bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vivo Antifatigue Activity of Spirulina Peptides Achieved by Their Antioxidant Activity and by Acting on Fat Metabolism Pathway in Mice
Authors: Chen Yuhao , Wang Feng , Zhou Jiawei , Niu Tingting , Xuan Rongrong , Chen Haimin , Wu Wei
Published: August 2020

Spirulina are multicellular and filamentous cyanobacteria that have achieved considerable popularity in the health sector, food industry, and aquaculture. In the present study, we aimed to evaluate the antifatigue effects of Spirulina-derived peptides on Institute for Cancer Research mice and explore the association between antifatigue activity and fat metabolism involving the adenosine monophosphate-activated protein kinase (AMPK) signaling pathway. We extracted the peptides from Spirulina by enzymatic hydrolysis and ultrafiltration. The mice were orally administered with Spirulina peptides (0.125, 0.5, and 2 mg/g bw/day) daily for 4 weeks. We found that Spirulina peptides, especially the high-dose group, significantly prolonged the swimming time by 126.1%, increased the activities of antioxidant enzymes, and decreased the content of malondialdehyde by 60.2% compared with the glutathione (GSH) group. The levels of some indicators of exercise fatigue, including lactic dehydrogenase, blood lactic acid, and creatine phosphokinase, were reduced. In the high-dose group, these indicators were reduced by 40.7%, 22.3%, and 11.3% compared with the GSH group. Spirulina peptides did not excessively consume blood sugar or glycogen in the liver and muscle to produce energy. However, the triglyceride level was reduced, and the level of free fatty acids was increased. Besides, the proteins in the AMPK signaling pathway were activated. Taken together, these findings indicated that Spirulina peptides could effectively alleviate physical fatigue by reducing the production of lactic acid and improving antioxidant capacity. Spirulina peptides also helped increase the energy resources by activating the AMPK signaling pathway to utilize fat metabolism.
David Slater: a leading geographical theorist
Authors: O’Keefe Phil
Published: August 2020

David Slater is an enigmatic figure in radical geography. He is much regarded for his theoretical contributions to geography although few geographers seem to know to what he contributed. David Slater appeared on the radical geography scene in Dar es Salaam, Tanzania. Dar es Salaam was described, in the early 1970s, as being a ‘hotspot’ for radical geographers. He focused his work on a critique of modernisation theory, publishing a two-piece article in Antipode. He rejected the western notions of the working class as the pivot for revolutionary change and, instead, sought to explore the power of peasant-worker movements drawing particularly on his Latin American experience. He moved to Amsterdam, The Netherlands, where his work was increasingly anti-imperialist and focused on theoretical discussions of territoriality. He began to take more open post-colonial positions although he was wary of the cultural turn in geography. This wariness came from his observation that most Anglo-American geographers do field work in developing countries without the relevant local language. This, plus his demand for close readings of classic texts, including Marx, was admired, but little followed, by geographers. He sought to define territoriality as a kind of Third Space but Soja had already done this. He moved again to Loughborough, United Kingdom, where his work became more stridently anti-American and where his exploration of territoriality took him away from political geography to international relations, away from economics and history towards politics and political action. Latin American exile groups that he championed very fondly remember him in the United Kingdom. To the end, he continued to explore theories of social change. His demand for knowledge of language, local culture and classic texts made him a somewhat foreboding supervisor. The body of literature, particularly the early critiques of development theory, stand the test of time.
Smoking duration and intensity associated with tumour aggressiveness in patients with urothelial carcinoma of the bladder: A correlation study
Authors: Pramod Sawkar Vijay , Safriadi Ferry , Hernowo Bethy S. , Dwiyana Reiva Farah , Bonar Ananta
Published: August 2020

Introduction:

Smoking is well recognized as the most important risk factor for the malignancy of bladder. Cigarette smoking is associated with a higher risk of bladder cancer. The influence of various parameters of smoking history was still unclear. The purpose of this study was to examine the relationship between smoking intensity and clinico-pathological features of bladder cancer.

Methods:

This was a retrospective study with non-probability consecutive sampling. All patients with urothelial cell carcinoma of the bladder in our hospital during 2009–2018 were included in the present study. The data were collected from medical records and then divided into three groups according to the intensity of smoking. The data were analysed, with statistical significance determined using Spearman’s rank correlation coefficient.

Result:

The data from a total of 260 urothelial bladder cancer patients were collected between 2009 and 2018. Based on statistical testing, it was found that there was a strong correlation between smoking intensity and local staging (T; rs=0.827), with a greater tendency to develop a larger tumour growth as the smoking intensity increased. There was also a weak correlation between smoke intensity and grading ( rs=0.139). Meanwhile, no correlation was found between smoking intensity and the incidence of regional (N; rs=0.119) and distant lymph node metastasis (M; rs=0.239). Smoke status and intensity had a weak correlation with lesion ( rs=0.163 and 0.206, respectively). The type of cigarette and local staging had a small correlation ( rs=0.166).

