bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke
Authors: Zhang Dongfeng , Song Xiantao , Raposeiras-Roubín Sergio , Abu-Assi Emad , Simao Henriques Jose Paulo , D’Ascenzo Fabrizio , Saucedo Jorge , González-Juanatey José Ramón , Wilton Stephen B. , Kikkert Wouter J. , Nuñez-Gil Iván , Ariza-Sole Albert , Alexopoulos Dimitrios , Liebetrau Christoph , Kawaji Tetsuma , Moretti Claudio , Huczek Zenon , Nie Shaoping , Fujii Toshiharu , Correia Luis , Kawashiri Masa-aki , Southern Danielle , Kalpak Oliver
Published: September 2021

Background:

Treatment of acute myocardial infarction (AMI) patients with prior stroke is a common clinical dilemma. Currently, the application of optimal medical therapy (OMT) and its impact on clinical outcomes are not clear in this patient population.

Methods:

We retrieved 765 AMI patients with prior stroke who underwent percutaneous coronary intervention (PCI) during the index hospitalization from the international multicenter BleeMACS registry. All of the subjects were divided into two groups based on the prescription they were given prior to discharge. Baseline characteristics and procedural variables were compared between the OMT and non-OMT groups. Mortality, re-AMI, major adverse cardiovascular events (MACE), and bleeding were followed-up for 1 year.

Results:

Approximately 5% of all patients presenting with AMI were admitted to the hospital for ischemic stroke. Although the prescription rate of each OMT medication was reasonably high (73.3%–97.3%), 47.7% lacked at least one OMT medication. Patients receiving OMT showed a significantly decreased occurrence of mortality (4.5% vs 15.1%, p < 0.001), re-AMI (4.2% vs 9.3%, p = 0.004), and the composite endpoint of death/re-AMI (8.6% vs 20.5%, p < 0.001) compared to those without OMT. No significant difference was observed between the groups regarding bleeding. After adjusting for confounding factors, OMT was the independent protective factor of 1-year mortality, while age was the independent risk factors.

Conclusions:

OMT at discharge was associated with a significantly lower 1-year mortality of patients with AMI and prior stroke in clinical practice. However, OMT was provided to just half of the eligible patients, leaving room for substantial improvement.

Clinical Trial Registration:

NCT02466854
Pro-protein convertase subtilisin/kexin type 9 promotes intestinal tumor development by activating Janus kinase 2/signal transducer and activator of transcription 3/SOCS3 signaling in ApcMin/+ mice
Authors: Yang Kai , Zhu Jie , Luo Huan-hua , Yu Shu-wen , Wang Lu
Published: September 2021

Introduction

Pro-protein convertase subtilisin/kexin type 9 (PCSK9) regulates lipoprotein homeostasis in humans. Evolocumab is a selective PCSK9 inhibitor that can reduce low-density lipoprotein cholesterol (LDLC) level and decrease hypercholesterolemia. The current study aimed to explore whether PCSK9 increases the risk of colorectal cancer.

Methods

First, we utilized the classic intestinal tumor ApcMin/+ mouse model and PCSK9 knock-in (KI) mice to establish ApcMin/+PCSK9(KI) mice. Then, we investigated the effect of PCSK9 overexpression in ApcMin/+PCSK9(KI) mice and PCSK9 inhibition using evolocumab on the progression of intestinal tumors in vivo by hematoxylin and eosin (HE) staining, Western blot, and immunohistochemistry (IHC) assay.

Results

ApcMin/+PCSK9(KI) mice had higher numbers and larger sizes of adenomas, with 83.3% of these mice developing adenocarcinoma (vs. 16.7% of ApcMin/+ mice). However, treatment with evolocumab reduced the number and size of adenomas and prevented the development of adenocarcinomas in ApcMin/+ mice. PCSK9 overexpression reduced tumor cell apoptosis, the Bax/bcl-2 ratio, and the levels of cytokine signaling 3 protein (SOCS3) suppressors, but activated Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signaling in intestinal tumors. In contrast, evolocumab treatment had the opposite effect on ApcMin/+mice.

Conclusion

PCSK9 might act as an oncogene or have an oncogenic role in the development and progression of colorectal cancer in vivo via activation of JAK2/STAT3/SOCS3 signaling.
Impact of Sustainable Tourism on Tourist’s Satisfaction: Evidence from India
Authors: Jasrotia Sahil Singh , Kamila Manoj Kumar , Patel Vinod Kumar
Published: September 2021

