bluuebunny/crossref_metadata_2025 huggingface dataset:
Myocardial work and left atrial function, by speckle tracking echocardiography, are the only independent predictors of mid-term mortality in HFpEF
Authors: Rimbas RC , Visoiu SI , Chitroceanu A , Mihaila-Baldea S , Magda LS , Velcea AA , Luchian ML , Memis H , Nicula A , Vinereanu D
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by 2 National grants of Romanian Ministry of Research and Innovation - UEFISCDI (PN-III-P1-1-TE-2016-0669, acronym Heart-Preserved and PN-III-P1-1.2-PCCDI2017-0527, acronym BIOVEA).

OnBehalf

HEART-PRESERVED

Background. Heart failure with preserved ejection fraction (HFpEF), defined by the 2021 ESC guidelines and the new universal definition, is one of the most challenging diagnosis in cardiology. Parameters for predicting mortality in HFpEF are still debatable. Left atrial (LA) function and myocardial work (MW) by speckle-tracking echocardiography (STE) might be promising tools for predicting mortality in HFpEF.

Methods. We assessed 88 patients (67 ± 9 years, 33 men) with HFpEF (mean NTproBNP of 357 ± 350 pg/ml) by 2D echo, STE, and CMR. By echo we measured LV ejection fraction (LVEF), E/E’, sPAP, left atrial volume indexed (LAVi), and global longitudinal strain (GLS). We assessed LA function by 2DSTE: reservoir function by strain from MVC to MVO (LASr) and positive strain rate (LASRr), conduit function by strain from MVO to onset of atrial contraction (LAScd) and early negative strain rate during conduit phase (LASRcd), and LA pump function by negative strain at MVC (LASct) and late negative strain rate during atrial contraction phase (LASRct) (Figure 1); and MW by 2DSTE: global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), as GCW/(GCW + GWW) in %. By CMR we evaluated LVEFcmr, LV mass, T1 mapping with mean extracellular volume (ECVm), and pre-gadolinium times quantification (preGDT1m) as markers of myocardial fibrosis. A follow-up visit for cardiovascular mortality was performed by phone at 18 months from the baseline visit.

Results. 12 patients died during follow-up (14%). Comparing non-survivors vs. survivors (see tables from Figure 2), NTproBNP level and LV mass were significantly higher in non-survivors (P < 0.001); meanwhile, GWE was lower, whereas GWW was higher in non-survivors vs. survivors. Moreover, LASRct was lower in non-survivors vs. survivors. All the other echo or CMR parameters, including markers of myocardial fibrosis were not different between non-survivors and survivors (Figure 2). By multiple regression analysis, GWE < 92% (AUC = 0.72, p = 0.018) and LASRct <-1 (AUC = 0.70, p = 0.014) were the only independent predictors of mortality, from all conventional echo, STE, and CMR parameters.

Conclusions

LV assessment by myocardial work and LA assessment by STE are the only independent predictors of mid-term mortality in HFpEF. Abstract Figure. LA deformation analysis  Abstract Figure. Survivors vs non-survivors
Bandwidth, perfusion standard deviation and entropy derived from single photon emission computed tomography are useful markers of systolic synchrony index evaluated thought echocardiography
Authors: Espinola-Zavaleta NG , Gonzalez-Hernandez MGH , Antonio-Villa NAV , Guerra ECG , Garcia-Cardenas MGC , Caballero-Guadarrama YCG , Lopez-Mendez ALM , Alexanderson-Rosas EAR
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Systolic synchrony (SS) is a fundamental predictor of adverse clinical outcomes in patients who develop myocardial ischemia or infarction. Although the evaluation could be assessed with myocardial perfusion image methods, the correlation with automatized methods such as the systolic synchrony index is still unclear.

AIMS

To evaluate the correlation of the bandwidth, perfusion standard deviation and entropy as makers of systolic synchrony derived from single photon emission computed tomography (SPECT) at basal and stress phase with the echocardiography systolic synchrony index.

METHODS

A cross-sectional cohort of patients with suspected ischemia or infarction were tested using SPECT in a center of reference in our city. An additional transthoracic echocardiography was performed. Pearson correlation test were used to extract the correlation coefficient of each variable after arithmetical normalization. An interaction analysis was performed to evaluate an interaction effect in patients either with ischemia or infarction.

RESULTS

We recruited 229 subjects, of which 49.3% (n = 83) had myocardial ischemia, 9.6% (n = 22) infarction and 4.8% (n = 11) both conditions. We observed a positive and significant correlation of bandwidth, perfusion standard deviation and entropy from SPECT with echocardiographic systolic synchrony index, which further increased at stress phase (Figure 1). We observe a positive interaction with subjects classified with only myocardial ischemia with all three SPECT parameters at stress phase (Figure 2).

CONCLUSION

We found a that SPECT bandwidth; perfusion standard deviation and entropy could adequately identify higher systolic dyssynchrony in stress phase and within patients with myocardial ischemia only. Abstract Figure. Dispersion plot  Abstract Figure. Interaction analysis
Aortic arch calcification: a new predictor for inconclusive Coronary CT angiography and coronary artery disease
Authors: Paredes Hurtado N , Carnero Montoro L , Gonzalez Manzanares R , Rodriguez Nieto J , Perea Armijo J , Gallo Fernandez I , Pastor Wulf D , Lopez Baizan J , Heredia Campos G , Fernandez Aviles C , Resua Collado A , Ruiz Ortiz M , Espejo Perez S , Mesa Rubio MD , Pan Alvarez M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Objective

 Coronary CT angiography (CTA) remains as the technique of choice to rule out coronary artery disease (CAD) in symptomatic patients with intermediate-low risk. Despite its sensitivity, numerous artifacts that reduce its accuracy have been described, as well as factors related to CAD. The presence of calcium in the aortic arch (AoA) on the chest radiography (CXR) is an accessible and highly available finding in this patients and to our knowledge it have not been studied at this scenario. Our aim is to evaluate the presence of AoA as a new CTA artifact and predictor of significant coronary lesions.

