bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of surface texture parameters of screw pump rotor on tribological properties of its friction pairs
Authors: Wang Meiling , Li Qin , Huang Zhiqiang , Qian Weiji , Chen Xiong , Li Qiang , Lai Tianhua
Published: February 2022

Purpose

This study aims to solve the premature failure of the rubber stator due to wear, reduce the frictional resistance moment of the screw pump to solve the problem of a model of Daqing oilfield screw pump oil recovery system shutdown after the difficult start.

Design/methodology/approach

For the first time, the rotor surface of a screw pump was treated with dot-matrix texture to study the effect of dot matrix texture on the tribological performance of the stator-rotor friction subsets of screw pump. Reciprocating friction tests with different texture morphologies (S-shape, double tongue) and angular parameters (0°, 45° and 90°) were conducted at 10% of the texture area and pump silicone grease.

Findings

When point texture was added to the surface of the rotor sample, the friction coefficient and wear quantity of the sample were lower than those of the surface without texture treatment, and the double tongue 0° combination showed the best tribological properties. At this time, the average coefficient of friction and wear is reduced by 22.8% and 62%, 28.6% and 64.8%.

Originality/value

The introduction of texture can effectively improve the tribological performance of progressive screw pumps, and this paper provides important theoretical and experimental support for the design of progressive screw pumps in practical applications.
Health expenditures (total, public and private) and per capita income in the BRICS+T: panel bootstrap causality analysis
Authors: Canbay Şerif , Kırca Mustafa
Published: February 2022

Purpose

The study aims to determine whether there is a bidirectional causality relationship between health expenditures and per capita income in Brazil, Russia, India, China, South Africa and Turkey (BRICS+T).

Design/methodology/approach

For that purpose, the 2000–2018 period data of the variables were tested with the Kónya (2006) panel causality test. Additionally, the causality relationships between public and private health expenditures and per capita income were also investigated in the study.

Findings

According to the analysis results, there is no statistically significant causality relationship from total health expenditures and public health expenditures to per capita income in the relevant countries. Besides, there is a unidirectional causality relationship from private health expenditures to per capita income only in Turkey. On the other hand, a unidirectional causality relationship from per capita income to total health expenditures in China, Russia, Turkey and South Africa and from per capita income to public health expenditures in India, Russia, Turkey and South Africa were determined. Consequently, a causality relationship from per capita income to private health expenditures was found out in Russia and Turkey.

Originality/value

The variables are tested for the first time for BRICS+T countries, vis-à-vis the period under consideration and the method used.
Addressing food waste with a socio-cultural approach to social marketing
Authors: Sutinen Ulla-Maija
Published: February 2022

Purpose

The paper aims to elucidate the potential of a socio-cultural approach to social marketing. Drawing on a practice-theoretical understanding of change, the paper discusses how a socio-cultural approach can inform social marketing and enhance the possibilities of the field to address complex, multifaceted issues that require changes beyond the individual.

Design/methodology/approach

While the paper is conceptual in nature, it uses an illustrative example of food waste as the basis for an investigation of what a socio-cultural approach, rooted in practice-theoretical understanding of change, means for social marketing.

Findings

The paper is conceptual in nature but highlights new opportunities for social marketing connected to a socio-cultural approach foregrounding practice changes. The paper introduces potential roles that social marketers can adopt to initiate and support practice changes in the context of food waste.

Practical implications

The paper emphasises the importance of focussing on the socio-culture and practices connected to the issue in question, both when scoping for insight and when developing the ways to address it.

Originality/value

By integrating a practice-theoretical understanding of change, social marketing and food waste literature, the paper offers novel insights about the potential of adopting a socio-cultural approach to social marketing. The paper discusses a socio-cultural approach to social marketing in context, emphasising the roles social marketers can play in practice changes.
Positive reframing as a mediator between gratitude and technostress amongst Indian students during the COVID-19 pandemic
Authors: Garg Naval , Verma Shivangi , Palframan Jason Timothy
Published: February 2022

Purpose

The aim of the current study was to examine the previously unexplored relationship between positive reframing as a mediator between gratitude and technostress in Indian students. By examining this relationship, the authors aim to expand the theoretical domain of gratitude research by examining its potential influence on technology-induced stress.

Design/methodology/approach

A cross-sectional survey was used to collect and analyze data from 552 Indian college students who participated in graduate and postgraduate programs across various educational institutions in India. Regression and mediation analyses were performed with both IBM SPSS 25 and AMOS.

Findings

This study’s data suggest that positive reframing plays an important mediating role between gratitude and technostress. Gratitude also encourages positive reframing, which reduced technostress among the students. Taken together, our data showed that gratitude induces positive reframing, which in turn reduces techno-stress among Indian students in the current study.

Research limitations/implications

The sample size in this study is relatively small in relation to the student population in India. The current study relied primarily on quantitative data and analysis and further research could use a mixed-method approach to better understand the underlying mechanisms between positive reframing, gratitude and technostress. The results are derived under an extreme coronavirus disease 2019 (COVID-19) pandemic situation; therefore, the results cannot be generalized to normal times.

Practical implications

The paper includes implications for teachers, academic leaders, parents and civil society.

