bluuebunny/crossref_metadata_2025 huggingface dataset:
First use of tofacitinib to treat an immune checkpoint inhibitor-induced arthritis
Authors: Murray Kieran , Floudas Achilleas , Murray Ciara , Fabre Aurelie , Crown John , Fearon Ursula , Veale Douglas
Published: February 2021

Immune checkpoint inhibitors have revolutionised cancer treatment; however, immune-related adverse events do occur, with up to 7% developing inflammatory arthritis. Common rheumatoid arthritis therapies such as methotrexate, prednisolone and biologics have been used to treat this arthritis in small, uncontrolled case series with varying success. In this case of personalised medicine, we report the first use of tofacitinib, a small molecular inhibitor of the Janus kinase-signal transducer and activator of transcription pathway, to treat checkpoint inhibitor-related inflammatory arthritis. This resulted in a rapid clinical response and complete, sustained remission of the arthritis with associated marked reduction in synovial molecular and cellular immune response.
Doxycycline Induced Severe Acute Pancreatitis: A Rare Finding To A Common Medication
Authors: Shah Neal , Razzano Anthony , Grendell James
Published: February 2021

Doxycycline is a commonly prescribed antibiotic with growing evidence suggesting a possible linkage with drug-induced acute pancreatitis. We present an elderly female presenting with severe acute pancreatitis likely secondary to doxycycline therapy after thorough investigation. We reviewed the evidence linking doxycycline-inducing acute pancreatitis and signs and symptoms for severe disease. Early recognition and intervention are critical for positive patient outcomes.
Successful drainage of complex haemoserous malignant pleural effusion with a single modified low-dose intrapleural alteplase and dornase alfa
Authors: Ng Boon Hau , Mohd Aminudin Nur Husna , Nasaruddin Mona Zaria , Abdul Rahaman Jamalul Azizi
Published: February 2021

Patients with symptomatic complex malignant pleural effusion (MPE) are frequently unfit for decortication and have a poorer prognosis. Septations can develop in MPE, which may lead to failure of complete drainage and pleural infection. Intrapleural fibrinolytic therapy (IPFT) is an alternative treatment. The use of IPFT in patients with anaemia and high risk for intrapleural bleeding is not well established. We report a successful drainage of complex haemoserous MPE with a single modified low-dose of intrapleural 5 mg of alteplase and 5 mg of dornase alfa in a patient with pre-existing anaemia with no significant risk of intrapleural bleeding.
Chronic urticaria and common variable immunodeficiency (CVID): an association to remember
Authors: Villatoro Santos Claudia , Yacoub Michael
Published: February 2021

The patient is a 64-year-old Caucasian woman with idiopathic chronic urticaria who presented to her primary care physician’s office with mucoid otitis media. Medical history was significant for hypertension, hyperlipidaemia, allergic rhinitis, pre-diabetes, gastro-oesophageal reflux, paroxysmal atrial fibrillation, chronic kidney disease, diverticulosis with prior diverticulitis and history of recurrent infections. Her chronic urticaria was initially treated with antibiotics, antihistamines and oral steroids, but later she developed refractory urticaria requiring dapsone with modest improvement. When she presented with mucoid otitis media, immunoglobulin levels were found to be decreased. The pneumococcal vaccine antibody challenge confirmed the diagnosis of common variable immunodeficiency (CVID). Her HIV test was negative. She was started on intravenous immunoglobulin infusions and her chronic urticaria stabilised.

In patients with chronic urticaria refractory to treatment, especially with a history of recurrent infections, a diagnosis of CVID should be considered, regardless of HIV status.
Non-ketotic hemichorea-hemiballismus presenting as generalised tonic-clonic convulsive state in uncontrolled diabetes
Authors: Enes Silva João , Esteves Joana Margarida Moreira , Ferreira Ana Isabel , Dias Celeste
Published: February 2021

We report the case of a 70-year-old diabetic woman who presented to the emergency department with multiple seizure episodes and coma, prompting the need for sedation and mechanical ventilation. She was transferred to our institution for neurosurgical evaluation as the initial CT scan identified hyperdense lesions in the left basal ganglia, interpreted as acute intracranial haemorrhage. On admission, laboratory tests were mostly normal except for blood glucose of 413 mg/dL. Medical records revealed a history of poorly controlled diabetes mellitus and non-adherence to therapy. After seizure control and lifting sedation, right-sided ataxia/involuntary movements were observed. Considering the patient’s history and these findings, the CT scan was reviewed and the striatal region hyperdensities interpreted as lesions typical of non-ketotic hemichorea-hemiballismus. MRI was latter performed and confirmed the diagnosis, even though the unusual presentation. Levetiracetam initiation and glycaemic control optimisation led to great neurological improvement without seizure recurrence.
Caucasian lean subjects with non-alcoholic fatty liver disease share long-term prognosis of non-lean: time for reappraisal of BMI-driven approach?
Authors: Younes Ramy , Govaere Olivier , Petta Salvatore , Miele Luca , Tiniakos Dina , Burt Alastair , David Ezio , Vecchio Fabio Maria , Maggioni Marco , Cabibi Daniela , McLeod Duncan , Pareja Maria Jesus , Fracanzani Anna Ludovica , Aller Rocio , Rosso Chiara , Ampuero Javier , Gallego-Durán Rocío , Armandi Angelo , Caviglia Gian Paolo , Zaki Marco Y W , Liguori Antonio , Francione Paolo , Pennisi Grazia , Grieco Antonio , Birolo Giovanni , Fariselli Piero , Eslam Mohammed , Valenti Luca , George Jacob , Romero-Gómez Manuel , Anstee Quentin Mark , Bugianesi Elisabetta
Published: February 2021

Objective

The full phenotypic expression of non-alcoholic fatty liver disease (NAFLD) in lean subjects is incompletely characterised. We aimed to investigate prevalence, characteristics and long-term prognosis of Caucasian lean subjects with NAFLD.

