bluuebunny/crossref_metadata_2025 huggingface dataset:
Antifungal activity of sustainable histone deacetylase inhibitors against planktonic cells and biofilms of Candida spp. and Cryptococcusneoformans
Authors: de Oliveira Andressa Souza , de Oliveira Jonathas Sales , Kumar Rajender , Silva Fabiana Brandão Alves , Fernandes Mirele Rodrigues , Nobre Feynman Dias , Costa Anderson da Cunha , Albuquerque Patrícia , Sidrim José Júlio Costa , Rocha Marcos Fábio Gadelha , Santos Flavia Almeida , Srivastava Vaibhav , Romeiro Luiz Antonio Soares , Brilhante Raimunda Sâmia Nogueira
Published: August 2023

The limited therapeutic options for fungal infections and the increased incidence of fungal strains resistant to antifungal drugs, especially Candida spp., require the development of new antifungal drugs and strategies. Histone deacetylase inhibitors (HDACi), like vorinostat, have been studied in cancer treatment and have antifungal effects, acting alone or synergistically with classical antifungals. Here we investigated the antifungal activity of two novel sustainable HDACi (LDT compounds) based on vorinostat structure. Molecular docking simulation studies reveal that LDT compounds can bind to Class-I HDACs of Candida albicans, C. tropicalis, and Cryptococcus neoformans, which showed similar binding mode to vorinostat. LDT compounds showed moderate activity when tested alone against fungi but act synergistically with antifungal azoles against Candida spp. They reduced biofilm formation by more than 50% in C. albicans (4 µg/mL), with the main action in fungal filamentation. Cytotoxicity of the LDT compounds against RAW264.7 cells was evaluated and LDT536 demonstrated cytotoxicity only at the concentration of 200 µmol/L, while LDT537 showed IC50 values of 29.12 µmol/L. Our data indicated that these sustainable and inexpensive HDACi have potential antifungal and antibiofilm activities, with better results than vorinostat, although further studies are necessary to better understand the mechanism against fungal cells.
Infection of bats with Histoplasma species
Authors: Gugnani Harish C , Denning David W
Published: August 2023

Histoplasma species infect humans and animals, notably bats. Histoplasma species are thermally dimorphic fungi existing in mycelial form in the natural environment and in yeast form in infected tissues. In this narrative literature review, we summarize the occurrence of Histoplasma spp. in different species of bat tissues (n = 49) and in soil admixed with bat guano where the species of bat dwelling nearby has been identified (an additional 18 species likely infected) to provide an up-to-date summary of data. Most positive isolations are from the Americas and Caribbean, with some studies from Thailand, Malaysia, Nigeria, Slovenia, France, and Australia. We also summarize some of the early experimental work to elucidate pathogenicity, latency, immune response, and faecal excretion in bats. Given the recent recognition of the global extent of histoplasmosis, thermal dimorphism in Histoplasma spp., and global heating, additional work on understanding the complex relationship between Histoplasma and bats is desirable.
Clinical features of Talaromyces marneffei infection in HIV-positive and HIV-negative individuals: A retrospective study in southern China
Authors: Wang Yuchen , Mo Xichao , Zhang Jian , Yan Ziyan , Fang Yiling , Deng Wenfeng , Xu Jian , Peng Jie , Miao Yun
Published: August 2023

Talaromyces marneffei (TSM) is a temperature-dependent dimorphic fungus endemic to Southeast Asia and southern China. As the number of people at risk of TSM infection continues to increase, the clinical manifestations are becoming increasingly complex, posing challenges for clinical management. In this study, we analyzed the medical records of 99 patients (71 human immunodeficiency virus [HIV]-positive and 28 HIV-negative) diagnosed with TSM infection from January 1, 2017, to December 31, 2022, in southern China and compared the clinical manifestations in HIV-positive and HIV-negative patients. Most patients (83/99, 84%) were male. The incidence of skin and soft tissue involvement (48% vs. 21%, P = .016); disseminated infection with blood circulation, hematopoietic, lymphatic, alimentary, or central nervous system involvement (69% vs. 36%, P = .002); and gastrointestinal bleeding (33% vs. 9%, P = .023) was higher in the HIV-positive group than the HIV-negative group. The HIV-positive group also had significantly higher alanine aminotransferase (ALT) levels (31 [26-42] vs. 14 [11-16] U/l, P < .001) and ALT/aspartate transaminase ratio (1.9 [1.5–2.2] vs. 1.3 [1.1–1.6], P = .006) than the HIV-negative group. The time to diagnosis (5.5 ± 1.1 vs. 5.1 ± 1.4 days, P = .103), antifungal regimen (P = .278), case fatality rate (20% vs. 21%, P = .849), and relapse/reinfection rate (11% vs. 19%, P = .576) did not differ significantly between the HIV-positive and HIV-negative groups. Poor antiretroviral therapy adherence (OR = 26.19, 95%CI 3.26–210.70, P = .002), advanced age (OR = 1.13, 95%CI 1.03–1.23, P = .010), and Epstein-Barr virus co-infection (OR = 37.13, 95%CI 3.03–455.64, P = .005) were independent risk factors for all-cause mortality from TSM infection in HIV-positive patients. Overall, the predominant infection sites, clinical manifestations, and complications of TSM infection differed by HIV status. However, with prompt diagnosis and appropriate treatment, HIV-positive patients with TSM infection can have similar outcomes to HIV-negative patients.
Multiphase fragmentation: molecular shattering
Authors: Farber Ryan J , Gronke Max
Published: August 2023

