bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple Mechanisms Confer Fipronil Resistance in the German Cockroach: Enhanced Detoxification and Rdl Mutation
Authors: González-Morales María A , DeVries Zachary C , Santangelo Richard G , Kakumanu Madhavi L , Schal Coby
Published: August 2022

Populations of Blattella germanica (L.) (German cockroach) have been documented worldwide to be resistant to a wide variety of insecticides with multiple modes of action. The phenylpyrazole insecticide fipronil has been used extensively to control German cockroach populations, exclusively in baits, yet the highest reported fipronil resistance is 38-fold in a single population. We evaluated five populations of German cockroaches, collected in 2018–2019 in apartments in North Carolina and assayed in 2019, to determine the status of fipronil resistance in the state. Resistance ratios in field-collected strains ranged from 22.4 to 37.2, indicating little change in fipronil resistance over the past 20 yr. In contrast, resistance to pyrethroids continues to escalate. We also assessed the roles of detoxification enzymes in fipronil resistance with four synergists previously shown to diminish metabolic resistance to various insecticides in German cockroaches—piperonyl butoxide, S,S,S-tributyl phosphorotrithioate, diethyl maleate, and triphenyl phosphate. These enzymes appear to play a variable role in fipronil resistance. We also sequenced a fragment of the Rdl (resistant to dieldrin) gene that encodes a subunit of the GABA receptor. Our findings showed that all field-collected strains are homozygous for a mutation that substitutes serine for an alanine (A302S) in Rdl, and confers low resistance to fipronil. Understanding why cockroaches rapidly evolve high levels of resistance to some insecticides and not others, despite intensive selection pressure, will contribute to more efficacious pest management.
Stress-Mediated Responses of Aedes aegypti (Diptera: Culicidae) Larvae When Exposed to Metarhizium brunneum (Hypocreales: Clavicipitaceae) and Toxorhynchites brevipalpis (Diptera: Culicidae)
Authors: Wood Martyn J , Alkhaibari Abeer M , Butt Tariq M
Published: August 2022

Aedes aegypti mosquitoes are capable of vectoring a wide range of diseases including dengue, yellow fever, and Zika viruses, with approximately half of the worlds’ population at risk from such diseases. Development of combined predator–parasite treatments for the control of larvae consistently demonstrates increased efficacy over single-agent treatments, however, the mechanism behind the interaction remains unknown. Treatments using the natural predator Toxorhynchites brevipalpis and the entomopathogenic fungus Metarhizium brunneum were applied in the laboratory against Ae. aegypti larvae as both individual and combined treatments to determine the levels of interaction between control strategies. Parallel experiments involved the removal of larvae from test arenas at set intervals during the course of the trial to record whole body caspase and phenoloxidase activities. This was measured via luminometric assay to measure larval stress factors underlying the interactions. Combined Metarhizium and Toxorhynchites treatments were seen to drastically reduce lethal times as compared to individual treatments. This was accompanied by increased phenoloxidase and caspase activities in combination treatments after 18 h (p < 0.001). The sharp increases in caspase and phenoloxidase activities suggest that combined treatments act to increase stress factor responses in the larvae that result in rapid mortality above that of either control agent individually. This work concludes that the underlying mechanism for increased lethality in combined parasite–predator treatments may be related to additive stress factors induced within the target host larvae.
A Sigh After Sleep: Poiesis and the Sacramentality of Nature in Annette von Droste-Hüshoff’s Late Lyric
Authors: Sorenson Alexander
Published: August 2022

Critics of Annette von Droste-Hülshoff have long pursued the dominant themes of natural depiction and religiosity in her poetry, and a more recent strain of scholarship has been drawing out the ecological implications of the former, though less so of the latter. The article brings these different lines of interpretation together by exploring how Droste’s late work presents the connection between nature and poiesis as an effect of the Fall, and thus as integral to the human condition. The article shows how these themes are gathered around the figure of Eve and the leitmotif of sleep and argues that tracing these topoi allows us to see that Droste depicts the encounter with nature to be an inherently sacramental event, one which ultimately lays bare a postlapsarian—and ecologically relevant—kinship between poiesis, nature, and human Being.
Galaxy And Mass Assembly: Galaxy Zoo spiral arms and star formation rates
Authors: Porter-Temple R , Holwerda B W , Hopkins A M , Porter L E , Henry C , Geron T , Simmons B , Masters K , Kruk S
Published: August 2022

Understanding the effect spiral structure has on star formation properties of galaxies is important to complete our picture of spiral structure evolution. Previous studies have investigated connections between spiral arm properties and star formation, but the effect that the number of spiral arms has on this process is unclear. Here, we use the Galaxy And Mass Assembly (GAMA) survey paired with the citizen science visual classifications from the Galaxy Zoo project to explore galaxies’ spiral arm number and how it connects to the star formation process. We use the votes from the GAMA-Kilo Degree Survey Galaxy Zoo classification to investigate the link between spiral arm number and stellar mass, star formation rate, and specific star formation rate (sSFR). We find that galaxies with fewer spiral arms have lower stellar masses and higher sSFRs, while those with more spiral arms tend towards higher stellar masses and lower sSFRs, and conclude that galaxies are less efficient at forming stars if they have more spiral arms. We note how previous studies’ findings may indicate a cause for this connection in spiral arm strength or opacity.
Effects of omega-3 supplementation on serum albumin, pre-albumin and the CRP/albumin ratio in hospitalized patients: a systematic review and meta-analysis
Authors: Bagheri Amir , Soltani Sanaz , Asoudeh Farzaneh , Esmaillzadeh Ahmad
Published: August 2022

Context

Low serum albumin and pre-albumin concentrations are associated with edema, infection, thrombosis, heart failure, and mortality.

