bluuebunny/crossref_metadata_2025 huggingface dataset:
Variant Reinterpretation in Survivors of Cardiac Arrest With Preserved Ejection Fraction (the Cardiac Arrest Survivors With Preserved Ejection Fraction Registry) by Clinicians and Clinical Commercial Laboratories
Authors: Davies Brianna , Bartels Kirsten , Hathaway Julie , Xu Fang , Roberts Jason D. , Tadros Rafik , Green Martin S. , Healey Jeffrey S. , Simpson Christopher S. , Sanatani Shubhayan , Steinberg Christian , Gardner Martin , Angaran Paul , Talajic Mario , Hamilton Robert , Arbour Laura , Seifer Colette , Fournier Anne , Joza Jacqueline , Krahn Andrew D. , Lehman Anna , Laksman Zachary W.M.
Published: May 2021

Background:

Following an unexplained cardiac arrest, clinical genetic testing is increasingly becoming standard of care. Periodic review of variant classification is required, as reinterpretation can change the diagnosis, prognosis, and management of patients and their relatives.

Methods:

This study aimed to develop and validate a standardized algorithm to facilitate clinical application of the 2015 American College of Medical Genetics and Association for Molecular Pathology guidelines for the interpretation of genetic variants. The algorithm was applied to genetic results in the Cardiac Arrest Survivors With Preserved Ejection Fraction Registry, to assess the rate of variant reclassification over time. Variant classifications were then compared with the classifications of 2 commercial laboratories to determine the rate and identify sources of variant interpretation discordance.

Results:

Thirty-one percent of participants (40 of 131) had at least 1 genetic variant with a clinically significant reclassification over time. Variants of uncertain significance were more likely to be downgraded (73%) to benign than upgraded to pathogenic (27%;
P
=0.03). For the second part of the study, 50% (70 of 139) of variants had discrepant interpretations (excluding benign variants), provided by at least 1 team.

Conclusions:

Periodic review of genetic variant classification is a key component of follow-up care given rapidly changing information in the field. There is potential for clinical care gaps with discrepant variant interpretations, based on the interpretation and application of current guidelines. The development of gene- and disease-specific guidelines and algorithms may provide an opportunity to further standardize variant interpretation reporting in the future.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT00292032.
Personality network neuroscience: Promises and challenges on the way
toward a unifying framework of individual variability
Authors: Hilger Kirsten , Markett Sebastian
Published: May 2021

We propose that the application of network theory to established psychological personality conceptions has great potential to advance a biologically plausible model of human personality. Stable behavioral tendencies are conceived as personality “traits.” Such traits demonstrate considerable variability between individuals, and extreme expressions represent risk factors for psychological disorders. Although the psychometric assessment of personality has more than hundred years tradition, it is not yet clear whether traits indeed represent “biophysical entities” with specific and dissociable neural substrates. For instance, it is an open question whether there exists a correspondence between the multilayer structure of psychometrically derived personality factors and the organizational properties of traitlike brain systems. After a short introduction into fundamental personality conceptions, this article will point out how network neuroscience can enhance our understanding about human personality. We will examine the importance of intrinsic (task-independent) brain connectivity networks and show means to link brain features to stable behavioral tendencies. Questions and challenges arising from each discipline itself and their combination are discussed and potential solutions are developed. We close by outlining future trends and by discussing how further developments of network neuroscience can be applied to personality research.
Survival Pessimism and the Demand for Annuities
Authors: O'Dea Cormac , Sturrock David
Published: May 2021

The “annuity puzzle” refers to the fact that annuities are rarely purchased despite the longevity insurance they provide. Most explanations for this puzzle assume that individuals have accurate expectations about their future survival. We provide evidence that individuals misperceive their mortality risk and study the demand for annuities in a setting where annuities are priced by insurers on the basis of objectively-measured survival probabilities but in which individuals make purchasing decisions based on their own subjective survival probabilities. Subjective expectations have the capacity to explain significant rates of nonannuitization, yielding a quantitatively important explanation for the annuity puzzle.
Strategic Citation: A Reassessment
Authors: Kuhn Jeffrey , Younge Kenneth , Marco Alan
Published: May 2021

The United States patent system is unique in that it requires applicants to cite documents they know to be relevant to the examination of their patent applications. Lampe (2012) presents evidence that applicants strategically withhold 21%–33% of relevant citations from patent examiners, suggesting that many patents are fraudulently obtained. We challenge this view. We first show that Lampe's empirical design is inconsistent with both legal standards and standard operating procedures, including how courts identify strategic withholding. We then compile comprehensive data to reassess the empirical basis for Lampe's main claim. We find no evidence that applicants withhold citations.
Economic Recessions and Congressional Preferences for Redistribution
Authors: Carreri Maria , Teso Edoardo
Published: May 2021

We study if U.S. Members of Congress who experienced an economic recession during early adulthood vote differently on redistribution-specific bills. We find that politicians who experienced a recession hold more conservative positions on redistribution, even compared to members of the same party. In light of recent empirical evidence showing that voters become more supportive of redistribution following a recession, our findings suggest that macroeconomic shocks might have a polarizing effect: recessions can create an ideological wedge between voters and their future representatives. We hypothesize and present evidence suggesting that this wedge might be explained by politicians' more privileged background.
Partisan Bias, Economic Expectations, and Household Spending
Authors: Mian Atif , Sufi Amir , Khoshkhou Nasim
Published: May 2021