Design

The study cohort comprises 1339 biopsy-proven NAFLD subjects from four countries (Italy, UK, Spain and Australia), stratified into lean and non-lean (body mass index (BMI) </≥25 kg/m2). Liver/non-liver-related events and survival free of transplantation were recorded during the follow-up, compared by log-rank testing and reported by adjusted HR.

Results

Lean patients represented 14.4% of the cohort and were predominantly of Italian origin (89%). They had less severe histological disease (lean vs non-lean: non-alcoholic steatohepatitis 54.1% vs 71.2% p<0.001; advanced fibrosis 10.1% vs 25.2% p<0.001), lower prevalence of diabetes (9.2% vs 31.4%, p<0.001), but no significant differences in the prevalence of thePNPLA3I148M variant (p=0.57). During a median follow-up of 94 months (>10 483 person-years), 4.7% of lean vs 7.7% of non-lean patients reported liver-related events (p=0.37). No difference in survival was observed compared with non-lean NAFLD (p=0.069).

Conclusions

Caucasian lean subjects with NAFLD may progress to advanced liver disease, develop metabolic comorbidities and experience cardiovascular disease (CVD) as well as liver-related mortality, independent of longitudinal progression to obesity andPNPLA3genotype. These patients represent one end of a wide spectrum of phenotypic expression of NAFLD where the disease manifests at lower overall BMI thresholds.

Lay summary

NAFLD may affect and progress in both obese and lean individuals. Lean subjects are predominantly males, have a younger age at diagnosis and are more prevalent in some geographic areas. During the follow-up, lean subjects can develop hepatic and extrahepatic disease, including metabolic comorbidities, in the absence of weight gain. These patients represent one end of a wide spectrum of phenotypic expression of NAFLD.
What are the non-technical skills required by junior doctors in the NHS to manage medical emergencies? A scoping review
Authors: Tan Ying Xin , Jalal Arif Hanafi Bin , Ngai Victoria , Manobharath Nivetha , Soh Terrence Chi Fang
Published: February 2021

Many junior doctors have reported a lack of confidence in managing emergency conditions. However, there is insufficient literature summarising the current knowledge about the non-technical skills needed by junior doctors to tackle medical emergencies. This paper aims to identify the non-technical skills necessary for the management of medical emergencies by junior doctors. Three databases were systematically searched to identify relevant articles published between January 2000 and March 2020. In total, 8707 unique articles were identified and independently screened by at least two authors, using predetermined inclusion and exclusion criteria. A coding framework was applied to extract relevant data and for thematic analysis of the included studies. These methods have been performed following the PRISMA-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. There were a total of 13 articles included in the thematic analysis. The result of this review was the identification of several key non-technical skills: teamwork, communication, asking for help, challenging seniority, task prioritisation, decision-making, leadership and handling stress. In conclusion, lack of non-technical skills in junior doctors has a negative impact on patient care in a medical emergency. The training of junior doctors can be re-evaluated and designed to reflect the importance of these non-technical skills.
Ultrasound scanning in the diagnosis of peripheral neuropathies
Authors: Telleman Johan A , Herraets Ingrid JT , Goedee H Stephan , van Asseldonk J Thies , Visser Leo H
Published: February 2021

Nerve ultrasound scanning has become a valuable diagnostic tool in the routine workup of peripheral nerve disorders, effectively complementing conventional electrodiagnostic studies. The most relevant sonographic features are nerve size and structural integrity. Several peripheral neuropathies show characteristic and distinct patterns of nerve enlargement, allowing their early and accurate identification, and reducing test-burden and diagnostic delay for patients. In mononeuropathies such as carpal tunnel syndrome and ulnar neuropathy at the elbow, nerve enlargement develops only at specific sites of entrapment, while in polyneuropathy the nerve enlargement may be multifocal, regional or even diffuse. Nerve ultrasound scanning can reliably identify chronic inflammatory neuropathies, even when extensive electrodiagnostic studies fail, and it should therefore be embedded in routine diagnostic workup of peripheral neuropathies. In this paper we describe a potential diagnostic strategy to achieve this.
Delayed diagnosis of spinal cord injuries in Huntington’s disease
Authors: Morrison Hamish D , Morgan Dafydd , McLauchlan Duncan J , Clenaghan Catherine , Rosser Anne E
Published: February 2021

Huntington’s disease is a neurodegenerative disorder, characterised by progressive cognitive, motor and psychiatric symptoms. Patients with advanced disease presenting to emergency medical services can pose a diagnostic and management challenge for physicians unfamiliar with the condition. We describe two patients with Huntington’s disease in whom the diagnosis of traumatic spinal cord injury was delayed, discuss the role that cognitive bias and other factors played in this delay, and the lessons we can learn.
Facile preparation of liposome-encapsulated Zn–DTPA from soy lecithin for decorporation of radioactive actinides
Authors: Almalki Manal , Lai Edward P.C. , Ko Raymond , Li Chunsheng
Published: February 2021

