bluuebunny/crossref_metadata_2025 huggingface dataset:
Saprochaete clavata Infection in Immunosuppressed Patients: Systematic Review of Cases and Report of the First Oral Manifestation, Focusing on Differential Diagnosis
Authors: Lajolo Carlo , Rupe Cosimo , Schiavelli Anna , Gioco Gioele , Metafuni Elisabetta , Contaldo Maria , Sica Simona
Published: March 2021

Background: Saprochaete clavata infection is an emerging issue in immunosuppressed patients, causing fulminant fungaemia. The purpose of this systematic review of cases is to retrieve all cases of S. clavata infection and describe oral lesions as the first manifestation of S. clavata infection. Methods: We report the first case of intraoral S. clavata infection in Acute Myeloid Leukemia (AML) affected subject, presenting as multiple grayish rapidly growing ulcerated swellings, and provide a review of all published cases of infection caused by S. clavata, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted by searching SCOPUS, Medline, and CENTRAL databases. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for S. clavata infection. Results: Seventeen of 68 retrieved articles were included in the review reporting data on 96 patients (mean age 51.8 years, 57 males and 38 females). Most cases were disseminated (86) with a 60.2% mortality rate. Ninety-five were hematological patients, with AML being the most common (57 cases). Conclusions:S. clavata infection in immunosuppressed patients has a poor prognosis: middle-age patients, male gender and Acute Myeloid Leukemia should be considered risk factors. In immunosuppressed patients, the clinical presentation can be particularly unusual, imposing difficult differential diagnosis, as in the reported case.
A Systems Understanding Underpins Actions at the Climate and Health Nexus
Authors: Pongsiri Montira J. , Bassi Andrea M.
Published: March 2021

Multiple sectors—health and non-health—can determine the health and well-being of people and the condition of the socio-ecological environment on which it depends. At the climate and human health nexus, a systems-based understanding of climate change and health should inform all stages of the policy process from problem conceptualization to design, implementation, and evaluation. Such an understanding should guide countries, their partners, and donors to incorporate health in strategic climate actions based on how health is affected by, and plays a role in, the dynamic interactions across economic, environmental, and societal domains. A systems-based approach to sustainable development has been widely promoted but operationalizing it for project level and policy development and implementation has not been well articulated. Such an approach is especially valuable for informing how to address climate change and health together through policy actions which can achieve multiple, mutually reinforcing goals. This commentary article describes strategic steps including the complementary use of health impact assessment, quantification of health impacts, and linking climate and health actions to national and global policy processes to apply a systems-based approach for developing climate mitigation and adaptation actions with human health benefits.
Food, Nutrition, Physical Activity and Microbiota: Which Impact on Lung Cancer?
Authors: Nigro Ersilia , Perrotta Fabio , Scialò Filippo , D’Agnano Vito , Mallardo Marta , Bianco Andrea , Daniele Aurora
Published: March 2021

Lung cancer still represents the leading cause of cancer-related death, globally. Likewise, malnutrition and inactivity represent a major risk for loss of functional pulmonary capacities influencing overall lung cancer severity. Therefore, the adhesion to an appropriate health lifestyle is crucial in the management of lung cancer patients despite the subtype of cancer. This review aims to summarize the available knowledge about dietary approaches as well as physical activity as the major factors that decrease the risk towards lung cancer, and improve the response to therapies. We discuss the most significant dietary schemes positively associated to body composition and prognosis of lung cancer and the main molecular processes regulated by specific diet schemes, functional foods and physical activity, i.e., inflammation and oxidative stress. Finally, we report evidence demonstrating that dysbiosis of lung and/or gut microbiome, as well as their interconnection (the gut–lung axis), are strictly related to dietary patterns and regular physical activity playing a key role in lung cancer formation and progression, opening to the avenue of modulating the microbiome as coadjuvant therapy. Altogether, the evidence reported in this review highlights the necessity to consider non-pharmacological interventions (nutrition and physical activity) as effective adjunctive strategies in the management of lung cancer.
An Investigation of the General Population’s Self-Reported Hand Hygiene Behaviour and Compliance in a Cross-European Setting
Authors: Lawson Aaron , Vaganay-Miller Marie , Cameron Robert
Published: March 2021