Objective

This comprehensive systematic review and meta-analysis of clinical trials was conducted to summarize the available findings on the impact of omega-3 supplementation on albumin, pre-albumin, and the C-reactive protein/albumin ratio in hospitalized patients.

Data sources

PubMed, Web of Science, Scopus, and Google Scholar databases were searched from January 1990 to October 2021.

Data Extraction

Extracted data from 50 randomized controlled trials (RCTs) with a total number of 3196 participants were analyzed using the random-effects model. The dose-dependent effect was also evaluated.

Data Analysis

Oral omega-3 supplementation significantly increased serum albumin concentrations in patients with cancer (weighted mean difference [WMD]: 0.19; 95% CI: 0.05, 0.33, P= 0.006), patients on dialysis (WMD: 0.14; 95% CI: 0.01, 0.28, P= 0.042), and those with hypoalbuminemia (WMD: 0.38; 95% CI: 0.03, 0.72, P = 0.033); however, there was no significant effect among patients with gastrointestinal or hepatologic diseases. Moreover, each 1000 mg/day increase in oral omega-3 supplementation resulted in elevated serum albumin levels in cancer patients (WMD: 0.15; 95% CI: 0.07, 0.24, P < 0.001). In addition, a favorable effect of oral omega-3 supplementation on pre-albumin levels was observed among patients with cancer (WMD: 33.87; 95% CI: 12.34, 55.39, P = 0.002). A similar significant effect of parenteral omega-3 supplementation on pre-albumin concentrations was seen among those with gastrointestinal and hepatologic diseases as well (WMD: 23.30; 95% CI: 13.58, 33.03, P < 0.001). No significant effect of oral omega-3 supplementation on the CRP/albumin ratio was found.

Conclusions

Overall, omega-3 fatty acids supplementation resulted in a favorable change in serum albumin and pre-albumin concentrations in hospitalized patients.

Systematic Review Registration

PROSPERO registration no. CRD42021285704.
The deubiquitinating enzymes UBP12 and UBP13 positively regulate recovery after carbon starvation by modulating BES1 stability inArabidopsis thaliana
Authors: Xiong Jiawei , Yang Fabin , Yao Xiuhong , Zhao Yuqing , Wen Yu , Lin Honghui , Guo Hongqing , Yin Yanhai , Zhang Dawei
Published: August 2022

BRI1-EMS-SUPPRESSOR1 (BES1), a core transcription factor in the brassinosteroid (BR) signaling pathway, primarily regulates plant growth and development by influencing BR-regulated gene expression. Several E3 ubiquitin (Ub) ligases regulate BES1 stability, but little is known about BES1 deubiquitination, which antagonizes E3 ligase-mediated ubiquitination to maintain BES1 homeostasis. Here, we report that two Arabidopsis thaliana deubiquitinating enzymes, Ub-SPECIFIC PROTEASE (UBP) 12 and UBP13, interact with BES1. UBP12 and UBP13 removed Ub from polyubiquitinated BES1 to stabilize both phosphorylated and dephosphorylated forms of BES1. A double mutant, ubp12-2w ubp13-3, lacking UBP12 and UBP13 function showed both BR-deficient and BR-insensitive phenotypes, whereas transgenic plants overexpressing UBP12 or UBP13 exhibited an increased BR response. Expression of UBP12 and UPB13 was induced during recovery after carbon starvation, which led to BES1 accumulation and quick recovery of stressed plants. Our work thus establishes a mechanism by which UBP12 and UBP13 regulate BES1 protein abundance to enhance BR-regulated growth during recovery after carbon starvation.
Virus-induced gene silencing forin plantavalidation of gene function in cucurbits
Authors: Rhee Sun-Ju , Jang Yoon Jeong , Park Jun-Young , Ryu Jisu , Lee Gung Pyo
Published: August 2022

Virus-induced gene silencing (VIGS) is a powerful tool for high-throughput analysis of gene function. Here, we developed the VIGS vector pCF93, from which expression of the cucumber fruit mottle mosaic virus genome is driven by the cauliflower mosaic virus 35S promoter to produce viral transcripts in inoculated plants. To test the utility of the pCF93 vector, we identified candidate genes related to male sterility (MS) in watermelon (Citrullus lanatus), which is recalcitrant to genetic transformation. Specifically, we exploited previously reported reference-based and de novo transcriptome data to define 38 differentially expressed genes between a male-sterile line and its fertile near-isogenic line in the watermelon cultivar DAH. We amplified 200- to 300-bp fragments of these genes, cloned them into pCF93, and inoculated DAH with the resulting VIGS clones. The small watermelon cultivar DAH enabled high-throughput screening using a small cultivation area. We simultaneously characterized the phenotypes associated with each of the 38 candidate genes in plants grown in a greenhouse. Silencing of 8 of the 38 candidate genes produced male-sterile flowers with abnormal stamens and no pollen. We confirmed the extent of gene silencing in inoculated flowers using reverse transcription–qPCR. Histological analysis of stamens from male-fertile and male-sterile floral buds and mature flowers revealed developmental defects and shrunken pollen sacs. Based on these findings, we propose that the pCF93 vector and our VIGS system will facilitate high-throughput analysis for the study of gene function in watermelons.
Police ethics committees in England and Wales: Exploratory online and web surveys
Authors: Snelling Paul , MacVean Allyson , Lewis Richard
Published: August 2022

