|

Endocarditis
Opioid use disorder
Prolonged hospitalizations
Stigma
Bacterial endocarditis
Disparities in care
Infective endocarditis
Injection drug use
Intravenous drug use


Ankle medial flexor retinaculum avulsion fracture.

Abstract: Medial flexor retinaculum injuries are not uncommon, but medial flexor retinaculum periosteal avulsion injuries are rare. This patient sustained a medial flexor retinaculum tear readily characterized at computed tomography by an associated proximal retinacular avulsion fracture from the posteromedial tibia. Medial flexor retinaculum injury is often also associated with superficial deltoid pathology and/or medial malleolar fracture. An additional significant complication of medial flexor retinaculum tear is anterior dislocation of the tibialis posterior tendon, which heralds a tibialis posterior fibro-osseous tunnel injury.

Flexor retinaculum avulsion
Tibialis posterior subluxation


Modification of the surface of titanium with multifunctional chimeric peptides to prevent biofilm formation via inhibition of initial colonizers.

Abstract:
Background
Prevention of bacterial colonization remains a major challenge in the field of oral implant devices. Chimeric peptides with binding, antimicrobial, and osteogenesis motifs may provide a promising alternative for the inhibition of biofilm formation on titanium (Ti) surfaces.

Methods
In this study, chimeric peptides were designed by connecting an antimicrobial sequence from human β-defensin-3 with a Ti-binding sequence and arginine-glycine-aspartic acid using a glycine-glycine-glycine linker. Binding to the Ti substrate and antimicrobial properties against streptococci were evaluated. Significant improvement in reduction of bacterial colonization onto the Ti surface was observed, with or without the presence of saliva or serum. The MC3T3-E1 cells grew well on the modified Ti surfaces compared with the control group.

Results
The data showed that the three peptide functional motifs maintained their respective functions, and that the antibiofilm mechanism of the chimeric peptide was via suppression of sspA and sspB gene expression.

Conclusion
These results indicated that the endogenous peptide fragments engineered on the Ti surface could provide an environmentally friendly approach for improving the biocompatibility of oral implants.

Zhang|Xi|X| Geng|Hongjuan|H| Gong|Lei|L| Zhang|Qian|Q| Li|Hongjie|H| Zhang|Xu|X| Wang|Yonglan|Y| Gao|Ping|P|


Thoracoscope combined with internal support system of chest wall in open reduction and internal fixation for multiple rib fractures.

Abstract: This study aimed to investigate the feasibility of applying thoracoscope combined with internal support system of chest wall (ISSW) in minimally invasive internal fixation for rib fracture on patients with multiple rib fractures. A total of 84 patients undergoing open reduction and internal fixation for rib fracture from January 2017 to December 2017 in the Department of Cardiothoracic Surgery, Tianjin Hospital were selected into the study, and retrospective analyses were carried out. The clinical data, pain score, operating time, intraoperative blood loss, indwelling time of thoracic tube, total drainage volume of thoracic tube for 3 days after operation, indwelling time of wound drainage tube, total drainage volume of wound drainage tube, length of stay, hospitalization costs, postoperative complications, C-reactive protein (CRP) and pulmonary function of patients in the groups were compared. The patients were followed up for prognosis for 2-4 months via re-examination, and chest numbness at 1 month after operation was recorded. Compared with that (145.27±18.80 min) in the traditional group, the operating time in the minimally invasive group (112.20±21.40 min) was shorter (p<0.05). The total drainage volume of wound drainage tube was 145.75±61.03 ml in the minimally invasive group and 248.91±93.95 ml in the traditional group (p<0.05). In addition, the chest numbness at 1 month after operation (11.8%) in the minimally invasive group was better than that (34.00%) in the traditional group (p<0.05). Postoperative pain score, CRP and pulmonary function tests were also significantly different between the two groups (p<0.05). The results indicated that the application of thoracoscope combined with ISSW in minimally invasive internal fixation for rib fracture can effectively improve the prognosis of patients and reduce the length of stay and adverse reactions, and has high economic benefits, which is worthy of promotion and use in clinical practice.

Xia|Honggang|H| Zhu|Pengzhi|P| Li|Jing|J| Zhu|Deqing|D| Sun|Zhongyi|Z| Deng|Limin|L| Zhang|Yongmin|Y| Wang|Dongbin|D|

thoracoscope
internal support system of chest wall
multiple rib fractures
minimally invasive internal fixation


Immunological and molecular basics of the primary open angle glaucoma pathomechanism.

