bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-coding RNAs: update on mechanisms and therapeutic targets from the ESC Working Groups of Myocardial Function and Cellular Biology of the Heart
Authors: Bär Christian , Chatterjee Shambhabi , Falcão Pires Inês , Rodrigues Patrícia , Sluijter Joost P G , Boon Reinier A , Nevado Rosa M , Andrés Vicente , Sansonetti Marida , de Windt Leon , Ciccarelli Michele , Hamdani Nazha , Heymans Stephane , Figuinha Videira Raquel , Tocchetti Carlo G , Giacca Mauro , Zacchigna Serena , Engelhardt Stefan , Dimmeler Stefanie , Madonna Rosalinda , Thum Thomas
Published: July 2020

Vast parts of mammalian genomes are actively transcribed, predominantly giving rise to non-coding RNA (ncRNA) transcripts including microRNAs, long ncRNAs, and circular RNAs among others. Contrary to previous opinions that most of these RNAs are non-functional molecules, they are now recognized as critical regulators of many physiological and pathological processes including those of the cardiovascular system. The discovery of functional ncRNAs has opened up new research avenues aiming at understanding ncRNA-related disease mechanisms as well as exploiting them as novel therapeutics in cardiovascular therapy. In this review, we give an update on the current progress in ncRNA research, particularly focusing on cardiovascular physiological and disease processes, which are under current investigation at the ESC Working Groups of Myocardial Function and Cellular Biology of the Heart. This includes a range of topics such as extracellular vesicle-mediated communication, neurohormonal regulation, inflammation, cardiac remodelling, cardio-oncology as well as cardiac development and regeneration, collectively highlighting the wide-spread involvement and importance of ncRNAs in the cardiovascular system.
International Organization for the Study of Inflammatory Bowel Disease: Global Strategies for Telemedicine and Inflammatory Bowel Diseases
Authors: Lewin Sara , Lees Charles , Regueiro Miguel , Hart Ailsa , Mahadevan Uma
Published: July 2020

Before the onset of the COVID-19 pandemic, the majority of care for inflammatory bowel disease patients was provided in-person. The practice of gastroenterology care has since rapidly transformed, with telemedicine emerging as an essential tool to provide medical care to patients while maintaining social distancing and conserving personal protective equipment. This article provides insight into past and current practices among inflammatory bowel disease specialists and shares regulatory, financial and practical considerations for incorporating telemedicine into clinical practice. Continued government and other payer support for telemedicine and ongoing innovation to provide remote objective patient data will help to sustain the use of telemedicine long after the current pandemic subsides.
Platelet-rich plasma fibrin glue for treatment of chylothorax following cavopulmonary connections
Authors: Tashnizi Mohhamad Abbasi , Maleki Mahmood Hossinzadeh , Javedanfar Omid , Damsaz Mohammadamin , Alamdari Aida Hamidi , Seifalian Alexander M , Asadi Mehdi , Hamidi Alamdari Daryoush
Published: July 2020

OBJECTIVES

The postoperative persistence of chylothorax is a fatal complication of paediatric cardiac surgery. There is an urgent need for an effective treatment of chylothorax. This study reports the application of allogenic platelet-rich plasma fibrin glue (PRP-FG) as a conservative therapy before reoperation.

METHODS

Over a 9-year period, from 2010 to 2019, 27 patients with persistent chylothorax following a cavopulmonary connection, with a mean latency period of 11 days (range 10–15 days), were treated with PRP-FG. These patients were selected because they had not responded positively to initial conservative management plans. The patients were followed up for 9 years.

RESULTS

Twenty-five patients (92%) responded positively to treatment with PRP-FG; 2 patients did not respond to the treatment and died after reoperation. All of the successfully treated patients in follow-up continued to live a healthy life without further complications.

CONCLUSIONS

Recalcitrant chylothorax that persists after paediatric cardiac surgery responded positively to treatment with PRP-FG. This technique precluded the need for another operation and significantly decreased the morbidity and mortality rates.
Loop neochord versus leaflet resection techniques for minimally invasive mitral valve repair: long-term results
Authors: Pfannmueller Bettina , Misfeld Martin , Verevkin Alexander , Garbade Jens , Holzhey David M , Davierwala Piroze , Seeburger Joerg , Noack Thilo , Borger Michael A
Published: July 2020

OBJECTIVES

Non-leaflet resection techniques including loop chordal replacement are being used with increasing frequency, but the long-term results of these techniques are still unknown. The aim of this study was to compare the long-term results of loop neochord replacement with leaflet resection techniques in patients undergoing minimally invasive mitral valve (MV) repair for MV prolapse.

METHODS

Between 1999 and 2014, 2134 consecutive MV prolapse patients underwent minimally invasive MV repair with isolated loop (n = 1751; 82.1%) or resection techniques (n = 383, 17.9%) at our institution. Follow-up data were available for 86% of patients with a mean follow-up time of 6.1 ± 4.3 years.

RESULTS

The 30-day mortality was 0.8% for all patients (loop: 0.7%, resection: 1.6%; P = 0.09). Leaflet resection was associated with more moderate or more mitral regurgitation on predischarge echocardiography (P = 0.003). The 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively (P = 0.003). Significant predictors for late mortality were MV repair technique (P = 0.004), left ventricular ejection fraction (P < 0.001), age (P < 0.001) and myocardial infarction (P < 0.001). Freedom from MV reoperation at 1, 5 and 10 years was 98 ± 1%, 97 ± 1%, 97 ± 1% and 97 ± 1%, 97 ± 1%, 96 ± 1% for patients operated on with the loop technique and leaflet resection (P = 0.4).

