bluuebunny/crossref_metadata_2025 huggingface dataset:
Glutathione Infusion Before and 3 Days After Primary Angioplasty Blunts Ongoing NOX2‐Mediated Inflammatory Response
Authors: Tanzilli Gaetano , Arrivi Alessio , Placanica Attilio , Viceconte Nicola , Cammisotto Vittoria , Nocella Cristina , Barillà Francesco , Torromeo Concetta , Pucci Giacomo , Acconcia Maria Cristina , Granatelli Antonino , Basili Stefania , Dominici Marcello , Gaudio Carlo , Carnevale Roberto , Mangieri Enrico
Published: September 2021

Background

Glutathione is a water‐soluble tripeptide with a potent oxidant scavenging activity. We hypothesized that glutathione administration immediately before and after primary angioplasty (primary percutaneous coronary intervention) could be effective in modulating immune cell activation, thereby preventing infarct expansion.

Methods and Results

One hundred consecutive patients with ST‐segment–elevation myocardial infarction, scheduled to undergo primary percutaneous coronary intervention were randomly assigned before the intervention to receive an infusion of glutathione (2500 mg/25 mL over 10 minutes), followed by drug administration at the same doses at 24, 48, and 72 hours elapsing time or placebo. Total leukocytes, NOX2 (nicotinamide adenine dinucleotide phosphate oxidase 2) activation, NO bioavailability, cTpT (serum cardiac troponin T), hsCRP (high‐sensitivity C‐reactive protein), and TNF‐α (tumor necrosis factor α) levels were measured. Left ventricular size and function were assessed within 120 minutes, 5 days, and 6 months from percutaneous coronary intervention. Following reperfusion, a significant reduction of neutrophil to lymphocyte ratio (
P
<0.0001), hsCRP generation (
P
<0.0001), NOX2 activation (
P
<0.0001), TNF‐α levels (
P
<0.001), and cTpT release (
P
<0.0001) were found in the glutathione group compared with placebo. In treated patients, blunted inflammatory response was linked to better left ventricular size and function at follow‐up (
r
=0.78,
P
<0.005).

Conclusions

Early and prolonged glutathione infusion seems able to protect vital myocardial components and endothelial cell function against harmful pro‐oxidant and inflammatory environments, thus preventing maladaptive cardiac repair and left ventricular adverse remodeling.

Registration

URL:
https://www.clinicaltrialsregister.eu
; Unique identifier: 2014‐004486‐25.
Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers
Authors: Holl Jane L. , Khorzad Rebeca , Zobel Rebecca , Barnard Amy , Hillman Maureen , Vargas Alejandro , Richards Christopher , Mendelson Scott , Prabhakaran Shyam
Published: September 2021

Background

Patients with acute stroke at non‐ or primary stroke centers (PSCs) are transferred to comprehensive stroke centers for advanced treatments that reduce disability but experience significant delays in treatment and increased adjusted mortality. This study reports the results of a proactive, systematic, risk assessment of the door‐in‐door‐out process and its application to solution design.

Methods and Results

A learning collaborative (clinicians, patients, and caregivers) at 2 PSCs and 3 comprehensive stroke centers in Chicago, Illinois participated in a failure modes, effects, and criticality analysis to identify steps in the process; failures of each step, underlying causes; and to characterize each failure’s frequency, impact, and safeguards using standardized scores to calculate risk priority and criticality numbers for ranking. Targets for solution design were selected among the highest‐ranked failures. The failure modes, effects, and criticality analysis process map and risk table were completed during in‐person and virtual sessions. Failure to detect severe stroke/large‐vessel occlusion on arrival at the PSC is the highest‐ranked failure and can lead to a 45‐minute door‐in‐door‐out delay caused by failure to obtain a head computed tomography and computed tomography angiogram together. Lower risk failures include communication problems and delays within the PSC team and across the PSC comprehensive stroke center and paramedic teams. Seven solution prototypes were iteratively designed and address 4 of the 10 highest‐ranked failures.

Conclusions

The failure modes, effects, and criticality analysis identified and characterized previously unrecognized failures of the door‐in‐door‐out process. Use of a risk‐informed approach for solution design is novel for stroke and should mitigate or eliminate the failures.
Hizbullah’s ʿAshura Posters (2007–2020)
Authors: Hamdar Sarah
Published: September 2021

This article examines Hizbullah’s annual ʿAshura posters. It focuses on the campaigns created between 2007 and 2020 and places them against a backdrop of contemporary political events to demonstrate how the posters act as a significant site of political contestation and nationalist manifestation. By linking ʿAshura to contemporary politics in an ongoing reinterpretation of Imam Husayn’s martyrdom, Hizbullah places the Karbala battle at the center of its ideological identity, political actions and resistance activities, ultimately elevating its own fighters to Husayn’s position during Karbala. While Husayn is a figure mostly venerated within Shiʿa Islam, the article also demonstrates how Hizbullah utilizes the ʿAshura narrative to elevate Husayn—and ultimately the party’s fighters—to a transnational context by transforming the Karbala battle into a model for global resistance and victory. This is manifested in the posters’ meanings but also within the visual transformations whereby aesthetic changes reveal Hizbullah’s attempts at broadening its reach to a wider audience.
Abyssal Heat Budget in the Southwest Pacific Basin
Authors: Lele Ratnaksha , Purkey Sarah G. , Nash Jonathan D. , MacKinnon Jennifer A. , Thurnherr Andreas M. , Whalen Caitlin B. , Mecking Sabine , Voet Gunnar , Talley Lynne D.
Published: September 2021

