bluuebunny/crossref_metadata_2025 huggingface dataset:
The cytokine MIF controls daily rhythms of symbiont nutrition in an animal–bacterial association
Authors: Koch Eric J. , Bongrand Clotilde , Bennett Brittany D. , Lawhorn Susannah , Moriano-Gutierrez Silvia , Pende Marko , Vadiwala Karim , Dodt Hans-Ulrich , Raible Florian , Goldman William , Ruby Edward G. , McFall-Ngai Margaret
Published: October 2020

Significance

Daily biological rhythms are fundamental, evolutionarily conserved features of many symbioses. Here we use the binary squid–vibrio association, the simplicity of which has offered the resolution to explore strategies of symbiosis that are shared with more complex systems, such as those of mammals. We demonstrate a pivotal role for an evolutionarily conserved cytokine, macrophage migration inhibitory factor, or MIF, which is abundant in epithelia supporting the symbionts of both the squid light organ and the mammalian gut. In the mature squid association, MIF regulates the cyclic metabolic dialogue that underlies oscillations in host-provided symbiont nutrients. As such, this study integrates the role of MIF across two distinct time scales: the host’s life history and its daily rhythms.
3D dose distribution measurement using 2D imaging from NaCl optical crystals
Authors: Chapsky A , Spooner N A , Santos A , Rutten T
Published: October 2020

In radiotherapy practice, 1D and 2D dosimeters are used for dose verification prior to patient treatment. Along with high accuracy and precision of dose measurements that these dosimeters provide, acquisition of dose deposition data in three dimensions requires extrapolation of measured data. Development of a 3D dosimeter would provide continuous information of dose distribution in matter. In this work, NaCl 3D crystal has shown that radiation deposition can be imaged using blue laser stimulation in two dimensions. It was further shown that the intensity of collected signal has near – linear dose dependence, however complete signal readout is required, to compensate for gradual signal collection at different depths along the profile of the stimulating laser beam, due to attenuation of the beam within the crystal. A method to extend dose measurement to three dimensions using imaging is proposed.
Knowledge-driven deep neural network models for brain tumour segmentation
Authors: Colecchia F , Ruffle J K , Pombo G C , Gray R , Hyare H , Nachev P
Published: October 2020

Image segmentation is a computer vision task aiming to establish a probabilistic mapping between individual pixels (2D) or voxels (3D) in an input image and a set of predefined semantic categories with reference to domain-specific knowledge. When applied to medical images, e.g. Magnetic Resonance Imaging (MRI), it allows delineation between healthy and abnormal tissue. Despite challenges due to lesion morphological heterogeneity, segmentation of brain tumours has the potential to streamline otherwise time-consuming manual annotation. Whereas brain tumour segmentation has continually advanced incorporating innovative deep learning methods, heuristics normally employed by radiologists have often been neglected. The focus of nearly all tumour segmentation articles thus far on 3D isotropic research-grade scans has also led to results of unknown generalisability to hospital-quality data. In order to address these gaps, this study has coalesced modern deep learning methods and clinical-driven priors into an optimised segmentation pipeline evaluated on clinical data at a large neurology and neurosurgery tertiary centre.
Effective treatment of metastatic cancer by an innovative intratumoral alpha particle-mediated radiotherapy in combination with immunotherapy: A short review
Authors: Keisari Y , Popovtzer A , Kelson I
Published: October 2020

Alpha radiation is a lethal form of radiation whose short range limits its use for cancer treatment. A unique intra-tumoral alpha radiation-based tumor ablation treatment termed Diffusing Alpha emitters Radiation Therapy (DaRT) was developed and tested for tumor ablation and stimulation of anti-tumor immunity. Radium-224 loaded wires (Alpha DaRT seeds) are inserted into the tumors and release by recoil short-lived alpha-emitting atoms. These atoms disperse in the tumor at least 5 mm from the source and spray it with highly destructive alpha radiation. DaRT was found to destroy solid malignant tumors experimental animals and in patients with cutaneous malignancies. Tumor destruction resulted in activation of specific antitumor immunity. DaRT provides, for the first time, an efficient method for treatment of the entire volume of solid tumors by alpha radiation, and could be used not only as a local treatment but also as a therapeutic strategy to induce strong systemic antitumor immune responses, which will eliminate residual disease and metastases in distant sites. This combined treatment modality holds significant potential for the treatment of non-resectable human cancers.
Water or Medium: Dose Specification in Trials and Real Life
Authors: Kron T , Hardcastle N
Published: October 2020

Radiation dose is the therapeutic agent in radiotherapy where the objective is to maximise radiation dose to a target while minimising the dose to surrounding healthy tissues. Dose in this context is typically associated with the quantity “absorbed dose” as energy deposited per unit mass and measured in J/kg of tissue. However, even if high doses are delivered (no stochastic distribution considered) and photon or electron radiation is considered (no neutrons or heavy charged particles), there will be differences in the actual dose delivered to different tissue types as the stopping power for the electrons that deliver the vast majority of dose varies with elemental composition. Historically, radiation beam calibration and dose calculations were performed in water as a readily available, easily standardised material that closely matches the radiation properties of many human tissues. However, many superior dose calculation algorithms that have recently become available due to improved computer power (Monte Carlo Calculations, Acuros) calculate dose as deposited in the medium. The present paper examines arguments for both and proposes that based on the current scientific and political developments specification of dose as dose to medium would be the more robust and future proof choice.
An Avalanche confinement TEPC as connecting bridge from micro to nanodosimetry
Authors: Mazzucconi D. , Bortot D. , Pola A. , Agosteo S. , Selva A. , Colautti P. , Conte V.
Published: October 2020

