bluuebunny/crossref_metadata_2025 huggingface dataset:
A calcified intestinal worm or Salgari’s syndrome?
Authors: Zammarchi Lorenzo , Viligiardi Riccardo , Modi Giulia , Spinicci Michele , Bartoloni Alessandro
Published: November 2020

A 49-year-old Latin American woman with severe abdominal pain underwent an abdominal X-ray, which showed a radiopaque foreign body in the left flank, initially suspected as an intestinal calcified parasite. Later, it turned out to be a displaced intrauterine device. A Salgari’s syndrome case is described.
Role of Cancer Surgery in the Improvement of the Operative Skills of Military Surgeons During Deployment: A Single-Center Study
Authors: Boudin Laurys , de Lesquen Henri , Patient Matthieu , Romeo Emilie , Rivière Damien , Cungi Pierre-Julien , Savoie Pierre-Henri , Avaro Jean-Philippe , Dagain Arnaud , Bladé Jean-Sébastien , Balandraud Paul , Bourgouin Stéphane
Published: November 2020

Introduction

The maintenance of military surgeons’ operative skills is challenging. Different and specific training strategies have been implemented in this context; however, little has been evaluated with regard to their effectiveness. Cancer surgery is a part of military surgeons’ activities in their home hospitals. This study aimed to assess the role of oncological surgery in the improvement of military surgeons’ operative skills.

Methods

Between January and June 2019, the surgical activities of the departments of visceral, ear, nose, and throat, urological, and thoracic surgery were retrospectively reviewed and assessed in terms of the operative time (OT). All surgeons working at the Sainte Anne Military Teaching Hospital were sent a survey to rate on a 5-point scale the current surgical practices on their usefulness in improving surgical skills required for treating war injuries during deployment (primary endpoint) and to compare on a 10-point visual analog scale the influence of cancer surgery and specific training on surgical fluency (secondary endpoint).

Results

Over the study period, 2,571 hours of OT was analyzed. Oncological surgery represented 52.5% of the surgical activity and almost 1,350 hours of cumulative OT. Considering the primary endpoint, the mean rating allocated to cancer surgery was 4.53 ± 0.84, which was not statistically different than that allocated to trauma surgery (4.42 ± 1.02, P = 0.98) but higher than other surgery (2.47 ± 1.00, P < 0.001). Considering the secondary endpoint, cancer surgery was rated higher than specific training by all surgeons, without statistically significant difference (positive mean score of + 2.00; 95% IC: 0.85–3.14).

Conclusion

This study demonstrates the usefulness of cancer surgery in improving the operative skills of military surgeons.
Neuropsychological, Neurocognitive, Vestibular, and Neuroimaging Correlates of Exposure to Repetitive Low-Level Blast Waves: Evidence From Four Nonoverlapping Samples of Canadian Breachers
Authors: Vartanian Oshin , Coady Lori , Blackler Kristen , Fraser Brenda , Cheung Bob
Published: November 2020

Introduction

We assessed the utility of a battery of neuropsychological, neurocognitive, physiological (balance, ataxia, postural tremor), and neuroimaging measures for studying the effects of blast waves in breachers—a population repeatedly exposed to low-level blast during military training and operations.

Materials and Methods

Data were collected from four nonoverlapping samples, in the course of similarly structured 4-day breacher training exercises in successive years involving a combination of indoor and outdoor blast events. In all cases, self-report and neuropsychological measures were administered once at baseline (i.e., 1 day before the start of training). In years 1-2, neurocognitive and physiological measures were administered daily before and after training. In years 3-4, neurocognitive data were collected once at baseline. In Year 4, we introduced 3 modifications to our design. First, in addition to breachers, we also collected data from sex—and age-matched military controls at the same time points. Second, we assessed balance, ataxia, and postural tremor immediately following blast exposure “in the field,” enabling us to quantify its acute effects. Third, structural magnetic resonance imaging (MRI) scans were acquired before and after the 4-day training exercise to explore differences between breachers and controls at baseline, as well as possible training-related changes using voxel-based morphometry. These design modifications were made to enable us to test additional hypotheses in the context of the same training exercise.

Results

At baseline, scores on the “Rivermead Post Concussion Symptoms Questionnaire,” “RAND SF-36” (physical functioning, role limitation due to physical health, social functioning, energy/fatigue, general health), and “Short Musculoskeletal Function Questionnaire” distinguished breachers from controls. Also at baseline, the MRI data revealed that there was greater regional gray matter volume in controls compared to breachers in the right superior frontal gyrus. Balance, ataxia, and postural tremor did not exhibit sensitivity to the acute effects of blast in the field, nor did neurocognitive measures to its cumulative or daily effects.

Conclusion

Our exploratory results suggest that self-report neuropsychological measures and structural MRI hold promise as sensitive measures for quantifying the long-term, cumulative effects of blast exposure in breachers. We discuss the limitations of our study and the need for prospective longitudinal data for drawing causal inferences regarding the impact of blast exposure on breachers’ health and performance.
The Development of Swedish Military Healthcare System: Part II—Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners
Authors: Khorram-Manesh Amir , Burkle Frederick M , Phattharapornjaroen Phatthranit , Ahmadi Marzaleh Milad , Sultan Mohammed Al , Mäntysaari Matti , Carlström Eric , Goniewicz Krzysztof , Santamaria Emelia , Comandante John David , Dobson Robert , Hreckovski Boris , Torgersen Glenn-Egil , Mortelmans Luc J , de Jong Mirjam , Robinson Yohan
Published: November 2020

Introduction

Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian–military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military’s involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare. This study investigated both these challenges and views from practitioners regarding the benefits of such collaboration and the manner in which it would be initiated.

