bluuebunny/crossref_metadata_2025 huggingface dataset:
Blockchain‐Based Trust Auction for Dynamic Virtual Machine Provisioning and Allocation in Clouds
Authors: Xu Hao , Liu Weifeng , Liu Xu
Published: June 2021

Cloud computing uses virtualization technology to provide users with different types of resources in the form of services. The third party plays a crucial role in coordinating cloud market between cloud providers and users. As for providing services or trading, the extra broker fees are required for the middleman because the third party facilitates transactions. Moreover, there is no guarantee that the third party is trusted, which can lead to information leakage, data tampering, and unfair trading. Blockchain technology is an emerging technology that can store and communicate data between entities that unnecessarily trust each other. To resolve the problems, this paper presents the blockchain‐based trust and fair system and develops the smart contract of auction and transaction. The prototype system is implemented based on the Hyperledger Fabric. The experimental results prove the feasibility of the scheme.
Brusatol Inhibits Tumor Growth and Increases the Efficacy of Cabergoline against Pituitary Adenomas
Authors: Wu Zerui , Xu Yunqiu , Xu Jiadong , Lu Jianglong , Cai Lin , Li Qun , Wang Chengde , Su Zhipeng
Published: June 2021

Cabergoline (CAB) is the first choice for treatment of prolactinoma and the most common subtype of pituitary adenoma. However, drug resistance and lack of effectiveness in other pituitary tumor types remain clinical challenges to this treatment. Brusatol (BT) is known to inhibit cell growth and promote apoptosis in a variety of cancer cells. In our present studies, we investigate the effects of BT on pituitary tumor cell proliferation in vitro and in vivo. BT treatment resulted in an increase in Annexin V‐expressing cells and promoted the expression of apoptosis‐related proteins in rat and human pituitary tumor cells. Investigation of the mechanism underlying this effect revealed that BT increased the production of reactive oxygen species (ROS) and inhibited the phosphorylation of 4EBP1 and S6K1. Furthermore, treatment with a combination of BT and CAB resulted in greater antitumor effects than either treatment alone in nude mice and pituitary tumor cells. Collectively, our results suggest that the BT‐induced ROS accumulation and inhibition of mTORC1 signaling pathway leads to inhibition of tumor growth. Combined use of CAB and BT may increase the clinical effectiveness of treatment for human pituitary adenomas.
An Access Network Selection Algorithm for Terrestrial-Satellite Networks Based on a QoS Guarantee
Authors: Lu Yongzhou , Chen Yuanbao , Huang Shuang , Zhang Mingqi
Published: June 2021

Considering the communication requirements of different monitoring services and the performance of different access networks, to ensure the quality of service and reliability of sensor networks, we propose an access network selection algorithm based on a quality-of-service (QoS) guarantee. According to the service requirements, the attributes that affect the terminal access options are determined. Then, utility functions are designed for normalizing the attribute values of the network. In addition, we construct a weight calculation model that combines subjective and objective factors. Finally, the algorithm calculates the relative closeness between each pair of networks by the technique for order preference by similarity to an ideal solution (TOPSIS) and sorts the candidate networks to obtain the best candidate network of each monitoring terminal to access. Simulation results show that the proposed algorithm can effectively meet the communication needs of different monitoring services, ensures network reliability, and can improve the utilization rate of network resources.
Schisandrin Protects against Norepinephrine-Induced Myocardial Hypertrophic Injury by Inhibiting the JAK2/STAT3 Signaling Pathway
Authors: Yang Min , Jiang Xing-Can , Wang Lei , Cui Dong-An , Zhang Jing-Yan , Wang Xu-Rong , Feng Hai-Peng , Zhang Kang , Zhang Kai , Li Jian-Xi , Wang Xue-Zhi
Published: June 2021

Aims. Heart failure is closely associated with norepinephrine-(NE-) induced cardiomyocyte hypertrophy. Schisandrin is derived from the traditional Chinese medicine Schisandra; it has a variety of pharmacological activities, and the mechanism of schisandrin-mediated protection of the cardiovascular system is not clear. Main Methods. NE was used to establish a cardiomyocyte hypertrophy model to explore the mechanism of action of schisandrin. An MTT assay was used for cell viability; Hoechst fluorescence staining was used to observe the cell morphology and calculate the apoptosis rate. The cell surface area was measured and the protein to DNA ratio was calculated, changes in mitochondrial membrane potential were detected, and the degree of hypertrophic cell damage was evaluated. WB, QRT-PCR, and immunofluorescence were used to qualitatively, quantitatively, and quantitatively detect apoptotic proteins in the JAK2/STAT3 signaling pathway. Key Findings. In the NE-induced model, schisandrin treatment reduced the apoptosis rate of cardiomyocytes, increased the ratio of the cell surface area to cardiomyocyte protein/DNA, and also, increased the membrane potential of the mitochondria. The expression of both JAK2 and STAT3 was downregulated, and the BAX/Bcl-2 ratio was significantly reduced. In conclusion, schisandrin may protect against NE-induced cardiomyocyte hypertrophy by inhibiting the JAK2/STAT3 signaling pathway and reducing cardiomyocyte apoptosis.
Accurate Virtual Trial Assembly Method of Prefabricated Steel Components Using Terrestrial Laser Scanning
Authors: Zhou Yin , Han Daguang , Hu Kaixin , Qin Guocheng , Xiang Zhongfu , Ying Chunli , Zhao Lidu , Hu Xingyi
Published: June 2021

