bluuebunny/crossref_metadata_2025 huggingface dataset:
Tocilizumab Effect on Lipid Profile in Correlation to Cardiovascular Events: A Retrospective Cohort Study
Authors: Alsulaim Toka , Alhassan Noor , Khalil Hala , Almutlaq Abdullah
Published: August 2021

Objective. To study the effect of tocilizumab initiation on the lipid profile, in correlation to a composite of any cardiovascular events. Methods. A retrospective cohort study, using data from the King Faisal Specialist Hospital & Research Centre database, from January 2014 to December 2019. Patients with rheumatoid arthritis or juvenile idiopathic arthritis who were ≥18 years old, initiated either on tocilizumab or other biologic treatment (anti-TNFs or Rituximab), were included, with a follow-up interval duration at a minimum of 6–12 months up to 3-5 years. Any patient with established cardiovascular disease or aged <18 were excluded. Results. Only one cardiovascular mortality was reported in the tocilizumab group. Fifty percent of patients reached

high
 
cholesterol
 
levels
≥
5.2
 
mmol
/
L

and

LDL
≥
3.37
 
mmol
/
L

in the tocilizumab group at 36 months in a shorter time period compared to controls (60 months),

P

 0.001. There were no significant differences between groups for statin use (27% vs. 28%) However, there was a significantly higher mean dose of atorvastatin in the tocilizumab group compared to controls (20.6 mg vs. 16.6 mg,

P

 0.03). Conclusion. There was a lack of evidence of increased cardiovascular risk in correlation to hyperlipidemia secondary to tocilizumab treatment.
Contrast-Enhanced Mammography in the Diagnosis of Breast Angiosarcoma
Authors: Kacen Maya Grisaru , Sangle Nikhil , Kornecki Anat
Published: August 2021

A 60-year-old female presented for further assessment of a new right breast lump (November 2020). She had a history of a stage I (T1bN0M0) right breast invasive mammary carcinoma, grade 2 (score 7/9) with receptors ER/PR-negative, HER2/neu-positive, diagnosed four years prior to her current presentation. At that time, she was treated with a right breast lumpectomy and local radiation. Breast assessment with contrast-enhanced mammography showed new skin thickening with associated enhancement within the palpable region. Histology of subsequent ultrasound-guided biopsy found radiation-induced breast angiosarcoma. Breast angiosarcoma is a rare entity that represents less than 1% of all breast cancers. To our knowledge, this is the first case describing the imaging findings of breast angiosarcoma on contrast-enhanced mammography.
Characterizations of Double Commutant Property on
B

H
Authors: Chen Chaoqun , Lu Fangyan , Cui Cuimei , Wang Ling
Published: August 2021

Let

H

be a complex Hilbert space. Denote by

B

H

the algebra of all bounded linear operators on

H

. In this paper, we investigate the non-self-adjoint subalgebras of

B

H

of the form

T
+
B

, where

B

is a block-closed bimodule over a masa and

T

is a subalgebra of the masa. We establish a sufficient and necessary condition such that the subalgebras of the form

T
+
B

has the double commutant property in some particular cases.
Isolation and Identification of Escherichia coli O157:H7 Lytic Bacteriophage from Environment Sewage
Authors: Sjahriani Tessa , Wasito Eddy Bagus , Tyasningsih Wiwiek
Published: August 2021

Escherichia coli O157:H7 is one of the pathogenic bacteria causing foodborne disease. The use of lytic bacteriophages can be a good solution to overcome the disease. This study is aimed at isolating lytic bacteriophages from environmental sewage with E. coli O157:H7 bacterial cells. The sample used in this study was eight bacteriophages, and the technique used in identifying E. coli O157:H7 carriers of the stx1 and stx2 genes was PCR. The double layer plaque technique was used to classify bacteriophages. Plaque morphology, host specificity, and electron micrograph were used to identify the bacteriophages. The result obtained plaque morphology as a clear zone with the largest diameter size of 3.5 mm. Lytic bacteriophage could infect E. coli O157:H7 at the highest titer of

10
×

10

8

 
PFU
/
mL

. Bacteriophages have been identified as Siphoviridae and Myoviridae. Phage 3, phage 4, and phage 8 could infect Atypical Diarrheagenic E. coli 1 (aDEC1) due to their host specificity. The Friedman statistical tests indicate that lytic bacteriophage can significantly lyse E. coli O157:H7 (

p
=
0.012

). The lysis of E. coli O157:H7 by phage 1, phage 2, phage 3, and phage 5 bacteriophages was statistically significant, according to Conover’s posthoc test (

p
<
0.05

). The conclusion obtained from this study is that lytic bacteriophages from environmental sewage could lyse E. coli O157:H7. Therefore, it could be an alternative biocontrol agent against E. coli O157:H7 that contaminates food causing foodborne disease.
Development from Jasminum sambac Flower Extracts of Products with Floral Fragrance and Multiple Physiological Activities
Authors: Wu Li-Chun , Lin Chieh-Li , Peng Chia-Chen , Huang Tzu-Ling , Tsai Teh-Hua , Kuan Yun-Erh , Chung Ying-Chien
Published: August 2021