CONCLUSIONS

In our patient cohort, MV repair with loop chordal replacement is associated with less early recurrent mitral regurgitation and very good long-term results when compared to classical leaflet resection techniques for MV prolapse and is therefore an excellent option for such patients.
Textbook outcome as a composite outcome measure in non-small-cell lung cancer surgery
Authors: ten Berge Martijn G , Beck Naomi , Steup Willem Hans , Verhagen Ad F.T.M , van Brakel Thomas J , Schreurs Wilhelmina H , Wouters Michel W.J.M ,   the Dutch Lung Cancer Audit for Surgery Group
Published: July 2020

OBJECTIVES

Quality assessment is an important element in providing surgical cancer care. The main objective of this study was to develop a new composite measure ‘textbook outcome’, to evaluate and improve quality of surgical care for patients undergoing a resection for non-small-cell lung cancer (NSCLC).

METHODS

All patients undergoing an anatomical resection for NSCLC from 2012 to 2016 registered in the nationwide Dutch Lung Cancer Audit were included in an analysis to assess usefulness of a composite measure as a quality indicator. Based on expert opinion, textbook outcome was defined as having a complete resection (negative resection margins and sufficient lymph node dissection), plus no 30-day or in-hospital mortality, no reintervention in 30 days, no readmission to the intensive care unit, no prolonged hospital stay (<14 days), no hospital readmission after discharge and no major complications. The percentage of patients with a textbook outcome was calculated per hospital. Between-hospital variation in textbook outcome was analysed using case-mix adjustment models.

RESULTS

In total, 5513 patients were included in this study. Textbook outcome was achieved in 26.4% of patients. Insufficient lymph node dissection had the most substantial effect on not realizing textbook outcome. If ‘sufficient lymph node dissection’ was not included as a criterion, textbook outcome would be 60.7%. Case-mix adjusted textbook outcome proportions per hospitals varied between 13.2% and 37.7%.

CONCLUSIONS

In contrast to focusing on a single aspect, the composite measure textbook outcome provides insight into comprehensive performance in NSCLC surgery. It can be used to evaluate both individual hospitals and national performance and provides the opportunity to give benchmarked feedback to thoracic surgeons.
The primary care workforce in Europe: a cross-sectional international comparison of rural and urban areas and changes between 1993 and 2011
Authors: Groenewegen Peter P , Bosmans Mark W G , Boerma Wienke G W , Spreeuwenberg Peter
Published: July 2020

Rural areas have problems in attracting and retaining primary care workforce. This might have consequences for the existing workforce. We studied whether general practitioners (GPs) in rural practices differ by age, sex, practice population and workload from those in less rural locations and whether their practices differ in resources and service profiles. We used data from 2 studies: QUALICOPC study collected data from 34 countries, including 7183 GPs in 2011, and Profiles of General Practice in Europe study collected data from 32 countries among 7895 GPs in 1993. Data were analyzed using multilevel analysis. Results show that the share of female GPs has increased in rural areas but is still lower than in urban areas. In rural areas, GPs work more hours and provide more medical procedures to their patients. Apart from these differences between locations, overall ageing of the GP population is evident. Higher workload in rural areas may be related to increased demand for care. Rural practices seem to cope by offering a broad range of services, such as medical procedures. Dedicated human resource policies for rural areas are required with a view to an ageing GP population, to the individual preferences and needs of the GPs, and to decreasing attractiveness of rural areas.
In vivo evaluation of the interaction between the Escherichia coli IGP synthase subunits using the Bacterial Two-Hybrid system
Authors: Chioccioli Sofia , Bogani Patrizia , Del Duca Sara , Castronovo Lara Mitia , Vassallo Alberto , Puglia Anna Maria , Fani Renato
Published: July 2020

Histidine biosynthesis is one of the most characterized metabolic routes for its antiquity and its central role in cellular metabolism; indeed, it represents a cross-road between nitrogen metabolism and de novo synthesis of purines. This interconnection is due to the activity of imidazole glycerol phosphate synthase, a heterodimeric enzyme constituted by the products of two his genes, hisH and hisF, encoding a glutamine amidotransferase and a cyclase, respectively. Despite their interaction was suggested by several in vitro experiments, their in vivo complex formation has not been demonstrated. On the contrary, the analysis of the entire Escherichia coli interactome performed using the yeast two hybrid system did not suggest the in vivo interaction of the two IGP synthase subunits. The aim of this study was to demonstrate the interaction of the two proteins using the Bacterial Adenylate Cyclase Two-Hybrid (BACTH) system. Data obtained demonstrated the in vivo interaction occurring between the proteins encoded by the E. coli hisH and hisF genes; this finding might also open the way to pharmaceutical applications through the design of selective drugs toward this enzyme.
Peroxisome proliferator-activated receptor gamma expression along the male genital system and its role in male fertility
Authors: Santoro Marta , De Amicis Francesca , Aquila Saveria , Bonofiglio Daniela
Published: July 2020