Material and Method

A primary study was conducted among responsive countries using a questionnaire created using the Nominal Group Technique. Relevant search subjects and keywords were extracted for a systematic review of the literature, according to the PRISMA model.

Results

The 14 countries responding to the questionnaire had either a well-developed military healthcare system or units created in collaboration with the civilian healthcare. The results from the questionnaire and the literature review indicated a need for transfer of military medical knowledge and resources in emergencies to the civilian health components, which in return, facilitated training opportunities for the military staff to maintain their skills and competencies.

Conclusions

As the world witnesses a rapid change in the etiology of disasters and various crises, neither the military nor the civilian healthcare systems can address or manage the outcomes independently. There is an opportunity for both systems to develop future healthcare in collaboration. Rethinking education and training in war and conflict is indisputable. Collaborative educational initiatives in disaster medicine, public health and complex humanitarian emergencies, international humanitarian law, and the Geneva Convention, along with advanced training in competency-based skill sets, should be included in the undergraduate education of health professionals for the benefit of humanity.
Physical Therapist Management of COVID-19 in the Intensive Care Unit: The West China Hospital Experience
Authors: Li Lei , Yu Pengming , Yang Mengxuan , Xie Wei , Huang Liyi , He Chengqi , Gosselink Rik , Wei Quan , Jones Alice Y M
Published: November 2020

Objective

Coronavirus disease 2019 (COVID-19) has dominated the attention of health care systems globally since January 2020. Various health disciplines, including physical therapists, are still exploring the best way to manage this new disease. The role and involvement of physical therapists in the management of COVID-19 are not yet well defined and are limited in many hospitals. This article reports a physical therapy service specially commissioned by the Health Commission of Sichuan Province to manage COVID-19 during patients’ stay in the intensive care unit (ICU) at the Public Health Clinical Center of Chengdu in China.

Methods

Patients diagnosed with COVID-19 were classified into 4 categories under a directive from the National Health Commission of the People’s Republic of China. Patients in the “severe” and “critical” categories were admitted to the ICU irrespective of mechanical ventilation was required. Between January 31, 2020, and March 8, 2020, a cohort of 16 patients was admitted to the ICU at the Public Health Clinical Center of Chengdu. The median (minimum to maximum) hospital and ICU stays for these patients were 27 (11–46) and 15 (6–38) days, respectively. Medical management included antiviral, immunoregulation, and supportive treatment of associated comorbidities. Physical therapist interventions included body positioning, airway clearance techniques, oscillatory positive end-expiratory pressure, inspiratory muscle training, and mobility exercises. All patients had at least 1 comorbidity. Three of the 16 patients required mechanical ventilation and were excluded for outcome measures that required understanding of verbal instructions. In the remaining 13 patients, respiratory outcomes—including the Borg Dyspnea Scale, peak expiratory flow rate, Pao2/Fio2 ratio, maximal inspiratory pressure, strength outcomes, Medical Research Council Sum Score, and functional outcomes (including the Physical Function in Intensive Care Test score, De Morton Mobility Index, and Modified Barthel Index)—were measured on the first day the patient received the physical therapist intervention and at discharge.

Results

At discharge from the ICU, while most outcome measures were near normal for the majority of the patients, 61% and 31% of these patients had peak expiratory flow rate and maximal inspiratory pressure, respectively, below 80% of the predicted value and 46% had De Morton Mobility Index values below the normative value.

Conclusion

The respiratory and physical functions of some patients remained poor at ICU discharge, suggesting that long-term rehabilitation may be required for these patients.

Impact

Our experience in the management of patients with COVID-19 has revealed that physical therapist intervention is safe and appears to be associated with an improvement in respiratory and physical function in patients with COVID-19 in the ICU.
Associations of social cohesion and quality of life with objective and perceived built environments: a latent profile analysis among seniors
Authors: Hua J , Mendoza-Vasconez A S , Chrisinger B W , Conway T L , Todd M , Adams M A , Sallis J F , Cain K L , Saelens B E , Frank L D , King A C
Published: November 2020

Background

Healthy aging requires support from local built and social environments. Using latent profile analysis, this study captured the multidimensionality of the built environment and examined relations between objective and perceived built environment profiles, neighborhood social cohesion and quality of life among seniors.

Methods

In total, 693 participants aged 66–97 were sampled from two US locales in 2005–2008 as part of the Senior Neighborhood Quality of Life Study (SNQLS). Perceived social cohesion and quality of life were assessed using validated surveys. Six objective (geographic information system (GIS)-based) and seven perceived built environment latent profiles generated in previous SNQLS publications were used for analyses. Mixed-effects models estimated social cohesion and quality of life separately as a function of the built environment profiles.

Results

More walkable and destination-rich perceived built environment profiles were associated with higher social cohesion and quality of life. Objective built environment profiles were not associated with social cohesion and only positively associated with quality of life in only one locale (Baltimore/DC).

