Miracle-dz/UniFAR-FTUs huggingface dataset:
Systematic review on barriers and facilitators of complex interventions for residents with dementia in long-term care

ABSTRACT Objectives: Psychotropic drugs are frequently and sometimes inappropriately used for the treatment of neuropsychiatric symptoms of people with dementia, despite their limited efficacy and side effects. Interventions to address neuropsychiatric symptoms and psychotropic drug use are multifactorial and often multidisciplinary. Suboptimal implementation of these complex interventions often limits their effectiveness. This systematic review provides an overview of barriers and facilitators influencing the implementation of complex interventions targeting neuropsychiatric symptoms and psychotropic drug use in long-term care. Design: To identify relevant studies, the following electronic databases were searched between 28 May and 4 June: PubMed, Web of Science, PsycINFO, Cochrane, and CINAHL. Two reviewers systematically reviewed the literature, and the quality of the included studies was assessed using the Critical Appraisal Skills Programme qualitative checklist. The frequency of barriers and facilitators was addressed, followed by deductive thematic analysis describing their positive of negative influence. The Consolidated Framework for Implementation Research guided data synthesis. Results: Fifteen studies were included, using mostly a combination of intervention types and care programs, as well as different implementation strategies. Key factors to successful implementation included strong leadership and support of champions. Also, communication and coordination between disciplines, management support, sufficient resources, and culture (e.g. openness to change) influenced implementation positively. Barriers related mostly to unstable organizations, such as renovations to facility, changes toward self-directed teams, high staff turnover, and perceived work and time pressures. Conclusions: Implementation is complex and needs to be tailored to the specific needs and characteristics of the organization in question. Champions should be carefully chosen, and the application of learned actions and knowledge into practice is expected to further improve implementation.
Hypertensive emergencies and urgencies: a single-centre experience in Northern Italy 2008-2015.

W e read with delight the article by Salvetti et al. [1], ‘Hypertensive emergencies and urgencies: a single-centre experience in Northern Italy 20082015’. The authors examined the medical records of patients admitted for hypertensive emergency or hypertensive urgency and reported on the prevalence, clinical presentation, and treatment. We want to thank the authors for this informative study and contribute further discussion. Notably, the authors should have excluded from the study hypertensive crises that presented with acute stroke. Hypertension in the context of stroke is considered to be an adaptive response to preserve cerebral perfusion pressure (CPP). CPP is calculated by the difference between intracranial pressure (ICP) and mean arterial pressure (MAP) or (CPP1⁄4MAP ICP). Strokes can cause an elevation in ICP. Due to this relationship, reduction of MAP in the context of stroke is limited in several circumstances. The Intravenous Nimodipine West European Stroke Trial (INWEST) found that reduction of DBP in patients with acute stroke was associated with worse neurological outcomes [2]. However, other studies have found positive outcomes associated with blood pressure reduction in acute stroke. Studies, such as the Acute Candesartan Cilexetil Evaluation in Stroke Survivors (ACCESS) have found reduced 12-month mortality rate and incidence of vascular events correlated with the use of candesartan in blood pressure reduction in ischemic stroke [3]. Overall, management of hypertensive crisis in stroke remains controversial because of the lack of conclusive evidence. In this study, stroke accounted for 40 and 37% of hypertensive emergencies in 2008 and 2015, respectively [1]. This may partially account for why a portion of patients with hypertensive crisis did not receive an antihypertensive drug. We do agree with the authors of this study who concluded that the application of recently published guidelines is needed. Adverse events, such as acute kidney injury and myocardial infarction can arise in hypertensive emergencies if the incorrect treatment is used. In fact, we believe that data on such adverse events that may have occurred in patients within this study would have accentuated the need for standardization of treatment. Historically, studies on the prevalence, clinical presentation, and treatment of hypertensive crises have been few. The results of this study are, thus, a major contribution to standardizing the management of hypertensive crises. ACKNOWLEDGEMENTS
Biology and Life Stages of Pine Spittle Bug Ocoaxo assimilis Walker (Hemiptera: Cercopidae)

