bluuebunny/crossref_metadata_2025 huggingface dataset:
Age and clinical outcomes after hip fracture surgery: do octogenarian, nonagenarian and centenarian classifications matter?
Authors: Ogawa Takahisa , Schermann Haggai , Kobayashi Hiroki , Fushimi Kiyohide , Okawa Atsushi , Jinno Tetsuya
Published: June 2021

Background

older patients with hip fractures are arbitrarily classified as octogenarians, nonagenarians and centenarians. We have designed this study to quantify in-hospital mortality and complications among each of these groups. We hypothesised that the associations between age and in-hospital mortality and complications are continuously increasing, and that these risks increase rapidly when patients reach a certain age.

Methods

this research is a retrospective cohort study using nationwide database between 2010 and 2018. Patients undergoing hip fracture surgery, and aged 60 or older, were included. The associations between patient age, in-hospital mortality and complications were visualised using the restricted cubic spline models, and were analysed employing multivariable regression models. Then, octogenarians, nonagenarians and centenarians were compared.

Results

among a total of 565,950 patients, 48.7% (n = 275,775) were octogenarians, 23.0% (n = 129,937) were nonagenarians and 0.7% (n = 4,093) were centenarians. The models presented three types of association between age, in-hospital mortality and complications: (i) a continuous increase (mortality and respiratory complications); (ii) a mild increase followed by a steep rise (intensive care unit admission, heart failure, renal failure and surgical site hematoma) and (iii) a steep increase followed by a limited change (coronary heart disease, stroke and pulmonary embolisms).

Conclusion

we identified three types of association between age and clinical outcomes. Patients aged 85–90 may constitute the upper threshold for age categorisations, because the risk of in-hospital complications changed dramatically at that stage. This information can improve clinical awareness of various complications and support collective decision-making.
Functional traits predict resident plant response to Reynoutria japonica invasion in riparian and fallow communities in southern Poland
Authors: Woch Marcin W , Kapusta Paweł , Stanek Małgorzata , Zubek Szymon , Stefanowicz Anna M
Published: June 2021

Reynoutria japonica is one of the most harmful invasive species in the world, dramatically reducing the diversity of resident vegetation. To mitigate the impact of R. japonica on ecosystems and properly manage affected areas, understanding the mechanisms behind this plant’s invasive success is imperative. This study aimed to comprehensively analyse plant communities invaded by R. japonica, taking into account species traits, habitat conditions and seasonal variability, and to determine the ecological profile of species that withstand the invader’s pressure. The study was performed in fallow and riparian areas in southern Poland. Pairs of adjacent plots were established at 25 sites with no obvious signs of recent human disturbance. One plot contained R. japonica, and the other contained only resident vegetation. For each plot, botanical data were collected and soil physicochemical properties were determined. Twelve sites were surveyed four times, in two springs and two summers, to capture seasonal variability. The presence of R. japonica was strongly associated with reduced resident plant species diversity and/or abundance. In addition to the ability to quickly grow and form a dense canopy that shades the ground, the success of the invader likely resulted from the production of large amounts of hard-to-decompose litter. The indirect impact of R. japonica by controlling the availability of nutrients in the soil might also play a role. A few species coexisted with R. japonica. They can be classified into three groups: (i) spring ephemerals – geophytic forbs with a mixed life history strategy, (ii) lianas with a competitive strategy and (iii) hemicryptophytic forbs with a competitive strategy. Species from the first two groups likely avoided competition for light by temporal or spatial niche separation (they grew earlier than or above the invasive plant), whereas the high competitive abilities of species from the third group likely enabled them to survive in R. japonica patches.
Polymorphic SERPINA3-R124C reduces pathogenesis of its wild type by shortening the lifetime of oligomeric Aβ
Authors: Akbor Maruf Mohammad , Kurosawa Nobuyuki , Tanaka Masashi , Isobe Masaharu
Published: June 2021

Amyloid beta (Aβ) 42 peptide accumulated in Alzheimer disease (AD) patients’ brain, often colocalized with serine protease inhibitor family A member 3 (SERPINA3). Being a chaperon, SERPINA3 accelerated Aβ42 fibrillization. While analyzing chaperon activity of human SERPINA3 polymorphisms, we found SERPINA3-R124C played a role in protecting cells from Aβ42 cytotoxicity. SH-SY5Y cells exposed to Aβ42 preincubated with wild-type SERPINA3 (SERPINA3-WT) resulted in extended toxicity leading cell death whereas Aβ42 with SERPINA3-R124C resulted in less cytotoxicity. Transmission electron microscope and thioflavin T assay revealed that SERPINA3-R124C shortened lifetime of small soluble oligomer and maintained β-sheet rich protofibril-like aggregates for longer time compared to that of with SERPINA3-WT. Western blot assay confirmed that SERPINA3-R124C converted Aβ42 mostly into high molecular aggregates. Here, we demonstrate first time that polymorphic SERPINA3 acts as a benign chaperon by modulating the transition states of Aβ42, which may contribute to the reduction of AD risk.
Efficacy and Tolerability of Quinacrine Monotherapy and Albendazole Plus Chloroquine Combination Therapy in Nitroimidazole-Refractory Giardiasis: A TropNet Study
Authors: Neumayr Andreas , Schunk Mirjam , Theunissen Caroline , Van Esbroeck Marjan , Mechain Matthieu , Hatz Christoph , Mørch Kristine , Soriano Pérez Manuel Jesús , Sydow Véronique , Sothmann Peter , Kuenzli Esther , Rothe Camilla , Bottieau Emmanuel
Published: June 2021

Background

Giardiasis failing nitroimidazole first-line treatment is an emerging problem in returning European travelers. We present data on the efficacy and tolerability of 2 second-line treatment regimens.