The tourism business is the most effective means to strengthen the economic and financial stability of a country. In a developing country like India this business acts as the backbone to improve the level of happiness of its residents. Sustainable tourism provides equal opportunity to every stakeholder to contribute their part in the development of the society as well as the site. The main purpose of the study was to explore the four dimensions of sustainable tourism, which involve “economic sustainability, environmental sustainability, sociocultural sustainability, and institutional sustainability,” and to study their impact on tourist’s satisfaction. This study involves a survey conducted on tourists visiting selected travel destinations from various states in India. The travel destinations selected for the study involved 26 destinations from 8 states of India. The results suggested a positive relationship of three (environmental, sociocultural, and institutional) sustainability dimensions on tourist’s satisfaction. Findings indicate that the dimensions of environment, sociocultural, and institutional sustainability are important for tourist’s satisfaction and should be included for a holistic approach to planning and monitoring sustainable tourism development.
Efficient production of human neutrophils from iPSCs that prevent murine lethal infection with immune cell recruitment
Authors: Miyauchi Masashi , Ito Yusuke , Nakahara Fumio , Hino Toshiya , Nakamura Fumi , Iwasaki Yuki , Kawagoshi Taiki , Koya Junji , Yoshimi Akihide , Arai Shunya , Kagoya Yuki , Kurokawa Mineo
Published: September 2021

Neutrophils play an essential role in innate immune responses to bacterial and fungal infections, and loss of neutrophil function can increase the risk of acquiring lethal infections in clinical settings. Here, we show that engineered neutrophil-primed progenitors derived from human induced pluripotent stem cells can produce functional neutrophil-like cells at a clinically applicable scale that can act rapidly in vivo against lethal bacterial infections. Using 5 different mouse models, we systematically demonstrated that these neutrophil-like cells migrate to sites of inflammation and infection and increase survival against bacterial infection. In addition, we found that these human neutrophil-like cells can recruit murine immune cells. This system potentially provides a straight-forward solution for patients with neutrophil deficiency: an off-the-shelf neutrophil transfusion. This platform should facilitate the administration of human neutrophils for a broad spectrum of physiological and pathological conditions.
The bone marrow niche from the inside out: how megakaryocytes are shaped by and shape hematopoiesis
Authors: Stone Andrew P. , Nascimento Thais F. , Barrachina Maria N.
Published: September 2021

Megakaryocytes (MKs), the largest of the hematopoietic cells, are responsible for producing platelets by extending and depositing long proplatelet extensions into the bloodstream. The traditional view of megakaryopoiesis describes the cellular journey from hematopoietic stem cells (HSCs) along the myeloid branch of hematopoiesis. However, recent studies suggest that MKs can be generated from multiple pathways, some of which do not require transit through multipotent or bipotent MK-erythroid progenitor stages in steady-state and emergency conditions. Growing evidence suggests that these emergency conditions are due to stress-induced molecular changes in the bone marrow (BM) microenvironment, also called the BM niche. These changes can result from insults that affect the BM cellular composition, microenvironment, architecture, or a combination of these factors. In this review, we explore MK development, focusing on recent studies showing that MKs can be generated from multiple divergent pathways. We highlight how the BM niche may encourage and alter these processes using different mechanisms of communication, such as direct cell-to-cell contact, secreted molecules (autocrine and paracrine signaling), and the release of cellular components (eg, extracellular vesicles). We also explore how MKs can actively build and shape the surrounding BM niche.
Insights in ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia
Authors: Greinacher Andreas , Selleng Kathleen , Palankar Raghavendra , Wesche Jan , Handtke Stefan , Wolff Martina , Aurich Konstanze , Lalk Michael , Methling Karen , Völker Uwe , Hentschker Christian , Michalik Stephan , Steil Leif , Reder Alexander , Schönborn Linda , Beer Martin , Franzke Kati , Büttner Andreas , Fehse Boris , Stavrou Evi X. , Rangaswamy Chandini , Mailer Reiner K. , Englert Hanna , Frye Maike , Thiele Thomas , Kochanek Stefan , Krutzke Lea , Siegerist Florian , Endlich Nicole , Warkentin Theodore E. , Renné Thomas
Published: September 2021

SARS-CoV-2 vaccine ChAdOx1 nCoV-19 (AstraZeneca) causes a thromboembolic complication termed vaccine-induced immune thrombotic thrombocytopenia (VITT). Using biophysical techniques, mouse models, and analysis of VITT patient samples, we identified determinants of this vaccine-induced adverse reaction. Super-resolution microscopy visualized vaccine components forming antigenic complexes with platelet factor 4 (PF4) on platelet surfaces to which anti-PF4 antibodies obtained from VITT patients bound. PF4/vaccine complex formation was charge-driven and increased by addition of DNA. Proteomics identified substantial amounts of virus production-derived T-REx HEK293 proteins in the ethylenediaminetetraacetic acid (EDTA)-containing vaccine. Injected vaccine increased vascular leakage in mice, leading to systemic dissemination of vaccine components known to stimulate immune responses. Together, PF4/vaccine complex formation and the vaccine-stimulated proinflammatory milieu trigger a pronounced B-cell response that results in the formation of high-avidity anti-PF4 antibodies in VITT patients. The resulting high-titer anti-PF4 antibodies potently activated platelets in the presence of PF4 or DNA and polyphosphate polyanions. Anti-PF4 VITT patient antibodies also stimulated neutrophils to release neutrophil extracellular traps (NETs) in a platelet PF4-dependent manner. Biomarkers of procoagulant NETs were elevated in VITT patient serum, and NETs were visualized in abundance by immunohistochemistry in cerebral vein thrombi obtained from VITT patients. Together, vaccine-induced PF4/adenovirus aggregates and proinflammatory reactions stimulate pathologic anti-PF4 antibody production that drives thrombosis in VITT. The data support a 2-step mechanism underlying VITT that resembles the pathogenesis of (autoimmune) heparin-induced thrombocytopenia.
SARS-CoV-2 vaccination and ITP in patients with de novo or preexisting ITP
Authors: Lee Eun-Ju , Beltrami-Moreira Marina , Al-Samkari Hanny , Cuker Adam , DiRaimo Jennifer , Gernsheimer Terry , Kruse Alexandra , Kessler Craig , Kruse Caroline , Leavitt Andrew D. , Lee Alfred I. , Liebman Howard A. , Newland Adrian C. , Ray Ashley E. , Tarantino Michael D. , Thachil Jecko , Kuter David J. , Cines Douglas B. , Bussel James B.
Published: September 2021