Peroxisome proliferator-activated receptor gamma (PPARγ) acts as a ligand activated transcription factor and regulates processes, such as energy homeostasis, cell proliferation and differentiation. PPARγ binds to DNA as a heterodimer with retinoid X receptor and it is activated by polyunsaturated fatty acids and fatty acid derivatives, such as prostaglandins. In addition, the insulin-sensitizing thiazolidinediones, such as rosiglitazone, are potent and specific activators of PPARγ. PPARγ is present along the hypothalamic–pituitary–testis axis and in the testis, where low levels in Leydig cells and higher levels in Sertoli cells as well as in germ cells have been found. High amounts of PPARγ were reported in the normal epididymis and in the prostate, but the receptor was almost undetectable in the seminal vesicles. Interestingly, in the human and in pig, PPARγ protein is highly expressed in ejaculated spermatozoa, suggesting a possible role of PPARγ signaling in the regulation of sperm biology. This implies that both natural and synthetic PPARγ ligands may act directly on sperm improving its performance. Given the close link between energy balance and reproduction, activation of PPARγ may have promising metabolic implications in male reproductive functions. In this review, we first describe PPARγ expression in different compartments of the male reproductive axis. Subsequently, we discuss the role of PPARγ in both physiological and several pathological conditions related to the male fertility.
Möbius Disjointness for Skew Products
Authors: de Faveri Alexandre
Published: July 2020

We show that for $\varepsilon> 0$, every $C^{1+\varepsilon }$ skew product on $\mathbb{T}^2$ over a rotation of $\mathbb{T}^1$ satisfies Sarnak’s conjecture. This is an improvement of earlier results of Kułaga–Przymus–Lemańczyk, Huang–Wang–Ye, and Kanigowski–Lemańczyk–Radziwiłł.
Detection of Drugs in Postmortem Specimens of Blood, Vitreous Humor and Bone Marrow Aspirate
Authors: Iskierka M , Zawadzki M , Szpot P , Jurek T
Published: July 2020

In case of basic biological materials (blood, urine, vitreous humor) being unavailable, bone marrow can be used for toxicological tests. The aim of the study was to assess the concentration of various xenobiotics in the bone marrow, as well as in the blood and the vitreous humor. The analysis was performed in the biological material originating from the autopsy (n = 120), using the LC–MS method and with liquid/liquid extraction at pH = 9. As many as 46 different xenobiotics were detected in the biological material, strong correlations between the concentration of a given xenobiotic in blood and bone marrow, as well as in the vitreous humor and bone marrow, were noted for most of them, with the exception of diazepam and 7-aminoclonazepam. The obtained results indicate the possibility of using bone marrow to determine the concentration of numerous xenobiotics in the situation of basic biological materials being unavailable, as well as using the results obtained in the future to better understand the pharmacokinetic processes and the effect of postmortem redistribution on medication and drug concentrations in the body of a deceased person.
New lineages within the Malagasy freshwater crab fauna: Agora n. gen. for Thelphusa goudoti H. Milne Edwards, 1853, and a phytotelmic new species of Malagasya Cumberlidge & Sternberg, 2002 (Brachyura: Potamonautidae: Deckeniinae)
Authors: Cumberlidge Neil , Soma Julia B , Leever Ellen M , Daniels Savel R
Published: July 2020

New molecular and morphological analyses of the relationships of 77 specimens of potamonautid freshwater crabs collected from all parts of Madagascar support the monophyly of the island’s freshwater crab fauna and verify most of the existing taxa. The phylogenetic tree identified several new lineages that represent four new genera and 10 new species, and found Foza Reed & Cumberlidge, 2006 to be paraphyletic. The present work is the first of a series of articles reporting on these discoveries that provide an improved understanding of the relationships between the endemic potamonautid species found on this tropical island. We describe a new species of Malagasya Cumberlidge & Sternberg, 2002 from a phytotelmic habitat in northeast Madagascar, and establish Agoragen. nov. to accommodate Thelphusa goudoti H. Milne Edwards, 1853. Both of these new taxa are recognized based on combinations of morphological characters and molecular data. The new species of Malagasya is distinguished from the other two species of this genus, which are illustrated here for comparative purposes. Agora goudotin. comb. is endemic to Madagascar, and is compared with and distinguished from the eight other genera of freshwater crabs occurring in that country.
The Good, the Bad, and the Risky: Can Birds Be Incorporated as Biological Control Agents into Integrated Pest Management Programs?
Authors: Garcia Karina , Olimpi Elissa M , Karp Daniel S , Gonthier David J
Published: July 2020

Some bird species often benefit farmers by suppressing invertebrate crop pests, yet birds are rarely considered in integrated pest management (IPM) strategies. This is likely because some bird species pose risks to farmers through crop damage, intraguild predation, and food safety concerns. Nonetheless, the benefits of some bird species on crop production are often substantial. Therefore, understanding when birds are most likely to enhance crop production (and when they are most likely to depress it) is crucial for designing effective IPM strategies. Here, we briefly review the literature on birds in agricultural systems, discuss examples of how birds can provide services and disservices to crops, examine factors that influence the net effects of birds, and discuss emerging tools that will help fill key knowledge gaps surrounding the complex roles of birds in agricultural systems.
Beauveria bassiana Culturing and Harvesting for Bioassays With House Flies
Authors: Johnson Dana M , White Roxie L , Pereira Roberto M , Geden Christopher J
Published: July 2020

