bluuebunny/crossref_metadata_2025 huggingface dataset:
Capture and transport of white rhinoceroses (Ceratotherium simum) cause shifts in their fecal microbiota composition towards dysbiosis
Authors: Pohlin Friederike , Frei Carolin , Meyer Leith C R , Roch Franz-Ferdinand , Quijada Narciso M , Conrady Beate , Neubauer Viktoria , Hofmeyr Markus , Cooper Dave , Stalder Gabrielle , Wetzels Stefanie U
Published: November 2023

Translocations of Rhinocerotidae are commonly performed for conservation purposes but expose the animals to a variety of stressors (e.g. prolonged fasting, confinement, novel environment, etc.). Stress may change the composition of gut microbiota, which can impact animal health and welfare. White rhinoceroses in particular can develop anorexia, diarrhea and enterocolitis after translocation. The aim of this study was to investigate the associations of age, sex and translocation on the rhinoceros’ fecal bacterial microbiota composition. Fecal samples were collected from rhinoceroses at capture (n = 16) and after a >30-hour road transport (n = 7). DNA was isolated from these samples and submitted for 16S rRNA V3-V4 phylotyping. Alpha diversity indices of the rhinoceros’ fecal microbiota composition of different age, sex and before and after transport were compared using non-parametric statistical tests and beta diversity indices using Permutational Multivariate Analysis Of Variance (PERMANOVA). Resulting P-values were alpha-corrected (Padj.). Alpha and beta diversity did not differ between rhinoceroses of different age and sex. However, there was a significant difference in beta diversity between fecal samples collected from adult animals at capture and after transport. The most abundant bacterial phyla in samples collected at capture were Firmicutes and Bacteroidetes (85.76%), represented by Lachnospiraceae, Ruminococcaceae and Prevotellaceae families. The phyla Proteobacteria (Padj. = 0.009) and Actinobacteria (Padj. = 0.012), amongst others, increased in relative abundance from capture to after transport encompassing potentially pathogenic bacterial families such as Enterobacteriaceae (Padj. = 0.018) and Pseudomonadaceae (Padj. = 0.022). Important commensals such as Spirochaetes (Padj. = 0.009), Fibrobacteres (Padj. = 0.018) and Lachnospiraceae (Padj. = 0.021) decreased in relative abundance. These results indicate that the stressors associated with capture and transport cause an imbalanced fecal microbiota composition in white rhinoceroses that may lead to potentially infectious intestinal disorders. This imbalance may result from recrudescence of normally innocuous pathogens, increased shedding of pathogens or increased vulnerability to new pathogens.
Agreement among high-sensitivity cardiac troponin assays and non-invasive testing, clinical outcomes, and quality-of-care outcomes based on the 2020 European Society of Cardiology Guidelines
Authors: Karády Júlia , Mayrhofer Thomas , Januzzi James L , Udelson James E , Fleg Jerome L , Merkely Bela , Lu Michael T , Peacock William F , Nagurney John T , Koenig Wolfgang , Ferencik Maros , Hoffmann Udo
Published: November 2023

Aims

Quality-of-care and safety of patients with suspected acute coronary syndrome (ACS) would benefit if management was independent of which high-sensitivity cardiac troponin (hs-cTn) assay was used for risk stratification. We aimed to determine the concordance of hs-cTn assays to risk-stratify patients with suspected ACS according to the European Society of Cardiology (ESC) 2020 Guidelines.

Methods and results

Blood samples were obtained at arrival and at 2 h from patients with suspected ACS using four hs-cTn assays. The patients were classified into rule-out/observe/rule-in strata based on the ESC 2020 Guidelines. Concordance was determined among the assays for rule-out/observe/rule-in strata. The prevalences of significant underlying disease (≥50% stenosis on coronary computed tomography or inducible myocardial ischaemia on stress testing) and adjudicated ACS, plus quality-of-care outcomes, were compared. Among 238 patients (52.7 ± 8.0 years; 40.3% female), the overall concordance across assays to classify patients into rule-out/observe/rule-in strata was 74.0% (176/238). Platforms significantly differed for rule-out (89.9 vs. 76.5 vs. 78.6 vs. 86.6%, P < 0.001) and observe strata (6.7 vs. 20.6 vs. 17.7 vs. 9.2%, P < 0.001), but not for rule-in strata (3.4 vs. 2.9 vs. 3.8 vs. 4.2%, P = 0.62). Among patients in ruled-out strata, 19.1–21.6% had significant underlying disease and 3.3–4.2% had ACS. The predicted disposition of patients and cost-of-care differed across the assays (all P < 0.001). When compared with observed strata, conventional troponin-based management and predicted quality-of-care outcomes significantly improved with hs-cTn-based strategies (direct discharge: 21.0 vs. 80.3–90.8%; cost-of-care: $3889 ± 4833 vs. $2578 ± 2896–2894 ± 4371, all P < 0.001).

Conclusion

Among individuals with suspected ACS, patient management may differ depending on which hs-cTn assay is utilized. More data are needed regarding the implications of inter-assay differences.

Trail registration

NCT01084239.
Streptococcus gordonii infective endocarditis complicated by brain abscess in a patient with a congenital bicuspid aortic valve: a case report
Authors: Bhatti Alysha , Sagar Viral , McFaul Katie
Published: November 2023

Background

Infective endocarditis is associated with significant morbidity and mortality. Oral trauma through dental procedures can result in infective endocarditis through displacement of commensal organisms into the bloodstream. Streptococcus gordonii is an oral commensal and is rarely implicated as a cause of infective endocarditis but should be considered in febrile patients with a recent history of odontological procedures.

