bluuebunny/crossref_metadata_2025 huggingface dataset:
New Onset of AV- Nodal Reentrant Tachycardia (AVNRT) in the elderly – an uncommon diagnosis?
Authors: Grosse A , Surber R , Kirsch K , Schulze P C
Published: October 2021

Background

Arrhythmias in elderly patients (>70 years) are common in daily clinical practice. Most frequently, they are based on atrial fibrillation or other atrial tachycardia with an indication for oral anticoagulation and specific antiarrhythmic medications. The electrographic (ECG) documentation related to symptoms is essential before therapy initiation. In case of suspected AVNRT based on surface ECG, an electrophysiological study (EP) with ablation as curative strategy should be planned.

Methods

We analysed all patients >70 years with AVNRT diagnosed by electrophysiologic (EP) studies between May 2018 and December 2020.

Results

An EP study for suspected AVNRT was performed in 27 patients >70 years. The diagnosis of AVNRT was confirmed in 20 patients (75%). From all EP- studies with the diagnosis of AVNRT (n=93) in this period, 20 patients (22%) were older than 70 years (mean age 77 years with a range of 70–85 years), 12 were women. In most of the patients, the duration of symptoms was short (3 month). Only 4 patients had symptoms of paroxysmal tachycardia longer than 10 years. Except for 2 patients, all patients had at least one ECG- documentation (12- lead- ECG, Holter- ECG, telemetric ECG and/or in the loop recorder). In 12 patients, a 12- lead- ECG- documentation was available, in 5 patients the tachycardia has been registered in the Holter-ECG and in 1 in a loop recorder. In the 12- lead- ECG before ablation in sinus rhythm the PQ interval was with 196 (120- 300) ms in the upper range. In 16/ 20 patients was during the EP- study a sustained AVNRT (CL 410, 314- 538 ms) inducible. In the others, up to 3 typical AV- nodal- echo beats were induced in the EP- study. A slow pathway ablation/ modification was performed in all patients in typical position. In 2 patients, the implantation of a dual- chamber- pacemaker was necessary due to intermittent high- degree AV-nodal-block during the same hospital stay. In both patients, a first degree AV-block with PQ- interval of 250 and 300 ms was pre-existing.

Discussion

Especially for the elderly patients with new onset of clinical symptoms of arrhythmia, clinical anamnesis including an ECG- documentation is required for planning the therapeutic strategy. A borderline long PQ- interval as sign of an age- dependent fibrosis in the AV- node and, therefore, altered conduction properties in the AV node can be a cause of AVNRT in these older patients. In patients with pre-existing long PQ- interval (>250 ms), the risk of pacemaker implantation after successful ablation is higher. In this group of patients, medical therapeutic options are limited and often associated with the need of pacemaker implantation.

Funding Acknowledgement

Type of funding sources: None.
Co-designing digital cardiac rehabilitation with patients living in rural and remote Australia – the Country Heart Attack Prevention (CHAP) Project
Authors: Nesbitt K , Beleigoli A , Du H , Champion S , Clark R A , Tirimacco R ,   The country heart attack prevention project
Published: October 2021

Background/Significance

Web-based CR can provide an alternative, patient centred, flexible delivery option. Co-design with consumers and clinicians is recommended to tailor web-based CR to their needs and preferences as a means of increasing attendance.

Purpose

The objective of this study is to describe how patient-generated data through workshops on desired content and features informs technology and implementation specifications for the patient portal of a CR website.

Methods

This study used the UX Design theoretical framework to gain critical feedback and insights from participants. The System Usability Scale (SUS) measured objective feedback, with one-way ANOVA performed on the SUS means, informing on variance. Thematic analysis of participants perceptions, via voice recording provided themes.

Results

Based on the feedback from participants in rural and remote SA, desired content and features were updated for improving user experience. We recruited 39 participants, into 6 workshops, across 5 regional Local Health Networks in SA. The median age of participants was 70 (IQR 17, minimum 40 – maximum 84), 19 (48.7%) were female and 39 (100%) had completed a cardiac rehabilitation program. More than half had experienced a myocardial infarction 24 (61.5%). A greater number used a smart phone (27, 69.2%) and Facebook (31, 79.5%). The SUS did not differ across the workshops (p=0.20), with a tendency to usability improving over time. Five themes were identified, input information, format of information, usability, support of health behaviour change and language.

Conclusion

The co-design process has contributed to the development of the CR website, improving desired content and features. Improved usability scores can be achieved through further incorporating consumer feedback into the development of the CR website.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Novartis Australia Figure 1. Mean SUS ScoresFigure 2. Workshop Themes
Costs analysis from a randomized comparison of immediate versus delayed angiography in patients successfully resuscitated after out-of-hospital cardiac arrest
Authors: Camaro C , Bonnes J L , Adang E M , Spoormans E M , Janssens G N , Meuwissen M , Van Der Horst I C C , Voskuil M , Stoel M , Vlaar A P J , Elbers P W G , Van De Ven P M , Lemkes J S , Van Royen N ,   COACT investigators
Published: October 2021

Background

In out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation, immediate coronary angiography did not improve clinical outcomes when compared to delayed angiography in the Coronary Angiography after Cardiac Arrest (COACT) trial (1,2). Whether one of the two strategies has benefits in terms of healthcare resource use and costs is currently unknown. We assess the healthcare resource use and costs in patients with OHCA.