The well-documented rise in political polarization among the U.S. electorate over the past 20 years has been accompanied by a substantial increase in the effect of partisan bias on survey-based measures of economic expectations. Individuals have a more optimistic view on future economic conditions when they are more closely affiliated with the party that controls the White House, and this tendency has increased significantly over time. Individuals report a large shift in economic expectations based on partisan affiliation after the 2008 and 2016 elections, but administrative data on spending shows no effect of these shifts on actual household spending.
The Economic Consequences of Political Hierarchy: Evidence from Regime Changes in China, 1000–2000 C.E.
Authors: Bai Ying , Jia Ruixue
Published: May 2021

We study how political hierarchy shapes regional development in China, using variations driven by regime changes during the 1000–2000 C.E. period. We find that changes in the status of the provincial capital led to the rise and decline of different prefectures as measured by population and urbanization. Two other novel findings stand out: (1) the economic advantages of the provincial capitals did not persist if they lost their political status, and (2) political hierarchy shaped economic development not only through public employment but also through the development of important infrastructure, such as transportation networks. Our findings highlight the importance of politics in determining the locations of economic activities.
The Rise and Persistence of Illegal Crops: Evidence from a Naive Policy Announcement
Authors: Prem Mounu , Vargas Juan F. , Mejía Daniel
Published: May 2021

Policies based on prohibition and repression to fight the war on drugs have largely failed in a variety of contexts. However, incentive-based policies may also fail and have unintended negative consequences if policymakers do not properly anticipate behavioral reactions. This is an particularly important concern in the case of policies announced prior to their implementation. In this paper, we show that a naive and untimely policy announcement generated an unprecedented escalation in cocaine production in Colombia, offsetting almost 20 years and billions of dollars of U.S.-backed efforts to stop drug production and cartel action.
Isidore of Seville on ius gentium: The View of a Theologian
Authors: Wauters Bart
Published: May 2021

In this article, my objective is to provide an understanding of Isidore of Seville’s enormously influential definition of ius gentium in its own right. Recent studies have primarily focused on the legal aspects of Isidore’s conception of ius gentium. However, while Isidore as a man of learning was familiar with the legal categories he used, it is by no means certain that his understanding of legal concepts would match that of a contemporary jurist. Isidore was a theologian, and there are strong indications that he was more than a mere transmitter of classical knowledge. In this article, I show that he was an original thinker whose conception of ius gentium contained several innovative features that could not be fully grasped without a deep understanding of his theological ideas based on Augustine and Gregory the Great.
The Illuminations of Mukhlis ibn ʿAbdallah al-Hindi: Identifying Manuscripts from Late Medieval Konya
Authors: Jackson Cailah
Published: May 2021

The arts of the book of late medieval Rum (Anatolia) constitute a rich resource for Islamic art historians that remains relatively unknown in the wider scholarship. This complex period saw the disintegration of Seljuk rule and the partial absorption of the region into the Ilkhanid realm. Konya (present-day central Turkey), the former Seljuk capital, was hardly isolated from its better-known neighbors and was evidently an active center for the patronage of the arts of the book. This article contributes to ongoing discussions concerning late medieval Islamic manuscripts by discussing illuminations that were produced by Mukhlis ibn ʿAbdallah al-Hindi in thirteenth-century Konya. One of the two named illuminators active in the city, Mukhlis extensively decorated two manuscripts, both in 677h (1278): a small Qurʾan and a monumental copy of Jalal al-Din Rumi’s Mas̱navī. Both are the initial focus of the article. Following an analysis of these manuscripts, the article presents additional material as possible products of Mukhlis’s hand or of Konya generally, demonstrating both the relative visual distinctiveness of Konya illumination and the need to potentially re-examine works previously attributed to Egypt or Persia.
“Compassionate Companion, Familiar Friend”: The Turin Safīna (Biblioteca Reale Ms. Or. 101) and Its Significance
Authors: Teece Denise-Marie
Published: May 2021

This article examines some of the more significant aspects of Turin Safīna manuscript Biblioteca Reale Ms. Or. 101. One of these is its unique and important six-page preface, which refers to the manuscript as a safīna (ship or vessel) and explains in poetic language why some Persian manuscripts are referred to using this term. In addition to this significant preface, which is translated and analyzed in the first half of the article, the manuscript also exhibits delicate illuminations and calligraphy work that may be connected to a network of artist-families active in western Persia (primarily in the region of Shiraz) around the time of its completion. The second half of this article revisits the careers of some of these artists, and discusses the broader artistic context for the creation of the Turin safīna manuscript. Special attention will be given to the careers of the illuminator known as Ruzbehan al-Modhahheb, and his calligrapher father Naʿim al-Din al-Kateb.
“The Illusion of an Authentic Experience”: a Luster Bowl in the Ashmolean Museum
Authors: Leoni Francesca , Norris Dana , Domoney Kelly , Matin Moujan , Shortland Andrew
Published: May 2021

