bluuebunny/crossref_metadata_2025 huggingface dataset:
Where should Scoliometer and EOS Imaging be Applied when Evaluating Spinal Rotation in Adolescent Idiopathic Scoliosis –A Preliminary Study with Reference to CT Images
Authors: Xiao Bin , Zhang Yanbin , Yan Kai , Jiang Jile , Ma Chaoyi , Xing Yonggang , Liu Bo , Tian Wei
Published: August 2022

Study Design

Retrospective study

Objective

Our purpose was to evaluate spinal rotation measurement by scoliometer or EOS Imagings with reference to that by CT images, and to clarify their applicability in clinical practice.

Methods

Patients with adolescent idiopathic scoliosis (AIS) who were indicated for surgery were enrolled and the informed consents were obtained. The angle of trunk rotation (ATR) was measured by the scoliometer. Apical vertebral rotation (AVR) was measured with EOS Imaging and CT images. Paired T tests were used to compare the measurements between ATR or AVR-EOS and AVR-CT. Pearson correlation analysis was performed to explore the relationship between ATR or AVR-EOS and AVR-CT. Then subgroup analysis was performed.

Results

Forty-seven consecutive AIS patients with 62 curves were identified. In the whole group, the ATR, as well as AVR-EOS, was significantly smaller than the AVR-CT. Both ATR and AVR-EOS correlated with AVR-CT, although AVR-EOS correlated better. In thoracic group, there was no significant difference between ATR and AVR-CT ( P = .236). A significant correlation was found between ATR and AVR-CT(r = .574, P < .001). In TL/L group, no significant difference was noted between AVR-EOS and AVR-CT ( P = .414), and a significant correlation was found between AVR-EOS and AVR-CT(r = .824, P < .001).

Conclusion

ATR by scoliometer is numerically similar to AVR by CT and may evaluate the spinal rotation more appropriately in thoracic spine. AVR by EOS is numerically similar to AVR by CT and may be more applicable in TL/L spine. Appropriate methods could be selected according to the location of the curve.
Single-cell genomics in AML: extending the frontiers of AML research
Authors: Ediriwickrema Asiri , Gentles Andrew J. , Majeti Ravindra
Published: August 2022

The era of genomic medicine has allowed acute myeloid leukemia (AML) researchers to improve disease characterization, optimize risk-stratification systems, and develop new treatments. Although there has been significant progress, AML remains a lethal cancer because of its remarkably complex and plastic cellular architecture. This degree of heterogeneity continues to pose a major challenge, because it limits the ability to identify and therefore eradicate the cells responsible for leukemogenesis and treatment failure. In recent years, the field of single-cell genomics has led to unprecedented strides in the ability to characterize cellular heterogeneity, and it holds promise for the study of AML. In this review, we highlight advancements in single-cell technologies, outline important shortcomings in our understanding of AML biology and clinical management, and discuss how single-cell genomics can address these shortcomings as well as provide unique opportunities in basic and translational AML research.
Headache-related circuits and high frequencies evaluated by EEG, MRI, PET as potential biomarkers to differentiate chronic and episodic migraine: Evidence from a systematic review
Authors: Gomez-Pilar Javier , Martínez-Cagigal Víctor , García-Azorín David , Gómez Carlos , Guerrero Ángel , Hornero Roberto
Published: August 2022

Background

The diagnosis of migraine is mainly clinical and self-reported, which makes additional examinations unnecessary in most cases. Migraine can be subtyped into chronic (CM) and episodic (EM). Despite the very high prevalence of migraine, there are no evidence-based guidelines for differentiating between these subtypes other than the number of days of migraine headache per month. Thus, we consider it timely to perform a systematic review to search for physiological evidence from functional activity (as opposed to anatomical structure) for the differentiation between CM and EM, as well as potential functional biomarkers. For this purpose, Web of Science (WoS), Scopus, and PubMed databases were screened.

Findings

Among the 24 studies included in this review, most of them (22) reported statistically significant differences between the groups of CM and EM. This finding is consistent regardless of brain activity acquisition modality, ictal stage, and recording condition for a wide variety of analyses. That speaks for a supramodal and domain-general differences between CM and EM that goes beyond a differentiation based on the days of migraine per month. Together, the reviewed studies demonstrates that electro- and magneto-physiological brain activity (M/EEG), as well as neurovascular and metabolic recordings from functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), show characteristic patterns that allow to differentiate between CM and EM groups.

Conclusions

Although a clear brain activity-based biomarker has not yet been identified to distinguish these subtypes of migraine, research is approaching headache specialists to a migraine diagnosis based not only on symptoms and signs reported by patients. Future studies based on M/EEG should pay special attention to the brain activity in medium and fast frequency bands, mainly the beta band. On the other hand, fMRI and PET studies should focus on neural circuits and regions related to pain and emotional processing.
Cogito: automated and generic comparison of annotated genomic intervals
Authors: Bürger Annika , Dugas Martin
Published: August 2022

Background

Genetic and epigenetic biological studies often combine different types of experiments and multiple conditions. While the corresponding raw and processed data are made available through specialized public databases, the processed files are usually limited to a specific research question. Hence, they are unsuitable for an unbiased, systematic overview of a complex dataset. However, possible combinations of different sample types and conditions grow exponentially with the amount of sample types and conditions. Therefore the risk to miss a correlation or to overrate an identified correlation should be mitigated in a complex dataset. Since reanalysis of a full study is rarely a viable option, new methods are needed to address these issues systematically, reliably, reproducibly and efficiently.