Every year, thousands of people from the UK travel to other countries for work and leisure. Europe, and particularly Spain, is one of the most popular travel destinations for people from the UK. However, it is known that travel to other countries can enhance the risk of communicable disease transmission from person to person, especially when a new one emerges. Adequate hand hygiene behaviour and compliance is widely accepted as being a simple, effective method in preventing the spread of communicable diseases that may be contracted during travel abroad. There is a well-established body of work investigating hand hygiene practice and compliance in community settings, but no recent studies have examined the hand hygiene practice and compliance of the general population when travelling abroad or in a cross-European context. The findings of this study indicated that most UK members of the general population when travelling abroad have a good level of understanding of the importance of adequate hand hygiene practice and compliance and its role regarding communicable disease prevention and control. As such, self-reported levels of compliance were high. Similar findings were made for Spanish members of the general population. However, while self-reported perceptions of adequacy of hand hygiene performance were relatively high, particularly among UK respondents, this was not supported by responses specifically focused on hand hygiene behaviour. However, differences in self-reported adequacy regarding the importance of handwashing versus hand drying, the number of steps that should be followed and the length of time that should be spent washing and drying hands were found for each group. This suggests that self-reported compliance may reflect intention to practice hand hygiene rather than true compliance. It also suggests that there are gaps in knowledge regarding the adequate method of hand hygiene among the cohort as a whole, and indeed these differences may account be a factor in for the high transmission rates of communicable disease when travelling abroad.
Factors Affecting Obesity in Urban and Rural Adolescents: Demographic, Socioeconomic Characteristics, Health Behavior and Health Education
Authors: Lee Gyu-Young , Um Youn-Joo
Published: March 2021

In this study, we aimed to analyze the demographic factors, socioeconomic factors, health behavior factors, and health education of urban and rural adolescents and their impact on obesity in rural and urban youths. We analyzed data from 60,040 students from 800 schools using the 14th Youth Health Behavior Web-based Survey data for 2018. The mean age of the participants was 15.01 ± 1.77; 30,463 (50.7%) males and 29,577 (49.3%) females. The data were analyzed using a chi-square test and multinominal logistic regression analysis. Rural adolescents had significantly lower parental income, parental education, and academic performance levels. Urban adolescents tended to have a higher rate of breakfast fasting, ate more fast-food, exercised less, had a higher rate of sleep dissatisfaction, and had significantly higher current alcohol intake. Rural adolescents reported more stress and obesity levels than their urban counterparts. Factors influencing the obesity of urban adolescents were grade level, father’s education, mother’s education, academic performance level, fast-food, exercise, current alcohol intake, and sleep satisfaction. Factors influencing the obesity of rural adolescents were parents’ income level, academic performance level, exercise, and sleep satisfaction. To effectively prevent and manage adolescent obesity, which is an indicator of health equity among adolescents, an effort must be made to improve health education and the local environment in both urban and rural areas.
Adjusted Indirect and Mixed Comparisons of Interventions for the Patient-Reported Outcomes Measures (PROMs) of Disabled Adults: A Systematic Review and Network Meta-Analysis
Authors: Xu Yining , Li Xin , Sun Zhihong , Song Yang , Baker Julien S. , Gu Yaodong
Published: March 2021

This systematic review adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) guidelines and used the method of network meta-analysis to compare the effects of different types of interventions from different perspectives which were abilities of daily life activity, psychological health, social functioning, and overall life quality. The eligibility criteria were: (1) Participants were adults above 18 years old with disabilities; (2) Interventions could be classified into active exercise, passive therapy, psychological education, psychosocial support program, multi-disciplinary program, and usual care; (3) Outcomes should be the patient-reported outcome measures (PROMs) that could be classified into abilities of daily life activity, psychological health, social functioning, and overall life quality; (4) Randomized designed and published in English. The keywords and their search field were: (1) “people with disabilities/disability”, “disabled”, “handicapped”, or “disable people” in titles or abstracts; (2) AND “randomized” or “randomised” in titles or abstracts; (3) NOT “design”, “protocol”, or “review” in titles. After searching in databases of Medline (EBSCO), PubMed, CINAHL, and Ovid, 16 studies were included. As a result, active exercise and passive therapy are most likely to be the best interventions for overall life quality, psychological education and passive therapy are most likely to be the best interventions for abilities of daily life activity, and psychosocial support programs are most likely to be the best intervention for psychological health and social functioning.
Erratum: Barboza Castillo, E., et al. Monitoring Wildfires in the Northeastern Peruvian Amazon Using Landsat-8 and Sentinel-2 Imagery in the GEE Platform. ISPRS Int. J. Geo-Inf. 2020, 9, 564
Authors: Barboza Castillo Elgar , Turpo Cayo Efrain Y. , de Almeida Cláudia Maria , Salas López Rolando , Rojas Briceño Nilton B. , Silva López Jhonsy Omar , Barrena Gurbillón Miguel Ángel , Oliva Manuel , Espinoza-Villar Raul
Published: March 2021

The authors would like to make the following corrections to the published paper [...]
DFFAN: Dual Function Feature Aggregation Network for Semantic Segmentation of Land Cover
Authors: Huang Junqing , Weng Liguo , Chen Bingyu , Xia Min
Published: March 2021