The first records of outbreaks of the Pine Spittle bug Ocoaxo assimilis Walker were recently identified from Puebla, Mexico, which promoted more than 2600 ha of forest foliar fall. Beyond the taxonomic and distribution information of this species, the basic traits of its biology remain unknown. This study aims to describe some biological aspects of O. assimilis, in a natural pine forest at Nicolás Bravo, Puebla (NB). Using morphological characteristics and a phylogenetic analysis of a fragment of cytochrome oxidase subunit I mtDNA (COI), immature instars with adults were studied; the instar number was determined by means of a multivariate analysis of 19 morphological characteristics of 121 specimens. The systematic sampling to evaluate the occurrence of nymphal specimens during a year, plus host selection experiments, allowed for determination of the abundance over time, voltism, and host preferences. Phylogenetic analysis of the COI supported that both nymphs and adults collected in NB correspond to O. assimilis. Principal coordinate analysis supported the existence of five nymphal stages. Field sampling and host selection experiments indicated that this species displays a single generation per year, is associated with the rainy season, and that specimens from the three first nymphal stages feed on roots of eight host species (one grass, four herbaceous species, one bush, and two trees). From the fourth instar, the insects feed on pine roots to complete their development, and when they are adults, they migrate to needles of young or mature pine stands of Pinus pseudostrobus to feed and reproduce.
Modulation of AMPA Receptors by Nitric Oxide in Nerve Cells

Nitric oxide (NO) is a gaseous molecule with a large number of functions in living tissue. In the brain, NO participates in numerous intracellular mechanisms, including synaptic plasticity and cell homeostasis. NO elicits synaptic changes both through various multi-chain cascades and through direct nitrosylation of targeted proteins. Along with the N-methyl-d-aspartate (NMDA) glutamate receptors, one of the key components in synaptic functioning are α-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) receptors—the main target for long-term modifications of synaptic effectivity. AMPA receptors have been shown to participate in most of the functions important for neuronal activity, including memory formation. Interactions of NO and AMPA receptors were observed in important phenomena, such as glutamatergic excitotoxicity in retinal cells, synaptic plasticity, and neuropathologies. This review focuses on existing findings that concern pathways by which NO interacts with AMPA receptors, influences properties of different subunits of AMPA receptors, and regulates the receptors’ surface expression.
Differences in species diversity, biomass, and soil properties of five types of alpine grasslands in the Northern Tibetan Plateau

Approximately 94% of the land area of the Northern Tibetan Plateau is covered by grasslands, which comprise one of five key livestock producing regions in China. In contrast to most other regions worldwide, these alpine grasslands are much more sensitive to global climate change, thus they are under intense study. The differences in species diversity, plant biomass, and soil properties of five representative’s alpine grassland types in the Northern Tibetan Plateau were investigated in this research. The results revealed that 11 community types were identified according to the importance of dominant species and constructive species. There were significant differences in the Margalef index (H), Simpson diversity index (D), Shannon-wiener diversity index (H'), and Pielou evenness index (J) indices between these five alpine grasslands. Further, the above-ground biomass (AGB), below-ground biomass (BGB), total biomass (TB), root:shoot (R/S) ratio, and coverage showed significant differences in 5 alpine grasslands. There were also considerable variations in the pH, total nitrogen concentration (TN), total phosphorus concentration (TP), soil organic carbon (SOC) and C-to-N ratio (C:N) among the five alpine grasslands. The highest value of biomass and soil characteristics was always in the alpine steppe (AS), or AM, while the lowest of that was in the alpine desert steppe (ADS), or alpine desert (AD). Moreover, there were significant differences in the soil particle size fractions between the five alpine grasslands. In the AM and AS, the dominant soil particle was clay, while in the alpine meadow-steppe (AMS), ADS, and AD it was fine and medium sand. Substantial correlations were found between the biomass and species diversity indices H, D or H' and soil TN, TP, or SOC. Moreover, silt had a significantly positive correlation with soil C:N, BGB, TB, and R/S, while medium sand and coarse sand was significant negatively correlated. With regard to these grassland types, it is proposed that the AM or AS may be an actively changing grassland types in the Northern Tibetan Plateau.
Diversity of Antimicrobial Peptides in Three Partially Sympatric Frog Species in Northeast Asia and Implications for Evolution