Results

Cogito “COmpare annotated Genomic Intervals TOol” provides a workflow for an unbiased, structured overview and systematic analysis of complex genomic datasets consisting of different data types (e.g. RNA-seq, ChIP-seq) and conditions. Cogito is able to visualize valuable key information of genomic or epigenomic interval-based data, thereby providing a straightforward analysis approach for comparing different conditions. It supports getting an unbiased impression of a dataset and developing an appropriate analysis strategy for it. In addition to a text-based report, Cogito offers a fully customizable report as a starting point for further in-depth investigation.

Conclusions

Cogito implements a novel approach to facilitate high-level overview analyses of complex datasets, and offers additional insights into the data without the need for a full, time-consuming reanalysis. The R/Bioconductor package is freely available at https://bioconductor.org/packages/release/bioc/html/Cogito.html, a comprehensive documentation with detailed descriptions and reproducible examples is included.
Scarf Injury: a qualitative examination of the emergency response and acute care pathway from a unique mechanism of road traffic injury in Bangladesh
Authors: Tupetz Anna , Strand Eleanor , Hoque Kazi Imdadul , Sultana Mohsina , Vissoci Joao Ricardo Nickenig , Staton Catherine , Landry Michel D.
Published: August 2022

Background

Road traffic injuries (RTI) are the leading cause of death worldwide in children over 5 and adults aged 18–29. Nonfatal RTIs result in 20–50 million annual injuries. In Bangladesh, a new mechanism of RTI has emerged over the past decade known as a ‘scarf injury.’ Scarf injuries occur when scarves, part of traditional female dress, are caught in the driveshaft of an autorickshaw. The mechanism of injury results in novel, strangulation-like cervical spine trauma. This study aimed to understand the immediate emergency response, acute care pathway, and subsequent functional and health outcomes for survivors of scarf injuries.

Methods

Key informant interviews were conducted with female scarf injury survivors (n = 12), caregivers (n = 6), and health care workers (n = 15). Themes and subthemes were identified via inductive content analysis, then applied to the three-delay model to examine specific breakdowns in pre-hospital care and provide a basis for future interventions.

Findings

Over half of the scarf injury patients were between the ages of 10 and 15. All but two were tetraplegic. Participants emphasized less than optimal patient outcomes were due to unawareness of scarf injuries and spinal cord injuries among the general public and health professionals; unsafe and inefficient bystander first aid and transportation; and high cost of acute health care.

Conclusions

Females in Bangladesh are at significant risk of sustaining serious and life-threatening trauma through scarf injuries in autorickshaws, further worsened through inadequate care along the trauma care pathway. Interventions designed to increase awareness and knowledge of basic SCI care at the community and provider level would likely improve health and functional outcomes.
Surgery for acute cholecystitis in severely comorbid patients: a population-based study on acute cholecystitis
Authors: Osterman Erik , Helenius Louise , Larsson Christina , Jakobsson Sofia , Majumder Tamali , Blomberg Anders , Wickenberg Jennie , Linder Fredrik
Published: August 2022

Background

International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis.

Method

1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery.

Results

725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months.

Conclusion

Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery.

Trial registration: Not applicable.
2-deoxy-d-glucose as an adjunct to standard of care in the medical management of COVID-19: a proof-of-concept and dose-ranging randomised phase II clinical trial
Authors: Bhatt Anant Narayan , Shenoy Srinivas , Munjal Sagar , Chinnadurai Vijayakumar , Agarwal Apurva , Vinoth Kumar A. , Shanavas A. , Kanwar Ratnesh , Chandna Sudhir
Published: August 2022

Background

At present, no single efficacious therapeutic exists for acute COVID-19 management and a multimodal approach may be necessary. 2-deoxy-d-glucose (2-DG) is a metabolic inhibitor that has been shown to limit multiplication of SARS-CoV-2 in-vitro. We evaluated the efficacy and safety of 2-DG as adjunct to standard care in the treatment of moderate to severe COVID-19 patients.

Methods

We conducted a randomized, open-label, phase II, clinical study to evaluate the efficacy, safety, and tolerability of 2-DG administered as adjunct to standard of care (SOC). A total of 110 patients between the ages of 18 and 65 years with moderate to severe COVID-19 were included. Patients were randomized to receive 63, 90, or 126 mg/kg/day 2-DG in addition to SOC or SOC only. Times to maintaining SpO2 ≥ 94% on room air, discharge, clinical recovery, vital signs normalisation, improvement by 1 and 2 points on WHO clinical progression scale, negative conversion on RT-PCR, requirement for intensive care, and mortality were analyzed to assess the efficacy.