Cases of de novo immune thrombocytopenia (ITP), including a fatality, following SARS-CoV-2 vaccination in previously healthy recipients led to studying its impact in preexisting ITP. In this study, 4 data sources were analyzed: the Vaccine Adverse Events Reporting System (VAERS) for cases of de novo ITP; a 10-center retrospective study of adults with preexisting ITP receiving SARS-CoV-2 vaccination; and surveys distributed by the Platelet Disorder Support Association (PDSA) and the United Kingdom (UK) ITP Support Association. Seventy-seven de novo ITP cases were identified in VAERS, presenting with median platelet count of 3 [1-9] ×109/L approximately 1 week postvaccination. Of 28 patients with available data, 26 responded to treatment with corticosteroids and/or intravenous immunoglobulin (IVIG), and/or platelet transfusions. Among 117 patients with preexisting ITP who received a SARS-CoV-2 vaccine, 19 experienced an ITP exacerbation (any of: ≥50% decline in platelet count, nadir platelet count <30 × 109/L with >20% decrease from baseline, and/or use of rescue therapy) following the first dose and 14 of 70 after a second dose. Splenectomized persons and those who received 5 or more prior lines of therapy were at highest risk of ITP exacerbation. Fifteen patients received and responded to rescue treatment. In surveys of both 57 PDSA and 43 UK patients with ITP, prior splenectomy was associated with worsened thrombocytopenia. ITP may worsen in preexisting ITP or be identified de novo post–SARS-CoV2 vaccination; both situations responded well to treatment. Proactive monitoring of patients with known ITP, especially those postsplenectomy and with more refractory disease, is indicated.
Correction to: Genetic dissection of grain architecture-related traits in a winter wheat population
Authors: Schierenbeck Matías , Alqudah Ahmad M. , Lohwasser Ulrike , Tarawneh Rasha A. , Simón María Rosa , Börner Andreas
Published: September 2021

An amendment to this paper has been published and can be accessed via the original article.
Clinical presentation and outcomes of non-typhoidal Salmonella infections in patients with cancer
Authors: Mori Nobuyoshi , Szvalb Ariel D. , Adachi Javier A. , Tarrand Jeffrey J. , Mulanovich Victor E.
Published: September 2021

Background

Non-typhoidal Salmonella (NTS) infection is thought to be more severe in cancer patients, but this has not been studied since the development of new cancer therapies, increasing antibiotic resistance and the introduction of new antibiotics. We sought to describe the demographic characteristics, microbiological findings, clinical manifestations, and outcomes of NTS infections in cancer patients at our institution.

Methods

We reviewed microbiology laboratory records and identified patients who had cancer and from whom NTS organisms were recovered between January 1, 2000 and December 31, 2013, at a comprehensive cancer center in Houston, Texas. Descriptive statistics were used to summarize patient characteristics, clinical presentation and outcomes.

Results

We identified 110 isolates from 82 patients with 88 episodes of NTS infection (including five relapses [6%] in four patients, and two consecutive episodes in one patient). Fifty-five patients (67%) had hematologic malignancies. Most NTS isolates were susceptible to the commonly prescribed antimicrobials. Sixty-nine percent of patients had sepsis and one-third had severe sepsis or septic shock. Gastroenteritis, bacteremia, or both were present in 69% of patients, and the rest had focal infection. Mortality at 30 days was low (8%). Relapses occurred only in patients receiving ≤ 10 days of antibiotic therapy.