Originality/value

Overall, the relationship between positive reframing, gratitude and technostress has not been thoroughly explored. To the best of the authors' understanding, this is the first study to examine the influence of gratitude on technology-induced stress and the role of reframing.
Advances in neuroscience and marketing: analyzing tool possibilities and research opportunities
Authors: Casado-Aranda Luis-Alberto , Sanchez-Fernandez Juan
Published: February 2022

Purpose

This study aims to illuminate the contribution of neurophysiological techniques in the field of marketing and consumer decision-making and to highlight avenues and research questions that marketing researchers can take advantage of from neuroscience and psychology to inform marketing phenomena.

Methodology

The authors first reviewed the roots and definition of consumer neuroscience. Then, the authors outlined the main characteristics of the most commonly used neurophysiological tools (namely, skin conductance, facial electromyography, electrocardiogram, eye-tracking, electroencephalography, functional magnetic resonance imaging, functional near-infrared spectroscopy, magnetoencephalography and transcranial magnetic stimulation) with a special emphasis on their advantages and weaknesses. Finally, the authors propose the development of research lines that could be implemented by marketing researchers with an appropriate application and understanding of tools and theories of neuroscience and psychology.

Findings

The authors propose research questions to be addressed within four thematic areas: opportunities in product decisions (predicting product purchasing decisions, consumer responses to branding efforts and packaging), pricing, communication and retailing scenarios. The authors also incorporate insights into the complementarity of neurophysiological tools to traditional ones and situations in which these tools are useful for enhancing marketing theory. The authors finally shed light on the moral–ethical criticisms of this new branch of marketing.

Value

To the best of the authors’ knowledge, this research constitutes the first study in identifying the research opportunities that marketing researchers could take advantage from neuroimaging and physiological tools to inform marketing theory and practice.
Quality 4.0 conceptualisation: an emerging quality management concept for manufacturing industries
Authors: Maganga Deusdedith Pastory , Taifa Ismail W.R.
Published: February 2022

Purpose

Quality 4.0 refers to a modern quality management approach that uses Industry 4.0 technologies, integration and digitalisation. This research explores the current understandings of Quality 4.0 in various publications. The focus is on Quality 4.0 concepts or explanations, available models, motivation and readiness factors for adoption, enablers and technologies that can be leveraged.

Design/methodology/approach

A qualitative approach was deployed to collect the findings. This paper employs bibliometric, scientometric and visual analytic tools to identify and analyse articles from Scopus, Web of Science (WOS), Google Scholar databases and other sources such as ScienceDirect and Taylor and Francis.

Findings

The bibliometric results revealed that Quality 4.0 publications began in 2016 and increased dramatically in 2020 and 2021, with India leading the way while scientometric analysis found no clear definition of Quality 4.0 hitherto. However, several authors have defined the concept of Quality 4.0, arguing that it is characterised by digitalisation and integration, Industry 4.0 technologies applications and big data management. Some of the Quality 4.0 models published in the theoretical underpinnings include total quality management (TQM) in the basis of Industry 4.0 model, the European Foundation for quality management model, Quality 4.0 model combining operational technology (OT) and information technology (IT) through digital transformation and the LSN Research eleven axes of Quality 4.0 model. The research highlights key enablers of Quality 4.0 adoption, such as enabling technologies, big data capability, skilled and competent workers, collaboration and leadership support.

Research limitations/implications

The findings can benefit Quality 4.0 researchers and practitioners on the available Quality 4.0 models, motivation and readiness factors for Quality 4.0 adoption, enablers and leveraged technologies in Quality 4.0.

Originality/value

This study attempted to explore the current understandings of Quality 4.0 concepts to sediment these emerging quality management concepts for manufacturing industries.
The ethics of marriage in American evangelicalism
Authors: Brenner Suzanne
Published: February 2022

The idea that marriage should be treated as a site of pious ethical work is widespread in conservative Christian discourse. This article considers how and why conservative American evangelicals have come to regard the everyday routines of heterosexual marriage as potential forms of religious labour that can cultivate robust Christian subjectivities along with successful conjugal relationships. It argues that the notion of pious marital work was strongly shaped by the secular culture of therapeutic counselling and self‐help that developed during the twentieth century. While pious ethics and secular, everyday ethics are often seen as distinct, this historical perspective illuminates the modern coevolution of secular and conservative religious conceptions of marriage, revealing how each has linked marital work to personal as well as societal redemption.
Enhanced bioavailability and anti‐hyperglycemic activity of young apple polyphenols by complexation with whey protein isolates
Authors: Li Dan , Yang Yongli , Yang Xi , Wang Zichao , Yao Xiaolin , Guo Yurong
Published: February 2022

This study aims to evaluate the effects of complexation of whey protein isolate (WPI) and young apple polyphenols (YAP) on the bioavailability and anti‐hyperglycemic activity of YAP. Two types of WPI‐YAP complexes were fabricated by mixing WPI with YAP at 25℃ (WPI‐YAP) and 90℃ (WPI‐YAP‐H), respectively. The intermolecular interactions between WPI and YAP were investigated by fluorescence spectroscopy and circular dichroism analyses. The in vitro bioaccessibility and bioavailability of YAP were determined using a simulated gastrointestinal digestion and human Caco‐2 cells model. It was found that the total polyphenols transport efficiency was improved from 39.8% (YAP) to 48.2% (WPI‐YAP) and 56.1% (WPI‐YAP‐H), indicating that the bioavailability of YAP was improved by complexation with WPI. Besides, after complexation with WPI, YAP displayed an improved in vivo effect on alleviating the increase in postprandial blood glucose level than the pure YAP, with WPI‐YAP‐H showing a better effect. This finding indicates that co‐complexation of YAP with WPI is an effective way to improve the functionality of YAP, and the WPI‐YAP complexes are also expected to have potential application in designing YAP‐containing functional foods.