Conclusions

Latent profile analysis offered a comprehensive approach to assessing the built environment. Seniors who perceived their neighborhoods to be highly walkable and recreationally dense experienced higher neighborhood social cohesion and quality of life, which may set the stage for healthier aging.
Emerging phylogenetic structure of the SARS-CoV-2 pandemic
Authors: Fountain-Jones Nicholas M , Appaw Raima Carol , Carver Scott , Didelot Xavier , Volz Erik , Charleston Michael
Published: November 2020

Since spilling over into humans, SARS-CoV-2 has rapidly spread across the globe, accumulating significant genetic diversity. The structure of this genetic diversity and whether it reveals epidemiological insights are fundamental questions for understanding the evolutionary trajectory of this virus. Here, we use a recently developed phylodynamic approach to uncover phylogenetic structures underlying the SARS-CoV-2 pandemic. We find support for three SARS-CoV-2 lineages co-circulating, each with significantly different demographic dynamics concordant with known epidemiological factors. For example, Lineage C emerged in Europe with a high growth rate in late February, just prior to the exponential increase in cases in several European countries. Non-synonymous mutations that characterize Lineage C occur in functionally important gene regions responsible for viral replication and cell entry. Even though Lineages A and B had distinct demographic patterns, they were much more difficult to distinguish. Continuous application of phylogenetic approaches to track the evolutionary epidemiology of SARS-CoV-2 lineages will be increasingly important to validate the efficacy of control efforts and monitor significant evolutionary events in the future.
AKSF1 Isolated From the Rice-Virulent Strain Acidovorax avenae K1 Is a Novel Effector That Suppresses PAMP-Triggered Immunity in Rice
Authors: Kawaguchi Takemasa , Nakamura Minami , Hirai Hiroyuki , Furukawa Takehito , Kondo Machiko , Che Fang-Sik
Published: November 2020

Microbial pathogens deliver effectors into plant cells to suppress plant immune responses and modulate host metabolism in order to support infection processes. We sought to determine if the Acidovorax avenae rice-virulent K1 strain can suppress pathogen-associated molecular pattern–triggered immunity (PTI) induced by flagellin isolated from the rice-avirulent N1141 strain. The flagellin-triggered PTI, including H2O2 generation, callose deposition, and expression of several immune-related genes were strongly suppressed in K1 preinoculated cultured rice cells in a type III secretion system (T3SS)-dependent manner. By screening 4,562 transposon-tagged mutants based on their suppression ability, we found that 156 transposon-tagged K1 mutants lost the ability to suppress PTI induction. Mutant sequence analysis, comprehensive expression analysis using RNA sequencing, and the prediction of secretion through T3SS showed that a protein named A. avenae K1 suppression factor 1 (AKSF1) suppresses flagellin-triggered PTI in rice. Translocation of AKSF1 protein into rice cells is dependent on the T3SS during infection, an AKSF1-disruption mutant lost the ability to suppress PTI responses, and expression of AKSF1 in the AKSF1-disruption mutant complemented the suppression activity. When AKSF1-disruption mutants were inoculated into the host rice plant, reduction of the disease symptoms and suppression of bacterial growth were observed. Taken together, our results demonstrate that AKSF1 is a novel effector that can suppress the PTI in a host rice plant.

[Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law. 2021
Sensitivity of Pyricularia oryzae Populations to Fungicides Over a 26-Year Time Frame in Brazil
Authors: D’Ávila Leilane S. , De Filippi Marta C. Corsi , Café-Filho Adalberto C.
Published: November 2020

The long-term dynamics of fungicide resistance of the rice blast fungus Pyricularia oryzae was monitored by examining the reaction of the fungal field isolates, collected over a period of 26 years, to the active ingredients of commercially relevant fungicides. The in vitro sensitivity of all isolates was measured against quinone outside inhibitors (QoI), melanin biosynthesis inhibitors, and sterol demethylation inhibitor (DMI) fungicides, namely azoxystrobin (as a QoI), tricyclazole (as a melanin biosynthesis inhibitor), tebuconazole (as a DMI), and trifloxystrobin + tebuconazole (QoI + DMI). Over the 26-year collection period, a gradual rise in the EC50 estimates for mycelial growth sensitivity was observed for all fungicides, but most strikingly for azoxystrobin. A rise in conidial germination and appressorium formation was also noted, most markedly for azoxystrobin. Consistently, the earlier isolates were much more sensitive to the active ingredients than the more contemporary isolates. The sequencing of the amplified cyt b fragment distinguished two haplotypes, H1 and H2. Haplotype H1 (six isolates) contained the G to C transversion at codon 143 (resulting in change G143A), linked to the resistant phenotype QoI-R. Haplotype H2 (40 isolates), gathered the isolates sensitive to QoI. This work documents the gradual rise in the frequency of fungicide-resistant isolates in P. oryzae rice populations on a long-term basis.
Predictors of appointment adherence following operative treatment of pediatric supracondylar humerus fractures: which patients are not following up?
Authors: Hubbard Elizabeth W. , Rathjen Karl E. , Elliott Marilyn , Wimberly Robert L. , Riccio Anthony I.
Published: November 2020