The abyssal Southwest Pacific Basin has warmed significantly between 1992-2017, consistent with warming along the bottom limb of the meridional overturning circulation seen throughout the global oceans. Here we present a framework for assessing the abyssal heat budget that includes the time-dependent unsteady effects of decadal warming and direct and indirect estimates of diapycnal mixing from microscale temperature measurements and finescale parameterizations. The unsteady terms estimated from the decadalwarming rate are shown to be within a factor of 3 of the steady state terms in the abyssal heat budget for the coldest portion of the water column and therefore, cannot be ignored. We show that a reduction in the lateral heat flux for the coldest temperature classes compensated by an increase in warmer waters advected into the basin has important implications for the heat balance and diffusive heat fluxes in the basin. Finally, vertical diffusive heat fluxes are estimated in different ways: using the newly available CTD-mounted microscale temperature measurements, a finescale strain parameterization, and a vertical kinetic energy parameterization from data along the P06 transect along 32.5°S. The unsteady-state abyssal heat budget for the basin shows closure within error estimates, demonstrating that (i) unsteady terms have become consequential for the heat balance in the isotherms closest to the ocean bottom and (ii) direct and indirect estimates from full depth GO-SHIP hydrographic transects averaged over similarly large spatial and temporal scales can capture the basin-averaged abyssal mixing needed to close the deep overturning circulation.
India’s Health Diplomacy as a Soft Power Tool towards Africa: Humanitarian and Geopolitical Analysis
Authors: Mol Rajani , Singh Bawa , Chattu Vijay Kumar , Kaur Jaspal , Singh Balinder
Published: September 2021

India and Africa have been sharing a multidimensional relationship of cooperation and friendship since the ancient civilizations. The COVID-19 pandemic has brought new possibilities and opportunities for India to leverage its soft power diplomacy towards Africa. The paper’s main focus is to analyze how India has made soft power part of its foreign policy and examine India’s relationship with the African continent through health diplomacy. A literature search was done in major databases, such as Web of Science, Medicine/PubMed, Scopus, OVID, and Google Scholar search engine to gather relevant information. Through humanitarian assistance and geopolitical influence, India had won the support and heart of Africans. Besides, India has become a global healthcare provider in the African continent through its global health diplomacy and vaccine diplomacy. India has achieved impressive gains through its soft power diplomacy and has become a compassionate and benevolent actor in the African continent.
Impact of Social Media on Travel Behaviors during the COVID-19 Pandemic: Evidence from New York City
Authors: Ye Qian , Ozbay Kaan , Zuo Fan , Chen Xiaohong
Published: September 2021

During the outbreak of COVID-19, people’s reliance on social media for pandemic-related information exchange, daily communications, and online professional interactions increased because of self-isolation and lockdown implementation. Most of the published research addresses the performance of nonpharmaceutical interventions (NPIs) and measures on the issues impacted by COVID-19, such as health, education, and public safety; however, not much is known about the interplay between social media use and travel behaviors. This study aims to determine the effect of social media on human mobility before and after the COVID-19 outbreak, and its impact on personal vehicle and public transit use in New York City (NYC). Apple mobility trends and Twitter data are used as two data sources. The results indicate that Twitter volume and mobility trend correlations are negative for both driving and transit categories in general, especially at the beginning of the COVID-19 outbreak in NYC. A significant time lag (13 days) between the online communication rise and mobility drop can be observed, thereby providing evidence of social networks taking quicker reactions to the pandemic than the transportation system. In addition, social media and government policies had different impacts on vehicular traffic and public transit ridership during the pandemic with varied performance. This study provides insights on the complex influence of both anti-pandemic measures and user-generated content, namely social media, on people’s travel decisions during pandemics. The empirical evidence can help decision-makers formulate timely emergency responses, prepare targeted traffic intervention policies, and conduct risk management in similar outbreaks in the future.
Effect of triangular oil pockets on friction reduction
Authors: Wos Slawomir , Koszela Waldemar , Dzierwa Andrzej , Pawlus Pawel
Published: September 2021

The effect of the apex angle of triangular oil pockets created on a disc surface on friction was studied. Experiments were carried out using an Optimol SRV5 tribotester equipped with a pin-on-disc module under unidirectional lubricated sliding. Both the sample and counter sample was made of steel of 45 Hardness Rockwell C (HRC) hardness. Only 1 ml of oil was put to the inlet side of the contact area at the beginning of each test. All textured surfaces had the same pit-area ratio and an average depth of dimples. Oil pockets were positioned in the spiral array. It was found that the effect of the apex angle of triangular dimples on friction reduction was important. When the normal load was lower, the smallest coefficient of friction was achieved for the sliding pair with a disc apex angle of 60°. Under a larger normal load, a higher apex angle corresponded to a higher coefficient of friction.
Book Review: Hall, J. C., and Harper, S., eds., 2019: Economic and Political Institutions and Development
Authors: Bhuta Aishwarya
Published: September 2021

Hall, J. C., and Harper, S., eds., 2019: Economic and Political Institutions and Development (1st ed.). Cham, Switzerland: Springer. 182 pp., ₹8,559 (eBook). ISBN: 978-3-030-06049-7.
Risk Communication After Health Care Exposures: An Experimental Vignette Survey With Patients
Authors: Elwy A. Rani , Maguire Elizabeth M. , Gallagher Thomas H. , Asch Steven M. , Durfee Janet M. , Martinello Richard A. , Bokhour Barbara G. , Gifford Allen L. , Taylor Thomas J. , Wagner Todd H.
Published: September 2021