The comprehensive utilization of prefabricated components (PCs) is one of the features of industrial construction. Trial assembly is imperative for PCs used in high‐rise buildings and large bridges. Virtual trial assembly (VTA) is a preassembly process for PCs in a virtual environment that can avoid the time‐consuming and economic challenges in physical trial assembly. In this study, a general framework for VTA that is performed between a point cloud, a building information model (BIM), and the finite element method is proposed. In obtaining point clouds via terrestrial laser scanning, the registration accuracy of point clouds is the key to building an accurate digital model of PCs. Accordingly, an accurate registration method based on triangular pyramid markers is proposed. This method can enable the general registration accuracy of point clouds to reach the submillimeter scale. Two algorithms for curved members and bolt holes are developed for PCs with bolt assembly to reconstruct a precise BIM that can be used directly in finite element analysis. Furthermore, an efficient simulation method for accurately predicting the elastic deformation and initial stress caused by forced assembly is proposed and verified. The proposed VTA method is verified on a reduced‐scale steel pipe arch bridge. Experimental results show that the geometric prediction deviation of VTA is less than 1/1800 of the experimental bridge span, and the mean stress predicted via VTA is 90% of the measured mean stress. In general, this research may help improve the industrialization level of building construction.
Recurrent Ischemic and Hemorrhagic Stroke in Cameroon: A Case-Control Study
Authors: Kamgang Jaurès , Tétinou Francklin , Zolo Yvan , Tan Chee Yang , Wambo Christian , Fongang Emerancienne J. N. , Kanmounye Ulrick Sidney
Published: June 2021

Introduction. Stroke recurrence accounts for a great percentage of catastrophic complications, yet no comprehensive study has analyzed the factors associated with stroke recurrence in Cameroon. We carried out this case-control study to better understand the factors associated with the stroke recurrence in Cameroon. Methods. We collected sociodemographic, clinical, neuroimaging, laboratory, and therapeutic data of eligible patients who consulted the neurology and cardiology department of the Yaounde Central Hospital in Cameroon. We included all patients at least five years removed from their first stroke event who consulted the authors’ institution as of January 15, 2019. Wilcoxon signed-rank and Fisher’s exact tests were used. Also, a Cox regression model was used to identify confounders.Results. We recruited 100 patients; seven out of ten patients had hypertension, while six out of 10 had a sedentary lifestyle. Half of the patients consumed alcohol regularly, while one patient out of five had diabetes. Most patients presented with their first stroke event, and a quarter had a stroke recurrence. Stroke recurrence was associated with right handedness (OR = 0.23, 95% CI = 0.16–0.33), congestive heart failure (OR = 3.45, 95% CI = 1.16–10.28), gout (OR = 4.34, 95% CI = 1.09–18.09), dysarthria (OR = 4.34, 95% CI = 1.30–14.54), and facial palsy (OR = 3.96, 95% CII = 1.49 – 10.51), as well as modifiable factors such as elevated abdominal circumference (P < 0.01), systolic blood pressure (P < 0.01), blood glucose level (PI <I 0.01), LDL cholesterol (P < 0.01), and triglyceride levels (P < 0.01). The mulitvariable regression model only identified laterality (B = –1.48, P = 0.04) as a statistically significant explanatory varibale for stroke recurrence. Conclusion. We mapped the landscape of recurrent strokes in Cameroon. There is a need to evaluate the causes of suboptimal drug adherence rates and both the role and adherence to nonpharmacologic interventions.
Prevalence and Phenotypic and Genotypic Resistance Mechanisms of Multidrug-Resistant Pseudomonas aeruginosa Strains Isolated from Clinical, Environmental, and Poultry Litter Samples from the Ashanti Region of Ghana
Authors: Odoi Hayford , Boamah Vivian Etsiapa , Boakye Yaw Duah , Agyare Christian
Published: June 2021

Background. Antibiotic resistance in bacteria is a major global health challenge. Reports on the prevalence of multidrug-resistant P. aeruginosa, a common pathogenic bacterium implicated in nosocomial infections and poultry diseases, are limited in Ghana. This study therefore sought to determine the prevalence of P. aeruginosa from hospitals, poultry farms, and environmental samples from the Ashanti region of Ghana. Methodology. Stool, urine, and blood samples from 364 patients from two hospitals in the Ashanti region of Ghana were randomly sampled. P. aeruginosa was isolated and confirmed using routine selective media and PCR-based oprL gene amplification. The Kirby-Bauer disk diffusion method employing EUCAST breakpoint values was used to identify multidrug-resistant strains. The occurrence of common antibiotic inactivating enzymes and resistance encoding genes and the assessment of strain efflux capacity were investigated with double disc synergy test (DDST), imipenem-EDTA synergy test, phenylboronic acid test, D-test, routine PCR, and ethidium bromide agar-cartwheel method. Results. A total of 87 (9.7%, n = 87/900) P. aeruginosa isolates were confirmed from the samples. 75% (n = 65/87) were resistant to more than one group of antipseudomonal agents, while 43.6% (n = 38/87) were multidrug-resistant (MDR). High prevalence of extended spectrum β-lactamases (84.2%), metallo-β-lactamases (34.1%), and AmpC inducible cephalosporinases (50%) was observed in the MDR strains. About 57.8% of the MDR strains showed moderate to very high efflux capacity. Class 1 integrons were detected in 89.4% of the MDR isolates but β-lactamase encoding genes (blaSHV, blaTEM, blaCTX-M, blaVIM, and blaIMP) were not detected. Conclusion. Surveillance of antibiotic-resistant strains of bacteria should be routinely conducted in clinical and veterinary practice in Ghana to inform selection of antibiotics for therapeutic use.
Systematic Pan-Cancer Population-Based Analysis Reveals the Incidence and Prognosis of Lung Metastases at Diagnosis
Authors: Liang Xiaohong , Cheng Yinan , Zhou Weijun , Ni Jun , Li Yuqing , Feng Gaohua
Published: June 2021