Case summary

We present a case of a previously healthy 26-year-old woman who presented with a 2-month history of fevers. Blood cultures on admission were positive for S. gordonii. Echocardiography demonstrated a congenital bicuspid aortic valve with vegetations and abscess, supporting a diagnosis of infective endocarditis. A magnetic resonance imaging (MRI) brain revealed a small cerebral empyema. She was treated with intravenous antibiotics and underwent an aortic valve replacement.

Discussion

Bicuspid aortic valve predisposes to infective endocarditis, and these patients have higher incidence of requiring cardiac surgery. Streptococcus gordonii belongs to the viridans group streptococci that are recognized as causative organisms for infective endocarditis particularly where dental sources are suspected. Patients with infective endocarditis may develop neurological sequelae including cerebrovascular accidents or central nervous system infections. If risk of haemorrhagic transformation is low, surgical intervention for valve replacement should not be delayed.
Paraganglioma-induced reverse takotsubo syndrome treated with extracorporeal membrane oxygenation in a young patient with a history of malignancy: a case report
Authors: Ajluni Steven C , Feroze Rafey , Asa Sylvia L , Sundaram Varun
Published: November 2023

Background

Reverse takotsubo-like cardiomyopathy (rTCC) is a rare type of stress-induced cardiomyopathy associated with catecholamine surges. Reverse takotsubo-like cardiomyopathy is characterized by basal and mid-ventricular hypokinesis with apical sparing. Paragangliomas are catecholamine-secreting neuroendocrine tumours outside the adrenal gland that can cause palpitations, hypertension, and rarely cardiomyopathy. In cases of occult paraganglioma, catecholamine-induced rTCC can be rapidly reversed with adequate haemodynamic support.

Case summary

A 28-year-old woman with a history of cervical cancer, ovarian insufficiency, and preeclampsia presented to the emergency department with nausea, vomiting, and chest pain. The patient was initially tachycardic, tachypnoeic, and hypotensive. On exam, she was in distress with diffuse rales and cool extremities. Electrocardiogram showed sinus tachycardia to 147 b.p.m. and lateral ST depression in V4 and V5. Troponin was elevated to 13 563 ng/L. An echocardiogram showed severely reduced left ventricular ejection fraction (LVEF) with hypokinesis of the basal segments and apical sparing, identified as rTCC. Computed tomography of the abdomen showed a 3.6 × 2.7 cm right adrenal mass. The patient rapidly developed respiratory failure and was subsequently intubated, sedated, and initiated on vasopressors. In the setting of cardiogenic shock refractory to vasopressor support, the decision was made to cannulate for venoarterial extracorporeal membrane oxygenation (VA-ECMO). Plasma and urine metanephrines were elevated. After 5 days, the patient’s LVEF recovered to her baseline, and the rTCC had resolved. The patient’s hypertension was managed with gradual alpha-blockade, and she subsequently underwent successful adrenalectomy on Day 44.

Discussion

An occult paraganglioma should be considered when rTCC pattern is identified. The pathophysiology of paraganglioma-mediated catecholamine surges predisposing to rTCC is unclear. Potential mechanisms for rTCC include oestrogen deficiency, catecholamine cardiotoxicity, and coronary artery spasm. The VA-ECMO is an increasingly used modality to provide haemodynamic support to patients with refractory cardiogenic shock.
Occlusion and catheter ablation using a large-size cryoballoon for various pulmonary veins: a case series
Authors: Yoshizawa Reisuke , Sasaki Hiroki , Urushikubo Takashi , Sawa Yohei , Owada Shingen
Published: November 2023

Background

It is established that pulmonary vein isolation using the POLARx™ (Boston Scientific, Marlborough, MA, USA) cryoballoon is a rapid, safe, and effective approach. The new POLARx™ FIT (Boston Scientific), which is expandable from 28 to 31 mm in diameter, is currently available. However, there is limited evidence available regarding the treatment of atrial fibrillation in this setting. In this article, we report a case series of cryoballoon ablation in patients with atrial fibrillation using POLARx™ FIT.

Case summary

This case series describes a comparison of obstruction in three patients with pulmonary veins of different shapes and diameters undergoing cryoballoon ablation and pulmonary vein isolation with a 31 mm diameter balloon.

Discussion

Cryoballoon ablation using the 31 mm mode of POLARx™ FIT has the potential to provide safe and stable pulmonary vein isolation with good occlusion for a variety of pulmonary vein geometries. In this case series, the 31 mm mode of the POLARx™ FIT resulted in better pulmonary vein occlusion than the 28 mm mode in patients with large left atria and large pulmonary veins, including the left common pulmonary vein. This approach may be considered a first-line therapy option of cryoballoon ablation in patients with atrial fibrillation.
Strategies for managing left main trunk compression by left atrial appendage clip: a case report
Authors: Mitsuishi Atsuyuki , Yoshida Keisuke , Miura Yujiro , Noguchi Tatsuya , Furushima Tomoki
Published: November 2023

Background

Closure of the left atrial appendage (LAA) using a clip in at-risk patients reduces stroke risk. The rate of LAA closure procedures is increasing worldwide; however, complications have been reported, with coronary compression being one possible lethal complication associated with the anatomical structures around the LAA.