Materials and methods

 We conducted an observational descriptive single-center study of patients who underwent CTA to rule out CAD from July 1st to December 31st of 2020. Patients without CXR were excluded. We evaluated the presence of AoA in the postero-anterior CXR. The results of the CTA were classified into 4 categories: absence of lesions, non-significant lesions, significant lesions and inconclusive study due to artifacts.

Results

 251 patients were included, mean age 60 ± 12 years, 51% males, 24% diabetics, 57% hypertensive, 13% smokers, 45% dyslipidemic. 18% presented AoA in the CXR. Mean heart rate (HR) was 60 ± 16 bpm. The results of the CTA were: 45% absense of lesions, 26% non-significant lesions, 17% significant lesions and 12% inconclusive due to artifacts. Patients with AoA presented a greater probability of inconclusive CTA and significant coronary lesions both in the univariate analysis and when adjusted for age, sex and HR [OR = 3.2 (1.2-8.1), p = 0.017 ] and [OR = 3.7 (1.5-8.7), p = 0.003] respectively.

Conclusions

 Calcification of the aortic arch on chest radiography is an independent factor of inconclusive CTA and significant coronary lesions with a 3.2 and 3.7 fold higher risk compared to those who do not present this finding
Coronary risk factors and plaque morphology; semi-automated quantative coronary CTA analysis
Authors: Zajanckauskiene L , Jankauskas A , Radionovaite L , Sakalyte G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

With advances in coronary computed tomography angiography (CTA) technology dedicated semi-automated coronary plaque analysis software become researches field of interest. With detailed plaque analysis we can improve CTA diagnostic accuracy and prognostic value, this way improving chronic coronary syndrome (CCS) outcomes.

Purpose

The aim of this study was to evaluate well known modifiable coronary risk factors (arterial hypertension (AH), smoking, diabetes mellitus (DM), hypercholesterolemia, physical inactivity, obesity) and statin use in relation to more detailed plaque features.

Methods

100 patients with stable angina and no previous history of CCS underwent CTA and were diagnosed with one or more intermediate stenosis (correspond to 50-69% stenosis). A total of 112 stenosis were analysed with post-processing semi-automated CTA dedicated software. This is a sub-study from a bigger trial, where intermediate lesions were analysed. 

Results

Overall all lesions were analyzed as whole and at the vessel cross-section of maximum obstruction site. 45 different parameters were obtained. Analysis made at the level of whole lesion showed that smokers had lower plaque and dense calcium volumes (Table 1), statin users lower fibrous fatty and necrotic core volumes (Table 2). Obstruction area analysis showed significant larger vessel wall area and diameter in non-smokers group (Table 1), whereas statin users had smaller lumen area and diameter stenosis (Table 2). Patients with DM had bigger necrotic core volume with significant bigger fibrous fatty and necrotic core percentages (Table 3).

AH, hypercholesterolemia, physical inactivity or obesity did not show any significant relation with plaque features (p≥0.05). Renal insufficiency was excluded as a risk factor as all patients referred to CTA had normal or slightly decreased renal function (GFR >60 ml/min.).

Conclusion

Our study shows that modifiable risk factors (smoking and DM) alongside with statin use are related to quantitative atherosclerotic plaque parameters. For risk factors modification impact on plaque characteristics studies should be done. Abstract Table 1; 2; 3.
Pacemaker lead rupture in a patient with subacute endocarditis: a case report
Authors: Caratti di Lanzacco Lorenzo , Wauters Aurélien
Published: February 2022

Background

Cardiac implantable electronic device (CIED)-related infections are associated with severe morbidity and mortality. Few cases have previously documented both lead endocarditis and lead rupture simultaneously.

Case summary

We describe the case of a 73-year-old man with a dual-chamber pacemaker presenting with subacute endocarditis and recurrent cholangitis. A few months prior, the patient was diagnosed with localized colon cancer and Streptococcus sanguinis lead endocarditis based on nuclear imaging. He was given prolonged antibiotic therapy and lead explantation was to be performed after sigmoidectomy. During the following weeks, his condition worsened and he was readmitted for biliary sepsis. A chest X-ray revealed, incidentally, a complete ventricular lead rupture. Pacemaker electrogram showed ventricular undersensing, loss of ventricular capture, and high impedance. As his health declined, removal of the pacemaker was deemed unreasonable and the patient died of biliary sepsis in the next few weeks.

Discussion

We describe the case of an asymptomatic intracardiac lead fracture in the setting of colon cancer and a medically managed Streptococcus lead infection. As this complication occurred during lead infection, bacterial damage may have weakened the lead over time. As illustrated by the patient’s outcomes, long-term antibiotic therapy should only be used in cases unsuitable for device removal. Complete hardware removal remains the first-line therapy in patients with CIED-related infections.
Giant coronary artery aneurysm associated with familial retinal artery macroaneurysm: a case report
Authors: Shah Muhammad Azam , Alqahtani Abdulrahman , Alshahrani Saeed T , Alshehri Halia Zain
Published: February 2022

Background

The term ‘Giant’ coronary aneurysm is usually defined as any coronary aneurysm more than 8 mm in maximum diameter. The form of familial retinal arterial macroaneurysms (FRAMs) is a rare autosomal recessive disease that is described by arterial aneurysm formation in the retina. Here, we report an association of coronary artery aneurysms with FRAM in a young male who presented with the acute coronary syndrome.