Recent observations suggest galaxies may ubiquitously host a molecular component to their multiphase circumgalactic medium (CGM). However, the structure and kinematics of the molecular CGM remain understudied theoretically and largely unconstrained observationally. Recent work suggests molecular gas clouds with efficient cooling survive acceleration in hot winds similar to atomic clouds. Yet the fragmentation of molecular clouds into a large number of fragments (‘shattering’) when subjected to external shocks or undergoing rapid cooling remains unstudied. We perform radiative, inviscid hydrodynamic simulations of clouds perturbed out of pressure equilibrium to explore the process of shattering to molecular temperatures. We find molecular clouds larger than a critical size can shatter into a mist of tiny droplets, with the critical size deviating significantly from the atomic case. We find that cold clouds shatter only if the sound crossing time exceeds the local maximum of the cooling time at ∼8000 K. Moreover, we find evidence for a universal mechanism to ‘shatter’ cold clouds into a ‘mist’ of tiny droplets as a result of rotational fragmentation – a process we dub ‘splintering’. Our results have implications for resolving the molecular phase of the CGM in observations and cosmological simulations.
A detached double X-ray tail in the merging galaxy cluster Z8338 with a large double tail
Authors: Ge Chong , Sun Ming , Nulsen Paul E J , Sarazin Craig , Markevitch Maxim , Schellenberger Gerrit
Published: August 2023

When subhaloes infall into galaxy clusters, their gas content is ram pressure stripped by the intracluster medium (ICM) and may turn into cometary tails. We report the discovery of two spectacular X-ray double tails in a single galaxy cluster, Z8338, revealed by 70 ks Chandra observations. The brighter one, with an X-ray bolometric luminosity of 3.9 × 1042 erg s−1, is a detached tail stripped from the host halo and extended at least 250 kpc in projection. The head of the detached tail is a cool core with the front tip of the cold front ∼30 kpc away from the nucleus of its former host galaxy. The cooling time of the detached cool core is ∼0.3 Gyr. For the detached gas, the gravity of the once-associated dark matter halo further enhances the Rayleigh–Taylor instability. From its survival, we find that a magnetic field of a few μG is required to suppress the hydrodynamic instability. The X-ray temperature in the tail increases from 0.9 keV at the front tip to 1.6 keV in the wake region, which suggests the turbulent mixing with the hotter ICM. The fainter double X-ray tail, with a total X-ray luminosity of 2.7 × 1042 erg s−1, appears to stem from the cool core of a subcluster in Z8338, and likely was formed during the ongoing merger. This example suggests that X-ray cool cores can be displaced and eventually destroyed by mergers, while the displaced cool cores can survive for some extended period of time.
Effect of vitamin B1 supplementation on blood creatinine and lactate levels and clinical outcomes in patients in intensive care units: a systematic review and meta-analysis of randomized controlled trials
Authors: Karimi Elmira , Gholizadeh Mohammad , Abdolahi Mina , Sedighiyan Mohsen , Salehinia Farahnaz , Siri Goli , Asanjarani Behzad , Yousefi Abolghasem , Gandomkar Hossein , Abdollahi Hamed
Published: August 2023

Context

The metabolic response to stress can deplete the remaining thiamine stores, leading to thiamine deficiency.

Objective

This study is the first meta-analysis of the effectiveness of thiamine supplementation on clinical and biochemical outcomes in adult patients admitted to the intensive care unit (ICU).

Data Sources

Scopus, PubMed, and Cochrane databases were searched to select studies up to 20 November 2022.

Study Selection

Studies investigating the effect of thiamine supplementation on serum lactate and creatinine levels, the need for renal replacement therapy, length of ICU stay, and mortality rate in ICU patients were selected.

Data Extraction

After excluding studies based on title and abstract screening, 2 independent investigators reviewed the full texts of the remaining articles. In the next step, a third investigator resolved any discrepancy in the article selection process.

Results

Of 1628 retrieved articles, 8 were selected for final analysis. This study showed that thiamine supplementation reduced the serum creatinine level (P = .03) compared with placebo. In addition, according to subgroup analysis, serum creatinine concentration was significantly lower in patients >60 years old (P < .00001). However, there was no statistically significant difference in the lactate level between the thiamine supplementation and placebo groups (P = .26). Thiamine supplementation did not decrease the risk of all-cause mortality (P = .71) or the need for renal replacement therapy (P = .14). The pooled results of eligible randomized controlled trials also showed that thiamine supplementation did not reduce the length of ICU stay in comparison to the placebo group (P = .39).

Conclusion

This meta-analysis provides evidence that thiamine supplementation has a protective effect against blood creatinine increase in ICU patients. However, further high-quality trials are needed to discover the effect of thiamine supplementation on clinical and biochemical outcomes in ICU patients.

