bluuebunny/crossref_metadata_2025 huggingface dataset:
Bronchial Brushing and Diagnosis of Pulmonary Nontuberculous Mycobacteria Infection
Authors: Urabe Naohisa , Sakamoto Susumu , Ito Ai , Sekiguchi Ryo , Shimanuki Yui , Kanokogi Takumi , Motohashi Takumi , Anzai Nanami , Homma Sakae , Kishi Kazuma
Published: May 2021

Background: The optimal bronchoscopy procedure for diagnosis of pulmonary nontuberculous mycobacteria (NTM) infection is unclear. Objective: This study investigated the usefulness of bronchial brushing in bronchoscopy for diagnosis of pulmonary NTM infection in patients with suspected NTM lung disease and nodular bronchiectasis on chest computed tomography (CT) images. Methods: Bronchoscopy was prospectively performed for 69 patients with clinically suspected pulmonary NTM infection on chest CT from December 2017 through December 2019. Before and after bronchial brushing, bronchial washing was performed with 20 or 40 mL of normal sterile saline at the same segmental or subsegmental bronchi. Before and after bronchial brushing, samples of the washing fluid (pre- and postbrushing samples) and brush deposits (brush samples) were obtained and cultured separately. Results: NTM was detected in 37 of the 69 (53.6%) patients (Mycobacterium avium in 27, Mycobacterium intracellulare in 7, M. abscessus in 2, and M. kansasii in 2). NTM was detected in 34 (49.3%) prebrushing samples, in 27 (39.1%) postbrushing samples, and in 20 (29.0%) brush samples from the 69 patients. In 2 (2.9%) patients, NTM was detected only in postbrushing samples; in 1 (1.4%) patient, NTM was detected only in a brush sample. As compared with bronchial washing only, additional bronchial brushing increased the NTM culture-positive rate by 4.3% (3/69). Bronchial brushing caused bleeding, requiring hemostasis in 5 (7.2%) patients. Conclusion: Additional bronchial brushing increased the NTM culture-positive rate by only 4.3% (3/69), as compared with bronchial washing alone. Thus, the usefulness of brushing appears to be limited.
Phenotype-Genotype Correlation in Colorectal Cancer: A Real-Life Study
Authors: Frias-Gomes Catarina , Sousa Ana Carla , Rolim Inês , Henriques Ana Raquel , Branco Francisco , Janeiro André , Malveiro Sara , Dário Ana Rita , Oliveira Maria Helena , Borralho Paula , Teixeira José Alberto , Faria Ana , Maio Rui , Fonseca Isabel , Cravo Marília
Published: May 2021

Background and Aims: Colorectal cancer (CRC) is a heterogeneous disease with distinctive genetic pathways, such as chromosomal instability, microsatellite instability and methylator pathway. Our aim was to correlate clinical and genetic characteristics of CRC patients in order to understand clinical implications of tumour genotype. Methods: Single-institution retrospective cohort of patients who underwent curative surgery for CRC, from 2012 to 2014. RAS and BRAF mutations were evaluated with the real-time PCR technique Idylla®. Mismatch repair deficiency (dMMR) was characterized by absence of MLH1, MSH6, MSH2 and/or PMS2 expression, evaluated by tissue microarrays. Overall survival (OS) and disease-free survival (DFS) were assessed using survival analysis. Results: Overall, 242 patients were included (males 57.4%, age 69.3 ± 12.9 years; median follow-up 49 months). RAS-mutated tumours were associated with reduced DFS (p = 0.02) and OS (p = 0.045) in stage I–III CRC. BRAF-mutated tumours were more predominant in females and in the right colon, similarly to dMMR tumours. BRAF status did not influence OS (4 years)/DFS (3.5 years) in stage I–III disease. However, after relapse, length of survival was 3.5 months in BRAF-mutated tumours in contrast to 18.6 months in BRAF wild-type tumours (p = NS). No germline mutations in mismatch repair genes were so far identified in the patients with dMMR tumours. Molecular phenotype (RAS, BRAF and MMR) did not influence OS in metastatic patients. Our small sample size may be a limitation of the study. Conclusion: In our cohort, RAS-mutated tumours were associated with worse DFS and OS in early-stage CRC, whereas the remaining molecular variables had no prognostic influence.
Improving Survival in Lymphangioleio­myomatosis: A 16-Year Observational Study in a Large Cohort of Patients
Authors: Harari Sergio , Torre Olga , Elia Davide , Caminati Antonella , Pelosi Giuseppe , Specchia Claudia , Zompatori Maurizio , Cassandro Roberto
Published: May 2021

Background: Over the last 2 decades, great progress has been made in the understanding of the clinical aspects and pathogenesis of lymphangioleiomyomatosis (LAM), leading to publication of guidelines and approval of an effective therapy. Objectives: Aim of our study was to describe how the management and the natural history of this rare disease have changed after the publication of the ERS and American Thoracic Society/Japanese Respiratory Society guidelines and the introduction of sirolimus. Methods: We examined 162 LAM patients followed at our center between 2001 and 2017, reporting clinical characteristics and diagnostic approach. Response to sirolimus in patients undergoing long-term treatment and mortality risk, estimated in terms of cumulative incidence taking into account organ transplantation as a competing cause of the event, were evaluated. The difference in the cumulative incidence between the patients admitted to the observation before 2011 and after 2011, year of the publication of the MILES trial for the efficacy of sirolimus, has also been estimated. Results: Sixty-one patients had a histological diagnosis (22 from 2010 onward). 101 patients received a radiological diagnosis according to the guidelines criteria. Pulmonary function tests remained stable over a 3-year treatment period in patients who received sirolimus for over 12 months. The cumulative incidence of mortality after 10 years in the whole population was 25.5%. The cumulative incidence of mortality after 5 years was significantly lower in patients who entered the study since 2011 (after publication of the MILES trial) than in patients who entered the study before. Conclusions: We provide the data supporting the long-term efficacy of sirolimus therapy in a large cohort of patients with functional impairment and other manifestations of the disease. Our results also suggest that the advent of sirolimus and the publication of international guidelines changed the natural history of the disease lowering the mortality and reducing the need of invasive diagnostic techniques.
Routine Use of Air Tamponade in Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair
Authors: Singh Alexandra , Boustani Gabriel , Michez Marine , Bali Ernesto
Published: May 2021