Diethylenetriaminepentaacetic acid (DTPA) is an attractive decorporation agent that can enhance the excretion of radioactive actinides such as plutonium, americium, and curium after a radiological incident. However, DTPA is excreted in a short period of time after administration. Several formulations have been developed to improve DTPA pharmacokinetics properties. In this project, liposomes were prepared facilely from soy lecithin as a nanocarrier for pulmonary delivery of Zn–DTPA. Lipid hydration, reverse phase evaporation, and mechanical sonication were three methods evaluated for the preparation of liposome-encapsulated Zn-DTPA (lipo-Zn-DTPA). Mechanical sonication was the method of choice due to simple apparatus and facile preparation. Lipo-Zn–DTPA exhibited a hydrodynamic diameter of 178 ± 2 nm and a spherical shape. The loading capacity and encapsulation efficiency of Zn–DTPA were 41 ± 5 mg/g and 10% ± 1%, respectively. Lyophilization of lipo-Zn–DTPA for extended storage did not affect the amount of encapsulated drug or damage the structure of liposomes. An in vivo cytotoxicity test confirmed no serious adverse effect of Zn–DTPA encapsulated lecithin liposomes in rats.
Reduced recruitment of Chinook salmon in a leveed bar-built estuary
Authors: Chen Emily K. , Henderson Mark J.
Published: February 2021

Estuaries are commonly touted as nurseries for salmonids, providing numerous advantages for smolts prior to ocean entry. In bar-built estuaries, sandbars form at the mouth of rivers during periods of low stream flow, closing access to the ocean and preventing outmigration. We evaluated how summer residency in a leveed bar-built estuary affects the growth, survival, and recruitment of a Chinook salmon (Oncorhynchus tshawytscha) population. We performed a mark–recapture study on outmigrants to determine juvenile estuary abundance, growth, and survival. We used returning adult scales and otoliths to determine the relative proportion of summer estuary residents in spawning adults. Juveniles in the estuary grew less after mouth closure, and ultimately summer estuary residents had lower smolt-to-adult survival and contributed disproportionately less to the spawning population than juveniles that reared in the ocean their first summer. Mouth closure may lower food availability and deteriorate estuary conditions by reducing marine prey influx and estuary circulation. This research demonstrates the complexity of estuary dynamics and function as salmonid nurseries, particularly when considering the extensive modification of estuaries.
Fault motion reversals predating the M
w
6.3 2009 L'Aquila earthquake: insights from synthetic aperture radar data
Authors: Mazzoli Stefano , Nardò Sergio , Ascione Alessandra , Di Donato Valentino , Terranova Carlo , Vilardo Giuseppe
Published: February 2021

The millimetre accuracy of Synthetic Aperture Radar (SAR) measurements and related multi-temporal data analyses provide fundamental information on surface displacements caused by strong earthquakes. The multi-temporal analysis of SAR interferometry data allows for the geometry, kinematics and temporal behaviour of earthquake-generating faults to be better constrained, and is being acknowledged as a promising technique in the field of earthquake precursors. We used SAR data obtained by multi-temporal interferometric techniques such as Permanent Scatterers (PS) interferometry for the investigation of pre- to post-seismic ground displacements in the region struck by the M
w
6.3, 2009 L'Aquila earthquake. We analysed Europen Remote Sensing (ERS) and Envisat PS-datasets from ascending and descending orbits, and COSMO-SkyMed PS-datasets from descending orbit, collectively covering a > 20 year long time span. On a yearly scale, a reversal of motions that affected the hanging-wall and footwall blocks of the earthquake-generating fault is detected. In particular, the hanging-wall block is characterized by pre-seismic uplift – which we document as being independent of any hydrological control – and eastward horizontal motion for about six years, followed by subsidence and westward motion (starting six to eight months prior to the earthquake). We suggest that such a ground displacement pattern may represent an earthquake precursor signal.

Supplementary material:
Figures showing SAR satellites viewing geometry, examples of raw PS time series of obtained from ERS ascending and descending orbits and maps of LoS-oriented mean velocities obtained from PS datasets from the Envisat ascending and descending orbits and a Table reporting detailed numerical results of the performed statistical analysis are available at
https://doi.org/10.6084/m9.figshare.c.5289357
New records of crinoids from Trearne Quarry SSSI (Mississippian, Lower Carboniferous), north Ayrshire
Authors: Hoare Gary , Donovan Stephen K.
Published: February 2021

The Mississippian succession of Ayrshire, SW Scotland, is rich in fossil crinoids, albeit mainly preserved as fragments. Trearne Quarry is exceptional in yielding moderately common crinoid cups and thecae from certain horizons. To the two nominal taxa that have been documented hitherto, we add a further seven, all cladids with one exception. These species all come from the Blackhall Limestone of the Lower Limestone Formation (Visean, Mississippian). Nominal crinoid species identified from Trearne Quarry include Cladida:
Rhabdocrinus scotocarbonarius
(Wright),
Ureocrinus bockschii
(Geinitz),
Ureocrinus globulus
(de Koninck),
Tyrieocrinus laxus
Wright,
Fifeocrinus tielensis
(Wright),
Hydreionocrinus formosus
Wright,
Parazeacrinites konincki
(Bather) and
Phanocrinus ardrossensis
(Wright); and Diplobathrida, Camerata:
Cribanocrinus baccatus
(Wright). Species have distributions limited to one or a few mudrock beds. Identifiable crinoids are uncommon in massive, coral-rich reefal facies.
COVID-19 Brings Data Equity Challenges to the Fore
Authors: Jagadish H. V. , Stoyanovich Julia , Howe Bill
Published: February 2021