Results

Patients treated with 90 mg/kg/day 2-DG plus SOC showed better outcomes. Time to maintaining SpO2 ≥ 94% was significantly shorter in the 2-DG 90 mg compared to SOC (median 2.5 days vs. 5 days, Hazard ratio [95% confidence interval] = 2.3 [1.14, 4.64], p = 0.0201). Times to discharge from isolation ward, to clinical recovery, and to vital signs normalization were significantly shorter for the 2-DG 90 mg group. All three doses of 2-DG were well tolerated. Thirty-three (30.3%) patients reported 65 adverse events and were mostly (86%) mild.

Conclusions

2-DG 90 mg/kg/day as adjunct to SOC showed clinical benefit over SOC alone in the treatment of moderate to severe COVID-19. The promising trends observed in current phase II study is encouraging for confirmatory evaluation of the efficacy and safety of 2-DG in a larger phase III trial.

Trial registration: CTRI, CTRI/2020/06/025664. Registered 5th June 2020, http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=44369&EncHid=&modid=&compid=%27,%2744369det%27.
Optimizing home-based long-term intensive care for neurological patients with neurorehabilitation outreach teams – protocol of a multicenter, parallel-group randomized controlled trial (OptiNIV-Study)
Authors: Platz Thomas , Kohlmann Thomas , Fleßa Steffen , Einhäupl Bernadette , Koppelow Martha , Willacker Lina , Gdynia Hans-Jürgen , Henning Esther , Herzog Jürgen , Müller Friedemann , Nowak Dennis A. , Pletz Romy , Schlachetzki Felix , Schmidt-Wilcke Tobias , Schüttler Michael , Straube Andreas , Süss Rebekka , Ziegler Volker , Bender Andreas
Published: August 2022

Background

Even with high standards of acute care and neurological early rehabilitation (NER) a substantial number of patients with neurological conditions still need mechanical ventilation and/or airway protection by tracheal cannulas when discharged and hence home-based specialised intensive care nursing (HSICN). It may be possible to improve the home care situation with structured specialized long-term neurorehabilitation support and following up patients with neurorehabilitation teams. Consequently, more people might recover over an extended period to a degree that they were no longer dependent on HSICN.

Methods

This healthcare project and clinical trial implements a new specialised neurorehabilitation outreach service for people being discharged from NER with the need for HSICN. The multicentre, open, parallel-group RCT compares the effects of one year post-discharge specialized outpatient follow-up to usual care in people receiving HSICN. Participants will randomly be assigned to receive the new form of healthcare (intervention) or the standard healthcare (control) on a 2:1 basis. Primary outcome is the rate of weaning from mechanical ventilation and/or decannulation (primary outcome) after one year, secondary outcomes include both clinical and economic measures. 173 participants are required to corroborate a difference of 30 vs. 10% weaning success rate statistically with 80% power at a 5% significance level allowing for 15% attrition.

Discussion

The OptiNIV-Study will implement a new specialised neurorehabilitation outreach service and will determine its weaning success rates, other clinical outcomes, and cost-effectiveness compared to usual care for people in need for mechanical ventilation and/or tracheal cannula and hence HSICN after discharge from NER.

Trial registration

The trial OptiNIV has been registered in the German Clinical Trials Register (DRKS) since 18.01.2022 with the ID DRKS00027326.
Association between lower uterine wall thickness measured at 18–22 weeks of gestation and risk of Preterm Birth: a prospective cohort study
Authors: Yapan Piengbulan , Wanitpongpan Prapat , Sripang Nawiya
Published: August 2022

Background

Preterm labour prediction has been relied on history of previous preterm birth and cervical length of current pregnancy. However, universal cervical length measurement has some limitation. We aim to find a surrogate marker of cervical length to close the gap in preterm prevention program and lower uterine wall thickness seems promising. We generate the nomogram of lower uterine wall thickness during 18–22 weeks of gestation and evaluate the accuracy of LUW thickness as a predictor of preterm delivery before 37 weeks.

Methods

This prospective cohort study included 524 Thai singleton pregnant women at 18–22 weeks of gestation between November 2016 and October 2017. After signing informed consent, transabdominal ultrasonography was performed to examine fetal anatomical structures and to measure LUW thickness. The results were blinded to the caregivers. The outcomes of all pregnancies were followed. The LUW thickness at 10th percentiles was established and was correlated with the outcomes of pregnancy. The performance of LUW thickness at 10th percentile as a predictor of preterm delivery was calculated. The intra-observer and inter-observer reliability of measurement were assessed by intraclass correlation coefficient and Bland-Altman plot.

Results

Of the 524 pregnant women, 64 (12.2%) delivered before 37 weeks of gestation. The reference value of lower uterine wall thickness at 18–22 weeks was established. Mean and 10th percentile of LUW thickness were 6.2 and 4.5 mm respectively. The inter-observer and intra-observer variation of measurement were small (intraclass correlation coefficient = 0.926 and 0.989 respectively). Using LUW thickness at less than 4.5 mm as a predictor of preterm delivery, we found a 2.37 folds increased risk of preterm delivery after adjustment of other factors (p = 0.037). Sensitivity, specificity, positive predictive value and negative predictive value were 14% (95% CI: 6.64–25.02), 92.8% (95% CI: 90.06–95.12), 22.5% (95% CI: 12.66–36.76) and 88% (95% CI: 86.92–89.08) respectively.