Systematic Review Registration

PROSPERO no. CRD42023399710 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399710).
Quality improvement dashboard for healthcare providers and targeted client communication to pregnant women to improve timely attendance and quality of antenatal care: A multi-arm cluster randomized trial (the eRegCom trial)
Authors: Mørkrid Kjersti , Ghanem Buthaina , Abbas Eatimad , Khader Khadija Abu , Ward Itimad Abu , Ataallah Amjad , Baniode Mohammad , Bogale Binyam , Hijaz Taghreed , Frost Kimberly Suzanne , Frost Michael James , Isbeih Mervett , Issawi Sally , Nazzal Zaher A S , O’Donnell Brian , Papadopoulou Eleni , Qaddomi Sharif E , Rabah Yousef , Rose Christopher J , Venkateswaran Mahima , Frøen J Frederik
Published: August 2023

Background: Digital health interventions can strengthen coverage and quality of care. Our aim was to assess the effectiveness of targeted client communication (TCC) to pregnant women via text messages, health care provider communication via a quality improvement dashboard (QID) and the combination of TCC and QID—generated and delivered from a digital maternal and child health registry (MCH eRegistry), running on the District Health Information Software 2 (DHIS2) platform in West Bank and Gaza. The control was the regular MCH eRegistry.

Methods: We included 137 clusters in a four-arm cluster randomized controlled trial. Primary outcomes were appropriate screening and management of anemia, hypertension and diabetes during pregnancy, and timely attendance to routine antenatal care (ANC).

Results: The COVID-19 pandemic interrupted the trial, which failed to achieve the estimated sample size. Between 1 December 2019 and 23 March 2020, 4138 women attended ANC in the TCC, 3553 in the QID, 4223 in the TCC & QID and 3324 in the control arm. In the TCC arm, 76.5% of the visits were attended timely versus 73.4% in the control arm, (adjusted odds ratio, 1.2; 95% confidence interval, 0.90–1.61). We found no difference between QID and control, or between TCC & QID control in the proportion of visits where anemia, hypertension and diabetes were appropriately screened and managed.

Conclusion: The routine individual-level data of the MCH eRegistry enabled the implementation of theory-driven TCC and QID. However, the COVID-19 pandemic interrupted this trial of TCC and QID, and we were unable to observe any significant effect.

Trial registration: ISRCTN Registry, ISRCTN10520687.
The Amount of Zeaxanthin Epoxidase But Not the Amount of Violaxanthin De-Epoxidase Is a Critical Determinant of Zeaxanthin Accumulation in Arabidopsis thaliana and Nicotiana tabacum
Authors: Küster Lukas , Lücke Rebecca , Brabender Christin , Bethmann Stephanie , Jahns Peter
Published: August 2023

The generation of violaxanthin (Vx) de-epoxidase (VDE), photosystem II subunit S (PsbS) and zeaxanthin (Zx) epoxidase (ZEP) (VPZ) lines, which simultaneously overexpress VDE, PsbS and ZEP, has been successfully used to accelerate the kinetics of the induction and relaxation of non-photochemical quenching (NPQ). Here, we studied the impact of the overexpression of VDE and ZEP on the conversion of the xanthophyll cycle pigments in VPZ lines of Arabidopsis thaliana and Nicotiana tabacum. The protein amount of both VDE and ZEP was determined to be increased to about 3- to 5-fold levels of wild-type (WT) plants for both species. Compared to WT plants, the conversion of Vx to Zx, and hence VDE activity, was only marginally accelerated in VPZ lines, whereas the conversion of Zx to Vx, and thus ZEP activity, was strongly increased in VPZ lines. This indicates that the amount of ZEP but not the amount of VDE is a critical determinant of the equilibrium of the de-epoxidation state of xanthophyll cycle pigments under saturating light conditions. Comparing the two steps of epoxidation, particularly the second step (antheraxanthin to Vx) was found to be accelerated in VPZ lines, implying that the intermediate Ax is released into the membrane during epoxidation by ZEP.
Deep Learning from Phylogenies for Diversification Analyses
Authors: Lambert Sophia , Voznica Jakub , Morlon Hélène
Published: August 2023

Birth–death (BD) models are widely used in combination with species phylogenies to study past diversification dynamics. Current inference approaches typically rely on likelihood-based methods. These methods are not generalizable, as a new likelihood formula must be established each time a new model is proposed; for some models, such a formula is not even tractable. Deep learning can bring solutions in such situations, as deep neural networks can be trained to learn the relation between simulations and parameter values as a regression problem. In this paper, we adapt a recently developed deep learning method from pathogen phylodynamics to the case of diversification inference, and we extend its applicability to the case of the inference of state-dependent diversification models from phylogenies associated with trait data. We demonstrate the accuracy and time efficiency of the approach for the time-constant homogeneous BD model and the Binary-State Speciation and Extinction model. Finally, we illustrate the use of the proposed inference machinery by reanalyzing a phylogeny of primates and their associated ecological role as seed dispersers. Deep learning inference provides at least the same accuracy as likelihood-based inference while being faster by several orders of magnitude, offering a promising new inference approach for the deployment of future models in the field.
A car-following model based on the optimized velocity and its security analysis
Authors: Fei Rong , Yang Lu , Hei Xinhong , Hu Bo , Li Aimin
Published: August 2023