This study aims to identify characteristics associated with poor appointment adherence after surgical stabilization of supracondylar humerus fractures (SCHFX) in children. A retrospective review of 560 consecutive, surgically managed patients with SCHFX from 2010 to 2015 was performed. One missed follow-up appointment was classified as ‘low adherence’, whereas missing two or more appointments was classified as ‘very low adherence’. Demographics, insurance status, estimated family income and distance from clinic were analyzed to identify differences in variables between adherent and low-adherent groups. Of 560, 121 (21.8%) missed one follow-up visit and 39/560 (7.1%) missed more than two visits. Age, gender, distance traveled, insurance status and primary language were nonpredictive. Estimated income <$50 000 was associated with a >200% increase in low adherence vs patients with estimated income >$50 000 (9.3 vs 3.8%; P = 0.012). African American patients had significantly lower adherence vs patients of other races (47.5 vs 19.6%; P < 0.0001). Ethnicity remained the only significant factor correlated to adherence after multivariate analysis. African Americans were three times more likely demonstrate low adherence (P = 0.0014). Ethnicity and estimated income <$50 000 were predictors of missing two or more visits. African American patients were four times more likely to miss two or more visits [odds ratio (OR), 4.17; P = 0.0026] than others; estimated income <$50 000 was associated with a two-fold increase in missing two or more visits (OR, 2.33; P = 0.035). By identifying at-risk patient populations, healthcare systems can adopt strategies to remove barriers of accessing follow-up care.
Calcified Aortic Valve Disease in Patients With Familial Hypercholesterolemia
Authors: Hu Haochang , Cheng Ji , Lin Shaoyi , Wang Shuangshuang , Chen Xiaomin
Published: November 2020

Familial hypercholesterolemia (FH) is a rare autosomal gene deficiency disease with increased low-density lipoprotein cholesterol, xanthoma, and premature coronary heart disease. Calcified aortic valve disease (CAVD) is prevalent in FH patients, resulting in adverse events and heavy health care burden. Aortic valve calcification is currently considered an active biological process, which shares several common risk factors with atherosclerosis, including aging, hypertension, dyslipidemia, and so on. Unfortunately, the pathogenesis and therapy of CAVD in FH are still controversial. There is no pharmacological intervention recommended to delay the development of CAVD in FH, and the only effective treatment for severe CAVD is aortic valve replacement. In this review, we summarize the detailed description of the pathophysiology, molecular mechanism, risk factors, and treatment of CAVD in FH patients.
The Glitazars Paradox: Cardiotoxicity of the Metabolically Beneficial Dual PPARα and PPARγ Activation
Authors: Kalliora Charikleia , Drosatos Konstantinos
Published: November 2020

The most common complications in patients with type-2 diabetes are hyperglycemia and hyperlipidemia that can lead to cardiovascular disease. Alleviation of these complications constitutes the major therapeutic approach for the treatment of diabetes mellitus. Agonists of peroxisome proliferator-activated receptor (PPAR) alpha and PPARγ are used for the treatment of hyperlipidemia and hyperglycemia, respectively. PPARs belong to the nuclear receptors superfamily and regulate fatty acid metabolism. PPARα ligands, such as fibrates, reduce circulating triglyceride levels, and PPARγ agonists, such as thiazolidinediones, improve insulin sensitivity. Dual-PPARα/γ agonists (glitazars) were developed to combine the beneficial effects of PPARα and PPARγ agonism. Although they improved metabolic parameters, they paradoxically aggravated congestive heart failure in patients with type-2 diabetes via mechanisms that remain elusive. Many of the glitazars, such as muraglitazar, tesaglitazar, and aleglitazar, were abandoned in phase-III clinical trials. The objective of this review article pertains to the understanding of how combined PPARα and PPARγ activation, which successfully targets the major complications of diabetes, causes cardiac dysfunction. Furthermore, it aims to suggest interventions that will maintain the beneficial effects of dual PPARα/γ agonism and alleviate adverse cardiac outcomes in diabetes.
LncRNA TUG1 Contributes to Hypoxia-Induced Myocardial Cell Injury Through Downregulating miR-29a-3p in AC16 Cells
Authors: Song Tao , Wang Pingping , Xin Lihong
Published: November 2020

Myocardial ischemia is a common reason that causes human death globally. Long noncoding RNA taurine upregulated 1 (TUG1) serves as an oncogene in a variety of cancers. In this article, we aimed to investigate the role of TUG1 and its underlying signal pathway in hypoxia-induced myocardial cell injury. Cell viability, apoptosis, and lactate dehydrogenase (LDH) release were detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, flow cytometry, western blot assay, and LDH cytotoxicity assay. Quantitative real-time polymerase chain reaction was applied to measure the enrichment of TUG1 and miR-29a-3p. MiR-29a-3p was predicted as a target of TUG1 by StarBase bioinformatic software, and the target relationship between TUG1 and miR-29a-3p was verified by dual-luciferase reporter assay. Hypoxia treatment induced the apoptosis and LDH release while inhibited the viability of AC16 cells. TUG1 was markedly upregulated while the level of miR-29a-3p was notably decreased in hypoxia-stimulated AC16 cells. TUG1 contributed to hypoxia-induced AC16 injury. MiR-29a-3p depletion intensified hypoxia-induced AC16 damage. TUG1 negatively regulated the expression of miR-29a-3p through their direct interaction in AC16 cells. TUG1 silencing-mediated influences in hypoxia-induced AC16 cells were partly reversed by the interference of miR-29a-3p. In conclusion, TUG1 accelerated hypoxia-induced AC16 injury through inversely modulating the level of miR-29a-3p. TUG1/miR-29a-3p axis might be an underlying therapeutic target for myocardial ischemia.
Efficacy of Long-Term Oral Beta-Blocker Therapy in Patients Who Underwent Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction With Preserved Left Ventricular Ejection Fraction: A Systematic Review and Meta-analysis
Authors: Maqsood Muhammad H. , Alam Mahboob , Atar Dan , Birnbaum Yochai
Published: November 2020