Drawing from practice and learning of Clinical Ethics Committees, Police Ethics Committees began to emerge in the years following the statutory creation of the College of Policing in 2012, but there is little research on their form and effectiveness. This paper reports the results of exploratory online and web surveys undertaken in 2021. The surveys revealed committees with the word ‘ethics’ in their title fell within two different types. First, discursive and advisory committees, largely inclusive but with those operated by the large forces in London and Greater Manchester functioning more like expert panels. Second, some committees operated within formal governance structures, receiving reports and scrutinizing aspects of police performance including complaints. Variation in operation between Police Ethics Committees was evident in respect of composition, web presence and reporting mechanisms. Further research on the operation and effectiveness of Ethics Committees is required.
Two kinds of problem-solving
Authors: Thacher David
Published: August 2022

Many of problem-oriented policing’s most thoughtful students have worried that it makes unrealistic demands on officers, and some of them have suggested that police might need to settle for a less ambitious version of Goldstein’s original model. This paper argues that these worries and suggestions rest on a faulty interpretation of that model’s logic. The most significant feature of problem-oriented policing lies not in the identification and resolution of community problems but in the identification and reform of defective organizational routines. ‘Problems’ are signals that organizational practices are failing, and ‘problem-solving’ is the work of analyzing how they can be reformed. This interpretation has implications for the kind of knowledge problem-solving should rely on and the organizational structure in which it should be embedded.
Are Intermediary Constraints Priced?
Authors: Du Wenxin , Hébert Benjamin , Huber Amy Wang
Published: August 2022

Violations of no-arbitrage conditions measure the shadow cost of intermediary constraints. Intermediary asset pricing and intertemporal hedging together imply that the risk of these constraints tightening is priced. We describe a “forward CIP trading strategy” that bets on CIP violations shrinking and show that its returns help identify the price of this risk. This strategy yields the highest returns for currency pairs associated with the carry trade. The strategy’s risk substantially contributes to the volatility of the stochastic discount factor, is correlated with both other near-arbitrages and intermediary wealth measures, and appears to be consistently priced across various asset classes.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
INVESTIGATION OF RADIATION RISKS BASED ON THE CLINICAL FINDINGS FROM HEAD CT SCANS IN TRAUMA
Authors: Shubayr Nasser , Alomairy Nada , Aldawood Saad
Published: August 2022

This study aimed to investigate the radiation risks in terms of effective dose and the cancer risk probability resulting from computed tomography (CT) scans of the head for traumatic patients and determine how often traumatic abnormalities occur. Data were collected retrospectively for 138 traumatic patients from the picture archiving and communication system, including exposure parameters and clinical findings. The mean values of the dose length product, CT dose index volume and effective dose for the CT head examinations were 787 ± 67.7 mGy•cm, 40.1 ± 1.33 mGy and 1.47 ± 0.12 mSv, respectively. Of the total cases of CT scans of the head, 57.2% (n = 79) exhibited positive findings. The cancer risk probability for the patients was 6.04 × 10−5 per procedure, with no statistically significant differences between positive and negative findings (p = 0.345). Taking into consideration the justification of the examination, the risk of missing positive findings and the radiation risks, the immediate benefit of head CT for trauma patients for guiding medical decisions outweighs the radiation risk that will probably manifest later.
Balancing interests between freedom and censorship: Organizational strategies for quality assurance in science communication
Authors: Fecher Benedikt , Kuper Freia , Fähnrich Birte , Schmid-Petri Hannah , Schildhauer Thomas , Weingart Peter , Wormer Holger
Published: August 2022

While science communication is increasingly being discussed as a third mission alongside research and teaching, there is little research on how universities and research organizations deal with issues regarding the quality of science communication. This article examines, from an organizational perspective, which new forms of quality assurance processes scientific organizations in Germany apply when addressing quality risks for science communication such as exaggeration in press releases or in the online communication of individual faculty members. Six focus group discussions were conducted with 22 participants (rectors or presidents of universities, heads of communication, ombudsmen, and high-impact researchers). Based on the results, proposals were developed to extend central as well as decentral organizational structures to assure good scientific communication practice. Their possible implementation was discussed in a workshop with representatives of all abovementioned groups. In conclusion, recommendations for future institutional policy are presented.
Metabolic Competency of Larval Zebrafish in Drug-Induced Liver Injury: A Case Study of Acetaminophen Poisoning
Authors: Chen Yijia , Song Weiyi , Ge Wei , Yan Ru
Published: August 2022