It is recognized today that the observable radiobiological effects of ionizing radiations are strongly correlated to the clustering of damages in micrometer- and nanometer-sized subcellular structures, hence to the particle track structure. The characteristic properties of track structure are directly measurable nowadays with bulky experimental apparatuses, which cannot be easily operated in a clinical environment. It is therefore interesting to investigate the feasibility of new portable detectors able to characterize the real therapeutic beams. With this in mind, a novel avalanche-confinement Tissue Equivalent Proportional Counter (TEPC) was constructed for simulating nanometric sites down to 25 nm. Experimental cluster size distributions measured with this TEPC were compared with Monte Carlo simulations of the same experiment and with cluster size distributions measured with the Startrack nanodosimeter.
Towards a compact experimental setup for gas-based microdosimetry
Authors: Selva A , Bianchi A , Colautti P , Conte V
Published: October 2020

Microdosimetry measures the stochastics of imparted energy at the micrometre scale, and is a reliable experimental technique to monitor complex radiation fields such as those used in hadron therapy. At the Legnaro National Laboratories of INFN, miniaturized gas-based microdosimeters were developed specifically for this kind of applications. However, their use outside research facilities has been hindered by the encumbrance of the gas-flow system which is used to preserve gas purity and of the high-resolution analog electronic chain. To overcome this drawback, a new detector designed to work without gas flow was developed recently. The stability and reproducibility of its response in sealed conditions were studied in two measuring shifts one year apart from each other, both with the analog electronic chain and with a compact digital acquisition system. Preliminary results confirm the possibility to operate the detector with a very compact experimental setup, which could be a major advantage in clinical facilities.
Dual MRI-SPECT imaging system realized with Timepix pixel detector inserted into MR small animal scanner
Authors: Zajicek J , Burian M , Ters J
Published: October 2020

Although MRI and SPECT are routine tools in medical imaging individually, the combination of these two modalities in multimodal imaging is still unexplored. By hybridizing high-resolution anatomical with functional imaging, combined MRI-SPECT could be a valuable addition to existing medical imaging methods, reducing overall scanning time and image co-registration errors. In contrast to PET, SPECT offers a cost-efficient range of applicable radioisotopes. This proof-of-principle study shows a modified experimental MRI-SPECT insert system consisting of an MR-compatible SPECT unit with hybrid semiconductor detectors Timepix. The insert system is equipped with CdTe pixelated sensors, tungsten collimators and a radiofrequency coil (RF). To increase the number of projections acquired, the setup is also equipped with an electromagnetic step motor Microcon SX 16-0503 for a sample rotation. Measurements were performed our own invented multimodal (1H/99mTc) inhomogeneous phantom filled with a liquid 99mTc radiotracer, emitting 140.5 keV γ-rays inside the RF coil by the Bruker BioSpec 47/20 (4.7 T) MR animal scanner. For the evaluation of measured data, SPECT-back projection software was developed in Matlab. Our results pave the way for a preclinical MRI-SPECT insert system. This research was performed in the framework of the Medipix Collaboration.
Sex Differences in the Relationship Between High-Risk Drinking and the Triglyceride-Glucose (TyG) Index: An Analysis Using 2013 and 2015 Korean National Health and Nutrition Examination Survey Data
Authors: Lee Yea-Chan , Park Byong Jin , Lee Jun-Hyuk
Published: October 2020

Aims

The alcohol use disorders identification test (AUDIT) was developed to evaluate excessive drinking in primary care. The triglyceride (TG) glucose (TyG) index is a novel marker used for assessing insulin resistance. We sought to document relationships between high-risk drinking according to AUDIT and the TyG index and to evaluate whether the TyG index is more correlated with high-risk drinking than TG or fasting plasma glucose (FPG).

Methods

We analyzed data for 7014 participants in the 2013 and 2015 Korea National Health and Nutrition Examination Surveys. Excessive drinking risk groups were categorized according to AUDIT scores (low-risk, 0–7 in men and 0–6 in women; moderate-risk, 8–14 in men and 7–12 in women; and high-risk, ≥15 in men and ≥13 in women).

Results

In men, compared with low-risk individuals, the odds ratios (95% confidence intervals) for higher TyG index values were 1.84 (1.16–2.93) in the moderate- and 2.82 (1.86–4.30) in the high-risk groups. The correlation coefficient for the TyG index and AUDIT score was significantly higher than those for TG and FPG. No significant associations were noted in women.