Case summary

A 31-year-old male smoker presented to the emergency department with atypical chest pain for 5 days. Blood investigations showed raised troponin enzymes. Review of his past medical history revealed decreased vision in the left eye, starting at the age of 10 years which progressed to blindness. He was diagnosed to have IGFBP7 mutation which causes eye manifestations in the form of FRAM. Fundoscopy showed bleeding retinal artery macroaneurysms in the right retina and sub-retinal gliosis suggesting laser treatment for the prior retinal arterial aneurysm. Coronary angiogram revealed a large aneurysm in the proximal segment of the left anterior descending (LAD) artery. Cardiac computed tomography scan with contrast was done which showed a 2.28 × 1.64 cm coronary aneurysm at the proximal segment of the LAD artery with peripheral calcification with a narrow neck of about 0.6 cm. After the heart team discussion, he underwent surgical ligation of the LAD and coronary aneurysm with implantation of the saphenous venous graft to distal LAD.

Discussion

Coronary artery aneurysms can be a part of multisystem diseases like FRAM. The management should be individualized based on symptoms at presentation, size of coronary aneurysms, and local expertise.
En face view of the transcatheter heart valve from deep right-anterior-oblique cranial position for coronary access after transcatheter aortic valve implantation: a case series
Authors: Hirose Suguru , Enta Yusuke , Ishii Kazunori , Inoue Arata , Nakashima Masaki , Nomura Takehiro , Saigan Makoto , Tada Norio
Published: February 2022

Background

Coronary access after transcatheter aortic valve implantation (TAVI) is challenging due to the changes in aortic geometry. The perpendicular (long-axis) view of the transcatheter heart valve (THV) is usually used as the primary fluoroscopic angle. However, it does not always provide sufficient information on the rotational axis needed for selective coronary ostia engagement. The en face (short-axis) view from the deep right-anterior-oblique cranial position gives us additional information about three-dimensional spatial relationship of the THV and coronary ostia.

Case summary

We present three cases of coronary access after TAVI. We were successful in the use of the ‘en face’ view along with the perpendicular view in these cases.

Discussion

The use of the en face view complements that of the perpendicular long-axis view since it allows the understanding of the three-dimensional spatial relationship of the THV and the coronary ostia during fluoroscopy and control of catheter manipulation in two directions (up/down for perpendicular and clockwise/counterclockwise for en face view). We believe that the en face view helps improve the technical success of coronary access after TAVI.
Chlamydomonas CHT7 is involved in repressing DNA replication and mitotic genes during synchronous growth
Authors: Lin Yang-Tsung , Takeuchi Tomomi , Youk Brian , Umen James , Sears Barbara B , Benning Christoph
Published: February 2022

In the green alga Chlamydomonas reinhardtii, regulation of the cell cycle in response to external cues is critical for survival in a changing environment. The loss of the nuclear COMPROMISED HYDROLYSIS OF TRIACYLGLYCEROLS 7 (CHT7) protein affects the expression of many genes especially in response to nitrogen availability. Cells lacking CHT7 exhibit abnormal cell morphology following nitrogen deprivation and fail to resume normal cell division after N resupply. To investigate the function of CHT7 in the regulation of cell cycle-related pathways, cells were synchronized, and RNA-seq analysis was performed during various stages of the cell cycle. In the cht7 mutant following nitrogen deprivation, the cells were not dividing, but a subset of cell cycle genes involved in DNA replication and mitosis were found to be derepressed, suggesting that the CHT7 protein plays a role in cell cycle regulation that is opposite to that of the mitotic cyclin-dependent kinases. Furthermore, genes for cell wall synthesis and remodeling were found to be abnormally induced in nondividing cht7 cells; this misregulation may deplete cellular resources and thus contribute to cell death following nitrogen deprivation. Lastly, 43 minimally characterized kinases were found to be highly misregulated in cht7. Further analysis suggested that some of these CHT7-regulated kinases may be related to the MAP3K and Aurora-like kinases, while others are unique. Together, these results suggest a role of CHT7 in transcriptional regulation of the cell cycle and reveal several pathways and genes whose expression appears to be subject to a CHT7-mediated regulatory network.
Levels of Depression and Anxiety Among Informal Caregivers During the COVID-19 Pandemic: A Study Based on the Canadian Longitudinal Study on Aging
Authors: Wister Andrew , Li Lun , Mitchell Barbara , Wolfson Christina , McMillan Jacqueline , Griffith Lauren E , Kirkland Susan , Raina Parminder ,   Canadian Longitudinal Study on Aging (CLSA) Team, Costa Andrew , Anderson Laura , Balion Cynthia , Yukiko Asada , Basta Nicole , Cossette Benoȋt , Levasseur Melanie , Hofer Scott , Paterson Theone , Hogan David , Liu-Ambrose Teresa , Menec Verena , St. John Philip , Mugford Gerald , Gao Zhiwei , Taler Vanessa , Davidson Patrick , Wister Andrew , Cosco Theodore
Published: February 2022

Objectives

Studies on informal caregiving during the coronavirus disease 2019 (COVID-19) pandemic have mainly focused on subgroups of caregivers using cross-sectional or convenience samples, limiting the generalizability of findings. Conversely, this longitudinal study examines the effects of the pandemic and caregiving factors on depressive symptoms and anxiety over 9 months among informal caregivers in Canada.