In 2014 the Ashmolean Museum conserved and examined one of the largest and most handsome ceramic vessels in its renowned Islamic art collection. An accomplished example of early thirteenth-century Persian lusterware from the bequest of Sir Alan Barlow, the salver had an unusually deformed profile and uneven wear that pointed at a number of past interventions. Some of these had already been uncovered in 2008 when the object was prepared for reinstallation in the revamped Ashmolean. However, it was only when analyzed by a team of inhouse specialists and scientists from Cranfield University and the Research Laboratory for Archaeology at the University of Oxford, that the extraordinary nature of its “restoration” could be assessed. This article presents the results of this collaborative effort and contributes important evidence to the thorny issue of the faking and forging of Islamic ceramics in the early twentiethc century, when collecting Islamic decorative arts was at its peak.
Jirivanaea, a new name for Vitalia P.E.A.S.Camara, Carv.-Silva & W.R.Buck, hom. illeg.  (Sematophyllaceae, Bryophyta) versus Vitalia Batista & Ciferri (Chaetothyriales, Ascomycota)
Authors: DESHMUKH UMAKANT BHOOPATI , RATHOR OMPRAKASH  SHYAMLAL
Published: May 2021

The genus Vitalia P.E.A.S.Camara, Carv.-Silva & W.R. Buck in Carvalho-Silva et al. (2017:825) was established by Carvalho-Silva, Camara and Buck on molecular and morphological basis, including four species, the new species “Vitalia caespitosa (Hedwig, 1801:49) P.E.A.S.Camara, Carv.-Silva & W.R.Buck in Carvalho-Silva et al. (2017:825)” as type, and three new combinations as V. cuspidifera (Mitten, 1869:480)  P.E.A.S.Camara, Carv.-Silva & W.R.Buck (2017:825), V. esmeraldica (Müller Hal.,1851:392) P.E.A.S.Camara, Carv.-Silva & W.R.Buck (2017:825)  and V. galipensis (Müller Hal., 1848:780)  P.E.A.S.Camara, Carv.-Silva & W.R.Buck (2017:825) (Carvalho-Silva et al. 2017).However, the generic name Vitalia Batista & Ciferri (1962:105) had previously been used in botanical nomenclature of fungal Ascomycetes.
Yield Components and Benefit Evaluation of Aerobic Rice Under Mulched Drip Irrigation in Eastern Inner Mongolia
Authors: Liu Hu , Wang Jian , Yin Chunyan , Chen Gong , Zhang Ruiqiang , Cheng Bo
Published: May 2021

It is a world-wide concerned problem to more efficiently use water resources in agricultural production, and it becomes a hot issue to adopt a more water and fertilizer-saving in grain production. Focusing the main rice producing areas in Inner Mongolia during 2018-2019, this study
analyzed the growth stage and morphological characteristics (plant height and root system) of the rice through mulched drip irrigation aerobic rice plot. And the yield of aerobic rice and the factors affecting the yield, as well as evaluated the economic benefit indexes (income and cost) of
mulched drip irrigation aerobic rice were discussed. The results showed that the seedling emergence rate of mulched drip irrigation aerobic rice was 4.1% lower than that of traditional transplanting rice, and the root length, average diameter, surface area and volume were lower than those
of traditional rice. In addition, the rice with higher plant height and more panicle would get less grain, while more effective tillers and larger 1000-grain weight would get better yield. Compared with conventional rice cultivation, mulched drip irrigation maize and soybean, mulched drip
irrigation aerobic rice has significant increase in production and efficiency.
Preparation and Biological Activity of Strontium Modified Titanium Oxide Surface
Authors: Li Hui-Xing , Zhao Quan-Ming , Liu Da-Chang , Ni Xiao-Hui , Zhu Xing-Yuan , Li Xiao-Dong , Liu Ren-Bao , Ma Zhi-Gang
Published: May 2021

Titanium (Ti) is a bone tissue replacement material with excellent mechanical properties. However, Ti has poor biological activity and lacks osseointegrative properties and may trigger inflammation and cause implantation failure. To address these issues, Ti surface modification has
become a widely used method. In this study, using microarc oxidation (MAO) technology, a strontium-doped MAO coating was prepared on Ti surfaces in an electrolyte solution comprising calcium acetate, calcium glycerophosphate and strontium acetate. Scanning electron microscopy (SEM) and energy
spectrum analysis (EDS) were used to analyze the tissue structure and elemental composition of the coating. The surface phase composition of the coating was analyzed by X-ray diffraction (XRD). We observed the proliferation of cells on the coating surface through in vitro cell experiments.
The results showed the surface of the strontium-doped MAO coating is porous, and strontium is evenly distributed on the surface. The coating can promote the adhesion, proliferation and differentiation of osteoblasts and has good biological activity and thus, could potentially be applied to
the surface of implants in clinical application.
Interannual Variability of Stratospheric Final Warming in the Southern Hemisphere and Its Tropospheric Origin
Authors: Hirano Soichiro , Kohma Masashi , Sato Kaoru
Published: May 2021