Larval zebrafish is emerging as a new model organism for studying drug-induced liver injury (DILI) with superiorities in visual assessment, genetic engineering as well as high throughput. Metabolic bioactivation to form reactive intermediates is a common event that triggers DILI. This study first addressed the correlation between acetaminophen metabolism and hepatotoxicity in zebrafish larvae (3-day postfertilization) and demonstrated the occurrence of cytochrome P450 enzymes-mediated acetaminophen (APAP) bioactivation at early developmental stage through characterizing the dose-effect (0–1.6 mg/ml) and the time course (0–72 h) of liver injury and metabolism in the AB strain and LiPan transgenic line Tg(lfabp10a: DsRed; elaA:egfp) expressing the liver-specific fluorescent protein. APAP caused multiorgan developmental retardation and elicited dose- and time-dependent hepatotoxicity. Liver imaging revealed significant changes earlier than histological and biochemical measurements. APAP bioactivation in larval zebrafish was first confirmed by the detection of the glutathione conjugate of the reactive intermediate NAPQI (NAPQI-GSH) and subsequent mercapturate derivatives NAPQI-cysteine and NAPQI-N-acetylcysteine after even short (0.5-h postexposure) or low (0.2 mg/ml) APAP exposure. APAP overdose impaired metabolic function, in particular sulfation, whereas facilitated GSH depletion and APAP sulfate excretion. Meanwhile, APAP displayed triphasic accumulation in the larvae, agreeing with fluctuating metabolic capabilities with sulfation dominating the early larval developmental stage. Most importantly, the dose-response effects and time course of APAP accumulation and metabolism agree well with those of the liver injury development. Overall, larval zebrafish has developed mammalian-like metabolic function, enabling it an ideal model organism for high-throughput screening hepatotoxicity and mechanistic study of bioactivation-based DILI.
Effect of Vitamin D Supplementation on CD4 Count in HIV-Infected Children and Adolescents in North India: A Non-Randomized Comparative Study
Authors: Verma Prabha , Shrivastava Anubha , Siddiqui Shahid Akhtar , Yadav Rajesh Kumar , Singh Mukesh Vir , Tripathi Ambuj , Maurya Manisha , Mishra Nandita
Published: August 2022

Background

HIV infection is still a serious public health issue globally. Suboptimal vitamin D status is highly prevalent in HIV-infected children and adolescents throughout the world.

Objectives

To evaluate the outcome of vitamin D supplementation on CD4 count in HIV-infected children and adolescents with suboptimal vitamin D status.

Methods

Vitamin D level of HIV-infected children and adolescents were measured at enrolment. Suboptimal vitamin D level was defined as 25(OH)D < 30 ng/ml. Vitamin D insufficiency and deficiency were defined as 21–29 and <20 ng/ml, respectively. Children with suboptimal vitamin D levels were supplemented with vitamin D.

Results

This was a single-centre, non-randomized comparative study enrolling 50 eligible participants. There were 20 patients who were vitamin D sufficient, 7 were vitamin D insufficient and 23 were found to be vitamin D deficient at enrolment. However, after supplementation, the status of sufficient remained same and 7 insufficient become sufficient, whereas in 23 deficient, 18 (78.3%) become sufficient and 5 (21.7%) become insufficient and this change was found statistically significant among the groups (χ2 = 6.52, p = 0.038). There was a significant improvement of CD4 count from baseline to 4 months in deficient group on vitamin D supplementation (p value < 0.001; 1.2-fold rise). No significant change was seen in vitamin D insufficient (p value = 0.791) and sufficient groups (p value = 0.168).

Conclusion

Vitamin D should be supplemented in HIV-infected children on ART with low CD4 counts.
Mitogenomes resolve the phylogeography and divergence times within the endemic New Zealand Callaeidae (Aves: Passerida)
Authors: Lubbe Pascale , Rawlence Nicolas J , Kardailsky Olga , Robertson Bruce C , Day Robert , Knapp Michael , Dussex Nicolas
Published: August 2022

The biogeographical origins of the endemic birds of New Zealand (Aotearoa) are of great interest, particularly Palaeogene lineages such as Callaeidae, a passerine family characterized by brightly coloured wattles behind the beak and, in some cases, extreme sexual dimorphism in bill size and shape. Ancestral representatives of Callaeidae are thought to have split from their closest relatives outside New Zealand in the Oligocene, but little is known about the timing of divergences within the family. We present a fully dated molecular phylogeny of Callaeidae mitogenomes and discuss the biogeographical implications. Our results suggest that formation of Pliocene marine seaways, such as the Manawatu Strait, are likely to have played a significant role in the differentiation of North Island and South Island kōkako (Callaeas spp.) and saddlebacks/tīeke (Philesturnus spp.).
Systemic Colonization of Potato Plants by Verticillium dahliae Leads to Infection of Tubers and Sprouting Buds
Authors: Zhang Yuanyuan , Kang Liru , Gao Jing , Puri Krishna D. , Jia Ruifang , Zhang Zhiwei , Zhang Jian , Zhao Jun
Published: August 2022

A green fluorescent protein (GFP)-tagged isolate of Verticillium dahliae was used to study its colonization in potato plants and tubers. Three-week-old potato plants of the highly susceptible cultivar ‘Shepody’ were inoculated with a conidial suspension of a GFP-tagged isolate of V. dahliae using a wound inoculation method. Colonization was studied using confocal microscopy combined with tissue sections. Conidia germinated and hyphae grew along the root hairs, elongation zones, and root caps between 24 and 96 h postinoculation (HPI). At 7 days postinoculation (DPI), the pathogen advanced to cortical tissues and grew into the root vascular bundles. At 8 weeks postinoculation (WPI), the stem epidermal cells, cortical tissues, vascular elements, and petioles were fully colonized by the mycelium of V. dahliae. At 11 WPI, the pathogen was detected in the stolon and progeny tubers, as confirmed by both GFP signals in tissues and reisolation of the pathogen on the semiselective NP-10 medium. Progeny potato tubers were harvested from the inoculated potato plants, and the GFP-signal was observed in the epidermal cells and vascular elements of sprouting buds that emerged from the harvested tubers. The infection rate of progeny tubers detected on semiselective NP-10 medium ranged from 34.55 to 55.56%, with an average of 45.31%. In conclusion, we report, for the first time, the entire progression of colonization by V. dahliae in potato plant tissues, progeny tubers, as well as of the sprouting buds that emerged from progeny tubers.
Vaping
Authors: DeGomez Chelsey , Feirstein Jennifer
Published: August 2022

