bluuebunny/crossref_metadata_2025 huggingface dataset:
C81. Pulse Dose Corticosteroid Improves Clinical Outcome in Pulmonary Hypertension Patient: A Potential of Immense Affordability and Availability Medication in Suburban Area
Authors: Sudirman A R , Sitompul S I
Published: March 2023

Background

Pulmonary hypertension (PH) in adolescence is a devastating diagnosis with significant morbidity and mortality. Despite limited literature exists on treating PH with anti-inflammatory medications in humans, hereby we present the case of prednisolone induced clinical outcomes improvement in PH patient.

Case Summary

A 20-year-old woman presented with exertional dyspnea. Her past-two-years medical history was remarkable for tricuspid regurgitation with multiple readmission. Upon arrival, her saturation-75% and BP-110/60. She was in respiratory distress with JVP increased and high-pitched-holosystolic murmur. Laboratory studies was unremarkable. The x-ray revealed cardiomegaly and ECG showing RVH-RAE. Initial echocardiography demonstrated TR-Vmax 4.55m/s and PR-Vmax 3.62m/s. The RVSP estimated around 107mmHg, which was highly suggestive for PH. Due to the aggressive nature of the disease, her condition deteriorated despite management with IV-furosemide-(40mg/d), beta-blocker-(2.5mg/d), and sodium beraprost-(60µg/d). Following days, a 5-days pulse-dose-steroid (methylprednisolone) at 2mg/kg/day was administered. Her condition improved with saturation from 50% to 90% and significant reduced in dyspnea. The steroid was tapering down for another 7 days and she was discharged for further referral.

Discussion

Inflammation plays unequivocal role in the pathogenesis of PH, which was involved in the development of pulmonary vascular remodeling. The possible mechanism of prednisolone were related with the inhibition of platelet-derived growth factor (PDGF)-induced accelerated proliferation and migration of pulmonary artery smooth muscle cell, and prevented the activation of NF-κB, key transcription factor that controls inflammation, cell-proliferation, and apoptosis. Thus, given the ready availability and features of this medication compared with other PH-medication, we decided to utilize steroid in this patient.
C82. Rare electrocardiography findings of Wellen’s Type A evolving into Type B on late onset Myocardial Infarction: A Case Report
Authors: Achmad R M P , Madiastuti Septi , Nadia Ina , Widyantoro Bambang
Published: March 2023

Background

Wellens' Syndrome is a left anterior descending (LAD) coronary artery disease which first described in 1982 by de Zwaan et al. A byphasic T or deeply inverted T are the typical Wellen's electrocardiogram (ECG) changes which represent a critical stenosis. It may be presented without any typical symptoms, and normal or mildly elevated enzymes depends on its onset.

Case Summary

A 56-years-old male, admitted to ER with typical chest pain within 1 day. The first ECG showed byphasic T wave on V2 and V3, and an hour serial ECG showed a deeply inverted T wave on V2 and V3. Cardiac marker showed an elevated Troponin I levels of 1,590.6 ng/L. The patient was diagnosed with acute NSTEMI and underwent an early invasive strategy on the next day. Coronary angiography revealed total occlusion of the proximal LAD, and implantation of drug eluting stent was done accordingly. The patient remained symptoms-free after the procedure and discharged in stable condition.

Discussion

This patient suffering a left coronary total occlusion with no appearance of any ST-elevation on ECG. Therefore, a critical stenosis does not always came up with a typical ST-segment changes. Wellen’s type ECG showed how the T waves evolution would represent a critical stenosis. Early recognition of Wellen's typical ECG in this patient lead to early invasive strategy decision and later resulted a good outcome.
C83. Recurrent Syncope in Isolated Right Ventricular Non-Compaction Cardiomyopathy: A Case Report
Authors: Chandra S , Lukito A A , Hutabarat H , Fernandes R A P
Published: March 2023

Isolated right ventricular non-compaction cardiomyopathy (iRVNC) is a rare disease, and often under diagnosed. The patients might come with right heart failure, ventricular arrhythmias and systemic embolism. A 64 –yo female presented with episodes of recurrent syncope. There is thickened trabecular on apical right ventricular (RV), moderate tricuspid regurgitation and moderate probability of pulmonary hypertension on echocardiography. Furthermore, cardiac MRI on this patient confirned hypertrabeculated and dilatation of RV, spongiform appearance of the RV apical, non-compacted (NC) thickness of the RV was 23.5 mm at the apical level with compacted thickness (C) of 2 mm (NC to C ratio 11,7), hypertrophic moderator band, and dilatation RA and global hypokinetic and decreased function of RV. Hence, the diagnosis was an isolated right ventricular non-compaction cardiomyopathy, without LV involvement. The medication given including sildenafil, nebivolol, spironolactone, digoxin and edoxaban. Lesson learned from this case, syncope might be one of iRVNC symptoms. Multiple modalities could be needed for diagnostic confirmation for patients with syncope. Echocardiography as a diagnostic tool is useful to find prominent trabeculations and when NC/C ratio >2. If the echocardiographic findings were inconclusive, cardiac MRI was could be performed for better discrimination between compact and non-compact inner and outer layers of myocardium with NC/C ratio > 2,3.
C84. Resistent Hypertension in Young Patient, what has Been Missed? A Case Report of Coartation of the Aorta
Authors: Hartoko A , Sulastomo H
Published: March 2023

Background

In children and adolescent patient the most common cause hypertension is secondary due to renal disease. There are other cause of secondary hypertension including Coartation of the Aorta (CoA). Early diagnosis and prompt treatment are important for CoA, if left untreated CoA can causes ventricular hypertrophy, premature coronary artery disease and eventually heart failure.