Purpose. We investigated how health care systems should communicate with patients about possible exposures to blood-borne pathogens that may have occurred during their care. Our goal was to determine how best to communicate uncertain risk information in a way that would minimize harm to patients, maintain their trust, and encourage patients to seek follow-up treatment. Methods. Participants ( N = 1103) were randomized to receive one of six vignette surveys; 997 (98.4%) responded. All vignettes described the same event, but differed by risk level and recommendations (lower risk v. higher risk) and by communication mode (telephone, letter, social media). We measured participants’ perceived risk of blood-borne infection, trust in the health care system, and shared decision making about next clinical steps. Open-ended questions were analyzed using grounded thematic analysis. Results. When the vignette requested patients to undergo testing and practice certain health behaviors (higher risk), participants’ likelihood of seeking follow-up testing for blood-borne pathogens and their understanding of health issues increased. Perceived trust was unaffected by risk level or communication processes. Qualitative data indicated a desire for telephone communication from providers known to the patient. Limitations. It is not clear whether higher risk language or objective risk levels in vignettes motivated patients’ behavioral intentions. Conclusion. Using higher risk language when disclosing large-scale adverse events increased participants’ willingness to seek follow-up care. Implications. Health care organizations’ disclosures should focus on the next steps to take after health care exposures. This communication should involve helping patients to understand their personal health issues better, make them feel that they know which steps to take following the receipt of this information, and encouraging them to seek follow-up infectious disease testing in order to better take care of themselves.
Clonal expansion of CD8+ T cells reflects graft-versus-leukemia activity and precedes durable remission following DLI
Authors: Schultze-Florey Christian R. , Kuhlmann Leonie , Raha Solaiman , Barros-Martins Joana , Odak Ivan , Tan Likai , Xiao Yankai , Ravens Sarina , Hambach Lothar , Venturini Letizia , Stadler Michael , Eder Matthias , Thol Felicitas , Heuser Michael , Förster Reinhold , Ganser Arnold , Prinz Immo , Koenecke Christian
Published: September 2021

Donor lymphocyte infusion (DLI) is a standard of care for relapse of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. Currently it is poorly understood how and when CD8+ αβ T cells exert graft-versus-leukemia (GVL) activity after DLI. Also, there is no reliable biomarker to monitor GVL activity of the infused CD8+ T cells. Therefore, we analyzed the dynamics of CD8+ αβ T-cell clones in patients with DLI. In this prospective clinical study of 29 patients, we performed deep T-cell receptor β (TRB ) sequencing of sorted CD8+ αβ T cells to track patients’ repertoire changes in response to DLI. Upon first occurrence of GVL, longitudinal analyses revealed a preferential expansion of distinct CD8+TRB clones (n = 14). This did not occur in samples of patients without signs of GVL (n = 11). Importantly, early repertoire changes 15 days after DLI predicted durable remission for the 36-month study follow-up. Furthermore, absence of clonal outgrowth of the CD8+TRB repertoire after DLI was an early biomarker that predicted relapse at a median time of 11.2 months ahead of actual diagnosis. Additionally, unbiased sample analysis regardless of the clinical outcome revealed that patients with decreasing CD8+TRB diversity at day 15 after DLI (n = 13) had a lower relapse incidence (P = .0040) compared with patients without clonal expansion (n = 6). In conclusion, CD8+TRB analysis may provide a reliable tool for predicting the efficacy of DLI and holds the potential to identify patients at risk for progression and relapse after DLI.
Circular RNA-0007059 protects cell viability and reduces inflammation in a nephritis cell model by inhibiting microRNA-1278/SHP-1/STAT3 signaling
Authors: Guo Peng-Wei , Huang Hai-Ting , Ma Jing , Zuo Yao , Huang Dan , He Lin-Lin , Wan Zi-Ming , Chen Cheng , Yang Fa-Fen , You Yan-Wu
Published: September 2021

Background

Increasing evidence has indicated that circular RNAs (circRNAs) play a role in various diseases. However, the influence of circRNAs in nephritis remains unknown.

Methods

Microarray analysis and RT-qPCR were used to detect the expression of circRNA. Type I IFN were administrated to RMC and HEK293 cells to establish a nephritis cell model. CCK-8, MTT assay, and flow cytometry were used to assess cell proliferation, viability, and apoptosis of cells. Bioinformatics analysis and dual luciferase reporter assay detect the interaction of circ_0007059, miRNA-1278, and SHP-1. Glomerulonephritis was performed in a mouse model by administration of IFNα-expressing adenovirus. IHC staining showed the pathogenic changes.