Practical Application

The research provided a method to improve the bioavavibility of polyphenols, and the WPI‐YAP complex can be developed in designing polyphenols related functional foods.
Pharmacological effects and safety of Andrographis paniculata (Burm.f.) Nees
Authors: Tian Jingzhuo , Li Chunying , Meng Jing , Wang Lianmei , Tong Yan , Zhao Yong , Yi Yan , Zhang Yushi , Xian Zhong , Pan Chen , Liu Suyan , Han Jiayin , Liang Aihua
Published: February 2022

Andrographis paniculata (Burm.f.) Nees (AP) is widely used in most Asian and some Western countries. However, its main effects and underlying pharmacological mechanism have not been thoroughly characterized, and its safety has not been sufficiently investigated. The present study aimed to predict and visualize the potential targets and pathways, clarify the main pharmacological effects, and investigate the toxicological properties of AP extract (APE).

First, ingenuity pathway analysis (IPA) was performed to directly predict AP's therapeutic targets and pathways; main pharmacological effects of AP were speculated based on IPA results and confirmed by pharmacodynamics experiments. Rodent toxicity studies were then performed through administration of a single dose of 10 g/kg or daily doses of 2, 1, or 0.5 g/kg for 8 weeks to evaluate the safety of APE, and a similar repeated‐dose study was performed using dogs with doses equal to half of the above‐mentioned doses. Thus, repeated‐dose toxicity studies were performed with both rodents and nonrodents.

The IPA analysis and confirmatory pharmacodynamics experiments revealed that the main pharmacological effect of APE was anti‐inflammation, which might be achieved by influencing various targets (e.g., AR, AKT, and BAX) and pathways (IL‐8). In the single‐dose toxicity test, no death or abnormal consequences were observed, and maximum tolerated dose of APE was 10 g/kg. Results from the repeated‐dose toxicity tests did not reveal any obvious toxic effects from the repeated daily intragastric administration of APE at 1 g/kg for 8 weeks.

In conclusion, APE at a dose of 1 g/kg did not exert any adverse effects, and administration of APE could be beneficial for the inflammatory diseases’ treatment.

Practical Application

Andrographis paniculata (Burm.f.) Nees is a plant that exerts clearing and detoxification effects and is widely used around the world, but a comprehensive analysis of its efficacy and safety is needed.
Immunization with a combination of recombinant Brucella abortus proteins induces T helper immune response and confers protection against wild‐type challenge in BALB/c mice
Authors: Li Zhiqiang , Wang Shuli , Wei Shujuan , Yang Guangli , Zhang Chunmei , Xi Li , Zhang Jinliang , Cui Yanyan , Hao Junfang , Zhang Huan , Zhang Hui
Published: February 2022

Protective efficiency of a combination of four recombinant Brucella abortus (B. abortus) proteins, namely, ribosomal protein L7/L12, outer membrane protein (OMP) 22, OMP25 and OMP31, was evaluated as a combined subunit vaccine (CSV) against B. abortus infection in RAW 264.7 cell line and murine model. Four proteins were cloned, expressed and purified, and their immunocompetence was analysed. BALB/c mice were immunized subcutaneously with single subunit vaccines (SSVs) or CSV. Cellular and humoral immune responses were determined by ELISA. Results of immunoreactivity showed that these four recombinant proteins reacted with Brucella‐positive serum individually but not with Brucella‐negative serum. A massive production of IFN‐γ and IL‐2 but low degree of IL‐10 was observed in mice immunized with SSVs or CSV. In addition, the titres of IgG2a were heightened compared with IgG1 in SSV‐ or CSV‐immunized mice, which indicated that SSVs and CSV induced a typical T‐helper‐1‐dominated immune response in vivo. Further investigation of the CSV showed a superior protective effect in mice against brucellosis. The protection level induced by CSV was significantly higher than that induced by SSVs, which was not significantly different compared with a group immunized with RB51. Collectively, these antigens of Brucella could be potential candidates to develop subunit vaccines, and the CSV used in this study could be a potential candidate therapy for the prevention of brucellosis.
Assessment of the iliocapsularis muscle on magnetic resonance imaging
Authors: Baker Kael S , Vesey Renuka M , Clark Barnaby , Billington Karen , Woodward Rebecca M
Published: February 2022

Introduction

Morphologic features of Iliocapsularis (IC) may aid clinical decision‐making in the symptomatic hip. The relationship between IC muscle size and underlying hip pathology is emerging; however, research is limited in the imaging literature. The purpose of this study was to determine the reliability and reproducibility of measurements of the IC muscle and its MRI appearances. It also looked for any association between IC dimension and axial levels, side, gender and bony features of hip instability.

Methods

Retrospective study of 37 MRI scans were assessed by four observers. MRI axial T1 images were used to define the IC anatomy, measure the IC and rectus femoris at the femoral head centre (FHC) and adjacent levels and calculate the iliocapsularis‐to‐rectus femoris (IR) ratio. Measurements were repeated at least 2 weeks later. Radiographic assessment of the lateral centre edge angle, acetabular index and femoral neck‐shaft angle were also conducted.