Methods

521 patients were eligible for a cost consequence analysis. Detailed healthcare resource use and cost-prices were collected from the initial hospital episode and compared between both groups. A generalized model (GLM) with a log link function and a gamma distribution was performed. Generic quality of life was measured with the RAND36 and collected at 12 months follow-up.

Results

Overall total mean costs were similar between both groups (EUR 33575±19612 vs EUR 33880±21044, P=0.86). GLM: (β 0.991 (95% CI 0.894–1.099), P=0.86. Mean procedural costs (CAG and/or PCI, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384±3447 vs EUR 3028±4220, P<0.001). Costs concerning Intensive Care Unit and ward stay did not show any significant difference. The median for the RAND-36 questionnaire physical component score was 49.2 in the immediate angiography group and 50.4 in the delayed group, P=0.57.

Conclusions

The mean total costs between OHCA patients randomized to an immediate angiography or a delayed invasive strategy were similar. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik, and AstraZeneca.
Assessment of cardiovascular risk factors in the health care centers among a Tunisian adults
Authors: Bannour R , Zammit N , Ghammem R , Ben Fredj S , Bennasrallah C , Mlouki I , EL Echi A , Maatoug J , Ghannem H
Published: October 2021

Background

Almost one third of deaths worldwide are attributable to cardiovascular diseases (CVD). In Tunisia, although a national strategy for the management of high blood pressure and diabetes has been implemented since 1999, CVD still represent a common cause of death. Purpose: To evaluate the assessment of cardiovascular risk factors in the health care centers among the adults of the governorate of Sousse, Tunisia.

Methods

Cross-sectional study was conducted in 2014 among 1977 adults living in 16 districts randomly selected from the delegations of the governorate of Sousse. Data collection was performed by trained doctors using a pre-tested questionnaire administered by interview to participants in their homes. Blood pressure and anthropometric measures were taken after each interview.

Results

The mean age of the participants was 39.8 (± 13.8) years. The sex ratio F/M was 1.54. Among patients with hypertension, 72% of were unbalanced; while 26.2% of participants without a history of hypertension had high blood pressure. Assessment of physical activity, dietary behaviors and weight in the health centers during the previous year, were reported by 28.3%, 32.6% and 36.5% of participants respectively. Assessment of smoking status and waist circumference were rarer with frequencies of 13.5% and 5.6% respectively.

Conclusions

The current national Tunisian program for diabetes and hypertension management should be reformed. Healthy life style promotion should integrate this national program.

Key messages

Dispite thenational strategy for the management of high blood pressure and diabetes in Tunisia; Cardio vascular disease still represent a common cause of death. The current national Tunisian program for diabetes and hypertension management should be reformed.
Parental Beliefs on the Harmfull Effects of Third Hand Smoke: Systematic Review and Meta-analysis
Authors: Oktar D , Ozcan L , Onsuz MF , Metintas S
Published: October 2021

Background

Third-hand smoke (THS); occurs as a result of the reaction of tobacco smoke residues left on furnitures or on smokers with the chemical substances in the environment. Children are a risky group in terms of THS exposure because they spend a lot of time at home and touch surfaces frequently. The aim is to systematically compile and meta-analyze studies in which parents' beliefs that THS are harmful are evaluated.

Methods

Pubmed, Scpous and Web of Science databases were scanned until April 6, 2021. Selective keywords were ‘third-hand smoke', ‘third hand smoke', ‘thirdhand smoke' and ‘belief'. Articles that were found to be suitable for the purpose of the study were also included by manually searching the references of the included articles. The PRISMA checklist was followed in the study. Studies that could not be clearly differentiated from THS from second-hand tobacco smoke and were not performed in parents were excluded. Duplicates were eliminated and the remaining article abstracts were read double-blind. Study data were entered into the OpenMeta [Analyst] program. Fixed effects model in the presence of homogeneous groups and random effects model in the presence of heterogeneous groups were used.

Results

As a result of the first literature search, 302 articles were reached. A total of 7 studies were included in the meta-analysis. As a result of the analysis, 4274 (57.3%, 95% CI 51.5-63.2) of 7632 parents were smoking and 5864 (76.3%, 95 CI 64.3-88.4) believed THS harms the health of children. In 4 studies, 2037 of 3581 parents (45.2%, 95% CI 24.2-66.1) were implementing a smoking ban at home. In 3 studies, the belief that THS is harmful to child health was higher in the presence of smoking ban at home (OR: 2.03, 95% GA 1.45-2.85, p < 0.001).

Conclusions

The frequency of smoking and smoking at home is high in parents. One in four parents does not believe THS is harmful to children's health.

Key messages

In order to protect children from THS harms, it is not enough just to not smoke in the house, and smoking should be evoided everywhere. Educational interventions should be planned to convince parents about the harmful effects of THS on child health.
Depicting socioeconomic disadvantage and social gradient in quality of life in Limassol, Cyprus
Authors: Middleton N , Theodorou E , Panayiotou A , Kleopa D , Ellina P , Kouta C
Published: October 2021

Background

The lack of validated and accepted area-level indices of socioeconomic disadvantage at national or regional level in Cyprus poses a barrier to “spatial thinking” among Public Health policy-makers and researchers.