Results

In the present study, the expression of circ_0007059 in type I interferon (IFN)-treated renal mesangial cells (RMCs), lupus nephritis (LN) specimens, and HEK293 cells was downregulated compared with that in normal healthy samples and untreated cells. Circ_0007059 overexpression resulted in increased cell proliferation, cell viability, apoptosis, and inflammation-associated factors (CXCL10, IFIT1, ISG15, and MX1) in RMCs and HEK293 cells. In addition, circ_0007059 overexpression significantly restored cell proliferation and viability and inhibited IFN-induced apoptosis. Further, the increased expression resulted in reduced inflammation and the downregulation of CXCL10, IFIT1, ISG15, and MX1 in RMCs and HEK293 cells. Circ_0007059 serves as a sponge for miR-1278 so that the latter can target the 3′-untranslated region of SHP-1. Overexpressed circ_0007059 inhibited miR-1278 expression and elevated SHP-1 expression, subsequently reducing STAT3 phosphorylation. Meanwhile, miR-1278 was upregulated and SHP-1 was downregulated in LN samples and IFN-treated cells. The restoration of miR-1278 counteracted the effect of circ_0007059 on viability, apoptosis, and inflammation as well as on SHP-1/STAT3 signaling in RMCs and HEK293 cells. We also investigated the role of SHP-1 overexpression in IFN-treated RMCs and HEK293 cells; SHP-1 overexpression resulted in a similar phenotype as that observed with circ_0007059 expression.

Conclusions

The study indicates that circ_0007059 protects RMCs against apoptosis and inflammation during nephritis by attenuating miR-1278/SHP-1/STAT3 signaling.
Boolean factor graph model for biological systems: the yeast cell-cycle network
Authors: Kotiang Stephen , Eslami Ali
Published: September 2021

Background

The desire to understand genomic functions and the behavior of complex gene regulatory networks has recently been a major research focus in systems biology. As a result, a plethora of computational and modeling tools have been proposed to identify and infer interactions among biological entities. Here, we consider the general question of the effect of perturbation on the global dynamical network behavior as well as error propagation in biological networks to incite research pertaining to intervention strategies.

Results

This paper introduces a computational framework that combines the formulation of Boolean networks and factor graphs to explore the global dynamical features of biological systems. A message-passing algorithm is proposed for this formalism to evolve network states as messages in the graph. In addition, the mathematical formulation allows us to describe the dynamics and behavior of error propagation in gene regulatory networks by conducting a density evolution (DE) analysis. The model is applied to assess the network state progression and the impact of gene deletion in the budding yeast cell cycle. Simulation results show that our model predictions match published experimental data. Also, our findings reveal that the sample yeast cell-cycle network is not only robust but also consistent with real high-throughput expression data. Finally, our DE analysis serves as a tool to find the optimal values of network parameters for resilience against perturbations, especially in the inference of genetic graphs.

Conclusion

Our computational framework provides a useful graphical model and analytical tools to study biological networks. It can be a powerful tool to predict the consequences of gene deletions before conducting wet bench experiments because it proves to be a quick route to predicting biologically relevant dynamic properties without tunable kinetic parameters.
Capnometric feedback training decreases 24-h blood pressure in hypertensive postmenopausal women
Authors: Anderson David E. , Reeves Alexis N. , Mehling Wolf E. , Chesney Margaret A.
Published: September 2021

Background

High normal resting pCO2is a risk factor for salt sensitivity of blood pressure (BP) in normotensive humans and has been associated with higher resting systolic BP in postmenopausal women. To date, however, no known studies have investigated the effects of regular practice of voluntary mild hypocapnic breathing on BP in hypertensive patients. The objective of the present research was to test the hypothesis that capnometric feedback training can decrease both resting pCO2and 24-h BP in a series of mildly hypertensive postmenopausal women.

Methods

A small portable end tidal CO2(etCO2) monitor was constructed and equipped with software that determined the difference between the momentary etCO2and a pre-programmed criterion range. The monitor enabled auditory feedback for variations in CO2outside the criterion range. 16 mildly hypertensive postmenopausal women were individually trained to sustain small decreases in etCO2during six weekly sessions in the clinic and daily sessions at home. 24-h BP monitoring was conducted before and after the intervention, and in 16 prehypertensive postmenopausal women in a control group who did not engage in the capnometric training.

Results

Following the intervention, all 16 capnometric training participants showed decreases in resting etCO2(− 4.3 ± 0.4 mmHg;p < .01) while 15 showed decreases in 24-h systolic BP (− 7.6 ± 2.0 mmHg;p < .01). No significant changes in either measure was observed in the control group. In addition, nighttime (− 9.5 ± 2.6;p < .01) and daytime (− 6.7 ± 0.2 mmHg) systolic BP were both decreased following capnometric training, while no significant changes in nighttime (− 2.8 ± 2.2 mmHg;p = .11) or daytime (− 0.7 ± 1.0 mmHg;p ≤ .247) systolic BP were observed in the control group.

Conclusions

These findings support the hypothesis that regular practice of mild hypocapnic breathing that decreases resting etCO2reliably decreases 24-h blood pressure in hypertensive postmenopausal women. The extent to which these effects persist beyond the training period or can be observed in other hypertensive subgroups remains to be investigated.
Mastery of type 2 diabetes prevention and treatment knowledge by general practitioners in Shanghai: a cross-sectional study
Authors: Li Yaling , Yan Yunyun , Dai Huimin , Cheng Yuan , Huang Qian , Shao Jie , Zhou Jianmin , Wang Haitang , Liu Pingyang , Shen Ao , Mi Yikai , Du Zhaohui
Published: September 2021

Background

To study the competency of general practitioners (GPs) in Shanghai, China on prevention and management of type 2 diabetes, also understand factors that may prohibit it.

