bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of cardiac strangulation following epicardial pacemaker implantation in an adult: a case report
Authors: Kang Ryeonshi , Tanaka Toshikazu D , Yoshitake Michio , Yoshimura Michihiro
Published: February 2022

Background

Cardiac strangulation (CS) is a rare but potentially devastating complication caused by the leads of an epicardial pacemaker (EP). Most cases have been reported in paediatric patients, and there has been no report wherein the diagnosis was made in a living, adult patient, and treated successfully.

Case summary

A 31-year-old woman with a history of atrial septal defect (ASD) patch closure and EP implantation for congenital atrial stand-still presented with dyspnoea on exertion. The blood investigation of the patient showed liver dysfunction, chest radiography showed pulmonary artery dilatation, and transthoracic echocardiography showed right chambers dysfunction. Right heart catheterization showed haemodynamics similar to those of constrictive pericarditis, eventually leading to the diagnosis of CS due to EP leads. The patient was successfully operated upon.

Discussion

We reported the first case where CS was diagnosed in adulthood and successfully treated with surgical intervention. Cardiac strangulation is challenging to diagnose because of the small number of cases reported and the lack of definitive diagnostic algorithms or criteria. Surgical EP lead removal should be performed without hesitation in cases where CS is considered the primary aetiology of critical symptoms or complications because surgical removal is the only fundamental treatment for CS. In addition, paediatric patients undergoing EP implantation need for close follow-up.
Minimally invasive lobectomy versus stereotactic ablative radiotherapy for stage I non-small cell lung cancer
Authors: de Ruiter Julianne Cynthia , van Diessen Judi Nani Annet , Smit Egbert Frederik , van der Noort Vincent , Damhuis Ronald Alphons Maria , Hartemink Koen Johan ,   ESLUNG group, Bongers E M , Braun J , Bussink J , Dielwart M F H , Ghamati M , de Groot M A , Hugen N , Hutteman M , Hüyük M , IJgosse W M , Klomp H M , Maat A P W M , Mali R , Marquenie N , Marres G M H , Martina B G , Mens D M , Oosterhuis J W A , Susa D , van Thiel E , Veen E J , Veenhof A A F A , Verbogt N P A , Verhagen A F T M , van der N C M G , van Zyp Voort , de Wee E M
Published: February 2022

OBJECTIVES

A minimally invasive lobectomy (MIL) is the standard treatment for stage I non-small cell lung cancer (NSCLC) in medically operable patients. Stereotactic ablative radiotherapy (SABR) is recommended for inoperable patients and has been proposed as a potential alternative for operable patients as well. Here, we present the results of a feasibility study in preparation for a nationwide retrospective cohort study, comparing outcomes between both treatment modalities.

METHODS

In this retrospective cohort study, data from patients with clinical stage I NSCLC treated with MIL or SABR in 2014–2015 were retrieved from databases from 12 Dutch hospitals. Progression-free survival (PFS), overall survival (OS) and lung cancer-specific survival (LCSS) were compared between MIL and SABR.

RESULTS

A total of 597 patients with clinical stage I NSCLC treated with MIL (n = 356) or SABR (n = 241) were included. In total, 106 (30%) patients had died in the MIL group and 142 (59%) in the SABR group. After MIL and SABR, unadjusted 5-year PFS was 63% and 30%, OS was 72% and 38% and LCSS was 81% and 76%, respectively. Propensity score-weighted analyses did not show significant differences between MIL and SABR in OS [hazard ratios (HR) 0.74 (95% confidence interval (CI) 0.43–1.29)], PFS [HR 0.74 (95% CI 0.42–1.32)] or LCSS [HR 0.81 (95% CI 0.42–1.59)].

CONCLUSIONS

Unadjusted analyses revealed superior OS and PFS for MIL and similar LCSS, but this feasibility study was not sufficiently powered to demonstrate significant differences using propensity score methodology. Therefore, this study is currently being extended to include more than half of Dutch hospitals in order to enlarge the population to ≥1880 patients, not only to determine the best treatment for patients with stage I NSCLC overall, but also to assess the preferred treatment for patient groups with specific characteristics.
Oral application of levosimendan before ischaemia/reperfusion with or without cardioplegic arrest in rats
Authors: Boening Andreas , Welk Edgar , Heep Martina , Hemmerich Carina , Niemann Bernd , Schlüter Klaus-Dieter , Taghiyev Zulfugar T
Published: February 2022

OBJECTIVES

Clinical studies have indicated minor beneficial effects of the calcium sensitizer levosimendan on clinical outcomes in patients undergoing cardiac surgery. Here, the influence of levosimendan administered 24 h before cardiac arrest on myocardial function was examined in rat hearts perfused in a Langendorff model.

METHODS

Levosimendan (Levo group) or NaCl (control group) was administered to 53 rats via drinking water 24 h prior to mounting excised hearts on a Langendorff apparatus. Cardiac arrest with or without cardioplegia was induced in both groups; another set of hearts was perfused continuously. During 90-min reperfusion at 36°C, functional parameters were measured and normalized to baseline values. Troponin I was quantified in coronary sinus effluent, and the functionality of isolated cardiomyocytes was studied.