The COVID-19 pandemic is compelling us to make crucial data-driven decisions quickly, bringing together diverse and unreliable sources of information without the usual quality control mechanisms we may employ. These decisions are consequential at multiple levels: They can inform local, state, and national government policy, be used to schedule access to physical resources such as elevators and workspaces within an organization, and inform contact tracing and quarantine actions for individuals. In all these cases, significant inequities are likely to arise and to be propagated and reinforced by data-driven decision systems. In this article, we propose a framework, called FIDES, for surfacing and reasoning about data equity in these systems.
Editors’ Choice—A Miniaturized Enzymatic Biosensor for Detection of Sensory-Evoked D-serine Release in the Brain
Authors: Moussa Siba , Van Horn Marion R. , Shah Aryan , Pollegioni Loredano , Thibodeaux Christopher J. , Ruthazer Edward S. , Mauzeroll Janine
Published: February 2021

D-serine has been implicated as a brain messenger with central roles in neural signaling and plasticity. Disrupted levels of D-serine in the brain have been associated with neurological disorders, including schizophrenia, depression and Alzheimer’s disease. Electrochemical biosensors are attractive tools for measuring real-time in vivo D-serine concentration changes. Current biosensors suffer from relatively large sizes (≥25 μm) making localized cellular measurements challenging, especially for single cell studies. In this work, a robust methodology for the fabrication of a reproducible miniaturized 10 μm D-serine detecting amperometric biosensor was developed. The miniature biosensor incorporated yeast D-amino acid oxidase immobilized on a poly-meta-phenylenediamine modified 10 μm Pt disk microelectrode. The biosensor offered a limit of detection of 0.361 μM (RSD < 10%) with high sensitivity (283 μA cm−2 mM−1, R2 = 0.983). The biosensor was stable for over four hours of continuous use, demonstrated a storage stability of four days and high analyte selectivity. Biosensor selectivity was validated with LC-MS and interferences with yeast D-amino acid oxidase were evaluated using drugs believed to stimulate D-serine release. Ex vivo D-serine measurements were made from Xenopus laevis tadpole brains, demonstrating the utility of the biosensors for measurements on living tissue. We observed that D-serine levels in the brain fluctuate with sensory experience. The biosensors were also used in vivo successfully. Taken together, this study addresses factors for successful and reproducible miniature biosensor fabrication for measuring D-serine in biological samples, for pharmacological evaluation, and for designing point of care devices.
Observation of Spontaneous Maturation Process of Young Wine by Application of the Voltammetric Quadruple Disk Iridium Sensor Combined with Chemometrics
Authors: Wójcik Szymon , Górski Łukasz , Jakubowska Małgorzata
Published: February 2021

This paper describes a straightforward strategy, which enabled monitoring of the natural young wine maturation and calculation of the time elapsed since the harvest. Samples of four natural young wines from the Polish vineyard have been measured during the period of late fermentation (day 14th and 35th since the harvest) and early maturation (day 54th, 119th and 229th since the harvest). Wine fingerprints were recorded by differential pulse voltammetry (DPV) using a quadruple disc iridium electrode (q-DIrE). Principal component analysis (PCA) and partial least squares (PLS) regression distinguished wines at each stage of maturation and enabled determination the time passed since the start of winemaking process. The best results provided the PLS models for each of the wines separately, with a prediction error of 2.04−3.24 days and correlation (R2 Pred) ranging from 0.9989−0.9994. The more universal model, based on all wine samples, delivered also satisfactory results with RMSEP 4.13 days and R2 Pred equal to 0.9970. The experiments also showed that even short-term storage under various conditions clearly changed natural wines, and these changes can be observed using the voltammetric signal and PCA.
Resilience Modeling Method of Airport Network Affected by Global Public Health Events
Authors: Guo Jiuxia , Zhu Xinping , Liu Chenxi , Ge ShuzhiSam
Published: February 2021

The COVID-19 global pandemic hit the aviation industry hard since the end of 2019. It has had an immediate, dramatic impact on airport traffic and revenue. Airports are the important nodes in the aviation system network, and the failure of a single airport can often affect the surrounding airports. The purpose of our analysis is to show how is the resilience and recovery of airports in the global public health crisis. Much research on resilience can be found in air transportation networks facing natural hazards or extreme weather, which focus on the robustness of the airport network. These methods are not suitable for the global public health event. Therefore, based on the collection of existing data, we combined with existing resilience measurement methods to analyze the resilience and recovery of airports during the global public health crisis. The resilience metrics results reflect the recovery of airports very well under different strategies. Here, we analyze airport network resilience by considering the performance-based methods. We integrate some metrics such as aircraft movements, passenger throughput, and freight throughput in the resilience metrics model, comparing the resilience evaluation under different preventive and control strategies, which can reflect the airport’s recovery speed during the COVID-19 pandemic. Our analysis indicates that the aviation system network deteriorates soon after the COVID-19 outbreak, but the recovery level of the aviation industry depends on what measures are taken to prevent and control the COVID-19 epidemic. In particular, the recovery of the aviation system network in Europe takes longer than in China, due to different prevention and control strategies for COVID-19. The study proves that the emergency response ability of the country for the public health crisis has a significant positive impact on speeding up the recovery of the aviation system.
Linear Array Synthesis for Wireless Power Transmission Based on Brain Storm Optimization Algorithm
Authors: Liu Guang Xu , Qin Qin , Zhang Qing He
Published: February 2021