Abstract: Glaucoma is a degenerative process of the optic nerve. Increased intraocular pressure is believed to be the main factor leading to the glaucomatous damage. The in vitro and in vivo animal glaucoma research models provide insight into the molecular changes in the retina in response to the injury factor. The damage is a complex process incorporating molecular and immunological changes. Such changes involve NF kB activity and complement activation. The processes affect the human antigen, JNK, MAPK, p53, MT2 and DBA/2J molecular pathways, activate the autophagy processes and compromise neuroprotective mechanisms. Activation and inhibition of immunological responses contribute to cell injury. The immunological mechanisms of glaucomatous degeneration include glial response, the complement, tumor necrosis factor α (TNF-α) pathways and toll-like receptors athways. Oxidative stress and excitotoxicity are factors contributing to cell death in glaucoma. The authors present an up-to-date review of the mechanisms involved and update on research focusing on a possible innovative glaucoma treatment.

Samelska|Katarzyna|K|
Zaleska-Żmijewska|Anna|A|
Bałan|Barbara|B|
Grąbczewski|Andrzej|A|
Szaflik|Jacek Paweł|JP|
Kubiak|Aleksander Jan|AJ|
Skopiński|Piotr|P|

glaucoma
complement
autophagy
oxidative stress
apoptosis
retinal ganglion cells (RGCs)


New molecular imprinted voltammetric sensor for determination of ochratoxin A.

Abstract: In this report, a novel molecular imprinted voltammetric sensor based on silver nanoparticles (AgNPs) involved in a polyoxometalate (H3PW12O40, POM) functionalized reduced graphene oxide (rGO) modified glassy carbon electrode (GCE) was presented for determination of ochrattoxin A (OCH). The developed surfaces were characterized using scanning electron microscope (SEM), transmission electron microscope (TEM), X-ray photoelectron spectroscopy (XPS) and X-ray diffraction (XRD) method. OCH imprinted GCE was prepared via electropolymerization process of 100mM phenol as monomer in the presence of phosphate buffer solution (pH6.0) containing 25 mM OCH. The linearity range and the detection limit of the method were calculated as 5.0 × 10(-11) - 1.5 × 10(-9)M and 1.6 × 10(-11) M, respectively. The voltammetric sensor was applied to grape juice and wine samples with good selectivity and recovery. The stability of the voltammetric sensor was also reported.

Yola|Mehmet Lütfi|ML|
Gupta|Vinod Kumar|VK|
Atar|Necip|N|

Silver nanoparticles
Polyoxometalate
Reduced graphene oxide
Molecular imprinted sensor
Ochratoxin A


Joint Replacement Volume Positively Correlates With Improved Hospital Performance on Centers for Medicare and Medicaid Services Quality Metrics.

Abstract:
BACKGROUND
The Center for Medicare and Medicaid Services (CMS) is transitioning Medicare from a fee-for-service program into a value-based pay-for-performance program. In order to accomplish this goal, CMS initiated 3 programs that attempt to define quality and seek to reward high-performing hospitals and penalize poor-performing hospitals. These programs include (1) penalties for hospital-acquired conditions (HACs), (2) penalties for excess readmissions for certain conditions, and (3) performance on value-based purchasing (VBP). The objective of this study was to determine whether high-volume total joint hospitals perform better in these programs than their lower-volume counterparts.

METHODS
We analyzed data from the New York Statewide Planning and Research Cooperative System database on total New York State hospital discharges from 2013 to 2015 for total knee and total hip arthroplasty. This was compared to data from Hospital Compare on HAC's, excess readmissions, and VBP. From these databases, we identified 123 hospitals in New York, which participated in all 3 Medicare pay-for-performance programs and performed total joint replacements.

RESULTS
Over the 3-year period spanning 2013-2015, hospitals in New York State performed an average of 1136.59 total joint replacement surgeries and achieved a mean readmission penalty of 0.005909. The correlation coefficient between surgery volume and combined performance score was 0.277. Of these correlations, surgery volume and VBP performance, and surgery volume and combined performance showed statistical significance (P < .01).

CONCLUSION
Our study demonstrates that there is a positive association between joint replacement volumes and overall hospital quality, as well as joint replacement volumes and VBP performance, specifically. These findings are consistent with previously reported associations between patient outcomes and procedure volumes. However, a relationship between joint replacement volume and HAC scores or readmission penalties could not be demonstrated.

Sibley|Rachel A|RA|
Charubhumi|Vanessa|V|
Hutzler|Lorraine H|LH|
Paoli|Albit R|AR|
Bosco|Joseph A|JA|

D014487:Centers for Medicare and Medicaid Services, U.S.

joint replacement
quality metrics
CMS
penalties
value-based purchasing
pay for performance


An Oximetry Based Wireless Device for Sleep Apnea Detection.