Background. Metastasis is one of the most prevalent causes of death in cancer patients and the lungs are among the organs most commonly affected by metastasis. However, analysis of the incidence and prognosis of lung metastasis (LM) based on primary cancer sites is lacking. Methods. We enrolled cancer patients with LM from the Surveillance, Epidemiology, and End Results (SEER) database. The risk factors for LM were determined using multivariate logistics regression. Forest plots were used to compare the impact of with LM versus without LM alone among different primary caner site subgroups. Results. Among 1,525,441 cases, 47,537 presented with LM at initial diagnosis. Multivariate logistics regression revealed that male sex, older age, later T/N stage, unmarried status, and lack of insurance were risk factors for LM. The incidence of LM was 11.91% in bone cancer and 11.19% in pancreatic cancer. In terms of the distribution of primary cancers, 19.22% of LMs originated from the colon and rectum, with 11.63% from the kidneys. The median survival for LM cases was 6 months, with the best survival in testicular cancer (19 months) and bone cancer (12 months). Patients with LM had higher hazard ratio (HR) for mortality compared to those without LM, except for those with primary cancer in the brain (

P
=
0.09

). We stratified patients by primary cancer site, and subgroup analyses showed that LM had a significant negative impact on survival. The most significant was in thyroid cancer (HR = 44.79), followed by melanoma (HR = 24.26), prostate (HR = 16.0), breast (HR = 13.46), endometrial (HR = 12.64), testicular (HR = 12.31), and kidney (HR = 11.33) cancer (all

P
<
0.001

). Conclusion. Patients presenting with LM had higher HR for mortality compared to those without LM, except for those with brain tumor. Clinicians should pay more attention to the occurrence of LM, especially in patients with a significantly increased HR for mortality, such as those with thyroid cancer, melanoma, and prostate cancer.
Transplacental Transfer and Fetal Pharmacodynamics of Sildenafil in the Pregnant Sheep Model
Authors: De Bie Felix Rafael , Sharma Dyuti , Lannoy Damien , Allegaert Karel , Storme Laurent , Deprest Jan , Russo Francesca Maria
Published: June 2021

Background: Sildenafil is a phosphodiesterase-5 inhibitor considered for antenatal use for a variety of indications. We sought to assess sildenafil pharmacokinetics in the pregnant ewe and fetus and evaluate its physiological fetal effects. Methods: Twelve fetal lambs (127–133 days GA, term 145) were chronically catheterized in utero. Ewes received different doses of sildenafil, either via subcutaneous injection (1.6, 2.0 mg/kg/day) or intravenous (IV) infusion (3, 5, 7, 10, and 12 mg/kg/day). Maternal and fetal sildenafil concentrations and metabolic status (blood gas analysis) were measured at given intervals. The fetal heart rate, pulmonary blood flow, systemic and aortic pressure, and maternal uterine artery pressure were continuously monitored. Results: The transplacental sildenafil transfer was 2.9% (range: 1.4–7.8%), preventing attainment of fetal target concentrations without toxic maternal levels. IV sildenafil infusion induced an immediate, temporary, dose-dependent reduction of pulmonary vascular resistance (38–78%) and increased both pulmonary blood flow (32–132%) and heart rate (13–49%), with limited nonlinear dose-dependent effects on systemic and pulmonary pressures. Fetal and maternal blood gases and maternal uterine artery pressures were unaffected by sildenafil infusion. Conclusion: In sheep, transplacental transfer of sildenafil is extremely low. Though, minimal fetal sildenafil concentrations induce an acute transient pulmonary vasodilation, well-tolerated by the fetus and ewe.
The Effect of Atrial Fibrillation on the Long-Term Mortality of Patients with Acute Coronary Syndrome: The TACOS Study
Authors: Konttila Kaari K. , Punkka Olli , Koivula Kimmo , Eskola Markku J. , Martiskainen Mika , Huhtala Heini , Virtanen Vesa K. , Mikkelsson Jussi , Järvelä Kati , Laurikka Jari , Niemelä Kari O. , Karhunen Pekka J. , Nikus Kjell C.
Published: June 2021