Conclusion:

This study demonstrated that smoking intensity was significantly correlated only with primary tumour progression and grading, but not with the progression of regional and distant metastasis. There was a weak correlation between smoking status and intensity with the type of lesion, whether a solitary nodule or multiple nodules. This study also demonstrated a small correlation between the type of cigarette and local staging.

Level of evidence:

3
A Relationship-Centered and Culturally Informed Approach to Studying Misinformation on COVID-19
Authors: Malhotra Pranav
Published: August 2020

The panic and anxiety that accompanies a global pandemic is only exacerbated by the spread of misinformation. For COVID-19, in many parts of the world, such misinformation is circulating through globally popular mobile instant messaging services (MIMS) like WhatsApp and Telegram. Compared to more public social media platforms like Facebook and Twitter, these services offer private, intimate, and often encrypted spaces for users to chat with family members and friends, making it difficult for the platform to moderate misinformation on them. Thus, there is an enhanced onus on users of MIMS to curb misinformation by correcting their family and friends within these spaces. Research on understanding how such relational correction occurs in different parts of the globe will need to attend to how the nature of these interpersonal relationships and the cultural dynamics that influence them shape the correction process. Thus, as people increasingly use MIMS to connect with close relations to make sense of this global crisis, studying the issue of misinformation on these services requires us to adopt a relationship-centered and culturally informed approach.
Unroofing of Myocardial Bridging After Septal Myectomy in a Child With Noonan Syndrome
Authors: Said Sameh M. , Marey Gamal , Hiremath Gurumurthy M.
Published: August 2020

Myocardial bridging is a controversial topic that remained with no well-defined management protocol. We present a ten-year-old child with Noonan syndrome and a myocardial bridge.
Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa
Authors: Wulff Irene , Duah Henry Ofori , Osei Tutu Henry , Ofori-Amankwah Gerhard , Yankey Kwadwo Poku , Owiredu Mabel Adobea , Bidemi Yahaya Halima , Akoto Harry , Oteng-Yeboah Audrey , Boachie-Adjei Oheneba ,   FOCOS Spine Research Group
Published: August 2020

Study Design:

Retrospective review of consecutive series.

Objectives:

This study sought to assess the incidence, risk factors, and outcomes of pulmonary complication following complex spine deformity surgery in a low-resourced setting in West Africa.

Methods:

Data of 276 complex spine deformity patients aged 3 to 25 years who were treated consecutively was retrospectively reviewed. Patients were categorized into 2 groups during data analysis based on pulmonary complication status: group 1: yes versus group 2: no. Comparative descriptive and inferential analysis were performed to compare the 2 groups.

Results:

The incidence of pulmonary complication was 17/276 (6.1%) in group 1. A total of 259 patients had no events (group 2). There were 8 males and 9 females in group 1 versus 100 males and 159 females in group 2. Body mass index was similar in both groups (17.2 vs 18.4 kg/m2, P = .15). Average values (group 1 vs group 2, respectively) were as follows: preoperative sagittal Cobb angle (90.6° vs 88.7°, P = .87.), coronal Cobb angle (95° vs 88.5°, P = .43), preoperative forced vital capacity (45.3% vs 62.0%, P = .02), preoperative FEV1 (forced expiratory volume in 1 second) (41.9% vs 63.1%, P < .001). Estimated blood loss, operating room time, and surgery levels were similar in both groups. Thoracoplasty and spinal osteotomies were performed at similar rates in both groups, except for Smith-Peterson osteotomy. Multivariate logistic regression showed that every unit increase in preoperative FEV1 (%) decreases the odds of pulmonary complication by 9% (OR = 0.91, 95% CI 0.84-0.98, P = .013).

Conclusion:

The observed 6.1% incidence of pulmonary complications is comparable to reported series. Preoperative FEV1 was an independent predictor of pulmonary complications. The observed case fatality rate following pulmonary complications (17%) highlights the complexity of cases in underserved regions and the need for thorough preoperative evaluation to identify high-risk patients.
The Status Dynamics of Role Blurring in the Time of COVID-19
Authors: Schieman Scott , Badawy Philip J.
Published: August 2020

Has the coronavirus disease 2019 pandemic altered the status dynamics of role blurring? Although researchers typically investigate its conflictual aspects, the authors assess if the work-home interface might also be a source of status—and the relevance of schedule control in these processes. Analyzing data from nationally representative samples of workers in September 2019 and March 2020, the authors find that role blurring is associated with elevated status, but the onset of coronavirus disease 2019 weakens that effect. Likewise, schedule control enhances the status of role blurring, but its potency is also weakened during the pandemic. These findings align with the suggestion that role blurring signals a commitment to work and adherence to ideal worker norms. However, the pandemic changed that by intensifying role integration and possibly by reducing the degree of agency once associated with role blurring. The loss of choice around role blurring might have also diluted the distinctive status that it once carried.
Reflections on Reflexive Theorizing: The Need for A Little More Conversation
Authors: Cutcher Leanne , Hardy Cynthia , Riach Kathleen , Thomas Robyn
Published: August 2020