Conclusions

The measurement of LUW thickness by transabdominal ultrasonography is feasible and reproducible. The risk of delivery before 37 weeks of gestation is increased significantly if the LUW thickness at 18–22 weeks is less than 4.5 mm.

Trial registration

The study protocol was approved by institutional ethical committee (COA No. Si 657/2016).
Consensus-building around the conceptualisation and implementation of sustainable healthy diets: a foundation for policymakers
Authors: Bach-Faig Anna , Wickramasinghe Kremlin , Panadero Natalia , Fàbregues Sergi , Rippin Holly , Halloran Afton , Fresán Ujué , Pattison Mary , Breda João
Published: August 2022

Background

Healthy and sustainable diets need to be adopted to reduce the negative impact of food consumption on human and planetary health. Food systems account for a third of greenhouse gas emissions. “Dietary Patterns for Health and Sustainability” is a World Health Organization (WHO) project that aims to build consensus among international food, health, and sustainability experts and policymakers on how to conceptualise healthy and sustainable diets and on the actions and policies that could be implemented in the WHO European Region to promote these diets.

Methods

A qualitative study among European food, health, and sustainability experts and policymakers to elicit their views on multiple dimensions of food sustainability and health was carried out using a three-phase process, including semi-structured interviews, a Nominal Group Technique, and focus groups during a participatory WHO workshop held in Copenhagen. Thematic analysis was used to analyse the three data sources.

Results

The workshop resulted in a shared understanding of the interconnected components of sustainable healthy eating habits. As a result of this understanding, a variety of potential solutions were identified, including actions across different policy domains, tools, strategic guidelines, needs, and pathways for sustainable healthy diets. The pathways included the need for a multi-stakeholder approach, as well as the simultaneous execution of an aligned and coherent mix of policies at the local and national levels.

Conclusions

The prioritised actions should be aimed at helping government policymakers promote sustainable healthy diets and make decisions on improving dietary patterns for citizens’ health and wellbeing in line with the United Nations Sustainable Development Goals in the European Region.
Examining the rural-urban divide in predisposing, enabling, and need factors of unsafe abortion in India using Andersen’s behavioral model
Authors: Rahaman Margubur , Das Puja , Chouhan Pradip , Das Kailash Chandra , Roy Avijit , Kapasia Nanigopal
Published: August 2022

Background

The prevalence of unsafe abortions significantly varies with geography; therefore, more research is needed to understand the rural-urban differences in unsafe abortion practices in India. The present study aims to explore the rural-urban differences in predisposing, enabling, and need factors of unsafe abortion in India.

Methods

The present study used the fourth round of the National Family Health Survey (2015–16) and included the women aged 15–49 who terminated pregnancies by induced abortion during the 5 years prior to the survey (N = 9113) as the study sample. Descriptive statistics, bivariate chi-square significance test and multivariate logistic regression model were used to accomplish the study objectives.

Results

The findings revealed that almost one-third of pregnancies were terminated through unsafe measures with sharp rural-urban contrast. The likelihood of unsafe abortions increases with decreasing women’s age and spousal level of education. Younger women in urban settings were more vulnerable to unsafe abortion practices. In rural settings, women with an uneducated spouse are more likely to have unsafe abortions (OR: 1.92). Poor households were more likely to undergo unsafe abortions, which were more common in rural settings (OR: 1.26). The unmet need for family planning was revealed to be a significant need factor for unsafe abortion, particularly in rural settings.

Conclusion

Although abortion is legal, India’s high estimated frequency of unsafe abortions reveals a serious public health issue. Due to socio-economic vulnerability, unmet family planning needs, and a lack of awareness, significant numbers of women still practice unsafe abortions in India.
Subsidence following cervical discectomy and implant-to-bone ratio
Authors: Godlewski Bartosz , Bebenek Adam , Dominiak Maciej , Karpinski Grzegorz , Cieslik Piotr , Pawelczyk Tomasz
Published: August 2022

Background

Implant subsidence is an undesirable effect after anterior cervical discectomy and fusion (ACDF). We investigated the relation between the rate of implant subsidence and the ratio of the implant surface area to the surface area of the adjacent bone.

Methods

We operated 170 disc spaces in a group of 104 patients. Two types of implants were used: 1) PEEK (polyetheretherketone) cages and 2) titanium-coated (TC) PEEK cages. Patients were randomised to receive a specific implant using a randomisation table. All implants had a surface area of 1.61 cm2. Based on computed tomography images, bone surface areas were calculated for vertebral bodies immediately adjacent to the interbody implants. The implant-to-bone surface ratio was then calculated for each disc space. Implant subsidence was assessed over 12 months of follow-up, and associations between implant subsidence, the type of implant, and the implant-to-bone surface ratio were investigated.

Results

Twelve months after the surgery, computed tomography was performed on 86 patients (144 disc spaces). Furthermore, in 166 disc spaces and 102 patients, conventional radiographs were obtained.

Subsidence was observed in 21% of the examined intervertebral spaces, and it was more frequently associated with higher values of bone surface area and lower values of the implant-to-bone surface ratio. The type of implant (PEEK vs TC-PEEK cages) did not significantly influence the rate of implant subsidence.