Conclusion

High-risk drinking is significantly associated with higher TyG index values in men only. The TyG index can be a novel marker for assessing high-risk drinking in men.
Regression-Based Norms for the Hopkins Verbal Learning Test-Revised and the Rey–Osterrieth Complex Figure in a Portuguese Adult Population
Authors: Vicente Selene G , Ramos-Usuga Daniela , Barbosa Fernando , Gaspar Nuno , Dores Artemisa R , Rivera Diego , Arango-Lasprilla Juan Carlos
Published: October 2020

Objective

The principal goal of this study was to produce adjusted normative data for European Portuguese native speakers from Portugal on 2 neuropsychological tests widely used to assess learning and memory: the Hopkins Verbal Learning Test-Revised (HVLT-R) and the Rey–Osterrieth Complex Figure Test (ROCF).

Method

The study included 300 individuals aged 18–92 years (M = 50.4, SD = 21.2), who had educational backgrounds ranging from 3 to 25 years (M = 10.4, SD = 5.2).

Results

Age, education, and sex were significantly associated with HVLT-R and ROCF performance. These demographic variables accounted for 61% of the variance in HVLT-R total recall, 54% in HVLT-R delayed recall, 18% in HVLT-R recognition, 55% in ROCF copy, and 39% in ROCF immediate recall.

Conclusions

The normative data are presented as regression-based algorithms to adjust direct and derived test scores for age, education, and sex. This study provides a calculator of normative data derived from the results of the regression models.
Exploring chromatin conformation and gene co-expression through graph embedding
Authors: Varrone Marco , Nanni Luca , Ciriello Giovanni , Ceri Stefano
Published: October 2020

Motivation

The relationship between gene co-expression and chromatin conformation is of great biological interest. Thanks to high-throughput chromosome conformation capture technologies (Hi-C), researchers are gaining insights on the tri-dimensional organization of the genome. Given the high complexity of Hi-C data and the difficult definition of gene co-expression networks, the development of proper computational tools to investigate such relationship is rapidly gaining the interest of researchers. One of the most fascinating questions in this context is how chromatin topology correlates with gene co-expression and which physical interaction patterns are most predictive of co-expression relationships.

Results

To address these questions, we developed a computational framework for the prediction of co-expression networks from chromatin conformation data. We first define a gene chromatin interaction network where each gene is associated to its physical interaction profile; then, we apply two graph embedding techniques to extract a low-dimensional vector representation of each gene from the interaction network; finally, we train a classifier on gene embedding pairs to predict if they are co-expressed. Both graph embedding techniques outperform previous methods based on manually designed topological features, highlighting the need for more advanced strategies to encode chromatin information. We also establish that the most recent technique, based on random walks, is superior. Overall, our results demonstrate that chromatin conformation and gene regulation share a non-linear relationship and that gene topological embeddings encode relevant information, which could be used also for downstream analysis.

Availability and implementation

The source code for the analysis is available at: https://github.com/marcovarrone/gene-expression-chromatin.

Supplementary information

Supplementary data are available at Bioinformatics online.
amPEPpy 1.0: a portable and accurate antimicrobial peptide prediction tool
Authors: Lawrence Travis J , Carper Dana L , Spangler Margaret K , Carrell Alyssa A , Rush Tomás A , Minter Stephen J , Weston David J , Labbé Jessy L
Published: October 2020

Antimicrobial peptides (AMPs) are promising alternative antimicrobial agents. Currently, however, portable, user-friendly and efficient methods for predicting AMP sequences from genome-scale data are not readily available. Here we present amPEPpy, an open-source, multi-threaded command-line application for predicting AMP sequences using a random forest classifier.

Availability and implementation

amPEPpy is implemented in Python 3 and is freely available through GitHub (https://github.com/tlawrence3/amPEPpy).

Supplementary information

Supplementary data are available at Bioinformatics online.
Finding the fixed points of a Boolean network from a positive feedback vertex set
Authors: Aracena Julio , Cabrera-Crot Luis , Salinas Lilian
Published: October 2020

Motivation

In the modeling of biological systems by Boolean networks, a key problem is finding the set of fixed points of a given network. Some constructed algorithms consider certain structural properties of the regulatory graph like those proposed by Akutsu et al. and Zhang et al., which consider a feedback vertex set of the graph. However, these methods do not take into account the type of action (activation and inhibition) between its components.

Results

In this article, we propose a new algorithm for finding the set of fixed points of a Boolean network, based on a positive feedback vertex set P of its regulatory graph and which works, by applying a sequential update schedule, in time O(2|P|·n2+k), where n is the number of components and the regulatory functions of the network can be evaluated in time O(nk), k≥0. The theoretical foundation of this algorithm is due a nice characterization, that we give, of the dynamical behavior of the Boolean networks without positive cycles and with a fixed point.

Availability and implementation

An executable file of FixedPoint algorithm made in Java and some examples of input files are available at: www.inf.udec.cl/˜lilian/FPCollector/.