Conclusions

NTS affects predominantly patients with hematologic malignancies, followed by gastrointestinal and genitourinary cancers. Invasive disease, sepsis, and septic shock are common presentations among admitted patients. Antimicrobial prophylaxis may not prevent NTS infection. Thirty-day mortality and attributable mortality rates were low in our series compared to older case series. Early appropriate antibiotic therapy may have had a role in decreasing mortality. Relapses occurred in patients receiving ≤ 10 days of therapy, suggesting the need for longer duration of antibiotic therapy in cancer patients with uncomplicated NTS infections.
The concordance between preoperative aspiration and intraoperative synovial fluid culture results: intraoperative synovial fluid re-cultures are necessary whether the preoperative aspiration culture is positive or not
Authors: Li Hao , Xu Chi , Hao LiBo , Chai Wei , Jun Fu , Chen Jiying
Published: September 2021

Aims

Preoperative aspiration culture and intraoperative cultures play pivotal roles in periprosthetic joint infection (PJI) diagnosis and pathogen identification. But the discordance between preoperative aspiration culture and intraoperative synovial fluid culture remains unknown. We aim to determine (1) the discordance between preoperative and intraoperative synovial fluid (SF) culture and. (2) compared to intraoperative synovial fluid cultures, the sensitivity of preoperative aspiration fluid culture. Then the following question is tried to be answered: Are intraoperative synovial fluid re-cultures necessary if the preoperative aspiration culture is positive?

Materials and methods

Between 2015 and 2019, 187 PJI patients managed with surgeries were included in this study. Compared to intraoperative synovial fluid culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative aspiration culture were calculated. Then, the discordance between preoperative aspiration culture and intraoperative SF culture was analyzed.

Results

The sensitivity of preoperative aspiration culture was 81.29% compared to intraoperative synovial fluid cultures. Concordance was identified in 147 PJI (78.61%) patients and culture discordance occurred in 40 patients (21.39%). In these discordant PJI patients, 24 patients (60%) were polymicrobial and no intraoperative synovial fluid culture growth was found in 16 PJI cases (40%). Preoperative monomicrobial staphylococcus results had a sensitivity of and a specificity of 80.43% and 83.16%, respectively. Preoperative polymicrobial results had the lowest sensitivity.

Conclusions

The intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when Streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture.

Level of evidence: Level III.
Rasch analysis of the Brain Injury Screening Tool (BIST) in mild traumatic brain injury
Authors: Shaikh Nusratnaaz , Theadom Alice , Siegert Richard , Hardaker Natalie , King Doug , Hume Patria
Published: September 2021

Objective

To evaluate the psychometric properties of the Brain Injury Screening Tool (BIST) symptom scale in a sample of people with a mild Traumatic Brain Injury (mTBI) through Rasch analysis, and to obtain an interval level measurement score for potential clinical use.

Materials and methods

Data were obtained from 114 adults aged over 16 years, who had experienced at least one mTBI in the past 10 years. Participants were recruited via social media, concussion clinics and sports organisations over a 4-month period between May and September 2020. Participants were asked to compete the symptom scale of the BIST tool via an anonymous online questionnaire. Internal construct validity, dimensionality, person separation index, and differential item functioning of the BIST were examined with Rasch analysis.

Results

BIST in its original form produced a satisfactory item-trait interaction, and good reliability, but was found to be multi-dimensional. Rasch analysis of the full scale with three domains as subtests resulted in acceptable model fit (χ2(6) =3.8, p >  0.05), with good reliability (Person Separation Index = 0.84), and uni-dimensionality. Differential Item Functioning (DIF) analysis displayed no significant DIF effects for sex or age revealing that people responded consistently and similarly to the individual BIST items based on severity of symptom burden.

Conclusions

The 15-item symptom scale of the BIST tool is a psychometrically sound measure of symptom burden following mTBI. The findings provide support for use of both total and sub scale scores for clinical use. Ordinal to interval score conversions are recommended for use when using the scores for research purposes in mTBI.
Hybrid Oxford unicompartmental knee arthroplasty has lower residual cement extrusion than cemented arthroplasty in treating end-stage unicompartmental knee osteoarthritis
Authors: Yang Guangzhong , Jiao Xufeng , Li Qianli , Li Zheng , An Shuai , Feng Mingli , Gao Guanghan , Huang Jiang , Cao Guanglei
Published: September 2021

Background

Hybrid Oxford unicompartmental knee arthroplasty (OUKA) consists of cementless femoral prostheses and cemented tibial prostheses. Although a hybrid OUKA has been used in clinical practice, the clinical outcome has not been reported. The purpose of this study was to compare the short-term clinical outcomes and rate of residual bone cement extrusion between hybrid and cemented prostheses and analyse the possible reasons for differences between outcomes.

Methods

A total of 128 knees (118 patients) with end-stage osteoarthritis were included in this study, of which underwent consecutive operations using unicondylar Oxford phase 3 implants from July 2017 and September 2019 in our centre. Follow-up was performed at 6 weeks, 3 and 6 months, 1 year and every year after operation, and complications and changes in the Oxford knee score (OKS) were recorded. The OKS of the two groups was analysed by the generalized estimating equation approach. Prosthesis-based standard fluoroscopy was performed in a timely manner after each operation, and the rate of residual cement extrusion of the two groups was estimated using T-tests and a multivariate regression analysis.

