bluuebunny/crossref_metadata_2025 huggingface dataset:
The Charlotte large artery occlusion endovascular therapy outcome score predicts outcome after basilar artery thrombectomy
Authors: Karamchandani Rahul R. , Satyanarayana Sagar , Yang Hongmei , Defilipp Gary , Strong Dale , Rhoten Jeremy B. , Patel Nikhil M. , Asimos Andrew W.
Published: August 2022

Background and Purpose

The Charlotte Large artery occlusion Endovascular therapy Outcome Score (CLEOS) and Totaled Health Risks in Vascular Events (THRIVE) predict functional outcomes after anterior circulation endovascular thrombectomy (EVT). We evaluated the performance of CLEOS and THRIVE in patients presenting with an acute basilar artery occlusion (BAO) treated with EVT.

Methods

We conducted a retrospective analysis of a health system's stroke registry. Patients presenting with an acute BAO treated with EVT and evaluated with pre‐thrombectomy CT perfusion (CTP) from January 2017 to December 2021 were included. CLEOS = (5 × age) + (10 × National Institutes of Health Stroke Scale [NIHSS]) + Glucose – (150 × CTP cerebral blood volume index) and THRIVE (0‐9 points) = age 60‐79 years, 1 point; age ≥ 80 years, 2 points; NIHSS 11‐20, 2 points; NIHSS ≥ 21, 4 points; hypertension, diabetes mellitus, atrial fibrillation, 1 point each. Multivariable logistic regression was performed for the ability of CLEOS and THRIVE to predict the primary outcome, modified Rankin Scale score 3‐6.

Results

Fifty‐seven patients had mean age 66.6 (± 14.9) years and median NIHSS 15.5 (5‐24). In the multivariable regression analysis, increased CLEOS was associated with significantly higher odds of a poor functional outcome (odds ratio [OR] = 1.0011, 95% confidence interval [CI]: 1.0003‐1.0019, p = .008), whereas THRIVE was not (OR = 1.0326, 95% CI: 0.9478‐1.1250, p = .466). CLEOS > 503 best predicted poor outcomes.

Conclusions

A higher CLEOS score was associated with elevated odds of a poor 90‐day functional outcome in our cohort of acute BAO patients treated with EVT.
Genetic variation and clonal diversity in floating aquatic plants: Comparative genomic analysis of water hyacinth species in their native range
Authors: da Cunha Nicolay Leme , Xue Haoran , Wright Stephen I. , Barrett Spencer C. H.
Published: August 2022

Many eukaryotic organisms reproduce by sexual and asexual reproduction. Genetic diversity in populations can be strongly dependent on the relative importance of these two reproductive modes. Here, we compare the amounts and patterns of genetic diversity in related water hyacinths that differ in their propensity for clonal propagation – highly clonal Eichhornia crassipes and moderately clonal E. azurea (Pontederiaceae). Our comparisons involved genotype‐by‐sequencing (GBS) of 137 E. crassipes ramets from 60 locations (193,495 nucleotide sites) and 118 E. azurea ramets from 53 locations (198,343 nucleotide sites) among six hydrological basins in central South America, the native range of both species. We predicted that because of more prolific clonal propagation, E. crassipes would exhibit lower clonal diversity than E. azurea. This prediction was supported by all measures of clonal diversity that we examined. Eichhornia crassipes also had a larger excess of heterozygotes at variant sites, another signature of clonality. However, genome‐wide heterozygosity was not significantly different between the species. Eichhornia crassipes had weaker spatial genetic structure and lower levels of differentiation among hydrological basins than E. azurea, probably because of higher clonality and more extensive dispersal of its free‐floating life form. Our findings for E. crassipes contrast with earlier studies from the invasive range which have reported very low levels of clonal diversity and extensive geographic areas of genetic uniformity.
Polygenic adaptation contributes to the invasive success of the Colorado potato beetle
Authors: Yang Fangyuan , Crossley Michael S. , Schrader Lukas , Dubovskiy Ivan M. , Wei Shu‐Jun , Zhang Runzhi
Published: August 2022

How invasive species cope with novel selective pressures with limited genetic variation is a fundamental question in molecular ecology. Several mechanisms have been proposed, but they can lack generality. Here, we addressed an alternative solution, polygenic adaptation, wherein traits that arise from multiple combinations of loci may be less sensitive to loss of variation during invasion. We tested the polygenic signal of environmental adaptation of Colorado potato beetle (CPB) introduced in Eurasia. Population genomic analyses showed declining genetic diversity in the eastward expansion of Eurasian populations, and weak population genetic structure (except for the invasion fronts in Asia). Demographic history showed that all populations shared a strong bottleneck about 100 years ago when CPB was introduced to Europe. Genome scans revealed a suite of genes involved in activity regulation functions that are plausibly related to cold stress, including some well‐founded functions (e.g., the activity of phosphodiesterase, the G‐protein regulator) and discrete functions. Such polygenic architecture supports the hypothesis that polygenic adaptation and potentially genetic redundancy can fuel the adaptation of CPB despite strong genetic depletion, thus representing a promising general mechanism for resolving the genetic paradox of invasion. More broadly, most complex traits based on polygenes may be less sensitive to invasive bottlenecks, thus ensuring the evolutionary success of invasive species in novel environments.
Cervical Anatomical Landmarks Indicate the Amount of Vertebra Resection during ACAF Surgery: A Semi‐Quantitative Anatomical Parameter Study on Imaging Data
Authors: Pang Qingyang , Ling Shiyong , Zhang Bin , Zhu Jian , Sun Jingchuan
Published: August 2022

Objective

With the innovation and development of cervical spine surgical procedures, there is currently a lack of new and reliable data on cervical anatomical landmarks. The purpose of this study is to measure the CT data of the cervical vertebrae of healthy volunteers, so as to make up for the missing part of the measured value of cervical vertebra bone markers, and provide data support for the safety and accuracy of anterior controllable antedisplacement and fusion (ACAF) surgery.