An enhanced optimal velocity model (EOVM) that considers driving safety is established to alleviate traffic congestion and ensure driving safety. Time headway is introduced as a criterion for determining whether the car is safe. When the time headway is less than the minimum time headway (THmin ) or more than the most comfortable time headway (THcom), the acceleration constraints are discussed to ensure the model’s safety and maintain the following state. A stability analysis of the model was carried out to determine the stability conditions of the model. The EOVM is compared with the optimal velocity model (OVM) and fuzzy car-following model using the real dataset. Experiments show that the EOVM model has the smallest error in average, maximum and median with the real dataset. To confirm the model’s safety, design fleet simulation experiments were conducted for three actual scenarios of starting, stopping and uniform process.
Hmga1‐overexpressing lentivirus protects against osteoporosis by activating the Wnt/β‐catenin pathway in the osteogenic differentiation of BMSCs
Authors: Wu Zhixin , Zhu Jiayong , Wen Yinxian , Lei Pengfei , Xie Jie , Shi Haifei , Wu Ronghuan , Lou Xianfeng , Hu Yihe
Published: August 2023

Postmenopausal osteoporosis is associated with bone formation inhibition mediated by the impaired osteogenic differentiation potential of bone marrow mesenchymal stem cells (BMSCs). However, identifying and confirming the essential genes in the osteogenic differentiation of BMSCs and osteoporosis remain challenging. The study aimed at revealing the key gene that regulated osteogenic differentiation of BMSCs and led to osteoporosis, thus exploring its therapeutic effect in osteoporosis. In the present study, six essential genes related to the osteogenic differentiation of BMSCs and osteoporosis were identified, namely, fibrillin 2 (Fbn2), leucine‐rich repeat‐containing 17 (Lrrc17), heat shock protein b7 (Hspb7), high mobility group AT‐hook 1 (Hmga1), nexilin F‐actin‐binding protein (Nexn), and endothelial cell‐specific molecule 1 (Esm1). Furthermore, the in vivo and in vitro experiments showed that Hmga1 expression was increased during the osteogenic differentiation of rat BMSCs, while Hmga1 expression was decreased in the bone tissue of ovariectomized (OVX) rats. Moreover, the expression of osteogenic differentiation‐related genes, the activity of alkaline phosphatase (ALP), and the number of mineralized nodules were increased after Hmga1 overexpression, which was partially reversed by a Wnt signaling inhibitor (DKK1). In addition, after injecting Hmga1‐overexpressing lentivirus into the bone marrow cavity of OVX rats, the bone loss, and osteogenic differentiation inhibition of BMSCs in OVX rats were partially reversed, while osteoclast differentiation promotion of BMSCs in OVX rats was unaffected. Taken together, the present study confirms that Hmga1 prevents OVX‐induced bone loss by the Wnt signaling pathway and reveals that Hmga1 is a potential gene therapeutic target for postmenopausal osteoporosis.
Anaphylaxis due to antiallergic and antiasthmatic biologics
Authors: Furci Fabiana , Luxi Nicoletta , Senna Gianenrico , Trifirò Gianluca
Published: August 2023

Purpose of review

To provide a better understanding of the risk of anaphylaxis due to antiallergic and antiasthmatic biologics through an analysis of data reported in literature and in clinical trials, and by conducting a retrospective descriptive analysis of individual case safety reports on VigiBase, the WHO International Pharmacovigilance database.

Recent findings

Analysis of the data, as described, demonstrated safety of the antiallergic and antiasthmatic biologics with a low incidence of anaphylaxis.

Biologic therapies have revolutionized the treatment of many diseases, such as atopic dermatitis, nasal polyps, spontaneous chronic urticarial and severe asthma with a precise immunological action, in the sphere of precision medicine.

Albeit these drugs are generally well tolerated, generating real-world evidence is crucial to re-evaluate clinically relevant adverse events, such as anaphylaxis, allowing to confirm their safety profile in particular in special populations such as paediatric patients.
Transition to Residency: National Study of Factors Contributing to Variability in Learner Milestones Ratings in Emergency Medicine and Family Medicine
Authors: Park Yoon Soo , Ryan Michael S. , Hogan Sean O. , Berg Katherine , Eickmeyer Adam , Fancher Tonya L. , Farnan Jeanne , Lawson Luan , Turner Laurah , Westervelt Marjorie , Holmboe Eric , Santen Sally A. ,   for the Medical School Outcomes Milestones Study Group
Published: August 2023

Purpose

The developmental trajectory of learning during residency may be attributed to multiple factors, including variation in individual trainee performance, program-level factors, graduating medical school effects, and the learning environment. Understanding the relationship between medical school and learner performance during residency is important in prioritizing undergraduate curricular strategies and educational approaches for effective transition to residency and postgraduate training. This study explores factors contributing to longitudinal and developmental variability in resident Milestones ratings, focusing on variability due to graduating medical school, training program, and learners using national cohort data from emergency medicine (EM) and family medicine (FM).

Method

Data from programs with residents entering training in July 2016 were used (EM: n=1,645 residents, 178 residency programs; FM: n=3,997 residents, 487 residency programs). Descriptive statistics were used to examine data trends. Cross-classified mixed-effects regression were used to decompose variance components in Milestones ratings.

Results

During postgraduate year (PGY)-1, graduating medical school accounted for 5% and 6% of the variability in Milestones ratings, decreasing to 2% and 5% by PGY-3 for EM and FM, respectively. Residency program accounted for substantial variability during PGY-1 (EM=70%, FM=53%) but decreased during PGY-3 (EM=62%, FM=44%), with greater variability across training period in patient care (PC), medical knowledge (MK), and systems-based practice (SBP). Learner variance increased significantly between PGY-1 (EM=23%, FM=34%) and PGY-3 (EM=34%, FM=44%), with greater variability in practice-based learning and improvement (PBLI), professionalism (PROF), and interpersonal communication skills (ICS).