Methods

A survey questionnaire with 25 questions was designed based on 2013 Chinese Type 2 Diabetes Prevention Guidelines and Chinese Type 2 Diabetes Prevention Guidelines (Grassroots Edition) and conducted among 789 GPs who work at 54 community healthcare centers (CHCs) within 16 districts at Shanghai, China. Excel 2016 and SPSS 24.0 were used for data analysis, and a difference of P < 0.05 was considered to be statistically significant.

Results

The GPs did poorly on three aspect of diabetes prevention and treatment: (1) treatment goals in elderly patients, (2) screening methods for high-risk population, and (3) aspirin contraindications. The statistical analysis data showed that GPs who finished standardized training had correct answer on 13.58 ± 3.31 questions out of total 25, with mean accuracy rate of 54.32%. Except the questions for high-risk population screening method and the diagnostic criteria for type 2 diabetes, there was no difference in the accuracy of other questions between GPs with or without standardized training (P < 0.05). However, sex, educational level, and subspecialty experience are affective factors on their competency in type 2 diabetes prevention and treatment knowledge.

Conclusion

The results indicated that communities should strengthen the training of GPs in diabetes management and bidirectional referral. Frequent continuing education and skills training should be provided among GPs at CHCs to ensure their competency of type 2 diabetes prevention and treatment knowledge after obtaining their GP license disregard of their standardized training. In addition, attention should be paid to GPs who had lower education background or non-clinical subspecialty experience to strengthen their clinical knowledge of type 2 diabetes.
What about the others: differential diagnosis of COVID-19 in a German emergency department
Authors: Fistera David , Härtl Annalena , Pabst Dirk , Manegold Randi , Holzner Carola , Taube Christian , Dolff Sebastian , Schaarschmidt Benedikt Michael , Umutlu Lale , Kill Clemens , Risse Joachim
Published: September 2021

Background

The ongoing COVID-19 pandemic remains a major challenge for worldwide health care systems and in particular emergency medicine. An early and safe triage in the emergency department (ED) is especially crucial for proper therapy. Clinical symptoms of COVID-19 comprise those of many common diseases; thus, differential diagnosis remains challenging.

Method

We performed a retrospective study of 314 ED patients presenting with conceivable COVID-19 symptoms during the first wave in Germany. All were tested for COVID-19 with SARS-Cov-2-nasopharyngeal swabs. Forty-seven patients were positive. We analyzed the 267 COVID-19 negative patients for their main diagnosis and compared COVID-19 patients with COVID-19 negative respiratory infections for differences in laboratory parameters, symptoms, and vital signs.

Results

Among the 267 COVID-19 negative patients, 42.7% had respiratory, 14.2% had other infectious, and 11.2% had cardiovascular diseases. Further, 9.0% and 6.7% had oncological and gastroenterological diagnoses, respectively. Compared to COVID-19 negative airway infections, COVID-19 patients showed less dyspnea (OR 0.440; p = 0.024) but more dysgeusia (OR 7.631; p = 0.005). Their hospital stay was significantly longer (9.0 vs. 5.6 days; p = 0.014), and their mortality significantly higher (OR 3.979; p = 0.014).

Conclusion

For many common ED diagnoses, COVID-19 should be considered a differential diagnosis. COVID-19 cannot be distinguished from COVID-19 negative respiratory infections by clinical signs, symptoms, or laboratory results. When hospitalization is necessary, the clinical course of COVID-19 airway infections seems to be more severe compared to other respiratory infections.

Trial registration: German Clinical Trial Registry DRKS, DRKS-ID of the study: DRKS00021675 date of registration: May 8th, 2020, retrospectively registered.
Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches
Authors: Cirillo Luigi , Romano Daniele Giuseppe , Vornetti Gianfranco , Frauenfelder Giulia , Tamburrano Chiara , Taglialatela Francesco , Isceri Salvatore , Saponiero Renato , Napoletano Rosa , Gentile Mauro , Romoli Michele , Princiotta Ciro , Simonetti Luigi , Zini Andrea
Published: September 2021

Background

Occlusion of the internal carotid artery (ICA), whether isolated or in the setting of a tandem lesion (TL) have a poor response to treatment with intravenous thrombolysis. Previous studies ​​have demonstrated the superiority of mechanical thrombectomy in the treatment of acute ischemic stroke (AIS) following large vessel occlusion, compared to standard intravenous fibrinolysis. The aim of our study was to describe endovascular treatment (EVT) in AIS due to isolated ICA occlusion or TL.

Methods

We assessed the association between 90-day outcome and clinical, demographic, imaging, and procedure data in 51 consecutive patients with acute isolated ICA occlusion or TL who underwent EVT. We evaluated baseline NIHSS and mRS, ASPECTS, type of occlusion, stent placement, use of stent retrievers and/or thromboaspiration, duration of the procedure, mTICI, postprocedural therapy and complications.

Results

A favorable 90-day outcome (mRS 0–2) was achieved in 34 patients (67 %) and was significantly associated with the use of dual antiplatelet therapy after the procedure (p = 0.008), shorter procedure duration (p = 0.031), TICI 2b-3 (p < 0.001) and lack of post-procedural hemorrhagic transformation (p = 0.001). Four patients did not survive, resulting in a mortality rate of 8 %.