Methods

From January 2019 to January 2020, the cervical computed tomography (CT) scan image data of volunteers in Changhai Hospital and Zhabei Hospital were randomly selected. The radiological parameters included three parameters were measured in the upper lamina plane. a: the distance from the anterior edge of the vertebral body to the anterior edge of the bilateral uncinate joint; c1: the sagittal diameter of the vertebral body; and d: the distance between the anterior edge of the uncinate joint. Three parameters were measured in the pedicle plane. b: the vertical distance from the anterior edge of the vertebral body to the junction line between the two lateral processes; c2: the sagittal diameter of the vertebral body; e: the transverse diameter of the vertebral body; and f: the sagittal diameter of the vertebral canal. The correlation ratios were calculated: a/c1, b/c2, a/f, b/f, d/e. The data between the two groups were compared by independent sample t‐test.

Results

Finally, 51 patients were included in this study, 18 males and 33 females, with an average age of 47.9 years (21–72 years). The maximum values of seven parameters measured were all at C7. The minimum b value was at C5, and the minimum f value was at C4. The minimum values of the other five parameters were all at C3, and there was an increasing relationship from C3 to C7 (P < 0.05). There was significant difference between male and female with regard to c1, c2, e and d values (P < 0.05). No significant differences were observed between men and women regard to the ratio of related parameters (a/c1, b/c2, a/f, b/f, d/e).

Conclusions

Anatomical consideration of this area is useful to estimate amount of vertebral body resection when performing the bony cut made in ACAF surgery; however, pre‐operative examinations with appropriate radiographic analysis are also recommended.
eQTLs play critical roles in regulating gene expression and identifying key regulators in rice
Authors: Liu Chang , Zhu Xiya , Zhang Jin , Shen Meng , Chen Kai , Fu Xiangkui , Ma Lian , Liu Xuelin , Zhou Chang , Zhou Dao‐Xiu , Wang Gongwei
Published: August 2022

The regulation of gene expression plays an essential role in both the phenotype and adaptation of plants. Transcriptome sequencing enables simultaneous identification of exonic variants and quantification of gene expression. Here, we sequenced the leaf transcriptomes of 287 rice accessions from around the world and obtained a total of 177 853 high‐quality single nucleotide polymorphisms after filtering. Genome‐wide association study identified 44 354 expression quantitative trait loci (eQTLs), which regulate the expression of 13 201 genes, as well as 17 local eQTL hotspots and 96 distant eQTL hotspots. Furthermore, a transcriptome‐wide association study screened 21 candidate genes for starch content in the flag leaves at the heading stage. HS002 was identified as a significant distant eQTL hotspot with five downstream genes enriched for diterpene antitoxin synthesis. Co‐expression analysis, eQTL analysis, and linkage mapping together demonstrated that bHLH026 acts as a key regulator to activate the expression of downstream genes. The transgenic assay revealed that bHLH026 is an important regulator of diterpenoid antitoxin synthesis and enhances the disease resistance of rice. These findings improve our knowledge of the regulatory mechanisms of gene expression variation and complex regulatory networks of the rice genome and will facilitate genetic improvement of cultivated rice varieties.
The mycorrhizal symbiosis alters the plant defence strategy in a model legume plant
Authors: Zeng Ming , Hause Bettina , van Dam Nicole M. , Uthe Henriette , Hoffmann Petra , Krajinski Franziska , Martínez‐Medina Ainhoa
Published: August 2022

Arbuscular mycorrhizal (AM) symbiosis modulates plant‐herbivore interactions. Still, how it shapes the overall plant defence strategy and the mechanisms involved remain unclear. We investigated how AM symbiosis simultaneously modulates plant resistance and tolerance to a shoot herbivore, and explored the underlying mechanisms. Bioassays with Medicago truncatula plants were used to study the effect of the AM fungus Rhizophagus irregularis on plant resistance and tolerance to Spodoptera exigua herbivory. By performing molecular and chemical analyses, we assessed the impact of AM symbiosis on herbivore‐triggered phosphate (Pi)‐ and jasmonate (JA)‐related responses. Upon herbivory, AM symbiosis led to an increased leaf Pi content by boosting the mycorrhizal Pi‐uptake pathway. This enhanced both plant tolerance and herbivore performance. AM symbiosis counteracted the herbivore‐triggered JA burst, reducing plant resistance. To disentangle the role of the mycorrhizal Pi‐uptake pathway in the plant's response to herbivory, we used the mutant line ha1‐2, impaired in the H+‐ATPase gene HA1, which is essential for Pi‐uptake via the mycorrhizal pathway. We found that mycorrhiza‐triggered enhancement of herbivore performance was compromised in ha1‐2 plants. AM symbiosis thus affects the defence pattern of M. truncatula by altering resistance and tolerance simultaneously. We propose that the mycorrhizal Pi‐uptake pathway is involved in the modulation of the plant defence strategy.
The novel HLA‐DQB1*03:493 allele, the first with glutamic acid at position—10 in the leader peptide
Authors: Niño Ramírez Jairo Eduardo , Gil Etayo Francisco Javier , Vicente Parra Ariadna , García Sanz Ramón , Tejeda Velarde Amalia
Published: August 2022