Results

Excluding the cases that lost follow-up, a total of 120 knees (65 in hybrid group and 55 in cemented group) were included in the analysis. There was no statistically significant difference in patient characteristics between the two groups (p > 0.05). The average follow-up time was 23.4 months (and ranged from 12 to 38 months). As of the last follow-up, there were no complications, such as dislocation, fracture, prosthesis loosening and subsidence, but one patient in the cemented group experienced symptoms caused by residual loose cement. Postoperative OKS in both groups improved significantly (p < 0.001). There was no significant difference in the OKS at any point during the follow-up or in the improvement of the OKS between the two groups (p > 0.05). Residual cement was mainly extruded behind the tibial prosthesis. The rate of hybrid periprosthetic residual cement extrusion was significantly lower in the hybrid group than in the cemented group, and the difference was statistically significant (OR = 3.38; p = 0.014).

Conclusions

Hybrid OUKA is as effective as cemented OUKA in the short term after operation and can significantly reduce the residual cement extrusion rate around the tibial prosthesis.
Acceptance of COVID-19 vaccination and its determinants among Lebanese dentists: a cross-sectional study
Authors: Nasr Lara , Saleh Nadine , Hleyhel Mira , El-Outa Abbass , Noujeim Ziad
Published: September 2021

Background

Dentists are at high risk of exposure to occupational Coronavirus Disease 2019 (COVID-19). Since vaccination is crucial to control COVID-19 pandemic, we aimed to assess COVID-19 vaccination acceptance and its determinants among Lebanese practicing dentists.

Methods

A cross-sectional online study was conducted between February 15 and 22, 2021, among dentists practicing in Lebanon. Prevalence of COVID-19 vaccine acceptance was estimated. A multivariable modified Poisson regression model was used to explore determinants of COVID-19 vaccine acceptance.

Results

In total, 86% of participants were willing to receive or have already received a COVID-19 vaccine. Having received the influenza vaccine during the COVID-19 pandemic was linked to a 12% increase in the COVID-19 vaccination acceptance rate. In addition, participants having moderate and high COVID-19 vaccination knowledge levels were more likely to accept receiving the vaccine, and participants whose fear of COVID-19 level was high were more likely to accept receiving the vaccine compared to those having a low fear level. Contrarily, those who visit the medical doctor only when needed and once a year were less likely to accept COVID-19 vaccine compared to participants who routinely visit the medical doctor.

Conclusions

Our study showed a high level of acceptance of COVID-19 vaccination among Lebanese practicing dentists. And since knowledge about COVID-19 vaccination was associated with the vaccine acceptance, it should be improved and updated to further increase the acceptance rate. High acceptability of COVID-19 vaccination among dentists is expected to have a positive impact among the population in terms of increasing awareness and vaccine uptake.
Interprofessional survey on communication skills in veterinary and veterinary-related education in Germany
Authors: Rauch Michèle , Wissing Sandra , Tipold Andrea , Kleinsorgen Christin
Published: September 2021

Background

Communication is an indispensable skill in the everyday working life of a veterinary team. In German higher educational institutions, communication skills training is explicitly mentioned in the curricula of veterinary assistants, including veterinary nurses and veterinary technicians, and of animal keepers, but not for undergraduate veterinary medicine. Little is known about interprofessional education in veterinary medicine and related professions. Therefore, the purpose of this study is to describe and explore the current interprofessional state of knowledge regarding communication skills of the aforementioned groups in Germany.

Methods

To explore the perception, assess the knowledge and identify the attitude regarding communication skills and interprofessional training, an online survey was distributed. The survey was sent to all five veterinary higher educational institutions, 38 schools for veterinary assistants and 15 schools for animal keepers throughout Germany.

Results

In total, 294 veterinary students, 111 veterinary assistant trainees and 62 animal keeper trainees participated. The majority of participants (98.07%, n = 458) perceived communication skills as highly important for their everyday work. In total, 413 participants (88.44%) felt that their communication skills needed improvement and more than half admitted having difficulties in effective communication (59.31%; n = 277). In addition, 62.74% of respondents (n = 293) were not sufficiently informed about the training content of their future colleagues. Most were convinced that training could positively influence on their communication with clients (95.72%; n = 447) and the team (92.29%; n = 431), and 76.45% of respondents (n = 357) wished to participate in an interprofessional training.

Conclusions

Results of this study confirm that communication skills are perceived as highly important for professional life. Students and trainees show a great interest in communication skills and interprofessional training. The findings indicate that appropriate adjustments to existing curricula are necessary in Germany.
Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis
Authors: León-Giraldo Sebastián , Cuervo-Sánchez Juan Sebastián , Casas Germán , González-Uribe Catalina , Kreif Noemi , Bernal Oscar , Moreno-Serra Rodrigo
Published: September 2021

Background

The present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016.

Methods

The study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method.

Results

The incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3 to 30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability.

Conclusions

Conflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.
Association between the APOE gene polymorphism and lipid profile and the risk of atrial fibrillation
Authors: Deng Xunwei , Hou Jingyuan , Deng Qiaoting , Zhong Zhixiong
Published: September 2021

Background

The relationship between the APOE gene polymorphism and lipid profiles and atrial fibrillation (AF) remains controversial. The current study purposed to investigate how the APOE gene SNPs (rs429358 and rs7412) and lipid profile are associated with the risk for AF among the Hakka population in southern China.

