Publications by authors named "J David Warren"

3,138 Publications

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Reopening Dental Offices for Routine Care Amid the COVID-19 Pandemic: Report From Palestine.

Int Dent J 2021 Feb 13. Epub 2021 Feb 13.

Department of Preventive and Community Dentistry, University of Iowa, Iowa City, Iowa, USA.

Objectives: This study reports on the readiness of Palestinian dentists to reopen their practices for routine care during the current coronavirus disease 2019 (COVID-19) pandemic.

Methods: A cross-sectional study targeted dentists in the West Bank area of Palestine using an online survey during the first 2 weeks of May 2020. Questions mainly asked about dentists' perception of the risks of COVID-19, readiness to reopen their clinics for routine care, and the level of confidence in dealing with patients suspected of having COVID-19.

Results: A total of 488 dentists completed the survey. Almost 60% believed that they were not ready to reopen their practices. Almost 13% had "no confidence" in dealing with patients with COVID-19, while 64% had "little to moderate" confidence. Confidence was correlated negatively with increased fear of becoming infected (ρ = -0.317, P < .0001) and positively with years of practice (ρ = 1.7, P < .0001). Dentists who received updated training on infection control or on COVID-19 reported higher levels of confidence (χ = 53.8, P < .0001, χ = 26.8, P < .0001, respectively). Although 88% preferred not to treat patients with COVID-19, 40% were willing to provide care to them. Almost 75% reported that they were already facing financial hardships and could not survive financially until the end of the current month.

Conclusions: Ethical and financial reasons were the main drivers for dentists in this sample to reopen their practices for routine care. Data from this study highlights the fragility of private dental practice in emergency situations. Ethical, health, and financial challenges that emerged during COVID-19 require dentists to adapt and be better prepared to face future crises.
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http://dx.doi.org/10.1016/j.identj.2021.01.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881762PMC
February 2021

Comparing the Accuracy of WhipPredict and a Modified Version of the Short Form Örebro Musculoskeletal Pain Screening Questionnaire: Which Tool Is Better for Predicting Poor Recovery After Whiplash Injury?

J Orthop Sports Phys Ther 2021 Feb 19:1-20. Epub 2021 Feb 19.

Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Herston, Australia.

Objective: To compare the accuracy of the whiplash specific risk-screening tool (WhipPredict) with a modified generic short-form Orebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMPSQ-M) for predicting poor recovery.

Design: Inception cohort study.

Methods: 202 participants with acute whiplash completed WhipPredict and SF-ÖMPSQ-M at baseline. Poor recovery was measured at 6 and 12 months: Neck Disability Index (> 10%), Numeric Pain Rating Scale (>3/10), global perceived recovery (< +4) and return to pre-injury work (RTW). Accuracy statistics for predicting poor recovery were calculated. A STARD Checklist was completed.

Results: 71% (143) of participants completed the 6 month and 56% (113) the 12 month assessment. At baseline, agreement between WhipPredict and SF-ÖMPSQ-M was fair (Prevalence-adjusted and bias-adjusted kappa= 0.26; 95% 0.12 - 0.39). Depending on the outcome, 20-72% of people had not recovered at 6 months and 12-71% at 12 months. At 6 and 12 months, WhipPredict showed high sensitivity (88-94%) and low specificity (all <31%) on all 4 separate outcomes. The SF-ÖMPSQ-M showed moderate sensitivity (54-75%) for NDI, NRS and global perceived recovery, high sensitivity for RTW (81-90%) and moderate specificity (57-77%) for all 4 outcomes.

Conclusion: Both tools showed acceptable accuracy in predicting poor recovery. WhipPredict is recommended if the goal is to correctly identify patients who will not recover but will falsely classify some who will recover well. SF-ÖMPSQ-M will result in fewer patients falsely categorised as being at risk of poor recovery and may result in some people being undertreated. .
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http://dx.doi.org/10.2519/jospt.2021.9987DOI Listing
February 2021

Impact of Initial eGlycemic Management System Dosing Strategy on Time to Target Blood Glucose Range.

J Diabetes Sci Technol 2021 Mar 15;15(2):242-250. Epub 2021 Feb 15.

Novant Health System, Charlotte, NC, USA.

Background: Glucommander™ (GM), an electronic glycemic management system, was implemented across a multi-hospital health system as the standard of care for glycemic control. GM provides insulin dosing recommendations based on patient-specific blood glucose (BG) trends after providers select either a custom dose or weight-based multiplier as the initial dosing strategy for the first 24 hours. This study evaluated the impact of initial subcutaneous (SC) GM insulin dosing strategies on glycemic management.

Methods: Non-intensive care unit patients treated with SC GM using either initial custom (based on provider discretion) or weight-based multiplier settings (0.3, 0.5, or 0.7 units/kg/day) were evaluated in this retrospective chart review. The primary endpoint was time to target BG range defined as time to first two consecutive in range point of care BG. Secondary endpoints included percentage of BG values in target range, percentage of orders following institutional recommendations, length of stay (LOS), average BG, and incidence of hypoglycemia and hyperglycemia.

Results: A review of 348 patients showed time to target BG was not significantly different between custom and multiplier groups (55 vs 64 hours, = .07). Target BG was achieved in less than half of patients in both groups (47% vs 44%, respectively). There were no differences in hospital LOS, proportion of BG in target range, rates of hypo/hyperglycemia, and average BG.

Conclusions: Custom initial SC GM insulin dosing settings showed a nonsignificant decrease in time to target BG range compared to pre-defined multiplier settings. Future studies evaluating the impact of compliance with institutional recommendations on BG control are warranted.
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http://dx.doi.org/10.1177/1932296821992352DOI Listing
March 2021

Effects of fluoride intake on cortical and trabecular bone microstructure at early adulthood using multi-row detector computed tomography (MDCT).

Bone 2021 Feb 10;146:115882. Epub 2021 Feb 10.

Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, IA, USA; Department of Epidemiology, College of Public Health, Iowa City, IA, USA.

