bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of prediction value of four bleeding risk scores for pulmonary embolism with anticoagulation: A real‐world study in Chinese patients
Authors: Zhang Zhu , Lei Jieping , Zhai Zhenguo , Yang Yuanhua , Wan Jun , Xie Wanmu , Wang Chen
Published: January 2019

Background

Major bleeding (MB) and clinically relevant bleeding (CRB) are the most common seen complications associated with anticoagulation treatment for pulmonary embolism (PE) patients. A bleeding risk score (BRS) may help to accurately determine the risk of bleeding and make better decisions for patients in clinical practice.

Methods

Patients diagnosed as acute PE and who met the inclusion criteria in Beijing Chao‐Yang Hospital from January 2009 to September 2013 were consecutively enrolled. Baseline data were collected. Four BRS (Kuijer score, RIETE score, Kearon score and Nieuwenhuis score) were assessed and compared using the area under the receiver operating characteristic curve (AUC).

Results

A total number of 563 patients were included in the study. Of which, 16 had MB and 89 had CRB within three months of anticoagulation treatment. Three months' cumulative incidence for MB and CRB events was 0.03 (95% CI 0.01‐0.05) and 0.17 (95% CI 0.12‐0.21), respectively. In our study population, the AUCs for Kuijer, RIETE, Kearon and Nieuwenhuis scores were 0.57 (95% CI 0.44~0.68), 0.56 (95% CI 0.45‐0.71), 0.75 (95% CI 0.60~0.89) and 0.59 (95% CI 0.41~0.74), respectively. In addition, the AUCs of four BRS for CRB were all poor, with values less than 0.65.

Conclusions

Only the Kearon score appeared to have more accuracy in predicting the risk of MB. Further large prospective studies are needed to externally validate a BRS for CRB.
Temporal trends in survival following ward‐based NIV for acute hypercapnic respiratory failure in patients with COPD
Authors: Trethewey Samuel P. , Edgar Ross G. , Morlet Julien , Mukherjee Rahul , Turner Alice M.
Published: January 2019

Introduction

Non‐invasive ventilation (NIV) is recommended for treatment of acute hypercapnic respiratory failure (AHRF) in acute exacerbations of COPD. National UK audit data suggests that mortality rates are rising in COPD patients treated with NIV.

Objective

To investigate temporal trends in in‐hospital mortality in COPD patients undergoing a first episode of ward‐based NIV for AHRF.

Methods

Retrospective study of hospitalised COPD patients treated with a first episode of ward‐based NIV at a large UK teaching hospital between 2004 and 2017. Patients were split into two cohorts based on year of admission, 2004‐2010 (Cohort 1) and 2013‐2017 (Cohort 2), to facilitate comparison of patient characteristics.

Results

In total, 547 unique patients were studied. There was no difference in in‐hospital mortality rate between the time periods studied (17.6% vs 20.5%, P = .378). In Cohort 2 there were more females, a higher rate of co‐morbid bronchiectasis and pneumonia on admission and more severe acidosis, hypercapnia and hypoxia. More patients in Cohort 2 had NIV as the ceiling of treatment. Patients in Cohort 2 experienced a longer time from AHRF diagnosis to application of NIV, higher maximum inspiratory positive airway pressure, lower maximum oxygen and shorter duration of NIV. Finally, patients in Cohort 2 experienced a shorter hospital length of stay (LOS), with no differences observed in rate of transfer to critical care or intubation.

Conclusion

In‐hospital mortality remained stable and LOS decreased over time, despite greater comorbidity and more severe AHRF in COPD patients treated for the first time with ward‐based NIV.
Invasive pulmonary aspergillosis in patients with influenza infection: A retrospective study and review of the literature
Authors: Huang Linna , Zhang Nannan , Huang Xu , Xiong Shuyu , Feng Yingying , Zhang Yi , Li Min , Zhan Qingyuan
Published: January 2019

Introduction

There has been a rapid increase in the number of influenza and invasive pulmonary aspergillosis (IPA) co‐infection.

Objectives

To explore the risk factors and predictors of a poor prognosis in influenza and IPA co‐infection.

Methods

We included patients with confirmed influenza during the 2017‐2018 influenza season and cases of influenza and IPA co‐infection in the literature.