Methods

This study uses data from the Baseline (2011–2015), Follow-up 1 (2015–2018), and COVID-19 Study Baseline survey (April to May 2020) and Exit surveys (September to December 2020) of the Canadian Longitudinal Study on Aging (CLSA). A total of 14,118 CLSA participants who were caregivers at Follow-up 1 and participated in the COVID-19 studies were selected. Linear mixed models were used to examine the effect of sex of caregiver, changes in caregiving (increase in caregiving hours and inability to care), and location of care (same household, another household, and health care institution) on depressive symptoms and anxiety from COVID-19 studies Baseline to Exit surveys (about 6–7 months apart).

Results

Informal caregivers reported more frequent depressive symptoms from the COVID-19 Baseline to Exit surveys, but not anxiety. Female caregivers reported greater depressive symptoms and anxiety, and male caregivers exhibited a greater increase in depressive symptoms and anxiety over time. More caregiving hours and inability to provide care were significantly positively associated with depressive symptoms and anxiety. Also, in-home caregivers reported more depressive symptoms and anxiety than those who cared for someone in health care institution, and more anxiety than those who cared for some in another household.

Discussion

The findings shed light on the change in mental health among informal caregivers during the outset of the pandemic. The demonstrated associations between studied variables and mental health among informal caregivers provide empirical evidence for intervention programs aiming to support caregivers, particularly those who are female, and providing intensive care at home.
Learning from the pandemic: mortality trends and seasonality of deaths in Australia in 2020
Authors: Gregory Gabriel , Zhu Lin , Hayen Andrew , Bell Katy J L
Published: February 2022

Aim

To assess whether the observed numbers and seasonality of deaths in Australia during 2020 differed from expected trends based on 2015–19 data.

Methods

We used provisional death data from the Australian Bureau of Statistics, stratified by state, age, sex and cause of death. We compared 2020 deaths with 2015-19 deaths using interrupted time series adjusted for time trend and seasonality. We measured the following outcomes along with 95% confidence intervals: observed/expected deaths (rate ratio: RR), change in seasonal variation in mortality (amplitude ratio: AR) and change in week of peak seasonal mortality (phase difference: PD).

Results

Overall 4% fewer deaths from all causes were registered in Australia than expected in 2020 [RR 0·96 (0·95-0·98)] with reductions across states, ages and sex strata. There were fewer deaths from respiratory illness [RR 0·79 (0·76-0·83)] and dementia [RR 0·95 (0·93-0·98)] but more from diabetes [RR 1·08 (1·04-1·13)]. Seasonal variation was reduced for deaths overall [AR 0·94 (0·92-0·95)], and for deaths due to respiratory illnesses [AR 0·78 (0·74-0·83)], dementia [AR 0.92 (0.89-0.95)] and ischaemic heart disease [0.95 (0.90-0.97)].

Conclusions

The observed reductions in respiratory and dementia deaths and the reduced seasonality in ischaemic heart disease deaths may reflect reductions in circulating respiratory (non-SARS-CoV-2) pathogens resulting from the public health measures taken in 2020. The observed increase in diabetes deaths is unexplained and merits further study.
Tough and Stretchy: Mechanical Properties of the Alimentary Tract in a Fish Without a Stomach
Authors: Horton Jaquan M , Gosline John M , Carrington Emily
Published: February 2022

Synopsis

The mechanical properties of intestinal tissues determine how a thin-walled structure exerts forces on food and absorbs the force of food as it enters and travels down the gut. These properties are critically important in durophagous and stomachless fish, which must resist the potential damage to foreign bodies (e.g., shells fragments) in their diet. We test the hypothesis that the mechanical properties of the alimentary tract will differ along its length. We predict that the proximal region of the gut should be the strongest and most extensible to handle the large influx of prey often associated with stomachless fish that lack a storage depot. We developed a custom inflation technique to measure the passive mechanical properties of the whole intestine of the stomachless shiner perch, Cymatogaster aggregata. We show that mechanical properties differ significantly along the length of the alimentary tract when inflated to structural failure, with 25–46% greater maximal stress, strain, extension ratio, and toughness at the proximal (25%) position. We also find that the alimentary tissues (excluding the heavily muscular rectum) are generally highly extensible and anisotropic, and do not differ in wall circumference or thickness along the alimentary tract. These findings contribute to our knowledge of the mechanical properties of fish intestinal tissues and guide future studies of factors influencing the evolution of fish alimentary systems.
Cystic fibrosis telemedicine in the era of COVID-19
Authors: Rad Elika J , Mirza Alicia A , Chhatwani Laveena , Purington Natasha , Mohabir Paul K
Published: February 2022

The coronavirus disease 2019 pandemic has resulted in large-scale changes to incorporate telemedicine for the delivery of care. People with cystic fibrosis (CF) have care considerations that pose challenges to telemedicine; they include frequent visits for pulmonary disease progression, medication management, and evaluation by a multidisciplinary team of providers. We share our center’s experience with video visits replacing in-person clinic evaluation, using quality improvement strategies to create a replicable workflow. Key considerations include incorporation of the multidisciplinary team into the visit, limitations of remote delivery of care, as well as patient and staff perceptions of this care model. Results revealed that video visits were convenient, efficacious, and comparable to in-person visits, with interest for its continued incorporation into the traditional CF care model.
Adding false-profile radiographs improves detection of developmental dysplasia of the hip, data from the CHECK cohort
Authors: Herfkens Julie , van Buuren Michiel M A , Riedstra Noortje S , Verhaar Jan A N , Mascarenhas Vasco V , Agricola Rintje
Published: February 2022