RESULTS

Oral application of levosimendan showed therapeutic efficacy. Baseline values were similar in the Levo and NaCl groups except for coronary flow. After ischaemia and reperfusion, Levo hearts did not recover better than NaCl hearts {left ventricular derived pressure: 63 [standard deviation (SD): 36.2] vs 46 (SD: 41.8)% baseline; P = 0.386}, In hearts exposed to cardioplegia, functional recovery only slightly differed in the Levo and NaCl groups [left ventricular derived pressure: 69.96 (SD: 12.7) vs 51.89 (SD: 28.1)% baseline; P = 0.09]. Cell shortening of cardiomyocytes isolated from hearts exposed to ischaemia or perfusion was better in Levo groups [cell shortening: 7.65 (SD: 1.95) %; 7.8 (SD: 1.79)% vs 6.28 (SD: 1.67)%; 6.5 (SD: 1.87)%, P < 0.001]; this benefit was absent in cardioplegia-treated hearts.

CONCLUSIONS

Levosimendan applied orally before ischaemia/reperfusion improves functional recovery, but this effect is only moderate when cardioplegia is included. Differences between hearts exposed to cardioplegia or to global ischaemia may indicate why levosimendan-related beneficial effects do not directly translate into better clinical outcome.
Body image, body composition and environment: do they affect adolescents’ physical activity?
Authors: Karchynskaya Viktoryia , Kopcakova Jaroslava , Madarasova Geckova Andrea , Klein Daniel , de Winter Andrea F , Reijneveld Sijmen A
Published: February 2022

Background

Most adolescents are less physically active than recommended, despite the strong effort of various stakeholders to promote physical activity (PA). Body image and body composition may play an important role not only in directly facilitating adolescents’ PA but also in enabling environment-related factors. As evidence is lacking, we aimed to assess the associations of adolescents’ PA with body-related and environment-related factors, whether this differs by age and gender, and whether these factors interact.

Methods

We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. We used multinomial logistic regression analysis to assess the association of adolescents’ PA with body-related factors (body image, body composition) and environment-related factors (PA-promoting environment, less leisure constraints), taking into account age and gender.

Results

Adolescents who perceived their body as not too fat were more likely to be physically very active rather than inactive [odds ratios (ORs)/95% confidence interval (CI) 2.15/1.44–3.22], and similarly those who were not overweight/obese (3.24/2.09–5.01) and perceived less leisure constraints (1.74/1.44–2.11). In older adolescents and in girls, the association of adolescents’ PA with body composition and environment-related factors was stronger. The association of adolescents’ PA with perceiving less leisure constraints was stronger among adolescents who did not perceive their body as too fat (OR/95% CI 1.98/1.26–3.14), and for those who were not overweight/obese (OR/95% CI 1.62/1.01–2.57).

Conclusion

Adolescents’ PA is associated with both body-related and environment-related factors. These associations are stronger in girls and older adolescents, if co-occurring.
Comparative phylogenomics of ESBL-, AmpC- and carbapenemase-producing Klebsiella pneumoniae originating from companion animals and humans
Authors: Garcia-Fierro Raquel , Drapeau Antoine , Dazas Melody , Saras Estelle , Rodrigues Carla , Brisse Sylvain , Madec Jean-Yves , Haenni Marisa
Published: February 2022

Background

WHO considers ESBL- and carbapenemase-producing Klebsiella pneumoniae a major global concern. In animals, ESBL- and carbapenemase-producing K. pneumoniae of human-related ST11, ST15 and ST307 have been reported, but not in the context of large WGS-based One Health investigations.

Objectives

To perform comparative phylogenomics on a large collection of multidrug-resistant (MDR) K. pneumoniae recovered from diseased companion animals and humans.

Methods

MDR K. pneumoniae (n = 105) recovered from companion animals in France during 2010–18 were phenotypically characterized. All isolates were whole-genome sequenced using the NovaSeq technology and phylogenomic analysis across animal and human K. pneumoniae was performed using appropriate pipelines.

Results

bla CTX-M-15, blaDHA-1 and blaOXA-48 were strongly associated with IncFIIk, IncR and IncL plasmids, respectively. When compared with human K. pneumoniae genomes, four groups of closely related French human and animal isolates belonging to ST11, ST15 and ST307 were detected, suggesting the circulation of clones between the human and animal sectors at country level. A large cluster of 31 ST11-KL105 animal isolates from France and Switzerland suggested it corresponds to a sub-lineage that is particularly well-adapted to the animal host.

Conclusions

This study demonstrates the spread of blaCTX-M-15-carrying ST15 and ST307, and blaDHA-1-carrying ST11 K. pneumoniae clones in animal populations. ST11 was the main vector of blaOXA-48/IncL, despite the absence of carbapenem use in French animals. Comparative phylogenomics suggests cross-transmission of K. pneumoniae sub-lineages more prone than others to colonize/infect the animal host. Our data also evidenced the emergence of convergent hypervirulent and MDR K. pneumoniae in animals.
Systematic review and narrative synthesis of computerized audit and feedback systems in healthcare
Authors: Tsang Jung Yin , Peek Niels , Buchan Iain , van der Veer Sabine N , Brown Benjamin
Published: February 2022

Objectives

(1) Systematically review the literature on computerized audit and feedback (e-A&F) systems in healthcare. (2) Compare features of current systems against e-A&F best practices. (3) Generate hypotheses on how e-A&F systems may impact patient care and outcomes.