Case Illustration

A 17 Years old patient with history of hypertension since the age of 12. He was suspected secondary hypertension due to renal disease and referred to pediatric nephrologist. Laboratory examination and CT angiography renal artery showed normal result. He was treated with multiple antihypertensive drugs, but remains hypertensive despite of medical therapy for 5 years.

He was referred to our hospital due to resistant hypertension. At physical examination this patient revealed blood pressure at upper 150/90 and lower extremities 100/60. Echocardiography examination and CT angiography showed Left Ventricle Hypertrophic (LVH) with coartation aorta located distal to left subclavian artery. Thoracic Endovascular Repair (TEVAR) was performed to dilated the coartation in this patient. Post TEVAR procedure peak systolic gradient reduced from 51 mmHg to 4 mmHg.

Discussion

CoA are one of the causes of secondary hypertension. Uncommonly resistant hypertension can occur in CoA. Early diagnosis and prompt treatment are important for CoA. In this patient the CoA already caused LVH, and if left untreated it can lead more severe complication such as heart failure, and premature coronary artery disease and death.
C85. Right heart failure due to chronic thromboembolic pulmonary hypertension in systemic lupus erythematosus patient: a case report
Authors: Saputra B M I , Darma K S S
Published: March 2023

Background

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with varying clinical manifestations and high risk of thrombosis. Chronic Thromboembolic Pulmonary Hypertension (CTEPH) as late complication of acute pulmonary embolic sometimes occured in SLE patients and in advanced condition it can manifest as right heart failure.

Case Summary

A female, 29 years old with complaints of bilateral ankle oedema and bloated stomach, as well as dyspneu on effort occurred progressively since approximately 4 months. These complaints were also accompanied by hair loss and redness on both cheeks. Physical examination revealed increased jugular venous pressure, systolic murmur in left lower sternal border, ascites, hepatomegaly, and bilateral ankle oedema. Echocardiography revealed dilated right atrium and right ventricle (RV), decreased RV systolic function, severe tricuspid regurgitation, and distended inferior vena cava. Computed tomography (CT) pulmonary angiography showed filling defect in the left pulmonary artery. Lab examination showed an increase in D-dimer, ANA titer >1: 1000, and lupus anticoagulant ratio 1.59. Diuretics therapy, anticoagulant, corticosteroid, and immunosuppressant were given to this patient. Right heart function was improved following the treatment.

Discussion

The increased risk of thrombosis in this case is related to several factors, including: antiphospholipid antibodies, inflammation and disease activity. CTEPH is formed as a result of poor resolution of the thrombus in the pulmonary arteries, resulting in fibrosis of residual thrombotic material that can impede blood flow. Increased intrapulmonary pressure due to pulmonary vascular obstruction causes RV remodeling and dysfunction.
C87. Serial Cases of Cardiovascular Manifestation on Leptospirosis: A Tales of Unfortunate Events
Authors: Ristiansah I H , Arifianto H , Irnizarifka  , Ahmad F , Kusumastuti F , Hafika A N , Myrtha R , Wulandari E L
Published: March 2023

Background

Leptospirosis is a zoonosis disease caused by Leptospira species. It's endemic and has become a major public health issue, especially in tropical regions. Clinical manifestation varies from mild or asymptomatic to severe multiple organ failure. We report cases of severe leptospirosis which complicates supraventricular tachycardia and myoperdicarditis from Universitas Sebelas Maret Academic Hospital.

Case Summary

The first case was a 44-year-old man referred from Internal Medicine Department with Leptospira infection with Weil’s disease. On 5th daycare, the patient was reporting had an episode of tachyarrhythmia, the ECG show SVT-AVNRT, there was no history of arrhythmic events before admitted to the hospital, the echocardiography was normal. The second case was a 67-year-old man who was referred from emergency department with shortness of breath, the ECG reveals diffuse ST-segment elevation in all limb and precordial leads with reciprocal ST-depression at aVR and V1, there was also downsloping of the PR and TP segment on precordial leads (Spodick’s sign), with normal ejection fraction on echocardiographic examination with pericardial thickening. Both patients have hsTroponin levels rose above the normal limit and serological testing found positive leptospira IgM.

Discussion

Severe leptospirosis can cause multi-organ dysfunction including cardiac involvement. The patients, in this case, suffered from leptospirosis with SVT-AVNRT and myopericarditis. The exact pathophysiology is still unclear, but there are several hypotheses, such as cytokine storms and direct damage from leptospira endotoxins. Arrhythmias and cardiac disturbance in leptospirosis patients are associated with poor outcomes and higher mortality rates.
C88. Sick sinus syndrome in acute anterior myocardial infarction: when culprit strategy ended up jeopardy
Authors: Nadia  , Fitra M
Published: March 2023

Background

Atrial arrhythmias occur in 10% of acute myocardial infarctions and increases incidence of death. Altered heart rhythm with brady-tachy episodes indicates sinus node dysfunction ordinarily cause by inferior myocardial infarction.