Case summary

A 75-year-old man presented with a diagnosis of a φ50 mm saccular thoracic aortic aneurysm. He had a history of chronic atrial fibrillation and functional tricuspid regurgitation. We performed total arch replacement with an open stent graft, tricuspid ring annuloplasty, left atrium Maze procedure, left atrial plication, and LAA closure using a LAA clip. The blood pressure of the patient dropped after closing the pericardium post-operatively. Coronary artery angiography (CAG) confirmed 90% stenosis at the left coronary main trunk (LMT) origin. Percutaneous coronary intervention (PCI) was performed, and the haemodynamics settled.

Discussion

The distance from the anterior wall of the LAA ostium to the LMT can be a risk for AtriClip-induced LMT compression. A different surgical strategy, such as internal sutures or surgical stapler for LAA closure, should be considered under such a condition. Selecting an appropriately sized AtriClip is essential while using the clip, placing it close to the orifice, and visually checking for compression after insertion to prevent LMT stenosis. When LMT compression by the clip was confirmed, levelling the endocardial adipose tissue with the LAA landing zone, cutting and removing the clip or coronary artery bypass grafting during operation, and PCI during CAG should be considered.
Bailout MitraClip therapy for deteriorated systolic anterior motion–related severe mitral regurgitation post-alcohol septal ablation: a case report
Authors: Nakano Shinsuke , Yamamoto Hiroyuki , Takahashi Nobuyuki , Takaya Tomofumi
Published: November 2023

Background

Percutaneous alcohol septal ablation (ASA) is a non-surgical treatment for symptomatic hypertrophic obstructive cardiomyopathy. It has a potential risk for systolic anterior motion (SAM)–related mitral regurgitation (MR) deterioration, leading to acute congestive heart failure. In such clinical scenarios, additional surgical interventions for SAM-MR are risky.

Case summary

A 70-year-old man experienced acutely deteriorated heart failure caused by SAM-related MR following ASA, for which venous-arterial extracorporeal membrane oxygenation (ECMO) and a percutaneous left ventricular assist device (Impella CP, Abiomed, MA, USA) were required. Transoesophageal echocardiography showed that an interventricular septal oedematous protrusion led to a large coaptation gap of mitral leaflets with a pseudo-prolapse of the posterior mitral leaflet (PML). Because of his prohibitive surgical risks, we opted for transcatheter edge-to-edge mitral valve repair with MitraClip therapy. After removing the Impella device, an XT clip (Abbott Vascular, CA, USA) was located to cover the pseudo-prolapsed PML, resulting in optimal MR reduction with an acceptable mean transmitral valve-pressure gradient. Thereafter, his heart failure was well controlled, and venous-arterial ECMO was successfully removed on post-MitraClip Day 2.

Discussion

This case demonstrated that MitraClip therapy rescued the patient from a rare complication of severe acute heart failure with haemodynamic collapse caused by massive SAM-related MR following ASA. MitraClip therapy can be a feasible, less-invasive interventional therapy for SAM-related MR in cases with acceptable severity of iatrogenic mitral stenosis post-MitraClip implantation.
Ticagrelor enhances the cardioprotective effects of ischemic preconditioning in stable patients undergoing percutaneous coronary intervention: the TAPER-S randomized study
Authors: D'Amario Domenico , Galli Mattia , Restivo Attilio , Canonico Francesco , Vergallo Rocco , Migliaro Stefano , Trani Carlo , Burzotta Francesco , Aurigemma Cristina , Laborante Renzo , Romagnoli Enrico , Francese Francesca , Ceccarelli Ilaria , Borovac Josip A , Angiolillo Dominick J , Tavazzi Barbara , Leone Antonio M , Crea Filippo , Patti Giuseppe , Porto Italo
Published: November 2023

Background

Ticagrelor improves clinical outcomes in patients with acute coronary syndromes compared with clopidogrel. Ticagrelor also inhibits cell uptake of adenosine and has been associated with cardioprotective effects in animal models. We sought to investigate the potential cardioprotective effects of ticagrelor, as compared with clopidogrel, in stable patients undergoing percutaneous coronary intervention (PCI).

Methods and results

This was a Prospective Randomized Open Blinded End-points (PROBE) trial enrolling stable patients with coronary artery disease (CAD) requiring fractional flow reserve–guided PCI of intermediate epicardial coronary lesions. ST-segment elevation at intracoronary electrocardiogram (IC-ECG) during a two-step sequential coronary balloon inflations in the reference vessel during PCI was used as an indirect marker of cardioprotection induced by ischemic preconditioning (IPC). The primary endpoint of the study was the comparison of the delta (Δ) (difference) ST-segment elevation measured by IC-ECG during two-step sequential coronary balloon inflations.

Results

Fifty-three patients were randomized to either clopidogrel or ticagrelor. The study was stopped earlier because the primary endpoint was met at a pre-specified interim analysis. ΔST-segment elevation was significantly higher in ticagrelor as compared to clopidogrel arms (P < 0.0001). Ticagrelor was associated with lower angina score during coronary balloon inflations. There was no difference in coronary microvascular resistance between groups. Adenosine serum concentrations were increased in patients treated with ticagrelor as compared to those treated with clopidogrel.

Conclusions

Ticagrelor enhances the cardioprotective effects of IPC compared with clopidogrel in stable patients with CAD undergoing PCI. Further studies are warranted to fully elucidate the mechanisms through which ticagrelor may exert cardioprotective effects in humans.