Antimicrobial peptides (AMPs) are evolutionarily ancient molecules that play an essential role in innate immunity across taxa from invertebrates to vertebrates. The evolution system of AMP system has not been well explained in the literature. In this study, we cloned and sequenced AMP transcriptomes of three frog species, namely Rana dybowskii, Rana amurensis, and Pelophylax nigromaculatus, which are partially sympatric in northeast Asia, but show different habitat preferences. We found that each species contained 7 to 14 families of AMPs and the diversity was higher in species with a large geographic range and greater habitat variation. All AMPs are phylogenetically related but not associated with the speciation process. Most AMP genes were under negative selection. We propose that the diversification and addition of novel functions and improvement of antimicrobial efficiency are facilitated by the expansion of family members and numbers. We also documented significant negative correlation of net charges and numbers of amino acid residues between the propiece and mature peptide segments. This supports the Net Charge Balance Hypothesis. We propose the Cut Point Sliding Hypothesis as a novel diversification mechanism to explain the correlation in lengths of the two segments.
A new process to measure postural sway using a Kinect depth camera during a Sensory Organisation Test

Posturography provides quantitative, objective measurements of human balance and postural control for research and clinical use. However, it usually requires access to specialist equipment to measure ground reaction forces, which are not widely available in practice, due to their size or cost. In this study, we propose an alternative approach to posturography. It uses the skeletal output of an inexpensive Kinect depth camera to localise the Centre of Mass (CoM) of an upright individual. We demonstrate a pipeline which is able to measure postural sway directly from CoM trajectories, obtained from tracking the relative position of three key joints. In addition, we present the results of a pilot study that compares this method of measuring postural sway to the output of a NeuroCom SMART Balance Master. 15 healthy individuals (age: 42.3 ± 20.4 yrs, height: 172 ± 11 cm, weight: 75.1 ± 14.2 kg, male = 11), completed 25 Sensory Organisation Test (SOT) on a NeuroCom SMART Balance Master. Simultaneously, the sessions were recorded using custom software developed for this study (CoM path recorder). Postural sway was calculated from the output of both methods and the level of agreement determined, using Bland-Altman plots. Good agreement was found for eyes open tasks with a firm support, the agreement decreased as the SOT tasks became more challenging. The reasons for this discrepancy may lie in the different approaches that each method takes to calculate CoM. This discrepancy warrants further study with a larger cohort, including fall-prone individuals, cross-referenced with a marker-based system. However, this pilot study lays the foundation for the development of a portable device, which could be used to assess postural control, more cost-effectively than existing equipment.
Sleep Disordered Breathing and Left Ventricular Scar on Cardiac Magnetic Resonance: Results of the Multi-Ethnic Study of Atherosclerosis (MESA).

STUDY OBJECTIVE To evaluate the independent association between sleep disordered breathing (SDB) using overnight polysomnography (PSG) and left ventricular (LV) scar using cardiac magnetic resonance (CMR) with late-gadolinium enhancement (LGE) in a community based cohort of the Multi-ethnic Study of Atherosclerosis (MESA). METHODS Our analytical sample includes 934 participants from the fifth examination of MESA who underwent both PSG and CMR. SDB was categorized as: no-SDB (apnea hypopnea index [AHI]<5), mild SDB (5≤AHI<15) and moderate-severe SDB (AHI≥15). LV scar was considered present if there was presence of scar on CMR (LGE>0%). Logistic regression with multivariable adjustment for confounders (age, sex, race/ethnicity, BMI, and cardiometabolic risk factors) was used to examine the independent association of SDB with LV scar. Confounders were identified using directed acyclic graphs. RESULTS The mean age of our sample was 67.0 years (SD 8.5), with 49% (n=461) females, and a prevalence of SDB (AHI≥5) of 63% (n=590). LV scar was more prevalent in individuals with SDB (9.5%) vs. those without SDB (3.8%) (p<0.01), and 88% of all LV scars were clinically unrecognized. After multivariable adjustment, both mild SDB and moderate-severe SDB were independently associated with LV scar, OR 2.53 (95% CI 1.13-5.64) and OR 2.31 (95% CI 1.01-5.24), respectively. CONCLUSION In a community based cohort, SDB (including mild) is independently associated with over a two-fold increase in the odds of LV scar presence measured using CMR with LGE. A majority of the LV scars were clinically unrecognized. The impact of SDB treatment on subclinical MI needs to be investigated in future studies.
Elicitor and Receptor Molecules: Orchestrators of Plant Defense and Immunity