Case Description

A 66-year-old-man, diagnosed with 2 days onset Acute Anterior Myocardial Infarction with history of syncope after chest pain, referred with sinus arrest and junctional rhythm that changed into atrial fibrillation. During hospitalization the heart rhythm changing periodically from bradycardia to tachycardia repeatedly with witnessed new ST elevation in inferior lead before an episode of cardiac arrest. After primary PCI to the RCA as the new culprit lesion, chest pain was relieved but hemodynamic condition was not stable and the rhythm remained continuously altered.

Discussion

Sick sinus syndrome is a cardiac conduction disorder characterized by symptomatic dysfunction of the sinoatrial node generally manifests as sinus bradycardia, sinus arrest, or sinoatrial block, and accompanied by supraventricular tachyarrhythmias (tachy-brady syndrome). This case of acute myocardial infarction with 3 vessel diseased lesion and total occlusion in RCA affected sinoatrial node causing sick sinus syndrome. Recently multi-vessels PCI strategy increasingly recommended at the time of primary PCI for patient with arrhythmia.

Conclusion

A man 66 years old with acute anterior MI compelling with sick sinus syndrome on presentation because apparently the culprit lesion was RCA. Unfortunately, at that time non-IRA lesion were not opened and TPM was not available, bradycardia continues and the patient ended up being jeopardy.
C96. The First Percutaneous Transvenous Mitral Commissurotomy guided by Three Dimensional Transesophageal Echocardiography in Haji Adam Malik General Hospital Medan
Authors: Indra R K , Lubis A C , Ardini T W , Hasan H
Published: March 2023

Background

Percutaneous Transvenous Mitral Commissurotomy (PTMC) has become the treatment of choice for patients with mitral stenosis. PTMC guided by three-dimensional Transesophageal Echocardiography (3D-TEE) promise of greater safety and efficacy.

Case Summary

We report a 29-year-old woman who came to our outpatient clinic with shortness of breath as a chief complaint for the past three months. ECG depicted sinus rhythm. Transthoracic Echocardiography (TTE) and 3D-TEE showed severe mitral stenosis with MVA planimetry: 0.8 cm2, MV mean PG 12 mmHg, MV PHT 403 ms, Wilkins score was 4 and no thrombus was found. Therefore, we decided to do PTMC. We successfully done the antegrade transseptal puncture by fluoroscopy guided by two-dimensional (2D) TEE . Then, we used Inoue-balloon catheter No. 24 to dilate the mitral valve. Afterthat, we did 3D-TEE evaluation of the mitral valve area and it showed a significant improvement, with MVA 3D planimetry: 2.0 cm2 and MV mean PG: 4 mmHg and we found moderate mitral regurgitation (MR VC 0.4 cm, MR PISA: 0.3 cm), so we decided to end the procedure.

Discussion

In this case, the PTMC procedure was carried with 2D and 3D-TEE guiding, where process run more easily because interventionist can ensure the targeted site during transeptal puncture, navigation to the mitral valve and post inflation inspection. 3D-TEE guiding can also directly ensure the success of PTMC in real time by evaluating the MVA planimetry (pre and post PTMC) and the mitral regurgitation.
C100. Torsades de Pointes (Polymorphic VT) as a Manifestation in Hypothyroid Patient’s: A Case Report
Authors: Akina M T , Muzakkir A
Published: March 2023

Background

Hypothyroidism is a common endocrine disorder with varying abnormalities including cardiac manifestations consisting of structural, functional, and electrical conduction problems especially in severe cases. Torsades de pointes (TdP) is a very rare initial presentation in a patient with hypothyroidism. We report a patient with severe hypothyroidism manifest with life-threatening arrhythmias.

Case Description

A 48-year-old man who underwent emergency resuscitation suffering from cardiac arrest. On admission, the patient collapsed and was unresponsive. Electrocardiography (ECG) showed QT interval prolongation, and polymorphic ventricular tachycardia (TdP). Laboratory test revealed marked hypokalemia (potassium concentration of 2.6 mmol per liter) and unexpected severe hypothyroid (Free T4 (FT4) was <0.07 [normal 0.93-1.71] μg/dl; thyroid-stimulating hormone (TSH) was >60.0 [normal 0.27-4.20] mIU/mL). Temporary cardiac pacing was placed for managing specific arrhythmias. The patient was also treated with levothyroxine 100 μg per day, and the underlying electrolyte disturbance was corrected. Treatment with levothyroxine was continued in outpatient clinic. ECG and thyroid tests were returned to normal limit within six weeks.

Discussion

Clinicians need to highlight that TdP is relatively rare in hypothyroidism. Early diagnosis and prompt management were needed due to potential fatal cardiac manifestation if left untreated. All patients with overt hypothyroidism with TSH >10 mIU/L should be treated. Administration of levothyroxine is a mandatory treatment and should be monitored carefully and safely to eliminate arrhythmias.
C102. Transjugular venous access for permanent pacemaker as an approach when there was no other choice : A Case Report
Authors: Fathoni E , Rizal A
Published: March 2023

Background

When conventional veins are inaccessible, the transjugular Seldinger technique for permanent pacemaker (PPM) implantation could be used as the last resort.