Abstract: Sleep related disorders can severely disturb the quality of sleep. Among these disorders, obstructive sleep apnea (OSA) is highly prevalent and commonly undiagnosed. Polysomnography is considered to be the gold standard exam for OSA diagnosis. Even though this multi-parametric test provides highly accurate results, it is time consuming, labor-intensive, and expensive. A non-invasive and easy to self-assemble home monitoring device was developed to address these issues. The device can perform the OSA diagnosis at the patient's home and a specialized technician is not required to supervise the process. An automatic scoring algorithm was developed to examine the blood oxygen saturation signal for a minute-by-minute OSA assessment. It was performed by analyzing statistical and frequency-based features that were fed to a classifier. Afterward, the ratio of the number of minutes classified as OSA to the time in bed in minutes was compared with a threshold for the global (subject-based) OSA diagnosis. The average accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve for the minute-by-minute assessment were, respectively, 88%, 80%, 91%, and 0.86. The subject-based accuracy was 95%. The performance is in the same range as the best state of the art methods for the models based only on the blood oxygen saturation analysis. Therefore, the developed model has the potential to be employed in clinical analysis.


Cannabinoid and nitric oxide signaling interplay in the modulation of hippocampal hyperexcitability: Study on electrophysiological and behavioral models of temporal lobe epilepsy in the rat.

Abstract: A growing bulk of evidence suggests that cannabinoid system plays a pivotal role in the control of hyperexcitability phenomena. Notwithstanding, the anticonvulsant action of cannabinoids has not been fully addressed, in particular the involvement of potential cellular neuromodulators, for instance nitric oxide. In the current study, we focused on two distinct rat models of temporal lobe epilepsy, the Maximal Dentate Activation and the pilocarpine-induced acute seizures, providing both electrophysiological and behavioral data on cannabinoid and nitrergic system interplay. We evaluated the antiepileptic effects of WIN 55,212-2, (R)-(+)-[2,3-dihydro-5-methyl-3-(4-morpholinylmethyl) pyrrolo[1,2,3-de]-1,4-benzoxazin-6-Yl]-1-naphthalenylmethanone (WIN), a CB agonist, and of 7-Nitroindazole (7NI), a preferential neuronal nitric oxide synthase (nNOS) inhibitor, at different doses, alone and in combination. MDA study showed that these drugs protected animals in a dose-dependent manner from electrically induced epileptiform discharges. In pilocarpine model, a dose-related activity of 7NI and WIN: a) decreased the behavioral scoring, used to describe the severity of chemically induced acute seizures; b) affected latency of the onset of acute convulsions; c) dampened mortality rate. Interestingly, the combination of the treatments brought to light that individually ineffective doses of WIN turn into effective when nNOS activity is pharmacologically inhibited in both experimental conditions. This effect is mediated by CB1 receptor since the co-administration of N-(piperidin-1-yl)-5-(4-iodophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamide (AM251), a CB1 receptor specific antagonist, thwarted the 7NI-WIN convergent action. In the light of this, our findings suggest a putative antagonism between CBr-activated pathway and NO signaling in the context of neuronal hyperexcitability and contribute to elucidate possible synaptic processes underlying neuroprotective properties of cannabinoids, with a view to better integrate antiepileptic therapy.

Carletti|F|F| Gambino|G|G| Rizzo|V|V| Ferraro|G|G| Sardo|P|P|

cannabinoids
electrophysiology
behavior
temporal lobe epilepsy
hippocampus
percentage of protection


Determinants of the Utilization of a Noncommunicable Disease Screening Service by White Collar Workers in Depok City, West Java Indonesia.

Abstract:
Background
Noncommunicable disease (NCD) screening provides a means for early detection of chronic diseases, thereby reducing the risks posed by NCDs. In 2012, 56 million deaths were reported globally, 38 million of which were attributed to NCDs. In Indonesia, NCDs are a major cause of mortality. In Depok City, an NCD screening program among white collar employees has been in place since 2016. This study aimed to establish the determinants of NCD screening among workers at the Depok City Hall.

Methods
The study used quantitative methods and a cross-sectional study design. It was conducted at Depok City Hall, Depok City, West Java, Indonesia. Data were collected using a self-reported questionnaire, which was pretested for validity and reliability. Data were analyzed using multiple logistic regressions.

Results
Only 45.7% of workers had used the NCD screening service. Peer support (P < 0.01) and having pre-existing NCDs (P < 0.05) were the determinants of NCD screening among respondents. Peer support was the dominant factor associated with the utilization of NCD screening. After controlling for having NCDs, workers with adequate peer support had increased odds of uptake of NCD screening by more than two times (OR: 2.37, 95% CI: 1.29-4.37).

Conclusions
Peer support is important in persuading workers to utilize NCD screening. Therefore, it is necessary to develop health promotion programs in the workplace and to empower peer educators to encourage their colleagues to undertake regular health screening.

Hasanah|Indah Jamiatun|IJ|
Hadi|Ella Nurlaela|EN|
Setio|Kartika Anggun Dimar|KAD|

Indonesia
Health care utilization
non-communicable diseases
prevention and control