Supplementary information

Supplementary material is available at Bioinformatics online.
Machine phenotyping of cluster headache and its response to verapamil
Authors: Tso Amy R , Brudfors Mikael , Danno Daisuke , Grangeon Lou , Cheema Sanjay , Matharu Manjit , Nachev Parashkev
Published: October 2020

Cluster headache is characterized by recurrent, unilateral attacks of excruciating pain associated with ipsilateral cranial autonomic symptoms. Although a wide array of clinical, anatomical, physiological, and genetic data have informed multiple theories about the underlying pathophysiology, the lack of a comprehensive mechanistic understanding has inhibited, on the one hand, the development of new treatments and, on the other, the identification of features predictive of response to established ones. The first-line drug, verapamil, is found to be effective in only half of all patients, and after several weeks of dose escalation, rendering therapeutic selection both uncertain and slow. Here we use high-dimensional modelling of routinely acquired phenotypic and MRI data to quantify the predictability of verapamil responsiveness and to illuminate its neural dependants, across a cohort of 708 patients evaluated for cluster headache at the National Hospital for Neurology and Neurosurgery between 2007 and 2017. We derive a succinct latent representation of cluster headache from non-linear dimensionality reduction of structured clinical features, revealing novel phenotypic clusters. In a subset of patients, we show that individually predictive models based on gradient boosting machines can predict verapamil responsiveness from clinical (410 patients) and imaging (194 patients) features. Models combining clinical and imaging data establish the first benchmark for predicting verapamil responsiveness, with an area under the receiver operating characteristic curve of 0.689 on cross-validation (95% confidence interval: 0.651 to 0.710) and 0.621 on held-out data. In the imaged patients, voxel-based morphometry revealed a grey matter cluster in lobule VI of the cerebellum (−4, −66, −20) exhibiting enhanced grey matter concentrations in verapamil non-responders compared with responders (familywise error-corrected P = 0.008, 29 voxels). We propose a mechanism for the therapeutic effect of verapamil that draws on the neuroanatomy and neurochemistry of the identified region. Our results reveal previously unrecognized high-dimensional structure within the phenotypic landscape of cluster headache that enables prediction of treatment response with modest fidelity. An analogous approach applied to larger, globally representative datasets could facilitate data-driven redefinition of diagnostic criteria and stronger, more generalizable predictive models of treatment responsiveness.
Establishing two principal dimensions of cognitive variation in logopenic progressive aphasia
Authors: Ramanan Siddharth , Roquet Daniel , Goldberg Zoë-lee , Hodges John R , Piguet Olivier , Irish Muireann , Lambon Ralph Matthew A
Published: October 2020

Logopenic progressive aphasia (LPA) is a neurodegenerative syndrome characterised by sentence repetition and naming difficulties arising from left-lateralised temporoparietal atrophy. Clinical descriptions of LPA largely concentrate on profiling language deficits, however, accumulating evidence points to the presence of cognitive deficits even on tasks with minimal language demands. Although non-linguistic cognitive deficits in LPA are thought to scale with disease severity, patients at discrete stages of language dysfunction display overlapping cognitive profiles, suggesting individual-level variation in cognitive performance, independent of primary language dysfunction. To address this issue, we used principal component analysis to decompose individual-level variation in cognitive performance in 43 well-characterised LPA patients who underwent multi-domain neuropsychological assessments and structural neuroimaging. The principal component analysis solution revealed the presence of two, statistically independent factors, providing stable and clinically intuitive explanations for the majority of variance in cognitive performance in the syndrome. Factor 1 reflected ‘speech production and verbal memory’ deficits which typify LPA. Systematic variations were also confirmed on a second, orthogonal factor mainly comprising visuospatial and executive processes. Adopting a case-comparison approach, we further demonstrate that pairs of patients with comparable Factor 1 scores, regardless of their severity, diverge considerably on visuo-executive test performance, underscoring the inter-individual variability in cognitive profiles in comparably ‘logopenic’ patients. Whole-brain voxel-based morphometry analyses revealed that speech production and verbal memory factor scores correlated with left middle frontal gyrus, while visuospatial and executive factor scores were associated with grey matter intensity of right-lateralised temporoparietal, middle frontal regions and their underlying white matter connectivity. Importantly, LPA patients with poorer visuospatial and executive factor scores demonstrated greater right-lateralised temporoparietal and frontal atrophy. Our findings demonstrate the inherent variation in cognitive performance at an individual- and group-level in LPA, suggesting the presence of a genuine co-occurring cognitive impairment that is statistically independent of language function and disease severity.
Isolation and culture of functional adult human neurons from neurosurgical brain specimens
Authors: Park Thomas I-H , Schweder Patrick , Lee Kevin , Dieriks Birger V , Jung Yewon , Smyth Leon , Rustenhoven Justin , Mee Edward , Heppner Peter , Turner Clinton , Curtis Maurice A , Faull Richard L M , Montgomery Johanna M , Dragunow Michael
Published: October 2020

The ability to characterize and study primary neurons isolated directly from the adult human brain would greatly advance neuroscience research. However, significant challenges such as accessibility of human brain tissue and the lack of a robust neuronal cell culture protocol have hampered its progress. Here, we describe a simple and reproducible method for the isolation and culture of functional adult human neurons from neurosurgical brain specimens. In vitro, adult human neurons form a dense network and express a plethora of mature neuronal and synaptic markers. Most importantly, for the first time, we demonstrate the re-establishment of mature neurophysiological properties in vitro, such as repetitive fast-spiking action potentials, and spontaneous and evoked synaptic activity. Together, our dissociated and slice culture systems enable studies of adult human neurophysiology and gene expression under normal and pathological conditions and provide a high-throughput platform for drug testing on brain cells directly isolated from the adult human brain.
Understanding the biological basis of dyslexia at a neural systems level
Authors: Al Dahhan Noor Z , Kirby John R , Brien Donald C , Gupta Rina , Harrison Allyson , Munoz Douglas P
Published: October 2020