We investigate the nature and impact of recent ‘reflexive theorizing’ in the field of Organization Studies by examining articles that critically reflect on research, practice and the profession more generally with a view to defining, refining or changing future trajectories for the field. We identify a range of discursive practices used in these articles to establish authority, describe the field and make claims about the nature of theorizing. We then present three ‘ideal types’ that represent particular constellations of these discursive practices. We interrogate each of these ideal types in order to demonstrate how particular combinations of discursive practices can limit the potential of reflexive theorizing by shutting down conversations. Finally, we make a number of suggestions for weaving together discursive practices in ways that help to ensure that reflexive theorizing generates new forms of knowledge through conversations which are open to a wider range of voices, and where respect and generosity are evident.
Performance of flexible frame building with horizontal and 3D seismic isolation when subjected to 3D ground shaking
Authors: Eltahawy Walaa , Ryan Keri L
Published: August 2020

Seismic isolation is known to effectively mitigate the effects of horizontal ground shaking in building structures. Recent research has suggested that vertical excitation causes high-intensity slab vibrations that lead to nonstructural component damage. A detailed case study of the application of three-dimensional (3D) isolation in a realistic multi-story frame building is presented. Specifically, the seismic responses of hypothetical special concentric braced frame buildings with horizontal and 3D isolation are compared to evaluate the effectiveness of 3D isolation to mitigate the vertical ground shaking. Overall, 3D isolation with a relatively short isolation period (0.5 s) is adequate to significantly mitigate the vertical acceleration in a flexible frame building, including the amplification at mid-slab relative to adjacent columns, without compromising the usual reductions in horizontal responses.
Seismic loss analysis of buildings with post-tensioned cross-laminated timber walls
Authors: Wilson Alex W , Phillips Adam R , Motter Christopher J , Lee Ji Y , Dolan J Daniel
Published: August 2020

The FEMA P-58 performance-based earthquake engineering methodology was used to assess the economic losses associated with earthquake damage to nonstructural components of two prototype buildings with post-tensioned cross-laminated timber rocking walls. A suite of 22 far-field ground motions were used for nonlinear time history (NLTH) analysis. Truncated incremental dynamic analysis was used to scale the ground motions, and results of the NLTH analyses were used to develop cumulative distribution functions for inter-story drift and peak floor accelerations. The economic factors assessed in the risk analysis included the expected repair cost with respect to spectral acceleration, the probability of exceeding an expected repair cost for selected time periods, and the expected annual loss over different time periods considering various discount factors. It was determined that the ratio of nonstructural repair cost to total building cost at the design earthquake and maximum considered earthquake was lower for the low-rise building than the mid-rise building. However, the probability of nonstructural damage at the service-level earthquake was lower for the mid-rise building than the low-rise building.
Kindlin-3 recruitment to the plasma membrane precedes high-affinity β2-integrin and neutrophil arrest from rolling
Authors: Wen Lai , Marki Alex , Roy Payel , McArdle Sara , Sun Hao , Fan Zhichao , Gingras Alexandre R. , Ginsberg Mark H. , Ley Klaus
Published: August 2020

Integrin-mediated neutrophil adhesion starts by arrest from rolling. Activation of integrins involves conformational changes from an inactive, bent conformation to an extended conformation (E+) with high affinity for ligand binding (H+). The cytoplasmic protein kindlin-3 is necessary for leukocyte adhesion; mutations of kindlin-3 cause leukocyte adhesion deficiency type 3. Kindlin-3 binds the β2-integrin cytoplasmic tail at a site distinct from talin-1, but the molecular mechanism by which kindlin-3 activates β2-integrins is unknown. In this study, we measured the spatiotemporal dynamics of kindlin-3 and β2-integrin conformation changes during neutrophil and HL-60 cell rolling and arrest under flow. Using high-resolution quantitative dynamic footprinting microscopy and kindlin-3–fluorescent protein (FP) fusion proteins, we found that kindlin-3 was recruited to the plasma membrane in response to interleukin-8 (IL-8) before induction of the H+ β2-integrin conformation. Intravital imaging revealed that EGFP-kindlin-3–reconstituted, kindlin-3–knockout neutrophils arrest in vivo in response to CXCL1. EGFP-kindlin-3 in primary mouse neutrophils was also recruited to the plasma membrane before arrest. Upon arrest, we found small clusters of high-affinity β2-integrin molecules within large areas of membrane-proximal kindlin-3 FP. Deletion of kindlin-3 or its pleckstrin homology (PH) domain in neutrophil-like HL-60 cells completely abolished H+ β2-integrin induction. IL-8 also triggered recruitment of the isolated kindlin-3 PH domain to the plasma membrane before arrest. In summary, we showed that the kindlin-3 PH domain is necessary for recruitment to the plasma membrane, where full-length kindlin-3 is indispensable for the induction of high-affinity β2-integrin.
Hemolysis in the spleen drives erythrocyte turnover
Authors: Klei Thomas robert leon , Dalimot Jill Jasmine , Nota Benjamin , Veldthuis Martijn , Mul Erik , Rademakers Timo , Hoogenboezem Mark , Nagelkerke Sietse Quirijn , van IJcken Wilfred F.J. , Oole Edwin , Svendsen Pia , Moestrup Soren k , van Alphen Floris , Meijer Alexander B , Kuijpers Taco W. , Zwieten Rob van , van Bruggen Robin
Published: August 2020