Methods

We searched MEDLINE (Ovid), EMBASE (Ovid), and CINAHL (Ebsco) databases to December 31, 2020. Two reviewers independently performed selection, extraction, and quality appraisal (Mixed Methods Appraisal Tool). System features were compared with 18 best practices derived from Clinical Performance Feedback Intervention Theory. We then used realist concepts to generate hypotheses on mechanisms of e-A&F impact. Results are reported in accordance with the PRISMA statement.

Results

Our search yielded 4301 unique articles. We included 88 studies evaluating 65 e-A&F systems, spanning a diverse range of clinical areas, including medical, surgical, general practice, etc. Systems adopted a median of 8 best practices (interquartile range 6–10), with 32 systems providing near real-time feedback data and 20 systems incorporating action planning. High-confidence hypotheses suggested that favorable e-A&F systems prompted specific actions, particularly enabled by timely and role-specific feedback (including patient lists and individual performance data) and embedded action plans, in order to improve system usage, care quality, and patient outcomes.

Conclusions

e-A&F systems continue to be developed for many clinical applications. Yet, several systems still lack basic features recommended by best practice, such as timely feedback and action planning. Systems should focus on actionability, by providing real-time data for feedback that is specific to user roles, with embedded action plans.

Protocol Registration

PROSPERO CRD42016048695.
Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want
Authors: Kiessling Karalyn A , Iott Bradley E , Pater Jessica A , Toscos Tammy R , Wagner Shauna R , Gottlieb Laura M , Veinot Tiffany C
Published: February 2022

Objective

To explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development.

Materials and Methods

We conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes.

Results

Providers lacked access to information about: patients’ ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related tools were helpful, they contained unclear insurance information and several questioned the information’s quality. Cost-related information was not available to everyone who needed it and was not always available when needed. Fragmentation of information across sources made cost-alleviation information difficult to access. Providers desired future tools to compare medication costs more directly; provide quick references on costs to facilitate clinical conversations; streamline medication resource referrals; and provide centrally accessible visual summaries of patient affordability challenges.

Discussion

These findings can inform the next generation of informatics tools for minimizing patients’ out-of-pocket costs. Future tools should support the work of a wider range of providers and situations and use cases than current tools do. Such tools would have the potential to improve prescribing decisions and better link patients to resources.

Conclusion

Results identified opportunities to fill multidisciplinary providers’ information gaps and ways in which new tools could better support medication affordability for patients.
Genetic diversity and population structure of invasive and native populations of Erigeron canadensis L.
Authors: Bhattacharya Saurav , Hernández Fernando , Alves Mariana Ferreira , Machado Raquel Moura , Sun Yan-Yan , Wang Meng-Ru , Zhang Chao-Bin , Hao Jian-Hua
Published: February 2022

Invasive alien plants threaten biodiversity across the world. Erigeron canadensis (horseweed) is one of the most problematic agricultural weeds and represents a classic example of intercontinental invasion. Here, we studied the genetic diversity and population structure of invasive alien populations from the Jiangsu and Zhejiang Provinces in China and native populations from Alabama, in the USA. We used 10 polymorphic SSR loci to genotype 312 individuals from 5 native and 5 invasive populations to estimate the genetic diversity and structure. Invasive populations from Jiangsu and Zhejiang Provinces showed, on average, similar genetic diversity to native populations from Alabama, indicating no severe genetic bottlenecks during the invasion. STRUCTURE revealed that low population differentiation occurred, and that only two genetic groupings were detected in both native and invaded ranges. The high diversity observed in the invasive populations suggested multiple introductions and/or the introduction of genetically diverse propagules during initial colonization. Our study provides new insights toward understanding the invasion dynamics of this globally noxious weed in Eastern China. Preventing gene flow via seed dispersal between invasive and native populations should be examined to prevent the introduction and dispersal of herbicide-resistant individuals and inform management practices.
Attenuation of opioid tolerance by ETA receptor antagonist, BQ123, administered intravenously in mice
Authors: Bhalla Shaifali , Lyne Jaimee , Gulati Anil , Andurkar Shridhar V
Published: February 2022

Objectives

Intracerebroventricular injection of endothelin-A receptor antagonist BQ123 potentiates opioid analgesia and reverses analgesic tolerance. This study explores whether these effects can be replicated by injecting BQ123 intravenously.

Methods

Male Swiss-Webster mice were used. Morphine tolerance was induced using 3- or 7-day dosing. Intravenous BQ123 (8 mg/kg) was injected only once on Day 1, 2, 3 or 4 (3-day studies), and on Day 4, 6 or 8 (7-day studies). On Day 4 or 8, respectively, tail-flick and hot-plate latencies were measured following a morphine challenge dose.

Key findings

Intravenous BQ123 increased the potency and duration of morphine antinociceptive responses. In the 3-day study, the antinociceptive response was unaffected by BQ123 given on Days 1 or 2. BQ123 treatment on Day 3 or 4 (Day 4, BQ123 given 15-min before morphine) significantly potentiated antinociceptive response versus vehicle-treated tolerant mice. In 7-day studies, the antinociceptive response was unaffected by BQ123 given on Day 4. BQ123 given on Day 6 or 8 (Day 8, BQ123 given 15-min before morphine) produced a >100% increase in antinociceptive response versus vehicle-treated tolerant mice for at least 48 h.