We examined the naming speed performance of 18 typically achieving and 16 dyslexic adults while simultaneously recording eye movements, articulations and fMRI data. Naming speed tasks, which require participants to name a list of letters or objects, have been proposed as a proxy for reading and are thought to recruit similar reading networks in the left hemisphere of the brain as more complex reading tasks. We employed letter and object naming speed tasks, with task manipulations to make the stimuli more or less phonologically and/or visually similar. Compared to typically achieving readers, readers with dyslexia had a poorer behavioural naming speed task performance, longer fixation durations, more regressions and increased activation in areas of the reading network in the left-hemisphere. Whereas increased network activation was positively associated with performance in dyslexics, it was negatively related to performance in typically achieving readers. Readers with dyslexia had greater bilateral activation and recruited additional regions involved with memory, namely the amygdala and hippocampus; in contrast, the typically achieving readers additionally activated the dorsolateral prefrontal cortex. Areas within the reading network were differentially activated by stimulus manipulations to the naming speed tasks. There was less efficient naming speed behavioural performance, longer fixation durations, more regressions and increased neural activity when letter stimuli were both phonologically and visually similar. Discussion focuses on the differences in activation within the reading network, how they are related to behavioural task differences, and how progress in furthering the understanding of the relationship between behavioural performance and brain activity can change the overall trajectories of children with reading difficulties by contributing to both early identification and remediation processes.
Severe Acute Respiratory Syndrome Coronavirus 2 Surveillance and Exposure in the Perioperative Setting With Universal Testing and Personal Protective Equipment Policies
Authors: Aslam Anoshe , Singh Jessica , Robilotti Elizabeth , Chow Karin , Bist Tarun , Reidy-Lagunes Diane , Shah Monika , Korenstein Deborah , Babady N Esther , Kamboj Mini
Published: October 2020

Background

New York City (NYC) experienced a surge of coronavirus disease 2019 (COVID-19) cases in March and April 2020. Since then, universal polymerase chain reaction (PCR)–based surveillance testing and personal protective equipment (PPE) measures are in wide use in procedural settings. There is limited published experience on the utility and sustainability of PCR-based surveillance testing in areas with receding and consistently low community COVID-19 rates.

Methods

The study was conducted at a tertiary care cancer center in NYC from 22 March to 22 August 2020. Asymptomatic patients underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing before surgeries, interventional radiology procedures, and endoscopy. Contact tracing in procedural areas was done if a patient with an initial negative screen retested positive within 48 hours of the procedure.

Results

From March 22 until August 22, 2020, 11 540 unique patients underwent 14 233 tests before surgeries or procedures at Memorial Sloan Kettering Cancer Center. Overall, 65 patients were positive, with a peak rate of 4.3% that fell below 0.3% after April 2020. Among the 65 positive cases, 3 were presymptomatic and 38 were asymptomatic. Among asymptomatic test-positive patients, 76% had PCR cycle threshold >30 at first detection. Five patients tested newly positive in the immediate postoperative period, exposing 82 employees with 1 case of probable transmission (1.2%).

Conclusions

The prevalence of SARS-CoV-2 infection identified on preprocedural surveillance was low in our study, which was conducted in an area with limited community spread at the later stage of the study. Universal PPE is protective in procedural settings. Optimal and flexible diagnostic strategies are needed to accomplish and sustain the goals of comprehensive preprocedure surveillance testing.
Digital Wellbeing as a Dynamic Construct
Authors: Vanden Abeele Mariek M P
Published: October 2020

Mobile media support our autonomy by connecting us to persons, content and services independently of time and place constraints. At the same time, they challenge our autonomy: We face new struggles, decisions, and pressure in relation to whether, when and where we connect and disconnect. Digital wellbeing is a new concept that refers to the (lack) of balance that we may experience in relation to mobile connectivity. This article develops a theoretical model of digital wellbeing that accounts for the dynamic and complex nature of our relationship to mobile connectivity, thereby overcoming conceptual and methodological limitations associated with existing approaches. This model considers digital wellbeing an experiential state of optimal balance between connectivity and disconnectivity that is contingent upon a constellation of person-, device- and context-specific factors. I argue that these constellations represent pathways to digital wellbeing that—when repeated—affect wellbeing outcomes, and that the effectiveness of digital wellbeing interventions depends on their disruptive impact on these pathways.
Very late stent expansion with intracoronary lithotripsy: a case report
Authors: Demarchi Andrea , Ugo Fabrizio , Cavallino Chiara , Rametta Francesco
Published: October 2020

Background

Underexpanded stent in heavily calcified coronary lesion is common and persists over years. It is related to long-term failure and negative outcomes. Treatment of this situation after many years with intracoronary lithotripsy (ICL-Shockwave®) could be an option.