Purpose: The aim of this study is to establish if air can be considered as a safe substitute for long-lasting tamponade agents for primary rhegmatogenous retinal detachment (RRD) treatment, regardless of the position or the number of retinal breaks. Methods: In this study, 230 consecutive patients (236 eyes) who underwent a pars plana vitrectomy (PPV) for primary RRD with air or SF6 tamponade from January 2014 till March 2020 were analyzed. The main outcome measure was the rate of an anatomically attached retina without the presence of any tamponade agent for at least 3 months postoperatively. Results: Our overall success rate in treating RRD with PPV in cases involving superior, inferior, and also multiple breaks is 88.5% (146/165 eyes) with air tamponade and 80.3% (57/71 eyes) with SF6 20% tamponade. Preoperative characteristics were almost similar between the two groups. Conclusion: Our study shows encouraging results for RRD treated with air tamponade, not only for superior breaks but also for inferior and multiple breaks. Thorough removal of vitreous traction, aspiration of subretinal fluid, and sealing of all the retinal breaks are mandatory elements to treat RRD. After this is accomplished, air tamponade seems to be a safe and effective agent for primary RRD. In order to clarify the use of intravitreal gases or air in the treatment of primary RRD with PPV, a randomized controlled prospective study should be realized in the future.
Virtual assistant upper respiratory tract infection education based natural language
Authors: Suwarningsih Wiwin
Published: May 2021

The high incidence of Upper Respiratory Tract Infection (URTI) in Indonesia requires an efficient healthcare solution to maintain human wellbeing. The e-health education model proposed in this paper is a virtual assistant in the form of an interactive question and answer system (Assistant Virtual Interactive Question Answering = AVIQA) with a natural language approach. AVIQA is a form of problem-solving approach to design some aspects of education and consultation in helping parents to recognize symptoms and dealing with several preventive actions for toddlers when exposed to Upper Respiratory Tract Infection. The technologies proposed for the development of AVIQA include (i) Representation of sentence meanings to build an URTI knowledge base; (ii) Design of dialogue models for interactive consultation using a combination between information state and frame base model and (iii) development of IQA based on casebase reasoning and semantic role labelling. The purpose of developing this technology is to achieve a system that is capable of assisting the users especially mothers in searching for information, reducing user time compared to reading a document, and providing a good advice for finding the right answers, which then can be constructed from a management model prototype information for the education and independent consultation for users. The final result of this study is e-health education system based Indonesian natural language that has an ability in terms of health consultations especially health of children under five in Acute Respiratory Infection disease. This system is expected to have a significant impact on the ability of a mother to recognize symptoms and deal with children attacked by URTI
Influência do uso do Wii Fit sobre o equilíbrio estático e a marcha na doença de Parkinson
Authors: Almeida Lícia Maria Belchior , Belchior Luciana Dias
Published: May 2021

Parkinson Disease (PD) is characterized, especially, by bradykinesia, postural instability, reduced reflexes and changes in gait, increasing the risk of falls. Objective: To evaluate the influence of protocol exercises on static balance and gait with Wii Fit in PD. Method: This is an original article that analyzed static changes and gait in two patients with Parkinson who were submitted to Nintendo Wii® and evaluated before and after the protocol. The evaluation took place by analyzing static balance and gait, at the beginning and at the end of 6 weeks after the protocol of three games: Penguin Slide, Platforms and Balance Bubble, twice a week, covering the same sequence. The research was carried out at the Laboratório de Análise do Movimento Humano, linked to the Universidade de Fortaleza, from February to September 2015. Results: The baropodometric data, referring to the variation of the surface, showed a lower value after intervention. The average speed variable increased after activity. The distances between the 2nd and 3rd step and between the 3rd and 4th step also increased after the intervention, except for the latter for the first patient. With the Nitendo Wii Fit protocol, participants reported greater agility and safety in their strides, which can be proven by increasing their average speed. Patients showed an improvement in static balance and gait. Conclusion: Exercises protocoled in virtual reality in patients with PD improved the performance of static balance and gait, which tends to favor orthostatic stability and walking.
Avaliação de sintomas na distrofia muscular de Duchenne: uma estratégia de cuidado paliativo
Authors: Pavão Josiane Rosires , Lizzi Elisângela Aparecida da Silva , Souza Mariana Angélica de , Sobreira Cláudia Ferreira da Rosa , Chaves Thais Cristina , Mattiello-Sverzut Ana Claudia
Published: May 2021