Conclusions

Intravenous administration of BQ123 is effective in potentiating morphine analgesia and restoring antinociceptive response in morphine-tolerant mice.
Pathways Between Psychological Trauma and the Development of Personality Disorders
Authors: Rosen Valerie , Fonzo Gregory , Rosen Emily , Preston Alex
Published: February 2022

This chapter explores the connection between trauma and personality disorders (PDs). The mindset of a survivor of trauma is examined to elucidate how patterns of behavior evolve after trauma that may lead to the development of character pathology. Psychological etiologic theories coupled with neuroanatomical changes from neuroimaging research are reviewed. Details on both structural and functional magnetic resonance imaging findings specific to PDs in the context of early-life adversity are reviewed. Borderline, schizotypal, paranoid, and antisocial PDs s are highlighted in detail to assess both the psychological and known biological dimensions of the impact of trauma in the formation of these disorders.
Crossing the Alphabet Divide
Authors: Levy Kenneth N. , Johnson Benjamin N. , Notsu Haruka
Published: February 2022

Treatment approaches for borderline personality disorder (BPD) derive from a range of traditions and theoretical orientations, oftentimes considered to be competing or mutually exclusive. In this chapter we describe the major psychotherapy approaches for treating BPD and examine the evidence from both randomized controlled trials and meta-analyses. We summarize the evidence for the efficacy various treatments for BPD, outline similarities and differences among these treatments, and provide a big-picture perspective by integrating research findings and distilling principles. We encourage researchers and clinicians to begin examining treatments more broadly, including how elements of various approaches may be combined or sequenced to better help patients. In this vein, strategies for adapting and integrating various treatments are discussed.
Managing Patients with Personality Disorders in Medical Settings
Authors: Feinstein Robert E.
Published: February 2022

Working with patients who have personality styles or disorders in medical settings can be challenging. Patients who have a personality disorder or certain personality traits often have an unintentional ability to create problematic patient–physician or clinician–staff relationships. This chapter is designed to facilitate understanding and management of these difficult patients so that optimal medical care can be delivered. To assist psychiatrists, physicians, clinicians, and medical staff, this chapter presents a personality disorder schema. The schema was developed utilizing components of psychodynamic, cognitive behavioral, and problem-solving therapies. The schema can be used in multiple clinical settings including inpatient hospitals, outpatient medical clinics of all varieties, psychiatric services, and integrated mental health settings. The schema includes: making a diagnosis; understanding common clinician reactions or countertransferences experienced with the different personality styles or disorders; establishing the patient psychopathological level of functioning; identifying the patient belief system or worldview; empathizing and addressing the patient’s fears; identifying the specific coping styles and defenses utilized by the patient; anticipating the patient’s adherence to medical recommendations and likely medical utilization. Both global/general and specific intervention strategies for the medical management of each personality disorder or style are described.
Cognitive-behavioral Therapy
Authors: Southward Matthew W. , Semcho Stephen A. , Sauer-Zavala Shannon
Published: February 2022

Cognitive-behavioral therapy (CBT) is a relatively efficacious treatment for personality disorders based on the theory that the way people think about stressful situations influences their emotional, behavioral, and physiological responses to them. It is a structured intervention characterized by specific cognitive and behavioral skills that are taught in session and practiced by patients between sessions. These skills are designed to help patients identify and examine the evidence regarding maladaptive thought patterns. CBT skills include cognitive skills (e.g., cognitive restructuring, downward arrow technique), behavioral skills (e.g., behavioral experiments, activity scheduling), and mindfulness and experiential skills (e.g., guided meditation, imagery practice). CBT has typically been studied as a year-long, once-weekly treatment. However, two brief variants of CBT that may be helpful for some patients with personality disorders have received preliminary analysis. One, manual assisted cognitive therapy (MACT), is a six-session, guided self-help protocol designed to help patients apply cognitive, behavioral, and relapse prevention skills to maladaptive and self-harming behaviors. The second, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, has been studied as a 12–16 week treatment for borderline personality disorder. It is designed to teach patients five cognitive, behavioral, and mindfulness skills that allow them to experience difficult emotions and learn to tolerate them. Because they are under-researched, these treatments generally have moderate strength of evidence. In this chapter, we describe these treatments, their approach to treating patients with personality disorders, and the evidence regarding their use. We include clinical vignettes throughout to illustrate specific CBT skills.
Histrionic Personality Disorder
Authors: Magid Michelle , Fox Isadora
Published: February 2022

This chapter reviews the characteristics, symptomology, diagnosis, epidemiological, biopsychosocial, genetic, pharmacological, psychotherapeutic aspects of treating patients with Histrionic Personality Disorder (HPD) who are in the Cluster B (dramatic/emotional) subset of personality disorders. HPD is marked by flamboyant, shallow, dysregulated emotional style, with attention-seeking behaviors. Patients rarely present for evaluation on their own, as many patients do not perceive that their behavior negatively affects their relationships or livelihood. There is a large body of literature that describes the disorder via a psychodynamic and psychoanalytic lens. However, there are few resources that focus on the treatment of the disorder by itself; rather, it is often discussed as a phenomenon embedded within or comorbid to additional diagnoses. Like many other personality disorders, it is thought to be a mosaic of genetic and environmental factors. These patients may be challenging to treat because of their limited insight, an inability to provide earnest feedback about their internal states, seductive and sexualized behaviors, and a distracting presentation meant to serve the patient’s needs rather than resolve behavioral, interpersonal, or emotional issues.
Masochistic/Self-defeating Personality Styles
Authors: Glick Robert Alan , Berger Brenda
Published: February 2022