After the results of the first multicenter, prospective randomized clinical trial (RCT) evaluating long-term efficacy of oral beta-blockers in patients with preserved left ventricular ejection fraction (LVEF) after ST elevation myocardial infarction (STEMI), we decided to conduct an updated systematic review and meta-analysis to evaluate the long-term efficacy of oral beta-blocker use in patients with preserved LVEF who underwent percutaneous coronary intervention (PCI) for STEMI. A time-limited search from January 1, 1999, to April 16, 2020, on PubMed and EMBASE was conducted on April 16, 2020, for observational studies and clinical trials evaluating the efficacy of long-term oral beta-blockers in patients with preserved LVEF after STEMI treated with PCI. The comparative outcomes between beta-blockers and non–beta-blockers were assessed by pooling weighted odds ratio (OR) with 95% confidence interval (CI) using random-effects model. The outcomes of interest were all-cause mortality and major adverse cardiac event (MACE). Twelve studies (11 observational and 1 RCT) comprising 32,108 patients (19,740 on beta-blocker therapy and 12,368 without beta-blocker therapy) were included. Of which, 75% percent were male (mean age of 64 years: 63.87 ± 3.01 years on beta-blocker therapy and 64.76 ± 3.02 years on non–beta-blocker therapy; P = 0.129) with a follow-up of up to 4.7 years. Unadjusted all-cause mortality [OR = 0.58 (95% CI: 0.42–0.79)] and adjusted all-cause mortality [OR = 0.64 (95% CI: 0.48–0.87)] were significantly lower in patients on the long-term beta-blocker therapy group. However, unadjusted MACE [OR = 0.87 (95% CI: 0.70–1.08)] was not reduced with beta-blocker therapy in these patients. Patients with preserved LVEF after STEMI treated with PCI on long-term oral beta-blocker therapy have a significant reduction in risk of all-cause mortality, without an effect on MACE rates. The only RCT included showed neutral effect, so results of ongoing RCTs are anticipated. Considering that the only high-quality data (RCT) suggest a neutral effect, one should be cautious in interpreting the conclusion.
Agrin Yes-associated Protein Promotes the Proliferation of Epicardial Cells
Authors: Jing Xiaodong , Liu Bin , Deng Songbai , Du Jianlin , She Qiang
Published: November 2020

Embryonic epicardial cells make an important contribution to cardiac development. However, their proliferation mechanism is still unclear. Epicardial cells from E12.5 fetal hearts were used in our study. Agrin was used to treat these cells. The expression of Aurora B, Ki67, and pH3 was measured by quantitative reverse transcription-polymerase chain reaction and immunofluorescence. The proportion of cells in G1/S/G2 phase was determined by flow cytometry. The results showed that agrin significantly increased the expression of ki67, pH3, and Aurora B in epicardial cells. Flow cytometry results showed that agrin significantly increased the proportion of epicardial cells in S phase. However, blocking yes-associated protein significantly downregulated the levels of ki67, pH3, and Aurora B and the proportion of epicardial cells in S phase. Thus, our results suggest that agrin may promote the proliferation of epicardial cells by regulating the yes-associated protein activity. This may be useful in exploring heart development mechanisms and preventing congenital heart disease.
Atorvastatin Enhances Foam Cell Lipophagy and Promotes Cholesterol Efflux Through the AMP-Activated Protein Kinase/Mammalian Target of Rapamycin Pathway
Authors: Zheng Shuzhan , Du Yanfei , Ye Qiang , Zha Kelan , Feng Jian
Published: November 2020

Foam cells are the main pathological components of atherosclerosis. Therapies reducing foam cell formation can effectively prevent atherosclerotic diseases and cardiovascular events. Beyond lowering plasma cholesterol levels, the pleiotropic functions of statins in atherosclerosis have not been fully elucidated. In the present study, atorvastatin reduced cholesterol content and increased cholesterol efflux from foam cells in a concentration-dependent manner. Atorvastatin (10 μM) inhibited foam cell formation within 48 hours. Furthermore, we found that atorvastatin inhibited foam cell formation by promoting lipophagy, which was manifested by increased autophagy-related gene 5 (Atg5) expression, elevated ratio of microtubule-associated protein1 light chain 3 (LC3) II to LC3I, reduced p62 expression, and increased LC3 and lipid droplets colocalization in foam cells treated with atorvastatin. The autophagy inducer, rapamycin (Rap), did not increase the lipophagy enhancement effect of atorvastatin, but the autophagy inhibitor, 3-methyladenine, suppressed the effect of atorvastatin on Atg5 expression and the LC3II/LC3I ratio, as well as the increased p62 expression, suppressed lipophagy, attenuated cholesterol efflux and increased cholesterol content in foam cells. Further analysis revealed that atorvastatin promoted lipophagy by upregulating adenosine 5′-monophosphate-activated protein kinase (AMPK) phosphorylation, and downregulating mammalian target of rapamycin phosphorylation, whereas the AMPK inhibiter, compound C, attenuated these effects. In conclusion, atorvastatin reduced lipid accumulation and promoted cholesterol efflux by enhancing lipophagy in foam cells and thereby inhibited foam cell formation. The enhanced lipophagy of foam cells was exerted through the AMPK/mammalian target of rapamycin signaling pathway.
Resection of hepatocellular carcinoma in patients with portal hypertension: long-term results based on direct intraoperative measurement of portal venous pressure
Authors: Wang Sheng-Yu , Chau Ivy Yenwen , Hsia Cheng-Yuan , Lei Hao-Jan , Chou Shu-Cheng , Kao Yi-Chu , Chau Gar-Yang
Published: November 2020