To obtain a potential commercial product with floral fragrance and physiological properties from Jasminum sambac flower extracts, enfleurage was conducted for a short time and followed by further extraction through supercritical fluid extraction (SFE). The product extracted through SFE (called 100%SFE) exhibited low physiological activity (including 50.7% antityrosinase activity, 38.6%–45.9% radical scavenging activity, and 6,518–15,003 mg/L half-maximal inhibitory concentration [IC50] of antioxidant activity) and an intense jasmine-like flavor but was nontoxic to CCD-996SK and HEMn cells. By contrast, the residue (called RO) exhibited high physiological activity (94.2%–100%), light jasmine-like flavor, and slight cytotoxicity at the concentration of 4,000 mg/L. When 100%SFE and RO were mixed in the ratio 2 : 8, the resultant mixture exhibited 100% antityrosinase activity, >91.3% radical scavenging activity, strong antioxidant activity (IC50: 273–421 mg/L), high total phenolic content (172.15 mg-GAE/g-extract), noncytotoxicity, and moderately intense jasmine-like flavor; it is also economically competitive. The major antioxidants in these extracts were revealed through gas chromatography-mass spectroscopy (GC-MS). Additionally, the composition and quality of fragrance were confirmed through GC-MS and sensory evaluation, respectively. The major fragrance components in the 2 : 8 extract mixture were benzyl acetate, β-pinene, pentadecyl-2-propyl ester, citronellol, jasminolactone, linalool, farnesol, and jasmone. On the basis of the results, we strongly suggest that the 2 : 8 mixture of extracts from J. sambac flowers can be a powerful antioxidant, whitening, and nontoxic ingredient that can be employed in the pharmaceutical, cosmeceutical, and food industries.
A Solar Photovoltaic Performance and Financial Modeling Solution for Grid-Connected Homes in Zambia
Authors: Imasiku Katundu
Published: August 2021

Zambia is today 90% hydropower dependent, but this may change because Zambia and the World at large are today facing a changing climate that affects the ecosystem, rain patterns, and spurs drought which reduces the production of hydropower. The current power deficit experienced in Zambia points to a need to deploy a renewable energy generation-mix strategy. This study conducts a solar photovoltaic performance and financial analysis for grid-connected homes in Zambia to investigate the role of solar energy as an enabler for energy security in Zambia using the National Renewable Energy Laboratory (NREL) System Advisor Model (SAM) simulation method. It further reviews the available solar irradiance, modeling a detailed grid-connected photovoltaic system using locally available products for a single owner in a power purchase agreement (PPA) with the Zambia Electricity Company Limited (ZESCO). This model would alleviate the current power load shedding experienced by the residential sector, of up to 22 hours of no electricity out of 24 hours in a day. Alongside the technical performance model and an unfavorable business climate in Zambia, a financial model is also developed to help assess project feasibility and financial viability. A 1 kW solar PV system was modeled at an installation cost of US$1.27 per watt on a short-term basis of 5 years and found that the project is feasible with a 28.52% IRR achieved in 3 years and a 69% performance ratio and a debt service coverage ratio (DSCR) of 5.12 by the end of the project life, thereby indicating capability to turn around Zambia’s energy poverty to meet the UN SDG 7.
An Implicit Algorithm for Finding a Fixed Point of a
Q
-Nonexpansive Mapping in Locally Convex Spaces
Authors: Soori E. , Omidi M.R. , Farajzadeh A.P. , Wang Yuanheng
Published: August 2021

In this paper, the notion of the

q

-duality mappings in locally convex spaces is introduced. An implicit method for finding a fixed point of a

Q

-nonexpansive mapping is provided. Finally, the convergence of the proposed implicit scheme is investigated. Some examples in order to illustrate of the main results are presented.
Hybrid Deep Learning Models for Sentiment Analysis
Authors: Dang Cach N. , Moreno-García María N. , De la Prieta Fernando
Published: August 2021

Sentiment analysis on public opinion expressed in social networks, such as Twitter or Facebook, has been developed into a wide range of applications, but there are still many challenges to be addressed. Hybrid techniques have shown to be potential models for reducing sentiment errors on increasingly complex training data. This paper aims to test the reliability of several hybrid techniques on various datasets of different domains. Our research questions are aimed at determining whether it is possible to produce hybrid models that outperform single models with different domains and types of datasets. Hybrid deep sentiment analysis learning models that combine long short‐term memory (LSTM) networks, convolutional neural networks (CNN), and support vector machines (SVM) are built and tested on eight textual tweets and review datasets of different domains. The hybrid models are compared against three single models, SVM, LSTM, and CNN. Both reliability and computation time were considered in the evaluation of each technique. The hybrid models increased the accuracy for sentiment analysis compared with single models on all types of datasets, especially the combination of deep learning models with SVM. The reliability of the latter was significantly higher.
TMB and Inflammatory Gene Expression Associated with Clinical Outcomes following Immunotherapy in Advanced Melanoma
Authors: Hodi F. Stephen , Wolchok Jedd D. , Schadendorf Dirk , Larkin James , Long Georgina V. , Qian Xiaozhong , Saci Abdel , Young Tina C. , Srinivasan Sujaya , Chang Han , Tang Hao , Wind-Rotolo Megan , Rizzo Jasmine I. , Jackson Donald G. , Ascierto Paolo A.
Published: August 2021