Case summary

We report a case of a man with underexpanded coronary stent implanted 11 years earlier. Optical coherence tomography highlighted the mechanism of stent underexpansion showing the presence of calcium stones under the old struts. Intracoronary lithotripsy crushed calcium under the stent struts causing its geometric change (from elliptical to round shape) and a consequent better transmission of the true radial force of the old stent.

Discussion

Heavily calcified coronary lesions lead to stent underexpansion which persists over years. Intracoronary lithotripsy could be a very late option to manage this unfavourable common result.
Is the EuroSCORE II reliable in surgical mitral valve repair? A single-centre validation study
Authors: Carino Davide , Denti Paolo , Ascione Guido , Del Forno Benedetto , Lapenna Elisabetta , Ruggeri Stefania , Agricola Eustachio , Buzzatti Nicola , Verzini Alessandro , Meneghin Roberta , Scandroglio Anna Mara , Monaco Fabrizio , Castiglioni Alessandro , Alfieri Ottavio , De Bonis Michele
Published: October 2020

OBJECTIVES

The EuroSCORE II is widely used to predict 30-day mortality in patients undergoing open and transcatheter cardiac surgery. The aim of this study is to evaluate the discriminatory ability of the EuroSCORE II in predicting 30-day mortality in a large cohort of patients undergoing surgical mitral valve repair in a high-volume centre.

METHODS

A retrospective review of our institutional database was carried on to find all patients who underwent mitral valve repair in our department from January 2012 to December 2019. Discrimination of the EuroSCORE II was assessed using receiver operating characteristic curves. The maximum Youden’s Index was employed to define the optimal cut-point. Calibration was assessed by generating calibration plot that visually compares the predicted mortality with the observed mortality. Calibration was also tested with the Hosmer–Lemeshow goodness-of-fit test. Finally, the accuracy of the models was tested calculating the Brier score.

RESULTS

A total of 2645 patients were identified, and the median EuroSCORE II was 1.3% (0.6–2.0%). In patients with degenerative mitral regurgitation (MR), the EuroSCORE II showed low discrimination (area under the curve 0.68), low accuracy (Brier score 0.27) and low calibration with overestimation of the 30-day mortality. In patients with secondary MR, the EuroSCORE II showed a good overall performance estimating the 30-day mortality with good discrimination (area under the curve 0.88), good accuracy (Brier score 0.003) and good calibration.

CONCLUSIONS

In patients with degenerative MR operated on in a high-volume centre with a high level of expertise in mitral valve repair, the EuroSCORE II significantly overestimates the 30-day mortality.
Upgrade from implantable cardioverter-defibrillator vs. de novo implantation of cardiac resynchronization therapy: long-term outcomes
Authors: Jędrzejczyk-Patej Ewa , Mazurek Michał , Kotalczyk Agnieszka , Kowalska Wiktoria , Konieczny-Kozielska Aleksandra , Kozielski Jonasz , Podolecki Tomasz , Szulik Mariola , Sokal Adam , Kowalski Oskar , Kalarus Zbigniew , Średniawa Beata , Lenarczyk Radosław
Published: October 2020

Aims 

To assess and compare long-term mortality and predictors thereof in de novo cardiac resynchronization therapy defibrillators (CRT-D) vs. upgrade from an implantable cardioverter-defibrillator (ICD) to CRT-D.

Methods and results 

Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in a tertiary care, university hospital, in a densely inhabited, urban region of Poland [480 subjects (84.3%) with CRT-D de novo implantation; 115 patients (15.7%) upgraded from ICD to CRT-D]. In a median observation of 1692 days (range 457–3067), all-cause mortality for de novo CRT-D vs. CRT-D upgrade was 35.5% vs. 43.5%, respectively (P = 0.045). On multivariable regression analysis including all CRT recipients, the previously implanted ICD was an independent predictor for death [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.10–2.29, P = 0.02]. For those, who were upgraded from ICD to CRT-D, the independent predictors for all-cause death were as follows: creatinine level (HR 1.01, 95% CI 1.00–1.02, P = 0.01), left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02–1.11, P = 0.002), New York Heart Association (NYHA) IV class at baseline (HR 2.36, 95% CI 1.00–5.53, P = 0.049) and cardiac device-related infective endocarditis during follow-up (HR 2.42, 95% CI 1.02–5.75, P = 0.046). A new CRT scale (Creatinine ≥150 μmol/L; Remodelling, left ventricular end-systolic ≥59 mm; Threshold for NYHA, NYHA = IV) showed high prediction for mortality in CRT-D upgrades (AUC 0.70, 95% CI 0.59–0.80, P = 0.0007).