Purpose: The aim of this study was to examine the effects of period-specific and cumulative fluoride (F) intake on bone at the levels of cortical and trabecular bone microstructural outcomes at early adulthood using emerging multi-row detector computed tomography (MDCT)-based novel techniques.

Methods: Ultra-high resolution MDCT distal tibia scans were collected at age 19 visits under the Iowa Bone Development Study (IBDS), and cortical and trabecular bone microstructural outcomes were computed at the distal tibia using previously validated methods. CT scans of a tissue characterization phantom were used to calibrate CT numbers (Hounsfield units) into bone mineral density (mg/cc). Period-specific and cumulative F intakes from birth up to the age of 19 years were assessed for IBDS participants through questionnaire, and their relationships with MDCT-derived bone microstructural outcomes were examined using bivariable and multivariable analyses, adjusting for height, weight, maturity offset (years since age of peak height velocity (PHV)), physical activity (questionnaire for adolescents (PAQ-A)), healthy eating index version 2010 (HEI-2010) scores, and calcium and protein intakes.

Results: MDCT distal tibia scans were acquired for 324 participants from among the total of 329 participants at age 19 visits. No motion artifacts were observed in any MDCT scans, and all images were successfully processed to measure cortical and trabecular bone microstructural outcomes. At early adulthood, males were observed to have stronger trabecular bone microstructural features, as well as thicker cortical bone (p < 0.01), as compared to age-similar females; however, females were found to have less cortical bone porosity as compared to males. Among participants with available F intake estimates (75 to 91% of the 324 with MDCT scans, depending on the period-specific F intake measure), no statistically significant associations were detected between any period-specific or cumulative F intake and bone microstructural outcomes of the tibia at the p < 0.01 level. Only for females, statistically suggestive associations (p < 0.05) were found between recent F intake (from 14 to 19 years) and trabecular mean plate width and trabecular thickness at the tibia. Those associations became somewhat weaker, but still statistically suggestive, for trabecular thickness in fully adjusted analysis with height, weight, PHV, calcium and protein intake, and HEI-2010 and PAQ-A scores as covariates.

Conclusion: The findings show that the effects of lifelong or period-specific F intake from combined sources for adolescents typical to the United States Midwest region are not strongly associated with bone microstructural outcomes at age 19 years. These findings are generally consistent with previously reported results of IBDS analyses, which further confirms that effects of lifelong or period-specific F intake on skeletons in early adulthood are absent or weak, even at the levels of cortical and trabecular bone microstructural details.
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http://dx.doi.org/10.1016/j.bone.2021.115882DOI Listing
February 2021

Hopeful monsters: unintended sequencing of famously malformed mite mitochondrial tRNAs reveals widespread expression and processing of sense-antisense pairs.

NAR Genom Bioinform 2021 Mar 12;3(1):lqaa111. Epub 2021 Jan 12.

Department of Biology, Colorado State University, Fort Collins, CO, 80521 USA.

Although tRNA structure is one of the most conserved and recognizable shapes in molecular biology, aberrant tRNAs are frequently found in the mitochondrial genomes of metazoans. The extremely degenerate structures of several mitochondrial tRNAs (mt-tRNAs) have led to doubts about their expression and function. Mites from the arachnid superorder Acariformes are predicted to have some of the shortest mt-tRNAs, with a complete loss of cloverleaf-like shape. While performing mitochondrial isolations and recently developed tRNA-seq methods in plant tissue, we inadvertently sequenced the mt-tRNAs from a common plant pest, the acariform mite , to a high enough coverage to detect all previously annotated tRNA regions. The results not only confirm expression, CCA-tailing and post-transcriptional base modification of these highly divergent tRNAs, but also revealed paired sense and antisense expression of multiple mt-tRNAs. Mirrored expression of mt-tRNA genes has been hypothesized but not previously demonstrated to be common in any system. We discuss the functional roles that these divergent tRNAs could have as both decoding molecules in translation and processing signals in transcript maturation pathways, as well as how sense-antisense pairs add another dimension to the bizarre tRNA biology of mitochondrial genomes.
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http://dx.doi.org/10.1093/nargab/lqaa111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803006PMC
March 2021

Novel instructionless eye tracking tasks identify emotion recognition deficits in frontotemporal dementia.

Alzheimers Res Ther 2021 02 8;13(1):39. Epub 2021 Feb 8.

Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK.

Background: Current tasks measuring social cognition are usually 'pen and paper' tasks, have ceiling effects and include complicated test instructions that may be difficult to understand for those with cognitive impairment. We therefore aimed to develop a set of simple, instructionless, quantitative, tasks of emotion recognition using the methodology of eye tracking, with the subsequent aim of assessing their utility in individuals with behavioural variant frontotemporal dementia (bvFTD).

Methods: Using the Eyelink 1000 Plus eye tracker, 18 bvFTD and 22 controls completed tasks of simple and complex emotion recognition that involved viewing four images (one target face (simple) or pair of eyes (complex) and the others non-target) followed by a target emotion word and lastly the original four images alongside the emotion word. A dwell time change score was then calculated as the main outcome measure by subtracting the percentage dwell time for the target image before the emotion word appeared away from the percentage dwell time for the target image after the emotion word appeared. All participants also underwent a standard cognitive battery and volumetric T1-weighted magnetic resonance imaging.

Results: Analysis using a mixed effects model showed that the average (standard deviation) mean dwell time change score in the target interest area was 35 (27)% for the control group compared with only 4 (18)% for the bvFTD group (p < 0.05) for the simple emotion recognition task, and 15 (26)% for the control group compared with only 2 (18)% for the bvFTD group (p < 0.05) for the complex emotion recognition task. Worse performance in the bvFTD group correlated with atrophy in the right ventromedial prefrontal and orbitofrontal cortices, brain regions previously implicated in social cognition.

Conclusions: In summary, eye tracking is a viable tool for assessing social cognition in individuals with bvFTD, being well-tolerated and able to overcome some of the problems associated with standard psychometric tasks.
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http://dx.doi.org/10.1186/s13195-021-00775-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871635PMC
February 2021

Primary Progressive Aphasia: Toward a Pathophysiological Synthesis.