Red pulp macrophages of the spleen mediate turnover of billions of senescent erythrocytes per day. However, the molecular mechanisms involved in sequestration of senescent erythrocytes, their recognition and their subsequent degradation by red pulp macrophages remain unclear. In this study we provide evidence that the splenic environment is of substantial importance in facilitating erythrocyte turnover through induction of hemolysis. Upon isolating human spleen red pulp macrophages we noted a substantial lack of macrophages that were in the process of phagocytosing intact erythrocytes. Detailed characterization of erythrocyte and macrophage subpopulations from human spleen tissue led to the identification of erythrocytes that are devoid of hemoglobin, so-called erythrocyte ghosts. By in vivo imaging and transfusion experiments we further confirmed that senescent erythrocytes that are retained in the spleen are subject to hemolysis. Additionally, we show that erythrocyte adhesion molecules, which are specifically activated on aged erythrocytes, cause senescent erythrocytes to interact with extracellular matrix proteins that are exposed within the splenic architecture. Such adhesion molecule-driven retention of senescent erythrocytes, under low shear conditions, was found to result in steady shrinkage of the cell and ultimately resulted in hemolysis. In contrast to intact senescent erythrocytes, the remnant erythrocyte ghost shells were prone to recognition and breakdown by red pulp macrophages. These data identify hemolysis as a key event in the turnover of senescent erythrocytes, which alters our current understanding of how erythrocyte degradation is regulated.
Prospective phase 2 trial of ixazomib after nonmyeloablative haploidentical peripheral blood stem cell transplant
Authors: Solomon Scott R. , Solh Melhem , Zhang Xu , Brown Stacey , Jackson Katelin C. , Holland H. Kent , Morris Lawrence E. , Bashey Asad
Published: August 2020

Proteasome inhibition results in extensive immunomodulatory effects that augment natural killer cell cytotoxicity and inhibit aspects of T-cell, B-cell, and dendritic cell function. We performed a phase 2 study that examined the effects of ixazomib for graft-versus-host disease (GVHD) prophylaxis (up to 12 cycles) with posttransplant cyclophosphamide and tacrolimus after standard nonmyeloablative haploidentical donor transplantation (HIDT). Ixazomib was started on day +5 (4 mg on days 1, 8, and 15 of a 28-day cycle), with dose reductions allowed in future cycles for toxicity. All patients received peripheral blood stem cells. Twenty-five patients were enrolled with a median age of 62 years (range, 35-77 years) who had acute leukemia (4), myelodysplastic syndrome (7), non-Hodgkin lymphoma/Hodgkin lymphoma/chronic lymphocytic leukemia (8), and myeloma (6). The hematopoietic cell transplant comorbidity index was ≥3 in 68% of the patients. After a median follow-up of 33.5 months, the cumulative incidence of relapse/progression at 1 year was 24% and 44% at 3 years, which failed to meet the statistically predefined goal of decreasing 1-year risk of relapse. Engraftment occurred in all patients with no secondary graft failure, and 3-year nonrelapse mortality (NRM) was 12%. Cumulative incidence of grade 3 to 4 acute GVHD was 8%, whereas moderate-to-severe chronic GVHD occurred in 19%. Nineteen patients survive with an estimated 1-year overall survival (OS) of 84% and 3-year OS of 74%. Hematologic and cutaneous toxicities were common but manageable. The substitution of ixazomib for mycophenolate mofetil (MMF) post-HIDT results in reliable engraftment, comparable rates of clinically significant GVHD, relapse and NRM, and favorable OS. This trial was registered at www.clinicaltrials.gov as # NCT02169791.
Seascape genomics reveals population isolation in the reef-building honeycomb worm, Sabellaria alveolata (L.)
Authors: Muir Anna P. , Dubois Stanislas F. , Ross Rebecca E. , Firth Louise B. , Knights Antony M. , Lima Fernando P. , Seabra Rui , Corre Erwan , Le Corguillé Gildas , Nunes Flavia L. D.
Published: August 2020