Methods

A composite index of socioeconomic disadvantage was constructed by exploring the factor structure of 28 commonly used census indicators at city quarter (N = 38, median population 3894, IQR 2570-6169) and postcode level (N = 124, median 1320, IQR 798-2014). Predictive validity was explored in mixed random-effect regression models in term of associations with SF-36 health-related quality of life among a stratified random sample aged 45-64 (N = 450, 45 neighbourhoods).

Results

There was wide variability across communities in all indicators, for instance, 0.4%-25.9% unemployment, 41.1%-90.7% at most secondary level education, 3.6%-95.9% residences built prior to 1980. Two factors were identified: “socioeconomic disadvantage” (SED), with the same set of 11-12 indicators at the two levels of geographical aggregation, and “built environment”, reflecting proximity to the city centre, with nevertheless no meaningful associations with the outcome of interest. The SED index captured a stepwise decrease in physical (-1.39 95%CI -2.06, -0.72) and mental health (-1.26 95% -1.98, -0.54) scores across quartiles of postcodes with increasing disadvantage, of similar clinically significant effect size by gender. Associations attenuated slightly but remained significant after adjusting for person-based indicators of social position, with some weak evidence of cross-level interactions for physical, but not mental, health.

Conclusions

The composite index, tapping on educational, economic, material, occupational and social disadvantage, allowed the exploration of socioeconomic disadvantage patterning at a small-area level in the city of Limassol and documented the social gradient in health-related quality of life among a late working-life sample of residents.

Key messages

First-time depiction of the geographical patterning of socioeconomic disadvantage across the small geographical level of postcodes in the city of Limassol, Cyprus. Social gradient in physical and mental health in men and women across the continuum of socioeconomic disadvantage over and above person-based indicators of social position.
Clinician responses to cannabis use during pregnancy and lactation: a systematic review and integrative mixed-methods research synthesis
Authors: Panday Janelle , Taneja Shipra , Popoola Anuoluwa , Pack Rachael , Greyson Devon , McDonald Sarah D , Black Morgan , Murray-Davis Beth , Darling Elizabeth , Vanstone Meredith
Published: October 2021

Background

Perinatal cannabis use is increasing, and clinician counselling is an important aspect of reducing the potential harm of cannabis use during pregnancy and lactation. To understand current counselling practices, we conducted a systematic review and integrative mixed-methods synthesis to determine “how do perinatal clinicians respond to pregnant and lactating patients who use cannabis?”

Methods

We searched 6 databases up until 2021-05-31. Eligible studies described the attitudes, perceptions, or beliefs of perinatal clinician about cannabis use during pregnancy or lactation. Eligible clinicians were those whose practice particularly focusses on pregnant and postpartum patients. The search was not limited by study design, geography, or year. We used a convergent integrative analysis method to extract relevant findings for inductive analysis.

Results

Thirteen studies were included; describing perspectives of 1,366 clinicians in 4 countries. We found no unified approach to screening and counselling. Clinicians often cited insufficient evidence around the effects of perinatal cannabis use and lacked confidence in counselling about use. At times, this meant clinicians did not address cannabis use with patients. Most counselled for cessation and there was little recognition of the varied reasons that patients might use cannabis, and an over-reliance on counselling focussed on the legal implications of use.

Conclusion

Current approaches to responding to cannabis use might result in inadequate counselling. Counselling may be improved through increased education and training, which would facilitate conversations to mitigate the potential harm of perinatal cannabis use while recognizing the benefits patients perceive.
Diameter, height and volume increment single tree models for improved Sitka spruce in Great Britain
Authors: Manso Rubén , Davidson Rachael , McLean J Paul
Published: October 2021

The British forestry sector lacks reliable dynamic growth models for stands of improved Sitka spruce, the most important commercial forest type in Great Britain. The aim of this study is to fill this gap by trialling a new modelling framework and to lay the foundations of a future dynamic growth simulator for that forest type. First, we present single tree diameter and height increment models that are climate sensitive and include explicit competition effects. The predictions from the increment models are pooled to project diameter and height at a given age. These projections are then used as inputs to an integrated taper model from which stochastic tree volume predictions are obtained. Retrospective data from over 1400 trees collected in two extensive genetic trials in Scotland and Wales were used for the purposes of this study. Diameter increment and height increment predictions were highly accurate and diameter and height projections proved consistent. The predicted volume at the time of harvesting also exhibited a high degree of accuracy, which shows the robustness of our approach. Further data will be needed in the future to recalibrate the present models and extend their range of validity to the whole of Great Britain.
Mutation rate and spectrum in obligately outcrossing Caenorhabditis elegans mutation accumulation lines subjected to RNAi-induced knockdown of the mismatch repair gene msh-2
Authors: Katju Vaishali , Konrad Anke , Deiss Thaddeus C , Bergthorsson Ulfar
Published: October 2021