Results

A total of 64 patients with influenza infection were admitted to ICU. Of these patients, 18 were co‐infected with IPA. Others were assigned to the control group (n = 46). A total of 45 patients from the literature were added to the IPA group (n = 63). A multivariate logistic regression suggested that influenza patients who were given steroids after ICU admission, who had a white blood count (WBC) of more than 10*109/L on ICU admission and whose CT findings manifested as multiple nodules and cavities might have a higher risk of developing IPA. Compared to survivors, non‐survivors had higher sequential organ failure assessment (SOFA) scores (16 ± 4 points vs 8 ± 4 points, P < 0.001), lower CD4+ T cell counts on ICU admission [315 (83‐466) cells/μL vs 152 (50‐220) cells/μL, P = 0.031] and more requirement extracorporeal membrane oxygenation (ECMO) support [13 (50%) vs 7 (18.9%), P = 0.015].

Conclusions

Influenza patients who are given steroids after ICU admission, who have WBCs of greater than 10*109/L on ICU admission, and whose CT imaging shows multiple nodules and cavities might have a high risk of IPA. Higher SOFA scores, CD4+ T cell counts lower than 200 cells/μL on ICU admission and more ECMO requirement might be predictors of a poor prognosis.
Chylous ascites following laparoscopic live donor nephrectomy: A new improved treatment paradigm
Authors: Dale Leigh‐Anne , Sandoval Pedro Rodrigo , Ratner Lloyd E.
Published: January 2019

Chylous ascites is a difficult, albeit uncommon complication of laparoscopic live donor nephrectomy (LLDN). Lymphatic leak is believed to be a result of injury to the cisterna chyli, regional lymph nodes, or other peri‐aortic lymphatics intraoperatively. Recommended management with dietary modifications can result in malnutrition and immunodeficiency. We present four patients who developed chylous ascites following LLDN. Approach to these patients evolved over time. Our initial two patients were successfully treated with a combination of surgical intervention followed by drain placement, after the failure of conservative management. The latter two cases were successfully treated with prompt intra‐abdominal drain placement, without dietary modifications. Our cohort challenges the standard of care for treatment of chylous ascites after LLDN. We believe that prompt diagnosis and placement of an intra‐abdominal drain can be used safely in select patients that develop this complication. We hypothesize that continuously draining the lymphatic leak, thus avoiding the re‐accumulation of ascites, allows bowel and mesentery to make contact and adhere to the retroperitoneal tissue. We believe that prompt, initial, percutaneous drain placement is a viable alternative to both conservative and reoperative management in the treatment of chylous ascites after LLDN and should be considered as a reasonable first‐line therapy.
Successful case of cholangioscope‐assisted extraction of a radiolucent intrahepatic bile duct stent
Authors: Komiyama Satoshi , Hijioka Susumu , Okusaka Takuji
Published: January 2019

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Are melanocortin peptides future therapeutics for cutaneous wound healing?
Authors: Böhm Markus , Luger Thomas
Published: January 2019

Cutaneous wound healing is a complex process divided into different phases, that is an inflammatory, proliferative and remodelling phase. During these phases, a variety of resident skin cell types but also cells of the immune system orchestrate the healing process. In the last year, it has been shown that the majority of cutaneous cell types express the melanocortin 1 receptor (MC1R) that binds α‐melanocyte‐stimulating hormone (α‐MSH) with high affinity and elicits pleiotropic biological effects, for example modulation of inflammation and immune responses, cytoprotection, antioxidative defense and collagen turnover. Truncated α‐MSHpeptides such as Lys‐Pro‐Val (KPV) as well as derivatives like Lys‐d‐Pro‐Thr (KdPT), the latter containing the amino acid sequence 193‐195 of interleukin‐1β, have been found to possess anti‐inflammatory effects but to lack the pigment‐inducing activity of α‐MSH. We propose here that such peptides are promising future candidates for the treatment of cutaneous wounds and skin ulcers. Experimental approaches in silico,in vitro,ex vivo and in animal models are outlined. This is followed by an unbiased discussion of the pro and contra arguments of such peptides as future candidates for the therapeutic management of cutaneous wounds and a review of the so‐far available data on melanocortin peptides and derivatives in wound healing.
Judging the Other: The Intersection of Race, Gender, and Class in Family Court
Authors: Lens Vicki
Published: January 2019