Introduction:

The existence of differences in long-term prognosis of hepatocellular carcinoma (HCC) patients with or without portal hypertension (PH) undergoing hepatic resection remains controversial. Our aim was to clarify the long-term prognosis of HCC patients with PH undergoing hepatectomy. PH diagnosis was based on intraoperative portal venous pressure (PVP) measurement.

Materials and Methods:

Between May 2001 and April 2005, 68 patients with HCC underwent liver resection. PVP was directly measured at the beginning of surgery. Patients were divided into a high (>11 mm Hg) (n=33) or a low (≤11 mm Hg) (n=35) PVP group. Clinicopathologic factors and postoperative outcomes were compared between the 2 groups, with tumor staging stratification according to Milan criteria (selection criteria for patients receiving transplantation). Median follow-up time was 101 months.

Results:

Postoperative mortality was 0. Median PVP was 10.7 mm Hg (range; 2.9–23.5 mm Hg). Compared with patients with low PVP, patients with high PVP had lower platelet counts, lower serum albumin levels, higher ALT concentration, higher international normalized ratio, higher Model for End-Stage Liver Disease (MELD score), and increased blood loss and blood transfusion. Multivariate logistic regression analysis revealed factors related to high PVP: serum albumin level <3.6 g/dL (odd ratio: 5.532, 95% confidence interval: 1.286-23.79, P=0.022), and MELD score >6 (odd ratio: 5.585; 95% confidence interval: 1.638-19.040, P=0.006). Postoperative morbidity was comparable between the 2 groups. Overall survival and disease-free survival rates in the high PVP group were significantly lower than in the low PVP group (P<0.05). Subgroup analysis showed that, for patients within Milan criteria, those in the high PVP group had lower overall survival (P=0.032) and disease-free survival (P=0.016) than in those in the low PVP group. For patients outside the Milan criteria, no differences in survival were observed.

Conclusions:

In patients with early stage HCC undergoing resection, high PVP is associated with impaired long-term prognosis. For these patients, close follow-up and early salvage liver transplants for recurrent disease may be necessary to improve long-term prognosis after surgery.
Update on pediatric pulmonary arterial hypertension
Authors: Ivy Dunbar , Frank Benjamin S.
Published: November 2020

Purpose of review

Pulmonary arterial hypertension (PAH) causes high morbidity and mortality in children. In this review, we discuss advances in diagnosis and treatment of this disorder.

Recent findings

Proceedings published from the 2018 World Symposium updated the definition of pulmonary hypertension to include all adults and children with mean pulmonary artery pressure more than 20 mmHg. Targeted PAH therapy is increasingly used off-label, but in 2017, bosentan became the first Food and Drug Administration-targeted PAH therapy approved for use in children.

In recent years, advanced imaging and clinical monitoring have allowed improved risk stratification of pulmonary hypertension patients. New therapies, approved in adults and used off-label in pediatric patients, have led to improved outcomes for affected children.
Efficiency and Safety of Scleral Lenses in Rehabilitation of Refractive Errors and High Order Aberrations After Penetrating Keratoplasty
Authors: Penbe Aysegul , Kanar Hatice Selen , Simsek Saban
Published: November 2020

Objectives:

Visual rehabilitation after penetrating keratoplasty (PK) has difficulties linked to the high spherical and/or cylindric refractive errors with high order aberrations (HOAs) based on the ocular surface irregularities. We aimed to present the scleral contact lens (SCL)-induced complications and improvements in refractive errors and HOA with SCL fitting in post-PK patients.

Methods:

In this prospective study, 38 eyes of 35 patients who underwent PK and using SCLs were included. Uncorrected visual acuity, best-corrected visual acuity (BCVA), spherical equivalence, manifest astigmatism (Cyl), keratometry, and wavefront analyses of HOAs with corneal topography of all patients were measured before SCL and after 8 hrs of SCL wearing-on. The endothelial cellular density (ECD) changes at 6 months were also recorded. Any complications related to SCL were noted.

Results:

All patients showed an improvement in visual acuity with SCL. Uncorrected visual acuity before SCL fitting was 1.15±0.26 log of minimal angle of resolution (logMAR) and BCVA was 0.84±0.24 logMAR. The contact lens-corrected visual acuity decreased to 0.13±0.09 logMAR. Spherical equivalence, Cyl, and keratometry parameters decreased significantly with SCL. The anterior corneal HOAs, coma, and astigmatism coefficients decreased significantly. Conjunctival prolapse (in one eye) and graft rejection episode (in two eyes) were observed during follow-up time (14.25±1.3 months) and they restarted to use SCLs after treatment. The ECD decrease was similar with those who not using SCLs after PK in the literature.