Conclusions

Our study has shown that EVT in the treatment of AIS due to ICA occlusion is safe, and effective in determining a good functional outcome. ICA stenting led to good angiographic results and therapy with a glycoprotein IIb / IIIa inhibitor immediately after stent release did not result in a greater risk of hemorrhage. The use of post-procedural dual antiplatelet therapy was associated with favorable outcome, without a significant increase in hemorrhagic transformation.
Acute relaxation during pregnancy leads to a reduction in maternal electrodermal activity and self-reported stress levels
Authors: Bauer Ilena , Hartkopf Julia , Wikström Anna-Karin , Schaal Nora K. , Preissl Hubert , Derntl Birgit , Schleger Franziska
Published: September 2021

Background

Prenatal maternal stress can have adverse effects on birth outcomes and fetal development. Relaxation techniques have been examined as potential countermeasures. This study investigates different relaxation techniques and their effect on self-reported stress levels and physiological stress levels in pregnant women.

Methods

In this cross-sectional study, 38 pregnant women in their 30th to 40th gestational week were assigned to one of three, 20-min lasting relaxation groups: listening to music (N = 12), following a guided imagery (N = 12) or resting (N = 12). The intervention, i.e., acute relaxation (music, guided imagery or resting) took place once for each study participant. Study inclusion criteria were age over 18 years, German speaking, singleton and uncomplicated pregnancy during the 30th and 40th week of gestation. The stress levels were determined during the study. Current stress level during the study was assessed by a visual analogue scale. Chronic stress levels were assessed by the Trier Inventory of Chronic Stress and the Pregnancy Distress questionnaire. Multivariate analyses of covariance were performed and dependent measures included stress levels as well as physiological measures, i.e., cardiovascular activity (electrocardiogram) and skin conductance levels.

Results

All three forms of relaxation led to reduced maternal stress which manifested itself in significantly decreased skin conductance, F(3,94) = 18.011, p = .001, ηp2 = .365, and subjective stress levels after the interventions with no significant group difference. Post-intervention stress ratings were further affected by gestational age, with less subjective relaxation in women later in gestation, F (1, 34)=4.971, p = .032, ηp2 = .128.

Conclusion

Independent of relaxation technique, single, 20-min relaxation intervention (music, guided imagery or resting) can significantly reduce maternal stress. Notably, women at an earlier stage in their pregnancy reported higher relaxation after the intervention than women later in gestation. Hence, gestational age may influence perceived stress levels and should be considered when evaluating relaxation or stress management interventions during pregnancy.

Trial registration

Not applicable.
Evaluating satisfaction with the quality and provision of end-of-life care for patients from diverse ethnocultural backgrounds
Authors: Nayfeh Ayah , Yarnell Christopher J. , Dale Craig , Conn Lesley Gotlib , Hales Brigette , Gupta Tracey Das , Chakraborty Anita , Pinto Ruxandra , Taggar Ru , Fowler Robert
Published: September 2021

Background

Recently immigrated and ethnic minority patients in Ontario, Canada are more likely to receive aggressive life-prolonging treatment at the end of life in comparison to other patients. To explore this finding further, this survey-based observational study aimed to evaluate satisfaction with the quality of end-of-life care for patients from diverse ethnocultural backgrounds.

Methods

The End-of-Life Satisfaction Survey was used to measure satisfaction with the quality of inpatient end-of-life care from the perspective of next-of-kin of recently deceased patients at Sunnybrook Health Sciences Centre in Toronto, Ontario (between March 2012 to May 2019). The primary outcome was the global rating of satisfaction. Associations with patient ethnicity, patient religion, level of religiosity/spirituality, language/communication barriers, and location of death were assessed using univariable and multivariable modified Poisson regression. Secondary outcomes included differences in satisfaction and rates of dying in intensive care units (ICU) among patient population subgroups, and identification of high priority areas for quality-of-care improvement.

Results

There were 1,543 respondents. Patient ethnicities included Caucasian (68.2%), Mediterranean (10.5%), East Asian (7.6%), South Asian (3.5%), Southeast Asian (2.1%) and Middle Eastern (2.0%); religious affiliations included Christianity (66.6%), Judaism (12.3%) and Islam (2.1%), among others. Location of death was most commonly in ICU (38.4%), hospital wards (37.0%) or long-term care (20.0%). The mean(SD) rating of satisfaction score was 8.30(2.09) of 10. After adjusting for other covariates, satisfaction with quality of end-of-life care was higher among patients dying in ICU versus other locations (relative risk [RR] 1.51, 95%CI 1.05-2.19, p=0.028), lower among those who experienced language/communication barriers (RR 0.49 95%CI 0.23-1.06, p=0.069), and lower for Muslim patients versus other religious affiliations (RR 0.46, 95%CI 0.21-1.02, p=0.056). Survey items identified as highest priority areas for quality-of-care improvement included communication and information giving; illness management; and healthcare provider characteristics such as emotional support, doctor availability and time spent with patient/family.

Conclusion

Satisfaction with quality-of-care at the end of life was higher among patients dying in ICU and lower among Muslim patients or when there were communication barriers between families and healthcare providers. These findings highlight the importance of measuring and improving end-of-life care across the ethnocultural spectrum.
Economic burden of comorbid chronic conditions among survivors of stroke in China: 10-year longitudinal study
Authors: Zhang Ji , Song Suhang , Zhao Yang , Ma Gaoting , Jin Yinzi , Zheng Zhi-Jie
Published: September 2021

Background

The coexistence of chronic diseases among people with stroke is common. However, little is known about the extent of incremental healthcare expenditures associated with having physically and psychologically chronic conditions among stroke survivors.