Introduction: Atrial fibrillation (AF) is a frequent finding in acute coronary syndrome (ACS), but there is conflicting scientific evidence regarding its long-term impact on patient outcome. The aim of this study was to survey and compare the ≥10-year mortality of ACS patients with sinus rhythm (SR) and AF. Methods: Patients were divided into 2 groups based on rhythm in their 12-lead ECGs: (1) SR (n = 788) at hospital admission and discharge (including sinus bradycardia, physiological sinus arrhythmia, and sinus tachycardia) and (2) AF/atrial flutter (n = 245) at both hospital admission and discharge, or SR and AF combination. Patients who failed to match the inclusion criteria were excluded from the final analysis. The main outcome surveyed was long-term all-cause mortality between AF and SR groups during the whole follow-up time. Results: Consecutive ACS patients (n = 1,188, median age 73 years, male/female 58/42%) were included and followed up for ≥10 years. AF patients were older (median age 77 vs. 71 years, p < 0.001) and more often female than SR patients. AF patients more often presented with non-ST-elevation myocardial infarction (69.8 vs. 50.4%, p < 0.001), had a higher rate of diabetes (31.0 vs. 22.8%, p = 0.009), and were more often using warfarin (32.2 vs. 5.1%, p < 0.001) or diuretic medication (55.1 vs. 25.8%, p < 0.001) on admission than patients with SR. The use of warfarin at discharge was also more frequent in the AF group (55.5 vs. 14.8%, p < 0.001). The rates of all-cause and cardiovascular mortality were higher in the AF group (80.9 vs. 50.3%, p < 0.001, and 73.8 vs. 69.6%, p = 0.285, respectively). In multivariable analysis, AF was independently associated with higher mortality when compared to SR (adjusted HR 1.662; 95% CI: 1.387–1.992, p < 0.001). Conclusion: AF/atrial flutter at admission and/or discharge independently predicted poorer long-term outcome in ACS patients, with 66% higher mortality within the ≥10-year follow-up time when compared to patients with SR.
Primary Alopecia Neoplastica: A Novel Case Report and Literature Review
Authors: Flanagan Kelly E. , Burns Laura J. , Pathoulas James T. , Walker Chloe J. , Pupo Wiss Isabel , Cornejo Kristine M. , Senna Maryanne M.
Published: June 2021

Alopecia neoplastica (AN) is caused by neoplastic cells damaging hair follicles, resulting in patchy hair loss like cicatricial alopecia and alopecia areata. AN has predominantly described cutaneous metastasis to the scalp from primary visceral malignant tumors. Less frequently, AN results from a primary scalp neoplasm. Compared to “secondary AN,” there is a paucity of literature on “primary AN.” Herein, we present a comprehensive literature review of primary AN and introduce a unique case of amelanotic melanoma causing primary AN. Including our presented case, 11 cases of primary AN have been reported with causative scalp neoplasms including angiosarcoma, hemangioendothelioma, syringomatous carcinoma, ectopic extramammary Paget’s disease, and primary desmoplastic melanoma. 27.3% (3 of 11) of cases were misdiagnosed and treated for a primary alopecia, and 36.4% (4 of 11) of lesions were present for multiple years or an unknown amount of time, likely due to difficulty in recognizing scalp lesion or misdiagnosis. All patients required surgical excision with 36.4% (4 of 11) requiring chemotherapy, radiation, or photodynamic therapy. Two patients with scalp angiosarcoma died from their aggressive disease. Due to the risks of malignant primary AN if allowed to progress, primary AN should be considered in patients presenting with scarring alopecia.
Molecular and Cellular Function of Transcription Factor 4 in Pitt-Hopkins Syndrome
Authors: Chen Huei-Ying , Bohlen Joseph F. , Maher Brady J.
Published: June 2021

Transcription factor 4 (TCF4, also known as ITF2 or E2-2) is a type I basic helix-loop-helix transcription factor. Autosomal dominant mutations in TCF4 cause Pitt-Hopkins syndrome (PTHS), a rare syndromic form of autism spectrum disorder. In this review, we provide an update on the progress regarding our understanding of TCF4 function at the molecular, cellular, physiological, and behavioral levels with a focus on phenotypes and therapeutic interventions. We examine upstream and downstream regulatory networks associated with TCF4 and discuss a range of in vitro and in vivo data with the aim of understanding emerging TCF4-specific mechanisms relevant for disease pathophysiology. In conclusion, we provide comments about exciting future avenues of research that may provide insights into potential new therapeutic targets for PTHS.
The Association of Urinary Sclerostin and Renal Magnesium Handling in Type 2 Diabetic Patients with Chronic Kidney Disease
Authors: Wu Ching-Fang , Liou Hung-Hsiang , Kuo Chin-Chi , Tsai Ming-Hsien , Chang Min-Yu , Lee Yi-Che , Lin Tsun-Mei , Hung Shih-Yuan
Published: June 2021

Introduction: Sclerostin could enhance renal excretion of calcium (Ca) and phosphate (P). The association between sclerostin and magnesium (Mg) has not yet discovered. In patients with type 2 diabetes mellitus (T2DM) or chronic kidney disease (CKD), higher serum sclerostin and altered renal excretion of Ca, P, and Mg were detected. Therefore, we tried to evaluate if there was any association between sclerostin and fractional excretion of Ca, P, and Mg (FeCa, FeP, and FeMg) in T2DM with CKD. Methods: In this prospective cohort study, 43 T2DM patients without CKD or with CKD stage 1–5 were enrolled. Values of parameters, including serum and urine sclerostin, were collected at baseline and 6 months later. For baseline data, the Mann-Whitney U test, χ2 test, or Spearman’s correlation were used. For multivariate repeated measurement analysis, generalized estimating equation (GEE) model was utilized. Results: Patients with lower estimated glomerular filtration rate had higher serum sclerostin, FeP, FeMg, and lower FeCa. By correlation analysis, serum sclerostin was negatively associated with FeCa (p = 0.02) and positively associated with FeP (p = 0.002). The urine sclerostin to creatinine ratio (Uscl/Ucre) was positively correlated with FeP (p = 0.007) and FeMg (p = 0.005). After multivariate analyses by GEE model, serum sclerostin was still inversely associated with FeCa, while Uscl/Ucre was significantly associated with FeMg. On the other hand, FeP lost its associations with serum sclerostin or Uscl/Ucre. Conclusion: In our study population of T2DM patients with or without CKD, the inverse correlation between serum sclerostin and FeCa could not be explained by the calciuric effect of sclerostin. In addition, a newly discovered positive association between urinary sclerostin and FeMg indicated a possible role of urinary sclerostin in regulating renal Mg handling especially over distal convoluted tubules.
Changes in Online Psychoactive Substance Trade via Telegram during the COVID-19 Pandemic
Authors: Blankers Matthijs , van der Gouwe Daan , Stegemann Lavinia , Smit-Rigter Laura
Published: June 2021