DNA mismatch repair (MMR), an evolutionarily conserved repair pathway shared by prokaryotic and eukaryotic species alike, influences molecular evolution by detecting and correcting mismatches, thereby protecting genetic fidelity, reducing the mutational load, and preventing lethality. Herein we conduct the first genome-wide evaluation of the alterations to the mutation rate and spectrum under impaired activity of the MutSα homolog, msh-2, in Caenorhabditis elegans male–female fog-2(lf) lines. We performed mutation accumulation (MA) under RNAi-induced knockdown of msh-2 for up to 50 generations, followed by next-generation sequencing of 19 MA lines and the ancestral control. msh-2 impairment in the male–female background substantially increased the frequency of nuclear base substitutions (∼23×) and small indels (∼328×) relative to wildtype hermaphrodites. However, we observed no increase in the mutation rates of mtDNA, and copy-number changes of single-copy genes. There was a marked increase in copy-number variation of rDNA genes under MMR impairment. In C. elegans, msh-2 repairs transitions more efficiently than transversions and increases the AT mutational bias relative to wildtype. The local sequence context, including sequence complexity, G + C-content, and flanking bases influenced the mutation rate. The X chromosome exhibited lower substitution and higher indel rates than autosomes, which can either result from sex-specific mutation rates or a nonrandom distribution of mutable sites between chromosomes. Provided the observed difference in mutational pattern is mostly due to MMR impairment, our results indicate that the specificity of MMR varies between taxa, and is more efficient in detecting and repairing small indels in eukaryotes relative to prokaryotes.
Chromosome-level genome assemblies of Channa argus and Channa maculata and comparative analysis of their temperature adaptability
Authors: Ou Mi , Huang Rong , Yang Cheng , Gui Bin , Luo Qing , Zhao Jian , Li Yongming , Liao Lanjie , Zhu Zuoyan , Wang Yaping , Chen Kunci
Published: October 2021

Background

Channa argus and Channa maculata are the main cultured species of the snakehead fish family, Channidae. The relationship between them is close enough that they can mate; however, their temperature adaptability is quite different.

Results

In this study, we sequenced and assembled the whole genomes of C. argus and C. maculata and obtained chromosome-level genome assemblies of 630.39 and 618.82 Mb, respectively. Contig N50 was 13.20 and 21.73 Mb, and scaffold N50 was 27.66 and 28.37 Mb, with 28,054 and 24,115 coding genes annotated for C. argus and C. maculata, respectively. Our analyses showed that C. argus and C. maculata have 24 and 21 chromosomes, respectively. Three pairs of chromosomes in C. argus correspond to 3 chromosomes in C. maculata, suggesting that 3 chromosomal fusion events occurred in C. maculata. Comparative analysis of their gene families showed that some immune-related genes were unique or expandable to C. maculata, such as genes related to herpes simplex infection. Analysis of the transcriptome differences related to temperature adaptation revealed that the brain and liver of C. argus rapidly produced more differentially expressed genes than C. maculata. Genes in the FoxO signalling pathway were significantly enriched in C. argus during the cooling process (P < 0.05), and the expression of 3 transcription factor genes in this pathway was significantly different between C. argus and C. maculata (P < 0.01).

Conclusions

C. maculata may have higher resistance to certain diseases, whereas C. argus has a faster and stronger response to low-temperature stress and thus has better adaptability to a low-temperature environment. This study provides a high-quality genome research platform for follow-up studies of Channidae and provides important clues regarding differences in the low-temperature adaptations of fish.
Studying mutation rate evolution in primates—a need for systematic comparison of computational pipelines
Authors: Bergeron Lucie A , Besenbacher Søren , Schierup Mikkel H , Zhang Guojie
Published: October 2021

The lack of consensus methods to estimate germline mutation rates from pedigrees has led to substantial differences in computational pipelines in the published literature. Here, we answer Susanne Pfeifer's opinion piece discussing the pipeline choices of our recent article estimating the germline mutation rate of rhesus macaques (Macaca mulatta). We acknowledge the differences between the method that we applied and the one preferred by Pfeifer. Yet, we advocate for full transparency and justification of choices as long as rigorous comparison of pipelines remains absent because it is the only way to conclude on best practices for the field.
Regression of oesophageal varices in total anomalous pulmonary venous connection
Authors: Takahara Shingo , Masaki Naoki , Tatewaki Hideki , Sai Sadahiro
Published: October 2021

The coexisting of oesophageal varices with total anomalous pulmonary venous connection is extremely rare but contains a potential leading to a lethal haemorrhage. The fate of the oesophageal varices after total anomalous pulmonary vein connection repair remains largely unknown. We herein report a case with infracardiac type total anomalous pulmonary venous connection with remarkable oesophageal varices. In the present case, of note, the oesophageal varices were completely regressed after total anomalous pulmonary venous connection repair without any intervention. This case might help a surgical team reduce the hesitation to repair the total anomalous pulmonary venous connection regardless of oesophageal varices, a potentially fatal condition.
Hindgut fermentation of starch is greater for pulse grains than cereal grains in growing pigs
Authors: Tan Felina P Y , Wang Li Fang , Gao Jun , Beltranena Eduardo , Vasanthan Thava , Zijlstra Ruurd T
Published: October 2021