Symptom assessment, in Duchenne Muscular Dystrophy (DMD), allows an adequate treatment, and the Edmonton Symptom Assessment System (ESAS) assess it:  evaluating clinical problems of patients in palliative care (pain, tiredness, drowsiness, nausea, appetite, shortness of breath, depression, anxiety, and well-being). Objective: To verify if patients with DMD understand the terms of the ESAS and if their symptoms could be assessed using this instrument. Methods: Ten patients with DMD were cross-sectional  evaluated in relation to the understanding of the ESAS items, capacity to describe symptom (using the ESAS and the Faces Scale) and the Motor Function Measure. The patient’s symptom by ESAS was also classified by evaluator. A descriptive and correlation (Spearman's correlation coefficient) analysis of data was performed. Results: All patients understood the symptoms of pain, tiredness, drowsiness, depression (sadness), and well-being. However, some patients did not understand the symptoms of nausea, appetite, shortness of breath. The general mean of all symptoms assessed by the ESAS was below 5 points. For the symptom ‘depression’ and ‘anxiety’, a strong correlation was found between the results of the ESAS and the Face scale (r= 0.64, and r= 0.65, respectively). Additionally, a perfect and strong correlation, respectively, was found between the ESAS completed by the patient and the evaluator for the items '‘depression’," and ‘anxiety’ (r= 1.0)" and a ‘drowsiness’ (r= 0.82). Conclusion: DMD patients understood the ESAS terms and graded their symptoms using this instrument. Therefore, it is not necessary to change the ESAS terms to assess patients with DMD.
Prática de atividade física e fisioterapia em indivíduos com doença de Parkinson
Authors: Alvim Alisson Luis Silva , Rodrigues Lara de Almeida , Gomes Aline Gonçalves , Christo Paulo Pereira , Cardoso Francisco Eduardo Costa , Scalzo Paula Luciana
Published: May 2021

Objective: The present study aimed to evaluate the profile of physical activity (PA) and physical therapy in individuals with Parkinson's disease (PD). Methods: Patients were recruited from two Outpatient Movement Disorder Clinics (Ambulatório Bias Fortes, Universidade Federal de Minas Gerais, and Centro Metropolitano de Especialidades Médicas, Santa Casa de Belo Horizonte) between February and December 2019. Results: One hundred and eighty-five individuals answered a questionnaire with sociodemographic profiles, medical conditions, and the practice of PA and physical therapy. When comparing individuals from the two centers, differences were only observed concerning the frequency of comorbidities. Arterial hypertension proved to be the most prevalent comorbidity. Only 37.8% and 20.5% of the individuals reported practicing PA or physical therapy, respectively. Walking was the most common physical activity. Sedentary patients were older, had lower levels of education, presented a longer duration of PD, and were more affected by other comorbidities, when compared to more physically active patients. Conclusion: The present study shows the influence of age, education, and PD time on adherence to the practice of PA and physical therapy. Public health initiatives are needed to promote behavioral change and improve PA opportunities among individuals with PD.
Impacto de um programa de fortalecimento muscular dos membros inferiores no equilíbrio e na performance funcional de idosos institucionalizados: um estudo controlado e randomizado
Authors: Leopoldino Amanda Aparecida Oliveira , Araújo Izabella Thalita , Pires Juliana Catarina , Brito Taís Reis de , Polese Janaine Cunha , Bastone Alessandra Carvalho , Lima Onésia Cristina de Oliveira , Schetino Luana Pereira Leite
Published: May 2021

Functional performance is maximized through muscle strengthening programs in the elderly. However, few interventions have been implemented in institutionalized elderly to assess the effects of muscle strengthening exercise programs in outcomes such as balance, functional performance and muscle strength. Objective: Assess the impact of a lower limb muscle strengthening program at the balance, functional performance and muscle strength of institutionalized elderly. Methods: Controlled, randomized clinical trial. Balance, functional performance and muscle strength were assessed using the Berg Balance Scale (BSE), Tandem Gait (MT), Short Physical Performance Battery (SPPB) and Sphygmomanometer Test (TE) respectively. The experimental group (GE, n = 11) participated in the group exercise program, three times a week, for eight weeks, while the control group (CG, n = 8) continued their usual routine.The intervals of 95% confidence for the differences between the experimental and control groups (experimental - control) and between the two moments of observation (post - pre). Intent to treat analysis was performed. Results: EG showed a significant gain in relation to CG for BSE (DM = 3.7 IC95% 1.0 to 6.5), MT DM = 3.5 IC95% 0.7 to 6.2), FMEJ (DM = 33.2 95% CI 4.9 to 61.5) and FMD (DM = 37.5 95% CI 9.6 to 65.3). Conclusion: The muscle strengthening program was able to improve balance, functional performance and muscle strength in institutionalized elderly.
Relationships between domains of functioning of workers with work-related disorders
Authors: Damasceno Ana Clarissa Lopes Silva , Porto Lauro Antonio , Viola Denise Nunes , Bernardes Kionna , Neves Robson da Fonseca , Lima Monica Angelim Gomes de
Published: May 2021