The entomopathogenic fungus Beauveria bassiana (Balsamo) Vuillemin (Hypocreales: Cordycipitaceae) has been widely studied against a wide range of arthropod pests, including many of medical and veterinary importance. New investigators must sort through a wide array of published methods for the production, harvest, storage, and bioassay methods for this pathogen. Simplified methods for production of conidia using Sabouraud dextrose agar with yeast (SDYA) plates and two conidial harvesting methods are described. Dry harvesting yields conidia that are ready to incorporate into dusts and food baits, but the fungal product includes mycelial debris that can hamper quantification and introduces variable amounts of unwanted bulk. Wet harvesting with filtration produces a cleaner product that is immediately ready for testing in liquid formulations. Examples of bioassays with house flies are presented that include conidia applied topically to the dorsal thorax for dose–mortality assays and conidial suspensions applied to filter paper disks for concentration mortality assays.
Judges ad hoc and the International Tribunal for the Law of the Sea: An Overview of its Practice
Authors: De Herdt Sandrine
Published: July 2020

The Statute of the International Tribunal for the Law of the Sea makes provision for the appointment of judges ad hoc. Out of the 29 cases submitted to the Tribunal to date, 22 judges ad hoc were appointed in 15 cases. This article provides an overview of the practice of the Tribunal with respect to the institution of judge ad hoc.
Centralized medical quarantine for imported COVID-19 in Shanghai, China
Authors: Li Xueyan , Liu Min , Zhou Runv , Zhang Yu , Wu Chunhua , Xu Li
Published: July 2020

A mandatory 14-day ‘centralized medical quarantine’ has been instituted in Shanghai, China, to prevent secondary transmission of imported COVID-19. Here, we summarize our experiences and describe the work flow and disinfection measures in our quarantine centre.
Acute Hemolytic Transfusion Reaction Due to Pooled Platelets: A Rare but Serious Adverse Event
Authors: Gammon Richard , Cook Susan , Trinkle Anthony , Thomas Korena , Benson Kaaron
Published: July 2020

A female patient aged 65 years with blood group A with relapsed lymphoma had thrombocytopenia; leukocyte-reduced group O prestorage pooled platelet concentrates (PPLTs) were transfused without adverse events. She was discharged home, but 1.5 hours later she returned with fever and dark urine. Hypotension and tachycardia developed; she was admitted to the intensive care unit. Post-transfusion blood and urine samples were obtained. Serial dilutions from 5 donor testing tubes and a simulated PLT pool were performed and read at immediate spin and IgG. Testing confirmed an acute hemolytic transfusion reaction (AHTR): elevated lactate dehydrogenase (996 U/L; normal range 135 U/L–225 U/L) and undetectable haptoglobin (<10 mg/dL; normal range 30 mg/dL–200 mg/dL) levels. Urinalysis showed dark amber urine but no significant quantity of red blood cells. At 37ºC the simulated pool and donor number 5 had high-titer anti-A. As a precaution, the donor was permanently deferred. Research has shown that PLT-associated AHTR has occurred with apheresis platelets but is very rare with whole blood–derived PLTs.
Near mean motion resonance of terrestrial planet pair induced by giant planet: application to Kepler-68 system
Authors: Pan Mengrui , Wang Su , Ji Jianghui
Published: July 2020

In this work, we investigate configuration formation of two inner terrestrial planets near mean motion resonance (MMR) induced by the perturbation of a distant gas giant for the Kepler-68 system, by conducting thousands of numerical simulations. The results show that the formation of terrestrial planets is relevant to the speed of type I migration, the mass of planets, and the existence of giant planet. The mass and eccentricity of the giant planet may play a crucial role in shaping the final configuration of the system. The inner planet pair can be trapped in 5:3 or 7:4 MMRs if the giant planet revolves the central star with an eccentric orbit, which is similar to the observed configuration of Kepler-68. Moreover, we find that the eccentricity of the middle planet can be excited to roughly 0.2 if the giant planet is more massive than 5 MJ; otherwise, the terrestrial planets are inclined to remain in near-circular orbits. Our study may provide a likely formation scenario for the planetary systems that harbour several terrestrial planets near MMRs inside and one gas giant exterior to them.
A Simulation Study to Examine the Information Content in Phylogenomic Data Sets under the Multispecies Coalescent Model
Authors: Huang Jun , Flouri Tomáš , Yang Ziheng
Published: July 2020

We use computer simulation to examine the information content in multilocus data sets for inference under the multispecies coalescent model. Inference problems considered include estimation of evolutionary parameters (such as species divergence times, population sizes, and cross-species introgression probabilities), species tree estimation, and species delimitation based on Bayesian comparison of delimitation models. We found that the number of loci is the most influential factor for almost all inference problems examined. Although the number of sequences per species does not appear to be important to species tree estimation, it is very influential to species delimitation. Increasing the number of sites and the per-site mutation rate both increase the mutation rate for the whole locus and these have the same effect on estimation of parameters, but the sequence length has a greater effect than the per-site mutation rate for species tree estimation. We discuss the computational costs when the data size increases and provide guidelines concerning the subsampling of genomic data to enable the application of full-likelihood methods of inference.
A tale of two cell-fates: role of the Hippo signaling pathway and transcription factors in early lineage formation in mouse preimplantation embryos
Authors: Karasek Challis , Ashry Mohamed , Driscoll Chad S , Knott Jason G
Published: July 2020