Patients with masochistic/self-defeating personality styles show recurrent and persistent patterns of pain, suffering, failure, loss, and disappointment in many facets of their lives. Psychodynamic explanatory theories of masochism can guide the clinician through the slow, difficult, and often discouraging treatment process. Combining aspects of cognitive-behavioral and psychodynamic treatment approaches may offer significant tools in the therapeutic process over long periods of time. Clinicians must pay close attention to the profound unconscious painful attachments that define these patients’ inner lives, and to the significant, difficult countertransference reactions that inevitably arise. This recognition is essential in sustaining effective treatments.
Practical Psychiatry for Students and Trainees
Authors: O'Dwyer A. M. , Campion M.
Published: February 2022

This brief, book is a practical, clinical-skills-focused guide, accessible to medical students, trainees, and any healthcare professional entering clinical environments. It provides the core knowledge and skills needed to interview and assess patients well. It provides additional, key information about mental illness, allowing the reader to deliver essential, initial psychiatric care to patients with mental health needs. The book focuses on clinical skills, noting that this is an area often overlooked in an era of technology-driven healthcare. It provides specific guidance, practical tips, and clinical stories/vignettes in each chapter to illustrate points made. It helps the reader to conduct a competent, empathic interview in any clinical scenario but especially in the context of mental illness. Reflecting the authors’ background in medicine, as well as psychiatry, the book discusses mental health not only in the context of psychiatry, but also in the context of medical settings, such as the Emergency Department, medical, surgical, and GP placements. Each chapter includes clinical examples, case vignettes, and practical tips from clinicians to aid the reader to improve their skills, to understand the subject, and to apply what they have studied. Mnemonics and chapter objectives aid learning. The book opens with a ‘Letter to the reader’ that explains the context and content of the text, and suggests how best to use the material. Chapters include topics such as ‘Setting the scene’, ‘What to ask and how to ask it’, ‘Proposing a diagnosis’, and ‘Emergencies’. The book ends with a chapter on ‘Professionalism, boundaries, and well-being’.
The VMC survey – XLVII. Turbulence-controlled hierarchical star formation in the Large Magellanic Cloud
Authors: Miller Amy E , Cioni Maria-Rosa L , de Grijs Richard , Sun Ning-Chen , Bell Cameron P M , Choudhury Samyaday , Ivanov Valentin D , Marconi Marcella , Oliveira Joana M , Petr–Gotzens Monika , Ripepi Vincenzo , van Loon Jacco Th
Published: February 2022

We perform a statistical clustering analysis of upper main-sequence stars in the Large Magellanic Cloud (LMC) using data from the Visible and Infrared Survey Telescope for Astronomy survey of the Magellanic Clouds. We map over 2500 young stellar structures at 15 significance levels across ∼120 square degrees centred on the LMC. The structures have sizes ranging from a few parsecs to over 1 kpc. We find that the young structures follow power-law size and mass distributions. From the perimeter–area relation, we derive a perimeter–area dimension of 1.44 ± 0.20. From the mass–size relation and the size distribution, we derive two-dimensional fractal dimensions of 1.50 ± 0.10 and 1.61 ± 0.20, respectively. We find that the surface density distribution is well represented by a lognormal distribution. We apply the Larson relation to estimate the velocity dispersions and crossing times of these structures. Our results indicate that the fractal nature of the young stellar structures has been inherited from the gas clouds from which they form and that this architecture is generated by supersonic turbulence. Our results also suggest that star formation in the LMC is scale-free from 10 to 700 pc.
Rotation measure and synchrotron emission signatures in simulations of magnetized galactic discs
Authors: Rappaz Yoan , Schober Jennifer , Girichidis Philipp
Published: February 2022