Conclusions

Implant subsidence was significantly related to the value of a coefficient representing the ratio of the implant's surface area to the bone surface area of the adjacent vertebral bodies, with subsidence occurring significantly more rarely for coefficient values ≥ 0.37.
Results from a cervical cancer screening program in Samsun, Turkey
Authors: Arslan Hatice Nilden , Oruc Muhammet Ali
Published: August 2022

Background

Cervical cancer is a preventable disease. This study aimed to share the results of the national cervical cancer screening program performed in primary health care institutions in Samsun between 2015 and 2019.

Methods

Women aged 30–65 years who were screened for cervical cancer in screening centers of Samsun between January 01, 2015, and December 31, 2019, were included in this descriptive study. The data were obtained from the automation program of the “National Human Papilloma Virus (HPV) Laboratory Application” used by the Provincial Directorate of Health Cancer Unit through filtering the completion time of the tests, and all results were evaluated without sampling. Thus, data were presented using descriptive statistics.

Results

The mean age of 89,302 women included in the cervical cancer screening program was 45.9 ± 9.0 years. Of the samples obtained from the participants, 1.0% were determined as insufficient material, 94.1% as HPV-negative, and 4.9% as HPV-positive. The most common HPV genotypes were 16, 51, 31, and 52. Of the 4337 HPV-positive women, 74.7% of the pap smear results were negative (including infection, 36.5%), and the most common premalignant lesions were atypical squamous cells of undetermined significance in 7.1% and low-grade squamous intraepithelial lesions in 6.9%. HPV 16/18 was also observed in 31.7% of HPV-positive women. Seven hundred ninety-five women were referred to a specialist physician for further examination and treatment within the scope of the screening algorithm.

Conclusion

Detecting HPV-positivity by reaching more women within the national cervical cancer screening program’s scope is vital in fighting against this disease. The effectiveness of cancer screening programs should be increased by ensuring community participation through awareness activities.
Effects of comprehensive nursing intervention based on self-disclosure on improving alexithymia in elder patients with coronary heart disease
Authors: Zhang Weixin , Zhang Haili
Published: August 2022

Objectives

Patients with coronary heart disease (CHD) experience stress and suffer from the risk of recurrence and death. Comprehensive nursing intervention based on self-disclosure (CNISD) is an interdisciplinary service and an effective approach to care that improves quality of life and alleviates suffering for patients with CHD. The purpose of this study was to analyze the effects of CNISD on alexithymia in patients with CHD.

Methods

A total of 1088 patients with CHD were recruited and received CNISD (n = 540) and usual care (n = 548). The quality of life, alexithymia, four statutory health insurance funds, recurrence, mortality, and satisfaction was compared in patients with CHD between CNISD and usual care group.

Results

Outcomes showed that CNISD improved sleep quality and quality of life, increased physical activity, reduced the hospital anxiety and depression scale in patients with CHD compared to usual care. Recurrence and mortality of patients with CHD were markedly improved by CNISD compared to patients with CHD in usual care group.

Conclusions

In conclusion, data in this study indicate that CNISD presents benefits in improving quality of life, physical activity, anxiety, depression, recurrence, and mortality for patients with CHD.
Clinical observations on infliximab treatment of infantile onset Takayasu arteritis
Authors: Kang Min , Lai Jianming , Zhang Dan , Xu Yingjie , Zhu Jia , Li Ming
Published: August 2022

Background

There is insufficient evidence on the clinical effectiveness and safety of infliximab (IFX) treatment of Takayasu arteritis (TA) in infants.

Methods

We evaluated the therapeutic effectiveness and safety of IFX in a retrospective case series of 10 infantile TA patients. Observations included assessment of clinical symptoms, laboratory testing, and vascular imaging.

Results

Fever was the presenting symptom for 8 of 10 infants with TA. During acute episodes, leucocyte and inflammatory indices were significantly increased. Vascular imaging showed the most commonly involved arteries to be carotid arteries, abdominal aortas, and coronary arteries (9 cases, 90%). Two weeks after initiating IFX treatment, leukocyte and platelet counts decreased and hemoglobin levels increased. There were statistically significant clinical improvements 6 weeks after starting treatment compared with before treatment (p < 0.05). Inflammatory indices decreased 2 weeks after starting IFX treatment compared with before treatment (p < 0.05). Vascular lesions began to recover within 1.5-3 months of initiating IFX therapy, and involved vessels significantly recovered within 13 months. Some arteries remained stenotic, with intimal thickening and uneven lumen wall thicknesses. The only adverse event was a treatment-responsive allergic reaction during IFX infusion in one infant.

Conclusions

Fever was the main manifestation of illness and was often accompanied by significantly increased inflammatory indices. IFX treatment was apparently effective and reduced or eliminated need for glucocorticoids. IFX had a reasonably good safety profile.
Comparison of outcomes of trans-subclavian versus trans-apical approaches in transcatheter aortic valve implantation
Authors: Tomala Olaf , Zamvar Vipin , Bing Rong , Pessotto Renzo , Cruden Nick
Published: August 2022

Background

Many patients are unsuitable for conventional femoral transcatheter aortic valve implantation (TAVI) but there is limited evidence as to which alternative approach has the best outcomes. We compared clinical outcomes in patients undergoing trans-subclavian (TS) or trans-apical (TA) TAVI.