Analyzing land cover using remote sensing images has broad prospects, the precise segmentation of land cover is the key to the application of this technology. Nowadays, the Convolution Neural Network (CNN) is widely used in many image semantic segmentation tasks. However, existing CNN models often exhibit poor generalization ability and low segmentation accuracy when dealing with land cover segmentation tasks. To solve this problem, this paper proposes Dual Function Feature Aggregation Network (DFFAN). This method combines image context information, gathers image spatial information, and extracts and fuses features. DFFAN uses residual neural networks as backbone to obtain different dimensional feature information of remote sensing images through multiple downsamplings. This work designs Affinity Matrix Module (AMM) to obtain the context of each feature map and proposes Boundary Feature Fusion Module (BFF) to fuse the context information and spatial information of an image to determine the location distribution of each image’s category. Compared with existing methods, the proposed method is significantly improved in accuracy. Its mean intersection over union (MIoU) on the LandCover dataset reaches 84.81%.
The T Cell Repertoires from Nickel Sensitized Joint Implant Failure Patients
Authors: Chen Lan , Zhang Yan , Pacheco Karin , Dai Shaodong
Published: March 2021

Nickel (Ni2+) is one of the most common allergens, affecting around 10–15% of the general population. As the demand for orthopedic implant surgery rises, the number of surgical revisions due to joint implant failure also increases. There is evidence that some patients develop joint failure due to an immune response to a component of the implant, and we have found that Ni2+ is an especially important cause. Hence, understanding the mechanisms by which Ni2+ allergy induces joint implant failure becomes a critical research question. The structural basis of Ni2+ activation of pathogenic T cells is still not clear. The purpose of this study was to characterize Ni2+-reactive T cell repertoires derived from the peripheral blood of joint failure patients due to Ni2+ sensitization using single-cell sequencing techniques. We stimulated the proliferation of Ni2+ -reactive T cells from two implant failure patients in vitro, and sorted them for single-cell VDJ sequencing (10× genomics). We identified 2650 productive V-J spanning pairs. Both TCR α chains and β chains were enriched. TRBV18 usage is the highest in the P7 CD4+ population (18.1%), and TRBV5-1 usage is the highest in the P7 CD8+ population (12.1%). TRBV19 and TRBV20-1 segments are present in a high percentage of both P7 and P9 sequenced T cells. Remarkably, the alpha and beta chain combination of TRAV41-TRBV18 accounts for 13.5% of the CD4+ population of P7 patient. Compared to current Ni specific T cell repertoire studies of contact dermatitis, the Vα and Vβ usages of these joint implant failure patients were different. This could be due to the different availability of self-peptides in these two different tissues. However, TRBV19 (Vβ17) was among frequently used TCR β chains, which are common in previous reports. This implies that some pathogenic T cells could be similar in Ni2+ hypersensitivities in skin and joints. The alignment of the TCR CDR3β sequences showed a conserved glutamic acid (Glu) that could potentially interact with Ni2+. The study of these Ni2+ specific TCRs may shed light on the molecular mechanism of T cell activation by low molecular weight chemical haptens.
Dynamics of Central Remyelination and Treatment Evolution in a Model of Multiple Sclerosis with Optic Coherence Tomography
Authors: Benítez-Fernández Rocío , Melero-Jerez Carolina , Gil Carmen , de la Rosa Enrique J. , Martínez Ana , de Castro Fernando
Published: March 2021

The need for remyelinating drugs is essential for healing disabling diseases such as multiple sclerosis (MS). One of the reasons for the lack of this class of therapies is the impossibility to monitor remyelination in vivo, which is of utmost importance to perform effective clinical trials. Here, we show how optical coherence tomography (OCT), a cheap and non-invasive technique commonly used in ophthalmology, may be used to assess remyelination in vivo in MS patients. Our pioneer approach validates OCT as a technique to study remyelination of the optic nerve and reflects what is occurring in non-accessible central nervous system (CNS) structures, like the spinal cord. In this study we used the orally bioavailable small molecule VP3.15, confirming its therapeutical potential as a neuroprotective, anti-inflammatory, and probably remyelinating drug for MS. Altogether, our results confirm the usefulness of OCT to monitor the efficacy of remyelinating therapies in vivo and underscore the relevance of VP3.15 as a potential disease modifying drug for MS therapy.
Genetic Regulation of Tryptase Production and Clinical Impact: Hereditary Alpha Tryptasemia, Mastocytosis and Beyond
Authors: Sprinzl Bettina , Greiner Georg , Uyanik Goekhan , Arock Michel , Haferlach Torsten , Sperr Wolfgang R. , Valent Peter , Hoermann Gregor
Published: March 2021