Methods

Finally, 1367 patients were enrolled in this study, including 706 participants with AF (41 ~ 98 years old, 58.64 % male) and 661 non-AF subjects (28 ~ 95 years old, 59.46 % male). The collected data included baseline characteristics, medical history, laboratory tests and echocardiography parameters. A general linear model (two-way analysis of variance (ANOVA)) and Tukey post-hoc tests were applied to identify an APOE allele, AF group, and interaction effect on lipid profiles. Logistic regression analysis was performed to identify risk factors for AF.

Results

For AF group, the most common genotype was E3/E3 (53.82 %), followed by E3/E4 (28.19 %), E2/E3 (13.60 %), E4/E4 (1.98 %), E2/E4 (1.84 %) and E2/E2 (0.57 %). The two-way ANOVA followed by the Tukey procedure showed the following: the lipid levels depended significantly on AF and APOE allele groups for TG, TC, LDL-C and Apo-B (all P < 0.001), and statistically significant interactions between AF and APOE allele were observed in the above 4 variables (all P < 0.05). Multivariate regression analysis indicated that age ≥ 65years (P < 0.001), high diastolic blood pressure (DBP ≥ 90mm Hg, P = 0.018), a high levels of total cholesterol (TC ≥ 5.2mmol/L, P < 0.001) and triglyceride (TG ≥ 1.7mmol/L, P = 0.028), but not the two SNPs of the APOE gene (rs7412 and rs429358) (OR 1.079, P = 0.683), were significant independent risk factors for AF in the study population.

Conclusions

The principal findings of this study showed that individuals at high risk for AF were those over 65 years of age, higher DBP as well as high levels of TC and TG among the southern China Hakka population. The levels of TG, TC, LDL-C and Apo-B depended significantly on AF and APOE allele groups, and statistically significant interactions between AF and APOE allele were observed in the above 4 variables, although the APOE gene SNPs (rs429358 and rs7412) were no significant risk for AF incidence. Further investigation is needed to elucidate whether other SNPs of the APOE gene have a bearing on AF incidents.
Main differences between two highly effective lipid-lowering therapies in subclasses of lipoproteins in patients with acute myocardial infarction
Authors: Pinto Leticia C. S. , Mello Ana P. Q. , Izar Maria C. O. , Damasceno Nagila R. T. , Neto Antonio M. F. , França Carolina N. , Caixeta Adriano , Bianco Henrique T. , Póvoa Rui M. S. , Moreira Flavio T. , Bacchin Amanda S. F. , Fonseca Francisco A.
Published: September 2021

Background

Large observational studies have shown that small, dense LDL subfractions are related to atherosclerotic cardiovascular disease. This study assessed the effects of two highly effective lipid-lowering therapies in the atherogenic subclasses of lipoproteins in subjects with ST-segment elevation myocardial infarction (STEMI).

Methods

Patients of both sexes admitted with their first myocardial infarction and submitted to pharmacoinvasive strategy (N = 101) were included and randomized using a central computerized system to receive a daily dose of simvastatin 40 mg plus ezetimibe 10 mg or rosuvastatin 20 mg for 30 days. Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) subfractions were analysed by polyacrylamide gel electrophoresis (Lipoprint System) on the first (D1) and 30th days (D30) of lipid-lowering therapy. Changes in LDL and IDL subfractions between D1 and D30 were compared between the lipid-lowering therapies (Mann-Whitney U test).

Results

The classic lipid profile was similar in both therapy arms at D1 and D30. At D30, the achievement of lipid goals was comparable between lipid-lowering therapies. Cholesterol content in atherogenic subclasses of LDL (p = 0.043) and IDL (p = 0.047) decreased more efficiently with simvastatin plus ezetimibe than with rosuvastatin.

Conclusions

Lipid-lowering therapy with simvastatin plus ezetimibe was associated with a better pattern of lipoprotein subfractions than rosuvastatin monotherapy. This finding was noted despite similar effects in the classic lipid profile and may contribute to residual cardiovascular risk.

Trial registration

ClinicalTrials.gov, NCT02428374, registered on 28/09/2014.
Association between thyroid disorders and COVID-19: a protocol for a systematic review and meta-analysis
Authors: Doustmohammadian Soraya , Doustmohammadian Azam , Momeni Marjan
Published: September 2021

Background

The novel coronavirus (COVID-19) epidemic initially appeared in Wuhan, Hubei Province, China, on 31 December 2019 and was spread rapidly worldwide. Most underlying diseases reported with COVID-19 patients are diabetes, hypertension, coronary heart diseases, and cerebrovascular disease. We do not know whether individuals with thyroid disease are at increased risk of COVID-19 infection.