Trabalhadoras com doenças musculoesqueléticas (DME) relacionadas ao trabalho possuem deficiências relacionadas às funções e estruturas do corpo, bem como têm dificuldades para executar atividades do cotidiano no âmbito individual e social. Somado a isso, os fatores do ambiente podem atuar como barreiras ou facilitadores, agravando ou melhorando o estado de saúde das pessoas. Objetivou-se verificar a correlação entre alguns domínios da saúde, que pertencem aos componentes das funções do corpo, atividades e participação e fatores ambientais de trabalhadoras estatutárias e não estatutárias com DME. Houve maior correlação negativa entre as funções mentais e sensoriais e de dor com as atividades e participação e fatores ambientais de trabalhadoras não estatutárias. As correlações indicaram que a funcionalidade das trabalhadoras não estatutárias esteve mais prejudicada, bem como as correlações positivas sinalizaram que maiores deficiências repercutiram em mais dificuldades na atividade e participação social. Quanto aos fatores ambientais como temperatura, vibração e atitudes foram obstáculos às funções mental e sensorial e de dor.
Validação de um instrumento de avaliação de habilidades de manejo de cadeira de rodas
Authors: Amorim Minerva Leopoldina de Castro , Lopes Kathya Augusta Thomé , Batista Luiz Henrique Rufino , Ponce Keegan Bezerra
Published: May 2021

Habilidades de manejo em cadeira de rodas são fundamentais para independência funcional de pessoas usuárias de cadeira de rodas. Ensiná-las, requer dos profissionais instrumentos que possam aferir a condição inicial do aprendiz permitindo verificar sua evolução durante o processo de intervenção. Objetivo: Validar um protocolo de avaliação de HMCR, com critérios dentro de conceitos e conhecimentos científicos existentes da psicometria. Método: Para construção e validação do instrumento, utilizamos o método Delphi de Survey e validade de conteúdo. Os participantes da pesquisa foram seis especialistas na área de atividades em cadeira de rodas com titulação de mestres ou doutores, usamos para medir a consistência interna do instrumento o alfa de Cronbach (α), índice de validade de conteúdo (IVC), Coeficiente de correlação intraclasse (CCI) e teste T de uma amostra com nível de 5% de significância. Resultados: Nos 17 itens obtivemos os critérios de clareza (CVI= 0,865±0,059; α= 0,834; CCI= 0,828; P<0,05), pertinência (CVI= 0,902±0,071; α= 0,774; CCI= 0,779; P<0,05), simplicidade (CVI= 0,918±0,054; α= 0,705; CCI= 0,694; P<0,05), objetividade (CVI= 0,888±0,067; α= 0,856; CCI= 0,850; P<0,05) e precisão (CVI= 0,922±0,060; α= 0,742; CCI= 0,721; P<0,05). Conclusão: Os itens na construção do instrumento de avaliação demonstram por meio da psicometria ser válido e garante medir aquilo que se propõe medir. A consistência interna dos itens garante que o desenvolvimento de uma escala se faz necessária para avaliação de pessoas com LM que utilizam CR, o que propõe novos estudos de aplicação do teste para concluirmos o processo de validação.
Seguimento de pessoas acometidas por doenças cerebrovasculares em um hospital regional amazônico: uma metodologia WHO STEP Stroke
Authors: Fernandes Tiotrefis Gomes , Baptista Pedro Porto Alegre , Costa Jonathas Gonçalves da , Lotufo Paulo Andrade , Campos Tania Fernandes
Published: May 2021

The WHO STEP Stroke is a tool developed to monitor cases of cerebrovascular and allow comparison of its incidence throughout the world. Objective: To describe the sociodemographic profile and functionality of stroke inpatients admitted in Coari´s Regional Hospital and followed up one month after admittance. Method: This is a prospective, descriptive observational and follow-up study of cases between October 2010 and October 2011. In this study, we used the first step (Step 1) of the WHO STEP Stroke to assess stroke hospitalization in Coari-AM Twenty-three patients were monitored with a standard questionnaire up to two days after hospitalization, 10 days, and 28 after hospitalization. Results: The studied population had average age of 72.8 (SD= 12.4) years, mostly men (65.7%), brown (65.2%), and hypertensive (95.7%), with a hospital incidence of 30 cases for 100.000 people, and  mortality in 10 days of 30.4% and 28 days of 34.8%. The neurological impairment at hospitalization had a median of 28 (IIQ= 15-38) points, with 73.9% classified as severe. There was an impairment in functionality among the survivors. Conclusion: This study showed the profile of hospital admittance for cerebrovascular disease in this city to be mainly composed by older men, brown, with no formal study, low income, and history of systemic arterial hypertension and diabetes. The hospital incidence for stroke was 30 (per 100.000) in Coari-AM, with severe neurological impairment at admission, with high mortality rates, and functional deficits 28 days after the event when compared to other regions in Brazil and in the world.
Ligação de um instrumento de avaliação clínica de exposição ao vírus Zika com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde
Authors: Souza Nathália Cristina Oliveira de , Cabral Lara Carolina Januário , Souza Laura Cristina Machado Ribeiro de , Pone Marcos Vinicius da Silva , Ribeiro Luciana Castaneda , Ribeiro Carla Trevisan Martins
Published: May 2021

The Zika epidemic and the emergence of a new health condition in Brazil, imposed a rapid organization on services to meet the current demand for care. Clinical assessment instruments were created, based on previous care experiences for other complex chronic conditions in order to plan and systematize actions. However, it is important that these instruments have external validation and include the current concept of health, biopsychosocial. An interlocution with the International Classification of Functioning, Disability and Health (CIF) could provide theoretical support and validation to the instruments created. Objective: To identify the common content among the clinical evaluation instrument applied to the population exposed to the Zika virus in a pediatric infectious disease outpatient clinic in a reference hospital in the State of Rio de Janeiro with the ICF. Methods: The link with the ICF was carried out by two independent reviewers, according to Cieza's proposal and the Kappa coefficient was used for interobserver analysis. Results: It was identified that the instrument is mainly composed of items of body structure (39; 46.4%). There were few categories related to contextual factors (11; 13.1%). And there were no items related to the categories of activity and participation. Conclusion: The assessment tool presents mainly domains of function and structure of the body, turning to a biomedical look. The lack of categories of activity and participation can compromise the perception of health status. A line of care in the light of the biopsychosocial model provides advantages for health services planning and actions.
Genetic Ablation of Transmembrane Prolyl 4-Hydroxylase Reduces Atherosclerotic Plaques in Mice
Authors: Määttä Jenni , Serpi Raisa , Hörkkö Sohvi , Izzi Valerio , Myllyharju Johanna , Dimova Elitsa Y. , Koivunen Peppi
Published: May 2021