The aim of this study was to determine the additional value of the false-profile (FP) view radiograph in the diagnosis of developmental dysplasia of the hip (DDH), as compared with an anteroposterior (AP) pelvic radiograph only, and evaluate the correlation between the Wiberg-lateral center edge angle (W-LCEA) and Wiberg-anterior center edge angle (W-ACEA). We used baseline data from a nationwide prospective cohort study (Cohort Hip and Cohort Knee). DDH was quantified on AP pelvic and FP hip radiographs using semi-automatic measurements of the W-LCEA and W-ACEA. A threshold of <20° was used to determine DDH for both the W-LCEA and the W-ACEA. The proportion of DDH only present on the FP view determined the FP view additional value. The correlation between the W-LCEA and W-ACEA was determined. In total 720 participants (1391 hips) were included. DDH was present in 74 hips (5.3%), of which 32 were only present on the FP view radiograph (43.2%). The Pearson correlation coefficient between W-LCEA and W-ACEA of all included hips was 0.547 (95% confidence interval: 0.503–0.591) and 0.441 (95% confidence interval: 0.231–0.652) in hips with DDH. A mean difference of 9.4° (SD 8.09) was present between the W-LCEA and the W-ACEA in the hips with DDH. There is a strong additional value of the FP radiograph in the diagnosis of DDH. Over 4 out of 10 (43.2%) individuals’ DDH will be missed when only using the AP radiograph. In hips with DDH a moderate correlation between W-LCEA and W-ACEA was calculated indicating that joints with normal acetabular coverage on the AP view can still be undercovered on the FP view.
Recurrent thromboses and major vessel compressions in autosomal dominant polycystic kidney disease
Authors: Chan Joel Ern Zher , Kuah Zhihong , Bhattacharjya Shantanu , Olakkengil Santosh Antony
Published: February 2022

A 41-year-old man with autosomal dominant polycystic kidney disease (ADPKD), who had multiple previous unprovoked thrombotic events and without a known coagulopathic disorder, presented with symptomatic extensive thrombus distal to the compression site of the left common iliac vein by a dominant cyst in the left inferior renal pole. This was managed with inferior vena cava filter insertion, left nephrectomy and warfarinization. Later, there was inferior vena cava compression by the right polycystic kidney, leading to elective right nephrectomy. Post-renal transplantation, he had further episodes of partial dialysis access stenosis and extensive thromboses in the left deep and right superficial venous systems of the lower limbs despite absence of extrinsic compression. This represents the first report of recurrent mass effect and thromboembolic events in ADPKD, both before and after nephrectomy and anticoagulation. The potential increased thromboembolic risks among patients with ADPKD warrant further investigation.
Locally advanced rectal cancer in a patient with ectopic kidney: case report and literature review
Authors: Alsaawy Saad Mohammed
Published: February 2022

The coexistence of ectopic kidney with locally advanced rectal cancer is rare. It poses a surgical and oncological challenge for the treating team. Careful preoperative surgical planning and decision about the neoadjuvant treatment are paramount.We report a 40-year-old male newly diagnosed with rectal adenocarcinoma with ectopic kidney. His preoperative staging was T3N2M0 with ectopic malrotated left kidney. After discussion in the multi-disciplinary team meeting, decision was to omit the neoadjuvant treatment and to go for low anterior resection. The procedure started open, and the findings showed the kidney lying in retroperitoneum around 3 cm above the peritoneal reflection and was separable from the tumor. Oncological resection of the rectosigmoid colon by lateral to medial approach with separation and preservation of the kidney, an end-to-end stapler anastomosis followed with a protective loop ileostomy. The patient had a smooth postoperative course, and the final pathology was T3N1Mx. He received eight cycles of adjuvant XELOX and was free of diseases on 1 year follow-up. There is no optimal option in managing this scenario due to a highly variable blood supply of the ectopic kidney and rarity of this condition. Multi-disciplinary team meeting with preoperative radiological mapping and patient counseling is crucial in making the best decision.
Non-axisymmetric dynamical instability of differentially rotating, self-gravitating masses
Authors: Luyten P J
Published: February 2022

We investigate the dynamical stability of differentially rotating, self-gravitating, homogeneous masses. Besides the classical bar-like instability we obtain a new non-axisymmetric Kelvin-Helmholtz-like instability which resembles the Papaloi-zou-Pringle instability in shearing accretion tori. We define the flattening parameter, f, as the ratio of the polar to the equatorial radius. The growth-rate curve can be divided into two components. For low angular velocities (f ≤ 1), the instability grows on a linear time-scale. The growth rate then rises towards a peak value. This occurs near the point where the uniformly rotating Maclaurin sequence exhibits a non-axisymmetric bifurcation point. For m = 2 this is the Jacobi bifurcation point. The instability is reduced for small values of f due to the stabilizing effect of the gravitational force. The results are almost independent of the form of the rotation law. Maximum instability occurs for intermediate values of m. A comparison is made with results obtained in the absence of self-gravitation. We discuss possible implications on stellar evolution
Limitations of Phylogenomic Data Can Drive Inferred Speciation Rate Shifts
Authors: Craig Jack M , Kumar Sudhir , Hedges S Blair
Published: February 2022