This critical ethnographic study of family court child maltreatment proceedings describes and illuminates the ways in which racial, gender, and class disadvantages can manifest on the ground as judges, attorneys, social service workers, and parents—joined often by gender but split by race and class—adjudicate cases. The findings suggest that intersectionality worked in ways that exponentially marginalized poor mothers of color in the courtroom. They were marginalized both through the rules of the adversarial process (which silenced their voices) and through the construction of narratives (which emphasized individual weakness) over structural obstacles as well as personal irresponsibility over expressions of maternal care and concern. Standard due process courtroom practices also communicated bias or social exclusion, especially in a courtroom split by race and class.
Mass spectrometry‐based proteomics reveals the distinct nature of the skin proteomes of photoaged compared to intrinsically aged skin
Authors: Newton V.L. , Riba‐Garcia I. , Griffiths C.E.M. , Rawlings A.V. , Voegeli R. , Unwin R.D. , Sherratt M.J. , Watson R.E.B.
Published: January 2019

Objective

With increasing age, skin is subject to alterations in its organization, which impact on its function as well as having clinical consequences. Proteomics is a useful tool for non‐targeted, semi‐quantitative simultaneous investigation of high numbers of proteins. In the current study, we utilize proteomics to characterize and contrast age‐associated differences in photoexposed and photoprotected skin, with a focus on the epidermis, dermal–epidermal junction and papillary dermis.

Methods

Skin biopsies from buttock (photoprotected) and forearm (photoexposed) of healthy volunteers (aged 18–30 or ≥65 years) were transversely sectioned from the stratum corneum to a depth of 250 μm. Following SDS‐PAGE, each sample lane was segmented prior to analysis by liquid chromatography‐mass spectrometry/mass spectrometry. Pathway analysis was carried out using Ingenuity IPA.

Results

Comparison of skin proteomes at buttock and forearm sites revealed differences in relative protein abundance. Ageing in skin on the photoexposed forearm resulted in 80% of the altered proteins being increased with age, in contrast to the photoprotected buttock where 74% of altered proteins with age were reduced. Functionally, age‐altered proteins in the photoexposed forearm were associated with conferring structure, energy and metabolism. In the photoprotected buttock, proteins associated with gene expression, free‐radical scavenging, protein synthesis and protein degradation were most frequently altered.

Conclusion

This study highlights the necessity of not considering photoageing as an accelerated intrinsic ageing, but as a distinct physiological process.
Accuracy of detecting vertical root fractures in non‐root filled teeth using cone beam computed tomography: effect of voxel size and fracture width
Authors: Guo X. L. , Li G. , Zheng J. Q. , Ma R. H. , Liu F. C. , Yuan F. S. , Lyu P. J. , Guo Y. J. , Yin S.
Published: January 2019

Aim

To investigate simultaneously the effect of voxel size and fracture width on the accuracy of detecting vertical root fractures (VRFs) in non‐root filled teeth when using cone beam computed tomography.

Methodology

Fifty‐one of 161 extracted human permanent teeth (16 anterior teeth, 132 premolars and 13 mandibular molars) were selected randomly for VRF induction with two fracture widths. All teeth were scanned with four CBCT units at different voxel sizes provided by the units. Three observers classified the presence or absence of VRF using a 5‐point scale. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the ROC curve (AUC) were calculated. AUCs amongst voxel sizes and between the fracture widths were compared using the Z test. Intra‐ and inter‐observer agreement was assessed using weighted Cohen kappa.

Results

For the NewTom VGi and ProMax 3D Mid CBCT unit, no significant differences were found amongst voxel sizes for the AUCs, irrespective of the fracture width (P > 0.05). There were significant differences between images scanned with voxel size 250 and 160 μm (P = 0.02), and images scanned with voxel size 250 and 80 μm for AUCs in the narrow VRF group for the 3D Accuitomo 170 unit (P = 0.03). For i‐CAT FLX, significant differences were found between the voxel protocols of 300 μm and of the other three voxel sizes for AUC, sensitivity and NPV (P < 0.05). Significant differences between the wide and the narrow VRF groups for AUCs were found for 3D Accuitomo 170 (P = 0.01) and ProMax 3D Mid (P < 0.01).