Background

Under the threat of climate change populations can disperse, acclimatise or evolve in order to avoid fitness loss. In light of this, it is important to understand neutral gene flow patterns as a measure of dispersal potential, but also adaptive genetic variation as a measure of evolutionary potential. In order to assess genetic variation and how this relates to environment in the honeycomb worm (Sabellaria alveolata(L.)), a reef-building polychaete that supports high biodiversity, we carried out RAD sequencing using individuals from along its complete latitudinal range. Patterns of neutral population genetic structure were compared to larval dispersal as predicted by ocean circulation modelling, and outlier analyses and genotype-environment association tests were used to attempt to identify loci under selection in relation to local temperature data.

Results

We genotyped 482 filtered SNPs, from 68 individuals across nine sites, 27 of which were identified as outliers using BAYESCAN and ARLEQUIN. All outlier loci were potentially under balancing selection, despite previous evidence of local adaptation in the system. Limited gene flow was observed among reef-sites (FST = 0.28 ± 0.10), in line with the low dispersal potential identified by the larval dispersal models. The North Atlantic reef emerged as a distinct population and this was linked to high local larval retention and the effect of the North Atlantic Current on dispersal.

Conclusions

As an isolated population, with limited potential for natural genetic or demographic augmentation from other reefs, the North Atlantic site warrants conservation attention in order to preserve not only this species, but above all the crucial functional ecological roles that are associated with their bioconstructions. Our study highlights the utility of using seascape genomics to identify populations of conservation concern.
Subcutaneous immunoglobulin in primary immunodeficiency – impact of training and infusion characteristics on patient-reported outcomes
Authors: Mallick R. , Henderson T. , Lahue B. J. , Kafal A. , Bassett P. , Scalchunes C.
Published: August 2020

Background

Subcutaneous immunoglobulin (SCIG) is increasingly utilized in primary immunodeficiency (PI). Understanding factors associated with treatment experience and satisfaction can optimize patient outcomes. We analyzed Immune Deficiency Foundation (IDF) survey data to evaluate patient-reported outcomes (PROs) in relation to SCIG training and infusion characteristics. Respondents’ PRO scores were rank ordered into ‘best’, ‘intermediate’, and ‘worst’ tertiles. Predicted probabilities of being in the best tertile with any combination of characteristics were generated for each PRO.

Results

In 366 SCIG respondents, higher odds of being in the best PRO tertile were driven by favorable training characteristics (particularly, higher confidence post-training and no training barriers) and efficient infusions (infusion preparation ≤20 min and actual infusion < 2 h). Age (≤17 years old) and treatment experience (> 2 years) increased the odds of being in the best tertiles. Compared with the least favorable training/infusion characteristics, those with the most favorable training/infusion characteristics had higher predicted probabilities of being in the best tertiles: TSQM side effects, 59% vs 4%; convenience, 52% vs 4%; effectiveness, 27% vs 13%; global, 26% vs 3%; PROMIS Fatigue, 44% vs 18%.

Conclusions

Increased experience with SCIG consistently improved PROs, but our findings predicted that enhanced training and infusion characteristics improve patient treatment satisfaction beyond that achieved by experience alone.
Metagenomics revealing molecular profiling of community structure and metabolic pathways in natural hot springs of the Sikkim Himalaya
Authors: Sharma Nitish , Kumar Jitesh , Abedin Md. Minhajul , Sahoo Dinabandhu , Pandey Ashok , Rai Amit K. , Singh Sudhir P.
Published: August 2020

Background

Himalaya is an ecologically pristine environment. The geo-tectonic activities have shaped various environmental niches with diverse microbial populations throughout the Himalayan biosphere region. Albeit, limited information is available in terms of molecular insights into the microbiome, including the uncultured microbes, of the Himalayan habitat. Hence, a vast majority of genomic resources are still under-explored from this region. Metagenome analysis has simplified the extensive in-depth exploration of diverse habitats. In the present study, the culture-independent whole metagenome sequencing methodology was employed for microbial diversity exploration and identification of genes involved in various metabolic pathways in two geothermal springs located at different altitudes in the Sikkim Himalaya.

Results

The two hot springs, Polok and Reshi, have distinct abiotic conditions. The average temperature of Polok and Reshi was recorded to be 62 °C and 43 °C, respectively. Both the aquatic habitats have alkaline geochemistry with pH in the range of 7–8. Community profile analysis revealed genomic evidence of plentiful bacteria, with a minute fraction of the archaeal population in hot water reservoirs of Polok and Reshi hot spring. Mesophilic microbes belonging to Proteobacteria and Firmicutes phyla were predominant at both the sites. Polok exhibited an extravagant representation of Chloroflexi, Deinococcus-Thermus, Aquificae, and Thermotogae. Metabolic potential analysis depicted orthologous genes associated with sulfur, nitrogen, and methane metabolism, contributed by the microflora in the hydrothermal system. The genomic information of many novel carbohydrate-transforming enzymes was deciphered in the metagenomic description. Further, the genomic capacity of antimicrobial biomolecules and antibiotic resistance were discerned.