The topic of vaping is becoming increasingly prevalent in healthcare, especially regarding adolescents as their use of electronic cigarette products continues to increase. The many factors to consider include the safety of these products, human health and behavior, and social effects. Healthcare providers need to be aware of these issues to provide appropriate education and care to adolescent patients.
Clinical care pathways for ambulatory total shoulder arthroplasty
Authors: Dong Xuezhi , Wu Christopher L. , YaDeau Jacques T.
Published: August 2022

Purpose of review

Total shoulder arthroplasty (TSA) is growing in popularity and is increasingly done on an ambulatory basis. This review examines recent developments in anesthesia and analgesia for ambulatory shoulder surgery. Pathway components are discussed and a sample pathway is described.

Recent Findings

Adoption of pathways for shoulder surgery improves patient experience by reducing pain, opioid use, and side effects while improving patient satisfaction. Long-acting nerve blockade using adjuvants like dexamethasone provide long-lasting analgesia without rebound pain. Peripheral nerve blockade provides better analgesia than peri-articular injection of local anesthetic. There are multiple approaches to nerve blockade for shoulder surgery to consider, including interscalene, superior trunk, supraclavicular, and anterior suprascapular nerve blocks. Multimodal analgesia should include acetaminophen and nonsteroidal anti-inflammatory drugs, but routine gabapentinoids should not be used.

Anesthesiologists should lead the way to create and implement pathways for ambulatory total shoulder arthroplasty, incorporating appropriate patient selection, patient education, long-lasting nerve blockade, and multimodal analgesia.
Financial Burden of Pediatric Anterior Cruciate Ligament Reconstruction
Authors: Xu Amy L. , Mun Frederick , Gupta Arjun , Margalit Adam , Prasad Niyathi , Lee Rushyuan J.
Published: August 2022

Background:

High costs and lack of price transparency for common pediatric orthopaedic procedures create financial burden for patients. We assessed (1) how patient medical debt after anterior cruciate ligament reconstruction (ACLR) correlates with health insurance type; and (2) factors associated with patient financial burden and worry after ACLR.

Methods:

We reviewed records of 122 patients aged below 18 years who underwent ACLR at our US academic hospital from 2016 to 2020. Patients were grouped by health insurance type: private (n=80) or public (n=42). A telephone survey about ACLR-related financial burden and worry was administered to patients’ parents (45% response rate). Primary outcomes were patient medical debt and patient-reported financial burden measured by the financial burden composite score (0 to 6, with 6 representing highest burden) and dichotomized worry score (1 to 3, low worry; 4 to 5, high worry). We used univariate analyses to compare financial outcomes and multivariable regressions to determine factors associated with reported financial burden (alpha=0.05).

Results:

Debt after ACLR was reported by 10 of 122 patients (8%), all of whom had private insurance (P=0.045). Of 55 survey respondents, treatment-related financial burden was reported by 32 (58%). Mean±SD financial burden composite scores were higher for privately insured (1.8±2.0) versus publicly insured patients (0.74±1.2) (P=0.02), but rates of high financial worry were similar (private, 8% vs. public, 21%) (P=0.22). A higher proportion of patients with private insurance (31%) reported having to use savings after ACLR compared with publicly insured patients (5%) (P=0.04). The most frequently cited reason for financial burden was the cost of postoperative physical therapy (PT) (n=21). Number of PT visits was independently associated with financial burden composite scores (P=0.02). Insurance type was not independently associated with financial burden (P>0.05).

Conclusion:

Although a small proportion of patients generated medical debt after ACLR (greater for those privately vs. publicly insured), the majority reported treatment-related financial burden primarily driven by PT costs.

Level of Evidence:

Level III.
Are Octogenarians at Higher Risk of Complications After Elective Lumbar Spinal Fusion Surgery? Analysis of a Cohort of 7,880 patients from the Kaiser Permanente Spine Registry
Authors: Kuo Calvin C. , Royse Kathryn E. , Prentice Heather A. , Harris Jessica E. , Guppy Kern H.
Published: August 2022

Study Design.

A retrospective cohort study with chart review

Objective.

To determine if there is a difference in risk of adverse outcomes following elective posterior instrumented lumbar spinal fusions for patients aged ≥80 compared to patients aged 50-79.

Summary of Background Data.

Patients aged ≥80 years are undergoing elective lumbar spinal fusion surgery in increasing numbers. There are conflicting data on the risks of intraoperative and postoperative complications in these patients.

Methods.

Patients aged ≥80 were compared to 50-79 (reference group) using time-dependent multivariable Cox-Proportional Hazards regression with a competing risk of death for longitudinal outcomes and multivariable logistic regression for binary outcomes. Outcome measures used were 1) intraoperative complications (durotomy), 2) postoperative complications: 30-day outcomes (pneumonia); 90-day outcomes (deep vein thrombosis [DVT], pulmonary embolism [PE], emergency room [ER] visits, readmission, reoperations, and mortality); and 2-year outcomes (reoperations and mortality).

Results.