Tryptase is a serine protease that is predominantly produced by tissue mast cells (MCs) and stored in secretory granules together with other pre-formed mediators. MC activation, degranulation and mediator release contribute to various immunological processes, but also to several specific diseases, such as IgE-dependent allergies and clonal MC disorders. Biologically active tryptase tetramers primarily derive from the two genes TPSB2 (encoding β-tryptase) and TPSAB1 (encoding either α- or β-tryptase). Based on the most common gene copy numbers, three genotypes, 0α:4β, 1α:3β and 2α:2β, were defined as “canonical”. About 4–6% of the general population carry germline TPSAB1-α copy number gains (2α:3β, 3α:2β or more α-extra-copies), resulting in elevated basal serum tryptase levels. This condition has recently been termed hereditary alpha tryptasemia (HαT). Although many carriers of HαT appear to be asymptomatic, a number of more or less specific symptoms have been associated with HαT. Recent studies have revealed a significantly higher HαT prevalence in patients with systemic mastocytosis (SM) and an association with concomitant severe Hymenoptera venom-induced anaphylaxis. Moreover, HαT seems to be more common in idiopathic anaphylaxis and MC activation syndromes (MCAS). Therefore, TPSAB1 genotyping should be included in the diagnostic algorithm in patients with symptomatic SM, severe anaphylaxis or MCAS.
Neural Circuitry–Neurogenesis Coupling Model of Depression
Authors: Kim Il Bin , Park Seon-Cheol
Published: March 2021

Depression is characterized by the disruption of both neural circuitry and neurogenesis. Defects in hippocampal activity and volume, indicative of reduced neurogenesis, are associated with depression-related behaviors in both humans and animals. Neurogenesis in adulthood is considered an activity-dependent process; therefore, hippocampal neurogenesis defects in depression can be a result of defective neural circuitry activity. However, the mechanistic understanding of how defective neural circuitry can induce neurogenesis defects in depression remains unclear. This review highlights the current findings supporting the neural circuitry-regulated neurogenesis, especially focusing on hippocampal neurogenesis regulated by the entorhinal cortex, with regard to memory, pattern separation, and mood. Taken together, these findings may pave the way for future progress in neural circuitry–neurogenesis coupling studies of depression.
A Robust and Hybrid Cryptosystem for Identity Authentication
Authors: Takieldeen Ali , Abd Elkhalik Said H. , Samra Ahmed S. , Mohamed Mohamed A. , Khalifa Fahmi
Published: March 2021

With the progressive development of a wide range of applications, interconnect things and internet of things (IoT) became an imperative required trend by industries and academicians. IoT became a base infrastructure for remote access or control depending on internet protocol (IP) networks, especially after the COVID-19 pandemic. The huge application domain’s infrastructure, which depends on IoT, requires a trusted connection to guarantee security and privacy while transferring data. This paper proposes a hybrid identity authentication pipeline that integrates three schemes, namely, an elliptic curve cryptography (ECC) scheme is integrated with the Ong, Schnorr, and Shamir (OSS) signature scheme and chaotic maps. The latter satisfies both security and guarantee criteria. The novelty of the proposal is in using chaotic mapping and a cyclic group to deduce a substitution box (S-Box) and a reversible matrix as a portion of the OSS signature equation. The ECC-based security part is an efficient public key cryptography mechanism with less computational cost, which makes it the most convenient to be used in IoT devices for authentication and privacy. The strength of the proposed scheme relies on combining the discrete logarithm problem (DLP) and integer factorization problem (IFP). The proposed approach was simulated using Lab-View and compared with other state-of-the art schemes. Extensive simulation results and analysis of the security and time rendering results confirmed its durability against different types of attacks, such as linear and differential attacks.
Fossils Shed a New Light on the Diversity and Disparity of the Family Limoniidae (Diptera, Nematocera)
Authors: Krzemiński Wiesław , Kania-Kłosok Iwona , Krzemińska Ewa , Ševčík Jan , Soszyńska-Maj Agnieszka
Published: March 2021

A new subfamily Drinosinae (Diptera, Limoniidae) is established with two fossil genera, Drinosa and Decessia gen. nov. with one new species, Decessia podenasi gen. et sp. nov. from Cretaceous Burmese amber. Additional description of Drinosa prisca is based on new material. A new subfamily shows unique reduction of radial veins combined with complete set of medial veins.
Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients
Authors: Schwaiger Karl , Weitgasser Laurenz , Mahrhofer Maximilian , Bachleitner Kathrin , Abed Selim , Wimbauer Julia , Russe Elisabeth , Schoeller Thomas , Wechselberger Gottfried
Published: March 2021

Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI.
Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection
Authors: Okugawa Takuya , Oshima Tadayuki , Nakai Keisuke , Eda Hirotsugu , Tamura Akio , Hara Ken , Ogawa Tomohiro , Kono Tomoaki , Kondo Takashi , Tozawa Katsuyuki , Fukushima Masashi , Tomita Toshihiko , Fukui Hirokazu , Watari Jiro , Miwa Hiroto
Published: March 2021

Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6–2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection. Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared. Results: A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction. Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.
Precision Treatment in ACS–Role of Assessing Fibrinolysis
Authors: Gue Ying X. , Jeong Young-Hoon , Farag Mohamed , Spinthakis Nikolaos , Gorog Diana A.
Published: March 2021

Despite advancements in pharmacotherapy and interventional strategies, patients with acute coronary syndrome (ACS) remain at risk of recurrent thrombotic events. In addition to an enhanced tendency to thrombus formation, impairment in the ability to naturally dissolve or lyse a developing thrombus, namely impaired endogenous fibrinolysis, is responsible for a major part of this residual risk regardless of optimal antiplatelet medication. Global assessment of endogenous fibrinolysis, including a point-of-care assay, can identify patients with ACS at persistent high cardiovascular risk and might play an important role in allowing the personalisation of potent antithrombotic therapy to enhance fibrinolytic status, providing precision treatment of ACS to improve long-term outcome.
The Role of Diagnostic Biomarkers, Omics Strategies, and Single-Cell Sequencing for Nonalcoholic Fatty Liver Disease in Severely Obese Patients
Authors: Wernberg Charlotte W. , Ravnskjaer Kim , Lauridsen Mette M. , Thiele Maja
Published: March 2021

Liver disease due to metabolic dysfunction constitute a worldwide growing health issue. Severe obesity is a particularly strong risk factor for non-alcoholic fatty liver disease, which affects up to 93% of these patients. Current diagnostic markers focus on the detection of advanced fibrosis as the major predictor of liver-related morbidity and mortality. The most accurate diagnostic tools use elastography to measure liver stiffness, with diagnostic accuracies similar in normal-weight and severely obese patients. The effectiveness of elastography tools are however hampered by limitations to equipment and measurement quality in patients with very large abdominal circumference and subcutaneous fat. Blood-based biomarkers are therefore attractive, but those available to date have only moderate diagnostic accuracy. Ongoing technological advances in omics technologies such as genomics, transcriptomics, and proteomics hold great promise for discovery of biomarkers and increased pathophysiological understanding of non-alcoholic liver disease and steatohepatitis. Very recent developments have allowed for single-cell sequencing and cell-type resolution of gene expression and function. In the near future, we will therefore likely see a multitude of breakthrough biomarkers, developed from a deepened understanding of the biological function of individual cell types in the healthy and injured liver.
SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group
Authors: Shahjouei Shima , Anyaehie Michelle , Koza Eric , Tsivgoulis Georgios , Naderi Soheil , Mowla Ashkan , Avula Venkatesh , Vafaei Sadr Alireza , Chaudhary Durgesh , Farahmand Ghasem , Griessenauer Christoph , Azarpazhooh Mahmoud , Misra Debdipto , Li Jiang , Abedi Vida , Zand Ramin ,   the Multinational COVID- Stroke Study Group
Published: March 2021

Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6–14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8–40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4–36.2) were associated with cardioembolic stroke. Conclusions. Although a cohort of young and healthy men with cardioembolic and large vessel occlusions can be distinguished using both clinical sub-grouping and unsupervised clustering, stroke in other patients may be explained based on the existing comorbidities.
Pharmacological Primary Cardiovascular Prevention and Subclinical Atherosclerosis in Men: Evidence from the Aragon Workers’ Health Study
Authors: Aguilar-Palacio Isabel , Malo Sara , Jarauta Estibaliz , Moreno-Franco Belén , Maldonado Lina , Compés Luisa , Rabanaque Mª José , Casasnovas José Antonio
Published: March 2021

The objective of this study is to describe the profile of primary preventive treatment for cardiovascular disease in adult males and to analyze the association between treatment profile and subclinical atherosclerosis. We selected male workers who had undergone ultrasound imaging and had no previous history of cardiovascular disease (n = 2138). Data on the consumption of primary cardiovascular drugs from the previous year were obtained. We performed bivariate analyses to compare patient characteristics according to cardiovascular treatment and the presence of subclinical atherosclerosis, and logistic regression models to explore the association between these two variables. Among participants with no personal history of cardiovascular disease, subclinical atherosclerosis was present in 77.7% and 31.2% had received some form of preventive treatment. Of those who received no preventive treatment, 73.6% had subclinical atherosclerosis. Cardiovascular preventive treatment was associated only with CACS > 0 (odds ratio (OR), 1.37; 95% confidence interval (95% CI), 1.06–1.78). Statin treatment was associated with a greater risk of any type of subclinical atherosclerosis (OR, 1.73) and with CACS > 0 (OR, 1.72). Subclinical atherosclerosis existed in almost 75% of men who had no personal history of cardiovascular disease and had not received preventive treatment for cardiovascular disease.
The Efficacy of Cone-Beam CT-Based Perfusion Mapping in Evaluation of Tissue Perfusion in Peripheral Arterial Disease
Authors: Kim Ran , Choi Sun Young , Kim Yeo Ju
Published: March 2021