Case Description

An 80-years-old woman had wound skin extrusion and infection at the site of left deltopectoral pocket of permanent pacemaker. After removing the PPM lead generator and debriding the wound, a single chamber PPM was implanted in right hemithorax after temporary pacemaker backup. There was no access in the left area and proximal vein stenosis was found following an early attempt to reach the right subclavian vein and cut-down surgical procedure. Other stenosis were also found at the upper right veins by venography. A single chamber PPM was implanted utilizing the Seldinger technique to puncture the internal jugular vein without surgical cut-down and dissection for tunneling the lead from right jugular area to deltopectoral pocket. Lead test came out acceptable: R wave of 12 mV, Slew >4 V/s current >25 mA, impedance 688 Ω and threshold of 0.87V. There were no pneumothorax and other complications followed.

Discussion

Venous occlusion could be found in patients undergoing pacemaker insertion. For some cases, the internal jugular vein works as an alternative access for PPM insertion without surgical cut down. Percutaneous access to the internal jugular vein is safer, and the risk of lead fractures is reduced.
C103. Viral Myocarditis Mimicking Acute Myocardial Infarction: A Case Report
Authors: Seriulina R A , Martanto E
Published: March 2023

Background

Acute myocarditis still challenging diagnosis in cardiology. Its entity is rarely recognized and its pathophysiology defectively understood. Viral infection remains the most commonly identified cause for myocarditis, but bacteria, fungi, protozoa, and helminths have also been implicated.

Case Summary

A 61 years old female was admitted to emergency department, complaining typical angina since 12 hours prior to admission. She also complains nausea, vomit, flu like syndrome, and low grade fever since 1 weeks prior to admission. She was a former smoker and had hypertension. ECG in 6 hours on admission ECG revealed sinus rhythm, ST-elevation anteroseptal, ischemic lateral-high lateral and there is no evolution compare to previous ECG which taken in other hospital. Laboratory findings showed increased of troponin enzyme. Coronary angiography was performed with result normal coroner. Echocardiography revealed normal all chambers, concentric LV remodelling, normal LV systolic function with ejection fraction 51% without regional wall motion abnormalities. On the next day, troponin levels decrease and the ECG remain abnormal without any changes. In order to get more data, CMR was planned, but she refused. Patients was discharged uneventful.

Discussion

Myocarditis is challenging diagnosis due to the heterogenicity clinical presentation. It presents in many different ways, ranging from mild “flu-like” symptoms, mild symptoms of chest pain and palpitations associated with transient ECG changes. Chest pain in acute myocarditis may mimic typical angina and be associated with electrocardiographic changes, including ST-segment elevation and often misdiagnosed as ACS until coronary angiography demonstrates normal or non-obstructive coronary arteries.
Time period effects in work disability due to common mental disorders among young employees in Sweden—a register-based cohort study across occupational classes and employment sectors
Authors: Amin Ridwanul , Mittendorfer-Rutz Ellenor , Björkenstam Emma , Virtanen Marianna , Helgesson Magnus , Gustafsson Niklas , Rahman Syed
Published: March 2023

Background

We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual).

Methods

Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19–29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573 516, 665 138 and 600 889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses.

Results

In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16–1.33 and 1.15, 1.08–1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34–1.76 and 3.64, 2.14–6.18, respectively).

Conclusions

Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.
Sex-specific transcription and DNA methylation landscapes of the Asian citrus psyllid, a vector of huanglongbing pathogens
Authors: Yu Xiudao , Marshall Hollie , Liu Yan , Xiong Yu , Zeng Xiangdong , Yu Haizhong , Chen Wei , Zhou Guchun , Zhu Bo , Ross Laura , Lu Zhanjun
Published: March 2023

The relationship of DNA methylation and sex-biased gene expression is of high interest, it allows research into mechanisms of sexual dimorphism and the development of potential novel strategies for insect pest control. The Asian citrus psyllid, Diaphorina citri Kuwayama, is a major vector for the causative agents of Huanglongbing (HLB), which presents an unparalleled challenge to citrus production worldwide. Here, we identify the X chromosome of D. citri and investigate differences in the transcription and DNA methylation landscapes between adult virgin males and females. We find a large number of male-biased genes on the autosomes and a depletion of such on the X chromosome. We have also characterized the methylome of D. citri, finding low genome-wide levels, which is unusual for an hemipteran species, as well as evidence for both promoter and TE methylation. Overall, DNA methylation profiles are similar between the sexes but with a small number of differentially methylated genes found to be involved in sex differentiation. There also appears to be no direct relationship between differential DNA methylation and differential gene expression. Our findings lay the groundwork for the development of novel epigenetic-based pest control methods, and given the similarity of the D. citri methylome to some other insect species, these methods could be applicable across agricultural insect pests.
Romboutsia lituseburensisJCM1404 supplementation ameliorated endothelial function via gut microbiota modulation and lipid metabolisms alterations in obese rats
Authors: Yin Honggang , Huang Junhao , Guo Xiaozheng , Xia Jingbo , Hu Min
Published: March 2023