The relation between interannual variability of stratospheric final warming (SFW) and tropospheric circulation in the Southern Hemisphere (SH) is explored using reanalysis data and a linear barotropic model. The analysis is focused on quasi-stationary waves with zonal wavenumber 1 (s = 1 QSWs; s is zonal wavenumber), which are the dominant component of the SH extratropical planetary waves. First, interannual variability of SFW is investigated in terms of amplitudes of stratospheric and tropospheric s = 1 QSWs, and wave transmission properties of the mean flow from the late austral winter to spring. Upward Eliassen–Palm flux due to s = 1 QSWs is larger from the stratosphere down to the middle troposphere in early-SFW years than late-SFW years. More favorable conditions for propagation of s = 1 stationary waves into the stratosphere are identified in early-SFW years. These results indicate that the amplification of tropospheric s = 1 QSWs and the favorable conditions for their propagation into the stratosphere lead to the amplification of stratospheric s = 1 QSWs and hence earlier SFWs. Next, numerical calculations using a linear barotropic model are performed to explore how tropospheric s = 1 QSWs at high latitudes amplifies in early-SFW years. By using tropical Rossby wave source and horizontal winds in the reanalysis data as a source and background field, respectively, differences in s = 1 steady responses between early- and late-SFWs are examined at high latitudes. It is suggested that the larger amplitudes of tropospheric s = 1 QSWs in early-SFW years are attributed to differences in wave propagation characteristics associated with structure of the midlatitude jets in austral spring.
Obinutuzumab and idelalisib in symptomatic patients with relapsed/refractory Waldenström macroglobulinemia
Authors: Tomowiak Cécile , Poulain Stéphanie , Herbaux Charles , Perrot Aurore , Mahé Béatrice , Morel Pierre , Aurran Thérèse , Tournilhac Olivier , Leprêtre Stéphane , Assaad Souad , Villemagne Bruno , Casasnovas Olivier , Nollet Delphine , Roos-Weil Damien , Chevret Sylvie , Leblond Véronique
Published: May 2021

We present the results of a phase 2 study evaluating the combination of obinutuzumab + idelalisib in relapsed/refractory (R/R) Waldenström macroglobulinemia (WM). The goal was to determine the safety and efficacy of a fixed-duration chemotherapy-free treatment. During the induction phase, patients received idelalisib + obinutuzumab for 6 cycles, followed by a maintenance phase with idelalisib alone for ≤2 years. Forty-eight patients with R/R WM were treated with the induction combination, and 27 patients participated in the maintenance phase. The best responses, reached after a median of 6.5 months (interquartile range, 3.4-7.1; range, 2.6-22.1 months), were very good partial response in 5 patients, partial response in 27 patients, and minor response in 3 patients, leading to overall response rate and major response rate estimates of 71.4% (95% confidence interval [CI], 56.7-83.4) and 65.3% (95% CI, 50.4-78.3), respectively. With a median follow-up of 25.9 months, median progression-free survival was 25.4 months (95% CI, 15.7-29.0). Univariate analysis focusing on molecular screening found no significant impact of CXCR4 genotypes on responses and survivals but a deleterious impact of TP53 mutations on survival. Although there was no grade 5 toxicity, 26 patients were removed from the study because of side effects; the most frequent were neutropenia (9.4%), diarrhea (8.6%), and liver toxicity (9.3%). The combination of idelalisib + obinutuzumab is effective in R/R WM. Nonetheless, the apparent lack of impact of genotype on outcome could give new meaning to targeting of the phosphatidylinositol 3-kinase pathway in WM. This trial was registered at www.clinicaltrials.gov as #NCT02962401.
Impact of R-CHOP dose intensity on survival outcomes in diffuse large B-cell lymphoma: a systematic review
Authors: Bataillard Edward J. , Cheah Chan Yoon , Maurer Matthew J. , Khurana Arushi , Eyre Toby A. , El-Galaly Tarec Christoffer
Published: May 2021

The dilemma of whether to treat elderly patients with diffuse large B-cell lymphoma (DLBCL) with a full or reduced dose intensity (DI) of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone+rituximab) is often faced by clinicians. We conducted a systematic review assessing the impact of R-CHOP DI on DLBCL survival outcomes, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) guidelines. We searched MEDLINE, EMBASE, and Cochrane CENTRAL for studies with ≥100 patients treated with R-CHOP/R-CHOP–like therapies published from January 2002 through November 2020. Studies were included if they reported the impact of R-CHOP DI on survival outcomes. We screened records, extracted data, and reviewed all the studies for quality and statistical appraisal. Of 380 screened records, 13 studies including 5188 patients were reviewed. DI was often calculated as the ratio of the cumulative delivered dose of prespecified drug(s) to the cumulative planned dose multiplied by a time-correction factor. Lower DI (intended or relative) was associated with inferior survival in 7 of 9 studies reporting crude survival analyses. Multivariable analysis using DI as a covariate was performed in 10 studies. Six showed an association (P < .05) with adjustment for other covariates, and 4 did not. Most studies and those larger studies of higher quality showed poorer outcomes associated with reduced DI. In subgroups aged ≥80 years, survival was not consistently affected by reduced DI. DI-specific randomized trials are warranted, but these data support full-dose R-CHOP in elderly and fit patients aged <80 years with DLBCL, but not in those aged ≥80 years, where dose-reduced R-CHOP does not appear to compromise survival.
Geometric Design-based Dimensional Synthesis of a Novel Metamorphic Multi-fingered Hand with Maximal Workspace
Authors: An Wei , Wei Jun , Lu Xiaoyu , Dai Jian S. , Li Yanzeng
Published: May 2021

Current research on robotic dexterous hands mainly focuses on designing new finger and palm structures, as well as developing smarter control algorithms. Although the dimensional synthesis of dexterous hands with traditional rigid palms has been carried out, research on the dimensional synthesis of dexterous hands with metamorphic palms remains insufficient. This study investigated the dimensional synthesis of a palm of a novel metamorphic multi-fingered hand, and explored the geometric design for maximizing the precision manipulation workspace. Different indexes were used to value the workspace of the metamorphic hand, and the best proportions between the five links of the palm to obtain the optimal workspace of the metamorphic hand were explored. Based on the fixed total length of the palm member, four nondimensional design parameters that determine the size of the palm were introduced; through the discretization method, the influence of the four design parameters on the workspace of the metamorphic hand with full-actuated fingers and under-actuated fingers was analyzed. Based on the analysis of the metamorphic multi-fingered hand, the symmetrical structure of the palm was designed, resulting in the largest workspace of the multi-fingered hand, and proved that the metamorphic palm has a massive upgrade for the workspace of underactuated fingers. This research contributed to the dimensional synthesis of metamorphic dexterous hands, with practical significance for the design and optimization of novel metamorphic hands.
Metabolomic insights into the browning of the peel of bagging ‘Rui Xue’ apple fruit
Authors: Wang Hui , Wang Shuang , Fan Miao-Miao , Zhang Shu-Hui , Sun Lu-Long , Zhao Zheng-Yang
Published: May 2021