Based on the brain storm optimization algorithm, this paper proposed a new method to optimize the beam collection efficiency of the linear antenna array. In the process of optimization, constraints such as aperture size and minimum antenna spacing are considered. In this paper, the optimization with different antenna apertures, different antenna angles, and different array numbers are studied. A series of representative data and simulation results are given and the superiority of the brainstorming algorithm is demonstrated by comparing with the genetic algorithm.
Coupling Coordinated Evolution and Forecast of Tourism-Urbanization-Ecological Environment: The Case Study of Chongqing, China
Authors: Li Liuxin , Yang Qing , ChangchengSun  , Xie Xinli , FengtaiZhang
Published: February 2021

As an important pioneering city in western China, Chongqing’s urbanization and tourism development have brought increasing pressure on the eco-environmental system. This paper presents a comprehensive index system for assessment of the level of tourism based on four aspects: market size, tourism economy, tourism resources, and tourism services. In this paper, we use five indices—economic urbanization, demographic urbanization, social urbanization, spatial urbanization, and cultural urbanization—to establishe a comprehensive index system for urbanization. The developed index system also characterizes the eco-environment based on three factors: eco-environmental pressure, eco-environmental response, and eco-environmental state. A coupling coordination degree model (CCDM) focusing on the degree of coupling coordination between tourism, urbanization, and the eco-environment was established using panel data collected from 2000 to 2017 for Chongqing, China. In addition, we used the gray prediction model to predict the degree of coupling coordination of the three systems in Chongqing from 2018 to 2023. The results showed that (1) overall, despite the twists and turns in the middle of the time period, the degree of coupling coordination of the three systems has become increasingly coordinated over time; (2) the three parameters (α-tourism, ß-urbanization, and d-eco-environmental) that have been widely used in previous studies had little effect on the coupling coordinated system; and (3) according to the prediction results, the degree of coupling coordination of the three systems will continue to rise slowly, and the cooperation between the three systems will be close to perfect by 2023, which means that the development of one system will greatly drive the other two systems.
Echocardiographic Features of Cardiomyopathy in Emery-Dreifuss Muscular Dystrophy
Authors: Marchel Michał , Madej-Pilarczyk Agnieszka , Tymińska Agata , Steckiewicz Roman , Kochanowski Janusz , Wysińska Julia , Ostrowska Ewa , Balsam Paweł , Grabowski Marcin , Opolski Grzegorz
Published: February 2021

Background. Emery-Dreifuss muscular dystrophy (EDMD) is a very rare type of muscular dystrophy characterized by musculoskeletal abnormalities accompanied by cardiac defects. Two most common genetic subtypes are EDMD1 due to EMD and EDMD2 caused by LMNA gene mutations. The aim of the study was to characterize and compare the cardiac morphology and function in the two main genetic subgroups of EDMD with the use of echocardiography. Methods. 41 patients with EDMD (29 EDMD1 and 12 EDMD2) as well as 25 healthy controls were enrolled in our study. Transthoracic echo with the use of a prescribed protocol was performed. Results. Highly statistically significant differences with regard to left ventricle (LV) volumes between the EDMD and the control group were found. 51% of EDMD patients had an enlarged left atrium and as many as 71% had an enlarged right atrium. The LV ejection fraction (LVEF) was significantly lower in EDMD patients than in the control group which corresponded also with a lower systolic velocity of the mitral annulus. 43% of EDMD patients had LVEF below the normal limit. Diastolic dysfunction was detected in 17% of EDMD patients. There were no significant differences between the two types of EDMD in terms of diameters and volumes of any chamber, as well as the systolic function of both left and right ventricles. Conclusions. A significant number of EDMD patients present LV dilatation and different degrees of systolic dysfunction. Dilatation of the atria dominates over ventricle dilatation. We did not present any significant differences between EDMD1 and EDMD2 in terms of the morphology and the function of the heart.
Can COVID-19 Cause Flare-Ups of Acute Hepatitis B? An Atypical Presentation of COVID-19 with Acute Hepatitis B
Authors: Yigit Yavuz , Haddad Mahmoud , Elmoheen Amr , Shogaa Mohamed Rezk , Tawel Rabee , Mohamed Y. Khatib , Salem Waleed , Fawzy Eltawagny Mahmoud
Published: February 2021

We report a case of fulminant liver failure in a patient with acute active hepatitis B infection who was found to have COVID-19 without lung involvement. A 24-year-old male was brought by ambulance service to Hamad General Hospital, Emergency Department (ED), in Doha on April 8, 2020, with chief complaints of fever and cough for 3 days. Upon initial evaluation, the patient was febrile (39.4°C), jaundiced, and disoriented regarding time, place, and person, with an unremarkable past medical history. Initial blood tests showed severely elevated urea, creatinine, transaminases, and ammonium in addition to an impaired coagulation profile consistent with fulminant liver failure. A swab was taken for COVID-19 PCR testing and found to be positive. Serological tests revealed hepatitis B surface antigen positivity and other serology indicating acute hepatitis B. Initial X-ray and repeat chest X-rays did not show lung infiltrates. On the 6th day after admission, the patient developed fixed dilated pupils, with brain edema on CT; cardiac arrest occurred on the 10th day after admission, and the patient died. Although it is still largely unclear, HBV0-activated sudden-onset strong cytotoxic T lymphocyte response and enhanced viral replication and/or retention of the viral capsid in infected hepatocytes may cause the pathogenesis of FH. These pathophysiological events cause extensive hepatocyte apoptosis and necrosis, which results in deadly severe liver failure. Our findings support that the liver damage occurring in COVID-19 is caused by an impaired innate immune system rather than by direct cell damage caused by SARS-CoV-2. We think that more consideration should be given to the presence of acute hepatitis B, especially in COVID-19 patients.
On the Experimental Determination of Poisson’s Ratio for Intact Rocks and Its Variation as Deformation Develops
Authors: Dong Lu , Xu Hongfa , Fan Pengxian , Wu Zhichou
Published: February 2021