Our previous study revealed moderate-intensity exercise improved endothelial function associated with decreasing Romboutsia in rats on a high-fat diet. However, whether Romboutsia influences endothelial function remains unclear. The aim of this study was to determine the effects of Romboutsia lituseburensis JCM1404 on the vascular endothelium of rats under standard diet (SD) or high-fat diet (HFD). Romboutsia lituseburensis JCM1404 had a better improvement effect on endothelial function under HFD groups, while no significant effect on small-intestinal and blood vessel morphology. HFD significantly decreased villus height of small intestine and increased outer diameter and media thickness of the vascular tissue. After the treatments by R. lituseburensis JCM1404, the expression of claudin5 was increased in the HFD groups. Romboutsia lituseburensis JCM1404 was found to increase alpha diversity in the SD groups, with an increase in beta diversity in the HFD groups. The relative abundance of Romboutsia and Clostridium_sensu_stricto_1 was decreased significantly in both diet groups after R. lituseburensis JCM1404 intervention. The functions of human diseases and endocrine and metabolic diseases significantly downregulated in the HFD groups by Tax4Fun analysis. Furthermore, we found Romboutsia was significantly associated with bile acids, triglycerides, amino acids and derivatives and organic acids and derivatives in the SD groups, while Romboutsia was significantly associated with triglycerides and free fatty acid in the HFD groups. Romboutsia lituseburensis JCM1404 significantly upregulated several metabolism-related pathways by KEGG analysis in the HFD groups, including glycerolipid metabolism, cholesterol metabolism, regulation of lipolysis in adipocytes, insulin resistance, fat digestion and absorption, thermogenesis. Overall, R. lituseburensis JCM1404 supplementation ameliorated endothelial function via gut microbiota modulation and lipid metabolisms alterations in obese rats.
Dynamic single cell analysis in a proximal-tubule-on-chip reveals heterogeneous epithelial colonization strategies of uropathogenic Escherichia coli under shear stress
Authors: Antypas Haris , Zhang Tianqi , Choong Ferdinand X , Melican Keira , Richter-Dahlfors Agneta
Published: March 2023

The urinary tract is a hydrodynamically challenging microenvironment and uropathogenic Escherichia coli (UPEC) must overcome several physiological challenges in order to adhere and establish a urinary tract infection. Our previous work in vivo revealed a synergy between different UPEC adhesion organelles, which facilitated effective colonization of the renal proximal tubule. To allow high-resolution real-time analysis of this colonization behavior, we established a biomimetic proximal-tubule-on-chip (PToC). The PToC allowed for single-cell resolution analysis of the first stages of bacterial interaction with host epithelial cells, under physiological flow. Time-lapse microscopy and single-cell trajectory analysis in the PToC revealed that while the majority of UPEC moved directly through the system, a minority population initiated heterogeneous adhesion, identified as either rolling or bound. Adhesion was predominantly transient and mediated by P pili at the earliest time-points. These bound bacteria initiated a founder population which rapidly divided, leading to 3D microcolonies. Within the first hours, the microcolonies did not express extracellular curli matrix, but rather were dependent on Type 1 fimbriae as the key element in the microcolony structure. Collectively, our results show the application of Organ-on-chip technology to address bacterial adhesion behaviors, demonstrating a well-orchestrated interplay and redundancy between adhesion organelles that enables UPEC to form microcolonies and persist under physiological shear stress.
Assessing Flexibility of Solution Strategy: Strategy Shifting as a Measure of Cognitive Reserve
Authors: Barulli Daniel , Habeck Christian , Stern Yaakov
Published: March 2023

Objectives

This series of experiments explores whether flexibility in strategy shifting might function as an expression of cognitive reserve (CR).

Methods

A reasoning task was designed using matrix reasoning stimuli that each required 1 of 2 specific solution strategies: logicoanalytic and visuospatial. It was formatted as a task-switching paradigm, assessing the ability to switch between solution strategies as measured by switch costs. Study 1 was done on Amazon Mechanical Turk and included an assessment of CR proxies. Study 2 used participants who had been studied extensively with neuropsychological assessments and structural neuroimaging.

Results

Study 1 found that switch costs increased with aging. In addition, a relationship between switch costs and CR proxies was noted, suggesting a relationship between the flexibility of strategy shifting and CR. The results of Study 2 again indicated that age negatively affected strategy-shifting flexibility, but that individuals with higher CR as measured with standard proxies performed better. The flexibility measure accounted for additional variance in cognitive performance over that explained by cortical thickness, suggesting that it may contribute to CR.

Discussion

Overall, the results are consistent with the idea that flexibility in strategy shifting might be 1 cognitive process that underlies cognitive reserve.
High-throughput imaging of powdery mildew resistance of the winter wheat collection hosted at the German Federal ex situ Genebank for Agricultural and Horticultural Crops
Authors: Hinterberger Valentin , Douchkov Dimitar , Lueck Stefanie , Reif Jochen C , Schulthess Albert W
Published: March 2023

Background

Genebanks worldwide are transforming into biodigital resource centers, providing access not only to the plant material itself but also to its phenotypic and genotypic information. Adding information for relevant traits will help boost plant genetic resources' usage in breeding and research. Resistance traits are vital for adapting our agricultural systems to future challenges.