Curr Neurol Neurosci Rep 2021 Feb 4;21(3). Epub 2021 Feb 4.

Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK.

Purpose Of Review: The term primary progressive aphasia (PPA) refers to a diverse group of dementias that present with prominent and early problems with speech and language. They present considerable challenges to clinicians and researchers.

Recent Findings: Here, we review critical issues around diagnosis of the three major PPA variants (semantic variant PPA, nonfluent/agrammatic variant PPA, logopenic variant PPA), as well as considering 'fragmentary' syndromes. We next consider issues around assessing disease stage, before discussing physiological phenotyping of proteinopathies across the PPA spectrum. We also review evidence for core central auditory impairments in PPA, outline critical challenges associated with treatment, discuss pathophysiological features of each major PPA variant, and conclude with thoughts on key challenges that remain to be addressed. New findings elucidating the pathophysiology of PPA represent a major step forward in our understanding of these diseases, with implications for diagnosis, care, management, and therapies.
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http://dx.doi.org/10.1007/s11910-021-01097-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861583PMC
February 2021

PROTACs: Promising Approaches for Epigenetic Strategies to Overcome Drug Resistance.

Curr Cancer Drug Targets 2021 Feb 2. Epub 2021 Feb 2.

Department of Microbiology and Immunology, Weill Cornell Medicine, 1300 York Ave, Box 62, New York, NY, 10065. United States.

Epigenetic modulation of gene expression is essential for tissue-specific development and maintenance in mammalian cells. Disruption of epigenetic processes, and the subsequent alteration of gene functions, can result in inappropriate activation or inhibition of various cellular signaling pathways and thus, lead to cancer. Recent advancements in the understanding of the role of epigenetics in cancer initiation and progression have uncovered functions for DNA methylation, histone modifications, nucleosome positioning, and non-coding RNAs. Epigenetic therapies have shown some promise for hematological malignancies, and a wide range of epigenetic-based drugs are undergoing clinical trials. However, in a dynamic survival strategy, cancer cells exploit their heterogeneous population which frequently results in the rapid acquisition of therapy resistance. Here, we describe novel approaches in drug discovery targeting the epigenome, highlighting recent advances the selective degradation of target proteins using Proteolysis Targeting Chimera (PROTAC) to address drug resistance.
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http://dx.doi.org/10.2174/1568009621666210203110857DOI Listing
February 2021

Demographic, Comorbidity, and Episode-of-Care Differences in Primary Total Knee Arthroplasty.

J Bone Joint Surg Am 2021 Feb;103(3):227-234

Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.

Background: Understanding time trends in age, demographic characteristics, and comorbidities is especially critical to highlight the effects on clinical practice change, outcomes, and the value of total knee arthroplasty (TKA). Therefore, the purpose of this study was to identify trends in the demographic characteristics, comorbidities, and episode-of-care outcomes for patients who underwent TKA from 2008 to 2018.

Methods: The National Surgical Quality Improvement Program (NSQIP) was queried to identify patient demographic characteristics, comorbidities, and episode-of-care outcomes in patients who underwent primary TKA from 2008 to 2018 (n = 350,879). Trends for continuous variables were analyzed using analysis of variance, and categorical variables were analyzed using chi-square tests.

Results: From 2008 to 2018, there was no clinically important difference in age, body mass index (BMI), and percentage of patients with BMI of >40 kg/m2 and no clinically important difference in chronic obstructive pulmonary disease (3.5% in 2008 and 3.2% in 2018), congestive heart failure within 30 days (0.3% in both 2008 and 2018), and acute renal failure (0.1% in 2008 and <0.1% in 2018) among patients undergoing TKA. However, modifiable comorbidities, including smoking status (9.5% in 2008 and 7.7% in 2018; p < 0.001), hypertension (71.0% in 2008 and 63.7% in 2018; p < 0.001), and anemia (16.2% in 2008 and 9.7% in 2018; p < 0.001), functional status, and overall morbidity and mortality probability have improved, with no clinically important difference in the percentage of diabetes (19.0% in 2008 and 18.1% in 2018). The hospital length of stay (mean [and standard deviation], 3.8 ± 2.2 days in 2008 and 2.1 ± 2.0 days in 2018; p < 0.001) and 30-day readmission (4.6% in 2011 and 3.0% in 2018; p < 0.001) decreased, with a significant increase in home discharge (65.6% in 2011 and 87.8% in 2018; p < 0.001).

Conclusions: The overall patient health status improved from 2008 to 2018, with improvement in the modifiable comorbidities of smoking status, malnutrition, hypertension, and anemia; the functional status; and the overall morbidity and mortality probability, with no clinically relevant change in patient age; patient BMI; percentage of patients with BMI of >40 kg/m2; or patients with diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure within 30 days, or acute renal failure. Our findings may be a reflection of a global shift toward value-based care focusing on patient optimization prior to arthroplasty, quality of care, and improved outcomes. The results of our study highlight the potential increase in TKA procedural value, which is paramount for health-care policy changes in today's incentivized, value-based, health-care environment.
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http://dx.doi.org/10.2106/JBJS.20.00597DOI Listing
February 2021

Divergent species-specific impacts of whole ecosystem warming and elevated CO on vegetation water relations in an ombrotrophic peatland.

Glob Chang Biol 2021 Feb 2. Epub 2021 Feb 2.

Environmental Sciences Division and Climate Change Science Institute, Oak Ridge National Laboratory, Oak Ridge, TN, USA.