Conclusions

The greatest variance in Milestone ratings can be attributed to the residency program and to a lesser degree, learners, and medical school. The dynamic impact of program-level factors on learners shifts during the first year and across the duration of residency training, highlighting the influence of curricular, instructional, and programmatic factors on resident performance throughout residency.
From Eggshells to Action: A Qualitative Study of Faculty Experience Responding to Microaggressions Targeting Medical Students
Authors: O’Brien Meghan T. , Bullock Justin L. , Minhas Prabhjot K. , Roman Sanziana A. , Joshi Priya , Lupton Katherine L. , Hauer Karen E.
Published: August 2023

Purpose

Microaggressions targeting clinical learners cause harm and threaten learning. Clinical supervisors can be powerful allies by intervening when microaggressions occur. This study explored general and student-nominated skilled supervisors’ perspectives on responding to microaggressions targeting clinical learners.

Method

This single-institution, qualitative study within a constructivist paradigm explored faculty supervisor experiences with bystander response to microaggressions targeting learners. Clinical supervisors in medicine and surgery departments and those across departments nominated by students as skilled microaggression responders were invited to discuss microaggression scenarios targeting students in semistructured focus groups in the U.S. in 2020–2021. Investigators applied the framework method of thematic analysis to identify themes.

Results

Forty-two faculty (31 medicine and surgery [“general”], 11 “student-nominated” as skilled responders) joined 10 focus groups (6 “general,” 3 “student-nominated,” 1 mixed). Four themes characterized experiences responding to microaggressions targeting learners: bystander goals, noticing, acting, and continuous learning. Participants’ response goals were protecting learners, safeguarding learning, and teaching microaggression response skills. Noticing was influenced by past experiences with microaggressions and acculturation to clinical environments. Bystander action stemmed from (1) microaggression type, (2) personal emotional vulnerability, (3) knowledge of student preferences for supervisor response, and (4) clinical and educational context. Bystander action was more common when participants regarded all microaggressions as harmful, understood student preferences for faculty response, expected to err (growth mindset), and framed microaggressions as opportunities for humble reflection, intellectual candor, and teaching. Microaggression response required continuous learning through informal and formal skills development.

Conclusions

Complex factors govern faculty bystander response to microaggressions targeting clinical learners. Efforts to strengthen faculty bystander response should incorporate skill-building around preemptive discussions with learners and using intellectual candor to promote psychological safety, learning, and bystander action. Additional investigation is needed on how to incorporate these skills into team workflows and to assess outcomes of specific response strategies.
Hearing Aids Reduce Self-Perceived Difficulties in Noise for Listeners With Normal Audiograms
Authors: Mealings Kiri , Valderrama Joaquin T. , Mejia Jorge , Yeend Ingrid , Beach Elizabeth F. , Edwards Brent
Published: August 2023

Objectives:

This study assessed hearing aid benefits for people with a normal audiogram but hearing-in-noise problems in everyday listening situations.

Design:

Exploratory double-blinded case-control study whereby participants completed retrospective questionnaires, ecological momentary assessments, speech-in-noise testing, and mental effort testing with and without hearing aids. Twenty-seven adults reporting speech-in-noise problems but normal air conduction pure-tone audiometry took part in the study. They were randomly separated into an experimental group that trialed mild-gain hearing aids with advanced directional processing and a control group fitted with hearing aids with no gain or directionality.

Results:

Self-reports showed mild-gain hearing aids reduce hearing-in-noise difficulties and provide a better hearing experience (i.e., improved understanding, participation, and mood). Despite the self-reported benefits, the laboratory tests did not reveal a benefit from the mild-gain hearing aids, with no group differences on speech-in-noise tests or mental effort measures. Further, participants found the elevated cost of hearing aids to be a barrier for their adoption.

Conclusions:

Hearing aids benefit the listening experience in some listening situations for people with normal audiogram who report hearing difficulties in noise. Decreasing the price of hearing aids may lead to greater accessibility to those seeking remediation for their communication needs.
Technology Usage, Physical Activity, and Motivation in Patients With Heart Failure and Heart Transplantation
Authors: Deka Pallav , Almenar Luis , Pathak Dola , Muñoz-Gómez Elena , Orihuela-Cerdeña Laura , López-Vilella Raquel , Klompstra Leonie , Marques-Sule Elena
Published: August 2023

The cross-sectional study enrolled 231 patients with heart failure (n = 115; 60.87% were men; mean age, 74.34 ± 12.70 years) and heart transplantation (n = 116; 72.41% were men; mean age, 56.85 ± 11.87 years) who self-reported their technology usage, physical activity, and source of motivation for exercise. Patients with heart failure were significantly older (P = .0001) than patients with heart transplantation. Physical activity levels in patients with heart failure decreased as the New York Heart Association classification increased. Patients with heart failure reported significantly lower physical activity than patients with heart transplantation (P = .0008). Smartphones were the most widely used electronic device to access the Internet in both groups. Patients with heart transplantation seemed to use more than one device to access the Internet. In both groups, patients reporting more technology usage also reported higher levels of physical activity. Patients who accessed the Internet daily reported lower levels of physical activity. Whereas patients with heart failure identified encouragement by family members as a source of motivation for exercise, patients with heart transplantation reported that they were likely to exercise if motivated by their healthcare provider. Patients with heart failure and heart transplantation have unique technological and motivational needs that need consideration for mobile health–driven interventions.
Effect of Chronic Rhinitis Treatment in Children with Attention-Deficit/Hyperactivity Disorder
Authors: Suntiwes Ruaywan , Chirdkiatgumchai Vilawan , Roongpraiwan Rawiwan , Kuptanon Teeradej , Kiatrungrit Komsan , Manuyakorn Wiparat
Published: August 2023