Methods

We used the nationally representative data from the China Health and Nutrition Survey, including 36,076 participants enrolled as our analytic cohort of ten years of follow-up visits (2006, 2009, 2011, 2015). Chronic conditions include hypertension, diabetes, obesity, and impaired cognitive function. Two-part models were used to estimate the effect of comorbid chronic conditions on total annual healthcare expenditure, out-of-pocket (OOP) healthcare expenditure, and incidence of catastrophic healthcare expenditure (CHE).

Results

Among survivors of stroke during 2006 to 2015, the prevalence rates of hypertension, diabetes, obesity and impaired cognitive function were 75.5, 9.8, 12.7 and 65.1%, significantly higher than those among adults without stroke history (27.9, 2.7, 10.0 and 41.2%). Having hypertension ($794.5, p = 0.004), diabetes ($3978.5, p < 0.001) were associated with the largest incremental total healthcare expenditures. Stroke survivors with diagnosed hypertension and diabetes had additional 5.7 (p < 0.001) and 10.4 (p < 0.001) percentage point of CHE rate, respectively. Total healthcare expenditures were $2413.0 (P < 0.001) and $5151.7 (P < 0.001) higher among patients with 2, and ≥ 3 chronic conditions, respectively, than those individuals with no chronic conditions.

Conclusions

Excess expenditures associated with chronic diseases were substantial among stroke survivors. These results highlight the needs for both prevention and better management of multimorbidity among stroke survivors, which in turn may lower the financial burden of treating these concurrent comorbidities.
Niemann–Pick disease type C in Palestine: genotype and phenotype of sixteen patients and report of a novel mutation in the NPC1 gene
Authors: Dweikat Imad , Thaher Othman , Abosleem Abdulrahman , Zeer Almotazbellah , Mokh Ameer Abo
Published: September 2021

Background

Niemann–Pick disease type C (NPC) is an autosomal recessive, neurodegenerative disease caused by mutations in either the NPC1 or NPC2 genes. Mutations in these genes are associated with abnormal endosomal–lysosomal trafficking, resulting in the accumulation of tissue-specific lipids in lysosomes.

Methods

We described sixteen patients with NPC diagnosed between the age of 1 month and 30 years at two tertiary care centers in Palestine. The clinical phenotype, brain magnetic resonance imaging (MRI), and molecular genetic analysis data were reviewed.

Results

The diagnosis was confirmed by molecular analysis in all patients. Fourteen out of sixteen patients were homozygous for the NPC1 p.G992W variant. Among them, most were categorized as having the late-infantile neurological form of disease onset. They predominantly manifested with early-onset visceral manifestations in the form of hepatosplenomegaly and prolonged neonatal jaundice, and late-onset neuropsychiatric manifestations in the form of vertical supranuclear gaze palsy (VSGP), ataxia, cognitive impairment and seizures. Brain MRI in 6 patients was normal in 5 or consistent with cerebellar hemisphere atrophy in 1 of them. Two other mutations were identified in the NPC1 gene, of which p.V845Cfs*24 was novel.

Conclusions

Our results revealed phenotypic heterogeneity of NPC even within the same genotype, and add to the increasingly recognized evidence that cholestatic jaundice and hepatosplenomegaly during infancy, should alert the physician for the possibility of NPC. We reported a novel mutation in the NPC1 gene further expanding its genotype.
The effective function of circular RNA in colorectal cancer
Authors: Ameli-Mojarad Mandana , Ameli-Mojarad Melika , Hadizadeh Mahrooyeh , Young Chris , Babini Hosna , Nazemalhosseini-Mojarad Ehsan , Bonab Maziar Ashrafian
Published: September 2021

Colorectal cancer (CRC) is the 3rd most common type of cancer worldwide. Late detection plays role in one-third of annual mortality due to CRC. Therefore, it is essential to find a precise and optimal diagnostic and prognostic biomarker for the identification and treatment of colorectal tumorigenesis. Covalently closed, circular RNAs (circRNAs) are a class of non-coding RNAs, which can have the same function as microRNA (miRNA) sponges, as regulators of splicing and transcription, and as interactors with RNA-binding proteins (RBPs). Therefore, circRNAs have been investigated as specific targets for diagnostic and prognostic detection of CRC. These non-coding RNAs are also linked to metastasis, proliferation, differentiation, migration, angiogenesis, apoptosis, and drug resistance, illustrating the importance of understanding their involvement in the molecular mechanisms of development and progression of CRC. In this review, we present a detailed summary of recent findings relating to the dysregulation of circRNAs and their potential role in CRC.
Accuracy of SD Malaria Ag P.f/Pan® as a rapid diagnostic test in French Amazonia
Authors: Pujo Jean Marc , Houcke Stéphanie , Lemmonier Sarah , Portecop Patrick , Frémery Alexis , Blanchet Denis , Djossou Felix , Kallel Hatem , Demar Magalie
Published: September 2021

Background

French Guiana (FG) is a French overseas territory where malaria is endemic. The current incidence rate is 0.74‰ inhabitants, and Plasmodium vivax is widely predominating even though Plasmodium falciparum is still present due to imported cases mainly from Africa. In FG, rapid diagnostic test (SD Malaria Ag P.f/Pan®) is based on the detection of pan-pLDH, PfHRP2, and PfHRP3 antigens, while in South America, the share of deletion of PfHRP2 gene is significantly increasing. Accordingly, the study questions the reliability of RDTs in the Amazonian context.