The nutritive value of starch, the major source of dietary energy in pigs, varies depending on its susceptibility for digestion. The botanical origin of starch determines starch structure, and therefore, digestibility. To compare digestibility of starch, fiber, gross energy (GE), crude protein, and amino acid (AA), and to characterize undigested starch of grains in growing pigs, seven ileal-cannulated barrows (initial body weight, 30 kg) were fed six diets containing 96% of one of six test ingredients (three pulse grains: zero-tannin faba bean, green field pea, or mixed-cultivar chickpea; three cereal grains: hulled barley, hard red spring wheat, or hybrid yellow, dent corn), or a N-free diet in a 7 × 7 Latin square at 2.8 × maintenance digestible energy. Grain samples were ground with a hammer mill through a 2.78-mm screen. Amylose content ranged from 29% to 34% for pulse grains and from 22% to 25% for cereal grains. The apparent ileal digestibility (AID) of starch was greater (P < 0.05) in cereal (94% to 97%) than pulse grains (85% to 90%) and was lowest (P < 0.05) in faba bean (85.3%) followed by field pea (87.2%) and chickpea (90.1%). However, apparent total tract digestibility (ATTD) of starch of all tested grains was close to 100%. Apparent hindgut fermentability (AHF, as ATTD − AID) of starch was greater (P < 0.05) in pulse grains (9.9% to 15%) than cereal grains (3.3% to 4.8%). The AHF of total dietary fiber tended to be the greatest (P < 0.10) for corn (43.5%) and lowest for wheat (25.3%). The AHF of GE was greater (P < 0.05) in pulse grains (17% to 20%) than in cereal grains (9% to 11%) and resulted in greater (P < 0.05) digestible energy (DE) contribution from hindgut fermentation for pulse grains than cereal grains (0.9 vs. 0.5 Mcal/kg). Wheat had the greatest standardized ileal digestibility of total AA (90.2%; P < 0.05). Confocal laser scanning microscopy images revealed that 20% to 30% of starch granules of pulse grains were entrapped in protein matrixes. In scanning electron microscopy images, starch granules were larger in faba bean and field pea than cereal grains. Digesta samples revealed pin holes and surface cracks in starch granules of corn and wheat, respectively. In conclusion, hindgut fermentation of starch and fiber was greater in pulse grains than cereal grains resulting in a greater DE value despite lower ileal DE for pulse grain than cereal grains. Defining the digestible and fermentable fractions of starch may enhance the accuracy of equations to predict the net energy value of these feedstuffs.
The National Cancer Institute and Cannabis and Cannabinoids Research
Authors: Ellison Gary L , Alejandro Salicrup L , Freedman Andrew N , Fu Yali , Ross Sharon , Johnson Ronald L , Bakos Alexis , White Jeffrey D
Published: October 2021

The landscape of both recreational and medicinal cannabis use has changed dramatically over the past decade; however, research examining the risks and benefits of cannabis and cannabinoid use has lagged significantly behind the increased media promotion and their use by the general public and cancer patients. The National Cancer Institute (NCI) has supported cannabis-related research projects and funding opportunity announcements. In addition, NCI organized a virtual symposium on December 15-18, 2020, to discuss recent research findings on the use of cannabis and cannabinoids in relationship to cancer risk, prevention, and care. Specifically, the symposium sought to highlight the state of the science regarding cannabis, including the chemical constituents of cannabis (eg, cannabinoids), and cancer research involving cannabis, including cancer epidemiology, use in cancer patients, cancer biology and prevention, and preclinical and clinical cancer symptom and treatment side effect management with cannabis and cannabinoids as therapeutics. The symposium identified promising areas of future study, current barriers to conducting the research, and strategies to overcome those barriers. The series of papers in this special edition provide a summary of the symposium sessions as well as a synopsis of opportunities and challenges related to conducting research in this area.
Safety verification of carbon-ion radiotherapy for patients with cardiac implantable electronic devices (CIEDs)
Authors: Okano Naoko , Sakai Makoto , Shibuya Kei , Tsuda Kazuhisa , Kanzaki Takao , Sano Masato , Kaneko Yoshiaki , Ohno Tatsuya
Published: October 2021

According to guidelines, carbon-ion beam therapy is considered to carry a high safety risk for patients with cardiac implantable electronic devices (CIEDs), although the actual impacts remain unclear. In this study, we investigated the safety of carbon-ion beam therapy in patients with CIEDs. Patients with CIEDs who underwent carbon-ion therapy at Gunma University Heavy Ion Medical Center between June 2010 and December 2019 were identified and investigated for abnormalities in the operation of their CIEDs, such as oversensing and resetting during irradiation, and abnormalities in operation after treatment. In addition, the risk of irradiation from carbon-ion beam therapy was evaluated by model simulations. Twenty patients (22 sites) with CIEDs were identified, 19 with pacemakers and one with an implantable cardioverter-defibrillator (ICD). Treatments were completed without any problems, except for one case in which the treatment was discontinued because of worsening of the primary disease. Monte Carlo simulation indicated that the carbon beam irradiation produced neutrons at a constant and high level in the irradiation field. Nevertheless, with the distances between the CIEDs and the irradiation fields in the analyzed cases, the quantity of neutrons at the CIEDs was lower than that within the irradiation. Although carbon-ion beam therapy can be safely administered to patients with CIEDs, it is advisable to perform the therapy with sufficient preparation and backup devices because of the risks involved.
HMDB 5.0: the Human Metabolome Database for 2022
Authors: Wishart David S , Guo AnChi , Oler Eponine , Wang Fei , Anjum Afia , Peters Harrison , Dizon Raynard , Sayeeda Zinat , Tian Siyang , Lee Brian L , Berjanskii Mark , Mah Robert , Yamamoto Mai , Jovel Juan , Torres-Calzada Claudia , Hiebert-Giesbrecht Mickel , Lui Vicki W , Varshavi Dorna , Varshavi Dorsa , Allen Dana , Arndt David , Khetarpal Nitya , Sivakumaran Aadhavya , Harford Karxena , Sanford Selena , Yee Kristen , Cao Xuan , Budinski Zachary , Liigand Jaanus , Zhang Lun , Zheng Jiamin , Mandal Rupasri , Karu Naama , Dambrova Maija , Schiöth Helgi B , Greiner Russell , Gautam Vasuk
Published: October 2021