Clinical Trial Registration

http://www.clinicaltrials.gov. Unique Identifier: NCT02701140.
Late clinical and echocardiographic results with the Magna Ease© pericardial aortic bioprosthesis
Authors: Anselmi Amedeo , Aymami Marie , Tomasi Jacques , D’Alessandro Gemma , Langanay Thierry , Corbineau Hervé , Mancini Julien , Flecher Erwan , Verhoye Jean-Philippe
Published: November 2023

OBJECTIVES

The population of candidates to surgical aortic valve replacement (SAVR) is evolving. The Perimount Magna Ease© bioprosthesis has been introduced relatively recently in the practice. We aimed at evaluating its long-term results.

METHODS

This article describes a single-centre cohort of 1016 consecutive SAVRs with the Magna Ease© valve (2008–2014), consisting of an all-comers population. We performed a prospective collection of in-hospital data, systematic clinical and echocardiographic follow-up. Valve-related events were as follows: structural valve deterioration (SVD; according to modified definition criteria), nonstructural valve dysfunction, patient–prosthesis mismatch (PPM).

RESULTS

Age at SAVR was 73.4 ± 9.5 years; calcified aortic stenosis was the indication to surgery in 59.6%. A total of 974 patients entered the follow-up; 564 were alive at the last follow-up (median duration: 9.8 years) (up to 13.4 years). New York Heart Association class was I or II in 92.1%. Overall survival at 10 years was 56.8 ± 1.8%. Freedom from SVD at 10 was 96.5 ± 0.8% (Kaplan–Meier) and 97.4 ± 0.6% (competing risks) (28 SVD events after 6.9 ± 3.3 years). There were 15 reinterventions for SVD (redo-SAVR and Transcatheter Aortic Valve Implantation (TAVI)); 10-year freedom from reintervention was 97.8 ± 0.6%. Moderate and severe PPM occurred in 26.8% and 5.4%, respectively, without association with late mortality (P = 0.12 for moderate and P = 0.70 for severe PPM). Freedom from valve-related mortality was 97.8 ± 0.5% at 10 years.

CONCLUSIONS

In this follow-up of the Magna Ease bioprosthesis for SAVR, data indicate good late outcomes (30-day outcomes are excluded). Continued follow-up is required to further support its use in patients with life expectancy >10–12 years.
Transcatheter versus surgical mitral valve repair in patients with mitral regurgitation
Authors: Majmundar Monil , Patel Kunal Nitinkumar , Doshi Rajkumar , Kumar Ashish , Arora Shilpkumar , Panaich Sidakpal , Kalra Ankur
Published: November 2023

OBJECTIVES

The aim of this study was to compare clinical outcomes of transcatheter and surgical mitral valve repair (SMVr) in primary mitral regurgitation (MR) and MR with heart failure with reduced ejection fraction (HFrEF).

METHODS

In this retrospective cohort study, we used the Nationwide Readmission Database to identify primary MR and MR with HFrEF patients who underwent transcatheter or SMVr from 2016 to 2019. A propensity score with 1:1 matching was applied. The primary outcome was a cumulative event rate of major adverse cardiovascular events (MACE), which was a composite of all-cause mortality, myocardial infarction, stroke, heart failure, cardiac arrest and mitral valve replacement. Other important secondary outcome was in-hospital mortality.

RESULTS

After propensity score matching, 2187 matched pairs were found in the primary MR cohort and 2178 matched pairs were found in the MR-HFrEF cohort. Transcatheter mitral valve repair (TMVr) had significantly higher medium-term MACE compared with SMVr in both cohorts (primary MR: hazard ratio: 1.73, 95% confidence interval: 1.33–2.26, P ≤ 0.001; MR-HFrEF: hazard ratio: 2.00, 95% confidence interval: 1.58–2.54, P ≤ 0.001). TMVr showed similar in-hospital mortality in both cohorts.

CONCLUSIONS

Although TMVr showed better short-term outcomes, it had significantly higher medium-term MACE than SMVr in both cohorts. Thus, shared decision-making should be performed for TMVr after discussing the benefits and risks in patients who can undergo SMVr.
Metabolic signatures of thymomas: potential biomarkers and treatment targets
Authors: Miller James W , Faubert Brandon M , Mathews Thomas P , Waters John K , DeBerardinis Ralph J , Kernstine Kemp H
Published: November 2023

OBJECTIVES

A study of tumour metabolic reprogramming has revealed disease biomarkers and avenues for therapeutic intervention. Metabolic reprogramming in thymoma is currently understudied and largely unknown. This study utilized metabolomics and isotope tracing with 13C-glucose to metabolically investigate thymomas, adjacent thymic tissue and benign thymic lesions.

METHODS

From 2017 to 2021, 20 patients with a suspected thymoma were recruited to this prospective Institutional Review Board approved clinical trial. At the time of surgery, 11 patients were infused with 13C-glucose, a stable, non-radioactive tracer which reports the flow of carbon through metabolic pathways. Samples were analysed by mass spectrometry to measure the abundance of >200 metabolites.13C enrichment was measured in patients who received 13C-glucose infusions.

RESULTS

Histological analysis showed that 9 patients had thymomas of diverse subtypes and 11 patients had benign cysts. In our metabolomic analysis, thymomas could be distinguished from both adjacent thymus tissue and benign lesions by metabolite abundances. Metabolites in pyrimidine biosynthesis and glycerophospholipid metabolism were differentially expressed across these tissues.13C-glucose infusions revealed differential labelling patterns in thymoma compared to benign cysts and normal thymus tissue. The lactate/3PG labelling ratio, a metabolic marker in aggressive lung tumours correlated with lactate uptake, was increased in thymomas (1.579) compared to normal thymus (0.945) and benign masses (0.807) (thymic tissue versus tumour P = 0.021, tumour versus benign P = 0.013).