Conclusion

The study provided comprehensive molecular information about the microbial treasury as well as the metabolic features of the two geothermal sites. The thermal aquatic niches were found a potential bioresource of biocatalyst systems for biomass-processing. Overall, this study provides the whole metagenome based insights into the taxonomic and functional profiles of Polok and Reshi hot springs of the Sikkim Himalaya. The study generated a wealth of genomic data that can be explored for the discovery and characterization of novel genes encoding proteins of industrial importance.
Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study
Authors: García Guzzo María E. , Fernandez María S. , Sanchez Novas Delfina , Salgado Sandra S. , Terrasa Sergio A. , Domenech Gonzalo , Teijido Carlos A.
Published: August 2020

Background

Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine the existence of associations between these events and potentially related variables.

Methods

This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age > 18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support.

Results

The most frequently encountered adverse event was oxygen desaturation < 95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation < 90% followed, with incidences of 19.2, 12.64, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P = 0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P = 0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, 95% confidence interval: 2.83 to 36.99) more likely to experience oxygen desaturation < 90% events.

Conclusions

Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with acceptable rates of adverse events and could be more widely adopted in clinical practice.
Knowledge of cardiovascular risk factors among caretakers of outpatients attending a tertiary cardiovascular center in Tanzania: a cross-sectional survey
Authors: Pallangyo Pedro , Misidai Nsajigwa , Komba Makrina , Mkojera Zabella , Swai Happiness J. , Hemed Naairah R. , Mayala Henry , Bhalia Smita , Millinga Jalack , Mollel Upendo W. , Kusima Happiness L. , Chavala Ester , Joram Ziada , Abdallah Halifa , Hamisi Rajabu , Janabi Mohamed
Published: August 2020

Background

Health literacy on cardiovascular diseases (CVDs) plays an effective role in preventing or delaying the disease onset as well as in impacting the efficacy of their management. In view of the projected low health literacy in Tanzania, we conducted this cross-sectional survey to assess for CVD risk knowledge and its associated factors among patient escorts.

Methods

A total of 1063 caretakers were consecutively enrolled in this cross-sectional study. An adopted questionnaire consisting of 22 statements assessing various CVD risk behaviors was utilized for assessment of knowledge. Logistic regression analyses were performed to assess for factors associated with poor knowledge of CVD risks.

Results

The mean age was 40.5 years and women predominated (55.7%). Over two-thirds had a body mass index (BMI) ≥25 kg/m2, 18.5% were alcohol drinkers, 3.2% were current smokers, and 47% were physically inactive. The mean score was 78.2 and 80.0% had good knowledge of CVD risks. About 16.3% believed CVDs are diseases of affluence, 17.4% thought CVDs are not preventable, and 56.7% had a perception that CVDs are curable. Low education (OR 2.6, 95%CI 1.9–3.7, p < 0.001), lack of health insurance (OR 1.5, 95%CI 1.1–2.3, p = 0.03), and negative family history of CVD death (OR 2.2, 95%CI 1.4–3.5, p < 0.001), were independently associated with poor CVD knowledge.

Conclusions

In conclusion, despite of a good level of CVD knowledge established in this study, a disparity between individual’s knowledge and self-care practices is apparent.
Predictors for the development of preoperative oxygenation impairment in acute aortic dissection in hypertensive patients
Authors: Zhao Xuemin , Bie Mengjun
Published: August 2020

Background

Acute aortic dissection (AAD) is an acute life-threatening cardiovascular disease, which is frequently complicated with oxygenation impairment (OI). We aim to investigate predictors of the development of OI in the patients with AAD.

Methods

We retrospectively collected clinical data of AAD in hypertensive patients from July 2012 to March 2020. The patients included in this study were divided into OI (+) group (oxygenation index≤200) and OI (−) group (oxygenation index> 200). Both groups were compared according to demographic and clinical characteristics, and laboratory findings. Characteristics of hypertension in the patients with AAD were described. Predictors for the development of OI were assessed. And cutoff values were determined by receiver operating characteristics (ROC) curve.