Objective:

Atherosclerosis is a key component of cardiovascular diseases. We set out to study here whether genetic ablation of P4H-TM (transmembrane prolyl 4-hydroxylase) could protect against atherosclerosis as does inhibition of the other 3 classical HIF-P4Hs (hypoxia-inducible factor prolyl 4-hydroxylases).

Approach and Results:

We generated a double knockout mouse line deficient in P4H-TM and LDL (low-density lipoprotein) receptor (
P4h-tm
−/−
/Ldlr
−/−
) and subjected these mice to a high-fat diet for 13 weeks. The double knockout mice had less atherosclerotic plaques in their full-length aorta than their
P4h-tm
+/+
/Ldlr
−/−
counterparts and also had lower serum triglyceride levels on standard laboratory diet and high-fat diet, higher levels of IgM autoantibodies against Ox-LDL (oxidized LDL), and significantly higher LPL (lipoprotein lipase) protein levels in white adipose tissue and sera. RNA-sequencing analysis revealed changes in expression of mRNAs in multiple pathways including lipid metabolism and immunologic response in the
P4h-tm
−/−
/
Ldlr
−/−
livers as compared with
P4h-tm
+/+
/
Ldlr
−/−
.

Conclusions:

Our data identify P4H-TM inhibition as a potential novel immuno-metabolic mechanism for intervening in the pathology of atherosclerosis, as hypertriglyceridemia is an individual risk factor for atherosclerosis, and IgM antibodies to Ox-LDL and increased lipoprotein lipase have been associated with protection against it.
Long-Term Outcomes of the Coarctation of the Aorta Stent Trials
Authors: Holzer Ralf J. , Gauvreau Kimberlee , McEnaney Kerry , Watanabe Hanano , Ringel Richard
Published: May 2021

Background:

Long-term outcome data of stent-implantation for coarctation of the aorta are limited. We report up to 5 years of postimplant follow-up in patients enrolled into the COAST (Coarctation of the Aorta Stent Trial) and the COAST II trial (Covered Cheatham-Platinum Stents for Prevention or Treatment of Aortic Wall Injury Associated With Coarctation of the Aorta), evaluating the bare and Covered Cheatham-Platinum Stents for the treatment of coarctation of the aorta and associated aortic wall injury.

Methods:

Data was prospectively collected during the 2 multi-center studies, enrolling 248 patients (COAST: n=121, COAST II: n=127). Late follow-up data (48–60 month) was compared with immediate (1 month) and early (12 months) follow-up.

Results:

There was a notable decrease in the use of antihypertensive medication, from 53% at immediate, to 42% at early, and 29% at late follow-up. The cumulative incidence of stent fractures was 0% immediately, 2.9% at early, and 24.4% at late follow-up. Independent predictors for stent fractures at late follow-up were age <18 years, male sex, minimum stent diameter ≥12 mm, and use of bare metal stent. The cumulative incidence of reintervention was 1.6% at immediate, 5.1% at early, and 21.3% at late follow-up. Independent predictors for reinterventions at late follow-up were age <18 years, post implantation systolic arm-leg blood pressure gradient ≥10 mm Hg, minimum stent diameter at implantation <12 mm, and initial coarctation minimum diameter <6 mm. There were 13 patients with aortic aneurysms, with a cumulative incidence of 6.3% at late follow-up.

Conclusions:

Coarctation stenting is effective at maintaining obstruction relief up to 60 months postimplant with reduction in the number of patients requiring antihypertensive medication. However, an increase in-stent fractures and reinterventions were observed between medium and long-term follow-up. Covered stents appear to confer some protection from the development of stent fractures but do not provide complete protection from late aneurysm formation.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifiers: NCT00552812 and NCT01278303.
COL5A1
Variants Cause Aortic Dissection by Activating TGF‐β‐Signaling Pathway
Authors: Chen Peng , Yu Bo , Li Zongzhe , Chen Yanghui , Sun Yang , Wang Dao Wen
Published: May 2021

Background

Aortic dissection (AD) is one of the most life‐threatening cardiovascular diseases that exhibit high genetic heterogeneity. However, it is unclear whether variants within the
COL5A1
gene can cause AD. Therefore, we intend to determine whether
COL5A1
is a causative gene of AD.