Methods

This prospective, open-label, multicenter study assessed the efficacy and tolerability of quinacrine monotherapy (100 mg 3 times per day for 5 days) and albendazole plus chloroquine combination therapy (400 mg twice daily plus 155 mg twice daily for 5 days) in nitroimidazole-refractory giardiasis. The defined end points were the clinical outcome, assessed at week 5 after treatment and the parasitological outcome, assessed using microscopy of 2 stool samples, ≥2 to ≤5 weeks after treatment.

Results

A total of 106 patients were included in the study. Quinacrine achieved clinical and parasitological cure in 81% (59/73) and 100% (56/56), respectively. Albendazole plus chloroquine achieved clinical and parasitological cure in 36% (12/33) and 48% (12/25), respectively. All patients (9/9) who clinically and parasitologically failed albendazole plus chloroquine treatment and opted for retreatment with quinacrine achieved clinical cure. Mild to moderate treatment-related adverse events were reported by 45% and 30% of patients treated with quinacrine and albendazole plus chloroquine, respectively. One patient treated with quinacrine developed severe neuropsychiatric side effects. The majority of nitroimidazole-refractory Giardia infections (57%) were acquired in India.

Conclusions

Quinacrine was a highly effective treatment in nitroimidazole-refractory giardiasis, but patients should be cautioned on the low risk of severe neuropsychiatric adverse event. Albendazole plus chloroquine had a low cure rate in nitroimidazole-refractory giardiasis. Nitroimidazole-refractory giardiasis was primarily seen in travelers returning from India.
Deaf Residents With Intellectual Disabilities During the First Covid-19 Associated Lockdown
Authors: Salzner Julia , Dall Magdalena , Weber Christoph , Holzinger Daniel , Fellinger Johannes
Published: June 2021

Two indicators for stress (mood and aggressive behavior) were evaluated in order to investigate the effect of the restrictions taken against the spread of the coronavirus on people who are deaf and hard of hearing (DHH) and have intellectual disabilities (ID). In three therapeutic living communities, specifically designed for the visual communication needs of people who are DHH and have ID, the mood of the residents is routinely assessed by staff members and every aggressive incident is recorded with the Staff Observation of Aggressions Scale-Revised (SOAS-R). For the 38 residents who were present 8 weeks before the first lockdown (t1) and the following 8 weeks (t2), mood ratings and ratings of aggressive behavior were compared between the two time periods. In contrast to our hypothesis the mood ratings of the residents had a slight significant improvement, whereas the incidents and severity of aggressive behavior did not change significantly.

These results suggest that with proper communicative support, individuals who are DHH and have ID can cope effectively with significant restrictions imposed by a pandemic-caused lockdown.
Emotional labour and professional development in ELT
Authors: Song Juyoung
Published: June 2021

Building upon the concept of emotional labour, this study explores one pre-service teacher’s emotional responses to her internship teaching experiences. Interviews, observations, and self-reflection statements revealed that her emotional struggles and tensions were generated, in part, from dissatisfaction with what she experienced as a gap between her theoretical understanding and the reality of ELT and with the perceived unfair practices and negative attitudes towards English learners. The student teacher’s efforts to manage her emotions in and out of the classroom became her emotional labour, and her emotional awareness of and resistance to what she perceived as negative attitudes towards her students evoked a deeper emotional reflexivity, which led to her emotional and professional growth. The results suggest that a student teacher’s understanding of her own emotions in relation to teaching may serve as a catalyst for problematizing practices and construct/transform teacher identity, leading to important implications for teacher education.
Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models
Authors: Withaar Coenraad , Lam Carolyn S P , Schiattarella Gabriele G , de Boer Rudolf A , Meems Laura M G
Published: June 2021

Heart failure (HF) with preserved ejection fraction (HFpEF) is a multifactorial disease accounting for a large and increasing proportion of all clinical HF presentations. As a clinical syndrome, HFpEF is characterized by typical signs and symptoms of HF, a distinct cardiac phenotype and raised natriuretic peptides. Non-cardiac comorbidities frequently co-exist and contribute to the pathophysiology of HFpEF. To date, no therapy has proven to improve outcomes in HFpEF, with drug development hampered, at least partly, by lack of consensus on appropriate standards for pre-clinical HFpEF models. Recently, two clinical algorithms (HFA-PEFF and H2FPEF scores) have been developed to improve and standardize the diagnosis of HFpEF. In this review, we evaluate the translational utility of HFpEF mouse models in the context of these HFpEF scores. We systematically recorded evidence of symptoms and signs of HF or clinical HFpEF features and included several cardiac and extra-cardiac parameters as well as age and sex for each HFpEF mouse model. We found that most of the pre-clinical HFpEF models do not meet the HFpEF clinical criteria, although some multifactorial models resemble human HFpEF to a reasonable extent. We therefore conclude that to optimize the translational value of mouse models to human HFpEF, a novel approach for the development of pre-clinical HFpEF models is needed, taking into account the complex HFpEF pathophysiology in humans.
Design of an autochthonous starter culture using strains isolated from traditional Matsoni
Authors: Kakabadze Elene , Zago Miriam , Rossetti Lia , Grdzelishvili Nino , Bonvini Barbara , Janashia Irakli , Tidona Flavio , Carminati Domenico , Giraffa Giorgio , Chanishvili Nina
Published: June 2021