Biodiversity analyses of phylogenomic timetrees have produced many high-profile examples of shifts in the rate of speciation across the tree of life. Temporally correlated events in ecology, climate, and biogeography are frequently invoked to explain these rate shifts. In a re-examination of 15 genomic timetrees and 25 major published studies of the pattern of speciation through time, we observed an unexpected correlation between the timing of reported rate shifts and the information content of sequence alignments. Here, we show that the paucity of sequence variation and insufficient species sampling in phylogenomic data sets are the likely drivers of many inferred speciation rate shifts, rather than the proposed biological explanations. Therefore, data limitations can produce predictable but spurious signals of rate shifts even when speciation rates may be similar across taxa and time. Our results suggest that the reliable detection of speciation rate shifts requires the acquisition and assembly of long phylogenomic alignments with near-complete species sampling and accurate estimates of species richness for the clades of study.
Fine-Scale Genetic Structure in the United Arab Emirates Reflects Endogamous and Consanguineous Culture, Population History, and Geography
Authors: Elliott Katherine S , Haber Marc , Daggag Hinda , Busby George B , Sarwar Rizwan , Kennet Derek , Petraglia Michael , Petherbridge Lawrence J , Yavari Parisa , Heard-Bey Frauke U , Shobi Bindu , Ghulam Tariq , Haj Dalia , Al Tikriti Alia , Mohammad Alshafi , Antony Suma , Alyileili Maitha , Alaydaroos Shatha , Lau Evelyn , Butler Mark , Yavari Arash , Knight Julian C , Ashrafian Houman , Barakat Maha T
Published: February 2022

The indigenous population of the United Arab Emirates (UAE) has a unique demographic and cultural history. Its tradition of endogamy and consanguinity is expected to produce genetic homogeneity and partitioning of gene pools while population movements and intercontinental trade are likely to have contributed to genetic diversity. Emiratis and neighboring populations of the Middle East have been underrepresented in the population genetics literature with few studies covering the broader genetic history of the Arabian Peninsula. Here, we genotyped 1,198 individuals from the seven Emirates using 1.7 million markers and by employing haplotype-based algorithms and admixture analyses, we reveal the fine-scale genetic structure of the Emirati population. Shared ancestry and gene flow with neighboring populations display their unique geographic position while increased intra- versus inter-Emirati kinship and sharing of uniparental haplogroups, reflect the endogamous and consanguineous cultural traditions of the Emirates and their tribes.
Malignant glioma subset from actuate 1801: Phase I/II study of 9-ING-41, GSK-3β inhibitor, monotherapy or combined with chemotherapy for refractory malignancies
Authors: Odia Yazmin , Cavalcante Ludimila , Safran Howard , Powell Steven Francis , Munster Pamela N , Ma Wen Wee , Carneiro Benedito A , Bastos Bruno R , Mikrut Stacy , Mikrut William , Giles Francis J , Sahebjam Solmaz
Published: February 2022

Background

GSK3β serine/threonine kinase regulates metabolism and glycogen biosynthesis. GSK3β overexpression promotes progression and resistance through NF-κB and p53 apoptotic pathways. GSK3β inhibits immunomodulation by downregulating PD-L1 and LAG-3 checkpoints and increasing NK and T-cell tumor killing. 9-ING-41, a small-molecule, selective GSK3β inhibitor, showed preclinical activity in chemo-resistant PDX glioblastoma models, including enhanced lomustine antitumor effect.

Methods

Refractory malignancies (n = 162) were treated with 9-ING-41 monotherapy (n = 65) or combined with 8 cytotoxic regimens after prior exposure (NCT03678883). Recurrent gliomas (n = 18) were treated with 9-ING-41 IV TIW q21day cycles at 3.3, 5, 9.3, 15 mg/kg, as monotherapy or combined with lomustine 30 mg/m² PO weekly q84day cycles. Primary objective was safety.

Results

RP2D of 15 mg/kg IV TIW was confirmed across all 9 regimens, no accentuated chemotherapy toxicity noted. Glioma subtypes included: 13 glioblastoma, 2 anaplastic astrocytomas, 1 anaplastic oligodendroglioma, 1 astrocytoma. Median age 52 (30–69) years; 6 female, 12 male; median ECOG 1 (0–2); median recurrences 3 (1–6). All received upfront radiation/temozolomide (18/18), plus salvage nitrosoureas (15/18), bevacizumab (8/18), TTFields (6/18), or immunotherapy (4/18). IDH/mutation(3/18); 1p19q/codeletion(1/18); MGMT/methylated(1/18). Four received 9-ING-41 monotherapy, 14 concurrent with lomustine. No severe toxicities were attributed to 9-ING-41, only mild vision changes (9/18, 50%), or infusion reactions (4/18, 22%). Lomustine-related toxicities: G3/4 thrombocytopenia (3/14, 21%), G1/2 fatigue (4/14, 28%). Median days on therapy was 55 (4–305); 1 partial response (>50%) was noted. Median OS was 5.5 (95% CI: 2.8–11.4) months and PFS-6 was 16.7%.