Conclusions

Cone beam computed tomography was accurate for detecting VRF in non‐root filled teeth. Fracture width had an effect on the detection of VRF. The effect of the voxel size on the detection of VRF depended on the CBCT unit used.
HOW WELL DID SOCIAL SECURITY MITIGATE THE EFFECTS OF THE GREAT RECESSION?
Authors: Peterman William B. , Sommer Kamila
Published: January 2019

Using a computational life cycle model, this article assesses how Social Security affects the welfare of different types of individuals during the Great Recession. Overall, we find that Social Security reduces the average welfare losses for agents alive at the time of the Great Recession by the equivalent of 1.4% of expected future lifetime consumption. Moreover, we show that although the program mitigates some of the welfare losses for most agents, it is particularly effective at mitigating the losses for agents who are poorer and/or older at the time of the shock.
Factors affecting Modern Apprenticeship completion in Scotland
Authors: Greig Malcolm
Published: January 2019

Completing an apprenticeship has been shown to be critical to an individual’s future employment, earnings and career development when compared with apprentices who do not complete. International research, notably in England, Australia and Germany, has identified factors specific to the apprentice, employer and training provision that are associated with a higher chance of completion. However, to date, there has been no comparable research in Scotland, which operates its own distinct and well‐established apprenticeship system. Based on the factors identified in other countries, logistic regression was conducted on records of apprenticeship leavers in Scotland, covering the period from 2007 to 2015. Data for a total of 78,952 leavers were analysed, consisting of 59,737 completers and 19,215 non‐completers. It was found that women are more likely to complete an apprenticeship than men, while those from deprived areas are less likely to complete. Apprentices employed by a large employer, those receiving training from public sector organizations and those studying for selected technical subjects are more likely to complete, as are apprentices living in an area with a high local unemployment rate. The paper considers the reasons why some apprentices are more likely to complete than others and discusses the implications for apprenticeship policy in Scotland and beyond.
Training‐related dimensions of apprenticeship programmes in crisis‐ridden Greece: an exploratory study
Authors: Lalioti Varvara
Published: January 2019

Since the 2008 financial crisis there has been increased interest in apprenticeships in Greece, largely due to the perception that apprenticeships, in comparison to academic studies, may improve the employment prospects of young people. Before this time, there had been little interest in vocational education and training (VET) and consequently few efforts to develop the VET system. This exploratory article focuses on training, a crucial aspect of apprenticeship programmes, and offers a critical overview of key dimensions of the training content of apprenticeships in Greece. The article draws on the findings of a large‐scale, mostly qualitative research project (carried out between December 2015 and March 2017), which aimed at reviewing the Greek apprenticeship system and gathered, inter alia, the views of 150 individuals representing different groups of stakeholders. It is argued that, despite positive features, the training offered in Greek apprenticeships still suffers from severe shortcomings, which highlight the need for urgent reform and restructuring. Without such reform, the potential of the system to be an effective, alternative to the academic pathway or to boost employment will be seriously constrained.
An investigation into apprenticeship completion and retention in Northern Ireland: a social exchange perspective
Authors: Smyth Ian , Zimba Chilemwa
Published: January 2019