Outcomes for patients with melanoma have improved over the past decade as a result of the development and FDA approval of immunotherapies targeting cytotoxic T lymphocyte antigen-4 (CTLA-4), programmed death-1 (PD-1), and programmed death ligand 1 (PD-L1). However, these therapies do not benefit all patients, and an area of intensive research investigation is identifying biomarkers that can predict which patients are most likely to benefit from them. Here, we report exploratory analyses of the associations of tumor mutational burden (TMB), a 4-gene inflammatory gene expression signature, and BRAF mutation status with tumor response, progression-free survival, and overall survival in patients with advanced melanoma treated as part of the CheckMate 066 and 067 phase III clinical trials evaluating immuno-oncology therapies. In patients enrolled in CheckMate 067 receiving the anti–PD-1 inhibitor nivolumab (NIVO) alone or in combination with the anti–CTLA-4 inhibitor ipilimumab (IPI) or IPI alone, longer survival appeared to associate with high (>median) versus low (≤median) TMB and with high versus low inflammatory signature scores. For NIVO-treated patients, the results regarding TMB association were confirmed in CheckMate 066. In addition, improved survival was observed with high TMB and absence of BRAF mutation. Weak correlations were observed between PD-L1, TMB, and the inflammatory signature. Combined assessment of TMB, inflammatory gene expression signature, and BRAF mutation status may be predictive for response to immune checkpoint blockade in advanced melanoma.
A. Muciniphila Suppresses Colorectal Tumorigenesis by Inducing TLR2/NLRP3-Mediated M1-Like TAMs
Authors: Fan Lina , Xu Chaochao , Ge Qiwei , Lin Yifeng , Wong Chi Chun , Qi Yadong , Ye Bin , Lian Qingwu , Zhuo Wei , Si Jianmin , Chen Shujie , Wang Liangjing
Published: August 2021

The interplay between gut microbiota and the host immune system is emerging as a factor in the pathogenesis of colorectal cancer. Here, we set out to identify the effect of Akkermansia muciniphila (A. muciniphila) on colorectal cancer pathogenesis. A. muciniphila abundance was significantly reduced in patients with colorectal cancer from two independent clinical cohorts and the GMrepo dataset. Supplementation with A. muciniphila suppressed colonic tumorigenesis in ApcMin/+ mice and the growth of implanted HCT116 or CT26 tumors in nude mice. Mechanistically, A. muciniphila facilitated enrichment of M1-like macrophages in an NLRP3-dependent manner in vivo and in vitro. As a consequence, NLRP3 deficiency in macrophages attenuated the tumor-suppressive effect of A. muciniphila. In addition, we revealed that TLR2 was essential for the activation of the NF-κB/NLRP3 pathway and A. muciniphila induced M1-like macrophage response. We observed positive correlations between M1-like macrophages, NLRP3/TLR2 and A. muciniphila in patients with colorectal cancer, which corroborated these findings. In summary, A. muciniphila–induced M1-like macrophages provide a therapeutic target in the colorectal cancer tumor microenvironment.
Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report
Authors: Rojanaporn Duangnate , Tipsuriyaporn Boontip , Chulalaksiriboon Patnarin , Virankabutra Tanit , Morakul Sunthiti , Damato Bertil
Published: August 2021

Background: The aim of this study was to report 2 cases of pulmonary air embolism developing several hours after choroidal melanoma endoresection without the use of air infusion during the surgery, with fatality in 1 patient. Methods: The method of this study was case report. Participants: Two patients with large choroidal melanomas who collapsed several hours after endoresection without air infusion as a result of pulmonary air embolism. Results: A 72-year-old man collapsed 4 h and 30 min after endoresection without air infusion. Computerized tomography angiography confirmed air embolism. The patient died after 86 min of cardiopulmonary resuscitation. A 41-year-old woman collapsed 5 h and 30 min after endoresection, performed without air infusion and with close monitoring, which included right internal jugular vein catheterization intraoperatively. Transthoracic and transesophageal echography, performed preoperatively, intraoperatively, and postoperatively, revealed air embolism only after collapse occurred. Imaging showed the embolism to be biventricular because of patent foramen ovale. The patient was treated promptly with extracorporeal membrane oxygenation and mechanical ventilation, which resulted in a full recovery. Conclusions: Air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion. Further studies are needed to understand how this occurs. Special measures are indicated to detect this complication and to treat it promptly and effectively.
José e a cidade: uma incursão geográfica na poesia política de Carlos Drummond de Andrade
Authors: Silva Felipe Cabañas da
Published: August 2021

Este artigo se insere nos estudos que relacionam geografia e literatura e tem como objetivo analisar a obra “José” (1942), de Carlos Drummond de Andrade, que é parte da fase mais politizada do autor (a primeira metade da década de 1940), que inclui ainda os livros Sentimento do mundo (1940) e A rosa do povo (1945). Para tanto, fizemos uma leitura crítica dos poemas, com enfoque geográfico, articulando a questão da política à vivência urbana na modernidade. Do ponto de vista teórico-metodológico, procuramos estabelecer um genuíno diálogo entre os versos e o pensamento geográfico, em que não há hierarquia entre os dois saberes e o discurso do poeta e do geógrafo se imiscuem. Por isso, também produzimos material cartográfico dialogando com o conteúdo literário.
Diferenciación y fragmentación socioespacial: La contradicción campo-ciudad como teoría y como método
Authors: Morcuende Alejandro
Published: August 2021

Se analiza aquí la posible superación de la contradicción campo-ciudad como una tendencia a la diferenciación espacial fruto de la geografía del capitalismo en crisis, y como elemento novedoso en las actuales relaciones entre el espacio y la sociedad mediadas por la fragmentación socioespacial. Se exploran, en primer lugar, las principales aportaciones que han tenido como objeto esa contradicción, con lo que establecer sus límites conceptuales. En segundo lugar se propone la urbanización planetaria como el desarrollo teórico de la contradicción campo-ciudad, y la urbanización diferencial como su método con la que empirizarla en última instancia. Se definen, por último, en forma de consideraciones, las relaciones entre diferenciación espacial, fragmentación socioespacial y contradicción campo-ciudad, como variables ascendentes del presente cambio social.
(In) segurança hídrica: garantindo o direito à água
Authors: Loftus Alex John , Sousa Ana Cristina Augusto de
Published: August 2021