A nonsynonymous nucleotide substitution in exon 1 results in the novel HLA‐DQB1*03:493 allele.
2,4‐dinitroanisole transformation during advanced oxidation with ultraviolet light emitting diodes and hydrogen peroxide
Authors: Burdsall Adam C. , Schober Jaya Das , Stubbs John E. , Agrawal Abinash , Harper Willie F.
Published: August 2022

This study investigated the kinetics and reaction mechanisms associated with advanced oxidation of 2,4‐dinitroanisole (DNAN) with light emitting diodes (LEDs) in the UV/H2O2 process. The pseudo first‐order reaction rate constants for DNAN oxidation depended on the H2O2/DNAN molar ratio and were between 0.017 and 0.026 min−1. Hydroxyl radical scavenging was strongly implicated by the experimental results. High mass spectrophotometric chromatograms showed the presence of several by‐products, including three with ecotoxicity that is greater than that of DNAN. Transformation pathways were analysed using Density Functional Theory (DFT), which helped to predict the presence of experimentally detected DNAN by‐products by considering Mulliken charges. This study is the first to elucidate DNAN transformation mechanisms using both experimental studies and computational chemistry.
Neumonitis por metotrexato en artritis reumatoidea: presentación de un caso
Authors: Herrera Céspedes Cristhian Emilio , González Avilés Catalina , García Morales Olga Milena , Prieto Campos Pierangely
Published: August 2022

El metotrexato (MTX) es un agente inmunomodulador utilizado como modificador de las enfermedades reumatológicas. Puede tener efectos tóxicos, sobre todo a nivel hematológico y cutáneo, e hipersensibilidad, que incluye la afectación en órganos como el pulmón, en forma de neumonitis. El artículo presenta el caso clínico de una mujer de 51 años con artritis reumatoide, quien presentó una neumonitis inducida por metotrexato con posterior mejoría de su estado clínico tras el retiro del medicamento e inicio de terapia con corticoesteroides. La neumonitis por metotrexato, por su baja frecuencia, debe considerarse un diagnóstico de exclusión, dada la similitud del cuadro clínico con entidades más comunes como enfermedades pulmonares infecciosas, inflamatorias y trastornos autoinmunes.
New insights on carbon black suspension rheology—Anisotropic thixotropy and antithixotropy
Authors: Wang Yilin , Ewoldt Randy H.
Published: August 2022

We report a detailed experimental study of peculiar thixotropic dynamics of carbon black (CB, Vulcan XC-72) suspensions in mineral oil, specifically the observation of sequential stress increase then decrease at a fixed shear rate in a step-down test. We verify that such dynamics, though peculiar, come from a true material response rather than experimental artifacts. We also reveal how this long-time stress decay is associated with antithixotropic structural change rather than viscoelastic stress relaxation by using orthogonal superposition (OSP) rheometry to probe viscoelastic moduli during the step-down tests. The orthogonal storage and loss moduli are present, showing this two-timescale recovery then decay response, which demonstrates that this response is antithixotropic, and it involves shear-induced structuring. We further show a mechanical anisotropy in the CB suspension under shear using OSP. Based on the rheological results, a microstructural schematic is proposed, considering qualitatively thixotropic structure build-up, antithixotropic densification, and anisotropic structure evolution. Our observation for these CB suspensions is outside the standard paradigm of thixotropic structure-parameter models, and the elastic response provides us with new insight into the transient dynamics of CB suspensions.
Forced microrheology of active colloids
Authors: Peng Zhiwei , Brady John F.
Published: August 2022

Particle-tracking microrheology of dilute active (self-propelled) colloidal suspensions is studied by considering the external force required to maintain the steady motion of an immersed constant-velocity colloidal probe. If the probe speed is zero, the suspension microstructure is isotropic but exhibits a boundary accumulation of active bath particles at contact due to their self-propulsion. As the probe moves through the suspension, the microstructure is distorted from the nonequilibrium isotropic state, which allows us to define a microviscosity for the suspension using the Stokes drag law. For a slow probe, we show that active suspensions exhibit a swim-thinning behavior in which their microviscosity is gradually lowered from that of passive suspensions as the swim speed increases. When the probe speed is fast, the suspension activity is obscured by the rapid advection of the probe and the measured microviscosity is indistinguishable from that of passive suspensions. Generally for finite activity, the suspension exhibits a velocity-thinning behavior—though with a zero-velocity plateau lower than passive suspensions—as a function of the probe speed. These behaviors originate from the interplay between the suspension activity and the hard-sphere excluded-volume interaction between the probe and a bath particle.
Effect of the GERAS DANcing for Cognition and Exercise Program on Physical Function in Older Adults
Authors: Kennedy Courtney C. , Hewston Patricia , Ioannidis George , Egbujie Bonaventure , Marr Sharon , Negm Ahmed , Lee Justin , Hladysh Genevieve , Sztramko Richard , Woo Tricia , Misiaszek Brian , Patterson Christopher , Papaioannou Alexandra
Published: August 2022