Conclusion 

All-cause mortality in patients upgraded from ICD is significantly higher compared with de novo CRT-D implantations and reaches almost 45% within 4.5 years. A new CRT scale (Creatinine; Remodelling; Threshold for NYHA) has been proposed to help survival prediction following CRT upgrade.
Hepatomegaly and short stature in a 14-year-old with type 1 diabetes mellitus: case report
Authors: Fox Miriam T , Tamaroff Jaclyn , Percy Andrew G , Baker Stephanie , Altshuler Courtney , Baluyot Mariju , Stewart Rosalyn W
Published: October 2020

Background

Mauriac syndrome is a rare consequence of poorly controlled insulin-dependent diabetes, characterized by hepatomegaly, growth failure, delayed onset of puberty, and cushingoid features. Case reports of patients with Mauriac syndrome are found infrequently in the literature given historic improvements in diabetes management due to readily available insulin therapy.

Methods

We describe a case of a 14-year-old girl who presented with acute onset abdominal pain, distention, and orthopnea.

Results

She had a history of poorly controlled insulin-dependent diabetes as well as short stature. Abdominal imaging revealed impressive hepatomegaly. Laboratory testing showed markedly elevated triglycerides and cholesterol. Mauriac syndrome was suspected and diagnosed by liver biopsy, which demonstrated significant glycogenic hepatopathy.

Conclusions

This case provides an illustrative example of Mauriac syndrome in a child who did not experience delayed onset of puberty and continued to have regular menses unlike what has been previously described. Furthermore, this case highlights the important consideration for significant dyslipidemia in patients with Mauriac syndrome and discusses the challenges of controlling insulin-dependent diabetes in the adolescent population.
Issues beyond resistance: inadequate antibiotic therapy and bacterial hypervirulence
Authors: Goneau Lee W , Delport Johannes , Langlois Luana , Poutanen Susan M , Razvi Hassan , Reid Gregor , Burton Jeremy P
Published: October 2020

The administration of antibiotics while critical for treatment, can be accompanied by potentially severe complications. These include toxicities associated with the drugs themselves, the selection of resistant organisms and depletion of endogenous host microbiota. In addition, antibiotics may be associated with less well-recognized complications arising through changes in the pathogens themselves. Growing evidence suggests that organisms exposed to antibiotics can respond by altering the expression of toxins, invasins and adhesins, as well as biofilm, resistance and persistence factors. The clinical significance of these changes continues to be explored; however, it is possible that treatment with antibiotics may inadvertently precipitate a worsening of the clinical course of disease. Efforts are needed to adjust or augment antibiotic therapy to prevent the transition of pathogens to hypervirulent states. Better understanding the role of antibiotic-microbe interactions and how these can influence disease course is critical given the implications on prescription guidelines and antimicrobial stewardship policies.
Within- and Between-Person Relationships Among Health, Awareness of Aging, and Control Beliefs: A Microlongitudinal Study
Authors: Zhang Shenghao , Neupert Shevaun D
Published: October 2020

Objective

Control beliefs are bidirectionally related to physical and cognitive health, and control beliefs are associated with awareness of aging (subjective age and awareness of age-related change [AARC]), but it is unclear how these processes unfold within persons over time. We examine these relationships from both between- and within-person perspectives.

Methods: Older adults (n = 116) ranging in age from 60 to 90 (M = 64.71) completed a 9-day daily diary study online, resulting in 743 total days. Participants reported their sociodemographic characteristics on Day 1 and physical symptoms, memory failures, felt age, daily AARC gain and loss experiences, and control beliefs on Days 2–9.

Results

Within-person deviations from one’s typical awareness of aging (AARC losses, AARC gains, and subjective age) were associated with fluctuations in control beliefs. Multilevel mediation results showed that between-person AARC losses mediated the relationship between health (both physical symptoms and memory failures) and control beliefs, whereas both within- and between-person control beliefs mediated the relationship between physical health and AARC losses. Model fit comparisons showed that models with control beliefs mediating health and awareness of aging fit better than models with awareness of aging mediating health and control beliefs.

Discussion

Our findings suggest that within-person physical and cognitive health indicators were associated with awareness of aging indirectly through control beliefs. Although between-person differences in AARC losses may link health and control beliefs, our results suggest that a more consistent pattern involves control beliefs linking health and awareness of aging.
Promoting Britain’s fight: Duff Cooper’s 1939–40 lecture tour and American public opinion during the ‘Phoney War’
Authors: Hart Bradley W , Carr Richard
Published: October 2020

From October 1939 to March 1940, Conservative member of parliament Alfred Duff Cooper and his wife Diana toured the United States. Their public appearances drew thousands of audience members and provoked the ire of isolationists, but the true importance of the Coopers’ tour lay in the conversations they undertook with prominent Americans. This article examines the controversy surrounding the Coopers’ wartime tour of the U.S., the significance of the trip and the conclusions both drew from their visit. These would have a demonstrable impact on British public relations efforts, particularly after Duff Cooper’s appointment as minister of information.
The development of a flexible heart model for simulation-based training
Authors: Man Jelle , Maessen Jos , Sardari Nia Peyman
Published: October 2020

OBJECTIVES

Simulation-based training has shown to be effective in training new surgical skills. The objective of this study is to develop a flexible 3-dimensional (3D)-printed heart model that can serve as a foundation for the simulation of multiple cardiovascular procedures.