Results

A total of 208 patients were included in this study and the incidence of OI was 32.2%. In OI (+) group, patients had significantly higher peak body temperature (37.85 ± 0.60 vs 37.64 ± 0.44 °C, P = .005), higher levels of CRP (42.70 ± 28.27 vs 13.90 ± 18.70 mg/L, P = .000) and procalcitonin (1.07 ± 3.92 vs 0.31 ± 0.77μg/L, P = .027), and lower levels of albumin (34.21 ± 5.65 vs 37.73 ± 4.70 g/L, P = .000). Spearman’s rank correlation test showed that the minimum oxygenation index was positively correlated with albumin, and was negatively correlated with the peak body temperature, serum CRP, procalcitonin, BNP and troponin. The stepwise multiple linear regression analysis showed that the peak body temperature, serum CRP and albumin were independently associated with development of OI. An optimal cutoff value for CRP for predicting OI was ≥9.20 mg/L, with a sensitivity of 91.0% and a specificity of 61.0%.

Conclusions

The peak body temperature, serum CRP and albumin were independent predictors of OI development in the patients with AAD. The serum CRP on admission≥9.20 mg/L might be a valuable and reliable indicator in predicting the development of OI.
Identification of key genes in atrial fibrillation using bioinformatics analysis
Authors: Liu Yueheng , Tang Rui , Zhao Ye , Jiang Xuan , Wang Yuchao , Gu Tianxiang
Published: August 2020

Background

Atrial fibrillation (AF) is one of the most common arrhythmia, which brings huge burden to the individual and the society. However, the mechanism of AF is not clear. This paper aims at screening the key differentially expressed genes (DEGs) of atrial fibrillation and to construct enrichment analysis and protein-protein interaction (PPI) network analysis for these DEGs.

Methods

The datasets were collected from the Gene Expression Omnibus database to extract data of left atrial appendage (LAA) RNA of patients with or without AF in GSE79768, GSE31821, GSE115574, GSE14975 and GSE41177. Batch normalization, screening of the differential genes and gene ontology analysis were finished by R software. Reactome analysis was used for pathway analysis. STRING platform was utilized for PPI network analysis. At last, we performed reverse transcription-quantitative polymerase chain reaction (RT-qPCR) to validate the expression of key genes in 20 sinus rhythm (SR) LAA tissues and 20 AF LAA tissues.

Results

A total of 106 DEGs were screened in the merged dataset. Among these DEGs, 74 genes were up-regulated and 32 genes down-regulated. DEGs were mostly enriched in extracellular matrix organization, protein activation cascade and extracellular structure organization. In PPI network, we identified SPP1, COL5A1 and VCAN as key genes which were associated with extracellular matrix. RT-qPCR showed the same expression trend of the three key genes as in our bioinformatics analysis. The expression levels of SPP1, COL5A1 and VCAN were increased in AF tissues compared to SR tissues (P < 0.05).

Conclusion

According to the analyses which were conducted by bioinformatics tools, genes related to extracellular matrix were involved in pathology of AF and may become the possible targets for the diagnosis and treatment of AF.
Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden
Authors: Höglund Erik , Andersson-Hagiwara Magnus , Schröder Agneta , Möller Margareta , Ohlsson-Nevo Emma
Published: August 2020

Background

There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data.

Methods

A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test.

Results

Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women.

Conclusions

Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.
Functional parameters indicative of mild cognitive impairment: a systematic review using instrumented kinematic assessment
Authors: Fuentes-Abolafio Iván José , Stubbs Brendon , Pérez-Belmonte Luis Miguel , Bernal-López María Rosa , Gómez-Huelgas Ricardo , Cuesta-Vargas Antonio
Published: August 2020

Background

Patients with mild cognitive impairment (MCI) experience alterations of functional parameters, such as an impaired balance or gait. The current systematic review set out to investigate whether functional objective performance may predict a future risk of MCI; to compare functional objective parameters in patients with MCI and a control group; and to assess changes in these parameters after different physical activity interventions.

Methods

Electronic databases, including PubMed, AMED, CINAHL, EMBASE, PEDro and Web of Science as well as grey literature databases, were searched from inception to February 2020. Cohort studies and Randomized Controlled Trials (RCTs) were included. The risk of bias of the included studies was assessed independently by reviewers using quality assessment checklists. The level of evidence per outcome was assessed using the GRADE criteria.

Results

Seventeen studies met inclusion criteria including patients with MCI. Results from RCTs suggested that gait speed, gait variability and balance may be improved by different physical activity interventions. Cohort studies showed that slower gait speed, above all, under Dual Task (DT) conditions, was the main impaired parameter in patients with MCI in comparison with a Control Gorup. Furthermore, cohort studies suggested that gait variability could predict an incident MCI. Although most of included cohort studies reported low risk of bias, RCTs showed an unclear risk of bias.

Conclusions

Studies suggest that gait variability may predict an incident MCI. Moreover, different gait parameters, above all under DT conditions, could be impaired in patients with MCI. These parameters could be improved by some physical activity interventions. Although cohort studies reported low risk of bias, RCTs showed an unclear risk of bias and GRADE criteria showed a low level of evidence per outcome, so further studies are required to refute our findings.