CONCLUSIONS

We report metabolic biomarkers, including differential 13C labelling of metabolites from central metabolism, that distinguish thymomas from benign tissues. Altered glucose and lactate metabolism warrant further investigation and may provide novel therapeutic targets for thymoma.
The effect of the dental follicle volume of palatally impacted canines on the relative position of the adjacent teeth
Authors: Lam Michael , Dekel Eyal , Nucci Ludovica , Grassia Vicenzo , Naoumova Julia , Pacheco-Pereira Camila , Perillo Letizia , Chaushu Stella , Flores-Mir Carlos
Published: November 2023

Objective

To assess if the dental follicle volume of palatally impacted canines (PICs) affects the relative root position of the adjacent lateral incisors (LIs) and first premolars (FPs).

Materials and Methods

A retrospective cross-sectional study of 49 patients with unilaterally PICs with dental follicles who had CBCT imaging previously taken. Four orthodontic centers in different countries provided the sample. A mean difference of 5° between the angular measurements (mesiodistal tip, buccolingual inclination, or mesiodistal rotation) of the LI and FP adjacent to the PIC and the controls was considered clinically relevant. A value of 0.05 was set for significance level and a power of 80%. The minimum sample size was determined to be 26 patients. These patients were further assigned to an LI sample (n = 49) and an FP sample (n = 23), dependent on the direct contact of the dental follicle to that adjacent tooth. A manual segmentation technique was used to obtain the volumetric measurements of the dental follicle. Angular measurements of adjacent teeth were then compared to the contralateral nonimpacted side, which acted as the control. A multivariant regression analysis was performed using IBM SPSS software, and statistical significance was set at α = 0.05.

Results

Adequate intra-rater reliability was accomplished. The multivariant regression analysis implied that there is no difference in the mean change in the tip, torque, and rotation of the LI and FP between the impacted and control sides when dental follicle volumes are considered (P = .509 for the LI sample and P = .804 for the FP sample).

Limitations

CBCT imaging of dental follicle border delimitations, partial volume effect, and scattering are limitations. This is a convenience sample where the FP subsample is small.

Conclusion

The dental follicle volume of the PICs does not seem to influence the relative position of the adjacent LI and FP mesiodistal tip, buccolingual inclination, and mesiodistal rotation. Early intervention could have been suggested to avoid certain malocclusion traits if significant displacements were demonstrated.
Extraction outcomes of implantable cardioverter-defibrillator leads vary by manufacturer and model family
Authors: Hayashi Katsuhide , Callahan Thomas , Rickard John , Younis Arwa , Baranowski Bryan , Martin David , Nakhla Shady , Tabaja Chadi , Wilkoff Bruce L
Published: November 2023

Aims

Transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads is considered challenging. The structure of each ICD leads is variable between manufacturer and model families. The net impact of lead family on the safety and effectiveness of TLE is poorly characterized. We assessed the safety and efficacy of ICD TLE and the impact of manufacturer ICD model family on the outcomes.

Methods and results

The study cohort included all consecutive patients with ICD who underwent TLE between 2013 and 2022 and are enrolled in the Cleveland Clinic Prospective TLE Registry. A total of 885 ICD leads (median implant duration 8 years) in 810 patients were included. Complete ICD TLE success was achieved in 97.2% of the leads (n = 860) and in 98.0% of the patients (n = 794). Major complications occurred in 22 patients (2.7%). Complete procedural success rate varied by manufacturer and lead family; Medtronic 98.9%, Abbott 95.9%, Boston Scientific 95.0%, Biotronik 91.2%, P = 0.03, and Linox family leads had the lowest, 89.7% P = 0.02. Multivariable predictors of incomplete ICD lead removal included ICD lead age > 10 years and Linox family lead. Multivariable predictors of major complications included ICD lead age > 15 years and longer lead extraction time, and predictors of all-cause mortality within 30 days included lead extraction for infection, end-stage renal disease, and higher New York Heart Association functional class.

Conclusion

Complete and safe ICD lead removal rate by TLE is extremely high but varied by manufacturer and lead family. Linox family lead and >10 years lead age were independent predictors of incomplete lead removal.
The evolution of female-biased genital diversity in bedbugs (Cimicidae)
Authors: Roth Steffen , Siva-Jothy Michael T , Balvín Ondřej , Morrow Edward H , Willassen Endre , Reinhardt Klaus
Published: November 2023

Rapid genitalia evolution is believed to be mainly driven by sexual selection. Recently, noncopulatory genital functions have been suggested to exert stronger selection pressure on female genitalia than copulatory functions. In bedbugs (Cimicidae), the impact of the copulatory function can be isolated from the noncopulatory impact. Unlike in other taxa, female copulatory organs have no function in egg-laying or waste-product expulsion. Males perform traumatic mating by piercing the female integument, thereby imposing antagonistic selection on females and suspending selection to morphologically match female genitalia. We found the location of the copulatory organ evolved rapidly, changing twice between dorsal and ventral sides, and several times along the anteroposterior and the left–right axes. Male genital length and shape varied much less, did not appear to follow the positional changes seen in females, and showed no evidence for coevolution. Female genitalia position evolved 1.5 times faster than male genital length and shape and showed little neutral or geographic signals. Instead, we propose that nonmorphological male traits, such as mating behavior, may drive female genitalia morphology in this taxon. Models of genitalia evolution may benefit from considering morphological genital responses to nonmorphological stimuli, such as male mating behavior or copulatory position.
rec-1 loss of function increases recombination in the central gene clusters at the expense of autosomal pairing centers
Authors: Parée Tom , Noble Luke , Ferreira Gonçalves João , Teotónio Henrique
Published: November 2023