We analyse observational signatures of magnetic fields for simulations of a Milky Way-like disc with supernova-driven interstellar turbulence and self-consistent chemical processes. In particular, we post-process two simulations data sets of the SILCC Project for two initial amplitudes of the magnetic field, B0 = 3 and 6 μG, to study the evolution of Faraday rotation measures (RM) and synchrotron luminosity. For calculating the RM, three different models of the electron density ne are considered. A constant electron density, and two estimations based on the density of ionized species and the fraction of the total gas, respectively. Our results show that the RM profiles are extremely sensitive to the ne models, which assesses the importance of accurate electron distribution observations/estimations for the magnetic fields to be probed using Faraday RMs. As a second observable of the magnetic field, we estimate the synchrotron luminosity in the simulations using a semi-analytical cosmic ray model. We find that the synchrotron luminosity decreases over time, which is connected to the decay of magnetic energy in the simulations. The ratios between the magnetic, the cosmic ray, and the thermal energy density indicate that the assumption of equipartition does not hold for most regions of the ISM. In particular, for the ratio of the cosmic ray to the magnetic field energy the assumption of equipartition could lead to a wrong interpretation of the observed synchrotron emission.
Urea levels and cardiovascular disease in patients with chronic kidney disease
Authors: Laville Solène M , Couturier Aymeric , Lambert Oriane , Metzger Marie , Mansencal Nicolas , Jacquelinet Christian , Laville Maurice , Frimat Luc , Fouque Denis , Combe Christian , Robinson Bruce M , Stengel Bénédicte , Liabeuf Sophie , Massy Ziad A ,   the CKD-REIN study collaborators, Ayav Carole , Briançon Serge , Cannet Dorothée , Combe Christian , Fouque Denis , Frimat Luc , Herpe Yves-Edouard , Jacquelinet Christian , Laville Maurice , Massy Ziad A , Pascal Christophe , Robinson Bruce M , Stengel Bénédicte , Lange Céline , Legrand Karine , Liabeuf Sophie , Metzger Marie , Speyer Elodie , Hannedouche Thierry , Moulin Bruno , Mailliez Sébastien , Lebrun Gaétan , Magnant Eric , Choukroun Gabriel , Deroure Benjamin , Lacraz Adeline , Lambrey Guy , Philippe Jean , Bourdenx  , Essig Marie , Lobbedez Thierry , Azar Raymond , Sekhri Hacène , Smati Mustafa , Jamali Mohamed , Klein Alexandre , Delahousse Michel , Combe Christian , Martin Séverine , Landru Isabelle , Thervet Eric , Massy Ziad A , Lang Philippe , Belenfant Xavier , Urena Pablo , Vela Carlos , Frimat Luc , Chauveau Dominique , Panescu Viktor , Noel Christian , Glowacki François , Hoffmann Maxime , Hourmant Maryvonne , Besnier Dominique , Testa Angelo , Kuentz François , Zaoui Philippe , Chazot Charles , Juillard Laurent , Burtey Stéphane , Keller Adrien , Kamar Nassim , Fouque Denis , Laville Maurice
Published: February 2022

Background

Elevated serum urea levels are common in moderate-to-advanced chronic kidney disease (CKD). Several studies have shown that urea is a direct and indirect uraemic toxin, especially with regard to cardiovascular disease. We sought to determine whether serum urea levels are associated with adverse cardiovascular events and death before renal replacement therapy (RRT) in patients with CKD.

Methods

CKD-REIN is a prospective cohort of CKD nephrology outpatients not receiving maintenance dialysis. The 2507 patients included in the analysis were divided into three groups according to the baseline serum urea level (T1 <10.5, T2 10.5–15.1 and T3 ≥15.1 mmol/L). Cox proportional hazard models were used to estimate hazard ratios (HRs) for first atheromatous or non-atheromatous cardiovascular (CV) events and all-cause mortality before RRT. The models were adjusted for baseline comorbidities, laboratory data and medications.

Findings

Of the 2507 included patients {median [interquartile range (IQR)] age: 69 [61–77]; mean (standard deviation) estimated glomerular filtration rate (eGFR) 33.5 (11.6) mL/min/1.73 m²}, 54% had a history of cardiovascular disease. After multiple adjustments for CV risk factors (including eGFR), patients in T3 had a higher risk of atheromatous and non-atheromatous CV events than patient in T1 (n events = 451, HR [95% CI]: 1.93 [1.39; 2.69]). The adjusted HRs for death before RRT (n events = 407) were 1.31 [0.97; 1.76] and 1.73 [1.22; 2.45] for patients T2 and those in T3, respectively.

Interpretation

Our data suggested that urea is a predictor of CV outcomes beyond CV risk factors including eGFR.
Insights into polyamine metabolism: homospermidine is double-oxidized in two discrete steps by a single copper-containing amine oxidase in pyrrolizidine alkaloid biosynthesis
Authors: Zakaria Mahmoud M , Stegemann Thomas , Sievert Christian , Kruse Lars H , Kaltenegger Elisabeth , Girreser Ulrich , Çiçek Serhat S , Nimtz Manfred , Ober Dietrich
Published: February 2022

Polyamines are important metabolites in plant development and abiotic and biotic stress responses. Copper-containing amine oxidases (CuAOs) are involved in the regulation of polyamine levels in the cell. CuAOs oxidize primary amines to their respective aldehydes and hydrogen peroxide. In plants, aldehydes are intermediates in various biosynthetic pathways of alkaloids. CuAOs are thought to oxidize polyamines at only one of the primary amino groups, a process frequently resulting in monocyclic structures. These oxidases have been postulated to be involved in pyrrolizidine alkaloid (PA) biosynthesis. Here, we describe the identification and characterization of homospermidine oxidase (HSO), a CuAO of Heliotropium indicum (Indian heliotrope), involved in PA biosynthesis. Virus-induced gene silencing of HSO in H. indicum leads to significantly reduced PA levels. By in vitro enzyme assays after transient in planta expression, we show that this enzyme prefers Hspd over other amines. Nuclear magnetic resonance spectroscopy and mass spectrometry analyses of the reaction products demonstrate that HSO oxidizes both primary amino groups of homospermidine (Hspd) to form a bicyclic structure, 1-formylpyrrolizidine. Using tracer feeding, we have further revealed that 1-formylpyrrolizidine is an intermediate in the biosynthesis of PAs. Our study therefore establishes that HSO, a canonical CuAO, catalyzes the second step of PA biosynthesis and provides evidence for an undescribed and unusual mechanism involving two discrete steps of oxidation that might also be involved in the biosynthesis of complex structures in other alkaloidal pathways.
Strengthening systematic reviews in public health: guidance in the Cochrane Handbook for Systematic Reviews of Interventions, 2nd edition
Authors: Cumpston Miranda S , McKenzie Joanne E , Welch Vivian A , Brennan Sue E
Published: February 2022