Artisanal products support the conservation of the indigenous biodiversity of food microbiomes, although they do not always comply to quality and hygienic requirements for the dairy industry. This study describes the development of an autochthonous starter culture to produce Matsoni, a traditional Georgian fermented milk. To this end, strains of lactic acid bacteria isolated from artisanal Matsoni samples were used to design a starter formulation reproducing the dominant microbial diversity, also preserving quality characteristics and ensuring the safety of the product. As a result, strains that represent the acidifying portion of the starter (Lactobacillus delbrueckii subsp. lactis, L. delbrueckii subsp. bulgaricus and Streptococcus thermophilus) were combined in different ratios and strain combinations, together with cultures of Lactobacillus rhamnosus that were chosen for their potential beneficial traits. The strain association acting better in milk cultures at laboratory scale was selected as starter culture for the production of Matsoni in pilot-scale industrial trials.
Meaningfulness among frail older adults receiving home-based care in Finland
Authors: Hemberg Jessica , Näsman Marina , Nyqvist Fredrica
Published: June 2021

Meaningfulness is a fundamental aspect in the promotion of frail older adults’ health and well-being. From a salutogenic point of view, meaningfulness is a vital component of a sense of coherence (SOC), since having a strong SOC aids toward assembling the resources needed to cope with stressors and manage tensions with success. In order to respond to the challenges of population aging and the need to enable frail older adults to live at home for as long as possible, it is important to explore their meaningfulness in the context of home-based care. A salutogenic framework was used to study meaningfulness. The aim was to explore what promotes meaningfulness among frail older adults. The study uses a hermeneutical approach and has a qualitative design. In total, 17 frail older adults were interviewed. The data were analyzed by content analysis. The results uncovered four themes that the respondents considered important in enhancing meaningfulness in daily life: home care personnel, outdoor activities and green spaces, cultural activities and spirituality. Our study revealed the important role of home care personnel as a resource in promoting meaningfulness in the context of home-based care. Hence, this group should be given sufficient resources, knowledge and competence for enabling meaningfulness and thus a SOC amongst frail older adults.
Co-occurring Environmental Stressors have Emerging Impacts on Sensory-Motor Behavior
Authors: Suriyampola Piyumika S , Lopez Melissa , Suárez-Rodríguez Monserrat , Ellsworth Brontë E , Conroy-Ben Otakuye , Martins Emília P
Published: June 2021

Anthropogenic activities often lead to alterations in the natural environment via multiple routes. Simultaneous occurrence of interacting environmental perturbations may influence animals via more complex pathways than when being exposed to environmental stressors discretely. In our study, we investigated the interactive effects of poor visual environment and exposure to an environmentally realistic concentration of a common contaminant on the behavior of larval zebrafish, Danio rerio. Specifically, we tested the sensory-motor behavior of zebrafish larvae by exposing them to low-light conditions and a low concentration of bisphenol-A (BPA) for 7 days postfertilization. We found that zebrafish exposed to both BPA and low-light conditions had significantly weaker response to a moving-visual cue. However, those exposed to only one of these treatments did not have altered response to visual cues. Since the response to a moving, visual cue involves locomotion, we also examined the distance they traveled as a proxy for activity level of individuals across treatments. However, the distance traveled by individuals did not significantly differ across treatments, suggesting that the differences in response are linked to visual sensory pathways. Here, we emphasize that the adverse effects of environmental stressors, particularly of those that occur at environmentally relevant concentrations, may emerge only when they co-occur with another environmental stressor. These findings highlight the need to incorporate multiple environmental stressors to comprehensively assess impacts that human activities have on behavioral strategies of animals.
Capability ofEnterococcus faecalisto shield Gram-negative pathogens from aminoglycoside exposure
Authors: McMurtry Tiffany A , Barekat Ayeh , Rodriguez Fantasia , Purewal Parwinder , Bulman Zackery P , Lenhard Justin R
Published: June 2021

Background

Enterococcus faecalis commonly produce aminoglycoside-modifying enzymes (AMEs) and are implicated in polymicrobial infections.

Objectives

To determine if AME-producing E. faecalis is capable of protecting Enterobacteriaceae and Pseudomonas aeruginosa from gentamicin exposure.

Methods

Two Klebsiella pneumoniae isolates, two Escherichia coli isolates, and two Pseudomonas aeruginosa isolates were investigated in monoculture time–kill experiments, and each Gram-negative organism was also evaluated during co-culture with either AME-producing or AME-deficient E. faecalis. A pharmacokinetic/pharmacodynamics analysis that utilized Log Ratio Areas and a Hill-type mathematical model was used to determine if the maximal killing or potency of gentamicin against the Gram-negative organisms was altered by the presence of the E. faecalis.