Methods

The study is retrospective. It is conducted over 4 years and analysed 12,880 rapid diagnostic tests (RDTs) compared to concomitant Blood Film Tests (BFTs) sampled for malaria diagnosis.

Results

The global assessment of the accuracy of SD Malaria Ag P.f/Pan® in the diagnostic of malaria shows both Positive and Negative Predictive Values (PPV and NPV) higher than 95%, except for PPV in the diagnosis of malaria to P. falciparum (88%). Overall, the concordance rate between RDT and BFT (positive/positive; negative/negative) was 99.5%. The PPV of the RDT in the follow-up of patients diagnosed with P. falciparum was the lowest during the first 28 days. The PPV of the RDT in the follow-up of patients diagnosed with P. vivax was the lowest during the first 21 days. The global sensitivity of SD Malaria Ag P.f/Pan® test was, on average, 96% (88.2–100) for P. falciparum and 93% (90.6–94.2) for P. vivax. The global specificity was 99.8% (99.5–100) for all included species.

Conclusion

SD Malaria Ag P.f/Pan® is a reliable rapid test used for the first-line diagnosis in remote healthcare centres. The test results should be interpreted in the light of patient’s recent medical history and the date of arrival to FG.
In search of the last malaria cases: ethnographic methods for community and private-sector engagement in malaria elimination in Vietnam, Laos, and Cambodia
Authors: Masunaga Yoriko , Muela Ribera Joan , Nguyen Thuan Thi , Tesfazghi Kemi , Peeters Grietens Koen
Published: September 2021

Background

Despite significant strides made in reducing malaria morbidity and mortality in the Greater Mekong Subregion, malaria transmission continues amongst the most ‘hard-to-reach’, such as forest-goers and mobile and migrant populations, who face access obstacles to malaria diagnosis and treatment. As such, regional malaria elimination strategies endeavour to incorporate the private sector and local communities in improving surveillance and detection of the last malaria cases in remote forested areas. The question remains, however, whether such strategies can reach these hard-to-reach populations and effectively reduce their disproportionate burden of malaria. This paper evaluates the strategy of community and private sector engagement in a malaria elimination project in Vietnam, Laos, and Cambodia.

Methods

Ethnographic research, incorporating in-depth interviews, participant observations with informal discussions, and group discussions were conducted in Bu Gia Map commune, Binh Phuc province of Vietnam; in Phouvong district, Attapeu province of Laos; and, in nine newly established and informal communities in the provinces of Mondul Kiri, Steung Treng, Kratie, Kampong Thom, and Prah Vihear of Cambodia.

Results

Different types of factors limited or enhanced the effectiveness of the participatory approaches in the different settings. In Vietnam, inter-ethnic tensions and sensitivity around forest-work negatively affected local population’s health-seeking behaviour and consequent uptake of malaria testing and treatment. In Laos, the location of the project collaborative pharmacies in the district-centre were a mismatch for reaching hard-to-reach populations in remote villages. In Cambodia, the strategy of recruiting community malaria-workers, elected by the community members, did manage to reach the remote forested areas where people visited or stayed.

Conclusions

‘Hard-to-reach’ populations remain hard to reach without proper research identifying the socio-economic-political environment and the key dynamics determining uptake in involved communities and populations. Solid implementation research with a strong ethnographic component is required to tailor malaria elimination strategies to local contexts.
Mixture toxicity, cumulative risk, and environmental justice in United States federal policy, 1980–2016
Authors: Sprinkle Robert Hunt , Payne-Sturges Devon C.
Published: September 2021

Toxic chemicals — “toxicants” — have been studied and regulated as single entities, and, carcinogens aside, almost all toxicants, single or mixed and however altered, have been thought harmless in very low doses or very weak concentrations. Yet much work in recent decades has shown that toxicants can injure wildlife, laboratory animals, and humans following exposures previously expected to be harmless. Additional work has shown that toxicants can act not only individually and cumulatively but also collectively and even synergistically and that they affect disadvantaged communities inordinately — and therefore, as argued by reformers, unjustly. As late as December 2016, the last full month before the inauguration of a president promising to rescind major environmental regulations, the United States federal environmental-health establishment, as led by the Environmental Protection Agency (EPA), had not developed coherent strategies to mitigate such risks, to alert the public to their plausibility, or to advise leadership in government and industry about their implications. To understand why, we examined archival materials, reviewed online databases, read internal industry communications, and interviewed experts. We confirmed that external constraints, statutory and judicial, had been in place prior to EPA’s earliest interest in mixture toxicity, but we found no overt effort, certainly no successful effort, to loosen those constraints. We also found internal constraints: concerns that fully committing to the study of complex mixtures involving numerous toxicants would lead to methodological drift within the toxicological community and that trying to act on insights from such study could lead only to regulatory futility. Interaction of these constraints, external and internal, shielded the EPA by circumscribing its responsibilities and by impeding movement toward paradigmatic adjustment, but it also perpetuated scientifically dubious policies, such as those limiting the evaluation of commercial chemical formulations, including pesticide formulations, to only those ingredients said by their manufacturers to be active. In this context, regulators’ disregard of synergism contrasted irreconcilably with biocide manufacturers’ understanding that synergism enhanced lethality and patentability. In the end, an effective national response to mixture toxicity, cumulative risk, and environmental injustice did not emerge. In parallel, though, the National Institute of Environmental Health Sciences, which was less constrained, pursued with scientific investigation what the EPA had not pursued with regulatory action.