Background

Bagging is one of the most important techniques for producting high-quality fruits. In the actual of cultivating, we found a new kind of browning in peel of apple fruit that occurs before harvest and worsen during storage period. There are many studies on metabonomic analysis of browning about storage fruits, but few studies on the mechanism of browning before harvest.

Results

In this study, five-year-old trees of ‘Rui Xue’ (CNA20151469.1) were used as materials. Bagging fruits without browning (BFW) and bagging fruits with browning (BFB) were set as the experimental groups, non-bagging fruits (NBF) were set as control. After partial least squares discriminant analysis (PLS-DA), 50 kinds of metabolites were important with predictive VIP > 1 and p-value < 0.05. The most important differential metabolites include flavonoids and lipids molecules, 11 flavonoids and 6 lipids molecules were significantly decreased in the BFW compared with NBF. After browning, 11 flavonoids and 7 lipids were further decreased in BFB compared with BFW. Meanwhile, the significantly enriched metabolic pathways include galactose metabolism, ABC membrane transporter protein, flavonoid biosynthesis and linoleic acid metabolism pathways et al. Physiological indicators show that, compared with NBF, the content of malondialdehyde (MDA), hydrogen peroxide (H2O2), superoxide anion (O2−) in peel of BFW and BFB were significantly increased, and the difference of BFB was more significant. Meanwhile, the antioxidant enzyme activities of BFW and BFB were inhibited, which accelerated the destruction of cell structure. In addition, the metabolome and physiological data showed that the significantly decrease of flavonoid was positively correlated with peel browning. So, we analyzed the expression of flavonoid related genes and found that, compared with NBF, the flavonoid synthesis genes MdLAR and MdANR were significantly up-regulated in BFW and BFB, but, the downstream flavonoids-related polymeric genes MdLAC7 and MdLAC14 were also significantly expressed.

Conclusions

Our findings demonstrated that the microenvironment of fruit was changed by bagging, the destruction of cell structure, the decrease of flavonoids and the increase of triterpenoids were the main reasons for the browning of peel.
Double kissing inflation outside the stent secures the patency of small side branch without rewiring
Authors: Yang Hongbo , Song Yanan , Cao Jiatian , Weng Xueyi , Zhang Feng , Dai Yuxiang , Lu Hao , Li Chenguang , Huang Zheyong , Qian Juying , Ge Junbo
Published: May 2021

Background

The jailed balloon technique is widely used for coronary bifurcation lesions, but a residual risk of SB occlusion remains, necessitating SB rewiring and further interventions, including balloon inflation or stenting, which may result in failure and SB loss. This study introduced a novel modified technique of small side branch (SB) protection, namely, double kissing inflation outside the stent (DKo) technique, for coronary bifurcations without the need for SB rewiring.

Methods

We performed the DKo technique in consecutive patients in our center from 1/2019 to 12/2019. The procedure was as follows. We inserted a guide wire into both branches followed by proper preparation. The SB balloon was simultaneously inflated with main vessel (MV) stenting. The SB balloon remained in situ until it was kissing inflated with postdilation of the bifurcation core, which is different from traditional strategies. The proximal optimization technique was performed with a short noncompliant balloon strictly not exceeding the bifurcation. Rates of SB loss and in-hospital outcomes were evaluated.

Results

The technique was successfully performed in all 117 enrolled patients without any rewiring or SB loss. The mean lesion lengths of the MV and SB were 38.3 ± 19.9 mm and 11.7 ± 7.1 mm, respectively. On average, 1.5 ± 0.6 stents were used per patient, while the mean pressure of the SB balloon was 7.4 ± 3.1 atm. DKo achieved excellent procedural success in the proximal and distal MVs: increased minimal lumen diameter (0.64 ± 0.58 mm to 3.05 ± 0.38 mm,p < 0.001; 0.57 ± 0.63 mm to 2.67 ± 0.35 mm,p < 0.001) and low residual stenosis (11.4 ± 3.4%; 7.2 ± 4.6%). DKo secured the patency of the SB without any rewiring and improved the SB stenosis with minimal lumen diameter (0.59 ± 0.48 mm to 1.20 ± 0.42 mm,p < 0.001) and stenosis (71.9 ± 19.4% to 42.2 ± 14.0%,p < 0.001). No MACE was noted in the hospital.

Conclusions

DKo for bifurcation lesions was shown to be acceptable with high procedural success and excellent SB protection.
Current diagnosis and treatment of acute pancreatitis in China: a real-world, multicenter study
Authors: Sun Chuandong , Li Zhu , Shi Zheng , Li Guichen
Published: May 2021

Background

Efficacy of pancreatic enzyme inhibitors in acute pancreatitis (AP) is unclear in China.