The cohort consisted of 7,880 patients who underwent primary elective posterior instrumented lumbar spinal fusion (L1-S1) for degenerative disc disease or spondylolisthesis. This was subdivided into 596 patients were aged ≥80 and 7284 patients aged 50-79. After adjustment, patients aged ≥80 had a higher likelihood of durotomy (odds ratio [OR]=1.43, 95% confidence interval [CI]=1.02-2.02) and 30-day pneumonia (OR=1.81, 95% CI=1.01-3.23). However, there was a lower risk of reoperation within 2-years of the index procedure (hazard ratio [HR]=0.69, 95% CI=0.48-0.99). No differences were observed for mortality, readmissions, ER visits, PE, or DVT.

Conclusions.

In a cohort of 7,880 elective posterior instrumented lumbar fusion patients for degenerative disc disease or spondylolisthesis, we did not observe any significant risks of adverse events between patients aged ≥80 and those aged 50-79 except higher durotomies and 30-day pneumonia in the former. We believe octogenarians can safely undergo lumbar fusions, but proper preoperative screening is necessary to reduce the risks of 30-day pneumonia.
Sex-specific association between coffee consumption and incident chronic kidney disease: a population-based analysis of 359,906 participants from the UK Biobank
Authors: Tang Lei , Yang Lina , Chen Wenwen , Li Chunyang , Zeng Yu , Yang Huazhen , Hu Yao , Qu Yuanyuan , Song Huan , Zeng Xiaoxi , Fu Ping
Published: August 2022

Background:

The risk for chronic kidney disease (CKD) is influenced by genetic predisposition, sex, and lifestyle. Previous research indicates that coffee is a potentially protective factor in CKD. The current study aims to investigate whether sex disparity exists in the coffee–CKD association, and whether genetic risk of CKD or genetic polymorphisms of caffeine metabolism affect this association.

Methods:

A total of 359,906 participants from the UK Biobank who were enrolled between 2006 and 2010 were included in this prospective cohort study, which aimed to estimate the hazard ratios for coffee intake and incident CKD using a Cox proportional hazard model. Allele scores of CKD and caffeine metabolism were additionally adjusted for in a subsample with qualified genetic data (n = 255,343). Analyses stratified by genetic predisposition, comorbidities, and sex hormones were performed. Tests based on Bayesian model averaging were conducted to ascertain the robustness of the results.

Results:

Coffee was inversely associated with CKD in a dose-dependent manner. The effects of coffee did not differ across different strata of genetic risk for CKD, but were more evident among slower genetically predicted caffeine metabolizers. Significant sex disparity was observed (P value for interaction = 0.013), in that coffee drinking was only associated with the risk reduction of CKD in females. Subgroup analysis revealed that testosterone and sex hormone-binding globulin (SHBG), but not estradiol, modified the coffee–CKD association.

Conclusions:

In addition to the overall inverse coffee–CKD association that was observed in the general population, we could also establish that a sex disparity existed, in that females were more likely to experience the benefit of the association. Testosterone and SHBG may partly account for the sex disparity.
Bile reflux and bile acids in the progression of gastric intestinal metaplasia
Authors: Qu Xiaodong , Shi Yongquan
Published: August 2022

Gastric intestinal metaplasia (GIM) is a precancerous lesion of gastric cancer (GC) and is considered an irreversible point of progression for GC. Helicobacter pylori infection can cause GIM, but its eradication still does not reverse it. Bile reflux is also a pathogenic factor in GIM and can continuously irritate the gastric mucosa, and bile acids in refluxed fluid have been widely reported to be associated with GIM. This paper reviews in detail the relationship between bile reflux and GIM and the mechanisms by which bile acids induce GIM.
Patient blood management in the ICU
Authors: Neef Vanessa , Blum Lea , Hof Lotta , Choorapoikayil Suma , Kieserling Kira , Meybohm Patrick , Steinbicker Andrea U. , Zacharowski Kai , Piekarski Florian
Published: August 2022

The majority of ICU patients are anaemic. Anaemia is associated with worse outcomes and a necessity for red blood cell transfusions. ICU patients are a heterogeneous patient group with a broad spectrum of main diagnoses and comorbidities. Evidence-based transfusion trigger guidelines have been established that are dependent on comorbidities. Special attention has been given to blood saving measures and point-of-care diagnosis of coagulation disorders in ICU patients. The administration of intravenous iron and erythropoiesis-stimulating agents can provide useful and individualised alternatives to the administration of red blood cell concentrates in treatment of iron deficiency anaemia. In presence of inflammation and infection, it is challenging to identify the cause of anaemia. The hepcidin-ferroportin pathway may facilitate the diagnosis of anaemia in ICU patients and indicate novel targets in anaemia treatment.

This review article presents patient blood management measures and summarises the current literature on transfusion thresholds and alternative therapeutic options using intravenous iron and erythropoiesis-stimulating agents with a key focus on the ICU.
Ventriculo-arterial coupling: from physiological concept to clinical application in peri-operative care and ICUs
Authors: Guinot Pierre-Grégoire , Andrei Stefan , Longrois Dan
Published: August 2022

As an extension of the traditional heart-centred pressure-flow model, the ventriculo-arterial coupling concept is based on the pressure–volume relationship of the left ventricle and the vascular system. Even though ventriculo-arterial coupling has been studied in cardiology for more than 30 years, its value in clinical practice in anaesthesia and ICU remains poorly known and used.