GERAS DANcing for Cognition and Exercise is a therapeutic dance program for older adults with cognitive or mobility impairments. Using a pre-/posttest study design, we investigated the effect of 12 weeks of dance on the short performance physical battery (SPPB). In 107 participants aged 61–93 (mean 76.1, SD = 7.0; 20% men), over 90% had multifrailty and/or cognitive impairment. The mean attendance rate was 18/24 classes (75%). A substantial minimal clinically important difference (>0.4) occurred for SPPB total (+0.53, SD = 2.04, p = .002) and chair stands (+0.45, SD = 0.92, p < .001). Individuals with baseline SPPB ≤8 points (n = 38)—indicative of sarcopenia and physical frailty—had the most marked improvement (SPPB total: +1.45, SD = 1.97, p < .001; balance: +0.65, SD = 1.27, p = .006; chair stands: +0.68, SD = 0.97, p < .001). GERAS DANcing for Cognition and Exercise may be a promising rehabilitation intervention to improve daily physical function.
Correlates of Physical Activity Among Adults in Botswana: Sociodemographic Factors, Health Status, and Body Image
Authors: Malete Leapetswe , Ricketts Chelsi , Chen Sisi , Jackson Jose
Published: August 2022

Background: Growing evidence of lower physical activity (PA), higher sedentary behavior, and prevalence of overweight and obesity in African countries calls for more research on PA behavior and its various correlates in this context. This study examined the proportion of adults meeting World Health Organization PA guidelines from 3 urban regions of Botswana, as well as the relationship among sociodemographic factors, body image, and participation in moderate to vigorous PA. Methods: Using a 2-stage stratified cluster sampling approach, cross-sectional data were collected from 699 participants (females = 66%; M = 32.60 y; SD = 11.96). Results: Overall, 45.8% of participants met World Health Organization PA guidelines. Censored regression analyses indicated that females (B = −221.573, P < .001), and individuals from middle- (B = −331.913, P < .001), and high-income (B = −165.185, P = .036) households spent significantly less minutes in moderate to vigorous PA per week. Evaluative (B = −333.200, P < .001) and affective (B = −158.753, P = .038) components of body image were associated with significantly less minutes spent in moderate to vigorous PA per week. Conclusions: A systematic approach to PA promotion that targets females, middle- to high-income groups, and individuals experiencing body image concerns is needed.
Using a cognitive network model of moral and social beliefs to explain belief change
Authors: Dalege Jonas , van der Does Tamara
Published: August 2022

Skepticism toward childhood vaccines and genetically modified food has grown despite scientific evidence of their safety. Beliefs about scientific issues are difficult to change because they are entrenched within many interrelated moral concerns and beliefs about what others think. We propose a cognitive network model that estimates network ties between all interrelated beliefs to calculate the overall dissonance and interdependence. Using a probabilistic nationally representative longitudinal study, we test whether our model can be used to predict belief change and find support for our model’s predictions: High network dissonance predicts subsequent belief change, and people are driven toward lower network dissonance. We show the advantages of measuring dissonance using the belief network structure compared to traditional measures. This study is the first to combine a unifying predictive model with an experimental intervention and to shed light on the dynamics of dissonance reduction leading to belief change.
Proteomic profiling platforms head to head: Leveraging genetics and clinical traits to compare aptamer- and antibody-based methods
Authors: Katz Daniel H. , Robbins Jeremy M. , Deng Shuliang , Tahir Usman A. , Bick Alexander G. , Pampana Akhil , Yu Zhi , Ngo Debby , Benson Mark D. , Chen Zsu-Zsu , Cruz Daniel E. , Shen Dongxiao , Gao Yan , Bouchard Claude , Sarzynski Mark A. , Correa Adolfo , Natarajan Pradeep , Wilson James G. , Gerszten Robert E.
Published: August 2022

High-throughput proteomic profiling using antibody or aptamer-based affinity reagents is used increasingly in human studies. However, direct analyses to address the relative strengths and weaknesses of these platforms are lacking. We assessed findings from the SomaScan1.3K (
N
= 1301 reagents), the SomaScan5K platform (
N
= 4979 reagents), and the Olink Explore (
N
= 1472 reagents) profiling techniques in 568 adults from the Jackson Heart Study and 219 participants in the HERITAGE Family Study across four performance domains: precision, accuracy, analytic breadth, and phenotypic associations leveraging detailed clinical phenotyping and genetic data. Across these studies, we show evidence supporting more reliable protein target specificity and a higher number of phenotypic associations for the Olink platform, while the Soma platforms benefit from greater measurement precision and analytic breadth across the proteome.
A highly selective JAK3 inhibitor is developed for treating rheumatoid arthritis by suppressing γc cytokine–related JAK-STAT signal
Authors: Chen Chengjuan , Yin Yuan , Shi Gaona , Zhou Yu , Shao Shuai , Wei Yazi , Wu Lei , Zhang Dayong , Sun Lan , Zhang Tiantai
Published: August 2022

Janus kinases (JAKs) play a critical role in immune responses by relaying signals from more than 50 cytokines, making them attractive therapeutic targets for autoimmune diseases. Although approved JAK inhibitors have demonstrated clinical efficacy, they target a broad spectrum of cytokines, which results in side effects. Therefore, next-generation inhibitors maintain efficacy, while sparing adverse events need to be developed. Among members of the JAK family, JAK3 only regulates a narrow spectrum of γc cytokines and becomes a potentially ideal target. Here, a highly JAK3-selective inhibitor Z583 is developed, which showed a potent inhibition of JAK3 with an IC
50
of 0.1 nM and exhibited a 4500-fold selectivity for JAK3 than other JAK subtypes. Furthermore, Z583 completely inhibited the γc cytokine signaling and sufficiently blocked the development of inflammatory response in RA model, while sparing hematopoiesis. Collectively, the highly selective JAK3 inhibitor Z583 is a promising candidate with significant therapeutic potential for autoimmune diseases.
Successive climate crises in the deep past drove the early evolution and radiation of reptiles
Authors: Simões Tiago R. , Kammerer Christian F. , Caldwell Michael W. , Pierce Stephanie E.
Published: August 2022