In mammals, the first cell-fate decision occurs during preimplantation embryo development when the inner cell mass (ICM) and trophectoderm (TE) lineages are established. The ICM develops into the embryo proper, while the TE lineage forms the placenta. The underlying molecular mechanisms that govern lineage formation involve cell-to-cell interactions, cell polarization, cell signaling and transcriptional regulation. In this review, we will discuss the current understanding regarding the cellular and molecular events that regulate lineage formation in mouse preimplantation embryos with an emphasis on cell polarity and the Hippo signaling pathway. Moreover, we will provide an overview on some of the molecular tools that are used to manipulate the Hippo pathway and study cell-fate decisions in early embryos. Lastly, we will provide exciting future perspectives on transcriptional regulatory mechanisms that modulate the activity of the Hippo pathway in preimplantation embryos to ensure robust lineage segregation.
Transcription of intragenic CpG islands influences spatiotemporal host gene pre-mRNA processing
Authors: Amante Samuele M , Montibus Bertille , Cowley Michael , Barkas Nikolaos , Setiadi Jessica , Saadeh Heba , Giemza Joanna , Contreras-Castillo Stephania , Fleischanderl Karin , Schulz Reiner , Oakey Rebecca J
Published: July 2020

Alternative splicing (AS) and alternative polyadenylation (APA) generate diverse transcripts in mammalian genomes during development and differentiation. Epigenetic marks such as trimethylation of histone H3 lysine 36 (H3K36me3) and DNA methylation play a role in generating transcriptome diversity. Intragenic CpG islands (iCGIs) and their corresponding host genes exhibit dynamic epigenetic and gene expression patterns during development and between different tissues. We hypothesise that iCGI-associated H3K36me3, DNA methylation and transcription can influence host gene AS and/or APA. We investigate H3K36me3 and find that this histone mark is not a major regulator of AS or APA in our model system. Genomewide, we identify over 4000 host genes that harbour an iCGI in the mammalian genome, including both previously annotated and novel iCGI/host gene pairs. The transcriptional activity of these iCGIs is tissue- and developmental stage-specific and, for the first time, we demonstrate that the premature termination of host gene transcripts upstream of iCGIs is closely correlated with the level of iCGI transcription in a DNA-methylation independent manner. These studies suggest that iCGI transcription, rather than H3K36me3 or DNA methylation, interfere with host gene transcription and pre-mRNA processing genomewide and contributes to the spatiotemporal diversification of both the transcriptome and proteome.
Cutting in-line with iron: ribosomal function and non-oxidative RNA cleavage
Authors: Guth-Metzler Rebecca , Bray Marcus S , Frenkel-Pinter Moran , Suttapitugsakul Suttipong , Montllor-Albalate Claudia , Bowman Jessica C , Wu Ronghu , Reddi Amit R , Okafor C Denise , Glass Jennifer B , Williams Loren Dean
Published: July 2020

Divalent metal cations are essential to the structure and function of the ribosome. Previous characterizations of the ribosome performed under standard laboratory conditions have implicated Mg2+ as a primary mediator of ribosomal structure and function. Possible contributions of Fe2+ as a ribosomal cofactor have been largely overlooked, despite the ribosome's early evolution in a high Fe2+ environment, and the continued use of Fe2+ by obligate anaerobes inhabiting high Fe2+ niches. Here, we show that (i) Fe2+ cleaves RNA by in-line cleavage, a non-oxidative mechanism that has not previously been shown experimentally for this metal, (ii) the first-order in-line rate constant with respect to divalent cations is >200 times greater with Fe2+ than with Mg2+, (iii) functional ribosomes are associated with Fe2+ after purification from cells grown under low O2 and high Fe2+ and (iv) a small fraction of Fe2+ that is associated with the ribosome is not exchangeable with surrounding divalent cations, presumably because those ions are tightly coordinated by rRNA and deeply buried in the ribosome. In total, these results expand the ancient role of iron in biochemistry and highlight a possible new mechanism of iron toxicity.
A cost–benefit analysis of the COVID-19 disease
Authors: Rowthorn Robert , Maciejowski Jan
Published: July 2020

The British government has been debating how to escape from the lockdown without provoking a resurgence of the COVID-19 disease. There is a growing recognition of the damage the lockdown has caused to economic and social life. This paper presents a simple cost–benefit analysis inspired by optimal control theory and incorporating the SIR model of disease propagation. It also reports simulations informed by the theoretical discussion. The optimal path for government intervention is computed under a variety of conditions. These include a cap on the permitted level of infection to avoid overload of the health system, and the introduction of a test and trace system. We quantify the benefits of early intervention to control the disease. We also examine how the government’s valuation of life influences the optimal path. A 10-week lockdown is only optimal if the value of life for COVID-19 victims exceeds £10m. The study is based on a standard but simple epidemiological model, and should therefore be regarded as presenting a methodological framework rather than giving policy prescriptions.
Paediatric hypertension for the primary care provider: What you need to know
Authors: Saini Priya , Betcherman Laura , Radhakrishnan Seetha , Etoom Yousef
Published: July 2020

The prevalence of hypertension has increased in the paediatric and adolescent populations, and is estimated between 1% and 2% in Canada. Paediatric and adolescent hypertension differs from adult hypertension in many ways, and primary care providers may not be up to date with current guidelines and recommendations. Recently, the American Academy of Pediatrics updated and published guidelines on the diagnosis, evaluation, and management of hypertension in children and adolescents. This paper summarizes these new guidelines in addition to the existing Canadian guidelines in a simple four-step approach, catered to a primary care setting, detailing the diagnosis, evaluation, workup, and management of hypertension in children and adolescents.
A Comparison of Attribute-Focused and Harm-Focused Methods for Assessing the Risk of Organized Crime Groups: Are They in Agreement?
Authors: Mulholland Paul , Cole Terri
Published: July 2020