Conclusion

9-ING-41 plus/minus lomustine is safe and warrants further study in glioma patients.
The First Reported Case of Bordetella pertussis Bacteremia in a Patient With Human Immunodeficiency Virus Infection
Authors: Wakimoto Yuji , Otsuka Nao , Yanagawa Yasuaki , Koide Kentaro , Kamachi Kazunari , Shibayama Keigo , Teruya Katsuji , Kikuchi Yoshimi , Oka Shinichi
Published: February 2022

We describe a case of bacteremia in a human immunodeficiency virus–infected patient caused by a Bordetella pertussis strain lacking 2 major virulence factors, filamentous hemagglutinin and fimbriae. Although B pertussis bacteremia is uncommon, physicians should be aware that even attenuated B pertussis strains can cause invasive infection in immunocompromised patients.

Bordetella pertussis is a gram-negative coccobacillus that causes a severe paroxysmal coughing disease known as whooping cough or pertussis. Bordetella pertussis colonizes the epithelial cells of the human respiratory tract, and the organisms are typically isolated from nasopharynx. We describe a case of B pertussis bacteremia in a patient with human immunodeficiency virus (HIV) infection. Interestingly, the isolate recovered from blood culture did not produce the major virulence factors, filamentous hemagglutinin (FHA) and fimbriae (FIM). Previously, 3 cases of B pertussis bacteremia were reported in the literature. We discuss the features of B pertussis bacteremia.
Association of Nonalcoholic Fatty Liver Disease With COVID-19 Severity and Pulmonary Thrombosis: CovidFAT, a Prospective, Observational Cohort Study
Authors: Vrsaljko Nina , Samadan Lara , Viskovic Klaudija , Mehmedović Armin , Budimir Jelena , Vince Adriana , Papic Neven
Published: February 2022

Background

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease associated with systemic changes in immune response, which might be associated with coronavirus disease 2019 (COVID-19) severity. The aim of this study was to investigate the impact of NAFLD on COVID-19 severity and outcomes.

Methods

A prospective observational study included consecutively hospitalized adult patients, hospitalized between March and June 2021, with severe COVID-19. Patients were screened for fatty liver by ultrasound and subsequently diagnosed with NAFLD. Patients were daily followed until discharge, and demographic, clinical, and laboratory data were collected and correlated to clinical outcomes.

Results

Of the 216 patients included, 120 (55.5%) had NAFLD. The NAFLD group had higher C-reactive protein (interquartile range [IQR]) (84.7 [38.6–129.8] mg/L vs 66.9 [32.2–97.3] mg/L; P = .0340), interleukin-6 (49.19 [22.66–92.04] ng/L vs 13.22 [5.29–39.75] ng/L; P < .0001), aspartate aminotransferase (58 [40–81] IU/L vs 46 [29–82] IU/L; P = .0123), alanine aminotransferase (51 [32–73] IU/L vs 40 [23–69] IU/L; P = .0345), and lactate dehydrogenase (391 [285–483] IU/L vs 324 [247–411] IU/L; P = .0027). The patients with NAFLD had higher disease severity assessed by 7-category ordinal scale, more frequently required high-flow nasal cannula or noninvasive ventilation (26, 21.66%, vs 10, 10.42%; P = .0289), had longer duration of hospitalization (IQR) (10 [8–15] days vs 9 [6–12] days; P = .0018), and more frequently had pulmonary thromboembolism (26.66% vs 13.54%; P = .0191). On multivariable analyses, NAFLD was negatively associated with time to recovery (hazard ratio, 0.64; 95% CI, 0.48 to 0.86) and was identified as a risk factor for pulmonary thrombosis (odds ratio, 2.15; 95% CI, 1.04 to 4.46).

Conclusions

NAFLD is associated with higher COVID-19 severity, more adverse outcomes, and more frequent pulmonary thrombosis.
The classification of surface states of topological insulators and superconductors with magnetic point group symmetry
Authors: Shiozaki Ken
Published: February 2022

We present the exhaustive classification of surface states of topological insulators and superconductors protected by crystallographic magnetic point group symmetry in three spatial dimensions. Recently, Cornfeld and Chapman [Phys. Rev. B 99, 075105 (2019)] pointed out that the topological classification of mass terms of the Dirac Hamiltonian with point group symmetry is recast as an extension problem of the Clifford algebra, and we use their results extensively. Comparing two types of Dirac Hamiltonians with and without the mass-hedgehog potential, we establish an irreducible character formula to read off which Hamiltonian in the whole K-group belongs to 4th-order topological phases in three spatial dimensions, which are equivalent to atomic insulators consisting of atoms localized at the point group center.
Does vitamin D supplementation reduce COVID-19 severity?: a systematic review
Authors: Shah K , Varna V P , Sharma U , Mavalankar D
Published: February 2022

Background

The evidence regarding the efficacy of vitamin D supplementation in reducing severity of COVID-19 is still insufficient. This is partially due to the lack of primary robust trial-based data and heterogeneous study designs.

Aim

This evidence summary, aims to study the effect of vitamin D supplementation on morbidity and mortality in hospitalized COVID-19 patients.

Design: Evidence summary of systematic reviews

Methods

For this study, systematic reviews and meta-analysis published from December 2019 to January 2022 presenting the impact of vitamin D supplementation on COVID-19 severity were screened and selected from PubMed and Google scholar. After initial screening, 10 eligible reviews were identified and quality of included reviews were assessed using AMSTAR and GRADE tools and overlapping among the primary studies used were also assessed.