Background: In this article, we present an evaluation of online psychoactive substance trade via Telegram, a free encrypted social media messenger service. The evaluation took place during the COVID-19 pandemic, which allowed us to monitor the effects of the spring 2020 lockdown in the Netherlands on substance trade via Telegram. Objective: The objective of this study was to evaluate whether changes in psychoactive substance trade on Telegram markets in the Netherlands can be observed during the COVID-19 pandemic. Results: Between December 2, 2019, and June 29, 2020, a total of 70,226 posts appeared in two analyzed Telegram groups. A total of 5,643 posts were psychoactive substance related. Based on the analyzed posts, Telegram is mostly a ‘“sellers” market as only a minority of the posts (6.3%) could be identified as a request for a substance. The proportion of posts related to specific substances varied between the periods before, during, and after the lockdown. The proportion of posts on the stimulants ecstasy, cocaine, and amphetamine was lower during the lockdown than before and after. For psychedelics – ketamine, lysergic acid diethylamide (LSD), and 2,5-dimethoxy-4-bromophenethylamine (2C-B) – and other substances, there was a relative increase in the number of posts during the lockdown, which was maintained after the lockdown. Conclusions: Telegram analysis shows that in the Netherlands, online psychoactive substance trade may have been affected during the COVID-19 pandemic. The direction of this effect was different for different classes of substances.
Mortality in Patients with Brainstem Cavernous Malformations
Authors: Velz Julia , Neidert Marian Christoph , Yang Yang , Akeret Kevin , Nakaji Peter , Regli Luca , Bozinov Oliver
Published: June 2021

Objective: Brainstem cavernous malformations (BSCM)-associated mortality has been reported up to 20% in patients managed conservatively, whereas postoperative mortality rates range from 0 to 1.9%. Our aim was to analyze the actual risk and causes of BSCM-associated mortality in patients managed conservatively and surgically based on our own patient cohort and a systematic literature review. Methods: Observational, retrospective single-center study encompassing all patients with BSCM that presented to our institution between 2006 and 2018. In addition, a systematic review was performed on all studies encompassing patients with BSCM managed conservatively and surgically. Results: Of 118 patients, 54 were treated conservatively (961.0 person years follow-up in total). No BSCM-associated mortality was observed in our conservatively as well as surgically managed patient cohort. Our systematic literature review and analysis revealed an overall BSCM-associated mortality rate of 2.3% (95% CI: 1.6–3.3) in 22 studies comprising 1,251 patients managed conservatively and of 1.3% (95% CI: 0.9–1.7) in 99 studies comprising 3,275 patients with BSCM treated surgically. Conclusion: The BSCM-associated mortality rate in patients managed conservatively is almost as low as in patients treated surgically and much lower than in frequently cited reports, most probably due to the good selection nowadays in regard to surgery.
Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome Undergoing Complex Percutaneous Coronary Intervention
Authors: Coughlan J.J. , Aytekin Alp , Ndrepepa Gjin , Schüpke Stefanie , Bernlochner Isabell , Mayer Katharina , Neumann Franz Josef , Menichelli Maurizio , Richardt Gert , Wöhrle Jochen , Witzenbichler Bernhard , Gewalt Senta , Xhepa Erion , Kufner Sebastian , Sager Hendrik B. , Joner Michael , Ibrahim Tareq , Fusaro Massimiliano , Laugwitz Karl Ludwig , Schunkert Heribert , Kastrati Adnan , Cassese Salvatore
Published: June 2021

Background:

The comparative efficacy and safety of ticagrelor and prasugrel in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention (PCI) has not been defined.

Methods:

This post hoc analysis included all patients with acute coronary syndrome treated with PCI and randomized to either ticagrelor or prasugrel in the ISAR-REACT 5 trial (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment). Complex PCI was defined as at least one of the following: multivessel PCI, ≥3 stents implanted, ≥3 lesions treated, and total stented length >60 mm. The primary efficacy end point was the composite of all-cause death, myocardial infarction, or stroke; the safety end point was Bleeding Academic Research Consortium types 3 to 5 bleeding. Outcomes were assessed out to 12 months after randomization.

Results:

Among the 3377 patients treated with PCI in the ISAR-REACT 5 trial, 1429 underwent complex PCI (ticagrelor, N=696 and prasugrel, N=733) and 1948 underwent noncomplex PCI (ticagrelor, N=980 and prasugrel, N=968). There was no interaction between PCI complexity, assignment to either ticagrelor or prasugrel, and the primary efficacy or safety end points (
P
for interaction: ≥0.13). In the complex PCI group, the primary efficacy end point (11.0% versus 9.2%, hazard ratio: 1.19 [0.85–1.66],
P
=0.303) and the safety end point (5.2% versus 6.1%, hazard ratio: 0.83 [0.53–1.31],
P
=0.419) were not statistically different in patients receiving either ticagrelor or prasugrel. In the noncomplex PCI group, the primary efficacy end point occurred more frequently in patients assigned to ticagrelor as compared to prasugrel (8.9% versus 5.5%, hazard ratio: 1.66 [1.18–2.34],
P
=0.004) without significant difference in terms of the safety end point (5.4% versus 4.1%, hazard ratio: 1.41 [0.92–2.17],
P
=0.110).