Climate change–induced mass extinctions provide unique opportunities to explore the impacts of global environmental disturbances on organismal evolution. However, their influence on terrestrial ecosystems remains poorly understood. Here, we provide a new time tree for the early evolution of reptiles and their closest relatives to reconstruct how the Permian-Triassic climatic crises shaped their long-term evolutionary trajectory. By combining rates of phenotypic evolution, mode of selection, body size, and global temperature data, we reveal an intimate association between reptile evolutionary dynamics and climate change in the deep past. We show that the origin and phenotypic radiation of reptiles was not solely driven by ecological opportunity following the end-Permian extinction as previously thought but also the result of multiple adaptive responses to climatic shifts spanning 57 million years.
Relationship of organic carbon deposition in the Monterey Formation to the Monterey excursion event based on an updated chronostratigraphic framework of the Naples Beach section, California
Authors: Blake Gregg H.
Published: August 2022

The Monterey Formation, consisting of siliceous and calcareous biogenic sediments, was deposited during the transition from a relatively warm greenhouse climate in the early Miocene to the cooler temperatures of icehouse climatic conditions during the early middle to late Miocene. This cooling event was associated with global paleoclimatic and oceanic changes assumed to be related to the deposition of organic carbon–rich sediments into the marginal basins of California.

This chapter introduces an age model for the Miocene strata at Naples Beach based on a composite stratigraphic section and standardized data set, providing the framework for the integration of biostratigraphic zones with a series of astronomically tuned siliceous and calcareous microfossil bioevents, an updated strontium isotope stratigraphy, new tephrochronology ages, and ages from specific magnetostratigraphic units. This multidisciplinary approach, utilizing the integration of microfossil disciplines with independent age controls, is critical to obtaining an age resolution of ~200 k.y. for the majority of the Monterey Formation section.

This chronostratigraphic framework improves the age control of the boundaries between the California benthic foraminiferal stages and provides more age refinement for the possible hiatus and condensed interval within the Carbonaceous Marl member of the Monterey Formation. The recalibrated ages for the tops of the Miocene benthic foraminiferal stages are Saucesian (ca. 17.4 Ma), Relizian (15.9 Ma), Luisian (13.1 Ma), and Mohnian (7.7 Ma). Also, the time missing in the hiatus between the Luisian and Mohnian is <200 k.y., and the duration of the condensed interval is from 13.0 to 11 Ma.

This refined age model provides a correlation of the organic carbon–rich intervals occurring in the Luisian and lower Mohnian stages within the Naples Beach strata to the deep-sea δ13C maxima events CM5 (ca. 14.7 Ma) and CM6 (ca. 13.6 Ma), suggesting episodic increases in organic carbon deposition along the continental margins coincided with the Miocene carbon isotope excursion found in deep-sea cores. The transition from the Miocene climatic optimum to the icehouse world consisted of four climatic and oceanic phases (from ca. 17.5 to ca. 7 Ma), which are represented in the onshore section by variations in the organic carbon and phosphate contents, the occurrence of calcareous and siliceous lithologic facies, and the distribution of microfossils, especially changes in the benthic foraminiferal assemblages.
Pellucid marginal corneal degeneration in a teenager
Authors: Nelapatla Gopikrishna I , Chaurasia Sunita
Published: August 2022

A teenage boy presented to the clinic complaining of poor vision in both eyes. His best-corrected visual acuity was 20/25. The slit lamp examination revealed vertically oval corneas, crescentic peripheral inferior corneal thinning and ectasia in both eyes. Corneal topography showed against-the-rule astigmatism with mean keratometry (Km) of 45.1 and 45.2 dioptres in the right and left eyes, respectively. High-resolution optical coherence tomography corroborated the clinical findings, and the patient was diagnosed with pellucid marginal corneal degeneration (PMD). Collagen cross-linking was performed in the right eye. Left eye cross-linking is awaited. Although PMD is typically seen in middle-aged (third-fourth decade) patients, it can also occur at earlier ages. Collagen cross-linking can be considered to prevent the progression of the condition.
Transconduit approach for pulmonary vein stenting in an extracardiac Fontan and plastic bronchitis case
Authors: Matsuo Kumiyo , Hirose Masaki , Aoki Hisaaki , Kayatani Futoshi
Published: August 2022

Plastic bronchitis (PB) is a rare but severe complication in patients following the Fontan operation, the final palliative procedure for single ventricle heart disease. PB is characterised by the formation of rubbery casts of the tracheobronchial tree that may cause cough, wheezing, dyspnoea and hypoxia. Progressive airway obstruction may lead to asphyxia and death, and the overall mortality rate is 15.2%. Most patients receive a combination therapy from three different treatment strategies, that is, therapy for relief of airway obstruction, anti-inflammatory treatment and treatment to improve haemodynamics of the Fontan physiology. Therapy improving haemodynamics consists of optimising the Fontan circulation or cardiac function, antiarrhythmic therapy, inhibition of lymph leakage/production, decompression of the Fontan circulation and heart transplantation.