Methods

This was a national retrospective observational study of patients undergoing surgical TAVI in Scotland between January 2013 and March 2020. The pre-operative patient characteristics, intraoperative details and post-operative outcomes were compared between TS and TA cohorts using data from the National Institute of Cardiovascular Outcomes Research (NICOR) registry.

Results

Among 1055 patients who underwent TAVI, TS or TA access was used in 50 (4.7%) and 90 (8.5%) patients respectively. Self-expanding Medtronic Evolut R valves were used in 84% of TS procedures, while balloon-expandable Edwards SAPIEN valves were used in all TA procedures. The TS group had a lower mean logistic EuroSCORE than the TA group (27.31 ± 19.44% vs 34.92 ± 19.61% p = 0.029). The TS approach was associated with a higher incidence of moderate postprocedural aortic regurgitation (12.5% vs 2.4%, p = 0.025). There was no significant difference in 30-day, 1-year or overall all-cause mortality.

Conclusions

Both trans-subclavian and trans-apical access are viable approaches for patients requiring non-transfemoral TAVI. Differences in peri-procedural indices reflect the disparate patient populations and factors governing prosthesis choice, and short- and long-term mortality was similar.
Incidence of thrombotic microangiopathies in Quebec: insight from a laboratory centralizing ADAMTS-13 testing
Authors: Merlen Clémence , Pépin Emmanuelle , Barry Ousmane , Cormier Anik , Dubois Caroline , Lapeyraque Anne-Laure , Troyanov Stéphan , Rivard Georges-Etienne , Bonnefoy Arnaud
Published: August 2022

Background

Thrombotic microangiopathies (TMA) are serious medical conditions requiring a prompt diagnosis to adapt treatment. The determination of ADAMTS-13 activity enables discriminating thrombotic thrombocytopenic purpura (TTP) from other forms of TMA. The purpose of this study was to provide an estimate of the incidence of TTP and TMA in the Canadian Quebec province using data collected from a laboratory centralizing ADAMTS-13 testing for the whole province.

Results

From 2012 to 2019, 846 patients were evaluated for plasma ADAMTS-13 activity due to a suspicion of TMA. TTP was identified in 147 patients. Of these, 118 patients with a median age of 51.5 years and a male–female ratio of 1:1.4 had their first episode of TTP during the study period. The number of ADAMTS-13 tests performed and the number of patients with suspected TMA increased annually by 19% and 21% respectively. While the incidence of non-TTP TMA increased annually, that for TTP remained unchanged. This averaged 10.2 (95% CI 5.9–14.4) per million persons per year for suspected non-TTP TMA and 1.8 (95% CI 1.3–2.4) for confirmed TTP. The incidence rate of TMA other than TTP was higher in the age group 70–79 years (21.8; 95% CI 5.4–38.1) for females and in the age group 80–89 years (24.4; 95% CI 7.2–41.7) for males compared to other age groups. The incidence rate of TTP was higher in the age group 40–49 years (4.0; 95% CI 2.0–5.9) for women and in the age group 60–69 years (3.4; 95% CI 1.1–5.6) for men compared to other age groups.

Conclusion

The analysis of centralized data measuring ADAMTS-13 activity allowed us to adequately establish the incidence rate and demographic characteristics of TMA, particularly TTP, in Quebec. TTP incidence remained stable while suspected non-TTP TMA steadily increased from 2012 to 2019.
Randomised controlled trial comparing the clinical and cost-effectiveness of various washout policies versus no washout policy in preventing catheter associated complications in adults living with long-term catheters: study protocol for the CATHETER II study
Authors: Abdel-fattah Mohamed , Johnson Diana , Constable Lynda , Thomas Ruth , Cotton Seonaidh , Tripathee Sheela , Cooper David , Boran Sue , Dimitropoulos Konstantinos , Evans Suzanne , Granitsiotis Paraskeve , Hashim Hashim , Kilonzo Mary , Larcombe James , Little Paul , MacLennan Sara , Murchie Peter , Myint Phyo Kyaw , N’Dow James , Norrie John , Omar Muhammad Imran , Paterson Catherine , Scotland Graham , Thiruchelvam Nikesh , MacLennan Graeme
Published: August 2022

Background

Various washout policies are widely used in adults living with long-term catheters (LTC). There is currently insufficient evidence on the benefits and potential harms of prophylactic LTC washout policies in the prevention of blockages and other LTC-related adverse events, such as urinary tract infections. CATHETER II tests the hypothesis that weekly prophylactic LTC washouts (normal saline or citric acid) in addition to standard LTC care reduce the incidence of catheter blockage requiring intervention compared to standard LTC care only in adults living with LTC.