Prospero

CRD42019119180.
Gaps in the care cascade for screening and treatment of refugees with tuberculosis infection in Middle Tennessee: a retrospective cohort study
Authors: Manful Adoma , Waller Leslie , Katz Ben , Cummins Jason , Warkentin Jon , Reagon Billy , Shaw-Kaikai Joanna , Zhu Yuwei , van der Heijden Yuri F.
Published: August 2020

Background

Treatment of tuberculosis infection (TBI) in individuals at high risk for tuberculosis (TB) disease is a priority for TB elimination in the US. Newly arrived refugees in Middle Tennessee are screened for TBI, but factors associated with gaps in the TBI care cascade are not well characterized.

Methods

We assessed the TBI care cascade from US entry to completion of treatment for refugees who resettled in Middle Tennessee from 2012 through 2016. We assessed factors associated with treatment initiation and completion using logistic regression models.

Results

Of 6776 refugees who completed initial health screening, 1681 (25%) screened positive for TBI, 1208 were eligible for treatment, 690 started treatment, and 432 completed treatment. Male sex (Odds Ratio [OR]: 1.42; 95% Confidence Interval [CI]: 1.06, 1.89) and screening with interferon gamma release assay compared to tuberculin skin test (OR: 2.89; 95% CI: 1.59, 5.27) were associated with increased treatment initiation; living farther away from TB clinic was associated with decreased treatment initiation (OR: 0.91; 95% CI: 0.83, 0.99). Existing diabetes (OR: 7.27; 95% CI: 1.93, 27.30), receipt of influenza vaccination (OR: 1.65; 95% CI: 1.14, 2.40) and region of origin from South-Eastern or Southern Asia (ORSEAsia: 2.30; 95% CI: 1.43, 3.70; ORSAsia: 1.64; 95% CI: 1.02, 2.64) were associated with increased treatment completion. Six refugees developed TB disease after declining (n = 4) or partially completing (n = 2) TBI treatment; none who completed treatment developed TB disease.

Conclusions

We determined gaps in the TBI care cascade among refugees in Middle Tennessee. Further assessment of barriers to treatment initiation and completion and interventions to assist refugees are warranted to improve these gaps and prevent TB disease.
Androgen Receptor mRNA levels determine the prognosis in triple-negative breast cancer patients
Authors: Govindan Sindhu , Siraganahalli Eswaraiah Mallikarjuna , Basavaraj Chetana , Adinarayan Manjula , Sankaran Satish , Bakre Manjiri
Published: August 2020

Background

Anti-Androgen Receptor (AR) therapy holds promise for a subset of AR expressing triple-negative breast cancer (TNBC) patients. However, current AR assays are suboptimal in detecting the dynamic range of AR expression, contributing to its controversial role in TNBC disease prognosis. This study is aimed at evaluating the feasibility of qRT-PCR to sensitively and robustly detect AR mRNA levels for prognostication.

Methods

mRNA expression profiling was performed on FFPE blocks from a retrospective cohort of 101 TNBC patients using qRT-PCR and compared with AR protein expression by immunohistochemistry . Statistical analyses included Spearman’s rank correlation, Chi-square and Kaplan-Meier analyses. Distant Metastasis Free Survival was used as the end point in survival analysis.

Results

AR mRNA expression was observed in 34/101 patients (34%) whereas 12/80 cases (15%) were positive by IHC. qRT-PCR could thus detect more AR positive patients as compared to IHC, with 75% (9/12) concordance between the two methods. Co-expression of GATA3 and FOXA1 mRNA was observed in 85 and 88% of AR mRNA positive tumors, respectively. AR mRNA positivity was significantly correlated with age at disease onset (p = 0.02), high FOXA1/GATA3 (p < 0.05) and distant recurrence. AR mRNA positive patients had poorer DMFS (43%; p = 0.002). DMFS dropped further to 26% (p = 0.006) in AR (+)/high FOXA1/GATA3 patients. AR mRNA expression together with node positivity had the worst DMFS (23%; p < 0.0001) compared to patients who were either positive for any one of these, or negative for both AR and node status. Low Ki67 mRNA with AR mRNA positivity also had poorer DMFS (39%; p = 0.001) compared to patients expressing low Ki67 with no AR mRNA expression.

Conclusion

qRT-PCR was more sensitive and reliable in detecting the dynamic expression levels of AR compared to IHC and this variation could be explained by the higher sensitivity of the former method. High AR mRNA expression was strongly associated with expression of AR protein, high FOXA1/GATA3 mRNA, and with poor prognosis. qRT-PCR was more efficient in detecting the AR positive cases compared to IHC. A distinct signature involving high GATA3/FOXA1, low Ki67, and node positivity in AR mRNA positive tumors correlated with poor prognosis. Thus, AR mRNA screening can serve as an effective prognostic marker along with offering potential targeted therapy options for TNBC.