Results

The maximal killing and potency of gentamicin was the same during monoculture and co-culture experiments for both K. pneumoniae isolates and one E. coli isolate (P > 0.05). In contrast, the maximal killing of gentamicin was attenuated against one E. coli isolate and both P. aeruginosa isolates during co-culture with E. faecalis (P < 0.05). The potency of gentamicin was variable against the three aforementioned isolates. Against the E. coli isolate, the potency of gentamicin was significantly reduced by the presence of either E. faecalis isolate (EC50 95% CI = 4.23–4.43 mg/L monoculture versus 3.86–4.19 mg/L and 3.55–3.96 mg/L during co-culture with AME-producing and AME-deficient E. faecalis, respectively). The potency of gentamicin increased or decreased for P. aeruginosa depending on which E. faecalis isolate was investigated.

Conclusions

The AME-producing E. faecalis did not provide a consistent protective effect from aminoglycosides for the Gram-negative pathogens.
Data Consult Service: Can we use observational data to address immediate clinical needs?
Authors: Ostropolets Anna , Zachariah Philip , Ryan Patrick , Chen Ruijun , Hripcsak George
Published: June 2021

Objective

A number of clinical decision support tools aim to use observational data to address immediate clinical needs, but few of them address challenges and biases inherent in such data. The goal of this article is to describe the experience of running a data consult service that generates clinical evidence in real time and characterize the challenges related to its use of observational data.

Materials and Methods

In 2019, we launched the Data Consult Service pilot with clinicians affiliated with Columbia University Irving Medical Center. We created and implemented a pipeline (question gathering, data exploration, iterative patient phenotyping, study execution, and assessing validity of results) for generating new evidence in real time. We collected user feedback and assessed issues related to producing reliable evidence.

Results

We collected 29 questions from 22 clinicians through clinical rounds, emails, and in-person communication. We used validated practices to ensure reliability of evidence and answered 24 of them. Questions differed depending on the collection method, with clinical rounds supporting proactive team involvement and gathering more patient characterization questions and questions related to a current patient. The main challenges we encountered included missing and incomplete data, underreported conditions, and nonspecific coding and accurate identification of drug regimens.

Conclusions

While the Data Consult Service has the potential to generate evidence and facilitate decision making, only a portion of questions can be answered in real time. Recognizing challenges in patient phenotyping and designing studies along with using validated practices for observational research are mandatory to produce reliable evidence.
Conditional Inferences Based on Vine Copulas with Applications to Credit Spread Data of Corporate Bonds
Authors: Pan Shenyi , Joe Harry , Li Guofu
Published: June 2021

Understanding the dependence relationship of credit spreads of corporate bonds is important for risk management. Vine copula models with tail dependence are used to analyze a credit spread dataset of Chinese corporate bonds, understand the dependence among different sectors, and perform conditional inferences. It is shown how the effect of tail dependence affects risk transfer, or the conditional distributions given one variable is extreme. Vine copula models also provide more accurate cross prediction results compared with linear regressions. These conditional inference techniques are a statistical contribution for analysis of bond credit spreads of investment portfolios consisting of corporate bonds from various sectors.
Robotic-assisted laparoscopic retrieval of a migrated IUCD in the pelvis
Authors: Adasonla Kelvin , Quraishi Mohammed K , Samateh Abdoulai , Tregunna Rebecca , Calleja Edward , Rimington Peter D
Published: June 2021

Intrauterine contraceptive devices (IUCDs) are a popular treatment choice for contraception. We report a case of a woman in her forties who presented to a urology clinic with visible haematuria. Flexible cystoscopy revealed a bladder lesion, suspicious for a tumour. However, subsequent imaging determined that this was in fact the arm of an IUCD, sited 7 years previously, which had migrated into the bladder. The patient underwent an uneventful robotic-assisted laparoscopic removal of the device.

IUCD-related complications are infrequent and can present atypically, warranting a broad diagnostic approach. Robotic-assisted laparoscopic removal of devices migrating into pelvic structures offers all the advantages of minimally invasive surgery, with the added benefits of three-dimensional views and endowrist movement facilitating tasks such as intracorporeal suturing. We report the first documented case of utilizing the da Vinci robotic system in safely assisting the removal of a migrated IUCD.
Temperature regulation of plant hormone signaling during stress and development
Authors: Castroverde Christian Danve M , Dina Damaris
Published: June 2021