The clinical interest in ventriculo-arterial coupling is derived from its strong connection with cardiac energetics and efficiency. An alteration of ventriculo-arterial coupling is a marker of disease severity and is associated with outcome. The main categories of cardio-circulatory failures observed in ICU patients commonly exhibit alterations in ventriculo-arterial coupling with typical patterns. Furthermore, the effectiveness of usual haemodynamic treatments and interventions correlates with ventriculo-arterial coupling improvements in ICU patients. Consequently, treatment and management bundles may be proposed to specifically target the correction of ventriculo-arterial uncoupling to optimise the patients’ haemodynamic status and outcome. Restoring ventriculo-arterial coupling with treatments improves outcomes in subgroups of ICU patients.

Even though ventriculo-arterial coupling evaluation cannot be considered as a part of the basic core curriculum of anaesthesiologists and ICU residents, anaesthesia and ICU practitioners must be familiarised with the clinical significance of ventriculo-arterial (un)coupling and availability of its bedside noninvasive evaluation. The understanding of ventriculo-arterial coupling may be particularly important in complex haemodynamic clinical situations.
Partial Identification of the Average Causal Effect in Multiple Study Populations: The Challenge of Combining Mendelian Randomization Studies
Authors: Diemer Elizabeth W. , Zuccolo Luisa , Swanson Sonja A.
Published: August 2022

Background:

Researchers often use random-effects or fixed-effects meta-analysis to combine findings from multiple study populations. However, the causal interpretation of these models is not always clear, and they do not easily translate to settings where bounds, rather than point estimates, are computed.

Methods:

If bounds on an average causal effect of interest in a well-defined population are computed in multiple study populations under specified identifiability assumptions, then under those assumptions the average causal effect would lie within all study-specific bounds and thus the intersection of the study-specific bounds. We demonstrate this by pooling bounds on the average causal effect of prenatal alcohol exposure on attention deficit-hyperactivity disorder symptoms, computed in two European cohorts and under multiple sets of assumptions in Mendelian randomization (MR) analyses.

Results:

For all assumption sets considered, pooled bounds were wide and did not identify the direction of effect. The narrowest pooled bound computed implied the risk difference was between −4 and 34 percentage points.

Conclusions:

All pooled bounds computed in our application covered the null, illustrating how strongly point estimates from prior MR studies of this effect rely on within-study homogeneity assumptions. We discuss how the interpretation of both pooled bounds and point estimation in MR is complicated by possible heterogeneity of effects across populations.
Long-term Traffic-related Air Pollutant Exposure and Amyotrophic Lateral Sclerosis Diagnosis in Denmark: A Bayesian Hierarchical Analysis
Authors: Parks Robbie M. , Nunez Yanelli , Balalian Arin A. , Gibson Elizabeth A. , Hansen Johnni , Raaschou-Nielsen Ole , Ketzel Matthias , Khan Jibran , Brandt Jørgen , Vermeulen Roel , Peters Susan , Goldsmith Jeff , Re Diane B. , Weisskopf Marc G. , Kioumourtzoglou Marianthi-Anna
Published: August 2022

Background:

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Limited evidence suggests ALS diagnosis may be associated with air pollution exposure and specifically traffic-related pollutants.

Methods:

In this population-based case–control study, we used 3,937 ALS cases from the Danish National Patient Register diagnosed during 1989–2013 and matched on age, sex, year of birth, and vital status to 19,333 population-based controls free of ALS at index date. We used validated predictions of elemental carbon (EC), nitrogen oxides (NOx), carbon monoxide (CO), and fine particles (PM2.5) to assign 1-, 5-, and 10-year average exposures pre-ALS diagnosis at study participants’ present and historical residential addresses. We used an adjusted Bayesian hierarchical conditional logistic model to estimate individual pollutant associations and joint and average associations for traffic-related pollutants (EC, NOx, CO).

Results:

For a standard deviation (SD) increase in 5-year average concentrations, EC (SD = 0.42 µg/m3) had a high probability of individual association with increased odds of ALS (11.5%; 95% credible interval [CrI] = –1.0%, 25.6%; 96.3% posterior probability of positive association), with negative associations for NOx (SD = 20 µg/m3) (–4.6%; 95% CrI = 18.1%, 8.9%; 27.8% posterior probability of positive association), CO (SD = 106 µg/m3) (–3.2%; 95% CrI = 14.4%, 10.0%; 26.7% posterior probability of positive association), and a null association for nonelemental carbon fine particles (non-EC PM2.5) (SD = 2.37 µg/m3) (0.7%; 95% CrI = 9.2%, 12.4%). We found no association between ALS and joint or average traffic pollution concentrations.

Conclusions:

This study found high probability of a positive association between ALS diagnosis and EC concentration. Further work is needed to understand the role of traffic-related air pollution in ALS pathogenesis.
Case Findings: Sodium Ferric Gluconate Complex and Fetal Bradycardia
Authors: Droney Madeline , Scovell Samuel , Hatfield Joanne , Pender Erin
Published: August 2022

Anemia in pregnancy is a significant event that often requires treatment to prevent long term effects in the mother and the fetus. Many factors determine which iron preparation to use, including route and ease of administration, patient tolerability, safety, and cost. This case report summarizes two separate patient cases where sodium ferric gluconate complex was administered intravenously to pregnant women, resulting in fetal bradycardia and emergent cesarean procedures.
The Association Between a Second Course of Cardiac Rehabilitation and Cardiovascular Outcomes Following Repeat Percutaneous Coronary Intervention Events
Authors: Zhang Wenliang , Supervia Marta , Dun Yaoshan , Lennon Ryan J. , Ding Rongjing , Sandhu Gurpreet , Tilbury Thomas , Squires Ray W. , Vardar Ufuk , Tabatabaei Niloufar , Thomas Randal J.
Published: August 2022

Purpose:

Survivors of coronary artery disease (CAD) events are at risk for repeat events. Although evidence supports cardiac rehabilitation (CR) after an initial CAD event, it is unclear whether a repeat course of CR (CR × 2) is beneficial after a recurrent CAD event. The purpose of this study was to determine the association of CR × 2 with clinical outcomes in persons undergoing repeat percutaneous coronary intervention (PCI).