Findings

Here we provide phenotypic data for the resistance against Blumeria graminis f. sp. tritici, the causal agent of wheat powdery mildew—a substantial risk to our agricultural production. Using a modern high-throughput phenotyping system, we infected and photographed a total of 113,638 wheat leaves of 7,320 winter wheat (Triticum aestivum L.) plant genetic resources of the German Federal ex situ Genebank for Agricultural and Horticultural Crops and 154 commercial genotypes. We quantified the resistance reaction captured by images and provide them here, along with the raw images.

Conclusion

This massive amount of phenotypic data, combined with already published genotypic data, also provides a valuable and unique training dataset for the development of novel genotype-based predictions as well as mapping methods.
Material encounters: the alternative use of clay tobacco pipes in England and Wales, c.1600–1900
Authors: Inskip Sarah , Joy Muir Angela
Published: March 2023

This article explores the ways in which clay tobacco pipes were used on or against the body for purposes other than smoking. Whereas most approaches to material culture in the past consider the intended uses of objects, this research focuses on alternative uses and the broader contexts in which these adaptations were made. Examination of pipes used as weapons and medical instruments provides new evidence of the physical worlds of those who encountered these objects. It also demonstrates how reading objects ‘against the grain’ through analysis of alternative uses of everyday objects expands what we can learn from material culture.
Race and COVID-19 among Social Workers in Health Settings: Physical, Mental Health, Personal Protective Equipment, and Financial Stressors
Authors: Zerden Lisa de Saxe , Ross Abigail M , Cederbaum Julie , Guan Ting , Zelnick Jennifer , Ruth Betty J
Published: March 2023

Social work is an essential workforce integral to the United States’ public health infrastructure and response to COVID-19. To understand stressors among frontline social workers during COVID-19, a cross-sectional study of U.S-based social workers (N = 1,407) in health settings was collected (in June through August 2020). Differences in outcome domains (health, mental health, personal protective equipment [PPE] access, financial stress) were examined by workers’ demographics and setting. Ordinal logistic, multinomial, and linear regressions were conducted. Participants reported moderate or severe physical (57.3 percent) and mental (58.3 percent) health concerns; 39.3 percent expressed PPE access concerns. Social workers of color were more likely to report significantly higher levels of concern across all domains. Those identifying as Black, American Indian/Alaska Native (AIAN), Asian American/Pacific Islander (AAPI), multiracial, or Hispanic/Latinx were over 50 percent more likely to experience either moderate or severe physical health concerns, 60 percent more likely to report severe mental health concerns, and over 30 percent more likely to report moderate PPE access concerns. The linear regression model was significantly associated with higher levels of financial stress for social workers of color. COVID-19 has exposed racial and social injustices that that hold true for social workers in health settings. Improved social systems are critical not just for those impacted by COVID-19, but also for the protection and sustainability of the current and future workforce responding to COVID-19.
Shedding New Light on High-Risk Phenotypes for Pouchitis
Authors: Barnes Edward L , Chang Shannon
Published: March 2023

Lay Summary

Identifying those patients at the greatest risk for pouchitis at the time of ileal pouch-anal anastomosis for ulcerative colitis remains a challenge. We discuss the importance of this topic by reviewing recent data regarding the impact of acute severe ulcerative colitis on risk of pouchitis and the implications for future clinical decisions and studies of risk stratification.
Examining pharmacists’ anti-doping knowledge and skills in assisting athletes to avoid unintentional use of prohibited substances
Authors: Greenbaum Deborah H , McLachlan Andrew J , Roubin Rebecca H , Moles Rebekah , Chaar Betty B
Published: March 2023

Objectives

To explore the knowledge and skills of pharmacists practicing in Sydney, Australia, in preventing the use of prohibited medications by athletes.

Methods

Using a simulated-patient study design, the researcher (an athlete and pharmacy student herself) contacted 100 Sydney pharmacies by telephone requesting advice about taking a salbutamol inhaler (a WADA-prohibited substance with conditional requirements), for exercise-induced asthma, following a set interview protocol. Data were assessed for both clinical and anti-doping advice appropriateness.

Key findings

Appropriate clinical advice was provided by 66% of pharmacists in the study, appropriate anti-doping advice was provided by 68%, and 52% provided appropriate advice across both aspects. Of the respondents, only 11% provided both clinical and anti-doping advice at a comprehensive level. Identification of accurate resources was made by 47% of pharmacists.

Conclusions

Whilst most participating pharmacists had the skills to deliver assistance regarding the use of prohibited substances in sports, many lacked core knowledge and resources to enable them to deliver comprehensive care to prevent harm and protect athlete-patients from anti-doping violations. A gap was identified regarding advising/counselling athletes, indicating the need for additional education in sport-related pharmacy. This education would need to be coupled with the incorporation of sport-related pharmacy into current practice guidelines to enable pharmacists to uphold their duty of care and for athletes to benefit from their medicines-related advice.
Dignity Deployed: An Examination of Refugee Rights through Domestic Dignity Jurisprudence
Authors: Garfinkel Rebecca J
Published: March 2023