This study investigated the use of cone-beam computed tomography (CBCT)-based perfusion mapping during percutaneous transluminal angioplasty (PTA) to predict clinical outcome in the peripheral arterial disease (PAD). From January 2016 to March 2020, 43 patients (28 male, 15 female; mean age, 69) with 51 limbs, who underwent PTA with CBCT-based foot perfusion mapping for PAD were included. Parenchymal blood volume (PBV) of foot was measured. Clinical response was investigated based on medical records. Predictive value for clinical success was evaluated using multiple logistic regression with C-statistics. Two reviewers visually assessed the improvement on angiography and CBCT-based foot perfusion mapping; inter-observer agreement of clinical success between the two were measured. Technical and clinical success rate of PTA was 90.8% and 68.6%, respectively. In multiple logistic regression, the maximum value of PBV (PBVmax) on perfusion mapping after PTA was significant (p = 0.03) for evaluating clinical success with the highest C-statistic (0.84). Using a cutoff of 235.7 mL/L for PBVmax after PTA, area under curve for prediction of clinical success was 0.664, and sensitivity and specificity were 71.4% and 68.8%, respectively. Consistency in prediction of clinical success between the two reviewers was almost perfect for CBCT-based foot perfusion mapping.
High CD200 Expression on T CD4+ and T CD8+ Lymphocytes as a Non-Invasive Marker of Idiopathic Pulmonary Hypertension–Preliminary Study
Authors: Tomaszewski Michał , Grywalska Ewelina , Topyła-Putowska Weronika , Błaszczak Piotr , Kurzyna Marcin , Roliński Jacek , Kopeć Grzegorz
Published: March 2021

Pulmonary arterial hypertension (PAH) can develop subsequently to disorganized endothelial cell proliferation within the pulmonary arteriolar layers that provide mechanical limits to the pulmonary vascular bed. Although the actual factor triggering vascular endothelial proliferation remains unknown to date, genetic susceptibility, hypoxia, inflammation, as well as response to drugs and toxins have been proposed as possible contributors. Since inflammation contributes to vascular remodeling, the changed immune response is increasingly considered a plausible cause of this cardiovascular disease. The interaction of a membrane glycoprotein cluster of differentiation 200 (CD200) and its structurally similar receptor (CD200R) plays a crucial role in the modulation of the inflammatory response. Our previous studies have shown that the overexpression of the other negative co-stimulatory molecule (programmed death cell-PD-1) and its ligand-1 (PD-L1) is closely related to iPAH and the presence of Epstein-Barr virus (EBV) reactivation markers. Therefore, we considered it necessary to analyze the different types of PAH in terms of CD200 and CD200R expression and to correlate CD200/CD200R pathway expression with important clinical and laboratory parameters. The CD200/C200R-signaling pathway has not been subject to much research. We included 70 treatment-naïve, newly diagnosed patients with PAH in our study. They were further divided into subsets according to the pulmonary hypertension classification: chronic thromboembolic pulmonary hypertension (CTEPH) subset, pulmonary arterial hypertension associated with congenital heart disease (CHD-PAH), pulmonary arterial hypertension associated with connective tissue disease (CTD-PAH), and idiopathic pulmonary arterial hypertension (iPAH). The control group consisted of 20 healthy volunteers matched for sex and age. The highest percentages of T CD200+CD4+ and T CD200+CD8+ lymphocytes were observed in the group of patients with iPAH and this finding was associated with the presence of EBV DNA in the peripheral blood. Our assessment of the peripheral blood lymphocytes expression of CD200 and CD200R indicates that these molecules act as negative co-stimulators in the induction and persistence of PAH-associated inflammation, especially that of iPAH. Similar results imply that the dysregulation of the CD200/CD200R axis may be involved in the pathogenesis of several immune diseases. Our work suggests that CD200 and CD200R expression may serve to distinguish between PAH cases. Thus, CD200 and CD200R might be useful as markers in managing PAH and should be further investigated.
Patient and Therapist Perspectives on Treatment for Adults with PTSD from Childhood Trauma
Authors: Boterhoven de Haan Katrina L. , Lee Christopher W. , Correia Helen , Menninga Simone , Fassbinder Eva , Köehne Sandra , Arntz Arnoud
Published: March 2021