Methods

Two experienced researchers will conduct an electronic search of the databases including PubMed/MEDLINE, the Cochrane Reviews, and the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and ProQuest, for articles published since October 2019. Clinical trials and observational studies will be included. Studies will be screened after de-duplication. A standardized data extraction form will be developed through discussions with the review team and will be revised after piloting. An appropriate risk of bias assessment tool will be used to assess the quality of studies. Two independent reviewers will assess the eligibility, extraction of detailed information, and quality assessment of studies. The results will be pooled for meta-analysis, subgroup analysis and/or descriptive analysis based on the included data conditions.

Conclusion

Results of this study will provide current evidence on the association of COVID-19 diseases with any thyroid disorders such as hypothyroidism, thyrotoxicosis, and thyroid cancer with or without radioiodine therapy. Findings will be disseminated in peer-reviewed publications and conference presentations.

Trial registration

PROSPERO registration number: CRD42020184289.

https://www.crd.york.ac.uk/PROSPERO/#recordDetails
Increasing the power of interpretation for soil metaproteomics data
Authors: Jouffret Virginie , Miotello Guylaine , Culotta Karen , Ayrault Sophie , Pible Olivier , Armengaud Jean
Published: September 2021

Background

Soil and sediment microorganisms are highly phylogenetically diverse but are currently largely under-represented in public molecular databases. Their functional characterization by means of metaproteomics is usually performed using metagenomic sequences acquired for the same sample. However, such hugely diverse metagenomic datasets are difficult to assemble; in parallel, theoretical proteomes from isolates available in generic databases are of high quality. Both these factors advocate for the use of theoretical proteomes in metaproteomics interpretation pipelines. Here, we examined a number of database construction strategies with a view to increasing the outputs of metaproteomics studies performed on soil samples.

Results

The number of peptide-spectrum matches was found to be of comparable magnitude when using public or sample-specific metagenomics-derived databases. However, numbers were significantly increased when a combination of both types of information was used in a two-step cascaded search. Our data also indicate that the functional annotation of the metaproteomics dataset can be maximized by using a combination of both types of databases.

Conclusions

A two-step strategy combining sample-specific metagenome database and public databases such as the non-redundant NCBI database and a massive soil gene catalog allows maximizing the metaproteomic interpretation both in terms of ratio of assigned spectra and retrieval of function-derived information.
Cultural dimensions of sacred forests in the Western Ghats Biodiversity Hot Spot, Southern India and its implications for biodiversity protection
Authors: Patwardhan Ankur , Ghate Pooja , Mhaskar Monali , Bansude Amit
Published: September 2021

Sacred groves are relict forests dedicated to local deities that have been informally protected and managed by local communities over centuries. To gain greater insights into underlying sociocultural reasons for protection, and possibilities of strengthening such efforts, a study has been undertaken in 66 sacred groves in the Maharashtra State of Western Ghats biodiversity hot-spot in India, which shows different facets of human-nature relationships. Primary data on size, ownership, deity, religious aspects and awareness amongst the local people was collected through site visits, semi-structured interviews, and by participating in village meetings. It was observed that village councils owned 48% of the groves as against temple trusts (41%) and forest department plus individually owned groves (11%). Nearly 52% of the groves have an area less than one-half hectare. Forty-seven percent of the groves have male deities, 29% female deities and 26% were dedicated to spirits. Eighty percent of the local people were aware of cultural and religious aspects associated with the groves, whereas awareness about ecological and utilitarian values declined steeply to less than 20% of the population, necessitating the explanation of scientific conservation values of these critical ecosystems to the local people. The paper also discusses the significance of such studies in connection with the relevant UN Sustainable Development Goals and AICHI Biodiversity targets. In addition, it also discusses links with national biodiversity targets and how legal provisions under India’s Biological Diversity Act (2002) can be used to benefit both the ecosystem and the cultural values of the people, and how such informal institutions can be strengthened under formal protection mechanisms.
Experimentation or projectification of urban change? A critical appraisal and three steps forward
Authors: Torrens Jonas , von Wirth Timo
Published: September 2021

Urban experimentation has proliferated in recent years as a response to sustainability challenges and renewed pressures on urban governance. In many European cities, diverse and rapidly changing experimental forms (e.g. urban living laboratories, pilots, trials, experimental districts) are becoming commonplace, addressing ambitious goals for smartness, circularity, and liveability. Academically, there is a growing concern for moving beyond the focus on individual experiments and the insistence on upscaling their primary transformation mechanism. However, the phenomena of ‘projectification’ – whereby project-based forms of organising have become ubiquitous, shaping expectations about experimentation – is increasingly perceived as a barrier. Nevertheless, how specifically experimentation and projectification intersect remains unclear. Our theoretical perspective examines how the widespread tendency towards projectification shapes urban experimentation and the potential implications for urban transformations. It problematises the current wave of experimentation and how it contributes to the projectification of urban change processes. We present three steps to redress this issue and indicate directions for future research.
Surgical management of cellular congenital mesoblastic nephroma in a neonate: a case report and review of literature
Authors: Ihab Ali , Abdullah Al Otaibi , Abdullah Abduldaem , Mohammad Alonazi , Maha Nojoom
Published: September 2021

Background

Congenital mesoblastic nephroma (CMN) is the most common type of renal stromal tumor in neonates. It is classified into cellular, classical, and mixed types. The multidisciplinary management approach is the mainstay of management. We are reporting a case of neonatal congenital mesoblastic nephroma in a full-term boy with intrauterine growth restriction and hypertension managed effectively in our institution.