The 1951 Convention relating to the Status of Refugees (Refugee Convention) provides protection for people with a well-founded fear of persecution who find themselves outside their country of nationality. The treaty not only sets out a legal status for those recognized as refugees by the country of asylum, but also certain civil, political, social, and economic rights throughout the refugee status determination process. Yet, despite being faced with the highest numbers of displaced people since the Second World War, States parties to the Refugee Convention routinely fail to meet the standards set out by the Convention. This article explores how domestic courts enforce treaty compliance not as a matter of international law, but rather by using the concept of constitutional dignity. The discussion examines how constitutional courts around the world have used dignity as both a substantive right and a functional standard in order to fulfil the promises of the Refugee Convention. The article concludes with an argument for dignity as a powerful tool to fill gaps in refugee protection globally.
Laplace Eigenfunctions on Riemannian Symmetric Spaces and Borel–Weil Theorem
Authors: Grantcharov Dimitar , Grantcharov Gueo , Montoya Camilo
Published: March 2023

We identify a geometric relation between the Laplace–Beltrami spectra and eigenfunctions on compact Riemannian symmetric spaces and the Borel–Weil theory using ideas from symplectic geometry and geometric quantization. This is done by associating with each compact Riemannian symmetric space, via Marsden–Weinstein reduction, a generalized flag manifold that covers the space parametrizing all of its maximal totally geodesic tori. In the process, we notice a direct relation between the Satake diagram of the symmetric space and the painted Dynkin diagram of its associated flag manifold. We consider in detail the examples of the classical simply connected spaces of rank one and the space $SU(3)/SO(3)$. In the 2nd part of the paper, with the aid of harmonic polynomials, we induce Laplace–Beltrami eigenfunctions on the symmetric space from holomorphic sections of the associated line bundle on the generalized flag manifold. In the examples we consider, we show that our construction provides all of the eigenfunctions.
The Defenders of the Alveolus Succumb in COVID-19 Pneumonia to SARS-CoV-2 and Necroptosis, Pyroptosis, and PANoptosis
Authors: Schifanella Luca , Anderson Jodi , Wieking Garritt , Southern Peter J , Antinori Spinello , Galli Massimo , Corbellino Mario , Lai Alessia , Klatt Nichole , Schacker Timothy W , Haase Ashley T
Published: March 2023

Alveolar type II (ATII) pneumocytes as defenders of the alveolus are critical to repairing lung injury. We investigated the ATII reparative response in coronavirus disease 2019 (COVID-19) pneumonia, because the initial proliferation of ATII cells in this reparative process should provide large numbers of target cells to amplify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus production and cytopathological effects to compromise lung repair. We show that both infected and uninfected ATII cells succumb to tumor necrosis factor-α (TNF)-induced necroptosis, Bruton tyrosine kinase (BTK)-induced pyroptosis, and a new PANoptotic hybrid form of inflammatory cell death mediated by a PANoptosomal latticework that generates distinctive COVID-19 pathologies in contiguous ATII cells. Identifying TNF and BTK as the initiators of programmed cell death and SARS-CoV-2 cytopathic effects provides a rationale for early antiviral treatment combined with inhibitors of TNF and BTK to preserve ATII cell populations, reduce programmed cell death and associated hyperinflammation, and restore functioning alveoli in COVID-19 pneumonia.
Population pharmacokinetics of unbound and total dolutegravir concentrations in children aged 12 years and older: a PK substudy of the SMILE trial
Authors: Abdalla Seef , Compagnucci Alexandra , Zheng Yi , Tréluyer Jean-Marc , Saidi Yacine , Ramos José T , Coelho Alexandra , Riault Yoann , Cressey Tim R , Hirt Déborah ,   the SMILE study group, Bologna R , Reliquet V , Elenga N , Pavia-Ruz N , Marques L , Candeias MF , Violari A , Cotton M , Rojo Conejo P , Mellado Peña MJ , Fortuny Guasch C , Navarro Gómez M , Muñoz Fernandez MA , Martin S , Ramos Amador JT , Kalhert C , Paioni P , Duppenthaler A , Ngampiyaskul C , Chanto N , Ounchanum P , Kanjanavanit S , Srirompotong U , Srirojana S , Amuge P , Musiime V , Raus I , Kenny J , Vergnano S , Nayagam D , Welch S
Published: March 2023

Background

SMILE, a multicentre randomized trial, compared the efficacy and safety of switching virologically suppressed children and adolescents with HIV to a once-daily dual regimen of dolutegravir plus ritonavir-boosted darunavir versus continuing standard ART. Within a nested pharmacokinetic (PK) substudy, we performed a population PK analysis to describe total and unbound dolutegravir plasma concentrations in children and adolescents receiving this dual therapy.

Methods

Sparse blood samples were obtained during follow-up for dolutegravir quantification. A population PK model was developed to simultaneously describe total and unbound dolutegravir concentrations. Simulations were performed and were compared with the protein-adjusted 90% inhibitory concentration (IC90) and the in vitro IC50, respectively. Dolutegravir exposures in children aged ≥12 years were also compared with values in treatment-experienced adults.

Results

Four hundred and fifty-five samples from 153 participants aged between 12 and 18 years were collected for this PK analysis. A one-compartment model with first-order absorption and elimination best described unbound dolutegravir concentrations. The relationship between unbound and total dolutegravir concentrations was best characterized by a non-linear model. Unbound dolutegravir apparent clearance was significantly influenced by total bilirubin concentrations and by Asian ethnicity. All children and adolescents had trough concentrations well above the protein-adjusted IC90 and the in vitro IC50 values. Dolutegravir concentrations and exposures were also similar to those obtained in adults receiving dolutegravir 50 mg once daily.