Poisson’s ratio is of crucial importance for the theoretical and numerical analysis of rock engineering. It is an elastic parameter of the material and the ratio of the absolute value of lateral strain and axial strain when the material is under uniaxial tension or compression. However, it was rarely investigated compared with deformation modulus and strength. Rock materials are different from metal materials. The pure elastic deformation stage is usually very short or nonexistent in the process of uniaxial tension or compression. In this paper, in order to explore the behavior of Poisson’s ratio, uniaxial compression tests according to The International Society for Rock Mechanics and Rock Engineering are performed on standard specimens of granite, marble, red sandstone, carbonate rock, coral concrete, etc. According to the results, Poisson’s ratio, both the secant Poisson’s ratio and tangent Poisson’s ratio, increase with the externally applied stress. Therefore, regarding it as an elastic constant is worthy of a second thought. If the midpoint of the stress interval is fixed in the 50% of uniaxial compressive strength, the average Poisson’s ratio is almost impervious to the varying span of the stress interval. In addition, the average Poisson’s ratio is immune to the nonlinear deformation in the early loading stage. Thus, the average Poisson’s ratio is a better index than the secant Poisson’s ratio in describing the relationship between axial and lateral strains of hard rocks. The determination of Poisson’s ratio of soft rocks needs further investigation because Poisson’s ratio tends to exceed the theoretical limit in relatively low stress levels. The proposed viewpoint provides a deeper insight into the testing, determining, and using of Poisson’s ratio.
Diet and Prognosis in Women with Breast Cancer
Authors: McTiernan Anne
Published: February 2021

Women who have obesity or who have metabolic abnormalities, including diabetes, prediabetes, or hyperglycemia/insulinemia, have poorer survival compared with other women with breast cancer. Data are lacking on specific lifestyle modifications to prevent or treat these conditions to improve women's chances of survival from breast cancer. The Nurses' Health Study cohorts provide new evidence that diets with the potential to elevate circulating insulin or glucose are associated with breast cancer prognosis. The researchers found statistically significant evidence that women in the highest quintile of glycemic load had a 31% higher risk of breast cancer–specific mortality and a 26% higher risk of all-cause mortality. While a randomized controlled clinical trial testing if a reduced glycemic load diet reduces recurrence or death would be optimal, evidence from this observational study suggests that diet matters in survival from breast cancer. The dietary guidelines provided by the World Cancer Research Fund/American Institute for Cancer Research, the American Cancer Society, and the American Society for Clinical Oncology, which collectively emphasize increased intake of vegetables, fruits, whole grains, and legumes, and reduced intake of sugar, calorie-dense foods, and sugary drinks, are reasonable for most breast cancer survivors to follow for optimal health.

See related article by Farvid et al., p. 335
Transcriptomic Analysis of Right Ventricular Remodeling in Two Rat Models of Pulmonary Hypertension
Authors: Park John F. , Clark Varina R. , Banerjee Somanshu , Hong Jason , Razee Asif , Williams Tiffany , Fishbein Gregory , Saddic Lou , Umar Soban
Published: February 2021

Background:

Right ventricular (RV) dysfunction is a significant prognostic determinant of morbidity and mortality in pulmonary arterial hypertension (PAH). Despite the importance of RV function in PAH, the underlying molecular mechanisms of RV dysfunction secondary to PAH remain unclear. We aim to identify and compare molecular determinants of RV failure using RNA sequencing of RV tissue from 2 clinically relevant animal models of PAH.

Methods:

We performed RNA sequencing on RV from rats treated with monocrotaline or Sugen with hypoxia/normoxia. PAH and RV failure were confirmed by catheterization and echocardiography. We validated the RV transcriptome results using quantitative real-time polymerase chain reaction, immunofluorescence, and Western blot. Immunohistochemistry and immunofluorescence were performed on human RV tissue from control (n=3) and PAH-induced RV failure patients (n=5).

Results:

We identified similar transcriptomic profiles of RV from monocrotaline- and Sugen with hypoxia-induced RV failure. Pathway analysis showed genes enriched in epithelial-to-mesenchymal transition, inflammation, and metabolism. Histological staining of human RV tissue from patients with RV failure secondary to PAH revealed significant RV fibrosis and endothelial-to-mesenchymal transition, as well as elevated cellular communication network factor 2 (top gene implicated in epithelial-to-mesenchymal transition/endothelial-to-mesenchymal transition) expression in perivascular areas compared with normal RV.