We present the case of a child with PB after extracardiac Fontan operation, who was refractory to balloon angioplasty and surgical release for pulmonary vein (PV) stenosis. We decided to perform stent implantation for the right PVs through transconduit puncture instead of fenestration because the position of fenestration was too high to access the PVs. After PV stenting via the transconduit approach, she experienced improvement in cough, wheezing and breathlessness, and a significant reduction in airway cast formation.
Hypercalcaemia as the initial presentation of Graves’ disease
Authors: Kaur Kirandeep , Batra Nisha , Kadian Kavita , Sridharan Kalyani
Published: August 2022

Hypercalcaemia in patients with hyperthyroidism is usually asymptomatic. It occurs due to increased bone turnover and demineralisation. There are only a few case reports where symptomatic hypercalcaemia was the presenting complaint of hyperthyroidism. An Asian man in his 40s presented to us with intractable vomiting for the last 6 months which was not controlled despite multiple antiemetic medications. On routine biochemistry performed at our institute, he was found to have hypercalcaemia and concomitant hyperthyroidism. Classical symptoms suggestive of hyperthyroidism were not present in our patient thus delaying the diagnosis. His symptoms resolved after the correction of hypercalcaemia. Hypercalcaemia did not recur after achieving an euthyroid status on treatment with carbimazole. Other common and more sinister causes for hypercalcaemia like malignancy were ruled out. This case highlights that symptomatic hypercalcaemia could be the initial presentation of hyperthyroidism and amelioration of hyperthyroidism corrects the hypercalcaemia.
Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 8, cohort analysis of the relationship between intraoperative complications of cataract surgery and axial length
Authors: Day Alexander C , Norridge Charlotte F E , Donachie Paul H J , Barnes Beth , Sparrow John M
Published: August 2022

Objectives

To describe the relationships between axial length and intraoperative complications in patients undergoing cataract surgery.

Design

Cohort analysis of the Royal College of Ophthalmologists’ National Ophthalmology Database (RCOphth NOD).

Setting

110 National Health Service Trusts in England, Health Boards in Wales, Independent Sector Treatment Centres and Guernsey.

Participants

820 354 patients, aged 18 years or older, undergoing cataract surgery. Eligible operations were those from centres with at least 50 operations with a recorded axial length measurement and age at surgery between 1 April 2010 and 31 August 2019.

Interventions

Phacoemulsification where the primary intention was cataract surgery alone.

Outcome measures

Posterior capsule rupture (PCR) and other recorded intraoperative complications.

Results

1 211 520 eligible operations were performed by 3210 surgeons. The baseline axial length was <21 mm (short eyes) for 17 170 (1.4%) eyes, 21–28 mm (medium eyes) for 1 182 513 (97.6%) eyes and >28 mm (long eyes) for 11 837 (1.0%) eyes. The median age at surgery was younger for patients with long eyes than those with short or medium eyes. The rate of any intraoperative complication was higher for short eyes than medium or long with complication rates of 4.5%, 2.9% and 3.3%, respectively (p<0.001). PCR occurred in 1.40% surgeries overall, and in 1.53%, 1.40% and 1.61% of short, medium and long eyes, respectively (p=0.043, not significant at the 1% level).

Conclusions

Overall PCR rates for cataract surgery in RCOphth NOD contributing centres are lower than previously reported and there is little change in PCR rates by axial length. Short eyes were more likely to have an intraoperative complication than medium or long eyes.
Socioeconomic inequalities in health status and survival: a cohort study in Rome
Authors: Dei Bardi Luca , Calandrini Enrico , Bargagli Anna Maria , Egidi Viviana , Davoli Marina , Agabiti Nera , Cesaroni Giulia
Published: August 2022

Objectives

To analyse the association between individual and contextual socioeconomic position (SEP) with health status and to investigate the role of SEP and baseline health status on survival.

Design

Cross-sectional and cohort study.

Setting

Rome, Italy.

Participants, primary and secondary outcomes

We selected the 25–99 year-olds included in the Rome 2011 census cohort. As a measure of health status on the census reference date (09 October 2011), we used the presence of chronic or rare conditions from the Disease-Related Co-payment Exemption Registry, a database implemented to provide free care to people with chronic or rare diseases. We used logistic regression to analyse the association between both individual (educational attainment) and contextual SEP (neighbourhood real estate price quintiles) with baseline health status. We analysed the role of SEP and the presence of chronic or rare conditions on 5-year survival (until 31 December 2016) using accelerated failure time models with Weibull distribution, reporting time ratios (TRs; 95% CI).

Results

In middle-aged, subjects with low SEP (either individual or contextual) had a prevalence of chronic conditions comparable with the prevalence in high SEP individuals 10 years older. Adjusted logistic models confirmed the direct association between SEP and baseline health status in both women and men. The lowest educated were up to 67% more likely to have a chronic condition than the highest educated, while the difference was up to 86% for lowest versus highest contextual SEP. Low SEP and the presence of chronic conditions were associated with shorter survival times in both sexes, lowest versus highest educated TR was TR=0.79 for women (95% CI: 0.77 to 0.81) and TR=0.71 for men (95% CI: 0.70 to 0.73). The contextual SEP shrunk survival times by about 10%.

Conclusion

Inequalities were present in both baseline health and survival. The association between SEP and survival was independent of baseline health status.
Benchmarking policy goals and actions for healthy food environments in Ethiopia to prevent malnutrition in all its forms using document analysis
Authors: Trübswasser Ursula , Candel Jeroen , Genye Tirsit , Bossuyt Anne , Holdsworth Michelle , Baye Kaleab , Talsma Elise
Published: August 2022

Objective

Unhealthy diets resulting in overweight and obesity and diet-related non-communicable diseases are of increasing concern in Ethiopia, alongside persistent undernutrition, and have been linked to unhealthy food environments. Little is known about the policy response to unhealthy food environments in Ethiopia. The objective of this study was to assess how different food environment domains have been addressed in Ethiopian policy goals and action over time and how this compares with global good practice benchmarks.