Results

The IC was always present, but was well‐defined in only 4% of cases with fair agreement. The intraclass correlation coefficient for reliability and reproducibility was the highest for IC width 0.94 (0.91–0.96). No significant correlation was identified between the IR ratio and radiographic parameters.

Conclusion

Iliocapsularis is visible and reliably measured on MRI despite observers considering the muscle to be not well‐defined. Despite gender differences in muscle size, the IR ratio was unchanged. There is a significant difference in the IR ratio above and below the FHC; therefore, clinicians need to be aware of how this may impact the clinical use when utilising the IR ratio.
Cisplatin resistance and malignant behaviors of lung cancer cells are promoted by circ_0002360 via targeting miR‐6751‐3p to regulate the expression of ZNF300
Authors: Ding Lingyan , Li Lizhi , Tang Zhaohui
Published: February 2022

Background

Circular RNAs (circRNAs) are key regulators in oncogenesis and chemoresistance of human cancers. Herein, we focused on the roles of circ_0002360 in regulating lung cancer progression and cisplatin (DDP) resistance.

Methods

The detection of circ_0002360, microRNA‐6751‐3p (miR‐6751‐3p) and zinc finger protein 300 (ZNF300) was conducted via reverse transcription‐quantitative polymerase chain reaction assay. Cell sensitivity was determined using cell counting kit‐8 assay. Proliferation detection was performed by colony formation assay and EdU assay. The migrated cells were examined via transwell assay. Cell apoptosis analysis was carried out through flow cytometry and caspase 3 activity assay. Western blot was used to examine the protein levels. Target interaction was confirmed through dual‐luciferase reporter assay and RNA immunoprecipitation assay. Circ_0002360 function in vivo was performed via xenograft tumor assay.

Results

Circ_0002360 was overexpressed in DDP‐resistant lung cancer tissues and cells. Silencing circ_0002360 inhibited DDP resistance, proliferation and migration but enhanced apoptosis of DDP‐resistant cells. Circ_0002360 could elevate ZNF300 expression. DDP resistance and lung cancer progression were also impeded by ZNF300 downregulation. ZNF300 overexpression reversed the function of circ_0002360 knockdown in DDP‐resistant lung cancer cells. The regulation of circ_0002360 for ZNF300 was achieved by sponging miR‐6751‐3p. Circ_0002360 promoted DDP resistance in xenograft mice through mediating the miR‐6751‐3p/ZNF300 axis.

Conclusion

Circ_0002360 targeted miR‐6751‐3p to regulate ZNF300 level, thus elevating DDP resistance and promoting the malignant progression of lung cancer cells.
Microwave ablation via a flexible catheter for the treatment of nonsurgical peripheral lung cancer: A pilot study
Authors: Xie Fangfang , Chen Junxiang , Jiang Yifeng , Sun Jiayuan , Hogarth D. Kyle , Herth Felix J. F.
Published: February 2022

Background

Endobronchial microwave ablation via flexible catheter offers the potential for local therapy for inoperable peripheral lung cancer. The study aimed to evaluate the feasibility and safety of navigation bronchoscopy‐guided water‐cooled microwave ablation catheter for nonsurgical peripheral lung cancer.

Methods

This was a prospective single arm pilot study. Patients with early stage or multiple primary peripheral lung cancer who were nonsurgical candidates for surgery were enrolled in the study. Bronchoscopic microwave ablation was performed via a flexible water‐cooled microwave ablation antenna under the guidance of navigation bronchoscopy. Radial probe endobronchial ultrasound combined with fluoroscopy was used to confirm the position. Treatment outcomes were evaluated based on follow‐up chest CT and positron emission tomography scans. Primary endpoints were technical success and safety. Secondary endpoints were complete ablation rate, 2‐year local control rate, and progression‐free survival.

Results

Thirteen patients were enrolled in the study from April 2018 to July 2019. A total of 19 sessions of microwave ablation were performed on 14 tumors under the guidance of navigation bronchoscopy. The technical success was 100%. Treatment‐related complications occurred in two patients. The complete ablation rate was 78.6% (11/14). The 2‐year local control rate was 71.4%. Median progression‐free survival was 33 months for all patients.

Conclusions

In this pilot study, bronchoscopic microwave ablation appears to be feasible with acceptable occurrence of complication in the treatment of peripheral lung cancer under the guidance of navigation bronchoscopy.
Hematopoietic progenitor cell liabilities and alarmins S100A8/A9‐related inflammaging associate with frailty and predict poor cardiovascular outcomes in older adults
Authors: Bonora Benedetta Maria , Palano Maria Teresa , Testa Gianluca , Fadini Gian Paolo , Sangalli Elena , Madotto Fabiana , Persico Giuseppe , Casciaro Francesca , Vono Rosa , Colpani Ornella , Scavello Francesco , Cappellari Roberta , Abete Pasquale , Orlando Patrizia , Carnelli Franco , Berardi Andrea Giovanni , De Servi Stefano , Raucci Angela , Giorgio Marco , Madeddu Paolo , Spinetti Gaia
Published: February 2022