Aims

Decision makers in public health practice and policy rely on access to trustworthy, relevant, synthesized evidence. The second edition of the Cochrane Handbook for Systematic Reviews of Interventions (‘the Handbook’) reflects a major revision in guidance for authors of systematic reviews, incorporating a decade of methodological development and a number of significant changes to previous recommendations. This paper aims to highlight new guidance that addresses a number of key methodological challenges for authors of systematic reviews in public health.

Results

The revised Handbook includes guidance on framing public health research questions for synthesis, considering equity, intervention complexity, risk of bias assessment and synthesis methods other than meta-analysis. Reviews of public health interventions frequently encounter the types of methodological complexity addressed in this new guidance.

Conclusion

We hope that readers will find that the Cochrane Handbook includes detailed and thoughtful guidance on both conceptualizing and executing systematic reviews relevant to public health questions. Considering the available methods guidance will, we hope, provide support for authors of public health reviews to tackle the challenges they encounter, strengthen their analysis and provide useful answers to the important questions asked by stakeholders and users of public health evidence.
The Growth of Telehealth
Authors: Fauteux Nicole
Published: February 2022

The pandemic's ‘silver lining.’
A retrospective comparison of COVID-19 and seasonal influenza mortality and outcomes in the ICUs of a French university hospital
Authors: de Marignan Donatien , Vacheron Charles-Hervé , Ader Florence , Lecocq Maxime , Richard Jean Christophe , Frobert Emilie , Casalegno Jean Sebastien , Couray-Targe Sandrine , Argaud Laurent , Rimmele Thomas , Aubrun Frédéric , Dailler Frédéric , Fellahi Jean Luc , Bohe Julien , Piriou Vincent , Allaouchiche Bernard , Friggeri Arnaud , Wallet Florent
Published: February 2022

BACKGROUND

SARS-Cov-2 (COVID-19) has become a major worldwide health concern since its appearance in China at the end of 2019.

OBJECTIVE

To evaluate the intrinsic mortality and burden of COVID-19 and seasonal influenza pneumonia in ICUs in the city of Lyon, France.

DESIGN

A retrospective study.

SETTING

Six ICUs in a single institution in Lyon, France.

PATIENTS

Consecutive patients admitted to an ICU with SARS-CoV-2 pneumonia from 27 February to 4 April 2020 (COVID-19 group) and seasonal influenza pneumonia from 1 November 2015 to 30 April 2019 (influenza group). A total of 350 patients were included in the COVID-19 group (18 refused to consent) and 325 in the influenza group (one refused to consent). Diagnosis was confirmed by RT-PCR. Follow-up was completed on 1 April 2021.

MAIN OUTCOME(S) AND MEASURE(S)

Differences in 90-day adjusted-mortality between the COVID-19 and influenza groups were evaluated using a multivariable Cox proportional hazards model.

RESULTS

COVID-19 patients were younger, mostly men and had a higher median BMI, and comorbidities, including immunosuppressive condition or respiratory history were less frequent. In univariate analysis, no significant differences were observed between the two groups regarding in-ICU mortality, 30, 60 and 90-day mortality. After Cox modelling adjusted on age, sex, BMI, cancer, sepsis-related organ failure assessment (SOFA) score, simplified acute physiology score SAPS II score, chronic obstructive pulmonary disease and myocardial infarction, the probability of death associated with COVID-19 was significantly higher in comparison to seasonal influenza [hazard ratio 1.57, 95% CI (1.14 to 2.17); P = 0.006]. The clinical course and morbidity profile of both groups was markedly different; COVID-19 patients had less severe illness at admission (SAPS II score, 37 [28 to 48] vs. 48 [39 to 61], P < 0.001 and SOFA score, 4 [2 to 8] vs. 8 [5 to 11], P < 0.001), but the disease was more severe considering ICU length of stay, duration of mechanical ventilation, PEEP level and prone positioning requirement.

CONCLUSION

After ICU admission, COVID-19 was associated with an increased risk of death compared with seasonal influenza. Patient characteristics, clinical course and morbidity profile of these diseases is markedly different.
Clinical outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation laser for treatment of glaucoma
Authors: Khodeiry Mohamed M. , Liu Xiangxiang , Lee Richard K.
Published: February 2022

Purpose of review

The complications and inadequate efficacy of prior cyclodestructive procedures limited their role in glaucoma management. Recent advances in treatment techniques and parameters for laser cyclophotocoagulation has expanded its role in today's glaucoma practice. In this review, we discuss the treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) as a glaucoma surgical procedure for multiple types of glaucoma in lowering intraocular pressure (IOP).