Aims

We aimed to present the current status of AP and evaluate the efficacy of pancreatic enzyme inhibitors in a larger population in China.

Method

A retrospective, cross-sectional, real-world, multicenter analysis of a large dataset of patients presenting with AP from four hospitals of China over a two-year period was performed. Data were collected from the existing clinical records and the patients were grouped into medication group (somatostatin or octreotide or somatostatin and octreotide) and no medication group. Pair wise propensity score matching was performed for comparing somatostatin, octreotide and somatostatin/octreotide. The end points were incidence of disease complications, organ failure, hospitalization duration, and recovery time taken (hours) for serum amylase/serum lipase to normalcy.

Results

A total of 3900 patients were recruited and 2775 patients were included for analysis. A total of 1100, 661, 676 and 338 patients received either somatostatin or octreotide or somatostatin and octreotide or no medication, respectively. The incidence of complications (7.6% vs 13.6%), organ failure (4.5% vs 7.4%), and the instances of entering ICU (9.3% vs 13.3%) were higher in unmedicated group. Complications at discharge (2.91 times), organ failure (2.53 times), and hospitalization stay were higher in octreotide-treated patients compared with somatostatin-treated patients. In comparison to the octreotide group, the serum amylase/lipase recovery time was shorter in the somatostatin group.

Conclusion

This real-world study suggested that the use of pancreatic enzyme inhibitors was positively associated with greater clinical efficacy in AP patients and somatostatin might be more effective than octreotide in real-world settings in China.
The performance of the Dutch Safety Management System frailty tool to predict the risk of readmission or mortality in older hospitalised cardiac patients
Authors: Jepma Patricia , Verweij Lotte , Tijssen Arno , Heymans Martijn W. , Flierman Isabelle , Latour Corine H. M. , Peters Ron J. G. , Scholte op Reimer Wilma J. M. , Buurman Bianca M. , ter Riet Gerben
Published: May 2021

Background

Early identification of older cardiac patients at high risk of readmission or mortality facilitates targeted deployment of preventive interventions. In the Netherlands, the frailty tool of the Dutch Safety Management System (DSMS-tool) consists of (the risk of) delirium, falling, functional impairment, and malnutrition and is currently used in all older hospitalised patients. However, its predictive performance in older cardiac patients is unknown.

Aim

To estimate the performance of the DSMS-tool alone and combined with other predictors in predicting hospital readmission or mortality within 6 months in acutely hospitalised older cardiac patients.

Methods

An individual patient data meta-analysis was performed on 529 acutely hospitalised cardiac patients ≥70 years from four prospective cohorts. Missing values for predictor and outcome variables were multiply imputed. We explored discrimination and calibration of: (1) the DSMS-tool alone; (2) the four components of the DSMS-tool and adding easily obtainable clinical predictors; (3) the four components of the DSMS-tool and more difficult to obtain predictors. Predictors in model 2 and 3 were selected using backward selection using a threshold of p = 0.157. We used shrunk c-statistics, calibration plots, regression slopes and Hosmer-Lemeshow p-values (PHL) to describe predictive performance in terms of discrimination and calibration.

Results

The population mean age was 82 years, 52% were males and 51% were admitted for heart failure. DSMS-tool was positive in 45% for delirium, 41% for falling, 37% for functional impairments and 29% for malnutrition. The incidence of hospital readmission or mortality gradually increased from 37 to 60% with increasing DSMS scores. Overall, the DSMS-tool discriminated limited (c-statistic 0.61, 95% 0.56–0.66). The final model included the DSMS-tool, diagnosis at admission and Charlson Comorbidity Index and had a c-statistic of 0.69 (95% 0.63–0.73; PHL was 0.658).

Discussion

The DSMS-tool alone has limited capacity to accurately estimate the risk of readmission or mortality in hospitalised older cardiac patients. Adding disease-specific risk factor information to the DSMS-tool resulted in a moderately performing model. To optimise the early identification of older hospitalised cardiac patients at high risk, the combination of geriatric and disease-specific predictors should be further explored.
Mild sodium reduction in peritoneal dialysis solution improves hypertension in end stage kidney disease: a case-report study
Authors: Vecchi Luigi , Bonomini Mario , Palumbo Roberto , Arduini Arduino , Borrelli Silvio
Published: May 2021

Introduction

Blood Pressure (BP) control is largely unsatisfied in End Stage Kidney Disease (ESKD) principally due to sodium retention. Peritoneal Dialysis (PD) is the most common type of home dialysis, using a peritoneal membrane to remove sodium, though sodium removal remains challenging.

Methods

This is a case-study reporting two consecutive ESKD patients treated by a novel peritoneal PD solution with a mildly reduced sodium content (130 mmol/L) to treat hypertension.

Results

In the first case, a 78-year-old woman treated by Continuous Ambulatory PD (CAPD) with standard solution (three 4 h-dwells per day 1.36% glucose 132 mmol/L) showed resistant hypertension confirmed by ambulatory blood pressure monitoring (ABPM), reporting 24 h-BP: 152/81 mmHg, day-BP:151/83 mmHg and night-ABP: 153/75 mmHg, with inversion of the circadian systolic BP rhythm (1.01), despite use of three anti-hypertensives and a diuretic at adequate doses. No sign of hypervolemia was evident. We then switched from standard PD to low-sodium solution in all daily dwells. A six-months low-sodium CAPD enabled us to reduce diurnal (134/75 mmHg) and nocturnal BP (122/67 mmHg), restoring the circadian BP rhythm, with no change in ultrafiltration or residual diuresis. Diet and drug prescription were unmodified too.