Global climate change has broad-ranging impacts on the natural environment and human civilization. Increasing average temperatures along with more frequent heat waves collectively have negative effects on cultivated crops in agricultural sectors and wild species in natural ecosystems. These aberrantly hot temperatures, together with cold stress, represent major abiotic stresses to plants. Molecular and physiological responses to high and low temperatures are intricately linked to the regulation of important plant hormones. In this review, we highlight our current understanding of how changing temperatures regulate plant hormone pathways during immunity, stress responses, and development. Here we present an overview of known temperature-sensitive or temperature-reinforced molecular hubs in hormone biosynthesis, homeostasis, signaling, and downstream responses. These include recent advances in temperature regulation at the genomic, transcriptional, post-transcriptional, and post-translational levels—directly linking some plant hormone pathways to known thermosensing mechanisms. Where applicable, diverse plant species and various temperature ranges are presented, along with emerging principles and themes. It is anticipated that a grand unifying synthesis of current and future fundamental outlooks on how fluctuating temperatures regulate important plant hormone signaling pathways can be leveraged towards forward-thinking solutions to develop climate-smart crops in our dynamically changing world.
Geochemical Systematics of High Arctic Large Igneous Province Continental Tholeiites from Canada—Evidence for Progressive Crustal Contamination in the Plumbing System
Authors: Bédard Jean H , Saumur Benoit Michel , Tegner Christian , Troll Valentin R , Deegan Frances M , Evenchick Carol A , Grasby Stephen E , Dewing Keith
Published: June 2021

Cretaceous High Arctic large igneous province (HALIP) sub-alkaline magmatic rocks in Canada are mostly evolved (MgO 2–7 wt%), sparsely plagioclase + clinopyroxene ± olivine-phyric tholeiitic basalts. There were two main HALIP continental flood basalt (CFB) eruption episodes: 135–120 Ma (Isachsen Fm.) and 105–90 Ma (Strand Fiord Fm.), both associated with cogenetic doleritic sills and dykes. Building on a large modern database, 16 HALIP tholeiite types are defined and grouped into genetic series using Ce vs Sm/YbNMORB distributions. Comparison with model melting curves implies that higher-Sm/Yb HALIP basalt types record low-degree melting of garnet-bearing mantle sources. More voluminous intermediate- and low-Sm/Yb HALIP basalt types separated from the mantle at shallower levels after further extensive melting in the spinel-peridotite field. Within a given Sm/Yb range, increases in incompatible elements such as Ce are coupled with progressive clockwise rotation of normalized incompatible trace element profiles. Trace element modeling implies this cannot be due to closed-system fractional crystallization but requires progressive and ubiquitous incorporation of a component resembling continental crust. The fractionation models imply that low-Sm/Yb HALIP basalts (∼7 wt% MgO) initially crystallized olivine gabbro assemblages, with lower-MgO basalts successively crystallizing gabbro and ilmenite-gabbro assemblages. In contrast, higher-Sm/Yb basalts fractionated more clinopyroxene and ilmenite, but extensive plagioclase fractionation is still required to explain developing negative Sr–Eu anomalies. Back-fractionation models require about 40 % addition of olivine to bring the most primitive HALIP basalts (∼7 % MgO) into equilibrium with Fo89 mantle. Inverse fractionation–assimilation modeling shrinks the CFB signature, making decontaminated model parental melts more similar to enriched mid-ocean ridge basalt. The progressive increase of the contamination signature within each HALIP tholeiitic differentiation series is not consistent with models involving derivation of HALIP basalts from a mantle source previously enriched by subduction. Strong interaction of basalt with Sverdrup Basin sedimentary rocks may cause localized over-enrichment in K–Rb–Th–U, but cannot explain strong Ba enrichment in the absence of concomitant K–Rb–Th–U enrichment. The localized Ba enrichment could reflect either a Ba-rich lithospheric mantle component that is strongly manifested in the coeval HALIP alkaline suites, or syn- to post-emplacement fluid-mediated transfer from Ba-rich host rocks.
Taxation and Innovation in the Twentieth Century
Authors: Akcigit Ufuk , Grigsby John , Nicholas Tom , Stantcheva Stefanie
Published: June 2021

This article studies the effect of corporate and personal taxes on innovation in the United States over the twentieth century. We build a panel of the universe of inventors who patented since 1920, and a historical state-level corporate tax database with corporate tax rates and tax base information, which we link to existing data on state-level personal income taxes and other economic outcomes. Our analysis focuses on the effect of personal and corporate income taxes on individual inventors (the micro level) and on states (the macro level), considering the quantity and quality of innovation, its location, and the share produced by the corporate rather than the noncorporate sector. We propose several identification strategies, all of which yield consistent results. We find that higher taxes negatively affect the quantity and the location of innovation, but not average innovation quality. The state-level elasticities to taxes are large and consistent with the aggregation of the individual-level responses of innovation produced and cross-state mobility. Corporate taxes tend to especially affect corporate inventors’ innovation production and cross-state mobility. Personal income taxes significantly affect the quantity of innovation overall and the mobility of inventors.
Anti-inflammatory and immunoregulatory effects of pinolenic acid in rheumatoid arthritis
Authors: Takala Rabaa , Ramji Dipak P , Andrews Robert , Zhou You , Burston James , Choy Ernest
Published: June 2021

Objectives

In pre-clinical studies, pinolenic acid (PNLA), an omega-6-polyunsaturated fatty acid from pine nuts, has shown anti-inflammatory effects. We aimed to investigate the effect of PNLA in human cell lines and peripheral blood mononuclear cells (PBMCs) from RA patients and healthy controls (HCs).