Boreal peatland forests have relatively low species diversity and thus impacts of climate change on one or more dominant species could shift ecosystem function. Despite abundant soil water availability, shallowly rooted vascular plants within peatlands may not be able to meet foliar demand for water under drought or heat events that increase vapor pressure deficits while reducing near surface water availability, although concurrent increases in atmospheric CO could buffer resultant hydraulic stress. We assessed plant water relations of co-occurring shrub (primarily Rhododendron groenlandicum and Chamaedaphne calyculata) and tree (Picea mariana and Larix laricina) species prior to, and in response to whole ecosystem warming (0 to +9°C) and elevated CO using 12.8-m diameter open-top enclosures installed within an ombrotrophic bog. Water relations (water potential [Ψ], turgor loss point, foliar and root hydraulic conductivity) were assessed prior to treatment initiation, then Ψ and peak sap flow (trees only) assessed after 1 or 2 years of treatments. Under the higher temperature treatments, L. laricina Ψ exceeded its turgor loss point, increased its peak sap flow, and was not able to recover Ψ overnight. In contrast, P. mariana operated below its turgor loss point and maintained constant Ψ and sap flow across warming treatments. Similarly, C. calyculata Ψ stress increased with temperature while R. groenlandicum Ψ remained at pretreatment levels. The more anisohydric behavior of L. laricina and C. calyculata may provide greater net C uptake with warming, while the more conservative P. mariana and R. groenlandicum maintained greater hydraulic safety. These latter species also responded to elevated CO by reduced Ψ stress, which may also help limit hydraulic failure during periods of extreme drought or heat in the future. Along with Sphagnum moss, the species-specific responses of peatland vascular communities to drier or hotter conditions will shape boreal peatland composition and function in the future.
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http://dx.doi.org/10.1111/gcb.15543DOI Listing
February 2021

Natural dimethyl sulfide gradients would lead marine predators to higher prey biomass.

Commun Biol 2021 Feb 1;4(1):149. Epub 2021 Feb 1.

Applied Ocean Physics and Engineering Department, Woods Hole Oceanographic Institution, Woods Hole, MA, USA.

Finding prey is essential to survival, with marine predators hypothesised to track chemicals such as dimethyl sulfide (DMS) while foraging. Many predators are attracted to artificially released DMS, and laboratory experiments have shown that zooplankton grazing on phytoplankton accelerates DMS release. However, whether natural DMS concentrations are useful for predators and correlated to areas of high prey biomass remains a fundamental knowledge gap. Here, we used concurrent hydroacoustic surveys and in situ DMS measurements to present evidence that zooplankton biomass is spatially correlated to natural DMS concentration in air and seawater. Using agent simulations, we also show that following gradients of DMS would lead zooplankton predators to areas of higher prey biomass than swimming randomly. Further understanding of the conditions and scales over which these gradients occur, and how they are used by predators, is essential to predicting the impact of future changes in the ocean on predator foraging success.
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http://dx.doi.org/10.1038/s42003-021-01668-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851116PMC
February 2021

Integrin α3β1 Promotes Invasive and Metastatic Properties of Breast Cancer Cells through Induction of the Brn-2 Transcription Factor.

Cancers (Basel) 2021 Jan 27;13(3). Epub 2021 Jan 27.

Department of Molecular & Cellular Physiology, Albany Medical College, Albany, NY 12208, USA.

In the current study, we demonstrate that integrin α3β1 promotes invasive and metastatic traits of triple-negative breast cancer (TNBC) cells through induction of the transcription factor, Brain-2 (Brn-2). We show that RNAi-mediated suppression of α3β1 in MDA-MB-231 cells caused reduced expression of Brn-2 mRNA and protein and reduced activity of the gene promoter. In addition, RNAi-targeting of Brn-2 in MDA-MB-231 cells decreased invasion in vitro and lung colonization in vivo, and exogenous Brn-2 expression partially restored invasion to cells in which α3β1 was suppressed. α3β1 promoted phosphorylation of Akt in MDA-MB-231 cells, and treatment of these cells with a pharmacological Akt inhibitor (MK-2206) reduced both Brn-2 expression and cell invasion, indicating that α3β1-Akt signaling contributes to Brn-2 induction. Analysis of RNAseq data from patients with invasive breast carcinoma revealed that high expression correlates with poor survival. Moreover, high expression positively correlates with high expression in basal-like breast cancer, which is consistent with our experimental findings that α3β1 induces Brn-2 in TNBC cells. Together, our study demonstrates a pro-invasive/pro-metastatic role for Brn-2 in breast cancer cells and identifies a role for integrin α3β1 in regulating Brn-2 expression, thereby revealing a novel mechanism of integrin-dependent breast cancer cell invasion.
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http://dx.doi.org/10.3390/cancers13030480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866210PMC
January 2021

A heme•DNAzyme activated by hydrogen peroxide catalytically oxidizes thioethers by direct oxygen atom transfer rather than by a Compound I-like intermediate.

Nucleic Acids Res 2021 02;49(4):1803-1815

Department of Chemistry, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada.

Hemin [Fe(III)-protoporphyrin IX] is known to bind tightly to single-stranded DNA and RNA molecules that fold into G-quadruplexes (GQ). Such complexes are strongly activated for oxidative catalysis. These heme•DNAzymes and ribozymes have found broad utility in bioanalytical and medicinal chemistry and have also been shown to occur within living cells. However, how a GQ is able to activate hemin is poorly understood. Herein, we report fast kinetic measurements (using stopped-flow UV-vis spectrophotometry) to identify the H2O2-generated activated heme species within a heme•DNAzyme that is active for the oxidation of a thioether substrate, dibenzothiophene (DBT). Singular value decomposition and global fitting analysis was used to analyze the kinetic data, with the results being consistent with the heme•DNAzyme's DBT oxidation being catalyzed by the initial Fe(III)heme-H2O2 complex. Such a complex has been predicted computationally to be a powerful oxidant for thioether substrates. In the heme•DNAzyme, the DNA GQ enhances both the kinetics of formation of the active intermediate as well as the oxidation step of DBT by the active intermediate. We show, using both stopped flow spectrophotometry and EPR measurements, that a classic Compound I is not observable during the catalytic cycle for thioether sulfoxidation.
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http://dx.doi.org/10.1093/nar/gkab007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913675PMC
February 2021

School performance and mortality: The mediating role of educational attainment and work and family trajectories across the life course.

Adv Life Course Res 2020 Dec 30;46. Epub 2020 Aug 30.

Indiana University.