Meiotic control of crossover (CO) number and position is critical for homologous chromosome segregation and organismal fertility, recombination of parental genotypes, and the generation of novel genetic combinations. We here characterize the recombination rate landscape of a rec-1 loss of function modifier of CO position in Caenorhabditis elegans, one of the first ever modifiers discovered. By averaging CO position across hermaphrodite and male meioses and by genotyping 203 single-nucleotide variants covering about 95% of the genome, we find that the characteristic chromosomal arm-center recombination rate domain structure is lost in the loss of function rec-1 mutant. The rec-1 loss of function mutant smooths the recombination rate landscape but is insufficient to eliminate the nonuniform position of CO. Lower recombination rates in the rec-1 mutant are particularly found in the autosomal arm domains containing the pairing centers. We further find that the rec-1 mutant is of little consequence for organismal fertility and egg viability and thus for rates of autosomal nondisjunction. It nonetheless increases X chromosome nondisjunction rates and thus male appearance. Our findings question the maintenance of recombination rate heritability and genetic diversity among C. elegans natural populations, and they further suggest that manipulating genetic modifiers of CO position will help find quantitative trait loci located in low-recombining genomic regions normally refractory to discovery.
Gravity inversion usingL0 norm for sparse constraints
Authors: Zhu Dan , Hu Xiangyun , Liu Shuang , Cai Hongzhu , Xu Shan , Meng Linghui , Zhang Henglei
Published: November 2023

Gravity surveys constitute an important method for investigating the Earth's interior based on density contrasts related to Earth material differentials. Because lithology depends on the environment and the period of formation, there are generally clear boundaries between rocks with different lithologies. Inversions with convex functions for approximating the L0 norm are used to detect boundaries in reconstructed models. Optimizations can easily be found because of the convex transformations; however, the volume of the reconstructed model depends on the weighting parameter and the density constraint rather than the model sparsity. To determine and adapt the modelling size, a novel non-convex framework for gravity inversion is proposed. The proposed optimization aims to directly reduce the L0 norm of the density matrix. An improved iterative hard thresholding algorithm is developed to linearly reduce the L0 penalty during the inner iteration. Accordingly, it is possible to determine the modelling scale during the iteration and achieve an expected scale for the reconstructed model. Both simple and complex model experiments demonstrate that the proposed method efficiently reconstructs models. In addition, granites formed during the Yanshanian and Indosinian periods in the Nanling region, China, are reconstructed according to the modelling size evaluated in agreement with the magnetotelluric profile and density statistics of rock samples. The known ores occur at the contact zones between the sedimentary rocks and the reconstructed Yanshanian granites. The ore-forming bodies, periods, and processes are identified, providing guidance for further deep resource exploration in the study area.
Knockout of the intellectual disability-linked gene Hs6st2 in mice decreases heparan sulfate 6-O-sulfation, impairs dendritic spines of hippocampal neurons, and affects memory
Authors: Moon Sohyun , Lee Hiu Ham , Archer-Hartmann Stephanie , Nagai Naoko , Mubasher Zainab , Parappurath Mahima , Ahmed Laiba , Ramos Raddy L , Kimata Koji , Azadi Parastoo , Cai Weikang , Zhao Jerry Yingtao
Published: November 2023

Heparan sulfate (HS) is a linear polysaccharide that plays a key role in cellular signaling networks. HS functions are regulated by its 6-O-sulfation, which is catalyzed by three HS 6-O-sulfotransferases (HS6STs). Notably, HS6ST2 is mainly expressed in the brain and HS6ST2 mutations are linked to brain disorders, but the underlying mechanisms remain poorly understood. To determine the role of Hs6st2 in the brain, we carried out a series of molecular and behavioral assessments on Hs6st2 knockout mice. We first carried out strong anion exchange-high performance liquid chromatography and found that knockout of Hs6st2 moderately decreases HS 6-O-sulfation levels in the brain. We then assessed body weights and found that Hs6st2 knockout mice exhibit increased body weight, which is associated with abnormal metabolic pathways. We also performed behavioral tests and found that Hs6st2 knockout mice showed memory deficits, which recapitulate patient clinical symptoms. To determine the molecular mechanisms underlying the memory deficits, we used RNA sequencing to examine transcriptomes in two memory-related brain regions, the hippocampus and cerebral cortex. We found that knockout of Hs6st2 impairs transcriptome in the hippocampus, but only mildly in the cerebral cortex. Furthermore, the transcriptome changes in the hippocampus are enriched in dendrite and synapse pathways. We also found that knockout of Hs6st2 decreases HS levels and impairs dendritic spines in hippocampal CA1 pyramidal neurons. Taken together, our study provides novel molecular and behavioral insights into the role of Hs6st2 in the brain, which facilitates a better understanding of HS6ST2 and HS-linked brain disorders.
Results of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer in a mixed practice medium-volume hospital: a propensity-matched study
Authors: Niskakangas Anne , Mustonen Olli , Puro Iiris , Karjula Topias , Helminen Olli , Yannopoulos Fredrik
Published: November 2023

OBJECTIVES

The aim of this study was to compare the short- and long-term results of video-assisted thoracoscopic surgery (VATS) and thoracotomy for non-small-cell lung cancer in a medium-volume centre, where cardiothoracic surgeons perform both cardiac and general thoracic surgery. The primary outcome of interest was 5-year overall survival and disease-specific survival. Secondary outcomes were short-term postoperative complications, length of hospital stay and lymph node yield.