Pathogen-associated molecular patterns (PAMPs), microbe-associated molecular patterns (MAMPs), herbivore-associated molecular patterns (HAMPs), and damage-associated molecular patterns (DAMPs) are molecules produced by microorganisms and insects in the event of infection, microbial priming, and insect predation. These molecules are then recognized by receptor molecules on or within the plant, which activates the defense signaling pathways, resulting in plant’s ability to overcome pathogenic invasion, induce systemic resistance, and protect against insect predation and damage. These small molecular motifs are conserved in all organisms. Fungi, bacteria, and insects have their own specific molecular patterns that induce defenses in plants. Most of the molecular patterns are either present as part of the pathogen’s structure or exudates (in bacteria and fungi), or insect saliva and honeydew. Since biotic stresses such as pathogens and insects can impair crop yield and production, understanding the interaction between these organisms and the host via the elicitor–receptor interaction is essential to equip us with the knowledge necessary to design durable resistance in plants. In addition, it is also important to look into the role played by beneficial microbes and synthetic elicitors in activating plants’ defense and protection against disease and predation. This review addresses receptors, elicitors, and the receptor–elicitor interactions where these components in fungi, bacteria, and insects will be elaborated, giving special emphasis to the molecules, responses, and mechanisms at play, variations between organisms where applicable, and applications and prospects.
Neural shutdown under stress: an evolutionary perspective on spreading depolarization.

Neural function depends on maintaining cellular membrane potentials as the basis for electrical signaling. Yet in mammals and insects, neuronal and glial membrane potentials can reversibly depolarize to zero, shutting down neural function by the process of spreading depolarization (SD) that collapses the ion gradients across membranes. SD is not evident in all metazoan taxa with centralized nervous systems. We consider the occurrence and similarities of SD in different animals and suggest that it is an emergent property of nervous systems that have evolved to control complex behaviours requiring energetically expensive, rapid information processing in a tightly regulated extracellular environment. Whether SD is beneficial or not in mammals remains an open question. However, in insects it is associated with the response to harsh environments and may provide an energetic advantage that improves the chances of survival. The remarkable similarity of SD in diverse taxa supports a model systems approach to understanding the mechanistic underpinning of human neuropathology associated with migraine, stroke and traumatic brain injury.
Cognitive Function, Access to Kidney Transplantation, and Waitlist Mortality Among Kidney Transplant Candidates With or Without Diabetes.