Evidence of a strong negative correlation between adolescent academic performance and mortality points to the importance of not only cognitive, but also non-cognitive, skills in predicting survival. We integrated two bodies of research to evaluate expectations regarding the role of educational attainment and trajectories of employment and marriage experience in mediating relationships between high school class rank and longevity. In particular, we used data from the Wisconsin Longitudinal Study ( = 9,232) to fit parametric mortality models from age 55 to age 77. Multiple mediator models allowed for quantification of the degree to which the association between high school class rank and mortality is mediated by life trajectories and educational attainment. Our results show that high school class rank is a statistically significant and substantively meaningful predictor of survival beyond age 55 and that this relationship is partially, but not fully, mediated by trajectories of employment and marriage experience across the life course. Higher educational attainment also mediates a substantial part of the relationship, but to varying degrees for men and women.
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http://dx.doi.org/10.1016/j.alcr.2020.100362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808718PMC
December 2020

Development of a treatment-decision algorithm for HIV-uninfected children evaluated for pulmonary tuberculosis.

Clin Infect Dis 2021 Jan 15. Epub 2021 Jan 15.

Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University and Department of Infectious Diseases, Imperial College; Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.

Background: Limitations in the sensitivity and accessibility of diagnostic tools for childhood tuberculosis contribute to the substantial gap between estimated cases and cases notified to national tuberculosis programs. Thus, tools to make accurate and rapid clinical diagnoses are necessary to initiate more children on antituberculosis treatment.

Methods: We analyzed data from a prospective cohort of children <13 years being routinely evaluated for pulmonary tuberculosis in Cape Town, South Africa from March 2012 to November 2017. We developed a regression model to describe the contributions of baseline clinical evaluation to the diagnosis of tuberculosis using standardized, retrospective case definitions. We included results from baseline chest radiography and Xpert MTB/RIF to the model to develop an algorithm with at least 90% sensitivity in predicting tuberculosis.

Results: Data from 478 children being evaluated for pulmonary tuberculosis were analyzed (median age: 16.2 months, interquartile range: 9.8-30.9); 242 (50.6%) were retrospectively classified with tuberculosis, of which 104 (43.0%) were bacteriologically-confirmed. The area under the receiver operating characteristic curve for the final model was 0.87. Clinical evidence identified 71.4% of all tuberculosis cases in this cohort, and inclusion of baseline chest radiography results increased the proportion to 89.3%. The algorithm was 90.1% sensitive and 52.1% specific, and maintained a sensitivity of above 90% among children <2 years or with low weight-for-age.

Conclusions: Clinical evidence alone was sufficient to make most clinical antituberculosis treatment decisions. The use of evidence-based algorithms may improve decentralized, rapid treatment-initiation, reducing the global burden of childhood mortality.
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http://dx.doi.org/10.1093/cid/ciab018DOI Listing
January 2021

Impact of pneumococcal conjugate vaccine uptake on childhood pneumonia mortality across income levels in Brazil, Colombia, and Peru.

Gates Open Res 2020 22;4:136. Epub 2020 Sep 22.

Comprehensive Family Immunization Unit/FPL, Pan American Health Organization, World Health Organization, District of Columbia, USA.

Pneumococcal conjugate vaccines (PCVs) have prevented deaths due to pneumonia among children. The effect may differ between higher- and lower-income populations due to various factors, such as differences in the distribution of pneumococcal serotypes, healthcare access, and PCV uptake. This study aims to evaluate an association between increasing PCV coverage and population-level declines in death due to pneumonia and its variation by socioeconomic status of subnational regions. We analyzed municipality-level mortality data from 2005 and 2015 for children aged 2-23 months in Brazil, Colombia, and Peru. We fit Poisson regression models to estimate the relationship between changes in PCV uptake and deaths due to all-cause pneumonia among subnational regions with different income levels. We controlled for changes unrelated to PCV by using data on non-respiratory deaths over time. Uptake of the third dose of PCV varied across subnational regions and was higher in high-income regions. Higher uptake of PCV was associated with larger declines in pneumonia mortality. This association did not differ by income level of the region in Brazil and Colombia. In Peru, low-income regions observed larger declines in pneumonia deaths, but there was large uncertainty in the difference between the low- and high-income regions. We estimated that, with 90% coverage, there would be 4-38% declines in all-cause pneumonia mortality across income levels and countries. Regions with higher PCV coverage experienced larger declines in pneumonia deaths, regardless of the income level. Having more reliable data on mortality records and vaccine uptake would improve the reliability of vaccine impact estimates.
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http://dx.doi.org/10.12688/gatesopenres.13187.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780121PMC
September 2020

Medical facemasks are adequate for healthcare worker safety at outdoor coronavirus disease 2019 (COVID-19) drive-through testing centers.

Infect Control Hosp Epidemiol 2021 Jan 12:1-2. Epub 2021 Jan 12.

Department of Pediatrics, Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon.

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http://dx.doi.org/10.1017/ice.2020.1430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853740PMC
January 2021

Excess Cerebrovascular Mortality in the United States During the COVID-19 Pandemic.

Stroke 2021 01 12;52(2):563-572. Epub 2021 Jan 12.

Department of Neurology, Division of Neurocritical Care and Emergency Neurology, New Haven, CT (G.F., K.N.S.).

Background And Purpose: The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We aim to quantify excess stroke-related deaths and characterize its association with social distancing behavior and COVID-19-related vascular pathology.

Methods: United States and state-level excess cerebrovascular deaths from January to May 2020 were quantified using National Center for Health Statistic data and Poisson regression models. Excess cerebrovascular deaths were analyzed as a function of time-varying stroke-related emergency medical service (EMS) calls and cumulative COVID-19 deaths using linear regression. A state-level regression analysis was performed to determine the association between excess cerebrovascular deaths and time spent in residences, measured by Google Community Mobility Reports, during the height of the pandemic after the first COVID-19 death (February 29).

Results: Forty states and New York City were included. Excess cerebrovascular mortality occurred nationally from the weeks ending March 28 to May 2, 2020, up to a 7.8% increase above expected levels during the week of April 18. Decreased stroke-related EMS calls were associated with excess stroke deaths one (70 deaths per 1000 fewer EMS calls [95% CI, 20-118]) and 2 weeks (85 deaths per 1000 fewer EMS calls [95% CI, 37-133]) later. Twenty-three states and New York City experienced excess cerebrovascular mortality during the pandemic height. A 10% increase in time spent at home was associated with a 4.3% increase in stroke deaths (incidence rate ratio, 1.043 [95% CI, 1.001-1.085]) after adjusting for COVID-19 deaths.