Conclusions

A once-daily 50 mg dolutegravir dose for children and adolescents produces adequate total and unbound concentrations when used as part of dual therapy with ritonavir-boosted darunavir.
Racism and Electronic Health Records (EHRs): Perspectives for research and practice
Authors: Emani Srinivas , Rodriguez Jorge A , Bates David W
Published: March 2023

Informatics researchers and practitioners have started exploring racism related to the implementation and use of electronic health records (EHRs). While this work has begun to expose structural racism which is a fundamental driver of racial and ethnic disparities, there is a lack of inclusion of concepts of racism in this work. This perspective provides a classification of racism at 3 levels—individual, organizational, and structural—and offers recommendations for future research, practice, and policy. Our recommendations include the need to capture and use structural measures of social determinants of health to address structural racism, intersectionality as a theoretical framework for research, structural competency training, research on the role of prejudice and stereotyping in stigmatizing documentation in EHRs, and actions to increase the diversity of private sector informatics workforce and participation of minority scholars in specialty groups. Informaticians have an ethical and moral obligation to address racism, and private and public sector organizations have a transformative role in addressing equity and racism associated with EHR implementation and use.
The Global Health Informatics landscape and JAMIA
Authors: Fraser Hamish S F , Zahiri Keyana , Kim Nicole , Kim Chloe , Craig Sansanee
Published: March 2023

Global Health Informatics (GHI) as a branch of health informatics has been established for 2 decades now. During that time, great strides have been made in the creation and implementation of informatics tools to improve healthcare delivery and outcomes in the most vulnerable and remote communities worldwide. In many of the most successful projects, innovation has been shared between teams in high- and low- or middle-income countries (LMICs). In this perspective, we review the state of the academic field of GHI and the work published in JAMIA in the last 6 1/2 years. We apply criteria for articles about LMICs, those on international health, and on indigenous and refugee population, and subtypes of research. For comparison, we apply those criteria to JAMIA Open and 3 other health informatics journals which publish articles on GHI. We make recommendations for future directions and the role that journals like JAMIA can play in strengthening this work worldwide.
Role and Mechanism of Endoplasmic Reticulum Stress in Mice Pancreatic Islet Dysfunction After Severe Burns
Authors: Li Zhisheng , Liu Xinzhu , Zhang Kun , Zhao Hongqing , Luo Peng , Li Dawei , Liu Zhaoxing , Yuan Huageng , Zhang Bohan , Xie Xiaoye , Shen Chuan’an
Published: March 2023

This study attempted to investigate the role and mechanism of endoplasmic reticulum (ER) stress in the islet dysfunction in mice after severe burns. C57BL/6 mice were randomly divided into the sham group, burn group, and burn+4-phenylbutyric acid (4-PBA) group. Mice were burned with full thickness of 30% total surface area (TBSA), and 4-PBA solution was intraperitoneally injected into mice in burn+4-PBA group. Glucose-stimulated insulin secretion (GSIS), Fasting blood glucose (FBG) and glucose tolerance were detected 24 hours post severe burns. The ER stress-related pathway markers immunoglobulin binding protein (BIP), X-box binding protein 1 (XBP1), phosphorylation-PKR-like ER kinase (p-PERK), phosphorylation-eukaryotic translation initiation factor 2α (p-eIF2α), CHOP, activating transcription factor 6 (ATF6), apoptosis-related protein Cleaved-Caspase 3, and islet cell apoptosis were measured. Mice were characterized with elevated FBG, decreased glucose tolerance and GSIS levels post severe burns. The expression of BIP, XBP1, p-PERK, p-eIF2α, CHOP, ATF6, Cleaved-Caspase 3, and islet cell apoptosis were increased significantly after severe burns. 4-PBA treatment contributed to decreased FBG, improved glucose tolerance, increased GSIS, inhibited islet ER stress, and reduced pancreatic islet cell apoptosis in mice post severe burns. ER stress occurs in islets of severely burned mice, which leads to increased apoptosis of islet cells, thus resulting in islet dysfunction.
Molecular Breast Imaging in the Screening Setting
Authors: Smith Katherine A , Hunt Katie N , Rauch Gaiane M , Fowler Amy M
Published: March 2023

Early detection of breast cancer through screening mammography saves lives. However, the sensitivity of mammography for breast cancer detection is reduced in women with dense breast tissue. Imaging modalities for supplemental breast cancer screening include MRI, whole breast US, contrast-enhanced mammography, and molecular breast imaging (MBI). Molecular breast imaging with 99mTc-sestamibi is a functional imaging test to identify metabolically active areas in the breast with positioning analogous to mammography. Since 2011, there have been six large, published studies of screening MBI as a supplement to mammography involving over 6000 women from four different institutions. A multicenter, prospective clinical trial of 3000 women comparing breast cancer detection using screening digital breast tomosynthesis alone or in combination with MBI recently completed enrollment. This review focuses on the current evidence of MBI use for supplemental breast cancer screening, the strengths and limitations of MBI, and recent technological advances.