Setting

Ethiopia.

Primary and secondary outcome measures

We analysed intentions and plans of the government to act, using policy documents (outputs of decision-making in the form of published strategies, plans or policies) related to improving diets and nutritional status through healthy food environments in Ethiopia between 2008 and 2020. Our coding framework was guided by the policy component (n=7 domains) of the Healthy Food-Environment Policy Index, which was modified to include food quality and safety as an eighth domain.

Results

From the 127 policy outputs identified, 38 were retained, published by 9 different government ministries and institutions. Our results show that eight food environment domains have been addressed to some extent, but gaps remain compared with global best practice, especially in food promotion, processing, retail, price and trade. From 2018, policy began to embrace the wider food system, with more explicit food environment interventions becoming apparent.

Conclusions

Policy efforts achieved in food safety, food processing, marketing and labelling are important stepping stones to building future policy actions addressing the food environment domains of food retail, food provision and food trade. Benchmarking of food environment policy actions should also consider actions on food fortification, agro-processing and informal markets in the context of multiple forms of malnutrition.
Unequal impact of the COVID-19 pandemic in 2020 on life expectancy across urban areas in Chile: a cross-sectional demographic study
Authors: Mena Gonzalo , Aburto José Manuel
Published: August 2022

Objectives

To quantify the impact of the COVID-19 pandemic on life expectancy in Chile categorised by rural and urban areas, and to correlate life expectancy changes with socioeconomic factors at the municipal level.

Design

Retrospective cross-sectional demographic analysis using aggregated national all-cause death data stratified by year, sex and municipality during the period 2010–2020.

Setting and population

Chilean population by age, sex and municipality from 2002 to 2020.

Main outcome measures

Stratified mortality rates using a Bayesian methodology. These were based on vital and demographic statistics from the national institute of statistics and department of vital statistics of ministry of health. With this, we assessed the unequal impact of the pandemic in 2020 on life expectancy across Chilean municipalities for males and females and analysed previous mortality trends since 2010.

Results

Life expectancy declined for both males and females in 2020 compared with 2019. Urban areas were the most affected, with males losing 1.89 years and females 1.33 years. The strength of the decline in life expectancy correlated positively with indicators of social deprivation and poverty. Also, inequality in life expectancy between municipalities increased, largely due to excess mortality among the working-age population in socially disadvantaged municipalities.

Conclusions

Not only do people in poorer areas live shorter lives, they also have been substantially more affected by the COVID-19 pandemic, leading to increased population health inequalities. Quantifying the impact of the COVID-19 pandemic on life expectancy provides a more comprehensive picture of the toll.
Exploring non-linear relationships between neighbourhood walkability and health: a cross-sectional study among US primary care patients with chronic conditions
Authors: Bonnell Levi Nicolas , Troy Austin R , Littenberg Benjamin
Published: August 2022

Background

A recent study of licensed drivers found a non-linear relationship between density of non-residential destinations (NRDs), a proxy for walkability and body mass index (BMI) across a wide range of development patterns. It is unclear if this relationship can be replicated in a population with multiple chronic conditions or translated to health outcomes other than BMI.

Methods

We obtained health data and home addresses for 2405 adults with multiple chronic conditions from 44 primary care clinics across 13 states using the Integrating Behavioral health and Primary Care Trial. In this cross-sectional study, the relationships between density of NRDs (from a commercial database) within 1 km of the home address and self-reported BMI, and mental and physical health indices were assessed using several non-linear methods, including restricted cubic splines, LOWESS smoothing curves, non-parametric regression with a spline basis and piecewise linear regression.

Results

All methods demonstrated similar non-linear relationships. Piecewise linear regression was selected for ease of interpretation. BMI had a positive marginal rate of change below the NRD density inflection point of 15 establishments/hectare (β=+0.09 kg/m2/non-residential buildings ha-1; 95% CI +0.01 to +0.14), and a negative marginal rate of change above the inflection point (β=−0.02; 95% CI −0.06 to 0.02). Mental health decreased with NRD density below the inflection point (β=−0.24; 95% CI −0.31 to −0.17) and increased above it (β=+0.03; 95% CI −0.00 to +0.07). Results were similar for physical health (β= −0.28; 95% CI −0.35 to −0.20) and (β=+0.06; 95% CI 0.01 to +0.10).

Conclusion

Health indicators were the lowest in middle density (typically suburban) areas and got progressively better moving in either direction from the peak. NRDs may affect health differently depending on home-address NRD density.

Trial registration number

NCT02868983.
Erlotinib plus bevacizumab versus erlotinib alone in patients withEGFR-positive advanced non-small-cell lung cancer: a systematic review and meta-analysis of randomised controlled trials
Authors: Deng Wusheng , Wang Ke , Jiang Yun , Li Dingbin , Bao Chongxi , Luo Jing , Liu Liuyuan , Huang Bing , Kong Jinliang
Published: August 2022

Objectives

Combination treatment with erlotinib plus bevacizumab has the potential to become a standard treatment regimen for patients with epidermal growth factor receptor mutation-positive (EGFRm+) advanced non-small cell lung cancer (NSCLC). This study aimed to investigate the efficacy and safety of erlotinib plus bevacizumab in patients withEGFRm+advanced NSCLC.

Design

Systematic review and meta-analysis.

Data sources

The PubMed, Embase, Web of Science and Cochrane Library databases were searched, from inception to 15 January 2022.