Risk assessment methods are used to map the threat posed by organized crime and assist in the prioritization of policing resources. Within policing, risk assessment methods are currently in use that either focus on the attributes of organized crime groups or the types of harm posed. Statistical analysis was undertaken of risk assessment data produced using one attribute-focused and one harm-focused method. The study was based on a non-random sample of 113 attribute-focused and 77 harm-focused risk assessments of the same 17 OCGs, and a sub-sample of 36 pairs of risk assessments of 16 of the OCGs. A moderate correlation was found between the two methods, despite differences in their risk assessment processes. Lower levels of agreement tended to be associated with OCGs posing high levels of harm, particularly financial and psychological. Using the two risk assessment methods in combination is proposed as a way of building consensus that draws on their alternative perspectives. The techniques applied in this analysis could be used to inform revisions to the methods and their supporting materials, identify outlying risk assessments, and potentially incorporate other information sources such as harm indices.
Thai Police Officers: A Survey of Police Attitudes Regarding Traffic Police Training
Authors: Khruakham Seksan , Cheurprakobkit Sutham
Published: July 2020

Traffic accidents have become a major issue in Thailand since the World Health Organization reported in 2018 that Thailand had the second highest death rate of road accidents in the world (over 24,000 deaths each year). Because the effectiveness of traffic enforcement was found to be a key factor that helps reduce the number of traffic accidents, this study examined how well the policy on traffic training programmes has been implemented and how traffic training programmes prepare traffic officials to perform their traffic duties. A random sample of 247 traffic officials was chosen from the four police regions and the Bangkok Metropolitan area to complete a survey. The results of the study show that the implementation of traffic training programmes is inconsistent with the given policy, resulting in traffic officials gaining insufficient knowledge and skills from training to do their work.
Blockchain without Waste: Proof-of-Stake
Authors: Saleh Fahad
Published: July 2020

Permissionless blockchains require a protocol to generate consensus. Many prominent permissionless blockchains employ Proof-of-Work (PoW) for that purpose, but PoW possesses significant shortcomings. Various alternatives have been proposed. This paper provides the first formal economic model of the most famous alternative, Proof-of-Stake (PoS), and establishes conditions under which PoS generates consensus. A sufficiently modest reward schedule not only implies the existence of an equilibrium in which consensus obtains as soon as possible but also precludes a persistent forking equilibrium. The latter result arises because PoS, unlike PoW, requires that validators are also stakeholders.
Renal involvement in eosinophilic granulomatosis with polyangiitis (EGPA): a multicentric retrospective study of 63 biopsy-proven cases
Authors: Durel Cécile-Audrey , Sinico Renato A , Teixeira Vitor , Jayne David , Belenfant Xavier , Marchand-Adam Sylvain , Pugnet Gregory , Gaultier Jacques , Le Gallou Thomas , Titeca-Beauport Dimitri , Agard Christian , Barbet Christelle , Bardy Antoine , Blockmans Daniel , Boffa Jean-Jacques , Bouet Julien , Cottin Vincent , Crabol Yoann , Deligny Christophe , Essig Marie , Godmer Pascal , Guilpain Philippe , Hirschi-Santelmo Sandrine , Rafat Cédric , Puéchal Xavier , Taillé Camille , Karras Alexandre ,   for the French Vasculitis Study Group (FVSG)
Published: July 2020

Objective

Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by asthma, hypereosinophilia and ANCA positivity in 40% of patients. Renal involvement is rare and poorly described, leading to this renal biopsy-proven based study in a large EGPA cohort.

Methods

We conducted a retrospective multicentre study including patients fulfilling the 1990 ACR criteria and/or the 2012 revised Chapel Hill Consensus Conference criteria for EGPA and/or the modified criteria of the MIRRA trial, with biopsy-proven nephropathy.

Results

Sixty-three patients [27 women, median age 60 years (18–83)] were included. Renal disease was present at vasculitis diagnosis in 54 patients (86%). ANCA were positive in 53 cases (84%) with anti-MPO specificity in 44 (83%). All patients had late-onset asthma. Peripheral neuropathy was present in 29 cases (46%), alveolar haemorrhage in 10 (16%). The most common renal presentation was acute renal failure (75%). Renal biopsy revealed pauci-immune necrotizing GN in 49 cases (78%). Membranous nephropathy (10%) and membranoproliferative GN (3%) were mostly observed in ANCA-negative patients. Pure acute interstitial nephritis was found in six cases (10%); important interstitial inflammation was observed in 28 (44%). All patients received steroids with adjunctive immunosuppression in 54 cases (86%). After a median follow-up of 51 months (1–296), 58 patients (92%) were alive, nine (14%) were on chronic dialysis and two (3%) had undergone kidney transplantation.

Conclusion

Necrotizing pauci-immune GN is the most common renal presentation in ANCA-positive EGPA. ANCA-negative patients had frequent atypical renal presentation with other glomerulopathies such as membranous nephropathy. An important eosinophilic interstitial infiltration was observed in almost 50% of cases.
A Comparison of Complications and Clinical and Radiologic Outcome Between the Mini-open Prepsoas and Mini-open Transpsoas Approaches for Lumbar Interbody Fusion
Authors: Spiessberger Alexander , Arvind Varun , Dietz Nicholas , Grueter Basil , Huber Florian , Guggenberger Roman , Moriggl Bernhard , Varma Vikas , Cho Samuel K.
Published: July 2020

Study Design:

Systematic review and meta-analysis.