Conclusions:

In patients with acute coronary syndrome, PCI complexity does not influence the comparative efficacy and safety of ticagrelor and prasugrel. The observed comparable performance of ticagrelor and prasugrel in patients with acute coronary syndrome undergoing complex PCI requires further confirmation.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01944800.
Characterisation of the complete mitochondrial genome of the insect-parasitic nematode Heterorhabditis bacteriophora: an idiosyncratic gene order and the presence of multiple long non-coding regions
Authors: Regeai Sassia Omar , Fitzpatrick David A. , Burnell Ann M. , Kakouli-Duarte Thomais
Published: June 2021

We present here the complete mtDNA genome (mitogenome) of Heterorhabditis bacteriophora, an important biological control agent of soil-dwelling insect pests in agriculture and horticulture. This is the first description of a mitogenome for a member of the family Heterorhabditidae. The genome contains the typical chromadorean complement of 12 protein-coding genes, 22 tRNA genes and two rRNA genes. All genes are transcribed in the same direction and have a nucleotide composition high in A and T. For the entire genome, the nucleotide contents are 47.02% (T), 28.81% (A), 16.10% (G), 8.08% (C) and 75.83% (AT). Heterorhabditis bacteriophora has a unique, idiosyncratic gene arrangement. It differs from that of Caenorhabditis elegans in having a block of seven genes: trnQ-trnF-cytb-trnL1-cox3-trnT-nad4 translocated to a position between nad3 and nad5, as well as having a change in the position of the four tRNA block gene cluster, trnC-trnM-trnD-trnG, where trnC and trnM have switched places and trnD and trnG have translocated between nad4 and nad5 genes. The H. bacteriophora mitogenome is 18 128 bp long, and thus is ca 4 kb larger than the mitogenomes of most chromadoreans. This relatively large genome is due to the presence of five non-coding regions (NCR): NCR1 (114 bp), NCR2 (159 bp), NCR3 (498 bp), NCR4 (1917 bp) and NCR5 (2154 bp), which make up 26.7% of the genome. The NCR5 had the highest A + T content of 83.47% indicating that this region is the likely AT-rich control region. The complete 498 bp NCR3 sequence is duplicated in NCR4 and in NCR5 (the putative AT-rich control region). Such an organisation has not been reported previously in nematode mtDNA.
An Archaeological Investigation of Laloi East Molluscs Site at Kpone, Ghana
Authors: Biveridge Fritz
Published: June 2021

This article is a report of an archaeological investigation of the Laloi East Molluscs Site at Kpone, Greater Accra Region, Ghana. Although radiometric dates for this shell midden are currently unavailable, we believe that Laloi East dates to the Later Stone Age. If so, this site would be one of only two LSA sites in Ghana found and excavated along the coast rather than in the forested interior. This article examines shellfish exploitation and other major subsistence strategies of the population that settled the site in the past. The principal cultural materials recovered from the excavations comprised large quantities of molluscs’ remains belonging to a variety of species, other faunal remains, pottery, palm kernel nuts, charcoal, stone slabs, and lithic tools. The combined evidence indicates that molluscs’ exploitation was the principal subsistence strategy of the settlers, undertaken alongside hunting, trapping, herding and the gathering of edible botanical resources such as palm fruits.
The Role of Low-Level Flow Direction on Tropical Cyclone Intensity Changes in a Moderate-Sheared Environment
Authors: Lee Tsung-Yung , Wu Chun-Chieh , Rios-Berrios Rosimar
Published: June 2021

The impact of low-level flow (LLF) direction on the intensification of intense tropical cyclones under moderate deep-layer shear is investigated based on idealized numerical experiments. The background flow profiles are constructed by varying the LLF direction with the same moderate deep-layer shear. When the maximum surface wind speed of the simulation without background flow reaches 70 kt (36 m s−1), the background flow profiles are imposed. After a weakening period in the first 12 h, the members with upshear-left-pointing LLF (fast-intensifying group) intensify faster between 12 and 24 h than those members (slow-intensifying group) with downshear-right-pointing LLF. The fast-intensifying group experiences earlier development of inner-core structures after 12 h, such as potential vorticity below the midtroposphere, upper-level warm core, eyewall axisymmetrization, and radial moist entropy gradient, while the inner-core features of the slow-intensifying group remain relatively weak and asymmetric. The FI group experiences smaller tilt increase and stronger midlevel PV ring development. The upshear-left convection during 6–12 h is responsible for the earlier development of the inner core by reducing ventilation, providing axisymmetric heating, and benefiting the eyewall development. The LLF of the fast-intensifying group enhances surface heat fluxes in the downshear side, resulting in higher energy supply to the upshear-left convection from the boundary layer. In all, this study provides new insights on the impact of LLF direction on intense storms under moderate shear by modulating the surface heat fluxes and eyewall convection.
An IMERG-Based Optimal Extended Probabilistic Climatology (EPC) as a Benchmark Ensemble Forecast for Precipitation in the Tropics and Subtropics
Authors: Walz Eva–Maria , Maranan Marlon , van der Linden Roderick , Fink Andreas H. , Knippertz Peter
Published: June 2021