Este artigo relê os debates sobre segurança e insegurança da água por meio de ferramentas dos estudos geográficos críticos. Ele busca demonstrar o valor dessa perspectiva crítica para a conquista do acesso à água para todos. Embora rejeite a simples desvalorização dos principais discursos sobre segurança hídrica, o artigo observa a falha deles em politizar adequadamente os processos e as relações que reproduzem as desigualdades hídricas. Encontrando lições em escritos recentes sobre ecologia política, o ciclo hidrossocial e sobre o direito à água, o artigo conclui com uma afirmaçãode Gramsci de construir a partir dos conhecimentos fragmentados, mas implícitos nas lutas, a conquista do acesso democrático à água.
Impacto da saúde bucal de pacientes com paralisia cerebral no cuidador
Authors: Moreira Vanessa Gonçalves , Santos Helare Adane Andrade , Martins Filho Paulo Ricardo Saquete , Barros Alina Lúcia de Oliveira , Vasconcellos Sara Juliana de Abreu de
Published: August 2021

Objetivo: O objetivo deste estudo foi avaliar o impacto da saúde bucal das crianças e adolescentes com paralisia cerebral (PC) na vida dos seus cuidadores. Materiais e Métodos: Trata-se de um estudo transversal e de abordagem quantitativa, realizado em Aracaju/SE, Brasil, de julho de 2019 a abril de 2020. Os dados de 22 cuidadores foram coletados por meio dos questionários sócio demográfico e Family Impact Scale (FIS) na Unidade Odontológica para Pacientes Especiais da Universidade Federal de Sergipe (Hospital Universitário). Resultados: Observou-se a prevalência de mulheres como cuidadoras principais (81%), e dos 22 dos entrevistados, 19 se dedicavam em tempo integral. Com relação ao perfil do paciente com PC, 67% eram do sexo masculino, entre 11 e 15 anos (38%). Para a análise do FIS, foram encontrados médias de impacto de 33 pontos. Conclusão: Foi observado alto impacto da saúde bucal dos pacientes com PC em seus cuidadores. Em contrapartida, foi observado que os cuidadores estão buscando cada vez mais recursos que possibilitem o bem-estar dos seus filhos, não só físico, como bucal, por meio de participação em programas governamentais que sejam voltados para a educação em saúde bucal.
Effect of light curing unit and antiseptic mouthwashes on the physical properties of gingiva-colored composite resin
Authors: Dotta Tatiane Cristina , Almeida Leonardo de Pádua Andrade , Arnez Mayara Manfrin , Castelo Raisa , Ugarte David Emanuel , Reis Andréa Cândido dos , Catirse Alma Blasida Concepcion Elizaur Benitez
Published: August 2021

Objective: This study evaluated surface roughness (Ra) and color difference (ΔE00) of a gingiva-colored composite resin (NT Premium Gengiva, Coltene), light-activated with three light curing units (LCU) and immersed in different mouthwash solutions. Methods: 90 composite specimens (n=10) were divided according to the LCU: L1-Valo, L2-Bluephase and L3-Optilight Max; and solution: S1-alcohol-based antiseptic mouthwash (Listerine Cool Mint), S2-alcohol-free antiseptic mouthwash (Listerine Cool Mint Zero Alcohol) and S3-water (control). Immersions were performed for 30 s, 2x/day, for 21 days. Ra and coordinates of luminosity (L*) and color (a* and b*) were measured using a rugosimeter (SJ-201 P/M) and a spectrophotometer (SP62S), respectively, at: T0-start, T1-7 days, T2-14 days and T3-21 days. Results: L1 (1.3±0.9) presented higher Ra than L3 (0.7±0.6) and L2 (1.0±0.8); and Ra for S2 (0.9±0.1) was greater than S3 (-0.1±0.1), and S1 (0.1±0.1). Moreover, L1 (23.3±0.3) presented lower ΔE00 t han L 2 (24.7±0.3) a nd L 3 (25.1±0.3). Conclusion: Ra of the gingiva-colored composite resin tested increased when L1 and S2 were used, although L1-cured specimens also showed the lowest ΔE00.
Impaired Exercise Tolerance in Repaired Tetralogy of Fallot Is Associated With Impaired Biventricular Contractile Reserve: An Exercise-Stress Real-Time Cardiovascular Magnetic Resonance Study
Authors: Steinmetz Michael , Stümpfig Thomas , Seehase Matthias , Schuster Andreas , Kowallick Johannes , Müller Matthias , Unterberg-Buchwald Christina , Kutty Shelby , Lotz Joachim , Uecker Martin , Paul Thomas
Published: August 2021

Background:

Correction of tetralogy of Fallot (cTOF) often results in pulmonary valve pathology and right ventricular (RV) dysfunction. Reduced exercise capacity in cTOF patients cannot be explained by these findings alone. We aimed to explore why cTOF patients exhibit impaired exercise capacity with the aid of a comprehensive cardiopulmonary exercise testing (CPET) and real-time cardiovascular magnetic resonance exercise testing (CMR-ET) protocol.

Methods:

Thirty three cTOF patients and 35 matched healthy controls underwent CPET and CMR-ET in a prospective case-control study. Real-time steady-state free precession cine and phase-contrast sequences were obtained during incremental supine in-scanner cycling at 50, 70, and 90 W. RV and left ventricle (LV) volumes and pulmonary blood flow (Qp) were calculated. Differences of CPET and CMR-ET between cTOF versus controls and correlations between CPET and CMR-ET parameters in cTOF were evaluated statistically for all CMR exercise levels using Mann-Whitney
U
and Spearman rank-order correlation tests.