Methods

A modified Boyden chamber was used to assess chemokine-induced migration of THP-1 monocytes. Macropinocytosis was assessed using Lucifer yellow and oxidized low-density lipoprotein (oxLDL) uptake using DiI-labelled oxLDL in THP-1 macrophages and human monocyte-derived macrophages (HMDMs). IL-6, TNF-α and prostaglandin E2 (PGE2) release by lipopolysaccharide (LPS)-stimulated PBMCs from RA patients and HCs was measured by ELISA. The transcriptomic profile of PNLA-treated, LPS-activated PBMCs was investigated by RNA-sequencing.

Results

PNLA reduced THP-1 cell migration by 55% (P < 0.001). Macropinocytosis and DiI-oxLDL uptake were reduced by 50% (P < 0.001) and 40% (P < 0.01), respectively, in THP-1 macrophages and 40% (P < 0.01) and 25% (P < 0.05), respectively, in HMDMs. PNLA reduced IL-6 and TNF-α release from LPS-stimulated PBMCs from RA patients by 60% (P < 0.001) and from HCs by 50% and 35%, respectively (P < 0.01). PNLA also reduced PGE2 levels in such PBMCs from RA patients and HCs (P < 0.0001). Differentially expressed genes whose expression was upregulated included pyruvate dehydrogenase kinase-4, plasminogen activator inhibitor-1, fructose bisphosphatase1 and N-Myc downstream-regulated gene-2, which have potential roles in regulating immune and metabolic pathways. Pathway analysis predicted upstream activation of the nuclear receptors peroxisome proliferator-activated receptors involved in anti-inflammatory processes, and inhibition of nuclear factor-κB and signal transducer and activator of transcription 1.

Conclusions

PNLA has immune-metabolic effects on monocytes and PBMCs that are pathogenic in RA and atherosclerosis. Dietary PNLA supplementation may be beneficial in RA.
Symptomatic Trauma: Japan, Drug Addiction, and the Limits of Treatment
Authors: CHRISTENSEN Paul
Published: June 2021

Possession and use of illegal drugs carry harsh penalties in Japan if an individual is apprehended by authorities. These severe legal restrictions stigmatize drug use while failing to eliminate narcotics from Japan. This makes individual efforts to take on recovery difficult, as admissions of past use are often met with fear and disdain. Drug Addiction Rehabilitation Center (DARC) is a Japanese organization that helps individuals work a program based on Narcotics Anonymous (NA), while providing members a place to spend their days free from temptation or judgment. Underestimated in this program is how DARC members drug use is often a symptomatic response to interpersonal trauma and struggles to meet societal expectations of success. I argue here that an NA influenced approach to recovery, typically the only option available to those seeking help in Japan, struggles to acknowledge contextual and societal factors that motivated members to begin using drugs. In doing so, I show the necessity for comprehensive change to the ways in which Japan understands, perceives, and treats those labeled as addicts.
Congenital Chagas disease in Santa Cruz Department, Bolivia, is dominated by Trypanosoma cruzi lineage V
Authors: Sanchez Leny , Messenger Louisa A , Bhattacharyya Tapan , Gilman Robert H , Mayta Holger , Colanzi Rony , Bozo Ricardo , Verástegui Manuela , Miles Michael A , Bern Caryn
Published: June 2021

Background

This study identified Trypanosoma cruzi discrete typing units (DTUs) in maternal and infant specimens collected from two hospitals in Bolivia, using conventional genotyping and DTU-specific serotyping.

Methods

Specimens from 142 mothers were used, including 24 seronegative and 118 seropositive individuals; 29 women transmitted T. cruzi to their infants. Maternal and infant parasite loads were determined by quantitative real-time PCR. Maternal sera were tested with an in-house parasite lysate ELISA and serotyped by a lineage-specific peptide ELISA, targeting the trypomastigote small surface antigen (TSSA). Trypanosoma cruzi genotypes in infected infants were determined by a triple PCR-RFLP assay.

Results

All infant specimens were genotyped as TcV. Maternal parasite loads and absorbance values by the lysate ELISA were significantly higher for transmitters compared with non-transmitters. Among seropositive mothers, 65.3% had positive results by the TSSA II/V/VI peptide ELISA. No significant difference in reactivity to TSSA II/V/VI was observed for transmitters compared with non-transmitters (79.3% vs 60.7%, respectively).

Conclusions

Our findings reinforce the difficulty in obtaining sufficient sample numbers and parasite DNA to investigate the interaction between parasite genetics and the risk of congenital transmission and argue for the inclusion of DTU-specific serotyping in prospective studies.
Risk clusters of Schistosoma mansoni infection in an endemic state of Brazil: space–time modelling and association with socio-economic and environmental factors
Authors: Souza Mariana do Rosário , de Jesus Damyres Menezes S , Santos Alexrangel H Cruz , Lima Shirley V M Almeida , dos Santos Allan , Tavares Débora dos Santos , de Araújo Karina Conceição G M , Bezerra-Santos Márcio
Published: June 2021

Background

We analysed the spatial distribution and the socio-economic and environmental factors (SEFs) associated with Schistosoma mansoni infection in the state of Alagoas, an important tourist area in northeastern Brazil.

Methods

We conducted an ecological time-series study (2007–2016) on schistosomiasis cases and SEFs. We evaluated the temporal trends of schistosomiasis cases (annual percentage change [APC]) and their correlation with SEFs. Spatial analysis maps were built using QGIS and TerraView software.