Frailty affects the physical, cognitive, and social domains exposing older adults to an increased risk of cardiovascular disease and death. The mechanisms linking frailty and cardiovascular outcomes are mostly unknown. Here, we studied the association of abundance (flow cytometry) and gene expression profile (RNAseq) of stem/progenitor cells (HSPCs) and molecular markers of inflammaging (ELISA) with the cardiorespiratory phenotype and prospective adverse events of individuals classified according to levels of frailty. Two cohorts of older adults were enrolled in the study. In a cohort of pre‐frail 35 individuals (average age: 75 years), a physical frailty score above the median identified subjects with initial alterations in cardiorespiratory function. RNA sequencing revealed S100A8/A9 upregulation in HSPCs from the bone marrow (>10‐fold) and peripheral blood (>200‐fold) of individuals with greater physical frailty. Moreover higher frailty was associated with increased alarmins S100A8/A9 and inflammatory cytokines in peripheral blood. We then studied a cohort of 104 more frail individuals (average age: 81 years) with multidomain health deficits. Reduced levels of circulating HSPCs and increased S100A8/A9 concentrations were independently associated with the frailty index. Remarkably, low HSPCs and high S100A8/A9 simultaneously predicted major adverse cardiovascular events at 1‐year follow‐up after adjustment for age and frailty index. In conclusion, inflammaging characterized by alarmin and pro‐inflammatory cytokines in pre‐frail individuals is mirrored by the pauperization of HSPCs in frail older people with comorbidities. S100A8/A9 is upregulated within HSPCs, identifying a phenotype that associates with poor cardiovascular outcomes.
Loss of heterochromatin and retrotransposon silencing as determinants in oocyte aging
Authors: Wasserzug‐Pash Peera , Rothman Rachel , Reich Eli , Zecharyahu Lital , Schonberger Oshrat , Weiss Yifat , Srebnik Naama , Cohen‐Hadad Yaara , Weintraub Amir , Ben‐Ami Ido , Holzer Hananel , Klutstein Michael
Published: February 2022

Mammalian oocyte quality reduces with age. We show that prior to the occurrence of significant aneuploidy (9M in mouse), heterochromatin histone marks are lost, and oocyte maturation is impaired. This loss occurs in both constitutive and facultative heterochromatin marks but not in euchromatic active marks. We show that heterochromatin loss with age also occurs in human prophase I‐arrested oocytes. Moreover, heterochromatin loss is accompanied in mouse oocytes by an increase in RNA processing and associated with an elevation in L1 and IAP retrotransposon expression and in DNA damage and DNA repair proteins nuclear localization. Artificial inhibition of the heterochromatin machinery in young oocytes causes an elevation in retrotransposon expression and oocyte maturation defects. Inhibiting retrotransposon reverse‐transcriptase through azidothymidine (AZT) treatment in older oocytes partially rescues their maturation defects and activity of the DNA repair machinery. Moreover, activating the heterochromatin machinery via treatment with the SIRT1 activating molecule SRT‐1720, or overexpression of Sirt1 or Ezh2 via plasmid electroporation into older oocytes causes an upregulation in constitutive heterochromatin, downregulation of retrotransposon expression, and elevated maturation rates. Collectively, our work demonstrates a significant process in oocyte aging, characterized by the loss of heterochromatin‐associated chromatin marks and activation of specific retrotransposons, which cause DNA damage and impair oocyte maturation.
Major adverse cardiac event rates in moderate‐risk patients: Does prior coronary disease matter?
Authors: McGinnis Henderson D. , Ashburn Nicklaus P. , Paradee Brennan E. , O'Neill James C. , Snavely Anna C. , Stopyra Jason P. , Mahler Simon A.
Published: February 2022

Background

Despite negative troponins and nonischemic electrocardiograms (ECGs), patients at moderate risk for acute coronary syndrome (ACS) are frequently admitted. The objective of this study was to describe the major adverse cardiac event (MACE) rate in moderate‐risk patients and how it differs based on history of coronary artery disease (CAD).

Methods

A secondary analysis of the HEART Pathway implementation study was conducted. This prospective interrupted time‐series study accrued adults with possible ACS from three sites (November 2013–January 2016). This analysis excluded low‐risk patients determined by emergency providers' HEART Pathway assessments. Non–low‐risk patients were further classified as high risk, based on elevated troponin measures or ischemic ECG findings or as moderate risk, based on HEAR score ≥ 4, negative troponin measures, and a nonischemic ECG. Moderate‐risk patients were then stratified by the presence or absence of prior CAD (MI, revascularization, or ≥70% coronary stenosis). MACE (death, myocardial infarction, or revascularization) at 30 days was determined from health records, insurance claims, and death index data. MACE rates were compared among groups using a chi‐square test and likelihood ratios (LRs) were calculated.

Results

Among 4,550 patients with HEART Pathway assessments, 24.8% (1,130/4,550) were high risk and 37.7% (1715/4550) were moderate risk. MACE at 30 days occurred in 3.1% (53/1,715; 95% confidence interval [CI] = 2.3% to 4.0%) of moderate‐risk patients. Among moderate‐risk patients, MACE occurred in 7.1% (36/508, 95% CI = 5.1% to 9.8%) of patients with known CAD versus 1.4% (17/1,207, 95% CI = 0.9% to 2.3%) in patients without known prior CAD (p < 0.0001). The negative LR for 30‐day MACE among moderate‐risk patients without prior CAD was 0.08 (95% CI = 0.05 to 0.12).