Methods and Results

We performed targeted sequencing in 702 patients with unrelated sporadic AD and 163 matched healthy controls using a predesigned panel with 152 vessel matrix‐related genes. As a result, we identified that 11 variants in
COL5A1
caused AD in 11 out of the 702 patients with AD. Furthermore,
Col5a1
knockout (

Col5a1
+/−

) rats were generated through the CRISPR/Cas9 system. Although there was no spontaneous AD, electron microscopy revealed a fracture of elastic fibers and disarray of collagenous fibers in 6‐week‐old

Col5a1
+/−

rats, but not in WT rats (93.3% versus 0.0%,
P
<0.001). Three‐week‐old rats were used to induce the AD phenotype with β‐aminopropionitrile monofumarate for 4 weeks followed by angiotensin II for 72 hours. The β‐aminopropionitrile monofumarate and angiotensin II‐treated rat model confirmed that

Col5a1
+/−

rats had considerably higher AD incidence than WT rats. Subsequent mechanism analyses demonstrated that the transforming growth factor‐β‐signaling pathway was significantly activated in

Col5a1
+/−

rats.

Conclusions

Our findings, for the first time, revealed a relationship between variants in
COL5A1
and AD via targeted sequencing in 1.57% patients with sporadic aortic dissection. The
Col5a1
knockout rats exhibited AD after an intervention, indicating that
COL5A1
is a causative gene of AD. Activation of the transforming growth factor‐β‐signaling pathway may be implicated in the pathogenesis of this kind of AD.
Can Children With Perinatal Stroke Use a Simple Brain Computer Interface?
Authors: Jadavji Zeanna , Zhang Jack , Paffrath Brett , Zewdie Ephrem , Kirton Adam
Published: May 2021

Background and Purpose:

Perinatal stroke is the leading cause of hemiparetic cerebral palsy resulting in lifelong disability for millions of people worldwide. Options for motor rehabilitation are limited, especially for the most severely affected children. Brain computer interfaces (BCIs) sample brain activity to allow users to control external devices. Functional electrical stimulation enhances motor recovery after stroke, and BCI-activated functional electrical stimulation was recently shown to improve upper extremity function in adult stroke. We aimed to determine the ability of children with perinatal stroke to operate a simple BCI.

Methods:

Twenty-one children with magnetic resonance imaging–confirmed perinatal stroke (57% male, mean [SD] 13.5 [2.6] years, range 9–18) were compared with 24 typically developing controls (71% male, mean age [SD] 13.7 [3.7] years, range 6–18). Participants trained on a simple EEG-based BCI over 2 sessions (10 trials each) utilizing 2 different mental imagery strategies: (1) motor imagery (imagine opening and closing of hands) and (2) goal oriented (imagine effector object moving toward target) to complete 2 tasks: (1) drive a remote controlled car to a target and (2) move a computer cursor to a target. Primary outcome was Cohen Kappa with a score >0.40 suggesting BCI competence.

Results:

BCI performance was comparable between stroke and control participants. Mean scores were 0.39 (0.18) for stroke versus 0.42 (0.18) for controls (t[42]=0.478,
P
=0.94). No difference in performance between venous (M=0.45, SD=0.29) and arterial (M=0.34, SD=0.22) stroke (t[82]=1.89,
P
=0.090) was observed. No effect of task or strategy was observed in the stroke participants. Over 90% of stroke participants demonstrated competency on at least one of the 4 task-strategy combinations.

Conclusions:

Children with perinatal stroke can achieve proficiency in basic tasks using simple BCI systems. Future directions include exploration of BCI-functional electrical stimulation systems for rehabilitation for children with hemiparesis and other forms of cerebral palsy.
Cognitive Impairment and Dementia After Stroke: Design and Rationale for the DISCOVERY Study
Authors: Rost Natalia S. , Meschia James F. , Gottesman Rebecca , Wruck Lisa , Helmer Karl , Greenberg Steven M. ,   on behalf of the DISCOVERY Investigators*, Barrett Kevin , Biffi Alessandro , Boden-Albala Bernadette , Fornage Myriam , Etherton Mark , Golland Polina , Graff-Radford Jonathan , Hinman Jason , Jack Cliff , Kalpathy-Cramer Jayashree , Knopman David , Kittner Steven , Lowe Val , Manly Jennifer , Mosley Thomas , Petersen Ronald , Rissman Robert , Schirmer Markus , Schwab Kristin , Seshadri Sudha , Sherman Alexander , Vemuri Prashanthi , Viswanathan Anand
Published: May 2021

Stroke is a leading cause of the adult disability epidemic in the United States, with a major contribution from poststroke cognitive impairment and dementia (PSCID), the rates of which are disproportionally high among the health disparity populations. Despite the PSCID’s overwhelming impact on public health, a knowledge gap exists with regard to the complex interaction between the acute stroke event and highly prevalent preexisting brain pathology related to cerebrovascular and Alzheimer disease or related dementia. Understanding the factors that modulate PSCID risk in relation to index stroke event is critically important for developing personalized prognostication of PSCID, targeted interventions to prevent it, and for informing future clinical trial design. The DISCOVERY study (Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on Recovery), a collaborative network of thirty clinical performance clinical sites with access to acute stroke populations and the expertise and capacity for systematic assessment of PSCID will address this critical challenge. DISCOVERY is a prospective, multicenter, observational, nested-cohort study of 8000 nondemented ischemic and hemorrhagic stroke patients enrolled at the time of index stroke and followed for a minimum of 2 years, with serial cognitive evaluations and assessments of functional outcome, with subsets undergoing research magnetic resonance imaging and positron emission tomography and comprehensive genetic/genomic and fluid biomarker testing. The overall scientific objective of this study is to elucidate mechanisms of brain resilience and susceptibility to PSCID in diverse US populations based on complex interplay between life-course exposure to multiple vascular risk factors, preexisting burden of microvascular and neurodegenerative pathology, the effect of strategic acute stroke lesions, and the mediating effect of genomic and epigenomic variation.
Hospital Factors, Performance on Process Measures After Transient Ischemic Attack, and 90-Day Ischemic Stroke Incidence
Authors: Levine Deborah A. , Perkins Anthony J. , Sico Jason J. , Myers Laura J. , Phipps Michael S. , Zhang Ying , Bravata Dawn M.
Published: May 2021

Background and Purpose:

We determined the association between hospital factors, performance on transient ischemic attack (TIA) process measures, and 90-day ischemic stroke incidence.