Conclusions:

Transcriptomic signature of RV failure in monocrotaline and Sugen with hypoxia models showed similar gene expressions and biological pathways. We provide translational relevance of this transcriptomic signature using RV from patients with PAH to demonstrate evidence of epithelial-to-mesenchymal transition/endothelial-to-mesenchymal transition and protein expression of cellular communication network factor 2 (CTGF [connective tissue growth factor]). Targeting specific molecular mechanisms responsible for RV failure in monocrotaline and Sugen with hypoxia models may identify novel therapeutic strategies for PAH-associated RV failure.
Prognostic Impact of Change in Nutritional Risk on Mortality and Heart Failure After Transcatheter Aortic Valve Replacement
Authors: González Ferreiro Rocío , López Otero Diego , Álvarez Rodríguez Leyre , Otero García Óscar , Pérez Poza Marta , Antúnez Muiños Pablo José , Cacho Antonio Carla , López Pais Javier , Juskowa Mária , Cid Álvarez Ana Belén , Trillo Nouche Ramiro , Sanmartín Pena Xoan Carlos , Sánchez Fernández Pedro Luis , Cruz-González Ignacio , González Juanatey José Ramón
Published: February 2021

Background:

Limited data are available regarding change in the nutritional status after transcatheter aortic valve replacement (TAVR). This study evaluated the prognostic impact of the change in the geriatric nutritional risk index following TAVR.

Methods:

TAVR patients were analyzed in a prospective and observational study. To analyze the change in nutritional status, geriatric nutritional risk index of the patients was calculated on the day of TAVR and at 3-month follow-up. The impact of the change in nutritional risk index after TAVR on all-cause mortality, heart failure hospitalization (HF-h), and the composite of all-cause death and HF hospitalization was analyzed using the Cox Proportional Hazards model.

Results:

Four hundred thirty-three patients were included. After TAVR, 68.4% (n=182) patients with baseline nutritional risk improved compared with 31.6% (n=84) who remained at nutritional risk. The change from no-nutritional risk to nutritional risk after TAVR occurred in 15.0% (n=25), while 85.0% (n=142) remained without risk of malnutrition. During follow-up, 157 (36.3%) patients died and 172 patients (39.7%) were hospitalized due to HF. Patients who continued to be at nutritional risk had a higher risk of mortality (hazard ratio [HR], 2.10 [95% CI, 1.30–3.39],
P
=0.002), HF-h (HR, 1.97 [95% CI, 1.26–3.06],
P
=0.000), and the composite of death and HF-h (HR, 2.0 [95% CI, 1.37–2.91],
P
<0.001). The change to non-nutritional risk after TAVR significantly impacted mortality (HR, 0.48 [95% CI, 0.30–0.78],
P
=0.003), HF-h (HR, 0.50 [95% CI, 0.34–0.74],
P
=0.001), and the composite outcome (HR, 0.44 [95% CI, 0.32–0.62],
P
<0.001).

Conclusions:

Remaining at nutritional risk after TAVR confers a poor prognosis and is associated with an increased risk of mortality and HF-h, while the change from risk of malnutrition to non-nutritional risk after TAVR was associated with a halving of the risk of mortality and HF-h. Further studies are needed to identify whether patients at nutritional risk would benefit from nutritional intervention during processes of care of TAVR programs.
Determinants of Hospital Variation in Cardiac Rehabilitation Enrollment During Coronary Artery Disease Episodes of Care
Authors: Thompson Michael P. , Yaser Jessica M. , Hou Hechuan , Syrjamaki John D. , DeLucia Alphonse , Likosky Donald S. , Keteyian Steven J. , Prager Richard L. , Gurm Hitinder S. , Sukul Devraj
Published: February 2021

Background:

Cardiac rehabilitation (CR) is associated with improved outcomes for patients with coronary artery disease (CAD). However, CR enrollment remains low and there is a dearth of real-world data on hospital-level variation in CR enrollment. We sought to explore determinants of hospital variability in CR enrollment during CAD episodes of care: medical management of acute myocardial infarction (AMI-MM), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG).

Methods:

A cohort of 71 703 CAD episodes of care were identified from 33 hospitals in the Michigan Value Collaborative statewide multipayer registry (2015 to 2018). CR enrollment was defined using professional and facility claims and compared across treatment strategies: AMI-MM (n=18 678), PCI (n=41 986), and CABG (n=11 039). Hierarchical logistic regression was used to estimate effects of predictors and hospital risk-adjusted rates of CR enrollment.

Results:

Overall, 20 613 (28.8%) patients enrolled in CR, with significant differences by treatment strategy: AMI-MM=13.4%, PCI=29.0%, CABG=53.8% (
P
<0.001). There were significant differences in CR enrollment across age groups, comorbidity status, and payer status. At the hospital-level, there was over 5-fold variation in hospital risk-adjusted CR enrollment rates (9.8%–51.6%). Hospital-level CR enrollment rates were highly correlated across treatment strategy, with the strongest correlation between AMI-MM versus PCI (R
2
=0.72), followed by PCI versus CABG (R
2
=0.51) and AMI-MM versus CABG (R
2
=0.46, all
P
<0.001).

Conclusions:

Substantial variation exists in CR enrollment during CAD episodes of care across hospitals. However, within-hospital CR enrollment rates were significantly correlated across all treatment strategies. These findings suggest that CR enrollment during CAD episodes of care is the product of hospital-specific rather than treatment-specific practice patterns.
Contemporary Trends in Hospital Admissions and Outcomes in Patients With Critical Limb Ischemia
Authors: Anantha-Narayanan Mahesh , Doshi Rajkumar P. , Patel Krunalkumar , Sheikh Azfar Bilal , Llanos-Chea Fiorella , Abbott Jinnette Dawn , Shishehbor Mehdi H. , Guzman Raul J. , Hiatt William R. , Duval Sue , Mena-Hurtado Carlos , Smolderen Kim G.
Published: February 2021

Background:

Critical limb ischemia (CLI) morbidity and mortality rates have historically been disproportionately higher than for other atherosclerotic diseases, however, recent trends have not been reported. In patients admitted with CLI, we aimed to examine trends in in-hospital mortality, major amputations, length of stay, and cost of hospitalizations overall and stratified by type of revascularization procedures.