This study aimed to explore patients’ and therapists’ experiences with trauma-focused treatments in patients with posttraumatic stress disorder from childhood trauma (Ch-PTSD). Semi-structured interviews were conducted with patients (n = 44) and therapists (n = 16) from an international multicentre randomised clinical trial comparing two trauma-focused treatments (IREM), imagery rescripting and eye movement and desensitisation (EMDR). Thematic analysis was used to identify key themes within the data. Patients and therapists commented about the process of therapy. The themes that emerged from these comments included the importance of the patients’ willingness to engage and commit to the treatment process; the importance and difficulty of the trauma work, observations of how the trauma focused therapy produced changes in insight, and sense of self and empowerment for the future. In addition, therapists made suggestions for optimising the therapist role in the trauma-focused treatment. This included the importance of having confidence in their own ability, confronting their own and their client’s avoidance and the necessity and difficulties of adhering to the treatment protocols. These reported experiences add further support to the idea that trauma-focused treatments, without a stabilisation phase, can be tolerated and deepens our understanding of how to make this palatable for individuals with Ch-PTSD.
The Relationship between Cardiovascular Risk Scores and Several Markers of Subclinical Atherosclerosis in an Asymptomatic Population
Authors: Mitu Ovidiu , Crisan Adrian , Redwood Simon , Cazacu-Davidescu Ioan-Elian , Mitu Ivona , Costache Irina-Iuliana , Onofrei Viviana , Miftode Radu-Stefan , Costache Alexandru-Dan , Haba Cristian Mihai Stefan , Mitu Florin
Published: March 2021

Background: The current cardiovascular disease (CVD) primary prevention guidelines prioritize risk stratification by using clinical risk scores. However, subclinical atherosclerosis may rest long term undetected. This study aimed to evaluate multiple subclinical atherosclerosis parameters in relation to several CV risk scores in asymptomatic individuals. Methods: A cross-sectional, single-center study included 120 asymptomatic CVD subjects. Four CVD risk scores were computed: SCORE, Framingham, QRISK, and PROCAM. Subclinical atherosclerosis has been determined by carotid intima-media thickness (cIMT), pulse wave velocity (PWV), aortic and brachial augmentation indexes (AIXAo, respectively AIXbr), aortic systolic blood pressure (SBPao), and ankle-brachial index (ABI). Results: The mean age was 52.01 ± 10.73 years. For cIMT—SCORE was more sensitive; for PWV—Framingham score was more sensitive; for AIXbr—QRISK and PROCAM were more sensitive while for AIXao—QRISK presented better results. As for SBPao—SCORE presented more sensitive results. However, ABI did not correlate with any CVD risk score. Conclusions: All four CV risk scores are associated with markers of subclinical atherosclerosis in asymptomatic population, except for ABI, with specific particularities for each CVD risk score. Moreover, we propose specific cut-off values of CV risk scores that may indicate the need for subclinical atherosclerosis assessment.
Risk Scores in ST-Segment Elevation Myocardial Infarction Patients with Refractory Cardiogenic Shock and Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Semaan Carl , Charbonnier Arthur , Pasco Jeremy , Darwiche Walid , Saint Etienne Christophe , Bailleul Xavier , Bourguignon Thierry , Fauchier Laurent , Angoulvant Denis , Ivanes Fabrice , Genet Thibaud
Published: March 2021

Although many risk models have been tested in patients implanted by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), few scores assessed patients’ prognosis in the setting of ST-segment elevation myocardial infarction (STEMI) with refractory cardiogenic shock. We aimed at assessing the performance of risk scores, notably the prEdictioN of Cardiogenic shock OUtcome foR AMI patients salvaGed by VA-ECMO (ENCOURAGE) score, for predicting mortality in this particular population. This retrospective observational study included patients admitted to Tours University Hospital for STEMI with cardiogenic shock and requiring hemodynamic support by VA-ECMO. Among the fifty-one patients, the 30-day and 6-month survival rates were 63% and 56% respectively. Thirty days after VA-ECMO therapy, probabilities of mortality were 12, 17, 33, 66, 80% according to the ENCOURAGE score classes 0–12, 13–18, 19–22, 23–27, and ≥28, respectively. The ENCOURAGE score (AUC of the Receiving Operating Characteristic curve = 0.83) was significantly better compared to other risk scores. The hazard ratio for survival at 30 days for each point of the ENCOURAGE score was 1.10 (CI 95% (1.06, 1.15); p < 0.001). Decision curve analysis indicated that the ENCOURAGE score had the best clinical usefulness of the tested risk scores and the Hosmer–Lemeshow test suggested an accurate calibration. Our data suggest that the ENCOURAGE score is valid and the most relevant score to predict 30-day mortality after VA-ECMO therapy in STEMI patients with refractory cardiogenic shock. It may help decision-making teams to better select STEMI patients with shock for VA-ECMO therapy.
Multiple Allergen Simultaneous Test-Immunoblot Assay for Immunoglobulin E Detection in Patients with Isolated Allergic Conjunctivitis
Authors: Han Jung Yeob , Lee Hun , Chung Jae Lim , Kim Young Jun , Kim Jae Yong , Tchah Hungwon
Published: March 2021