Conclusions: Excess US cerebrovascular deaths during the COVID-19 pandemic were observed and associated with decreases in stroke-related EMS calls nationally and mobility at the state level. Public health measures are needed to identify and counter the reticence to seeking medical care for acute stroke during the COVID-19 pandemic.
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http://dx.doi.org/10.1161/STROKEAHA.120.031975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834664PMC
January 2021

Environmentally Relevant Iron Oxide Nanoparticles Produce Limited Acute Pulmonary Effects in Rats at Realistic Exposure Levels.

Int J Mol Sci 2021 Jan 8;22(2). Epub 2021 Jan 8.

Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Didcot, Oxfordshire OX11 0RQ, UK.

Iron is typically the dominant metal in the ultrafine fraction of airborne particulate matter. Various studies have investigated the toxicity of inhaled nano-sized iron oxide particles (FeONPs) but their results have been contradictory, with some indicating no or minor effects and others finding effects including oxidative stress and inflammation. Most studies, however, did not use materials reflecting the characteristics of FeONPs present in the environment. We, therefore, analysed the potential toxicity of FeONPs of different forms (FeO, α-FeO and γ-FeO) reflecting the characteristics of high iron content nano-sized particles sampled from the environment, both individually and in a mixture (FeO-mix). A preliminary in vitro study indicated FeO and FeO-mix were more cytotoxic than either form of FeO in human bronchial epithelial cells (BEAS-2B). Follow-up in vitro (0.003, 0.03, 0.3 µg/mL, 24 h) and in vivo (Sprague-Dawley rats, nose-only exposure, 50 µg/m and 500 µg/m, 3 h/d × 3 d) studies therefore focused on these materials. Experiments in vitro explored responses at the molecular level via multi-omics analyses at concentrations below those at which significant cytotoxicity was evident to avoid detection of responses secondary to toxicity. Inhalation experiments used aerosol concentrations chosen to produce similar levels of particle deposition on the airway surface as were delivered in vitro. These were markedly higher than environmental concentrations. No clinical signs of toxicity were seen nor effects on BALF cell counts or LDH levels. There were also no significant changes in transcriptomic or metabolomic responses in lung or BEAS-2B cells to suggest adverse effects.
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http://dx.doi.org/10.3390/ijms22020556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827273PMC
January 2021

A Hierarchical Bayesian Implementation of the Experience-Weighted Attraction Model.

Comput Psychiatr 2020 Nov;4:40-60

Department of Biostatistics, Yale University, New Haven, Connecticut, USA.

Social and decision-making deficits are often the first symptoms of neuropsychiatric disorders. In recent years, economic games, together with computational models of strategic learning, have been increasingly applied to the characterization of individual differences in social behavior, as well as their changes across time due to disease progression, treatment, or other factors. At the same time, the high dimensionality of these data poses an important challenge to statistical estimation of these models, potentially limiting the adoption of such approaches in patients and special populations. We introduce a hierarchical Bayesian implementation of a class of strategic learning models, experience-weighted attraction (EWA), that is widely used in behavioral game theory. Importantly, this approach provides a unified framework for capturing between- and within-participant variation, including changes associated with disease progression, comorbidity, and treatment status. We show using simulated data that our hierarchical Bayesian approach outperforms representative agent and individual-level estimation methods that are commonly used in extant literature, with respect to parameter estimation and uncertainty quantification. Furthermore, using an empirical dataset, we demonstrate the value of our approach over competing methods with respect to balancing model fit and complexity. Consistent with the success of hierarchical Bayesian approaches in other areas of behavioral science, our hierarchical Bayesian EWA model represents a powerful and flexible tool to apply to a wide range of behavioral paradigms for studying the interplay between complex human behavior and biological factors.
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http://dx.doi.org/10.1162/cpsy_a_00028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790055PMC
November 2020

Frontotemporal dementia, music perception and social cognition share neurobiological circuits: A meta-analysis.

Brain Cogn 2021 Mar 7;148:105660. Epub 2021 Jan 7.

Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam UMC, Amsterdam, the Netherlands.

Frontotemporal dementia (FTD) is a neurodegenerative disease that presents with profound changes in social cognition. Music might be a sensitive probe for social cognition abilities, but underlying neurobiological substrates are unclear. We performed a meta-analysis of voxel-based morphometry studies in FTD patients and functional MRI studies for music perception and social cognition tasks in cognitively normal controls to identify robust patterns of atrophy (FTD) or activation (music perception or social cognition). Conjunction analyses were performed to identify overlapping brain regions. In total 303 articles were included: 53 for FTD (n = 1153 patients, 42.5% female; 1337 controls, 53.8% female), 28 for music perception (n = 540, 51.8% female) and 222 for social cognition in controls (n = 5664, 50.2% female). We observed considerable overlap in atrophy patterns associated with FTD, and functional activation associated with music perception and social cognition, mostly encompassing the ventral language network. We further observed overlap across all three modalities in mesolimbic, basal forebrain and striatal regions. The results of our meta-analysis suggest that music perception and social cognition share neurobiological circuits that are affected in FTD. This supports the idea that music might be a sensitive probe for social cognition abilities with implications for diagnosis and monitoring.
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http://dx.doi.org/10.1016/j.bandc.2020.105660DOI Listing
March 2021

Bilateral Simultaneous Total Knee Arthroplasty May Not Be Safe Even in the Healthiest Patients.

J Bone Joint Surg Am 2021 02;103(4):303-311

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

Background: Bilateral total knee arthroplasty (TKA) has been shown to increase both mortality and complications, but has potential benefits including decreased length of stay, rehabilitation time, and costs. The purpose of this study was to use data from a nationally representative database to identify if there is a population of patients undergoing TKA in whom bilateral TKA can be safely performed, by comparing 30-day mortality and complication rates with those of patients undergoing unilateral TKA.