Objective:

To compare complication rates and clinical and radiologic outcome between the mini-open prepsoas and mini-open transpsoas approaches for lateral lumbar interbody fusion.

Summary of Background Data:

Both approaches are believed to be safe with similar complication rates. Previous studies suggest that the rate of neurological injury might be higher in the transpsoas group, whereas visceral or vascular injury might be more frequent in the prepsoas group.

Methods:

A systematic review of the literature was performed. Data were extracted from original publications up until December 26, 2018. Evidence was extracted from well-designed case-control or cohort studies and sorted in 2 groups, the prepsoas and transpsoas approaches. A meta-analysis was performed using a random-effects model (I
2 statistic >50% for all analyses).

Results:

A total of 115 studies included data of 13,260 patients, 2450 in the prepsoas group and 10,810 in the transpsoas group. Demographics for prepsoas versus transpsoas group were (N-weighted means): age 61.9 versus 60.9 years; %female sex 53% versus 63%, levels fused 1.4 versus 2.6, blood loss 52.4 versus 122.3 mL, and operating time 125.1 versus 200.7 min. The following statistically significant differences in complication rates between prepsoas and transpsoas approaches were found: transient psoas weakness or thigh/groin numbness 4% versus 26% [95% confidence interval (CI): 11%–17%], motor neural injury 0.4% versus 1.3% (95% CI: 16%–62.3%); no statistically significant differences were found for: major vascular injury 2% versus 1% (95% CI: 1.04%–2.31%), kidney or ureter injury 0.04% versus 0.08% (95% CI: 0.057%–5.2%), injury pleural/peritoneal structures 0.6% versus 0.2% (95% CI: 0.89%–6.58%), cage subsidence 5% versus 4% (95% CI: 0.9%–1.97%), surgical site infection 1% versus 1% (95% CI: 0.57%–1.66%), abdominal wall pseudohernia 1% versus 1% (95% CI: 0.07%–21.22%), sympathetic chain injury 5% versus 0% (95% CI: 0.34%–97.86%), and directly procedure-related death 0.04% versus 0% (95% CI: 0.127%–76.8%). Pooled mean perioperative changes between prepsoas and transpsoas approaches were: segmental sagittal Cobb angle 3.07 versus 1.99 degrees; foraminal height 2 versus 6.96 mm.

Conclusions:

The prepsoas had fewer complications than the transpsoas approach. Furthermore, the prepsoas approach showed superior restoration of segmental lordosis, whereas foraminal height restoration was superior with the transpsoas approach. This could be explained by the differences in location of the interbody device placement in relation to the center of rotation of the spine between the 2 surgical techniques.
Associations Between Preoperative Hyponatremia and 30-Day Perioperative Complications in Lumbar Interbody Spinal Fusion
Authors: Pennington Zach , Bomberger Thomas T. , Lubelski Daniel , Benzel Edward C. , Steinmetz Michael P. , Mroz Thomas E.
Published: July 2020

Study Design:

Retrospective population database study.

Objective:

To investigate the relationship of preoperative hyponatremia to postoperative morbidity and mortality in lumbar interbody fusion patients.

Summary of Background Data:

Optimization of preoperative patient selection and perioperative management can improve patient outcomes in spinal surgery. Hyponatremia, incidentally identified in 1.7% of the US population, has previously been tied to poorer postoperative outcomes in both the general surgery and orthopedic surgery populations.

Materials and Methods:

Using the National Surgical Quality Improvement Program database, the authors identified all lumbar interbody fusion patients treated between 2012 and 2014. Patients were classified as hyponatremic (Na<135 mEq/L) or as having normal sodium levels (135–145 mEq/L) preoperatively. The primary outcome was major morbidity and secondary endpoints were prolonged hospitalization, 30-day readmission, and reoperation. Multivariable linear regression was used to find independent predictors of these outcomes.

Results:

Of 10,654 patients, 45.6% were male individuals, 5.5% were hyponatremic, and 4.2% experienced a major postoperative complication. On multivariable analysis, preoperative hyponatremia was independently associated with major morbidity (odds ratio, 1.22; 95% confidence interval, 1.03–1.44; P<0.05) and prolonged hospitalization (odds ratio, 1.14; 95% confidence interval, 1.02–1.27).

Conclusions:

Here the authors provide the first evidence suggesting preoperative hyponatremia is an independent predictor of major morbidity after lumbar interbody fusion. Hyponatremia may represent a modifiable risk factor for improved patient care and preoperative risk counseling.
Are the Outcomes of Minimally Invasive Transforaminal/Posterior Lumbar Fusion Influenced by the Patient’s Age or BMI?
Authors: Manson Neil , Hubbe Ulrich , Pereira Paulo , Lam Khai , Fuster Salvador , Senker Wolfgang
Published: July 2020

Study Design:

A retrospective subgroup analysis of a prospective observational study was carried out.

Summary of Background Data:

Patients’ baseline characteristics may influence the clinical outcomes after minimally invasive lumbar interbody fusion (MILIF).

Objective:

This study aimed to investigate the influence of patient’s age and body mass index (BMI) on the clinical outcomes of MILIF for degenerative lumbar disorder.