Case presentation

A full-term boy with intrauterine growth restriction (IUGR) with a birth weight of 2.3 kg, referred at birth with an abdominal mass. His antenatal scan at 35 weeks showed a cystic abdominal mass. On delivery, a huge visible abdominal mass of cystic consistency and smooth surface was noticed at the right side of the abdomen. blood pressure was 98/75 mmHg. It was responsive to hydralazine. Aldosterone and renin were significantly elevated at more than 100 and 500 ng/dl, respectively. Serum neurone-specific enolase (NSE) was 35 ng/ml while alfa feto protein was (AFP) 50,000 kIU/L. An abdominal ultrasound scan revealed an ill-defined large heterogeneous mass of 6.09 × 6.5 × 5.77 cm that arises from the right kidney. A computed tomography scan confirmed a right kidney mass with peripheral claw sign of the normal right renal tissue. It was crossing the midline and causing a mass effect on the adjacent structures. The right renal artery and vein were compressed and shifted posteriorly and inferomedially. Right radical nephrectomy was performed via a right lower transverse incision. The tumor was completely excised with a tumor weight of 270 g and a size of 10.5 × 8 × 5.5 cm. Histopathological diagnosis was mesoblastic nephroma of a cellular type which was confirmed by immunohistochemistry. Post-operatively, the blood pressure has significantly reduced and antihypertensive medications were eventually weaned off. The multidisciplinary team decided to preserve chemotherapy only in case of recurrence. At 3 months follow-up, no features of recurrence were noticed based on surveillance ultrasonography.

Conclusion

Mesoblastic nephroma should be considered in any newborn with renal mass. The multidisciplinary team approach with aggressive management of hypertension, detailed radiological investigation, and complete tumor resection is fundamental for obtaining an excellent outcome for such entities.
Rayleigh wave equations with couple stress: Modeling and dispersion characteristic
Authors: Wu Yanqi , Ma Jianwei
Published: September 2021

In elastostatics, the scale effect is a phenomenon in which the elastic parameters of a medium vary with the specimen size when the specimen is sufficiently small. Linear elasticity cannot explain the scale effect because it assumes that the medium is a continuum and does not consider microscopic rotational interactions within the medium. In elastodynamics, wave-propagation equations are usually based on linear elasticity. Thus, nonlinear elasticity must be introduced to study the scale effect on wave propagation. We have developed one of the generalized continuum theories, a so-called couple-stress theory, into solid earth geophysics to build a more practical model of the underground medium. The first-order velocity-stress wave equation is derived to simulate the propagation of Rayleigh waves. Body and Rayleigh waves are compared using elastic theory and couple-stress theory in a homogeneous half-space and a layered space. The results indicate that couple stress causes the dispersion of surface waves and S-waves even in a homogeneous half-space. The effect is enhanced by increasing the source frequency and characteristic length, despite its insufficiently clear physical meaning. Rayleigh waves are more sensitive to the couple-stress effect than are body waves. Based on the phase-shifting method, it is determined that Rayleigh waves exhibit different dispersion characteristics in the couple-stress theory than in the conventional elastic theory. For the fundamental mode, dispersion curves tend to move to a lower frequency with an increase in characteristic length [Formula: see text]. For the higher modes, the dispersion curve energy is stronger with a greater characteristic length [Formula: see text].
Model reduction in geostatistical seismic inversion with functional data analysis
Authors: Azevedo Leonardo
Published: September 2021

In subsurface modeling and characterization, predicting the spatial distribution of subsurface elastic properties is commonly achieved by seismic inversion. Stochastic seismic inversion methods, such as iterative geostatistical seismic inversion (GSI), are widely applied to this end. Global iterative GSI methods are computationally expensive because they require, at a given iteration, the stochastic sequential simulation of the entire inversion grid at once multiple times. Functional data analysis (FDA) is a well-established statistical method suited to model long-term and noisy temporal series. This method allows us to summarize spatiotemporal series in a set of analytical functions with a low-dimension representation. FDA has been recently extended to problems related to geosciences, but its application to geophysics is still limited. We have developed the use of FDA as a model reduction technique during the model perturbation step in global iterative GSI. FDA is used to collapse the vertical dimension of the inversion grid. We illustrate our hybrid inversion method with its application to 3D synthetic and real data sets. The results indicate the ability of our inversion methodology to predict smooth inverted subsurface models that match the observed data at a similar convergence as obtained by a global iterative GSI, but with a considerable decrease in the computational cost. Although the resolution of the inverted models might not be enough for a detailed subsurface characterization, the inverted models can be used as a starting point of global iterative GSI to speed up the inversion or to test alternative geologic scenarios by changing the inversion parameterization and obtaining inverted models in a relatively short time.