Conclusion:

Our results indicate that scleral lenses may be a safe and effective option for the treatment of corneal astigmatism and HOAs associated with PK.
Nocturnal Variability of Intraocular Pressure Monitored With Contact Lens Sensor Is Associated With Visual Field Loss in Glaucoma
Authors: Yang Zhiyong , Mansouri Kaweh , Moghimi Sasan , Weinreb Robert N.
Published: November 2020

Purpose:

The aim was to determine whether 24-hour recording of intraocular pressure (IOP)-related ocular dimensional changes with a contact lens sensor (CLS, Triggerfish) is associated with the rate of visual field (VF) progression in primary open-angle glaucoma (POAG) patients.

Design:

This was a retrospective, observational cohort study.

Participants:

Patients with POAG were included from the Glaucoma Clinic and Diagnostic Innovations in Glaucoma Study at the Hamilton Glaucoma Center at University of California, San Diego.

Methods:

A session of 24-hour CLS recording was acquired for 1 eye from each patient. The mean follow-up time was 9.9±4.0 years. The association between CLS variables and rate of change of mean deviation was determined by univariate and multivariate mixed linear regression models.

Results:

Thirty-two patients, aged 69.8±13.6 years were included, 50% were female. An average of 11.6±5.6 standard automated perimetry examinations was available with a mean rate of mean deviation progression of −0.2±0.4 dB/year. Mean IOP was 17.8±4.2 mm Hg. The mean number of IOP-lowering medications were 1.2±1.0. Each 10-unit larger nocturnal variability of IOP-related ocular dimensional changes measured by CLS recording was significantly associated with −0.25±0.11 dB faster VF loss in POAG patients (P=0.035).

Conclusions:

Twenty-four-hour CLS recording of IOP-related ocular dimensional change was associated with faster VF progression. Such CLS recordings are useful to assess the risk of in progression in POAG patients.
COVID-19: gastrointestinal symptoms from the view of gut–lung axis
Authors: Zhang Mengna , Zhou Yunjiao , Li Haiou , Peng Yanan , Qiu Peishan , Shi Xianyan , Pan Xingfei , Liu Jing
Published: November 2020

The main symptoms of coronavirus disease 2019 (COVID-19) are respiratory manifestations, while some confirmed patients developed gastrointestinal symptoms or even initially presented digestive symptoms. The link between pneumonia and gastrointestinal symptoms caused by severe acute respiratory symptoms coronavirus 2 focused our attention on the concept of ‘gut–lung axis’. In this review, we discuss the inevitability and possible mechanisms of the occurrence of intestinal symptoms or intestinal dysfunction in COVID-19 from the perspective of the gut–lung axis, as well as the influence of the imbalance of intestinal homeostasis on the respiratory symptoms of COVID-19. The interaction between lung and intestine might lead to a vicious cycle of pulmonary and intestinal inflammation which may be a potential factor leading to the death of patients with COVID-19.
The interobserver agreement of the HEART-score, a multicentre prospective study
Authors: van Meerten Kirsten F. , Haan Rowan M.A. , Dekker Ineke M.C. , van Zweden Henriëtte J.J. , van Zwet Erik W. , Backus Barbra E.
Published: November 2020

Background and importance

Chest pain is one of the most common presentations to the emergency department (ED). The HEART-score is used to assess the 30-day risk of developing a major adverse cardiac event (MACE). The HEART-score enables clinicians to classify patients in low, intermediate, or high-risk groups though little is known as to whether this can be done reliably and reproducibly in a prehospital setting.

Objective

The aim of this study was to compare the interobserver agreement of the HEART-score between ambulance nurses and ED physicians.

Design, settings, and participants

Patients ≥18 years, with chest pain of suspected cardiac origin presented by ambulance to the EDs of four regional hospitals, were prospectively enrolled between October 2018 and April 2019.

Outcomes measure and analysis

The primary endpoint was interobserver agreement of the HEART-scores calculated by ambulance nurses compared to those calculated by ED physicians. Agreement was measured using Cohen’s Kappa (K) both for overall HEART-score and dichotomized HEART categories. A secondary endpoint was the occurrence of a MACE at 30 days after inclusion.

Main results

A total of 307 patients were enrolled of which 166 patients were male (54%). The mean age was 64.8 years. In 23% (95% confidence interval, 18–27), patients were scored in the low-risk category by both ambulance nurses and ED physicians. The K for the overall HEART-score compared between ambulance nurses and ED physicians was 0.514. The K for the low-risk category versus intermediate and high-risk category was 0.591. Both are defined as ‘moderate’. MACE within 30 days occurred in 64 patients (21%). In the low-risk group as defined by the ambulance nurses, there was a 7% risk of MACE compared to an average 5% MACE risk in the ED physician group.

Conclusions

The moderate interobserver agreement of the HEART-score does not currently support the use of the HEART-score by ambulance nurses in a prehospital setting. Training for prehospital nurses is vital to ensure that they are able to calculate the HEART-score accurately.
Hydroxychloroquine and COVID-19: Lack of Efficacy and the Social Construction of Plausibility
Authors: Rughiniş Cosima , Dima Lorena , Vasile Sorina
Published: November 2020

Background:

Severe acute respiratory syndrome coronavirus 2 SARS- Cov2 has taken the world by surprise. Among the first promising repurposing agents proposed for treatment and prophylaxis, 2 antimalarial agents came into limelight: chloroquine and its less toxic derivative, hydroxychloroquine (HCQ). Intense research and public debates have followed.