RATIONALE & OBJECTIVE Intact cognition is generally a prerequisite for navigating through and completing evaluation for kidney transplantation. Despite kidney transplantation being contraindicated for those with severe dementia, screening for more mild forms of cognitive impairment before referral is rare. Candidates may have unrecognized cognitive impairment, which may prolong evaluation, elevate mortality risk, and hinder access to kidney transplantation. We estimated the burden of cognitive impairment and its association with access to kidney transplantation and waitlist mortality. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,630 participants (January 2009 to June 2018) with cognitive function measured (by the Modified Mini-Mental State Examination [3MS]) at kidney transplantation evaluation at 1 of 2 transplantation centers. PREDICTORS Cognitive impairment (3MS score<80). OUTCOMES Listing, waitlist mortality, and kidney transplantation. ANALYTICAL APPROACH We estimated the adjusted chance of listing (Cox regression), risk for waitlist mortality (competing-risks regression), and kidney transplantation rate (Poisson regression) by cognitive impairment. Given potential differences in cause of cognitive impairment among those with and without diabetes, we tested whether these associations differed by diabetes status using a Wald test. RESULTS At evaluation, 6.4% of participants had cognitive impairment, which was independently associated with 25% lower chance of listing (adjusted HR, 0.75; 95% CI, 0.61-0.91); this association did not differ by diabetes status (Pinteraction=0.07). There was a nominal difference by diabetes status for the association between cognitive impairment and kidney transplantation rate (Pinteraction=0.05), while the association between cognitive impairment and waitlist mortality differed by diabetes status kidney transplantation rates (Pinteraction=0.02). Among candidates without diabetes, those with cognitive impairment were at 2.47 (95% CI, 1.31-4.66) times greater risk for waitlist mortality; cognitive impairment was not associated with this outcome among candidates with diabetes. LIMITATIONS Single measure of cognitive impairment. CONCLUSIONS Cognitive impairment is associated with a lower chance of being placed on the waitlist, and among patients without diabetes, with increased mortality on the waitlist. Future studies should investigate whether implementation of screening for cognitive impairment improves these outcomes.
Identification immunophenotyping of lung adenocarcinomas based on the tumor microenvironment

The tumor immune microenvironment is heterogeneous, and its impact on treatment responses is not well understood. It is still a challenge to analyze the interaction between malignant cells and the tumor microenvironment to apply suitable immunotherapy in lung adenocarcinoma. We performed the nonnegative matrix factorization method to 513 messenger RNA expression profiles of lung adenocarcinomas (LUADs) from The Cancer Genome Atlas (TCGA) to obtain an immune‐related expression pattern. Subsequently, we characterized the immune‐related gene signatures and clinical and survival characteristics. We used 576 patients from Gene Expression Omnibus to confirm our findings. Of the patients in the training cohort, 51% had a high immune enrichment score, high expression of immune cell signaling, cytolytic activity, and interferon (IFN)‐related signatures (all P < .05). We denoted these as the Immune Class. We further subdivided the Immune Class into two subclasses based on the tumor microenvironment. These were denoted the Active Immune Class and Exhausted Immune Class. The former showed significant IFN, T‐cells, M1 macrophage signatures, and better prognosis (all P < .05), while the latter presented an exhausted immune response with activated stromal enrichment, M2 macrophage signatures, and immunosuppressive factors such as WNT/transforming growth factor‐β (all P < .05). Furthermore, we predicted the response of our immunophenotypes to immunological checkpoint inhibitors (P < .05). Our findings provide a novel insight into the immune‐related state of LUAD and can identify the patients who will be receptive to suitable immunotherapeutic treatments.
Efficacy of combined bland embolization and chemoembolization for huge (≥10 cm) hepatocellular carcinoma

Abstract Introduction To assess the efficacy of combined therapy involving bland transarterial embolization using gelatin sponge particles (bland GS-TAE) followed by transarterial chemoembolization using lipiodol mixed with anticancer agents and GS particles (Lip-TACE) to reduce the adverse events and increase the therapeutic effect of Lip-TACE in the treatment of huge (≥10 cm) hepatocellular carcinoma (HCC). Material and methods Twenty-one consecutive patients with huge HCCs (≥10 cm in diameter) were enrolled in this study. First, bland GS-TAE was performed to reduce the tumor volume, and then Lip-TACE was performed to control the remaining tumor at intervals of around three weeks. Tumor response, survival, and adverse events of this combined therapy were assessed. Results The tumor response was assessed three months after combined TACE, with complete response in 38.1% and partial response in 57.1% of cases. Severe adverse events were seen in two patients, acute cholecystitis and tumor rupture. The median survival time was 2.7 years, and the one-, two-, three-, and five-year overall survival rates were 76.2%, 66.7%, 42.9%, and 25.0%, respectively. Conclusion Combined therapy involving bland GS-TAE followed by Lip-TACE can be performed safety and may improve survival in patients with huge HCCs.