Results:

CPET capacity was significantly lower in cTOF than in controls. cTOF patients exhibited not only significantly reduced Qp and RV function but also lower LV function on CMR-ET. Higher CPET values in cTOF correlated with higher Qp (Qp 90 W versus carbon dioxide ventilatory equivalent %:
R
=−0.519,
P
<0.05), higher LV–end-diastolic volume indexed to body surface area (LV–end-diastolic volume indexed to body surface area at 50 W versus oxygen uptake in % at maximum exercise on CPET
R
=0.452,
P
<0.05), and change in LV ejection fraction (EF; LV-EF at 90 W versus Watt %:
r
=−0.463,
P
<0.05). No correlation was found with regard to RV-EF. Significant RV-LV interaction was observed during CMR-ET (RV-EF versus LV-EF at 50 W and 70 W:
r
=0.66,
P
<0.02 and
r
=0.52,
P
<0.05, respectively).

Conclusions:

Impaired exercise capacity in cTOF resulted from a reduction in not only RV, but also LV function. cTOF with good exercise capacity on CPET demonstrated higher LV reserve and pulmonary blood flow during incremental CMR-ET. Apart from RV parameters, CMR-ET–derived LV function could be a valuable tool to stratify cTOF patients for pulmonary valve replacement.
Clinical Significance of Partial Anomalous Pulmonary Venous Connections (Isolated and Atrial Septal Defect Associated) Determined by Cardiovascular Magnetic Resonance
Authors: Hatipoglu Suzan , Almogheer Batool , Mahon Ciara , Houshmand Golnaz , Uygur Begum , Giblin Gerard T. , Krupickova Sylvia , Baksi A. John , Alpendurada Francisco , Prasad Sanjay K. , Babu-Narayan Sonya V. , Gatzoulis Michael A. , Mohiaddin Raad H. , Pennell Dudley J. , Izgi Cemil
Published: August 2021

Background:

Partial anomalous venous connections (PAPVC) are associated with left to right shunting and right heart dilatation. Identification of PAPVC has increased with widespread use of cross-sectional imaging modalities. However, management strategies are mostly based on expert opinion given the scarcity of data from large series. We aimed to define types and significance of isolated and atrial septal defect (ASD) associated PAPVC detected by cardiovascular magnetic resonance.

Methods:

We retrospectively reviewed our cardiovascular magnetic resonance database from 2002 to 2018 to identify isolated or ASD-associated PAPVC cases.

Results:

A total of 215 patients (median age 46 years; range, 6–83) with isolated or ASD-associated PAPVC were identified among 102 135 clinical cardiovascular magnetic resonance studies. Of these, 104 were isolated and 111 were associated with an ASD. Anomalous connection of right upper pulmonary vein was the most common single venous anomaly (99/215), but in the isolated PAPVC group there were more anomalous left than right upper pulmonary veins (39 versus 34). The Qp/Qs was significantly higher for isolated anomalous single right upper pulmonary vein than left upper pulmonary vein (1.6 versus 1.4 respectively;
P
=0.01) as were right ventricular end-diastolic volumes (113.7±30.9 versus 90 [57–157] mL/m
2
,
P
=0.004). In the PAPVC with an ASD group, sinus venosus ASDs (82%) were associated with right-sided PAPVCs while both right and left-sided venous anomalies were seen in secundum ASDs (18%). In a substantial number of patients (30 out of 91) with sinus venosus ASDs, PAPVCs were more complex and involved more than a single anomalous right upper pulmonary vein; and in 5 patients with ASD, PAPVC was identified only after the ASD closure.

Conclusions:

This large series provides descriptive and hemodynamic features for isolated and ASD-associated PAPVCs. Anomalous isolated right upper pulmonary vein may cause a significant shunt (Qp/Qs >1.5). PAPVC associated with sinus venosus and secundum ASDs might be more complex than a single anomalous pulmonary vein and missed before ASD correction.
Association of Mildly Reduced Kidney Function With Cardiovascular Disease: The Framingham Heart Study
Authors: Ataklte Feven , Song Rebecca J. , Upadhyay Ashish , Musa Yola Ibrahim , Vasan Ramachandran S. , Xanthakis Vanessa
Published: August 2021

Background

Data are limited on the association of mildly reduced estimated glomerular filtration rate (eGFR 60–89 mL/min per 1.73 m
2
) with cardiovascular disease (CVD) in the community.

Methods and Results

We evaluated 3066 Framingham Offspring Study participants (55% women, mean age 58 years), without clinical CVD. Using multivariable regression, we related categories of mildly reduced eGFR (80–89, 70–79, or 60–69 versus ≥90 mL/min per 1.73 m
2
[referent]) to prevalent coronary artery calcium, carotid intima media thickness, and left ventricular hypertrophy, and to circulating concentrations of cardiac stress biomarkers. We related eGFR categories to CVD incidence and to progression to ≥Stage 3 chronic kidney disease (eGFR <60 mL/min per 1.73 m
2
) using Cox regression. Individuals with eGFR 60–69 mL/min per 1.73 m
2
(n=320) had higher coronary artery calcium score (odds ratio 1.69; 95% CI 1.02–2.80) compared with the referent group. Individuals with eGFR 60–69 and 70–79 mL/min per 1.73 m
2
had higher blood growth differentiating factor‐15 concentrations (β=0.131 and 0.058 per unit‐increase in log‐biomarker, respectively). Participants with eGFR 60–69 and 80–89 mL/min per 1.73 m
2
had higher blood B‐type natriuretic peptide concentrations (β=0.119 and 0.116, respectively). On follow‐up (median 16 years; 691 incident CVD and 252 chronic kidney disease events), individuals with eGFR 60–69 and 70–79 mL/min per 1.73 m
2
experienced higher CVD incidence (hazard ratio [HR], 1.40; 95% CI, 1.02–1.93 and 1.45, 95% CI, 1.05–2.00, respectively, versus referent). Participants with eGFR 60–69 mL/min per 1.73 m
2
experienced higher chronic kidney disease incidence (HR, 2.94; 95% CI, 1.80–4.78 versus referent).