Methods:

Using 2011 to 2017 National Inpatient Sample data, we identified CLI-related admissions based on
International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification
codes. Primary outcomes of interest were in-hospital mortality and major amputations. Secondary outcomes were the length of stay and cost of hospitalization. We stratified outcomes based on endovascular or open surgical interventions. We also performed hierarchical multivariable regression analyses of outcomes based on age, sex, race, hospital size, type, and location.

Results:

We identified 2 643 087 CLI-related admissions between 2011 and 2017. CLI admissions increased from 0.9% to 1.4%
P
trend
<0.0001 as well as overall peripheral artery disease admissions (4.5%–8.9%,
P
trend
<0.0001). In-hospital mortality for the entire CLI cohort decreased from 3.3% to 2.7%,
P
trend
<0.0001, and major amputations decreased from 10.9% to 7%,
P
trend
<0.0001. A decline was also noted for the length of stay from 5.7 (3.1–10.1) to 5.4 (3.0–9.2) days (
P
trend
<0.0001), whereas admission costs increased from USD $11 791 ($6676–$21 712) to $12 597 ($7248–$22 748;
P
trend
<0.0001). Endovascular interventions increased (
P
trend
<0.0001) against a decline in surgical interventions (
P
trend
<0.0001). Black race, female sex, and age ≥60 years were associated with higher in-hospital mortality, whereas Black race, male sex, and age<60 years were associated with higher major amputations.

Conclusions:

A relatively small decrease in absolute numbers for mortality and major amputations were observed against a backdrop of increasing CLI admissions over recent years. Patients with CLI received more endovascular interventions than surgical interventions over time. However, admissions for endovascular interventions were characterized by higher risk patient profiles and a higher risk of major amputations as compared with surgical interventions.
An Increasing Burden of Disease: Emergency Department Visits Among Patients With Ventricular Assist Devices From 2010 to 2017
Authors: Edelson Jonathan B. , Edwards Jonathan J. , Katcoff Hannah , Mondal Antara , Reza Nosheen , Hanff Thomas C. , Griffis Heather , Mazurek Jeremy A. , Wald Joyce , Owens Anjali T. , Burstein Danielle S. , Atluri Pavan , O’Connor Matthew J. , Goldberg Lee R. , Zamani Payman , Groeneveld Peter W. , Rossano Joseph W. , Lin Kimberly Y. , Birati Edo Y.
Published: February 2021

Background

With a growing population of patients supported by ventricular assist devices (VADs) and the improvement in survival of this patient population, understanding the healthcare system burden is critical to improving outcomes. Thus, we sought to examine national estimates of VAD‐related emergency department (ED) visits and characterize their demographic, clinical, and outcomes profile. Additionally, we tested the hypotheses that resource use increased and mortality improved over time.

Methods and Results

This retrospective database analysis uses encounter‐level data from the 2010 to 2017 Nationwide Emergency Department Sample. The primary outcome was mortality. From 2010 to 2017, >880 million ED visits were evaluated, with 44 042 VAD‐related ED visits identified. The annual mean visits were 5505 (SD 4258), but increased 16‐fold from 2010 to 2017 (824 versus 13 155). VAD‐related ED visits frequently resulted in admission (72%) and/or death (3.0%). Median inflation‐adjusted charges were $25 679 (interquartile range, $7450, $63 119) per encounter. The most common primary diagnoses were cardiac (22%), and almost 30% of encounters were because of bleeding, stroke, or device complications. From 2010 to 2017, admission and mortality decreased from 82% to 71% and 3.4% to 2.4%, respectively (
P
for trends <0.001, both).

Conclusions

We present the first study using national‐level data to characterize the growing ED resource use and financial burden of patients supported by VAD. During the past decade, admission and mortality rates decreased but remain substantial; in 2017 ≈1 in every 40 VAD ED encounters resulted in death, making it critical that clinical decision–making be optimized for patients with VAD to maximize good outcomes.
The Maqāṣid al-Sharīʿah and Islamic Finance Debate: The Underlying Philosophy and Perspectives of Sharīʿah Scholars
Authors: Alkhan Ahmed Mansoor
Published: February 2021

Islamic finance is a system of finance that adheres to Sharīʿah rulings. The Sharīʿah consists of rulings where certain objectives are intended to be achieved through applying such rulings, known as maqāṣid al-sharīʿah. Since Islamic finance follows Sharīʿah rulings, this by extension means that Islamic finance should contribute in achieving certain maqāṣid. However, there has been a continued debate on whether Islamic finance has been realising/fulfilling relevant maqāṣid. The key question that arises is: if Islamic finance adheres to Sharīʿah rulings, which consists of rulings that are focused towards realising/fulfilling relevant maqāṣid, why is there a debate on Islamic finance realising/fulfilling those maqāṣid in the first place? This research delves into this question, by first exploring the philosophy of maqāṣid al-sharīʿah in relation to Islamic finance, and thereafter gains an insight into the minds of two contemporary Sharīʿah Supervisory Board scholars pertaining to the philosophy in question.