Results

We observed that 4.9% of the municipalities had a high prevalence of S. mansoni infection and were located mainly in the coastal strip of Alagoas state. The positivity rate for schistosomiasis decreased during the period (8.1% in 2007 to 4.9% in 2016; APC=−5.71). There was a reduction in the number of tests performed (APC=−5.05). There was a negative correlation between S. mansoni infection and the municipal human development index (ρ=−0.34) and schooling rate (ρ=−0.24). The main species of snail was Biomphalaria glabrata (94.79%), but Biomphalaria straminea showed a higher percentage of S. mansoni detection (10.11%). Lastly, Biomphalaria tenagophila specimens were identified for the first time in Alagoas (n=28).

Conclusions

Despite a reduction in the number of cases, intestinal schistosomiasis still represents a serious public health concern in Alagoas. It urgently requires planning and improvements in diagnosis, prevention programs and the state's socio-economic indicators.
Anesthetic Management of Acute Ischemic Stroke in the Interventional Neuro-Radiology Suite: State of the Art
Authors: Sou Brian S. , Aglio Linda S. , Zhou Jie
Published: June 2021

Purpose of review

This review discusses the general anesthetic approach of endovascular stroke therapy and highlights recent advances and considerations for optimal intraoperative management of acute ischemic stroke.

Recent findings

Recent randomized controlled trials have shown no differences in clinical outcomes between monitored anesthesia care with sedation compared with general anesthesia for endovascular stroke therapy. The COVID-19 pandemic has complicated decision-making in the neurointerventional setting. Advances in imaging techniques have extended the window of treatment for endovascular therapy.

Optimal time to intervention, hemodynamic stability, novel imaging techniques, and careful consideration of anesthetic plan can impact patient outcomes in reperfusion stroke therapy.
Effect of cardiac resynchronization therapy on ambulatory blood pressure monitoring indices in patients with heart failure and hypertension
Authors: Sherafati Alborz , Tootoonchian Mohammad Jalil , Eslami Masoud , Najafi Mohammad Taghi , Mollazadeh Reza
Published: June 2021

Objective

Blood pressure (BP) variability is associated with increased mortality in patients with hypertension and heart failure. The aim of our study was to evaluate the effect of cardiac resynchronization therapy (CRT) on different parameters of 24-h ambulatory blood pressure monitoring (ABPM) in patients with hypertension and heart failure.

Methods

Patients with heart failure and hypertension who were candidate for CRT implantation were enrolled in our study. Twenty-four hour ABPM was performed before, and 6 months after CRT implantation. BP variables and average real variability (ARV) were compared in all patients.

Result

Sixteen consecutive patients entered our study. There was a significant increase in ARV following CRT implantation (P value = 0.009).

Conclusion

CRT implantation is associated with increased ARV, but the effect of this improvement on cardiovascular outcome needs more investigation.
Impact of blood pressure lowering on ventricular repolarization heterogeneity in patients with newly diagnosed hypertension
Authors: Eyuboglu Mehmet , Celik Atac
Published: June 2021

Objective

Frontal plane QRS-T (fQRS-T) angle is a marker of ventricular repolarization heterogeneity and increased fQRS-T angle is associated with arrhythmias, adverse events and mortality. However, little is known about the importance and usefulness of fQRS-T angle in hypertensive patients. The present study aimed to investigate the association between blood pressure (BP) levels and fQRS-T angle. The main goal was to demonstrate whether BP lowering has a favorable effect on fQRS-T angle in hypertensive patients.

Methods

This study included 392 newly diagnosed hypertensive patients who underwent antihypertensive therapy. Responders and nonresponders to antihypertensive therapy were compared regarding baseline and post-treatment fQRS-T angle. fQRS-T angle was calculated as the absolute difference between QRS and T wave axes that were obtained from electrocardiography. Response to treatment was defined as achieving BP levels <140/90 mmHg.

Results

At the 1-month follow-up visit, responders had significantly lower fQRS-T angle compared to nonresponders despite the similar baseline fQRS-T angle (baseline: 57° ± 18.2° vs.56.6° ± 16.3°; P = 0.819, at 1 month: 36.9° ± 13.7 vs.53.5° ± 15.6°; P < 0.001). Moreover, after 3 months of antihypertensive treatment, both responders at 1 month and 3 months had significantly lower fQRS-T angle compared to nonresponders (34.8° ± 13.3° vs. 35.4° ± 12.9° vs. 52.3° ± 13.9°; P < 0.001). Furthermore, a significant moderate positive correlation was observed between systolic BP and fQRS-T angle (r:0.797; P < 0.001), and between diastolic BP and fQRS-T angle (r:0.761; P < 0.001).

Conclusion

In the present study, a significant decrease in fQRS-T angle was observed following BP lowering throughout the study period. Therefore, fQRS-T angle may be useful in the monitoring of antihypertensive treatment.
Sodium-glucose cotransporter 2 inhibition in non-diabetic kidney disease
Authors: Almaimani Mohanad , Sridhar Vikas S. , Cherney David Z.I.
Published: June 2021

Purpose of review

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have proven cardiorenal protection in patients with diabetes and chronic kidney disease (CKD) as seen in cardiovascular outcome trials (CVOTs) and CREDENCE. In this review, we aim to discuss the mechanisms of kidney protection with SGLT2 inhibition as well as review the results of multiple translational studies and clinical trials of SGLT2 inhibition in the nondiabetic kidney disease (non-DKD) population.