This paper investigates effective strategies for enhancing completion rates of apprentices and their retention after completing their training. The study was cross sectional and qualitative, involving semi‐structured interviews with managers and four focus groups involving current and completed apprentices from within the engineering sector. The findings revealed that the factors that can enhance intentions of completing an apprenticeship were perceived organisation support (POS) factors such as apprentice pay, recognition and employer support. Leader Member Exchange (LMX) factors such as support from trainers and supervisors, would increase their intentions to complete an apprenticeship and stay on with an organisation after training. The key Percieved Organisational Support factors that would enhance intentions to stay with the organisation after completion were post apprenticeship pay, career progression and challenging and interesting work. Participants with high Perceived Organisational Support and Leader‐Member Exchange, had higher intentions of completing an apprenticeship and staying with the employer after completion and vice versa. This research added to the literature on apprenticeships as it analysed the factors influencing current and completed apprentices’ intentions to discontinue or complete an apprenticeship and stay with or leave their employer after completion through the lens of social exchange theory (SET) (Blau, 1964). This is unlike previous studies that emphasised motivation theory. Social Exchange Theory was supported as both employers and apprentices weighed the costs and benefits of their relationship which impacted on their completion and retention choices. The implication of this study is that employers should develop effective strategies for enhancing completion and retention rates to reap the full benefits from apprenticeships.
Mixed alkali effects in Er3+‐doped borate glasses: Influence on physical, mechanical, and photoluminescence properties
Authors: Hu Qingliu , Wang Tongyao , Chu Yushi , Wang Xin , Du Yanqiu , Ren Jing , Yang Xinghua , Yang Guang , Kong Xueqian , Wang Pengfei
Published: January 2019

Engineering borate glass structure by simple compositional modification is essential to meet the particular demands from both industrial and photonic research communities. In this article, we demonstrate how the mixing of Li2O with Na2O, K2O, or Cs2O influences the relative abundance of 3‐ and 4‐coordinated borons in the glass network, as exhibited by nuclear magnetic resonance (NMR) and Raman spectra. A systematic study is given of the alkali mixing effect on the glass properties including: glass transition temperature, microhardness, density, refractive index, and particularly the near‐infrared photoluminescence properties (eg, bandwidth and lifetime) of Er3+ which has been barely studied in mixed alkali borate glasses. It is interesting to note that the glass transition temperature, refractive index and emission lifetime of Er3+ manifest mixed alkali effect, in sharp contrast with microhardness, density, and emission bandwidth which vary monotonically upon the alkali mixing. The possible causes for the differences are discussed in the light of the compositional dependence of boron species and nonbridging oxygen upon alkali mixing.
Ablation of ventricular arrhythmias with predominant monophasic “R” waves in precordial leads from the left sinus of Valsalva: Electrocardiographic and electrophysiologic characteristics
Authors: Yang Jian‐du , Sun Qi , Guo Xiao‐gang , Zhou Gong‐bu , Liu Xu , Luo Bin , Wei Hui‐qiang , Xie Hai‐yang , Liang Jackson J , Ma Jian
Published: January 2019

Background

While the left sinus of Valsalva (LSV) is a frequent origin of ventricular arrhythmias (VAs). Uncommonly, VAs with right bundle branch block (RBBB) morphology may be successfully terminated from the LSV.

Objective

We aimed to investigate the electrocardiographic and electrophysiologic characteristics of VAs with RBBB which were successfully eliminated from the LSV.

Methods

We identified patients with VAs successfully ablated from the LSV from January 2014 to December 2017 and compared electrophysiologic characteristics and ablation sites of those VAs with RBBB versus a control group of patients with left bundle branch block morphology.

Results

We identified 18 patients with RBBB and predominant “R” waves in the precordial leads. In 12 (66.7%) patients, a small “s” wave in lead V2 and positive “R” in the remaining pericardial leads could be seen. Overall, a single “V” potential was seen in 72.2% of patients in the study group, while discrete potentials were recorded in 80% of the patients in the control group. The majority (88.9%) of the VAs could only be terminated at the nadir of the LSV in the study group. After mean follow‐up of 33 ± 14 months, 93.8% and 92% were free of VAs after initial ablation in study and control group, respectively (P = 0.99).

Conclusion

Some VAs with predominant monophasic “R” wave in precordial leads could be terminated from LSV, especially a small “s” wave in lead V2 was recorded. The nadir of LSV is highly successful for RBBB VAs and single electrogram was recorded at the target for most of the cases.
Atrial fibrosis in non–atrial fibrillation individuals and prediction of atrial fibrillation by use of late gadolinium enhancement magnetic resonance imaging
Authors: Siebermair Johannes , Suksaranjit Promporn , McGann Christopher J , Peterson Kathryn A , Kheirkhahan Mobin , Baher Alex A , Damal Kavitha , Wakili Reza , Marrouche Nassir F , Wilson Brent D
Published: January 2019

Introduction

Besides the traditional concept of atrial fibrillation (AF) perpetuating atrial structural remodeling, there is increasing evidence that atrial fibrosis might precede AF, highlighting the need for better characterization of the fibrotic substrate. We aimed to assess atrial fibrosis by use of late gadolinium enhancement magnetic resonance imaging (LGE‐MRI) in non‐AF individuals and to identify predisposing risk factors. A second aim was to establish a risk score for the prevalence of AF using atrial fibrosis in addition to established clinical variables.