Methods: The National Surgical Quality Improvement Program (NSQIP) was queried to compare 30-day rates of mortality and any complication between bilateral TKA and unilateral TKA. A total of 8,291 patients who underwent bilateral TKA were matched 1:1 with a unilateral TKA control cohort (n = 315,219) by morbidity probability, which is a cumulative variable encompassing demographic characteristics, comorbidities, and laboratory values. Patients were divided into quartiles based on morbidity probability. Binary logistic regression comparing bilateral TKA and unilateral TKA for the same quartiles was performed to establish if any population could safely have bilateral TKA performed.

Results: Bilateral TKA had an increased risk for all complications (p < 0.001) and major complications (p < 0.001) when compared with unilateral TKA regardless of health status. For all complications, there was a greater than threefold increase for the first quartile (healthiest patients) (p < 0.001), a greater than fourfold increase for the second and third quartiles (p < 0.001), and a greater than threefold increase for the fourth quartile (least healthy patients) (p < 0.001). For major complications, there was a greater than twofold increase for the first quartile (p = 0.001) and the second quartile (p < 0.001), an almost threefold increase for the third quartile (p < 0.001), and a 57% increase for the fourth quartile (p = 0.005).

Conclusions: This study will assist shared decision-making between orthopaedic surgeons and patients by suggesting that bilateral TKA may not be as safe an option for even healthy individuals compared with unilateral TKA.

Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.20.01046DOI Listing
February 2021

Simultaneous auditory agnosia: Systematic description of a new type of auditory segregation deficit following a right hemisphere lesion.

Cortex 2021 Feb 26;135:92-107. Epub 2020 Nov 26.

Wellcome Centre for Human Neuroimaging, UCL, London, UK; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.

We investigated auditory processing in a young patient who experienced a single embolus causing an infarct in the right middle cerebral artery territory. This led to damage to auditory cortex including planum temporale that spared medial Heschl's gyrus, and included damage to the posterior insula and inferior parietal lobule. She reported chronic difficulties with segregating speech from noise and segregating elements of music. Clinical tests showed no evidence for abnormal cochlear function. Follow-up tests confirmed difficulties with auditory segregation in her left ear that spanned multiple domains, including words-in-noise and music streaming. Testing with a stochastic figure-ground task-a way of estimating generic acoustic foreground and background segregation-demonstrated that this was also abnormal. This is the first demonstration of an acquired deficit in the segregation of complex acoustic patterns due to cortical damage, which we argue is a causal explanation for the symptomatic deficits in the segregation of speech and music. These symptoms are analogous to the visual symptom of simultaneous agnosia. Consistent with functional imaging studies on normal listeners, the work implicates non-primary auditory cortex. Further, the work demonstrates a (partial) lateralisation of the necessary anatomical substrate for segregation that has not been previously highlighted.
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http://dx.doi.org/10.1016/j.cortex.2020.10.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856551PMC
February 2021

Hearing and dementia: from ears to brain.

Brain 2020 Dec 22. Epub 2020 Dec 22.

Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK.

The association between hearing impairment and dementia has emerged as a major public health challenge, with significant opportunities for earlier diagnosis, treatment and prevention. However, the nature of this association has not been defined. We hear with our brains, particularly within the complex soundscapes of everyday life: neurodegenerative pathologies target the auditory brain, and are therefore predicted to damage hearing function early and profoundly. Here we present evidence for this proposition, based on structural and functional features of auditory brain organization that confer vulnerability to neurodegeneration, the extensive, reciprocal interplay between 'peripheral' and 'central' hearing dysfunction, and recently characterized auditory signatures of canonical neurodegenerative dementias (Alzheimer's disease, Lewy body disease and frontotemporal dementia). Moving beyond any simple dichotomy of ear and brain, we argue for a reappraisal of the role of auditory cognitive dysfunction and the critical coupling of brain to peripheral organs of hearing in the dementias. We call for a clinical assessment of real-world hearing in these diseases that moves beyond pure tone perception to the development of novel auditory 'cognitive stress tests' and proximity markers for the early diagnosis of dementia and management strategies that harness retained auditory plasticity.
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http://dx.doi.org/10.1093/brain/awaa429DOI Listing
December 2020

First report of causing crown rot in greenhouse grown (L.) in California.

Plant Dis 2020 Dec 18. Epub 2020 Dec 18.

Dark Heart Nursery, Davis, California, United States;

In April of 2020 cuttings of (L.) in a greenhouse in San Mateo County, CA were observed collapsing, and further observation revealed: water-soaked stems, tan discoloration to the cortex, and discolored roots. The greenhouse irrigation system was supplied by a local stream. We collected one-liter water samples from: intake pond, reservoir tank, irrigation lines, and local potable water tap. Water samples were filtered and plated as described previously (Rollins et al., 2016). Filter papers were removed after 24 hours. Crown sections from four symptomatic plants and one asymptomatic plant were surfaced sterilized in 10% bleach for five minutes, rinsed in sterile deionized water, cut into four-millimeter long sections, and plated onto V8 media, then incubated at room temperature for three days. White mycelial growth was observed from foci within the print of the filter paper from all irrigation water samples but not the potable water supply sample. Similar mycelial growth was observed from plated crown tissue from symptomatic plants only. Observation under light microscope revealed characteristics congruent with , including aseptate hyphae and globose sporangia (Watanabe, 2002). Mycelia was collected for DNA extraction from each of the water and plant sample plates with DNA extractions performed using Quick DNA Fungi/Bacterial Kit (Zymo Research Irvine, CA, USA) and PCR amplified using primers ITS100/ITS4 as described by Riit et al. (2016). All amplicons were Sanger sequenced, aligned using SnapGene software (from GSL Biotech; available at snapgene.com), and compared to barcode referencPe sequences to identify the species using the BarCode of Life Database (BOLDsystems) within the National Center for Biotechnology Information nucleotide database. After trimming and aligning, all amplicons were found to be identical, yielding the 810-nucleotide long consensus ITS amplicon (accession MW114807), which aligned with ITS sequences (e.g., accession HQ643886.1) with 100% identity and homology. We then completed Koch's postulates by using pure cultures from root sections of to stem inoculate plants. We used a three-millimeter corer to remove a disc of epidermis and applied a plug of pure culture to the wound. We inoculated 10 plants, with two plants mock-inoculated using clean V8 agar. Inoculation sites were wrapped in parafilm, and plants were grown in the greenhouse for 20 days. Stems of mock and oomycete inoculated plants were examined for callus formation and 30 centimeters of stem were excised from each plant. The mock inoculated plants had fully callused inoculation sites and were discolored only where wounded. inoculated plant inoculation sites were partially callused over and had tan discoloration of the cortex that extended 6.0 mm +/- 2.0 mm above and below the inoculation site. Stem segments above and below inoculation sites were surface sterilized and plated on V8 media as previously described and recovered from inoculated plants, confirmed as identical to the inoculum by ITS amplification and sequencing. Mock inoculated plant stem cultures yielded no oomycete growth. Together, these results indicate that has the ability to cause crown rot in in greenhouse cultivation.
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http://dx.doi.org/10.1094/PDIS-10-20-2228-PDNDOI Listing
December 2020