Methods

CATHETER II is a pragmatic three-arm open multi-centre superiority randomised controlled trial with an internal pilot, economic analysis, and embedded qualitative study. Eligible participants are adults aged ≥ 18 years, who have had a LTC in use for ≥ 28 days, have no plans to discontinue the use of the catheter, are able to undertake the catheter washouts, and complete trial documentation or have a carer able to help them. Participants are identified from general practitioner practices, secondary/tertiary care, community healthcare, care homes, and via public advertising strategies. Participants are randomised 1:1:1 to receive a weekly saline (0.9%) washout in addition to standard LTC care, a weekly citric acid (3.23%) washout in addition to standard LTC care or standard LTC care only. Participants and/or carers will receive training to administer the washouts. Patient-reported outcomes are collected at baseline and for 24 months post-randomisation. The primary clinical outcome is catheter blockage requiring intervention up to 24 months post-randomisation expressed per 1000 catheter days. Secondary outcomes include symptomatic catheter-associated urinary tract infection requiring antibiotics, catheter change, adverse events, NHS/ healthcare use, and impact on quality of life.

Discussion

This study will guide treatment decision-making and clinical practice guidelines regarding the effectiveness of various prophylactic catheter washout policies in men and women living with LTC. This research has received ethical approval from Wales Research Ethics Committee 6 (19/WA/0015).

Trial registration

ISRCTNISRCTN17116445. Registered prospectively on 06 November 2019
Reilly-type inequality for the Φ-Laplace operator on semislant submanifolds of Sasakian space forms
Authors: Li Yanlin , Mofarreh Fatemah , Agrawal Ravi P. , Ali Akram
Published: August 2022

This paper aims to establish new upper bounds for the first positive eigenvalue of the Φ-Laplacian operator on Riemannian manifolds in terms of mean curvature and constant sectional curvature. The first eigenvalue for the Φ-Laplacian operator on closed oriented m-dimensional semislant submanifolds in a Sasakian space form

M
˜

2
k
+
1

(
ϵ
)
is estimated in various ways. Several Reilly-like inequalities are generalized from our findings for Laplacian to the Φ-Laplacian on semislant submanifolds in a sphere

S

2
n
+
1

with $\epsilon =1$
ϵ
=
1
and $\Phi =2$
Φ
=
2
.
1029 genomes of self-declared healthy individuals from India reveal prevalent and clinically relevant cardiac ion channelopathy variants
Authors: Bajaj Anjali , Senthivel Vigneshwar , Bhoyar Rahul , Jain Abhinav , Imran Mohamed , Rophina Mercy , Divakar Mohit Kumar , Jolly Bani , Verma Ankit , Mishra Anushree , Sharma Disha , Deepti Siddharthan , Sharma Gautam , Bansal Raghav , Yadav Rakesh , Scaria Vinod , Naik Nitish , Sivasubbu Sridhar
Published: August 2022

Background

The prevalence and genetic spectrum of cardiac channelopathies exhibit population-specific differences. We aimed to understand the spectrum of cardiac channelopathy-associated variations in India, which is characterised by a genetically diverse population and is largely understudied in the context of these disorders.

Results

We utilised the IndiGenomes dataset comprising 1029 whole genomes from self-declared healthy individuals as a template to filter variants in 36 genes known to cause cardiac channelopathies. Our analysis revealed 186,782 variants, of which we filtered 470 variants that were identified as possibly pathogenic (440 nonsynonymous, 30 high-confidence predicted loss of function ). About 26% (124 out of 470) of these variants were unique to the Indian population as they were not reported in the global population datasets and published literature. Classification of 470 variants by ACMG/AMP guidelines unveiled 13 pathogenic/likely pathogenic (P/LP) variants mapping to 19 out of the 1029 individuals. Further query of 53 probands in an independent cohort of cardiac channelopathy, using exome sequencing, revealed the presence of 3 out of the 13 P/LP variants. The identification of p.G179Sfs*62, p.R823W and c.420 + 2 T > C variants in KCNQ1, KCNH2 and CASQ2 genes, respectively, validate the significance of the P/LP variants in the context of clinical applicability as well as for large-scale population analysis.

Conclusion

A compendium of ACMG/AMP classified cardiac channelopathy variants in 1029 self-declared healthy Indian population was created. A conservative genotypic prevalence was estimated to be 0.9–1.8% which poses a huge public health burden for a country with large population size like India. In the majority of cases, these disorders are manageable and the risk of sudden cardiac death can be alleviated by appropriate lifestyle modifications as well as treatment regimens/clinical interventions. Clinical utility of the obtained variants was demonstrated using a cardiac channelopathy patient cohort. Our study emphasises the need for large-scale population screening to identify at-risk individuals and take preventive measures. However, we suggest cautious clinical interpretation to be exercised by taking other cardiac channelopathy risk factors into account.
Preoperative hemodynamics as predictors of right heart failure post-left ventricular assist device
Authors: Orozco-Hernandez Erik J. , Kurt DeLay T. , Hoopes Charles W. , Gongora Enrique , Pamboukian Salpy , Xie Rongbing , Davies James E. , Vardas Panos N.
Published: August 2022

Background

Mechanical circulatory support has garnered significant popularity as both a bridge to transplant as well as a destination therapy for patients with end-stage heart failure. Right heart failure (RHF) is a devastating complication after LVAD placement and is very unpredictable. Assisted circulation of the left ventricle (LV) with an LVAD device could unmask an underlying RHF. However, otherwise healthy right ventricles (RVs) can develop RHF after LVAD placement as well due to poor adaptation to new filling pressures and altered hemodynamics. It has been proposed that preoperative volumetric measurements in the pulmonary and systemic vasculature may serve as indicators for a risk of RHF after LVAD implantation. The aim of this study is to examine a potential relationship of preoperative hemodynamic values such as pulmonary artery pulsatility index (PAPi) and the ratio of central venous pressure to pulmonary wedge pressure (CVP/PWP) as preoperative predictors for RHF post LVAD placement.