Objective:

The purpose of this study is to examine the effect of chronic rhinitis treatment on attention-deficit/hyperactivity disorder (ADHD) symptoms in children with ADHD.

Methods:

Children and adolescents with ADHD were screened for chronic rhinitis symptoms. Participants with positive chronic rhinitis screening underwent the skin prick test and received rhinitis treatment for 3 months. All participants were evaluated using the parent's and teacher's Vanderbilt ADHD rating scales, total nasal symptom score, and Quality of Life Questionnaire (OSA-18) for pediatric obstructive sleep apnea at pretreatment and posttreatment.

Results:

Overall, 140 children and adolescents with ADHD were enrolled and screened for chronic rhinitis. Fifty-four children and adolescents with positive screening results underwent the skin prick test and received rhinitis treatment. After 3 months of treatment, inattentive, hyperactive/impulsive, and total ADHD symptom scores were significantly decreased as reported by parents (p = 0.031 to <0.001) and teachers (p = 0.001 to <0.001) compared with those before treatment. A subgroup analysis also showed improvement in ADHD symptoms as reported by parents and teachers in the allergic and nonallergic rhinitis groups. Pearson's correlation coefficient analyses showed positive correlations between improvement in the ADHD symptom scores reported by parents and improvement in the quality of life related to sleep problems from the OSA-18 questionnaire (r = 0.377–0.387).

Conclusion:

Treating chronic rhinitis can improve ADHD symptoms in children and adolescents with ADHD. Pediatricians should be aware of and treat chronic rhinitis to maximize ADHD symptom control.
The Dynamic Lymphaticovenular Anastomosis for Breast Cancer–related Lymphedema without Compression: Salvaging Lymphedema Patients Who Lost Conservative Treatment Opportunity
Authors: Seki Yukio , Kajikawa Akiyoshi , Asai Rintaro , Tomochika Mayo , Nemoto Hitoshi , Terashima Takahiro , Kurogi Norimitsu
Published: August 2023

Background:

In conservative treatment for breast cancer–related lymphedema (BCRL), compression therapy has a crucial role. However, some BCRL patients are unable to use compression, and then their lymphedema continues to worsen as they miss treatment opportunity. Although lymphaticovenular anastomosis (LVA) is an effective and minimally invasive surgical treatment for BCRL, compression therapy is still important to enhance lymphatic fluid flow in LVA. The authors previously reported the dynamic LVA method for BCRL, in which patient's natural hand movements theoretically propel lymph to the anastomosed vein. This study is conducted to clarify whether dynamic LVA can salvage BCRL patients without pre- and postoperative compression therapy.

Methods:

The study involved 17 BCRL patients, 18 limbs. All patients had International Society of Lymphology stage-2 lymphedema, but they had no compression: six patients had difficulty by other diseases to undergo compression, and other 11 patients refused any compression usage because of the burden of the treatment itself. Three dynamic LVAs were performed in each patient.

Results:

Patients’ mean age was 60.4 ± 10.1, and mean body mass index was 24.0 ± 3.3. The mean follow-up period was 25.5 ± 9.2 months. The volume of the lymphedematous limb, according to the upper extremity lymphedema (UEL) index, was reduced in all 18 limbs postoperatively (postoperative UEL index 101.8 ± 9.4 versus preoperative UEL index 116.0 ± 20.1; P < 0.01). Twelve of the 18 limbs were cured without edema.

Conclusion:

Even without compression therapy, International Society of Lymphology stage-2 BCRL patients can be treated by the dynamic LVA method.
Disparity issues in coronary artery surgery
Authors: Dahle Gry
Published: August 2023

Purpose of review

Coronary artery disease is the third leading cause of mortality worldwide. Coronary artery surgery is an important treatment option. Certain groups such as people of color, those from lower socioeconomic backgrounds and women tend to have lower rates of receiving the surgery they need (Fig. 1).

Recent findings

Still there are disparities in treatment options for coronary artery disease among different groups, due to geographic location, economical situation, institutional tradition and sex.

Through continued research, awareness and utilization of innovative technologies, we can improve access and equity in healthcare for all patients, including patients in need of coronary surgery.
Strategic use of tobacco treatment specialists as an innovation for tobacco cessation health systems change within health care organizations
Authors: Burns Ashlyn , Gutta Jyotsna , Kooreman Harold , Spitznagle Miranda , Yeager Valerie A.
Published: August 2023

Background

Tobacco screening interventions have demonstrated effectiveness at improving population health, yet many people who want to quit using tobacco lack access to professional assistance. One way to address this gap is to train members of the clinical team as tobacco treatment specialists (TTSs).