METHODS

This was a retrospective cohort study including 670 lung cancer patients undergoing VATS (n = 207) or open surgery (n = 463) with a curative intent in Oulu University Hospital between the years 2000–2020. Propensity score matching was implemented with surgical technique as the dependent and age, sex, Charlson comorbidity index, pulmonary function, pathological stage, histological type and the year of the operation as covariates resulting in 127 pairs.

RESULTS

In the propensity-matched cohort, 5-year overall survival was 64.3% after VATS and 63.2% after thoracotomy (P = 0.969). Five-year disease-specific survival was 71.6% vs 76.2% (P = 0.559). There were no differences in overall (34.6% vs 44.9%, p = 0.096) or major postoperative complications (8.7% vs 14.2%, P = 0.167) between the study groups. The average length of hospital stay was shorter (5.8 vs 6.6 days, P = 0.012) and the median lymph node yield was lower (4.0 vs 7.0, P < 0.001) in the VATS group compared to the thoracotomy group.

CONCLUSIONS

According to this study, the long-term results of lung cancer surgery in a mixed practice are comparable between VATS and open surgery.
Analytical study to assess the impact of health service quality on patient satisfaction in Hamad Medical Corporation Hospitals in Qatar: using SERVQUAL
Authors: Alrwashdh Saddam , Alishaq Moza
Published: November 2023

Objective

The study aims to assess the impact of the five dimensions of service quality on patient satisfaction and determine which dimension has the greatest impact on patient satisfaction. We can judge service quality through the delivery of excellent services concerning patients’ expectations. Consequently, we can define it as the difference between the patient’s expectations and experiences (patient views, subjectively).

Methods

A total of 400 patients were randomly selected in this study. This study was conducted in Hamad Medical Corporation Hospital, Qatar, in the first half of 2019. We utilized the cross-sectional method using a modified Assessment of Service Quality Questionnaire. The response was recorded on a 5-point Likert scale, wherein ‘one’ indicates ‘strongly disagree’ and ‘five’ indicates ‘strongly agree.’ In addition to these items, global satisfaction was measured by a single item asking participants how they felt after the delivery of health services.

Results

Univariable and multivariable linear regressions were made to test the predefined hypotheses. The study findings showed a statistically significant impact of health service quality on patient satisfaction (P = 0.00). The Standardized Beta proved that the empathy dimension had the greatest impact on patient satisfaction, while assurance had the lowest (β = 0.23 and 0.05, respectively). Also, socio-demographic data have a significant impact on patient satisfaction. The study sample showed that 81% were single, 55.5% were males, and 79.8% were non-Qatari. All hospitals have significant values (P < 0.05). There is variation in patient satisfaction between the newly opened hospitals and the old ones.

Conclusion

Hospital management and policymakers must improve and maintain patient confidentiality, encouraging staff to build confidence and trust in the patient. The management must consider contemporary managerial orientation’s crucial role in delivering quality services and patient satisfaction.
Needs assessment of global pharmaceutical development goals: an explanatory mixed-methods study of 21 countries
Authors: Aqqad Farah , Meilianti Sherly , John Christopher , Koudmani Diala , Akel Marwan , Bates Ian
Published: November 2023

Objectives

Investment in the development of the pharmacy workforce has been recognized as crucial for achieving universal health coverage. The 21 International Pharmaceutical Federation (FIP) Development Goals (DGs) have been used when conducting national needs assessments in several countries to provide evidence-based policy on workforce development. This study aimed to explore factors contributing to education and training in a FIP sample of mainly low- to middle-income countries (LMICs), and current national policy initiatives and priorities, mapped against the FIP DGs.

Methods

The study employed a mixed-methods approach, including an online survey questionnaire and interviews with representatives from 26 national professional organizations from 21 countries. A Multiple Correspondence Analysis (MCA), descriptive analysis, and thematic analysis were carried out to analyse the data.

Key findings

A total of 26 national professional organizations from 21 countries participated in this study. The quantitative MCA results indicated categorical correlations with variables related to the maintenance of licensed pharmacy practice and mechanisms for personal career development and advancement, such as the availability of competency development frameworks. Six themes emerged from the qualitative analysis of ongoing national programmes in the sampled countries: strengthening initial education and training, competency and career development programmes, initiatives related to pharmacists’ role in patient safety, communicable diseases, and antimicrobial stewardship, pharmaceutical care and medicines access, strengthening research to improve pharmacists’ impact, and outcomes and policy review and development.