The Human Metabolome Database or HMDB (https://hmdb.ca) has been providing comprehensive reference information about human metabolites and their associated biological, physiological and chemical properties since 2007. Over the past 15 years, the HMDB has grown and evolved significantly to meet the needs of the metabolomics community and respond to continuing changes in internet and computing technology. This year's update, HMDB 5.0, brings a number of important improvements and upgrades to the database. These should make the HMDB more useful and more appealing to a larger cross-section of users. In particular, these improvements include: (i) a significant increase in the number of metabolite entries (from 114 100 to 217 920 compounds); (ii) enhancements to the quality and depth of metabolite descriptions; (iii) the addition of new structure, spectral and pathway visualization tools; (iv) the inclusion of many new and much more accurately predicted spectral data sets, including predicted NMR spectra, more accurately predicted MS spectra, predicted retention indices and predicted collision cross section data and (v) enhancements to the HMDB’s search functions to facilitate better compound identification. Many other minor improvements and updates to the content, the interface, and general performance of the HMDB website have also been made. Overall, we believe these upgrades and updates should greatly enhance the HMDB’s ease of use and its potential applications not only in human metabolomics but also in exposomics, lipidomics, nutritional science, biochemistry and clinical chemistry.
Evaluation of the Warrior Programme intervention among UK ex-service personnel
Authors: Thandi G , Phillips A , Greenberg N , Maguire N , Fear N T
Published: October 2021

Background

Research has shown that of the myriad services available to veterans in the UK, very few have been independently evaluated. This report presents the results of a randomized controlled trial assessing the impact of Time Line Therapy™ delivered by the Warrior Programme (a third-sector organization).

Aims

This study was aimed to determine if the intervention is effective in reducing emotional and functional difficulties in ex-service personnel.

Methods

A mixed-design analysis of variance model was used to investigate whether the Warrior Programme had a statistically significant impact on self-reported scores. The intervention and control group provided data on measures prior to and immediately after the intervention, and at 3-month follow-up.

Results

Those in the intervention group (n = 23) reported statistically significant improvements in self-reported scores immediately following intervention: the Clinical Outcomes in Routine Evaluation (CORE) scores (CORE global distress mean difference [MD] = 45.0, 95% confidence interval [CI] 31–60) (CORE subjective well-being MD = 5.9, 95% CI 3.5–8.3) (CORE functioning MD = 16.7, 95% CI 11.4–21.9) (CORE problems/symptoms MD = 19.4, 95% CI 13.1–25.7), general self-efficacy (MD = −9.8, 95% CI −13.6 to –6.8), anxiety (MD = 8.6, 95% CI 5.2–12.1), depression (MD = 10, 95% CI 6.6–13.5), post-traumatic stress disorder (MD = 26.3, 95% CI 17–25) and functional impairment (MD = 11.1, 95% CI 5.3–16.8) over time, compared to the control group (n = 29). However, score improvement was not sustained over time or statistically significant at follow-up.

Conclusions

The Warrior Programme was effective in reducing emotional and functional difficulties in ex-service personnel immediately after the intervention, but the effect was not sustained at 3-month follow-up.
Suprabulbar Approach to Jugular Fossa Tumors: 2-Dimensional Operative Video
Authors: Wu Kyle C , Aboud Emad , Al-Mefty Ossama
Published: October 2021

Owing to their scarcity, location, and intricate neurovascular associations, jugular fossa tumors are among the most challenging pathologies encountered by the neurosurgeon.
1
While paragangliomas originate within and often occlude the jugular bulb, schwannomas and meningiomas are extra-bulbar and typically do not impede venous flow.
2
Schwannomas typically arise from an extradural origin, expanding the jugular foramen.
3-5
Meningiomas are intradural and cause hyperostosis of the jugular tubercle.
6
We described and have been exposing and resecting jugular fossa tumors through a presigmoid suprabulbar infralabyrinthine window
6
that has been detailed in cadaveric studies.
7,8
This approach maintains the patency of the jugular bulb without breaching the labyrinths or manipulating the facial nerve. It is applicable to cases with partially impaired hearing and intact lower cranial nerves. The carotid artery can be identified by neuronavigation and micro-Doppler ultrasonography. This approach provides a direct lateral trajectory with a short distance to the jugular fossa and cerebellopontine angle. Early exposure and central debulking of the tumor minimize manipulation of the exquisitely sensitive lower cranial nerves. The distal aspect of these tumors can be removed with endoscopic assisted techniques.
9
The first patient is a 49-yr-old woman with a previously irradiated schwannoma who presented with worsening neurologic deficits—an extradural suprabulbar approach was used to resect this tumor. The second patient is a 27-yr-old woman with an enlarging meningioma and associated neurological dysfunction; this tumor was resected using the suprabulbar approach with opening of the presigmoid dura. Both patients have consented to surgery and publication of images.