Purpose

The purpose of this study was to understand how TTSs have been used across a variety of health care organizations implementing health systems change for tobacco treatment and examine the sustainability of TTSs as a health systems change innovation for tobacco cessation.

Methodology

This study used qualitative interviews (n = 25) to identify themes related to implementing TTSs as a health systems change innovation and examined these themes within the constructs of the theory of innovation implementation.

Results

Insights about implementing TTSs as an innovation primarily aligned with four theoretical constructs: implementation policies and practices, implementation climate, innovation-values fit, and implementation effectiveness. Specific themes were perceived to facilitate the sustainability of TTSs including team-based TTS efforts, widespread awareness of TTS roles, leadership buy-in, and recognized value of TTS services. Barriers to sustainability included inadequate resources (e.g., time and staff), lack of tracking outcomes, inappropriate referrals, and lack of reimbursement.

Practice Implications

Health care organizations planning to implement health systems change for tobacco cessation can encourage committed use of TTSs as an innovation by considering the insights provided in this study. These primarily related to five overarching implementation considerations: staff selection and training, tracking and dissemination of impacts, adequate resources, referrals and workflow, and billing and reimbursement.
Cost of illness of patients with small fiber neuropathy in the Netherlands
Authors: Geerts Margot , Hoeijmakers Janneke G.J. , van Eijk-Hustings Yvonne , Brandts Lloyd , Gorissen-Brouwers Carla M.L. , Merkies Ingemar S.J. , Joore Manuela A. , Faber Catharina G.
Published: August 2023

Neuropathic pain is associated with substantial healthcare costs. However, cost-of-illness studies of small fiber neuropathy (SFN) are scarce. Our aim was to estimate the healthcare, patient and family, and productivity costs of patients with SFN in the Netherlands from a healthcare and societal perspective. In addition, the association of costs with age, pain impact on daily life, anxiety, depression, and quality of life (Qol) were examined. Cost questionnaires were completed by 156 patients with confirmed SFN. The average annual total health care and societal cost (€, 2020) was calculated at patient, SFN adult population, and societal level. The average annual healthcare, patient and family, and productivity costs per patient with a Pain Impact Numerical Rating Scale of 0 to 3 (mild), 4 to 6 (moderate), and 7 to 10 (severe) were calculated by using the cost questionnaire data. Quality of life was determined by the EuroQol 5D utility scores. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Associations of all costs were analyzed using linear regression analyses. At the patient level, the average annual SFN healthcare and societal cost of SFN was €3614 (95% confidence interval [CI] €3171-€4072) and €17,871 (95% CI €14,395-€21,480). At the SFN population level, the average healthcare costs were €29.8 (CI €26.4-€34.2) million, and on a societal level, these were €147.7 (CI 120.5-176.3) million. Severe pain was associated with significant lower Qol and higher depression scores, higher healthcare, patient and family, and productivity costs (P < 0.001).
Pulmonary Vasodilator Therapy in Pediatric Patients on Ventricular Assist Device Support: A Single-Center Experience and Proposal for Use
Authors: Schramm Jennifer E. , Dykes John C. , Hopper Rachel K. , Feinstein Jeffrey A. , Rosenthal David N. , Kameny Rebecca J.
Published: August 2023

Pediatric precapillary pulmonary hypertension can develop in response to systemic atrial hypertension. Systemic atrial decompression following ventricular assist device (VAD) implantation may not sufficiently lower pulmonary vascular resistance (PVR) to consider heart transplant candidacy. Prostacyclins have been used in adult VAD patients with success, but pediatric data on safety and efficacy in this population are limited. We sought to describe our center’s experience to show its safety and to present our current protocol for perioperative use. We reviewed our use of prostacyclin therapy in pediatric patients on VAD support with high PVR from 2016 to 2021. Of the 17 patients who met inclusion, 12 survived to transplant and 1 is alive with VAD in situ. All patients survived posttransplant. With continuous intravenous (IV) epoprostenol or treprostinil therapy, there were no bleeding complications or worsening of end-organ function. A significant reduction was observed in vasoactive inotropic scores by 49% in the first 24 hours post-prostacyclin initiation. The proportion of patients surviving to transplant in this high-risk cohort is favorable. In conclusion, prostacyclins may be safe to use in patients with elevated PVR as part of their VAD and transplant course and may provide a transplant option in those otherwise not candidates.
Long-term multimodality imaging follow-up of ST-segment elevation myocardial infarction patients treated with bioresorbable vascular scaffold: advantages and challenges
Authors: Eriksen Erlend , Neghabat Omeed , Larsen Terje H. , Saeed Sahrai , Bleie Øyvind
Published: August 2023

Background:

Multislice computed tomography (MSCT) offers a non-invasive method of imaging bioresorbable scaffolds (BRS).

Objectives:

To investigate the advantages and challenges using MSCT in the follow-up after BRS implantation.

Method:

The BRS cohort consisting of 31 patients in the ‘BRS in STEMI’ trial was examined by multimodality imaging and followed long-term. Minimum lumen area (MLA) and average lumen area (ALA) were examined 12 and 36 months after BRS implantation with MSCT. Optical coherence tomography (OCT) at 12 months was used as a reference.

Results:

Measured by MSCT, the mean MLA was 0.05 ± 1.32 mm² (P = 0.85), but ALA was 1.32 (±2.59 mm², P = 0.015) greater than by OCT. ALA and MLA did not change significantly from 12 to 36 months. MSCT identified all cases of restenosis but missed one patient with massive malapposition.