Conclusion

MACE rates at 30 days were low among moderate‐risk patients but were significantly higher among those with prior CAD.
Fertility preservation in gynaecology oncology patients: Experience from an Australian tertiary oncology centre
Authors: Robson Danielle , de Vries Bradley , Pather Selvan , Marren Anthony
Published: February 2022

Background

Management for gynaecological cancers often includes removal of the reproductive organs and/or the use of gonadotoxic therapies resulting in sub‐fertility. Oncofertility and discussion of fertility preservation in these patients is critical.

Aim

To determine the rate of fertility preservation discussion among a cohort of patients with a gynaecological cancer and what determinants impact likelihood of a discussion.

Materials and Methods

A seven‐year quantitative retrospective study was conducted at a single oncology centre, including 15–45 year old patients with a gynaecological cancer. The primary outcome was if a fertility preservation discussion occurred during a consultation. Secondary outcomes included if a referral was made and what fertility preservation services were undertaken. Determinants that impacted the likelihood of a fertility preservation discussion were analysed.

Results

One hundred and twenty‐one patients were analysed. There were 84 (69%) patients who had a documented fertility preservation discussion, and 46% were referred to a fertility specialist for consultation. Age was a significant determinant, with patients aged 30–39 years of age more commonly having a fertility preservation discussion. Patients with a high‐grade cancer compared to patients with a lower‐grade cancer (grade one or two) were only a third as likely to have a discussion surrounding their fertility (odds ratio: 0.33, 95% CI: 0.13–0.86; P = 0.02).

Conclusion

We conclude that rates of discussion around fertility options for patients with cancer are lower than the recommended guidelines. Oncofertility is an important discipline which we believe needs to be emphasised within the gynaecology oncology community and management of patients should include a multi‐disciplinary team.
Implementing advance care plans in the peri‐operative period, including plans for cardiopulmonary resuscitation: Association of Anaesthetists clinical practice guideline
Authors: Meek T. , Clyburn R. , Fritz Z. , Pitcher D. , Ruck Keene A. , Young P. J.
Published: February 2022

Contemporary guidance takes a patient‐centred approach and recommends discussing and planning treatments that should be considered, not just those that should be withheld. Although some organisations and communities still use specific DNACPR (do not attempt cardiopulmonary resuscitation) forms to recommend that cardiopulmonary resuscitation is not attempted, this approach has been shown to have disadvantages and is no longer regarded as best practice. The following guidelines have been produced in response to this change. They are designed to help anaesthetists, as part of the wider healthcare team, to implement and respond to advance care planning documents before and during procedures. The guidelines apply to all procedures, however minor and low risk they are considered to be, and the same ethical and legal principles apply to procedures carried out under local or regional anaesthesia and/or conscious sedation, as well as to those under general anaesthesia.
Enhanced peri‐operative care to improve outcomes for high‐risk surgical patients in Brazil: a single‐centre before‐and‐after cohort study
Authors: Stahlschmidt A. , Passos S. C. , Cardoso G. R. , Schuh G. J. , Gutierrez C. S. , Castro S. M. J. , Caumo W. , Pearse R. M. ,   the Ex‐Care collaborative, Stefani L. C.
Published: February 2022

Mortality and morbidity for high‐risk surgical patients are often high, especially in low‐resource settings. Enhanced peri‐operative care has the potential to reduce preventable deaths but must be designed to meet local needs. This before‐and‐after cohort study aimed to assess the effectiveness of a postoperative 48‐hour enhanced care pathway for high‐risk surgical patients (‘high‐risk surgical bundle’) who did not meet the criteria for elective admission to intensive care. The pathway comprised of six elements: risk identification and communication; adoption of a high‐risk post‐anaesthesia care unit discharge checklist; prompt nursing admission to ward; intensification of vital signs monitoring; troponin measurement; and prompt access to medical support if required. The primary outcome was in‐hospital mortality. Data describing 1189 patients from two groups, before and after implementation of the pathway, were compared. The usual care group comprised a retrospective cohort of high‐risk surgical patients between September 2015 and December 2016. The intervention group prospectively included high‐risk surgical patients from February 2019 to March 2020. Unadjusted mortality rate was 10.5% (78/746) for the usual care and 6.3% (28/443) for the intervention group. After adjustment, the intervention effect remained significant (RR 0.46 (95%CI 0.30–0.72). The high‐risk surgical bundle group received more rapid response team calls (24% vs. 12.6%; RR 0.63 [95%CI 0.49–0.80]) and surgical re‐interventions (18.9 vs. 7.5%; RR 0.41 [95%CI 0.30–0.59]). These data suggest that a clinical pathway based on enhanced surveillance for high‐risk surgical patients in a resource‐constrained setting could reduce in‐hospital mortality.
The effect of SARS‐Co‐V2 infection on prothrombotic and anticoagulant factors in dialysis patients
Authors: Riddell Anne , Chowdary Pratima , Davenport Andrew
Published: February 2022

Background

Patients with COVID‐19 infection are at increased risk of thrombosis. We wished to determine whether this was is due to an increase in prothrombotic or reduction in anticoagulant factors and whether heparin would be an appropriate anticoagulant.

Methods

We measured routine coagulation and prothrombotic factors in dialysis patients after a positive COVID‐19 test between March 2020 –April 2021.