Conclusion

This study provided an evidence-based needs assessment exploring factors contributing to workforce development and identifying pharmaceutical development priorities mapped to the FIP DGs across a cohort of nations.
Adaptive minimax density estimation on ℝd for Huber’s contamination model
Authors: Zhang Peiliang , Ren Zhao
Published: November 2023

We address the problem of adaptive minimax density estimation on $\mathbb{R}^{d}$ with $L_{p}$ loss functions under Huber’s contamination model. To investigate the contamination effect on the optimal estimation of the density, we first establish the minimax rate with the assumption that the density is in an anisotropic Nikol’skii class. We then develop a data-driven bandwidth selection procedure for kernel estimators, which can be viewed as a robust generalization of the Goldenshluger-Lepski method. We show that the proposed bandwidth selection rule can lead to the estimator being minimax adaptive to either the smoothness parameter or the contamination proportion. When both of them are unknown, we prove that finding any minimax-rate adaptive method is impossible. Extensions to smooth contamination cases are also discussed.
Janus kinase inhibitors ameliorate clinical symptoms in patients with STAT3 gain-of-function
Authors: Kaneko Shuya , Sakura Fumiaki , Tanita Kay , Shimbo Asami , Nambu Ryusuke , Yoshida Masashi , Umetsu Shuichiro , Inui Ayano , Okada Chizuru , Tsumura Miyuki , Yamada Mamiko , Suzuki Hisato , Kosaki Kenjiro , Ohara Osamu , Shimizu Masaki , Morio Tomohiro , Okada Satoshi , Kanegane Hirokazu
Published: November 2023

Germline gain-of-function (GOF) variants in the signal transducer and activator of transcription 3 (STAT3) gene is an inborn error of immunity presenting with autoimmunity and lymphoproliferation. Symptoms can vary widely, and no effective treatment has been established. This study investigated the efficacy of Janus kinase (JAK) inhibitors (JAKi) in patients with STAT3-GOF. Four patients were enrolled and their clinical symptoms before and after the initiation of treatment with JAKi were described. A cell stimulation assay was performed using Epstein-Barr virus transformed lymphoid cell lines (EBV-LCLs) that were derived from the patients with STAT3-GOF. The patients presented with various symptoms, and these symptoms mostly improved after the initiation of JAKi treatment. Upon interleukin-6 stimulation, the EBV-LCLs of patients showed enhanced STAT3 phosphorylation compared with those of the EBV-LCLs of healthy controls. In conclusion, four Japanese patients with STAT3-GOF were successfully treated with JAKi. JAKi ameliorated various symptoms and therefore, the use of JAKi could be an effective treatment option for patients with STAT3-GOF.
Use of Transcriptional Signatures to Differentiate Pathogen-Specific and Treatment-Specific Host Responses in Patients With Bacterial Bloodstream Infections
Authors: Thaden Joshua T , Ahn Richard , Ruffin Felicia , Gjertson David W , Hoffmann Alexander , Fowler Vance G , Yeaman Michael R
Published: November 2023

Background

Clinical outcomes in bacterial bloodstream infections (BSIs) are influenced by bacterial species, host immunity, and antibiotic therapy. The mechanisms by which such factors influence outcomes are poorly understood. We aimed to identify bacterial- and antibiotic-specific host transcriptional signatures in patients with bacterial BSI.

Methods

RNA sequencing was performed on blood samples from patients with BSI due to gram-negative (GN) versus gram-positive (GP) pathogens: Escherichia coli (n = 30) or Klebsiella pneumoniae (n = 28) versus methicillin-susceptible Staphylococcus aureus (MSSA) (n = 24) or methicillin-resistant S. aureus (MRSA) (n = 58). Patients were matched by age, sex, and race.

Results

No significant host transcriptome differences were detected in patients with E. coli versus K. pneumoniae BSI, so these were considered together as GN BSI. Relative to S. aureus BSI, patients with GN BSI had increased activation of the classic complement system. However, the most significant signal was a reduction in host transcriptional signatures involving mitochondrial energy transduction and oxidative burst in MRSA versus MSSA. This attenuated host transcriptional signature remained after controlling for antibiotic therapy.

Conclusions

Given the importance of immune cellular energetics and reactive oxygen species in eliminating hematogenous or intracellular MRSA, these findings may offer insights into its persistence relative to other bacterial BSIs.
Alarming Trends in Dengue Incidence and Mortality in Bangladesh
Authors: Mahmud Ayesha S , Bhattacharjee Joyita , Baker Rachel E , Martinez Pamela P
Published: November 2023

Bangladesh is currently experiencing the country's largest and deadliest dengue outbreak on record. This year's outbreak has been characterized by an early seasonal surge in cases, rapid geographic spread, and a high fatality rate. The alarming trends in dengue incidence and mortality this year is an urgent wake-up call for public health policymakers and researchers to pay closer attention to dengue dynamics in South Asia, to strengthen the surveillance system and diagnostic capabilities, and to develop tools and methods for guiding strategic resource allocation and control efforts.
Culturing the unculturables: strategies, challenges, and opportunities for gut microbiome study
Authors: Yadav Asha , Ahlawat Shruti , Sharma Krishna K
Published: November 2023

Metagenome sequencing techniques revolutionized the field of gut microbiome study. However, it is equipped with experimental and computational biases, which affect the downstream analysis results. Also, live microbial strains are needed for a better understanding of host-microbial crosstalks and for designing next-generation treatment therapies based on probiotic strains and postbiotic molecules. Conventional culturing methodologies are insufficient to get the dark gut matter on the plate; therefore, there is an urgent need to propose novel culturing methods that can fill the limitations of metagenomics. The current work aims to provide a consolidated evaluation of the available methods for host-microbe interaction with an emphasis on in vitro culturing of gut microbes using organoids, gut on a chip, and gut bioreactor. Further, the knowledge of microbial crosstalk in the gut helps us to identify core microbiota, and key metabolites that will aid in designing culturing media and co-culturing systems for gut microbiome study. After the deeper mining of the current culturing methods, we recommend that 3D-printed intestinal cells in a multistage continuous flow reactor equipped with an extended organoid system might be a good practical choice for gut microbiota-based studies.