Conclusion:

Our data support using MSCT in the follow-up after BRS implantation. Invasive investigation should still be considered for patients with unexplained symptoms.
The cardiac preparticipation sports evaluation
Authors: Donovan Denis J. , Nelson Joanna E. , Monaco Michael A.
Published: August 2023

Purpose of review

Sudden cardiac death (SCD) is the leading cause of death in young athletes during sports participation. Preparticipation cardiovascular screening aims to identify those at an increased risk of SCD. This review aims to provide a background of SCD in young athletes, to discuss the various screening recommendations of major medical societies, and to review recent evidence and current practice.

Recent findings

Numerous studies have evaluated various preparticipation screening practices, particularly regarding the inclusion of ECG as part of an initial evaluation to identify conditions with an increased risk of SCD. Some analyses have shown ECG inclusion to provide increased screening sensitivity and specificity, though others have shown no benefit when compared with evaluation with history and physical examination alone. Furthermore, in countries for which more extensive screening protocols have been employed, postimplementation statistics have not shown a significant decrease in SCD.

SCD in young athletes primarily results from underlying cardiac disease. Various preparticipation screening recommendations exist globally, with the common goal of decreasing the rates of SCD by identifying youth at risk during sports participation. Current guidelines in the United States support universal preparticipation evaluation using history and physical examination, with cardiology referral if abnormalities are identified.
Association between hypertension and clinical outcomes in COVID-19 patients: a case-controlled study
Authors: Aslanbeigi Fatemeh , Rahimi Habiballah , Malekipour Adeleh , Pahlevani Hamed , Najafizadeh Maedeh , Ehteram Hassan , Izadpanah Fatemeh , Haddad Kashani Hamed
Published: August 2023

Background:

The outbreak of coronavirus disease 2019 (COVID-19), which was originated from a severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) infection, has become an international public health emergency. The aim of this study was to assess the clinical symptoms and physical findings in both hypertensive and nonhypertensive patients infected with COVID-19.

Methods:

A retrospective observational case–control study with diagnosis of COVID-19 by laboratory-confirmed test was conducted on 280 consecutive unselected patients. This was a single-center study. The demographics, laboratory, and clinical findings data were extracted from the hospital registry database.

Results:

Of our 280 patients in the study, there were 149 men (53%) and 138 (50%) were older than 60 years (mean=67.75), and also 50 in-hospital deaths occurred (mortality rate, 17%). Total 19(6.9%) were taking opioid, and smoking. There were no significant differences in the rate of fever, cough, sputum production, gastrointestinal symptoms, myalgia, and headache in the both hypertensive and nonhypertensive groups. The prevalence of underlying diseases was significantly higher in older patients in comparison with younger ones (P=0<0.05), COVID-19 mortality was noticed to be higher among hypertensive patients as compared with nonhypertensive patients (P=0<0.05).

Conclusion:

Hypertension is associated with a poor prognosis and higher mortality among COVID-19 patients. Optimizing blood pressure is essential during the management of COVID-19. Our research implies the importance of early care and education of old patient with hypertension and other comorbidities.
Difference of cardiac rehabilitation in the morning or evening on indexes of left ventricular and N-terminal pro-brain natriuretic peptide: a randomized controlled trial
Authors: Dehghani Mostafa , Cheragi Mostafa , Delfan Bahram , Dehghani Morteza , Shakarami Amir , Bagheri Yagoob , Namdari Parsa , Namdari Mehrdad
Published: August 2023

Background:

The present study aimed to evaluate the effects a cardiac rehabilitation program (CRP) performed in the morning or evening on left ventricular (LV) filling indices and the level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in patients undergoing percutaneous coronary angioplasty during the COVID-19 pandemic.

Methods:

This was a randomized controlled single-blinded clinical trial. Ninety-six patients (mean age: 50.2 ± 8.1 years, 36 women and 44 men) with percutaneous coronary angioplasty were divided into two groups of intervention and control. In each group, the CRP was performed in either morning or evening. The CRP included walking and performing push-ups and sit-ups for 8 weeks. The participants of the control groups received routine care. The functional indices of LV, including LV ejection fraction, systolic function, and diastolic function (i.e. the transmitral flow), the E/e’ to left atrium peak strain ratio (as an estimation for LA stiffness), and NT-proBNP level were measured in all participants before starting and at the end of the CRP.

Results:

In the intervention group, the individuals performing the CRP in the evening had significantly higher E-wave (0.76±0.02 vs. 0.75±0.03; P=0.008), ejection fraction (52.5±5.64 vs. 55.5±3.59; P=0.011), and diastolic function velocity (E/A ratio, 1.03±0.06 vs. 1.05±0.03; P=0.014) and significantly lower A-wave (0.72±0.02 vs. 0.71±0.01; P=0.041), E/e’ ratio (6.74±0.29 vs. 6.51±0.38; P=0.038), and NT-proBNP level (2007.9±214.24 vs. 1933.9±253.13; P=0.045) compared with those performing the program in the morning.

Conclusions:

A supervised CRP performed in the evening compared with morning was more effective in improving LV functional indices. Therefore, such home-based interventions are recommended to be performed in the evening during the COVID-19 pandemic.