Results

Routine coagulation tests were measured in 227 dialysis patients, 148 males (65.2%), median age 67.5 (53.8–77.0) years. The international normalized ratio was prolonged in 11.5%, activated partial thromboplastin time in 48.5%, thrombin time in 57%. Factor VIII was increased in 59.1%, fibrinogen 73.8%, and D‐dimer 95.5%. Protein C was reduced in 15.3%, protein S 28%, and antithrombin (AT) in 12.1%. Two patients were Lupus anticoagulant positive, and two Factor VLeiden positive. Factor VIII levels increased with clinical disease; outpatients 159 (136–179) IU/dl, hospitalized but not ventilated 228 (167–311) IU, ventilated 432 (368–488) IU/dl (p < 0.01). Overall 75% had an AT level ≥ 88 IU/dl (reference range 79–106), but only 11.7% of non‐hospitalized patients compared to 45% of those who died, p < 0.01, fibrinogen, D‐dimers, and protein S or C did not differ with clinical disease severity, whether patients required hospital admission or not and between survivors and those who died.

Conclusion

COVID‐19 dialysis patients have increased levels of fibrinogen and D‐Dimers, but only factor VIII levels in the clotting profile increased with clinical disease severity increasing systemic hypercoagulability. AT concentrations are maintained and as such should not compromise anticoagulation with heparins.
Factors influencing the functional status of aortic valve in ovine models supported by continuous‐flow left ventricular assist device
Authors: Yu Xin‐Yi , Shi Jian‐Wei , Zang Yi‐Rui , Zhang Jie‐Min , Liu Zhi‐Gang
Published: February 2022

Objectives

An acute animal experiment was performed to observe factors influencing the functional status of the aortic valve functional status after continuous‐flow left ventricular assist device (CF‐LVAD) implantation in an ovine model, and a physiologic predictive model was established.

Methods

A CF‐LVAD model was established in Small Tail Han sheep. The initial heart rate (HR) was set to 60 beats/min, and grouping was performed at an interval of 20 beats/min. In all groups, the pump speed was started from 2000 rpm and was gradually increased by 50–100 rpm. A multi‐channel physiological recorder recorded the HR, aortic pressure, central venous pressure, and left ventricular systolic pressure (LVSP). A double‐channel ultrasonic flowmeter was used to obtain real‐time artificial vascular blood flow (ABF). A color Doppler ultrasound device was applied to assess the aortic valve functional status. Multivariate dichotomous logistic regression was used to screen significant variables for predicting the functional status of the aortic valve.

Results

Observational studies showed that ABF and the risk of aortic valve closure (AVC) were positively correlated with pump speed at the same HR. Meanwhile, the mean arterial pressure (MAP) was unaltered or slightly increased with increased pump speed. When the pump speed was constant, an increase in HR was associated with a decrease in the size of the aortic valve opening. This phenomenon was accompanied by an initial transient increase in the ABF and MAP, which subsequently decreased. Statistical analysis showed that the AVC was associated with increased pump speed (OR = 1.02, 95% CI = 1.01–1.04, p = 0.001), decreased LVSP (OR = 0.95, 95% CI = 0.91–0.98, p = 0.003), and decreased pulse pressure (OR = 0.82, 95% CI = 0.68–0.96, p = 0.026). ABF or MAP was negatively associated with the risk of AVC (OR < 1). The prediction model of AVC after CF‐LVAD implantation exhibited good differentiation (AUC = 0.973, 95% CI = 0.978–0.995) and calibration performance (Hosmer–Lemeshow χ2 = 9.834, p = 0.277 > 0.05).

Conclusions

The pump speed, LVSP, ABF, MAP, and pulse pressure are significant predictors of the risk of AVC. Predictive models built from these predictors yielded good performance in differentiating aortic valve opening and closure after CF‐LVAD implantation.
Review article: emerging drug therapies in inflammatory bowel disease
Authors: Grossberg Laurie B. , Papamichael Konstantinos , Cheifetz Adam S.
Published: February 2022

Background

The landscape of inflammatory bowel disease (IBD) treatment is rapidly expanding with the development of new therapeutic options.

Aim

To review the mechanisms of action and the available clinical trial data on emerging drug therapies for IBD.

Methods

Pubmed, Medline and Cochrane databases were queried up to July 2021 using keywords “inflammatory bowel disease,” “IBD,” “Crohn’s disease,” “ulcerative colitis” and “trial,” “phase” and “study.” In addition, we manually reviewed the grey literature including clinical trial registries and abstracts from major gastroenterology conferences in 2020 and 2021 to include pertinent information.

Results

In ulcerative colitis (UC), phase 2b and/or phase 3 studies met primary endpoints for S1P receptor agonists (estrasimod, ozanimod), anti‐IL‐23 agent (mirikizumab), anti‐lymphocyte trafficking agents (ontamalimab, subcutaneous vedolizumab), JAK inhibitors (upadacitinib, filgotinib) and TLR9 agonist (cobitolimod). In Crohn’s disease (CD), anti‐IL‐23 agents (risankizumab, mirikizumab, guselkumab), JAK inhibitors (upadacitinib, filgotinib) and anti‐lymphocyte trafficking agents (ontamalimab, etrolizumab) met primary endpoints in randomised controlled clinical trials.