Eligibility criteria

We included randomised controlled trials (RCTs), reported in English, assessing the efficacy of erlotinib plus bevacizumab versus erlotinib monotherapy in patients withEGFRm+advanced NSCLC.

Data extraction and synthesis

The main objective was to assess overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and adverse events (AEs). Two independent reviewers extracted data and assessed the risk of bias. A random-effects model was used where there was evidence for homogeneous effects.

Results

Four RCTs (reported across six publications) were included in the meta-analysis, with a total of 775 patients included in the pooled analyses of PFS, OS and ORR (387 in the erlotinib plus bevacizumab intervention group and 388 in the erlotinib group). Compared with the erlotinib alone group, the erlotinib plus bevacizumab group achieved a significantly prolonged PFS (HR: 0.59; 95% CI 0.49 to 0.72; p<0.00001; I2=0%), but OS (HR: 0.95; 95% CI 0.78 to 1.15; p=0.59; I2=0%) and ORR (OR: 1.25; 95% CI 0.89 to 1.74; p=0.19; I2=0%) were not significantly prolonged. A total of 776 cases were used for a pooled analysis of AEs. Regarding AEs, combined treatment significantly increased the incidence of diarrhoea (51% vs 43%, 95% CI 1.03 to 1.38; p=0.006), haemorrhagic events (41% vs 20%, 95% CI 1.12 to 6.31; p=0.03), proteinuria (25% vs 3%, 95% CI 4.86 to 17.66; p<0.0001) and hypertension (40% vs 8%, 95% CI 3.66 to 7.88; p<0.0001).

Conclusions

Erlotinib plus bevacizumab for the treatment of patients withEGFRm+advanced NSCLC was associated with significantly prolonged PFS compared with erlotinib alone, but the combination did not prolong OS.
Implementation of a chest injury pathway in the emergency department
Authors: Dalla Vecchia Claudio , McDermott Cian , O'Keeffe Francis , Ramiah Vinny , Breslin Tomas
Published: August 2022

Rib fractures represent a substantial health burden. Chest injuries contribute to 25% of deaths after trauma and survivors can experience long-standing consequences, such as reduced functional capabilities and loss of employment. Over recent years, there has been an increase in the awareness of the importance of early identification, aggressive pain management and adequate safety netting for patients with chest injuries. Substandard management leads to increased rates of morbidity and mortality. The development of protocols in the emergency department (ED) for management of patients with chest wall injuries has demonstrated reduction of complication rates.

Our aim was to develop an evidence-based, multidisciplinary chest injury pathway for the management of patients presenting with rib injury to our ED.

Prior to implementation of the pathway in our department, only 39% of patients were documented as having received analgesia and only 7% of discharged patients had documented written verbal advice. There was no standardised method to perform regional anaesthetic blocks. Using quality improvement methods, we standardised imaging modality, risk stratification with a scoring system, analgesia with emphasis on regional anaesthesia blocks and disposition with information leaflets for those discharged.

Implementation of the pathway increased rates of documented analgesia received from 39% to 70%. The number of regional anaesthetic blocks performed went from 0% to 60% and the number of patients receiving discharge advice went from 7% to 70%. Compliance of doctors and nurses with the pathway was 63%.

Our previous audits showed substandard management of patients with chest injuries in our department. Through this quality improvement project, we were able to improve the quality of care provided to patients attending with rib fractures by increasing rate of analgesia received, regional blocks performed and discharge advice given.
Locked-in syndrome responding to endovascular treatment
Authors: Song Jiaxing , Huang Jiacheng , Li Linyu , Yang Jie , Yue Chengsong , Liu Shuai , Kong Weilin , Luo Xiaojun , Liao Jiasheng , Du Jie , Song Bo , Liu Jiazuo , Tian Xiaolong , Tan Xiaolin , Li Fengli , Zi Wenjie
Published: August 2022

Background

Locked-in syndrome (LiS) is a rare and devastating condition in patients with acute basilar artery occlusion. However, the benefits of endovascular treatment (EVT) for LiS remain unclear.

Objective

To assess the outcomes associated with EVT and identify the factors associated with outcomes of LiS.

Methods

We used the data of the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry (BASILAR) from 47 tertiary stroke centers in China. The included patients had LiS and received EVT or standard medical treatment (SMT) alone. The primary outcome was improvement in the modified Rankin Scale (mRS) score at 90 days.

Results

Among the 120 patients with LiS, 92 (76.7%) received EVT and 28 (23.3%) received SMT. Compared with SMT, EVT was associated with improved mRS score (common OR (cOR)=2.68 (95% CI 1.16 to 6.20); p=0.02) and decreased mortality (aOR=0.35 (95% CI 0.13 to 0.90); p=0.03). Moreover, the benefit of EVT for LiS was sustained for at least 1 year (p=0.008). Higher baseline posterior circulation Alberta Stroke Prognosis Early CT Score (pc-ASPECTS, aOR=2.04 (95% CI 1.34 to 3.10); p<0.001) and absence of pneumonia (aOR=0.26 (95% CI 0.08 to 0.90); p=0.03) were significantly associated with favorable functional outcome at 90 days in patients who received EVT, while lower pc-ASPECTS (aOR=0.52 (95% CI 0.36 to 0.76); p<0.001) was associated with increased 90-day mortality.

Conclusions

This study found that EVT was associated with favorable functional outcomes and decreased mortality among patients with LiS. Baseline pc-ASPECTS and pneumonia were independent predictors of outcomes.