Methods:

Longitudinal analysis of retrospectively obtained data on 9168 veterans ≥18 years with TIA presenting to the emergency department or inpatient unit at 69 Veterans Affairs hospitals with ≥10 eligible patients per year in fiscal years 2015 to 2018. Process measures were high/moderate potency statin within 7 days of discharge, antithrombotic by day 2, and hypertension control (<140/90 mm Hg) at 90 days. The outcome was 90-day stroke incidence.

Results:

During the 4-year study period, hospitals significantly increased statin use (adjusted odds ratio [aOR] per 1-year increase, 1.24 [95% CI, 1.17–1.32];
P
<0.001), whereas neither hypertension control (
P
=0.44) nor antithrombotic use (
P
=0.82) improved over time. Hospitals that admitted a higher proportion of TIA patients versus emergency department discharge had significantly greater use of statins (aOR per 10-percentage point increase in the proportion of TIA patients admitted, 1.09 [1.03–1.16];
P
=0.003) and antithrombotics (aOR per 10-percentage point increase in TIA patients admitted, 1.14 [1.06–1.23];
P
<0.001). Hospitals with higher emergency physician staffing and lower TIA patient volume had greater use of antithrombotics (aOR per 1 full-time physician increase, 1.05 [1.01–1.08];
P
=0.008 and aOR per 10-patient decrease in volume, 1.09 [1.01–1.16];
P
=0.02). Higher emergency physician staffing was associated with lower 90-day stroke incidence (aOR per 1 full-time physician increase, 0.96 [0.92–0.99];
P
=0.02) but other hospital factors were not.

Conclusions:

Hospitals admitting higher percentages of TIA patients and having higher emergency physician staffing have greater performance on select guideline-concordant process measures for TIA. Higher emergency physician staffing was associated with improved outcomes 90 days after TIA.
P2Y12 Inhibitors Plus Aspirin Versus Aspirin Alone in Patients With Minor Stroke or High-Risk Transient Ischemic Attack
Authors: Li Zi-Xiao , Xiong Yunyun , Gu Hong-Qiu , Fisher Marc , Xian Ying , Johnston S. Claiborne , Wang Yong-Jun
Published: May 2021

Background and purpose:

We performed a systemic review and meta-analysis to elucidate the effectiveness and safety of dual antiplatelet (DAPT) therapy with P2Y12 inhibitors (clopidogrel/ticagrelor) and aspirin versus aspirin monotherapy in patients with mild ischemic stroke or high-risk transient ischemic attack.

Methods:

Following Preferred Reported Items for Systematic Review and Meta-Analysis standards for meta-analyses, Medline, Embase, Cochrane Central Register of Controlled Trials, and the Cochrane Library were searched for randomized controlled trials that included patients with a diagnosis of an acute mild ischemic stroke or high-risk transient ischemic attack, intervention of DAPT therapy with clopidogrel/ticagrelor and aspirin versus aspirin alone from January 2012 to July 2020. The outcomes included subsequent stroke, all-cause mortality, cardiovascular death, hemorrhage (mild, moderate, or severe), and myocardial infarction. A DerSimonian-Laird random-effects model was used to estimate pooled risk ratio (RR) and corresponding 95% CI in R package meta. We assessed the heterogeneity of data across studies with use of the Cochran Q statistic and
I
2
test.

Results:

Four eligible trials involving 21 493 participants were included in the meta-analysis. DAPT therapy started within 24 hours of symptom onset reduced the risk of stroke recurrence by 24% (RR, 0.76 [95% CI, 0.68–0.83],
I
2
=0%) but was not associated with a change in all-cause mortality (RR, 1.30 [95% CI, 0.90–1.89],
I
2
=0%), cardiovascular death (RR, 1.34 [95% CI, 0.56–3.17],
I
2
=0%), mild bleeding (RR, 1.25 [95% CI, 0.37–4.29],
I
2
=94%), or myocardial infarction (RR, 1.45 [95% CI, 0.62–3.39],
I
2
=0%). However, DAPT was associated with an increased risk of severe or moderate bleeding (RR, 2.17 [95% CI, 1.16–4.08],
I
2
=41%); further sensitivity tests found that the association was limited to trials with DAPT treatment duration over 21 days (RR, 2.86 [95% CI, 1.75–4.67],
I
2
=0%) or ticagrelor (RR, 2.17 [95% CI, 1.16–4.08],
I
2
=37%) but not within 21 days or clopidogrel.