Methods:

We assessed the prevalence of CR × 2 and its impact on cardiovascular outcomes in individuals who experienced a repeat PCI at the Mayo Clinic hospitals between January 1, 1998, and December 31, 2013. Landmark analyses were used to calculate unadjusted and propensity score adjusted mortality rates and cardiovascular (CV) events rates for patients who underwent CR × 2 compared with those who did not.

Results:

Among 240 individuals who had a repeat PCI and who had participated in CR after their first PCI, 97 (40%) participated in CR × 2. Outcomes were assessed for a mean follow-up time of 7.8 yr (IQR 7.1-9.0 yr). Propensity score-based inverse probability weighting analysis revealed that CR × 2 was associated with significantly lower target lesion revascularization (HR = 0.47: 95% CI, 0.26-0.86; P = .014), lower combined end point of CV death, myocardial infarction, and target lesion revascularization (HR = 0.57: 95% CI, 0.36-0.89; P = .014), and lower CV hospitalization (HR = 0.60; 95% CI, 0.43-0.84; P = .003).

Conclusion:

A second course of CR following repeat PCI is associated with a lower risk of adverse clinical outcomes. These findings support current policies that allow for repeat courses of CR following recurrent CV events.
Arterial stiffness and atrial fibrillation: shared mechanisms, clinical implications and therapeutic options
Authors: Vio Riccardo , Giordani Andrea S. , Stefil Maria , Madine Jillian , Fairbairn Timothy , Themistoclakis Sakis , Salvi Paolo , Caforio Alida L.P. , Shantsila Alena , Shantsila Eduard , Akhtar Riaz , Field Mark , Lip Gregory Y.H. , Proietti Riccardo
Published: August 2022

Arterial stiffness (AS) and atrial fibrillation (AF) share commonalities in molecular and pathophysiological mechanisms and numerous studies have analyzed their reciprocal influence. The gold standard for AS diagnosis is represented by aortic pulse wave velocity, whose measurement can be affected by arrhythmias characterized by irregularities in heart rhythm, such as AF. Growing evidence show that patients with AS are at high risk of AF development. Moreover, the subset of AF patients with AS seems to be more symptomatic and rhythm control strategies are less effective in this population. Reducing AS through de-stiffening interventions may be beneficial for patients with AF and can be a new appealing target for the holistic approach of AF management.

In this review, we discuss the association between AS and AF, with particular interest in shared mechanisms, clinical implications and therapeutic options.
Forkhead box O3 longevity genotype may attenuate the impact of hypertension on risk of intracerebral haemorrhage
Authors: Nakagawa Kazuma , Chen Randi , Greenberg Steven M. , Ross G. Webster , Willcox Bradley J. , Donlon Timothy A. , Allsopp Richard C. , Willcox D. Craig , Morris Brian J. , Masaki Kamal H.
Published: August 2022

Objective:

Since the G allele of forkhead box O3 (FOXO3) single nucleotide polymorphism (SNP) rs2802292 is associated with resilience and longevity, ostensibly by mitigating the adverse effects of chronic cardiometabolic stress on mortality, our aim was to determine the association between the FOXO3 SNP rs2802292 genotype and risk of hypertension-mediated intracerebral haemorrhage (ICH).

Methods:

From a prospective population-based cohort of Japanese American men from the Kuakini Honolulu Heart Program (KHHP), age-adjusted prevalence of ICH by hypertension was assessed for the whole cohort after stratifying by FOXO3 genotype. Cox regression models, adjusted for age, cardiovascular risk factors and, FOXO3 and APOE genotypes, were utilized to determine relative risk of hypertension's effect on ICH. All models were created for the whole cohort and stratified by FOXO3 G-allele carriage vs. TT genotype.

Results:

Among 6469 men free of baseline stroke, FOXO3 G-allele carriage was seen in 3009 (46.5%) participants. Overall, 183 participants developed ICH over the 34-year follow-up period. Age-adjusted ICH incidence was 0.90 vs. 1.32 per 1000 person-years follow-up in those without and with hypertension, respectively (P = 0.002). After stratifying by FOXO3 genotype, this association was no longer significant in G allele carriers. In the whole cohort, hypertension was an independent predictor of ICH (relative risk [RR] = 1.70, 95% confidence interval [CI] 1.25, 2.32; P = 0.0007). In stratified analyses, hypertension remained an independent predictor of ICH among the FOXO3 TT-genotype group (RR = 2.02, 95% CI 1.33, 3.07; P = 0.001), but not in FOXO3 G-allele carriers (RR = 1.39, 95% CI 0.88, 2.19; P = 0.15).

Conclusions:

The longevity-associated FOXO3 
G allele may attenuate the impact of hypertension on ICH risk.