Areas of Uncertainty:

As HCQ is still used and studied, future research may bring novel evidence, modifying the state-of-the-art. Despite the lack of a single randomized control trial (RCT) with positive results, there are currently (as for the search on 30th of August 2020) more than 250 RCT registered on ClinicalTrials.gov with HCQ in COVID patients, and more than 150 of them are “still recruiting” or “not yet recruiting” patients.

Data Sources:

Our study combines a therapeutic evaluation of RCT data with a sociological analysis of related controversies, examining scientific and public arena discourses.

Results:

Although any hope of a positive effect was brought exclusively by some and not all of the observational studies, none of the 7 RCT published until now have found any benefit. From a sociological perspective, the HCQ controversy is a useful case study for understanding the construction of plausibility in a cultural context polarized into competing versions of reality, with different epistemologies and ideologies.

Conclusions:

The results of the first RCTs have been published, and they are disappointing; beneficial effects of HCQ could not be proven either for negative conversion on polymerase chain reactions of COVID patients or for postexposure prophylaxis. The question to be asked is: how many studies do we need until HCQ is abandoned? Argumentative time work, appealing to temporal properties of HCQ including its historical use, accumulation of evidence, alternative therapeutic scenarios, and sensationalist tempo for rhetorical purpose, plays a significant role in its continuing legitimation.
Adapting Index/Partner Services for the Treatment of Chlamydia Among Young African American Men in a Community Screening Program
Authors: Jones Austin T. , Craig-Kuhn Megan Clare , Schmidt Norine , Gomes Gérard , Scott Glenis , Watson Shannon , Hines Phazal , Davis Javone , Lederer Alyssa M. , Martin David H. , Kissinger Patricia J.
Published: November 2020

Background

Screening for asymptomatic Chlamydia trachomatis (Ct) among men has not been recommended because feasibility and efficacy are unknown. Check It is a seek-test-treat community-based Ct screening program for African American men who have sex with women and who are 15 to 24 years of age. This is an evaluation of adaptations made to the program aimed at improving index/partner notification and treatment rates.

Methods

The original Check It intervention included free testing and treatment, contact tracing performed by a third party, expedited index therapy, and expedited partner therapy via pharmacy pickup. The intervention was adapted after a series of in-depth interviews eliciting information to refine the program. Changes included continuity of testing, notification, and treatment by the same staff; expanded hours; and patient-delivered partner therapy with a medication mail-delivery option. Rates of index male and partner treatment were compared using log-binomial models and generalized estimating equations.

Results

Men in the adapted intervention (n = 85) were more likely than men in the original intervention (n = 99) to be contacted (relative risk [RR], 1.14; 95% confidence interval [CI], 1.02–1.27), make a treatment plan (RR, 1.14; 95% CI, 1.01–1.27), and complete treatment (RR, 1.45; 95% CI, 1.20–1.75). Female sexual partners were significantly more likely to complete treatment in postadaptation (n = 153) compared with preadaptation (n = 161; RR, 3.02; 95% CI, 1.81–5.05).

Conclusions

Compared with third-party notification and expedited index therapy/expedited partner therapy available by pharmacy pickup only, patient-delivered partner therapy with mail-delivery option, staff available at nontraditional hours, and staff continuity across testing, notification, and treatment significantly improved index and partner treatment completion.
Vision Screening among Children with Autism Spectrum Disorder
Authors: Swanson Mark W. , Lee Sarah Dille , Frazier Marcela G. , Bade Annette , Coulter Rachel Anastacia
Published: November 2020

SIGNIFICANCE

Vision problems occur at higher rates in children with autism spectrum disorder (ASD) than in the general population. Some professional organizations recommend that children with neurodevelopmental disorders need comprehensive assessment by eye care professionals rather than vision screening.

METHODS

Data from the 2011 to 2012 National Survey of Children's Health (NSCH) were accessed. Logistic regression was used to evaluate differences between vision screening rates in eye care professionals' offices and other screening locations among children with and without ASD.

RESULTS

Overall, 82.21% (95% confidence interval [CI], 78.35 to 86.06%) of children with ASD were reported to have had a vision screening as defined by the NSCH criteria. Among children younger than 5 years with ASD, 8.87% (95% CI, 1.27 to 16.5%) had a vision screening at a pediatrician's office, 41.1% (95% CI, 20.54 to 61.70%) were screened at school, and 37.62% (95% CI, 9.80 to 55.45%) were examined by an eye care professionals. Among children with ASD older than 5 years, 24.84% (95% CI, 18.42 to 31.26%) were screened at school, 22.24% (95% CI, 17.26 to 27.21%) were screened at the pediatricians' office, and 50.15% (95% CI, 44.22 to 56.08%) were examined by eye care professionals. Based on estimates from NSCH, no children in the U.S. population younger than 5 years with ASD screened in a pediatrician's office were also seen by an eye care provider.

CONCLUSIONS

If the public health goal is to have all children with ASD assessed in an eye care professional's office, data from the NSCH indicate that we as a nation are falling far short of that target.