Results

The number of primary studies included in the systematic reviews ranged from 3 to 13. Meta-analysis of seven systematic reviews showed strong evidence that vitamin D supplementation reduces the risk of mortality (Odds ratio: 0.48, 95% CI: 0.346–0.664; P < 0.001) in COVID patients. It was also observed that supplementation reduces the need for intensive care (Odds ratio: 0.35; 95%CI: 0.28–0.44; P < 0.001) and mechanical ventilation (Odds ratio: 0.54; 95% CI: 0.411–0.708; P < 0.001) requirement. The findings were robust and reliable as level of heterogeneity was considerably low. However the included studies were of varied quality. Qualitative analysis showed that supplements (oral and IV) are well tolerated, safe and effective in COVID patients.

Conclusion

The findings of this study show that vitamin D supplementation is effective in reducing the COVID-19 severity. Hence, vitamin D should be recommended as an adjuvant therapy for COVID-19.However, more robust and larger trials are required to substantiate it further.
State Capacity and Opportunistic Governance: The Causes and Consequences of Regulatory Brokerage in Thailand’s Guestwork Formalization Process
Authors: Palmgren Pei
Published: February 2022

How and why does brokerage become pivotal to guest work governance? While research on intermediaries in temporary migrant labor programs has proliferated in the last decade, there is limited analysis of the conditions that create regulatory roles for brokers and shape their policy and social impacts in host states. By analyzing the causes and consequences of documentation brokerage in Thailand’s guest work formalization process, I link sociological work on brokerage with relational conceptions of state power. Drawing from 17 months of ethnographic fieldwork in Thailand, I argue that gaps in the state’s regulatory infrastructure amid heightened coercive policy enforcement create profitable opportunities for brokers to act as intermediaries between migrants, employers, and state offices to facilitate policy implementation. The informality and opportunism of such brokerage, however, can also generate activities that undermine official policy, with varying consequences for state control. Comparing brokerage between two sites, I show that brokers in each location improve the state’s capacity to formalize migrant labor, but the added social/regulatory dimension of the border in the second site creates brokerage opportunities that push the boundaries of official policy. In both sites, documentation brokerage imposes adverse economic effects on migrants.
Is it time to rethink our one-size-fits-all approach to nitrate toxicity thresholds in forages?
Authors: Reynolds Mary Beth , Drewnoski Mary E
Published: February 2022

Annual forages provide a valuable grazing resource for cattle producers; however, annuals are prone to accumulating nitrate and have the potential to cause nitrate toxicity. Although these forages pose a risk of containing high nitrate concentrations, they can be a high-quality feed source. Understanding the factors that affect the potential for toxicity when using these forages is important to help nutritionists and producers make management decisions. This review describes the previous research, current guidelines for nitrate toxicity, and the potential for improvement in our current recommendations. Current extension toxicity guidelines appear to be founded primarily on drenching based studies and overestimate the nitrate toxicity potential of forages. Recommendations need to account for multiple factors that affect the threshold for toxicity. There is evidence that fresh forages have a lower risk of toxicity because of slower release of nitrate into the rumen and a slower rate of dry matter intake. Increased dietary energy and sulfur content reduce the potential for toxicity. Microbial adaptation can reduce the risk and allow use of potentially toxic forages. These factors should influence feeding recommendations. However, there is currently not enough data available to establish new guidelines that account for these main factors. Thus, there is a need for renewed research in this area. The limited number of studies grazing elevated nitrate forages seems to suggest that there is less risk in grazing situations, especially if animals graze selectively. There is a need to develop guidelines for nitrate toxicity and management recommendations when grazing. To accomplish this, there is a need for more studies to evaluate risk of toxicity in grazing situations. These grazing studies need to evaluate the effects of nitrate concentration, forage quality, and grazing management on the potential for nitrate toxicity. While the conservative guidelines that are currently in use reduce risk of nitrate toxicity, they may also cause a significant increase in feed costs for producers.
Trade-offs between xylem hydraulic efficiency and mechanical strength in Chinese evergreen and deciduous savanna species
Authors: Zhang Shu-Bin , Wen Guo-Jing , Qu Ya-Ya , Yang Lin-Yi , Song Yu
Published: February 2022

Evergreen and deciduous species coexist in tropical dry forests and savannas, but differ in physiological mechanisms and life-history strategies. Hydraulic conductivity and mechanical support are two major functions of the xylems of woody plant species related to plant growth and survival. In this study, we measured sapwood-specific hydraulic conductivity (Ks), leaf-specific hydraulic conductivity (KL), modulus of rupture (MOR) and elasticity (MOE), xylem anatomical traits and fiber contents in the xylems of 20 woody species with contrasting leaf phenology (evergreen vs deciduous) in a Chinese savanna. Our results showed that deciduous species had significantly higher Ks and KL but lower MOR and MOE than evergreen species. Evergreen species experienced more negative seasonal minimum water potential (Pmin) than deciduous species during the dry season. Furthermore, we found trade-offs between xylem hydraulic efficiency and mechanical strength across species and within the evergreen and deciduous groups, and these trade-offs were modulated by structural and chemical traits. Both Ks and KL were significantly related to hydraulic weighted vessel diameter (Dh) across all species and within the deciduous group. Both MOR and MOE were significantly related to wood density, neutral detergent fiber and acid detergent fiber across species and within evergreen and deciduous groups. Our findings demonstrated that Chinese evergreen and deciduous savanna species diverged in xylem hydraulic and mechanical functions, reflecting conservative and acquisitive life-history strategies for evergreen and deciduous species, respectively. This study provides new information with which to understand the hydraulic and biomechanical properties and ecological strategies of savanna species in long-term dry-hot environments.