METHODS

Using a pre-existing digital heart model, 3D transoesophageal echocardiography scans and a thoracic CT scan, a full volume new heart model was developed. The valves were removed from this model, and the internal structures were remodelled to make way for insertable patient-specific structures. Groves at the location of the coronaries were created using extrusion tools in a computer-modelling program. The heart was hollowed to create a more flexible model. A suitable material and thickness was determined using prior test prints. An aortic root and valve was built by segmenting the root from a thoracic CT scan and a valve from a transoesophageal echocardiogram. Segmentations were smoothed, small holes in the valves were filled and surrounding structures were removed to make the objects suitable for 3D printing.

RESULTS

A hollow 3D-printed heart model with the wall thicknesses of 1.5 mm and spaces to insert coronary arteries, valves and aortic roots in various sizes was successfully printed in flexible material.

CONCLUSIONS

A flexible 3D-printed model of the heart was developed onto which patient-specific cardiac structures can be attached to simulate multiple procedures. This model can be used as a platform for surgical simulation of various cardiovascular procedures.
None of the Above: Protest Voting in the World's Largest Democracy
Authors: Ujhelyi Gergely , Chatterjee Somdeep , Szabó Andrea
Published: October 2020

Who are “protest voters” and do they affect elections? We study this question using the introduction of a pure protest option (“None Of The Above” (NOTA)) on Indian ballots. Using structural estimation, we find that in elections without NOTA, most protest voters simply abstain. Protest voters who turn out scatter their votes among many candidates and consequently have little impact on election results. From a policy perspective, NOTA may be an effective tool to increase political participation, and can attenuate the electoral impact of compulsory voting.
Intellectuals Debate #MeToo in China: Legitimizing Feminist Activism, Challenging Gendered Myths, and Reclaiming Feminism
Authors: Ling Qi , Liao Sara
Published: October 2020

This study focuses on the intellectual debate over #MeToo in China provoked by an article written by a well-known Chinese scholar and public intellectual Liu Yu. Raising such countervailing issues as women’s supposed complicity in sexual harassment and the drawbacks of digital activism in comparison with legal action, Liu’s article marked a crucial moment in the public awareness and discussion of #MeToo and digital activism in China in 2018. By analyzing the critical responses to Liu’s argumentations, we examined the discursive impact of these critical efforts to destabilize Liu’s hegemonic reading of the sexual harassment culture in China. We show how Liu’s critics offered a compelling defense of #MeToo, deconstructed enduring gendered myths, and had a significant impact in terms of reclaiming feminism in China. We argue further that the critics’ intellectual and deliberative efforts exemplify China’s local struggles in the global #MeToo movement and feminist activism.
Domains of Polarity Items
Authors: Homer Vincent
Published: October 2020

This article offers a unified theory of the licensing of Negative and Positive Polarity Items (PIs), focusing on the acceptability conditions of PPIs of the some-type, and NPIs of the any-type. It argues that licensing has both a syntactic and a semantic component. On the syntactic side, the acceptability of PIs is checked in constituents; in fact, for any given PI, only some constituents, referred to as `domains', are eligible for the evaluation of that PI. The semantic dimension of licensing consists in the sensitivity of PIs to the monotonicity properties of the syntactic environments they find themselves in. Two pieces of evidence support the semantic dimension of what I call the ‘environment-based’ approach defended here: (i.) PIs are subject to flip-flop and (ii.) certain inferences affect their acceptability by modifying the monotonicity of their environment. A third property, called ‘entanglement’ and so far unnoticed, is described: the acceptability of PIs depends on the acceptability of other PIs in the same syntactic environment. The latter property is exploited to determine what semantic property some is sensitive to: it turns out that, contrary to the consensus among researchers, some is acceptable in the complement of the set of environments in which any is acceptable, and vice versa.
Sociodevelopmental Challenges Faced by Young People with Chronic Pain: A Scoping Review
Authors: Jones Abigail , Caes Line , McMurtry C Meghan , Eccleston Christopher , Jordan Abbie
Published: October 2020

Objective

Map the current literature investigating autonomy development, identity development, and peer relationships in young people aged 10–24 years with chronic pain.

Methods

A scoping review method was used to systematically search four databases (APA PsycNET, PubMed, Web of Science, and Cinahl) for peer-reviewed articles. Search results were screened against inclusion and exclusion criteria to ensure they met the objective. Eligible papers were assessed for quality, their data relating to the objective were extracted, and results are synthesized.

Results

Searches returned 3,815 papers after the removal of duplicates, with 42 papers included in the full review. The majority of papers investigated peer relationships (86%). Fewer papers investigated autonomy (43%) and identity (21%) development. Included papers were mostly quantitative (64%), with fewer qualitative (34%) and mixed-methods papers (2%). Overall, we found bidirectional relationships between chronic pain in young people, their social development, and a range of functional outcomes. However, the mechanisms underlying these relationships remain relatively unexplored.

Conclusions

Review results are mapped onto the model proposed by Palermo et al. (2014). Guided by this model, clinical treatment for young people with chronic pain should consider social development. The model also sets out a future research agenda focused on exploring: (a) identity development, (b) the mechanisms underlying the relationships between social–developmental domains, pain, and outcomes, (c) a variety of participants and populations, and (d) a variety of methods, including longitudinal study designs.