Materials and Methods:

A total of 252 patients underwent MILIF. The clinical outcomes, including time to first ambulation, time to postsurgical recovery, back/leg pain in visual analog scale, Oswestry Disability Index, and EuroQol-5 Dimension, were collected at baseline, 4 weeks, 6, and 12 months. Patients were subgrouped by age (50 y and below: N=102; 51–64 y: N=102; 65 y and above: N=48) and BMI (≤25.0: N=79; 25.1–29.9: N=104; ≥30.0: N=69). Data from baseline to 12 months were compared for all clinical outcomes within age/BMI subgroups. Adverse events (AEs) and serious adverse events (SAEs) were summarized by age and BMI subgroups.

Results:

All age and BMI subgroups showed significant improvements in clinical outcomes at 12 months compared with the baseline. The median time to first ambulation was similar for all subgroups (age groups: P=0.8707; BMI: P=0.1013); older people show a trend of having longer time to postsurgical recovery (age groups: P=0.0662; BMI: P=0.1591). Oswestry Disability Index, back, and leg pain visual analog scale, and EuroQol-5 Dimension were similar in all subgroups at every timepoint. A total of 50 AEs (N=39) were reported, 9 of which were SAEs; 3 AEs and 1 SAE were considered to be related to surgical procedure. No differences were observed in safety by age groups and BMI groups.

Conclusion:

MILIF appears to be safe and effective, independent of age or weight in the treatment of degenerative lumbar disorder.

Level of Evidence:

Level II.
Processing and Handling Cost of Single-use Versus Traditional Instrumentation for 1 Level Lumbar Fusions
Authors: Galetta Matthew S. , Divi Srikanth N. , Shapses Mark A. , Hartman Joseph B. , Nicholson Kristen J. , Goyal Dhruv K.C. , Fang Taolin , Mangan John J. , Kaye Ian David , Kurd Mark F. , Woods Barrett I. , Radcliff Kris E. , Rihn Jeffrey A. , Anderson David Greg , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: July 2020

Study Design:

A single center, observational prospective clinical study.

Objective:

The aim of this study was to compare the instrumentation-related cost and efficiency of single-use instrumentation versus traditional reusable instrument trays.

Summary of Background Data:

Single-use instrumentation provides the opportunity to reduce costs associated with cleaning and sterilizing instrumentation after surgery. Although previous studies have shown single-use instrumentation is effective in other orthopedic specialties, it is unclear if single-use instrumentation could provide economic advantages in spine surgery.

Materials and Methods:

A total of 40 (20 reusable instrumentation and 20 single-use instrumentation) lumbar decompression (1–3 level) and fusion (1 level) spine surgeries were collected. Instrument handling, opening, setup, re-stocking, cleaning, sterilization, inspection, packaging, and storage were recorded by direct observation for both reusable and single-use instrumentation. The rate of infection was noted for each group.

Results:

Mean time of handling instruments by the scrub nurse was 11.6 (±3.9) minutes for reusable instrumentation and 2.1 (±0.5) minutes for single-use instrumentation. Mean cost of handling reusable instruments was estimated to be $8.52 (±$2.96) per case, and the average cost to reprocess a single tray by Sterilization Processing Department (SPD) was $58. Thus, the median cost for sterilizing 2 reusable trays per case was $116, resulting in an average total Costresuable of $124.52 (±$2.96). Mean cost of handling single-use instrumentation was estimated to be $1.57 ($0.38) per case.

Conclusion:

Single-use instrumentation provided greater cost savings and reduced time from the opening of instrumentation to use in surgery when compared with reusable instrumentation.
A Community Hospital’s Response to the COVID-19 Pandemic
Authors: Tyo Mirinda Brown , Tardy Kathleen , Kerwin Kaitlyn
Published: July 2020

The novel coronavirus 2019-nCoV (COVID-19) has disrupted and altered the way health care is delivered in the United States and across the world. Patient care guidelines and isolation recommendations continue to hastily change, demonstrating the key role of nursing professional development practitioners in educating and preparing frontline staff to provide safe patient care during the COVID-19 pandemic. This article describes a community hospital’s strategic educational response to a highly contagious respiratory pandemic. Initiatives to increase staff education and conserve personal protective equipment are discussed.
Spontaneous Intracranial Hypotension Followed by Intracranial Hypertension
Authors: Videira Gonçalo , Carneiro Ângelo , Mota Dória Hugo , Mendes Alexandre , Andrade Carlos
Published: July 2020

Introduction:

Spontaneous intracranial hypotension is a secondary cause of headache caused by suspected cerebrospinal fluid leaks. It is associated with vascular changes that may predispose to superficial siderosis. When treated with an epidural blood patch, rebound intracranial hypertension may ensue.

Case Report:

A 55-year-old man presented with orthostatic headaches responsive to rest and hydration. Brain magnetic resonance revealed subdural collections, consistent with intracranial hypotension. Three weeks later, the patient experienced sudden severe holocranial headache and spontaneous subarachnoid hemorrhage was found. This resulted in rebound intracranial hypertension with bilateral papilledema and sixth-nerve palsy, which completely resolved with acetazolamide.

Discussion:

Spontaneous intracranial hypotension may predispose to subarachnoid hemorrhage through vascular compensatory changes. Blood in subarachnoid space may seal the hidden cerebrospinal fluid leak or trigger an inflammatory reaction, leading to rebound intracranial hypertension, a well-known epidural blood patch complication.