Current numerical weather prediction models show limited skill in predicting low-latitude precipitation. To aid future improvements, be it with better dynamical or statistical models, we propose a well-defined benchmark forecast. We use the arguably best currently high-resolution, gauge-calibrated, gridded precipitation product, the Integrated Multi-Satellite Retrievals for GPM (Global Precipitation Measurement) (IMERG) “final run” in a ± 15-day window around the date of interest to build an empirical climatological ensemble forecast. This window size is an optimal compromise between statistical robustness and flexibility to represent seasonal changes. We refer to this benchmark as Extended Probabilistic Climatology (EPC) and compute it on a 0.1°×0.1° grid for 40°S–40°N and the period 2001–2019. In order to reduce and standardize information, a mixed Bernoulli-Gamma distribution is fitted to the empirical EPC, which hardly affects predictive performance. The EPC is then compared to 1-day ensemble predictions from the European Centre for Medium-Range Weather Forecasts (ECMWF) using standard verification scores. With respect to rainfall amount, ECMWF performs only slightly better than EPS over most of the low latitudes and worse over high-mountain and dry oceanic areas as well as over tropical Africa, where the lack of skill is also evident in independent station data. For rainfall occurrence, EPC is superior over most oceanic, coastal, and mountain regions, although the better potential predictive ability of ECMWF indicates that this is mostly due to calibration problems. To encourage the use of the new benchmark, we provide the data, scripts, and an interactive webtool to the scientific community.
How to Capture Global Protest Trends: Using Survey Data Recycling Data to Construct Cross-National Trends in Protest
Authors: Jenkins J. Craig , Kwak Joonghyun
Published: June 2021

A common claim about the affluent democracies is that protest is trending, becoming more legitimate and widely used by all political contenders. In the new democracies, protest is seen as having contributed to democratization, but growing apathy has led to protest decline while in authoritarian regimes protest may be spurring more democratization. Assessing these ideas requires comparative trend data covering 15 or more years but constructing such data confronts problems. The major problem is that the most available survey item asks “have you ever joined (lawful) demonstrations,” making it difficult to time when this protest behavior occurred. We advance a novel method for timing these “ever” responses by focusing on young adults (aged 18-23 years), who are likely reporting on participation within the past 5 years. Drawing on the Survey Data Recycling harmonized data set, we use a multilevel model including harmonization and survey quality controls to create predicted probabilities for young adult participation (576 surveys, 119 countries, 1966-2010). Aggregating these to create country-year rate estimates, these compare favorably with overlapping estimates from surveys asking about “the past 5 years or so” and event data from the PolDem project. Harmonization and survey quality controls improve these predicted values. These data provide 15+ years trend estimates for 60 countries, which we use to illustrate the possibilities of estimating comparative protest trends.
Patients With Invasive Breast Cancer Who Refuse Treatment: An Analysis of Associated Factors and Impact on Survival
Authors: Moya Jackelyn J. , Moazzez Ashkan , Ozao-Choy Junko J. , Dauphine Christine
Published: June 2021

Background

Completion of surgical resection and adjuvant/neoadjuvant treatments (chemotherapy, radiation, and endocrine therapy) is necessary to achieve optimal outcomes in invasive breast cancer. The objective of this study was to determine the characteristics of patients refusing treatment and to analyze the impact of refusal on survival.

Study Design

A retrospective cohort study of invasive breast cancer cases diagnosed 2004-2016 was performed utilizing the National Cancer Database.

Results

Of 2 058 568 cases comprising the study cohort, .6% refused recommended surgery, 14.1% refused chemotherapy, 5.5% refused radiation, and 6.3% refused endocrine therapy. Patients refusing therapy were older and more likely uninsured; they did not live farther from the treating hospital. Racial disparities were also associated with refusal. Surgery refusal had the highest hazard ratio for mortality (2.7; 95% CI: 2.5-3.0, P < .001) compared to chemotherapy (1.3; 95% CI: 1.3-1.4, P < .001), radiation (1.8; 95% CI: 1.7-1.9, P < .001), and endocrine therapy (1.5; 95% CI: 1.4-1.6, P < .001) independent of race, insurance, receptor status, and stage.

Conclusion

This study demonstrates significant associations with refusal of breast cancer treatment and quantifies the impact on mortality, which may help to identify at-risk groups for whom interventions could prevent increases in mortality associated with declining treatment.
The Fellow’s Perspective: The Impact of the COVID-19 Pandemic on Fellowship Training and Job Appointment
Authors: Truong Adam , Amersi Farin , Chau Van , Imai Taryne
Published: June 2021

Background

Fellows have been uniquely affected by the widespread changes in educational structure, mandatory limitations in elective procedural volume, and hiring freezes during the COVID-19 global pandemic.

Study Design

A voluntary and anonymous survey was distributed to all Graduate Medical Education fellows at a tertiary medical center querying perspectives on clinical and didactic training and job placement.

Results

A total of 47 of 121 fellows (39%) completed the survey. The majority were in a medical (43%) or surgical specialty (34%) followed by critical care (13%) and procedure-based (11%) fellowships. Approximately 59% of surveyed fellows felt their programs were providing a virtual curriculum that would train them just as well as the in-person curriculum. Twenty-eight (60%) fellows were in their final or only year of training. Of the 25 fellows who were seeking employment, 52% have experienced difficulty in finding a job due to hiring freezes and 40% have encountered challenges with job interview cancellations and changes to virtual interview formats.