The lethality of non-familial child abductions: Characteristics and outcomes of 565 incidents involving youth under the age of 18 years.

Behav Sci Law 2020 Dec 10. Epub 2020 Dec 10.

Federal Bureau of Investigation, Washington, DC, USA.

Offender motivation for child abduction determines both the nature and final outcome of the abduction. Research has identified victim characteristics, offender characteristics, and sexual motivations as factors influencing child abduction and child abduction homicide. We examine 565 child abductions identified through the Federal Bureau of Investigation (FBI) to determine the characteristics of victim, perpetrator, and crime and their influence on whether the child is murdered. Central to this research was the finding that 88.6% of the abductions involved a sexual motivation for the crime, and sexual motivation was significantly more likely when the victim was female and when the victim was post-pubescent. Of 581 child victims for whom the outcome of the abduction was known, 281 (48.3%) were found alive and 300 (51.7%) were found dead or presumed dead. There was a significant interaction between motive for the crime and the final abduction outcome, with victims abducted for sexual purposes being at higher risk of being murdered.
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http://dx.doi.org/10.1002/bsl.2495DOI Listing
December 2020

"The Dichotic Digit Test" as an Index Indicator for Hearing Problem in Dementia: Systematic Review and Meta-Analysis.

J Am Acad Audiol 2020 Dec 9. Epub 2020 Dec 9.

UCL Ear Institute, Faculty of Brain Science, University College London, London, United Kingdom.

Background:  Patients with dementia commonly have problems processing speech in the presence of competing background speech or noise. This difficulty can be present from the very early stages of dementia, and may be a preclinical feature of Alzheimer's disease.

Purpose:  This study investigates whether people with dementia perform worse on the dichotic digit test (DDT), an experimental probe of speech processing in the presence of competing speech, and whether test performance may predict dementia onset.

Research Design:  Systematic review and meta-analysis.

Data Collection And Analysis:  A literature search was conducted in Medline, Embase, Scopus, and Psycinfo. We included (1) studies that included people with a diagnosis of dementia and a healthy control group with no cognitive impairment; (2) studies that reported results from a DDT in a free-recall response task; and (3) studies that had the dichotic digit mean correct percentage score or right-ear advantage, as outcome measurements.

Results:  People with dementia had a lower DDT total score, with a pooled mean difference of 18.6% (95% confidence interval [CI]: 21.2-15.9). Patients with dementia had an increased right-ear advantage relative to controls with a pooled difference of 24.4% (95% CI: 21.8-27.0).

Conclusion:  The DDT total scores are lower and the right-ear advantage increased in cognitively impaired versus normal control participants. The findings also suggest that the reduction of dichotic digit total score and increase of right-ear advantage progress as cognitive impairment increases. Whether abnormalities in dichotic digit scores could predict subsequent dementia onset should be examined in further longitudinal studies.
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http://dx.doi.org/10.1055/s-0040-1718700DOI Listing
December 2020

Estimated glomerular filtration rate is a prognosticator of adverse outcomes after primary total knee arthroplasty among patients with chronic kidney disease and glomerular hyperfiltration.

Knee 2020 Dec 4;28:36-44. Epub 2020 Dec 4.

Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA. Electronic address:

Background: The goals of this study were: (1) to test whether patients with an Estimated glomerular filtration rate (eGFR) that is higher or lower than population-based standards have an increased risk of 30-day mortality, return to the operating room, readmission, non-home discharge, any complication, major complications, and minor complications after primary total knee arthroplasty (TKA); and (2) to find out whether there is a significant non-linear relationship between eGFR and those same variables.

Methods: A total of 168,919 primary TKAs were identified using The National Surgical Quality Improvement Program (NSQIP) database between 1 January 2008 and 31 December 2016. The following outcomes were assessed at 30 days: mortality, return to the operating room, readmission, non-home discharge, any complication, major complications, and minor complications.

Results: Multivariate binomial logistical regression found that patients with hyperfiltration had higher rates of readmission (P < 0.03), non-home discharge (P < 0.01), any complication (P < 0.01), major complications (P = 0.03), and minor complications (P < 0.01) compared to reference patients with eGFR in the normal range. Patients with an eGFR less than 60 (stage 3 chronic kidney disease or higher) had increased odds of mortality (P < 0.05), readmission (P < 0.05), any complication (P < 0.01), major complications (P < 0.01), and minor complications (P < 0.01). Spline regression found statistically significant non-linear relationships between eGFR and mortality (P < 0.001), return to the operating room (P = 0.0029), and readmission as well as non-home discharge (P < 0.001).

Conclusion: Low eGFR and hyperfiltration may be associated with elevated risk of 30-day adverse events. GFR can be used as a risk stratification tool to counseling patients with particular attention paid to those with a GFR < 30 ml/min/1.73 m.
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http://dx.doi.org/10.1016/j.knee.2020.11.008DOI Listing
December 2020