We aimed to investigate the immunoglobulin E (IgE) detection rate and allergen patterns in patients with isolated allergic conjunctivitis using the multiple allergen simultaneous test (MAST)-immunoblot assay. A total of 120 patients with allergic conjunctivitis and no associated rhinitis, asthma, or dermatitis underwent the MAST-immunoblot assay to measure serum total IgE (TIgE) and serum specific IgE (SIgE) against 57 allergens. Patients were classified into subgroups based on the season when the eye symptoms were exacerbated, and TIgE and SIgE positivity. Differences between sex and age groups were also analyzed. Of the 120 patients, 57.5% (69 patients) and 69.2% (83 patients) were positive for TIgE (≥100 IU/mL) and SIgE (≥0.7 IU/mL), respectively. The allergens that most frequently triggered sensitization in the study population were Dermatophagoides farinae, Dermatophagoides pteronyssinus, Tyrophagus putrescentiae, Alternaria, and house dust. House dust mites, such as D. farinae and D. pteronyssinus, showed the highest detection rates regardless of the season. Men had a higher positive rate for TIgE than women, whereas a higher rate of sensitization, detected as SIgE positivity, was seen in younger patients. In conclusion, MAST-immunoblot assay can detect sensitizing allergens in patients with isolated allergic conjunctivitis.
Generalizability of Deep Learning Models for Caries Detection in Near-Infrared Light Transillumination Images
Authors: Holtkamp Agnes , Elhennawy Karim , Cejudo Grano de Oro José E. , Krois Joachim , Paris Sebastian , Schwendicke Falk
Published: March 2021

Objectives: The present study aimed to train deep convolutional neural networks (CNNs) to detect caries lesions on Near-Infrared Light Transillumination (NILT) imagery obtained either in vitro or in vivo and to assess the models’ generalizability. Methods: In vitro, 226 extracted posterior permanent human teeth were mounted in a diagnostic model in a dummy head. Then, NILT images were generated (DIAGNOcam, KaVo, Biberach), and images were segmented tooth-wise. In vivo, 1319 teeth from 56 patients were obtained and segmented similarly. Proximal caries lesions were annotated pixel-wise by three experienced dentists, reviewed by a fourth dentist, and then transformed into binary labels. We trained ResNet classification models on both in vivo and in vitro datasets and used 10-fold cross-validation for estimating the performance and generalizability of the models. We used GradCAM to increase explainability. Results: The tooth-level prevalence of caries lesions was 41% in vitro and 49% in vivo, respectively. Models trained and tested on in vivo data performed significantly better (mean ± SD accuracy: 0.78 ± 0.04) than those trained and tested on in vitro data (accuracy: 0.64 ± 0.15; p < 0.05). When tested in vitro, the models trained in vivo showed significantly lower accuracy (0.70 ± 0.01; p < 0.01). Similarly, when tested in vivo, models trained in vitro showed significantly lower accuracy (0.61 ± 0.04; p < 0.05). In both cases, this was due to decreases in sensitivity (by −27% for models trained in vivo and −10% for models trained in vitro). Conclusions: Using in vitro setups for generating NILT imagery and training CNNs comes with low accuracy and generalizability. Clinical significance: Studies employing in vitro imagery for developing deep learning models should be critically appraised for their generalizability. Applicable deep learning models for assessing NILT imagery should be trained on in vivo data.
Expression of Selected Genes Involved in Neurogenesis in the Etiopathogenesis of Depressive Disorders
Authors: Bliźniewska-Kowalska Katarzyna , Gałecki Piotr , Szemraj Janusz , Talarowska Monika
Published: March 2021

(1) Background: The neurogenic theory suggests that impaired neurogenesis within the dentate gyrus of the hippocampus is one of the factors causing depression. Immunology also has an impact on neurotrophic factors. The aim of the study was to assess the importance of selected genes involved in the process of neurogenesis i.e., nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF) and neuron-restrictive silencer factor (REST gene) in the etiopathogenesis of depressive disorders. (2) Methods: A total of 189 subjects took part in the study (95 depressed patients, 94 healthy controls). Sociodemographic data were collected. The severity of depressive symptoms was assessed using the Hamilton Depression Rating Scale (HDRS). RT-PCR was used to assess gene expression at the mRNA levels, while Enzyme-Linked Immunosorbent Assay (ELISA) was used to assess gene expression at the protein level. (3) Results: Expression of NGF, BDNF, REST genes is lower in depressed patients than in the control group, whereas the expression of GDNF gene is higher in patients with depressive disorders than in the group of healthy volunteers. (4) Conclusions: The expression of selected genes might serve as a biomarker of depression.