Conclusions

Individuals with mildly reduced eGFR 60–69 mL/min per 1.73 m
2
have a higher burden of subclinical atherosclerosis cross‐sectionally, and a greater risk of CVD and chronic kidney disease progression prospectively. Additional studies are warranted to confirm our findings.
Circulating Growth Differentiation Factor 15 Is Increased Preceding Preeclampsia Diagnosis: Implications as a Disease Biomarker
Authors: Cruickshank Tess , MacDonald Teresa M. , Walker Susan P. , Keenan Emerson , Dane Kirsten , Middleton Anna , Kyritsis Valerie , Myers Jenny , Cluver Catherine , Hastie Roxanne , Bergman Lina , Garcha Damanpreet , Cannon Ping , Murray Elizabeth , Nguyen Tuong‐Vi , Hiscock Richard , Pritchard Natasha , Hannan Natalie J. , Tong Stephen , Kaitu’u‐Lino Tu’uhevaha J.
Published: August 2021

Background

We investigated the biomarker potential of growth differentiation factor 15 (GDF‐15), a stress response protein highly expressed in placenta, to predict preeclampsia.

Methods and Results

In 2 prospective cohorts (cohort 1: 960 controls, 39 women who developed preeclampsia; cohort 2: 950 controls, 41 developed preeclampsia), plasma concentrations of GDF‐15 at 36 weeks' gestation were significantly increased among those who developed preeclampsia (P<0.001), area under the receiver operating characteristic curves (AUC) of 0.66 and 0.71, respectively. In cohort 2 a ratio of sFlt‐1/PlGF (a clinical biomarker for preeclampsia) had a sensitivity of 61.0% at 83.2% specificity to predict those who will develop preeclampsia (AUC of 0.79). A ratio of GDF‐15×sFlt‐1/PlGF yielded a sensitivity of 68.3% at 83.2% specificity (AUC of 0.82). GDF‐15 was consistently elevated across a number of international cohorts: levels were higher in placenta and blood from women delivering <34 weeks' gestation due to preterm preeclampsia in Melbourne, Australia; and in the blood at 26 to 32 weeks' gestation among 57 women attending the Manchester Antenatal Vascular Service (MAViS, UK) who developed preeclampsia (P=0.0002), compared with 176 controls. In the Preeclampsia Obstetric adVerse Events biobank (PROVE, South Africa), plasma GDF‐15 was significantly increased in women with preeclampsia with severe features (P=0.02; n=14) compared to controls (n=14).

Conclusions

We conclude circulating GDF‐15 is elevated among women more likely to develop preeclampsia or diagnosed with the condition. It may have value as a clinical biomarker, including the potential to improve the sensitivity of sFlt‐1/PlGF ratio.
Early Risk of Stroke in Patients Undergoing Acute Versus Elective Cardioversion for Atrial Fibrillation
Authors: Forslund Tomas , Braunschweig Frieder , Holzmann Martin J. , Siddiqui Anwar J.
Published: August 2021

Background

Electrical cardioversion (ECV) is routinely used to restore sinus rhythm in patients with symptomatic atrial fibrillation. The European guidelines have been updated in recent years. Current information on differences in the risk for stroke after acute versus elective ECV is lacking.

Methods And Results

All patients with a first‐time acute or elective ECV in the Stockholm regional health care data warehouse from 2011 to 2018 were included. Cox regression analyses were performed evaluating ischemic or unspecified stroke within 30 days after ECV with adjustments for the CHA
2
DS
2
‐VASc score, medical treatment, and year of inclusion. The study included 9139 patients, 3094 after acute and 6045 after elective ECV. The mean age was 65.9±11.3 years, 69.5% were men, and the mean CHA
2
DS
2
‐VASc score was 2.4±1.7. Before the intervention, 49.6% of patients with an acute ECV and 96.4% of those with an elective ECV had claimed an oral anticoagulant prescription. Ischemic or unspecified stroke occurred in 26 (0.28%) patients within 30 days. The unadjusted risk was higher after acute compared with elective ECV (hazard ratio [HR], 2.29; 95% CI, 1.06–4.96), whereas there was no difference after multivariable adjustments (adjusted HR, 0.99; 95% CI, 0.36–2.72). Both non–vitamin K oral anticoagulants (adjusted HR, 0.28; 95% CI, 0.08–0.98) and warfarin (adjusted HR, 0.17; 95% CI, 0.05–0.53) were associated with a lower risk for stroke compared with no anticoagulation.

Conclusions

Acute ECV was associated with a higher unadjusted risk for stroke than elective ECV, but the risk was similar after adjustment for anticoagulant treatment. This study indicates the importance of anticoagulation before ECV according to recent European guidelines.
Diplodia parva sp. nov., a novel species of the family Botryosphaeriaceae isolated from soil in Korea
Authors: LEE SEUNG-YEOL , TEN LEONID N. , AYIM BENJAMIN YAW , FULBERT OKOUMA NGUIA , DAS KALLOL , JUNG HEE-YOUNG
Published: August 2021