Methods

We retrospectively reviewed patients undergoing initially planned isolated LVAD implantation with or without concomitant procedures in our institution from January 1, 2017 to June 12, 2020. Data were gathered from hemodynamic records, echocardiographic interpretations, and clinical notes. Patients who had RHF after LVAD implantation but without hemodynamic data available within 14 days from the operation were excluded. Univariable analysis was performed.

Results

Of the 114 patients who received planned isolated LVAD surgery, 70 (61.4%) experienced RHF within the first 7 days postoperatively. PAPi did not correlate significantly with RHF vs non-RHF among LVAD recipients (3.1 ± 2.1 vs. 3.8 ± 3.4P= 0.21). Pre-op CVP/PWP did not differ significantly between RHF and non-RHF patients (0.4 ± 0.2 vs. 0.5 ± 0.8P= 0.28). There was a nonsignificant correlation between elevated pre-op PWP and those with RHF vs those without,OR= 1.05 (95%CI: 1.00, 1.10). Pre-op systolic pulmonary artery pressure (SysPAP) was elevated in patients with post-LVAD RHF compared to those without (51.3 ± 12.3 vs. 47.2 ± 13.0,P= 0.09).

Conclusion

Preoperative hemodynamic variables such as PAPi or CVP/PWP did not show a significant correlation predicting RHF post LVAD implantation. Acute RHF post LVAD implantation remains a complex medical entity. Several studies have devised multivariable risk scores; however, their performance has been limited. Despite the widespread use of preoperative hemodynamics measurements as risk scores, our study suggests these scores are not as accurate as their use would suggest, particularly among especially morbid patient populations. More prospective studies are needed to accurately demonstrate how preoperative hemodynamics could predict and help prevent this catastrophic complication.
Towards adapting reverse vertical seismic profiling for ambient-noise imaging with transient sources: Automatic estimation of stationary-phase receivers for improved retrieval of the interferometric Green’s function
Authors: Chamarczuk Michał , Draganov Deyan , Quiros Diego , Malinowski Michał
Published: August 2022

Most of the ambient-noise studies are performed with sensor arrays located at the surface. Passive recordings containing seismic arrivals from subsurface sources could be seen as having a geometry resembling reverse vertical seismic profiling (RVSP). In such scenarios, the intersource seismic-interferometry technique can be used to redatum the surface receivers to the subsurface source positions resulting in virtual shot gathers at depth. The success of the interferometric processing primarily requires that a correlation panel created in the interferometric process contains stationary-phase regions that, when summed, retrieve events with correct timing, whereas nonstationary contributions are canceled. We have addressed the combination of the RVSP configuration and ambient-noise measurements. We develop a prototype of a data-driven technique allowing us to adapt the summation process such that changes in the stationary-phase requirements imposed by changes in the noise-sources distribution can be adaptively satisfied without the need for array redeployment. We propose to identify the receivers located in the stationary-phase regions by scanning for stationary contributions in the correlation panel prior to stacking. Our method uses the correlation coefficient and time windowing to distinguish between stationary and nonstationary arrivals. The improved Green’s function estimate is obtained by limiting the summation to only those receivers that, when summed, enhance the stationary and attenuate the nonstationary contributions. We test this using a simple 2D numerical example to find a practical way to alleviate insufficient receiver coverage. We determine the theoretical possibility to improve the intersource Green’s function estimates without explicit knowledge of the target and the source distribution. However, our data-driven approach has the disadvantage of being limited to scenarios in which the correlation panel from all receivers contains identifiable stationary-phase arrivals.
Determination of the phase-velocity direction in anisotropic media using a direction vector
Authors: Yang Kai , Zhang Jianfeng
Published: August 2022

Determination of the phase-velocity direction in anisotropic media is important in the general research of wave phenomena and in the construction of seismic modeling, imaging, and inversion algorithms for practical applications. By taking the dot-product of a scaled displacement vector with both sides of the elastic wave equation and rearranging terms, we identify two relevant computational formulas for the group-velocity and slowness vectors. The quantity in the numerator of this group-velocity vector is linked to the conventional Poynting vector which points in the group-velocity direction, and we thus refer to it as the direction vector for the group-velocity direction. Similarly, the quantity in the numerator of this slowness vector provides a new direction vector which points in the phase-velocity direction, and we thus refer to it as the direction vector for the phase-velocity direction. This new direction vector provides a convenient way to directly compute the phase-velocity direction by using extrapolated vector wavefields in general anisotropic media. We vali- date the effectiveness of the proposed Poynting vector for the phase-velocity direction by using an analytical relation in a homogeneous transversely isotropic medium. After that, three anisotropic models are used to show the differences between the group-velocity and phase-velocity directions, which are estimated by using the direction vectors for the group- velocity and phase-velocity directions. The proposed direction vector is also suitable for the computation of the phase-velocity direction in low-symmetry anisotropic media, including orthorhombic, monoclinic, or triclinic media.