The second case was a 61-year-old woman in standard CAPD (three 5 h-dwells per day) suffering from hypertension confirmed by ABPM (mean 24 h-ABP: 139/84 mmHg; mean day-ABP:144/88 mmHg and mean night-ABP:124/70 mmHg). She was switched from 132-Na CAPD to 130-Na CAPD, not changing dialysis schedule. No fluid expansion was evident. During low-sodium CAPD, antihypertensive therapy (amlodipine 10 mg and Olmesartan 20 mg) has been reduced until complete suspension. After 6 months, we repeated ABPM showing a substantial reduction in mean 24 h-ABP (117/69 mmHg), mean diurnal ABP (119/75 mmHg) and mean nocturnal ABP (111/70 mmHg). Ultrafiltration and residual diuresis remained unmodified. No side effects were reported in either cases.

Conclusions

This case-report study suggests that mild low-sodium CAPD might reduce BP in hypertensive ESKD patients.
Recipient C7 rs9292795 genotype and the risk of hepatocellular carcinoma recurrence after orthotopic liver transplantation in a Han Chinese population
Authors: Jiang Zhongyi , Jiang Qianwei , Fang Xu , Wang Pusen , Que Weitao , Li Hao , Yu Yang , Liu Xueni , Wang Chunguang , Zhong Lin
Published: May 2021

Background

Complement component(C7) gene has been shown to influence the prognosis in Hepatocellular carcinoma (HCC) patients. The association between C7 and HCC recurrence after orthotopic liver transplantation (OLT), however, is still unknown. The purpose of this study was to evaluate whether the donor and recipient C7 gene polymorphisms are related to HCC recurrence after OLT in the Han Chinese population.

Methods

A total of 73 consecutive patients with HCC who had undergone OLT, both donors and recipients, were involved in this research. A single nucleotide polymorphism of C7, rs9292795, was genotyped using Sequenom MassARRAY in the cohort. The expression of C7 and the association between C7 gene polymorphisms and HCC recurrence following OLT were analyzed by bioinformatics and statistical analysis, respectively.

Results

As shown in database, the expression of C7 was higher in HCC tissues than that in normal tissues, and represented a worse prognosis. We also found that recipient C7 rs9292795 polymorphism, rather than the donor, was significantly associated with HCC recurrence after OLT. Multivariate logistic regression analysis confirmed that TNM stage (P = 0.001), Milan criteria (P = 0.000) and recipient rs9292795 genotype (TT vs AA/AT, P = 0.008) were independent risk factors for HCC recurrence. Furthermore, the recipient carrying AA/AT showed higher recurrence-free survival (RFS) and overall survival (OS) than that carrying TT (P < 0.05). In Cox proportional hazards model, TNM stage, recipient rs9292795 genotype, and Milan criteria were identified as independent factors for RFS and OS (P < 0.05) as well as pre-OLT serum alpha fetoprotein (AFP) level was associated with OS (P < 0.05).

Conclusions

Recipient C7 rs9292795 gene polymorphism is related to the recurrence of HCC after OLT, which may be a helpful prognostic marker for HCC patients who receive OLT.
Clinical and prognostic features of patients with detailed RAS/BRAF-mutant colorectal cancer in Japan
Authors: Ikoma Tatsuki , Shimokawa Mototsugu , Kotaka Masahito , Matsumoto Toshihiko , Nagai Hiroki , Boku Shogen , Shibata Nobuhiro , Yasui Hisateru , Satake Hironaga
Published: May 2021

Background

RAS/BRAFV600E mutations are the most remarkable oncogenic driver mutations in colorectal cancer (CRC) and play an important role in treatment selection. No data are available regarding the clinical and prognostic features of patients with detailed RAS/BRAFV600E-mutant metastatic CRC (mCRC) in Japan.

Methods

A total of 152 chemotherapy-naïve patients with mCRC were included in this study between August 2018 and July 2019. Tumor samples were collected, and RAS/BRAFV600E status was investigated. RAS/BRAFV600E status was examined using a MEBGEN RASKET-B kit and polymerase chain reaction reverse sequence-specific oligonucleotide method.

Results

RAS/BRAFV600E mutations were detected in 54% of cases (KRAS codon 12, 26%; KRAS codon 13, 17%; KRAS non-Exon2, 5%; NRAS, 5%; and BRAFV600E, 7%). BRAFV600E-mutant CRC mainly existed in the right colon, whereas KRAS non-Exon2 and NRAS-mutant CRC was predominantly present in the left colon. KRAS non-Exon2 and NRAS-mutant CRC were associated with shorter survival time than RAS wild-type CRC (hazard ratio [HR], 2.26; 95% confidence interval [CI], 0.64–8.03; p = 0.19; HR, 2.42; 95% CI, 0.68–8.61; p = 0.16) and significantly shorter overall survival than KRAS Exon2-mutant CRC (HR, 3.88; 95% CI, 0.92–16.3; p = 0.04; HR, 4.80; 95% CI, 1.14–20.2; p = 0.02).

Conclusions

In our multicenter study, the findings elucidated the clinical and prognostic features of patients with detailed RAS/BRAFV600E-mutant mCRC in Japan.
Prediction of postoperative refractive astigmatism before toric intraocular lens implantation
Authors: Kawahara Atsushi
Published: May 2021

Background

To determine the preoperative factors influencing refractive astigmatism after cataract surgery for astigmatism correction by toric intraocular lens (IOL) implantation and to evaluate the prediction model using these factors.