Recent findings

Slow-coagulation TSCPC is a relatively new technique for CW-TSCPC that, unlike the ‘pop’ power titration technique of laser energy delivery, aims to avoid the production of the ‘pop’ sound that signals explosive inflammatory energy delivery to the ciliary body and nearby tissue. In slow-coagulation TSCPC, laser energy is applied in a fixed and lower amount over a longer duration, compared with the conventional pop technique. This laser energy approach leads to more stable, reliable, titratable, and selective ciliary body ablation for control of IOP, especially relative to the controversial current use of micropulse TSCPC.

Slow-coagulation CW-TSCPC can be used safely, efficiently, reproducibly, and efficaciously in wide range of glaucoma types including those with no history of incisional surgeries, good visual acuity, and medically refractory glaucomas.
Differential expression of a brain aging biomarker across discrete chronic pain disorders
Authors: Hung Peter Shih-Ping , Zhang Jia Y. , Noorani Alborz , Walker Matthew R. , Huang Megan , Zhang Jason W. , Laperriere Normand , Rudzicz Frank , Hodaie Mojgan
Published: February 2022

Chronic pain has widespread, detrimental effects on the human nervous system and its prevalence and burden increase with age. Machine learning techniques have been applied on brain images to produce statistical models of brain aging. Specifically, the Gaussian process regression is particularly effective at predicting chronological age from neuroimaging data which permits the calculation of a brain age gap estimate (brain-AGE). Pathological biological processes such as chronic pain can influence brain-AGE. Because chronic pain disorders can differ in etiology, severity, pain frequency, and sex-linked prevalence, we hypothesize that the expression of brain-AGE may be pain specific and differ between discrete chronic pain disorders. We built a machine learning model using T1-weighted anatomical MRI from 812 healthy controls to extract brain-AGE for 45 trigeminal neuralgia (TN), 52 osteoarthritis (OA), and 50 chronic low back pain (BP) subjects. False discovery rate corrected Welch t tests were conducted to detect significant differences in brain-AGE between each discrete pain cohort and age-matched and sex-matched controls. Trigeminal neuralgia and OA, but not BP subjects, have significantly larger brain-AGE. Across all 3 pain groups, we observed female-driven elevation in brain-AGE. Furthermore, in TN, a significantly larger brain-AGE is associated with response to Gamma Knife radiosurgery for TN pain and is inversely correlated with the age at diagnosis. As brain-AGE expression differs across distinct pain disorders with a pronounced sex effect for female subjects. Younger women with TN may therefore represent a vulnerable subpopulation requiring expedited chronic pain intervention. To this end, brain-AGE holds promise as an effective biomarker of pain treatment response.
COVID-19 Patient Vaccine Program Design and Implementation
Authors: Boogaard Claire O'Connell , Graves Teresa , Ricks Jeanne R. , Badh Ranjodh , Cronin Bridget , Koay Wei Li Adeline , Hanisch Benjamin , Rahn Katie , Williams Andrew R. , Gorman Kathleen , Shah Rahul K. , Biddle Cara L.
Published: February 2022

To slow the spread of the 2019 novel coronavirus disease (COVID-19) and reduce the associated morbidity and mortality, the Children's National Hospital developed a multidisciplinary, collaborative vaccine program aimed at equitably and expeditiously vaccinating the pediatric population of the surrounding community. Interdepartmental collaboration, professional expertise, and community partnerships allowed for a dynamic and successful program design that began as large volume–centralized vaccine clinics and expanded to smaller volume ambulatory clinics. This strategy proved successful at meeting local vaccine demand; however, strategies to improve vaccine uptake in communities with high rates of hesitancy are still needed to maximize vaccine equity.
Incentive Programs for Physicians to Practice in Underserved Areas
Authors: Quigley Leo
Published: February 2022

Access to health care is limited in part by maldistribution of physicians. Physicians agreeing to work in underserved areas can receive a financial incentive or a visa waiver that eases immigration restrictions. However, the overall landscape and scale of incentive programs and providers remains unelucidated. This article aggregates the reported output of state and federal programs and assesses their relative contributions to increasing the physician workforce in underserved areas. The estimates derived suggest that in 2017 the National Health Service Corps supported placement of around 2000 physicians, fully state-funded financial incentive programs about 1000, and visa waiver programs over 3500.
Gut-derived serotonin and its emerging roles in immune function, inflammation, metabolism and the gut–brain axis
Authors: Banskota Suhrid , Khan Waliul I.
Published: February 2022

Purpose of review

To shed light on the recently uncovered diverse role of serotonin (5-hydroxytryptamine; 5-HT) in the regulation of immune functions, inflammation, metabolism, and gut–brain axis.

Recent findings

Peripheral 5-HT which accounts for approximately 95% of the total is largely synthesized in the gut by enterochromaffin cells. Enterochromaffin cells release 5-HT in response to various stimuli including microbial products. Released 5-HT influences secretomotor, sensory and immune functions as well as inflammatory processes in the gut. 5-HT released from enterochromaffin cells enters circulation and is taken up and concentrated in platelets. 5-HT released from the activated platelets interacts with different organs to alter their metabolic activity. 5-HT also serves as a link in the gut–brain axis.

Emerging evidence regarding the role of peripheral 5-HT in the regulation of various physiological and pathophysiological conditions opens up new targets for researchers to explore and for clinicians to treat and manage different diseases associated with the altered 5-HT signalling.