Conclusion

Several new IBD drug therapies have positive efficacy and safety data in early clinical trials, and there are several drugs in the therapeutic pipeline. As more treatments for CD and UC are approved for clinical use, research to assess predictors of response to therapy and head‐to‐head trials is needed to inform providers on how to best position therapeutic options for patients with IBD.
Systematic review with meta‐analysis: incidence and factors for progression to advanced neoplasia in inflammatory bowel disease patients with indefinite and low‐grade dysplasia
Authors: Wan Jian , Wang Xuan , Zhang Yujie , Chen Min , Wang Min , Wu Kaichun , Liang Jie
Published: February 2022

Background

Due to limited research on the natural history of indefinite for dysplasia (IND) and low‐grade dysplasia (LGD) in inflammatory bowel disease (IBD), the management of these patients is controversial.

Aims

This systematic review and meta‐analysis aimed to estimate the incidence and identify the risk factors for advanced neoplasia in IBD patients with IND and LGD.

Methods

PubMed, Embase and Cochrane Central Register of Controlled Trials were searched until 24 December, 2021, to identify studies that reported pathological results of follow‐up colonoscopy or surgery in IBD patients with IND and LGD. The main outcomes were the incidence and risk factors for advanced neoplasia in IBD patients with IND and LGD.

Results

Based on the analysis of 38 studies, the pooled incidences of advanced neoplasia in IBD patients with IND and LGD were 9.9% (95% CI 4.4%‐15.4%) and 10.7% (95% CI 7.0%‐14.4%) respectively. The risk factors for advanced neoplasia in IND patients were primary sclerosing cholangitis (PSC) and aneuploidy. The risk factors for advanced neoplasia in LGD patients included male, PSC, previous IND, colonic stricture, index lesion ≥1 cm, distal location, multifocal lesions, distal and flat lesions, nonpolypoid/flat lesions and invisible lesions.

Conclusions

The incidence of advanced neoplasia was similar between IND and LGD in IBD patients, as high as one in ten, so more rigorous surveillance is also suggested in IND patients. Since the effects of most factors were derived from the pooled results of only two to three studies, further research was needed to confirm our results.
Gut‐brain axis dysfunction underlies FODMAP‐induced symptom generation in irritable bowel syndrome
Authors: Wu Jie , Masuy Imke , Biesiekierski Jessica R , Fitzke Heather E , Parikh Chinar , Schofield Laurel , Shaikh Hafsa , Bhagwanani Anisha , Aziz Qasim , Taylor Stuart A , Tack Jan , Van Oudenhove Lukas
Published: February 2022

Background

FODMAPs produce similar small bowel water and colonic gas in patients with irritable bowel syndrome (IBS) and healthy controls (HCs), despite IBS patients reporting increased gastrointestinal (GI) symptoms.

Aim

To unravel the mechanisms underlying FODMAP‐induced symptom reporting, we investigated gut and brain responses to fructan administration in IBS patients and HC.

Methods

This randomised, double‐blind, cross‐over study consisted of three visits where fructans (40 g/500 mL saline), glucose (40 g/500 mL saline) or saline (500 mL) were infused intragastrically during 1 h MR brain scanning; abdominal MRI was performed before, 1 h, and 2 h post‐infusion. Symptoms were rated using validated scales.

Results

In IBS (n = 13), fructans induced more cramps, pain, flatulence and nausea compared to glucose (P = 0.03, 0.001, 0.009 and <0.001 respectively), contrary to HC (n = 13) (all P > 0.14), with between‐group differences for cramps and nausea (P = 0.004 and 0.023). Fructans increased small bowel motility and ascending colonic gas and volume equally in IBS and HC (between‐group P > 0.25). The difference in colonic gas between fructans and saline covaried with differences in bloating and cramps in IBS (P = 0.008 and 0.035 respectively). Pain‐related brain regions responded differentially to fructans in IBS compared to HC, including the cerebellum, supramarginal gyrus, anterior and midcingulate cortex, insula and thalamus (pFWE‐corrected < 0.05); these brain responses covaried with symptom responses in IBS.

Conclusions

Fructans increase small bowel motility and colon gas and volume similarly in IBS patients and HC. Increased symptom responses to fructans in IBS covary with altered brain responses in pain‐related regions, indicating that gut‐brain axis dysregulation may drive FODMAP‐induced symptom generation in IBS.
Inference for Set-Based Effects in Genetic Association Studies with Interval-Censored Outcomes
Authors: Sun Ryan , Zhu Liang , Li Yimei , Yasui Yutaka , Robison Leslie
Published: February 2022

The rapid acceleration of genetic data collection in biomedical settings has recently resulted in the rise of genetic compendiums filled with rich longitudinal disease data. One common feature of these data sets is their plethora of interval-censored outcomes. However, very few tools are available for the analysis of genetic data sets with interval-censored outcomes, and in particular, there is a lack of methodology available for set-based inference. Set-based inference is used to associate a gene, biological pathway, or other genetic construct with outcomes and is one of the most popular strategies in genetics research. This work develops three such tests for interval-censored settings beginning with a variance components test for interval-censored outcomes, the interval-censored sequence kernel association test (ICSKAT). We also provide the interval-censored version of the Burden test, and then we integrate ICSKAT and Burden to construct the interval censored sequence kernel association test—optimal (ICSKATO) combination. These tests unlock set-based analysis of interval-censored data sets with analogs of three highly popular set-based tools commonly applied to continuous and binary outcomes. Simulation studies illustrate the advantages of the developed methods over ad hoc alternatives, including protection of the type I error rate at very low levels and increased power. The proposed approaches are applied to the investigation that motivated this study, an examination of the genes associated with bone mineral density deficiency and fracture risk.