Methods

Prospective, observational case series. The right eyes of forty consecutive patients with preoperative corneal astigmatism of the total cornea of 1.5 diopters (D) or more in magnitude and scheduled for implantation of a non-toric IOL during cataract surgery with a 2.4-mm temporal clear corneal incision were examined prospectively. The vertical/horizontal astigmatism component (J0) and oblique astigmatism component (J45) of refractive and corneal astigmatism were converted using power vector analysis. Multivariate regression analysis was performed with refractive astigmatism at three months postoperatively as the dependent variable, and preoperative parameters including age, sex, refractive astigmatism, corneal astigmatism, sphere, spherical equivalent, intraocular pressure, corneal thickness, anterior chamber depth, lens thickness, lens positions (tilt and decentration), axial length, and corneal higher order aberrations as independent variables. The root mean square (RMS) errors were calculated to express the regression model fit.

Results

The regression model for the J0 component was $$ Postoperative\kern0.34em refractive\kern0.2em J0=1.05\times Coneal\kern0.2em J0-0.14 $$
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(R2 = 0.72, P < 0.001). The mean RMS errors for preoperative corneal astigmatism alone and the multivariate model were 0.58 D and 0.46 D, respectively. There was a statistically significant difference between them (P = 0.02).

Conclusions

Refractive astigmatism after implantation of a toric IOL can be predicted by the regression model more accurately than by corneal astigmatism alone. However, the prediction of oblique astigmatism remains a challenge.
Development and evaluation of a new measure of children’s play: the Children’s Play Scale (CPS)
Authors: Dodd Helen F. , Nesbit Rachel J. , Maratchi Laura R.
Published: May 2021

Background

There is increasing recognition of the importance of children’s play from a public health perspective, given the links between play and children’s physical and mental health. The present research aimed to develop and evaluate a new parent-report questionnaire that measures the time children spend playing across a range of places and includes a supplement to evaluate how adventurously children play.

Methods

The questionnaire was developed with input from a diverse group of parents and experts in children’s play. It was designed to yield a range of metrics including time spent playing per year, time spent playing outside, time spent playing in nature and level of adventurous play. The reliability of the questionnaire was then evaluated with 245 parents (149 mothers, 96 fathers) of 154 children aged 5–11 years. All participants completed the measure at time 1. At time 2, an average of 20 days later, 184 parents (111 mothers and 73 fathers) of 99 children completed the measure again.

Results

Cross-informant agreement, evaluated using Concordance Correlation Coefficients (CCCs), ranged from 0.36 to 0.51. These fall in the poor to moderate range and are largely comparable to cross-informant agreement on other measures. Test-retest reliability for mothers was good (range 0.67–0.76) for time spent playing metrics. For fathers, test-retest reliability was lower (range 0.39–0.63). For both parents the average level of adventurous play variable had relatively poor test retest reliability (mothers = 0.49, fathers = 0.42). This variable also showed a significant increase from time 1 to time 2. This instability over time may be due to the timing of the research in relation to the Covid-19 lockdown and associated shifts in risk perception.

Conclusions

The measure will be of value in future research focusing on the public health benefits and correlates of children’s play as well as researchers interested in children’s outdoor play and play in nature specifically. The development of the measure in collaboration with parents and experts in children’s play is a significant strength. It will be of value for future research to further validate the measure against play diaries or activity monitors.
Associations of midpoint of sleep and night sleep duration with type 2 diabetes mellitus in Chinese rural population: the Henan rural cohort study
Authors: Zhai Zhihan , Liu Xiaotian , Zhang Haiqing , Dong Xiaokang , He Yaling , Niu Miaomiao , Pan Mingming , Wang Chongjian , Wang Xiaoqiong , Li Yuqian
Published: May 2021

Background

The study aimed to investigate the independent and combined effects of midpoint of sleep and night sleep duration on type 2 diabetes mellitus (T2DM) in areas with limited resources.

Methods

A total of 37,276 participants (14,456 men and 22,820 women) were derived from the Henan Rural Cohort Study. Sleep information was assessed based on the Pittsburgh Sleep Quality Index. Logistic regression models and restricted cubic splines were used to estimate the relationship of the midpoint of sleep and night sleep duration with T2DM.

Results

Of the 37,276 included participants, 3580 subjects suffered from T2DM. The mean midpoint of sleep among the Early, Intermediate and Late groups were 1:05 AM ±23 min, 1:56 AM ±14 min, and 2:57 AM ±34 min, respectively. Compared to the Intermediate group, adjusted odds ratios (ORs) and 95% confidence interval (CI) of T2DM were 1.13 (1.04–1.22) and 1.14 (1.03–1.26) in the Early group and the Late group. Adjusted OR (95% CI) for T2DM compared with the reference (7- h) was 1.28 (1.08–1.51) for longer (≥ 10 h) night sleep duration. The combination of late midpoint of sleep and night sleep duration (≥ 9 h) increased 38% (95% CI 10–74%) prevalence of T2DM. These associations were more obvious in women than men.

Conclusions

Late and early midpoint of sleep and long night sleep duration were all associated with higher prevalence of T2DM. Meanwhile, midpoint of sleep and night sleep duration might have combined effects on the prevalence of T2DM, which provided potential health implications for T2DM prevention, especially in rural women.

Trial registration

The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06.