A fungal strain designated KNU16-007, belonging to the family Botryosphaeriaceae, was isolated from soil in Daegu, Korea. Phylogenetic analyses based on the concatenated nucleotide sequences of the ITS and TEF-1α regions, showed that the isolate resides in a clade together with Diplodia species but occupies a distinct phylogenetic position. Conidial dimensions of strain KNU16-007 (22.7–29.3 μm × 8.9–10.9 μm) or its conidial length:width ratio were significantly differed from those of the closely related D. sapinea, D. intermedia, D. scrobiculata, D. seriata, D. crataegicola, D. rosacearum, and D. citricarpa clearly indicating morphological differences from these species. Detailed descriptions, illustrations, and discussions regarding the morphological and phylogenetic analyses of the closely related species are provided to support the novelty of the isolated species. The results of phylogenetic analysis and morphological observations indicate that strain KNU16-007 represents a novel species in the genus Diplodia, for which the name Diplodia parva sp. nov. is proposed.
Phylogeny of Phyllachora species on bamboo and P. cephalostachyi sp. nov. from China
Authors: LI XIAO-LING , YU HAI-YING , LUO XI , WU HAO , ZHAO CHUN-YAN , PROMPUTTHA ITTHAYAKORN , SUN DA-FENG
Published: August 2021

Thirty-seven Phyllachora specimens were collected in China and examined for morphological characteristics. A molecular phylogenetic analysis based on a combined sequence dataset of ITS and LSU was also undertaken. Phyllachora cephalostachyi sp. nov. on Cephalostachyum pergracile is described based on its distinct phylogenetic relationships and a comparison of its morphological characteristics with known Phyllachora species on bamboo. Our results indicate a high species diversity of Phyllachora on bamboo in China. A full description and colour photographs of micro-characters are provided for the new species. A phylogenetic tree to show placement of the new species, and a table to compare morphology of the Phyllachora species reported on bamboo are also provided.
Peliosanthes longiracemosa (Asparagaceae), a new species from limestone areas of northern Vietnam
Authors: NGUYEN KHANG SINH , TANAKA NORIYUKI , AVERYANOV LEONID V. , NGUYEN THANH SON , PHAM VAN THE
Published: August 2021

Peliosanthes longiracemosa, a new species from limestone areas of northern Vietnam, is described and illustrated. It is most similar to P. macrostegia in having a distally incurved staminal corona and a distinct pyramidal style, but clearly distinguishable chiefly by the broader leaf blades with more longitudinal veins and closer transverse veinlets, relatively longer, more slender raceme, more numerous widely expanded flowers with recurved perianth segments, and more incrassate, depressed globose staminal corona. Information on the habitat and phenology as well as notes on the taxonomic relationships with other congeners is also provided.
Soil Moisture Control of Precipitation Reevaporation over a Heterogeneous Land Surface
Authors: Cheng Yu , Chan Pak Wah , Wei Xin , Hu Zeyuan , Kuang Zhiming , McColl Kaighin A.
Published: August 2021

Soil moisture heterogeneity can induce mesoscale circulations due to differential heating between dry and wet surfaces, which can, in turn, trigger precipitation. In this work, we conduct cloud-permitting simulations over a 100 km × 25 km idealized land surface, with the domain split equally between a wet region and a dry region, each with homogeneous soil moisture. In contrast to previous studies that prescribed initial atmospheric profiles, each simulation is run with fixed soil moisture for 100 days to allow the atmosphere to equilibrate to the given land surface rather than prescribing the initial atmospheric profile. It is then run for one additional day, allowing the soil moisture to freely vary. Soil moisture controls the resulting precipitation over the dry region through three different mechanisms: as the dry domain gets drier, (i) the mesoscale circulation strengthens, increasing water vapor convergence over the dry domain, (ii) surface evaporation declines over the dry domain, decreasing water vapor convergence over the dry domain, and (iii) precipitation efficiency declines due to increased reevaporation, meaning proportionally less water vapor over the dry domain becomes surface precipitation. We find that the third mechanism dominates when soil moisture is small in the dry domain: drier soils ultimately lead to less precipitation in the dry domain due to its impact on precipitation efficiency. This work highlights an important new mechanism by which soil moisture controls precipitation, through its impact on precipitation reevaporation and efficiency.
The Virtual Interview Experience for MATCH 2021: A Pilot Survey of General Surgery Residency Program Directors
Authors: Rajesh Aashish , Asaad Malke , Elmorsi Rami , Ferry Andrew M. , Maricevich Renata S.
Published: August 2021

Background

Virtual interviews (VIs) for the 2020 residency application season were mandated as a result of the COVID-19 pandemic. We aimed to determine the perspectives of general surgery (GS) program directors (PDs) on the benefits and drawbacks of VIs.

Methods

A 14-item survey was emailed to all GS PDs from programs identified on the American Council for Graduate Medical Education website. Program directors were asked about the cost-time benefit of VIs, its ability to assess candidates, and their thoughts on the future of VIs for evaluating residency applicants.

Results

60 PDs responded corresponding to a response rate of 21%. While 93% agreed/strongly agreed that VIs were less expensive, only 35% found VIs to be less time-consuming. 75% and 67%, respectively, disagreed/strongly disagreed that VIs allowed for an easier assessment of an applicant’s fit, and personality and communication skills. Almost one-half of our survey respondents suggested that VIs made the selection committee rely more heavily on objective applicant data. Almost two-thirds of GS PDs suggested that they would adopt both VI and in-person interview formats for future application cycles. The median [interquartile range] cost saved through the implementation of VIs was US$ 4500 [1625 – 10 000].