Image at 2:27 and 6:38 reprinted from Arnautović et al, with permission from JNSPG. Image at 2:50 and 6:45 ©Ossama Al-Mefty 1997, reused with permission.
Auxin-Responsive (Phospho)proteome Analysis Reveals Key Biological Processes and Signaling Associated with Shoot-Borne Crown Root Development in Rice
Authors: Singh Harshita , Singh Zeenu , Zhu Tingting , Xu Xiangyu , Waghmode Bhairavnath , Garg Tushar , Yadav Shivani , Sircar Debabrata , De Smet Ive , Yadav Shri Ram
Published: October 2021

The rice root system is primarily composed of shoot-borne adventitious/crown roots (ARs/CRs) that develop from the coleoptile base, and therefore, it is an excellent model system for studying shoot-to-root trans-differentiation process. We reveal global changes in protein and metabolite abundance and protein phosphorylation in response to an auxin stimulus during CR development. The liquid chromatography–tandem mass spectrometry (LC–MS/MS) and gas chromatography–mass spectrometry (GC–MS) analyses of developing crown root primordia (CRP) and emerged CRs identified 334 proteins and 12 amino acids, respectively, that were differentially regulated upon auxin treatment. Gene ontology enrichment analysis of global proteome data uncovered the biological processes associated with chromatin conformational change, gene expression and cell cycle that were regulated by auxin signaling. Spatial gene expression pattern analysis of differentially abundant proteins disclosed their stage-specific dynamic expression pattern during CRP development. Further, our tempo-spatial gene expression and functional analyses revealed that auxin creates a regulatory module during CRP development and activates ethylene biosynthesis exclusively during CRP initiation. Further, the phosphoproteome analysis identified 8,220 phosphosites, which could be mapped to 1,594 phosphoproteins and of which 66 phosphosites were differentially phosphorylated upon auxin treatment. Importantly, we observed differential phosphorylation of the cyclin-dependent kinase G-2 (OsCDKG;2) and cell wall proteins, in response to auxin signaling, suggesting that auxin-dependent phosphorylation may be required for cell cycle activation and cell wall synthesis during root organogenesis. Thus, our study provides evidence for the translational and post-translational regulation during CR development downstream of the auxin signaling pathway.
DISTRIBUTION OF RADON AND URANIUM LEVELS IN GROUNDWATER OF DISTRICT PALWAL, SOUTHERN HARYANA, INDIA
Authors: Singh Bhupender , Kant Krishan , Garg Maneesha
Published: October 2021

Scintillation-detector-based SMART RnDuo (AQTEK System, India) and LED fluorimeter (Quantalase Instrument, India) were used for measurements of radon and uranium concentration in 54 groundwater samples collected from different locations in the Palwal district of Haryana (India). Radon in 26% and uranium in 54% of samples were found to be at higher levels than the maximum contamination limit (11 Bq l−1) for drinking water recommended by US Environmental Protection Agency and provisional guideline level (30 μg l−1) stated by World Health Organization.
Association between oral health and cardiovascular outcomes in patients with hypertension: a nationwide cohort study
Authors: Kim Jinkwon , Kim Hyung Jun , Jeon Jimin , Song Tae-Jin
Published: October 2021

Objective:

Studies on the association of oral hygiene indicators with cardiovascular disease in hypertensive patients have been lacking. Oral hygiene is directly or indirectly associated with systemic inflammation, one of the essential mechanisms of cardiovascular disease. Therefore, we hypothesized that oral hygiene would be related to the risk of cardiovascular diseases in hypertensive patients.

Methods:

We included 52 677 hypertensive participants who completed oral health checkups from the Korean National Health Insurance Service-National Health Screening Cohort between 2003 and 2004. We collected data on periodontitis diagnosis and treatment history, number of teeth loss, number of dental caries, and frequency of tooth brushing from medical records of health claims and oral health examination. The primary outcome was defined as composite outcomes of stroke and myocardial infarction. Follow-up was done until the date of primary outcome, or 31 December 2015.

Results:

During the 11.26 ± 2.39 years (mean ± standard deviation) of the study follow-up, 3292 participants developed primary outcomes [stroke (n = 2430), myocardial infarction (n = 862)]. In multivariable Cox regression analyses, participants with dental caries (≥ 5) were independently associated with occurrence of a primary outcome [adjusted hazard ratio: 1.37; 95% confidence interval (CI):1.10–1.72; P = 0.006]. Frequent tooth brushing (≥ 2 times/day) was significantly related to lower risk of primary outcomes (adjusted hazard ratio: 0.88; 95% CI: 0.81–0.96; P = 0.002).

Conclusion:

Our study demonstrated that multiple dental caries were related to the risk of cardiovascular diseases in hypertensive patients. Better oral hygiene may attenuate the risk of cardiovascular events in hypertensive patients.
Quadrant-Specific Changes in Corneal and Tear Fluid Reservoir Thickness for After 2 Hours of Wear
Authors: Nau Cherie B. , Dodda Samantha , Hodge David O. , Schornack Muriel M.
Published: October 2021

Objective:

To measure corneal swelling and thickness of the tear fluid reservoir (TFR) after wearing scleral lenses (SLs).

Methods:

Thirty-five participants had 1 eye fitted with each of three SLs (15.0-mm Jupiter, 18.2-mm Jupiter, and 18.0-mm Digiform). Scheimpflug images were obtained before wear, after application, after 2 hr of wear, and after removal. Initial and final TFR thickness and corneal thickness were measured in the central cornea and 3 mm from the center in the superior, inferior, temporal, and nasal quadrants.