Conclusions:

In patients with noncardioembolic mild stroke or high-risk transient ischemic attack, DAPT with aspirin and clopidogrel/ticagrelor is more effective than aspirin alone for recurrent stroke prevention with a small absolute increase in the risk of severe or moderate bleeding.
Piper (Piperaceae) in eastern Northeast Brazil

Authors: MELO ALINE , ALVES MARCCUS
Published: May 2021

Brazil is considered one of the richest countries in Piper species in South America, with the genus being considered one of the most representative of the Brazilian Atlantic Forest. The aim of this study is to improve the knowledge about Piper in the northeastern region of Brazil, and to this end, we recorded the taxa that occur in the eastern portion of this region. Collection expeditions were conducted in the study area between August 2017 and July 2019, 21 herbaria were visited, and other internationally important collections were consulted online. Thirty tree taxa were registered, from which one was recorded for the northeastern region for the first time (P. nematanthera), besides 11 new records for at least one of the states. We present a synopsis with comments about morphology, habitat and phenology.
An annotated type catalogue of the centipedes (Myriapoda: Chilopoda) held in the Zoological Museum Hamburg
Authors: THOFERN DETLEF , DUPÉRRÉ NADINE , HARMS DANILO
Published: May 2021

Centipedes (Myriapoda: Chilopoda) are carnivorous arthropods that live in leaf litter and soil habitats on all continents except Antarctica. Roughly 3,300 species have been described to date but the taxonomy is still progressing and requires a thorough documentation of type material and type deposits. In this paper we provide an annotated catalogue of the centipede type collection at the Zoological Museum (ZMH) in Hamburg. This collection comprises 490 type specimens belonging to 141 taxa originally described as species, subspecies and varieties. More than half of these taxa were described by the pioneering myriapodologists Carl Graf Attems (Vienna) and Karl Kraepelin (Hamburg). The collection includes material representing 93 valid species or subspecies and contains specimens predominantly from Australia (33%), Asia (22%), Africa (20%) and South America (20%). Taxonomically, the focus is on the centipede orders Scolopendromorpha (56 valid species) and Geophilomorpha (28 valid species) with fewer types for the Lithobiomorpha (8 species). A total of 48 taxa (34% of type species) have been synonymized since they were originally described and the type material for 12 additional species at the ZMH is lost. We provide a brief historical overview of this collection from its origin at the Museum Godeffroy and the Johanneum in Hamburg, including the most relevant taxonomists and collectors, followed by an annotated taxonomic catalogue with details on all species that are or were represented by type material.
Predictability of U.S. Regional Extreme Precipitation Occurrence Based on Large-Scale Meteorological Patterns (LSMPs)
Authors: Gao Xiang , Mathur Shray
Published: May 2021

In this study, we use analogue method and Convolutional Neural Networks (CNNs) to assess the potential predictability of extreme precipitation occurrence based on Large-Scale Meteorological Patterns (LSMPs) for the winter (DJF) of Pacific Coast California (PCCA) and the summer (JJA) of Midwestern United States (MWST). We evaluate the LSMPs constructed with a large set of variables at multiple atmospheric levels and quantify the prediction skill with a variety of complementary performance measures. Our results suggest that LSMPs provide useful predictability of daily extreme precipitation occurrence and its interannual variability over both regions. The 14-year (2006-2019) independent forecast shows Gilbert Skill Scores (GSS) in PCCA range from 0.06 to 0.32 across 24 CNN schemes and from 0.16 to 0.26 across 4 analogue schemes, in contrast to those from 0.1 to 0.24 and from 0.1 to 0.14 in MWST. Overall, CNN is shown to be more powerful in extracting the relevant features associated with extreme precipitation from the LSMPs than analogue method, with several single-variate CNN schemes achieving more skillful prediction than the best multi-variate analogue scheme in PCCA and more than half of CNN schemes in MWST. Nevertheless, both methods highlight the Integrated Vapor Transport (IVT, or its zonal and meridional components) enables higher skills than other atmospheric variables over both regions. Warm-season extreme precipitation in MWST presents a forecast challenge with overall lower prediction skill than in PCCA, attributed to the weak synoptic-scale forcing in summer.
Development of Convective-Scale Static Background Error Covariance within GSI-Based Hybrid EnVar System for Direct Radar Reflectivity Data Assimilation
Authors: Wang Yongming , Wang Xuguang
Published: May 2021

A convective-scale static background-error covariance (BEC) matrix is further developed to include the capability of direct reflectivity assimilation and evaluated within the GSI-based three-dimensional variational (3DVar) and hybrid ensemble–variational (EnVar) methods. Specific developments are summarized as follows: 1) Control variables (CVs) are extended to include reflectivity, vertical velocity, and all hydrometeor types. Various horizontal momentum and moisture CV options are included. 2) Cross correlations between all CVs are established. 3) A storm intensity-dependent binning method is adopted to separately calculate static error matrices for clear-air and storms with varying intensities. The resultant static BEC matrices are simultaneously applied at proper locations guided by the observed reflectivity. 4) The EnVar is extended to adaptively incorporate static BECs based on the quality of ensemble covariances. Evaluation and examination of the new static BECs are first performed on the 8 May 2003 Oklahoma City supercell. Detailed diagnostics and 3DVar examinations suggest zonal/meridional winds and pseudo–relative humidity are selected as horizontal momentum and moisture CVs for direct reflectivity assimilation, respectively; inclusion of cross correlations favors spin up and maintains the analyzed storms; application of binning improves characteristics and persistence of the simulated storm. Relative to an experiment using the full ensemble BECs (Exp-PureEnVar), incorporating static BECs in hybrid EnVar reduces spinup time and better analyzes reflectivity distributions while the background ensemble is deficient in sampling errors. Compared to both pure 3DVar and Exp-PureEnVar, hybrid EnVar better predicts reflectivity distributions and better maintains a strong mesocyclone. Further examination through the 20 May 2013 Oklahoma supercells confirms these results and additionally demonstrates the effectiveness of adaptive hybridization.