Recent findings

The application of SGLT2 inhibitors as dedicated kidney-protective agents continues to evolve with the publication of the dapagliflozin in patients with chronic kidney disease (DAPA CKD) trial, which extends their cardiorenal protection to patients with nondiabetic CKD. This trial was preceded by CREDENCE, a dedicated kidney outcome study in participants with DKD that demonstrated a 30% reduction in the risk of the composite kidney outcome. From a physiological perspective, mechanistic benefits of SGLT2 inhibitors are independent of their glucose-lowering effects as demonstrated in preclinical studies and post hoc analyses of dedicated CVOTs in participants with type 2 diabetes. From a clinical perspective, there is a growing body of evidence for kidney protection in nondiabetes mellitus patients.

There exists strong rationale for SGLT2 inhibition to be incorporated into standard of care for appropriate groups of patients with nondiabetic kidney disease.
Rubber Bullet Induced Traumatic Brain Injury
Authors: Ali Rohaid , Poggi Jonathan , Doberstein Cody A. , Woo Albert S. , Oyelese Adetokunbo A.
Published: June 2021

Rubber bullets have long been known to cause, on rare occasions, traumatic brain injury (TBI). However, neurosurgical literature on this occurrence is limited, and no focused review of this injury pattern has been conducted. The authors present the case of a 28-year-old male struck by a rubber bullet in the left periorbital region, causing TBI in addition to complete left visual loss and complex facial fractures. After developing a cerebrospinal fluid (CSF) leak, the patient was taken to the operating room for combined neurosurgical-craniofacial intervention. Utilizing frameless intraoperative computation tomography navigation assistance, a successful repair was made of both the patient's CSF leak and complex craniofacial injuries. TBI due to a rubber bullet is a rare but severe occurrence. Unfortunately, much of the limited literature on this topic is bereft of demographic, clinical course, injury pattern, and imaging data. Presented here is the first operative case report of TBI due to a rubber bullet. Volume rendered imaging is provided to demonstrate the extent of trauma incurred. Additionally, a methodology for frameless intraoperative computation tomography navigation assistance is shared for consideration, as it served as a helpful adjunct for a combined intracranial-craniofacial surgical repair. The experience of treating the patient's traumatic CSF leak in the context of severe craniofacial and ophthalmologic injuries highlights the need for a multidisciplinary surgical approach that may arise when treating patients with TBI due to a rubber bullet.
Device Malfunction Associated With Mandibular Distraction for Infants With Robin Sequence
Authors: Manrique Monica , McGrath Jeniffer L. , Bryant Justin R. , Mantilla-Rivas Esperanza , Rana Md Sohel , Boyajian Michael K. , Rogers Gary F. , Oh Albert K.
Published: June 2021

Introduction:

Mandibular distraction osteogenesis (MDO) effectively treats upper airway obstruction (UAO) in young patients with Robin sequence (RS). The most commonly used MDO devices have internal and external components that require manual activation. Although complications associated with MDO in infants with RS have been well documented, hardware/device malfunction has not been precisely described. The present study reports the authors’ recent experiences with such problems, in an effort to shed light on these complications and identify potential steps to mitigate future related issues.

Design:

The authors reviewed a prospectively gathered database to identify all young children under the age of 3 years who underwent MDO using buried internal devices for UAO associated with grade 3 RS from March 2007 to September 2019. We specifically focused on complications attributable to the hardware itself.

Results:

Nineteen patients with 40 devices met inclusion criteria. The median age at MDO was 2.3 months (interquartile range 1.4–6.3 months). Intraoperative activation of all devices under direct vision resulted in satisfactory distraction. Four devices (10.5%) developed postoperative complications directly related to the device, including break down of component parts (N = 3) and failure to maintain distraction distance (N = 1). Two patients required surgical replacement of one device each, whereas the remaining complications occurred during the consolidation phase and did not require intervention.

Conclusions:

This report documents a series of device/hardware malfunction in infants and young children undergoing MDO for severe UAO associated with RS. Despite rigorous testing and development, these devices may fail, resulting in patient morbidity.
Postpartum Urinary Incontinence: A Qualitative Study on Sexuality and Life Experiences of Muslim Turkish Women
Authors: Erkal Aksoy Yasemin , Akin Bihter , Dereli Yilmaz Sema
Published: June 2021

Objectives

The study was planned to identify the sexuality and life experiences of Muslim Turkish women with urinary incontinence (UI) within 12 months postpartum.

Methods

A qualitative study was conducted using a semistructured interview. Data were collected between July and December 2019 via an in-depth, face-to-face interview technique using an interview form. The qualitative data obtained in this study were analyzed with the content analysis technique.

Results

The main themes related to sexuality and life experiences of the women with UI in the postpartum period were identified as “problems in daily life,” “emotional effects,” “baby-related effects,” and “spouse’s and family’s attitudes.”

Conclusions

As a result, it was found that women in the postpartum period were affected by UI in terms of behavioral, emotional, and social aspects.