Results:

Corneal thickness increased with wear, but no between-lens differences were observed in the superior (P=0.09), inferior (P=0.38), or temporal (P=0.53) quadrants. The greatest change in central and nasal cornea thickness was with the 15.0-mm SL (P<0.001). All areas showed settling, with no between-lens differences. Greater final TFR thickness was noted for the superior and nasal quadrants with the 18.0-mm SL (P<0.001), and less final TFR thickness was noted in the inferior (P<0.001) and temporal (P<0.001) quadrants with the 15.0-mm SL. Corneal thickness was not associated with the final TFR thickness.

Conclusions:

The greatest corneal swelling was observed in the inferior quadrant with the 15.0-mm SL, although this lens had the least TFR thickness inferiorly. TFR thickness alone did not account for observed corneal swelling.
Integration of Athletic Training Services on a Smokejumper Base
Authors: Callis Isabella , Moody Valerie J.
Published: October 2021

Objective:

To examine utilization of an athletic trainer (AT) at a Smokejumper base throughout fire season and document Smokejumper satisfaction with services provided.

Methods:

The AT documented patient encounters with Smokejumpers who were invited to complete a five-part injury prevention movement and mobility assessment (MMS) during fire season with follow up consultations to incorporate injury prevention strategies. Smokejumpers were asked to complete an AT satisfaction survey (ATSS) at the end of season.

Results:

One hundred ninety-two documented patient encounters revealed four primary reasons for AT consultation: exercise prescription (31%, n = 59/192); MMS (30%, n = 58/192); injury consultation (27%, n = 51/192); and patient education (12%, n = 24/192). Likert scores on the ATSS ranged from 4.67 to 4.92 out of a possible 5.

Conclusions:

Although continued research into Smokejumper injuries is critical, it is evident that Smokejumpers are interested in having direct access to AT services.
Pulmonary rehabilitation in a postcoronavirus disease 2019 world: feasibility, challenges, and solutions
Authors: Wen Jing , Milne Stephen , Sin Don D.
Published: October 2021

Purpose of review

Pulmonary rehabilitation improves clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). Traditional centre-based (in-person) pulmonary rehabilitation was largely shut down in response to the COVID-19 pandemic, forcing many centres to rapidly shift to remote home-based programs in the form of telerehabilitation (tele-pulmonary rehabilitation). This review summarizes the recent evidence for the feasibility and effectiveness of remote pulmonary rehabilitation programs, and their implications for the delivery of pulmonary rehabilitation in a postpandemic world.

Recent findings

A number of innovative adaptations to pulmonary rehabilitation in response to COVID-19 have been reported, and the evidence supports tele-pulmonary rehabilitation as a viable alternative to traditional centre-based pulmonary rehabilitation. However, these studies also highlight the challenges that must be surmounted in order to see its widespread adoption.

There are outstanding questions regarding the optimal model for tele-pulmonary rehabilitation. In the post-COVID-19 world, a ‘hybrid’ model may be more desirable, with some components held in person and others via telehealth technology. This would be determined by the infrastructure and expertise of individual centres, and the needs of their patients. In order to achieve a truly patient-centred pulmonary rehabilitation program, high-quality studies addressing these outstanding questions, as well as multidisciplinary collaboration, are required.
Concordance Among 10 Different Anticholinergic Burden Scales in At-Risk Older Populations
Authors: Tristancho-Pérez Ángela , Villalba-Moreno Ángela , Santos-Rubio María Dolores , Belda-Rustarazo Susana , Santos-Ramos Bernardo , Sánchez-Fidalgo Susana
Published: October 2021

Objective

The aim of the study was to evaluate the concordance among 10 anticholinergic scales for the measurement of anticholinergic drug exposure in at-risk elderly complex chronic patients in primary care.

Methods

An 8-month cross-sectional, multicenter study was carried out in a cohort of complex chronic patients older than 65 years in treatment with at least 1 drug with anticholinergic activity. Demographic, pharmacological, and clinical data were collected. Anticholinergic burden and risk were detected using the 10 scales included on the anticholinergic burden calculator (http://www.anticholinergicscales.es/). We used κ statistics to evaluated the concordance 2 to 2 (according to risk: high, medium, low or without risk) among the included scales.

Results

Four hundred seventy-three patients were recruited (60.3% female, median age of 84 years [interquartile range = 10]). Eighty was the total number of anticholinergic drugs with any scale (1197 prescriptions), with a median of 2 drugs with anticholinergic activity per patient (interquartile range = 2). The κ statistics comparing all the 10 scales ranged from −0.175 (Drug Burden Index versus Chew Scale) to 0.708 (Anticholinergic Activity Scale [AAS] versus Chew Scale). The best concordance was obtained between AAS and Chew Scale (κ = 0.708), followed by Clinician-Rated Anticholinergic Scale and Duran Scale (κ = 0.632) and AAS and Anticholinergic Cognitive Burden Scale (κ = 0.618), being considered substantial strengths of concordance.

Conclusions

The agreement among the 10 scales in elderly patients with complex chronic conditions was highly variable. Great care should be taken when assessing anticholinergic drug exposure using existing scales because of the wide variability among them. The only scales that showed agreement were the AAS-Chew, Clinician-Rated Anticholinergic Scale–Duran, and AAS–Anticholinergic Cognitive Burden Scale pairs. In the rest of the cases, the scales are not interchangeable.