Conclusion

Almost half of surveyed fellows reported an educational deterioration due to COVID-19 and graduating fellows seeking employment felt hindered by both the virtual interview format and widespread hiring freeze. Fellows are both unique and vulnerable as they balance the solidification of clinical training with securing employment during these tumultuous and unprecedented times.
Nationwide Analysis of Dog Bite Injuries: Different Age Groups, Different Injury Patterns
Authors: Tam Benjamin , Matsushima Kazuhide , Chiba Hiroto , Park Timothy , Slocum Charles , Lam Lydia , Inaba Kenji , Demetriades Demetrios
Published: June 2021

Background

As the number of households with dogs in the United States has increased, so has the incidence of dog bites. Contemporary analysis of nationwide epidemiological data regarding such injuries is scarce. The purpose of this study is to describe dog bite injury patterns and related surgical interventions with a focus on differences between pediatric and adult age groups.

Study Design

This is a retrospective study (2015-2017) using the National Trauma Data Bank. 10 569 patients were included.

Results

Of these, 4729 (44.7%) qualified as pediatric (age ≤ 12 years) and 5840 (55.3%) qualified as adults (age ≥ 13 years). Pediatric patients were more frequently admitted with facial injuries (78.1% vs. 29.3%, P < .01) and facial fractures (4.8% vs. 2.5%, P < .01), and had a higher incidence of facial bone surgical procedures (1.3% vs. .5%, P < .01). Adult patients were more frequently admitted with upper extremity injuries (65.8% vs. 21.2%, P < .01) and upper extremity vascular arterial injuries (2.3% vs. .2%, P < .01) with a higher incidence of upper extremity arterial procedures (1.3% vs. .2%, P < .01).

Conclusion

This study demonstrates the contrast in injury patterns from dog bite between adults and children. These findings can dictate injury prevention policies and prepare clinicians to treat dog bite victims.
Hypoglycemia in a Surgical Intensive Care Unit
Authors: Switzer Emily , Schellenberg Morgan , Lewis Meghan , Owattanapanich Natthida , Lam Lydia , Inaba Kenji
Published: June 2021

Background

Glycemic control is an important aspect of critical care because derangements are associated with morbidity and mortality. Patients at highest risk for hypoglycemia in the surgical intensive care unit (SICU) are incompletely described by existing literature. Our objective was to delineate this high-risk patient population in our SICU.

Study Design

In this single-center, retrospective, observational study, SICU patients admitted from June 1, 2019 to July 31, 2020 with ≥1 episode of hypoglycemia (blood glucose <60 mg/dL) were included.

Results

There were 41 hypoglycemic events in 27 patients, comprising an incidence of 1.5% among SICU patients. The most common admission diagnoses were cirrhosis (n = 13, 48%), polytrauma (n = 12, 44%), multisystem organ failure (n = 11, 41%), diabetes mellitus (n = 9, 33%), and soft tissue infection (n = 8, 30%). Four high-risk populations were identified: patients in multisystem organ failure (MSOF) (n = 11, 41%); those who were nil per os (NPO) (n = 10, 37%); patients receiving long acting subcutaneous insulin, for example, Lantus (n = 3, 11%); and those on continuous intravenous insulin infusions (n = 3, 11%). After multi-disciplinary peer review, most hypoglycemic events (n = 16, 59%) were deemed iatrogenic.

Conclusions

Hypoglycemia is rare in surgical critical care. When it does occur, patients are typically in MSOF, NPO, on long acting subcutaneous insulin or continuous insulin infusions, have soft tissue infections, or have acute or chronic liver failure. Increased vigilance with frequent blood glucose monitoring in these high-risk patients may reduce the risk of hypoglycemia in the SICU.
Occupational Outcomes of a Physical Activity Intervention for Post-Secondary Student Mental Health
Authors: Nesbitt Amy E. , Collins Kristina J. , Nalder Emily , Sabiston Catherine M.
Published: June 2021

Background.

Physical activity (PA) is a therapeutic approach to address post-secondary student mental health, yet the effect of PA on occupational outcomes has been understudied among students.

Purpose.

This study (1) identified and described occupational performance issues (OPIs) among post-secondary students seeking mental health support and (2) assessed pre- and post-intervention differences in occupational performance and performance satisfaction.

Method.

Using a single group pre-test post-test pilot study design, participants ( N = 20) completed a 6-week, 1-hour PA intervention. The Canadian Occupational Performance Measure was administered pre- and post-intervention.

Findings.

The most commonly reported OPIs included academics, PA, and sleep hygiene. There were significant improvements in participants’ occupational performance (mean change: 2.7, p < .001; dz = 2.28) and performance satisfaction (mean change: 3.7, p < .001; dz = 3.04).

Implications.

Results provide an initial demonstration of the benefits of PA for occupational outcomes within a post-secondary mental health context.
Assessing Measurement Invariance Across Multiple Groups: When Is Fit Good Enough?
Authors: van Dijk Wilhelmina , Schatschneider Christopher , Al Otaiba Stephanie , Hart Sara A.
Published: June 2021

Complex research questions often need large samples to obtain accurate estimates of parameters and adequate power. Combining extant data sets into a large, pooled data set is one way this can be accomplished without expending resources. Measurement invariance (MI) modeling is an established approach to ensure participant scores are on the same scale. There are two major problems when combining independent data sets through MI. First, sample sizes will often be large leading to small differences becoming noninvariant. Second, not all data sets may include the same combination of measures. In this article, we present a method that can deal with both these problems and is user friendly. It is a combination of generating random normal deviates for variables missing completely in combination with assessing model fit using the root mean square error of approximation good enough principle, based on the hypothesis that the difference between groups is not zero but small. We demonstrate the method by examining MI across eight independent data sets and compare the MI decisions of the traditional and good enough approach. Our results show the approach has potential in combining educational data.