Conclusion

Remarkably, VIs have been swiftly imbibed by all residency programs and many aspects of the VI experience were positive. While MATCH 2021 has definitely proved to be one of its kind, the implementation of VIs has been met with overall broad success and a promising future awaits this novel modality of resident selection to GME programs in the United States.
Impact of Adjunctive Pharmacotherapy With Intragastric Balloons for the Treatment of Obesity
Authors: Mehta Amit , Shah Shawn , Dawod Enad , Hajifathalian Kaveh , Kumar Rekha , Igel Leon I. , Saunders Katherine H. , Kumbhari Vivek , Farha Jad , Badurdeen Dilhana , Itani Mohamad I. , Moore Rachel L. , Starpoli Anthony A. , Carr-Locke David L. , Shukla Alpana , Aronne Louis J. , Sharaiha Reem Z.
Published: August 2021

Background

We conducted this study to compare the weight loss outcome of intragastric balloons (IGBs) in conjunction with pharmacotherapy vs IGB and intensive lifestyle changes alone.

Methods

This was a multicenter, non-randomized, retrospective study involving 4 academic hospitals. Patients underwent IGB placement with or without concomitant anti-obesity pharmacotherapy. The primary outcome was percent total weight loss (TBWL) after IGB placement at 6 and 12 months.

Results

This study included 102 patients, with 23 patients (mean age 46.6 years, 82.6% female) treated with IGB/pharmacotherapy and 79 patients (mean age 46.0 years, 88.6% female) treated with IGB/lifestyle modifications. Patients had a 100% follow-up rate at 6 and 12 months. At 6 months following IGB placement, both groups achieved a similar %TBWL. At 12 months, %TBWL was greater in the IGB/pharmacotherapy group (12.6% ± 1.2 vs 9.7% ± 0.7, P = .04). 65.2% of patients achieved ≥10% TBWL at 12 months in the IGB/pharmacotherapy group, compared to 38.0% in the IGB/lifestyle group ( P < .05). The proportion of patients that achieved ≥15% weight loss at 12 months was also significantly different between the IGB/pharmacotherapy and IGB/lifestyle groups (30.4% vs 20.3%, P < .05).

Discussion

IGB with concomitant use of pharmacotherapy did not improve weight loss while the IGB was in place compared to IGB and lifestyle changes. However, patients receiving IGB with pharmacotherapy did have greater weight loss and diminished weight regain after balloon removal compared to those receiving just IGB and lifestyle changes.
Operative Confidence Among U.S General Surgery Residents
Authors: Elkbuli Adel , Ehrlich Haley , Gargano Toria , Newsome Kevin , Liu Huazhi , McKenney Mark , Ang Darwin
Published: August 2021

Background

General surgery residents (GSRs) must develop operative autonomy skills to practice independently after graduation. We aim to investigate perceived confidence and operative autonomy of GSR physicians in order to identify and address influential factors.

Methods

A 28-question anonymous online survey was distributed to 23 United States general surgery residency programs. Multivariable logistic regression was used for calculating the adjusted odds ratio (aOR) for binary outcomes. Significance was defined as P-values ≤ .05 or 95% confidence intervals (CIs) >1 or <1.

Results

There were 120/558 (21.5%) GSR respondents. General surgery residents with >200 overall operative case volume reported significantly higher confidence with minor cases (P = .05) and major cases (P = .02). General surgery residents that performed both minor and major surgeries reported higher confidence with minor cases at 85.7% compared to GSRs that performed mostly minor surgeries (64.7%) and mostly major surgeries (62.5%). General surgery residents who performed >50 minor surgeries during their PGY 1 and 2 were less confident with major cases than GSRs who performed <50 minor surgeries (aOR: 19.98, 95% CI: 1.26, 318). General surgery residents from community teaching hospitals reported higher confidence with major and minor cases than GSRs from university teaching hospitals and combined programs.

Conclusion

Increased case volume, predominant case type, early surgical experience during PGY 1 and 2 years, and training at community teaching hospitals were identified as the most important factors that positively influence perception of operative confidence and autonomy among GSRs. These may have important implications in the development of future surgeons.
Collective Decision-Making and the Economic Vote
Authors: Duch Raymond M. , Falcó-Gimeno Albert
Published: August 2021

Experimental evidence suggests that decision makers with proposal power are held responsible for collective decisions. In the case of coalition governments, voter heuristics assign responsibility for economic outcomes to individual parties, directing the economic vote toward the Prime Minister party. Using extensive survey data from 1988 to 2010 in 28 democracies, we demonstrate that voters also identify the Finance Minister party as responsible depending on whether the coalition context exaggerates or mutes its perceived agenda power. When parties take ownership for particular policy areas, and decision-making is compartmentalized, voters perceive the Finance Minister as having proposal power and it receives a larger economic vote. Online survey experiments in Ireland and the Netherlands confirm that subjects employ compartmentalization signals to identify, and punish, coalition parties with proposal power.
Militarization of childhood(s) in Donbas: ‘Growing together with the Republic’
Authors: Hoban Iuliia
Published: August 2021

This essay critically examines how the militarization of childhood(s) takes place in the Luhansk and Donetsk People’s Republics. The intensification of hostilities in Eastern Ukraine in mid-2014 has had a profound impact on local populations, particularly children. While no systematic recruitment and participation of children in conflict has been reported, childhood has become what Agathangelou and Killian would characterize as a ‘site for displacement and maneuvering for militarization.’ Drawing on feminist methodologies, I examine processes of the militarization of children’s everyday lives. This article investigates a range of ways in which authorities of proto-states in the Donbas region address children as participants and potential collaborators in the processes of militarization. In my analysis, I examine how war and preparation for it are simultaneously co-constituted by the geopolitical—legitimation of new proto-states—and everyday practices, such as engaging with school curricula, visiting museums, and (re)inventing historical narratives. Understanding of mechanisms that militarize childhood and how children become subjects and objects of militarization allows for a critical analysis that reveals spaces of everyday violence. This article, therefore, enhances our understanding about the intersections of childhood, militarism, and security.