Methods and Results

Non‐AF individuals without structural heart disease (n = 91) and matched AF controls (n = 91) underwent MRI for assessment of LGE. According to the established UTAH classification, atrial LGE ≥20% was considered extensive.

Mean left atrial (LA) fibrosis in non‐AF and AF individuals were 8.8 ± 6.5% and 12.5 ± 5.8%, respectively. Body mass index (BMI) >30 kg/m
2 and LA volume were predictors of atrial fibrosis. Diastolic function was not significantly different with respect to atrial fibrosis. A novel scoring system for the prevalence of AF (2 points for arterial hypertension and/or left ventricular ejection fraction <55%; 3 points for atrial fibrosis >6%) was derived demonstrating that patients in the intermediate/high‐risk group had a significantly increased risk of AF.

Conclusion

This study reports unexpectedly high atrial fibrosis in non‐AF patients without apparent heart disease, highlighting the concept that structural fibrotic alterations may precede AF onset in a significant proportion of individuals. BMI as a predictor of atrial fibrosis suggests that lifestyle and drug intervention, that is, weight reduction, could positively influence fibrosis development. The derived risk score for AF prevalence provides the basis for prospective studies on AF incidence.
Catheter ablation of supraventricular tachycardia in patients with dextrocardia and situs inversus
Authors: Zhou Gong‐Bu , Ma Jian , Zhang Jin‐Lin , Guo Xiao‐Gang , Yang Jian‐Du , Liu Shu‐Wang , Ouyang Fei‐Fan
Published: January 2019

Background

Dextrocardia with situs inversus is a rare cardiac positional anomaly. Catheter ablation procedures performed in this set of patients have not been sufficiently reported.

Methods

A total of 10 patients with dextrocardia and situs inversus who received catheter ablation for supraventricular tachycardia (SVT) were included from a cohort of over 20 000 cases of catheter ablation for SVT in three centers from 2005 to 2016. All patients underwent electrophysiologic study and catheter ablation of SVT. Ablation targets were selected based on different tachycardia mechanisms with the primary endpoint of noninduction of tachycardia.

Results

The average age was 32.4 ± 5.6 years. Congenitally corrected transposition of great arteries (TGA) with situs inversus and D‐looping of the ventricles and aorta (congenitally corrected TGA {I,D,D}) was found in four patients, while the other six patients exhibited mirror‐image dextrocardia {I,L,L}. The mechanisms of SVT were atrioventricular nodal reentrant tachycardia in four patients, atrioventricular reentrant tachycardia in three, typical atrial flutter in one, intra‐atrial reentrant tachycardia in one, and focal atrial tachycardia in one. Immediate procedural success was achieved in 9 out of 10 patients with no procedural complications. During a follow‐up period of 6.3 ± 3.5 years on average, all patients remained free from recurrent tachycardia.

Conclusions

For patients with dextrocardia and situs inversus, catheter ablation of SVT is safe and feasible. Differences in catheter maneuver and fluroscopy projection, along with difficulties in distorted anatomy are major obstacles for successful ablation.
Early repolarization and risk of lone atrial fibrillation
Authors: Hasegawa Yuki , Watanabe Hiroshi , Ikami Yasuhiro , Otsuki Sou , Iijima Kenichi , Yagihara Nobue , Sato Akinori , Izumi Daisuke , Minamino Tohru
Published: January 2019

Introduction

Early repolarization syndrome is a recently proposed condition characterized by an early repolarization pattern in the electrocardiogram (ECG) and ventricular fibrillation in the absence of structural heart abnormalities. Although some studies have suggested that early repolarization is associated with frequency of atrial fibrillation, the association of early repolarization with atrial fibrillation is not well known.

Hypothesis

Early repolarization indicates the substrate for atrial fibrillation in addition to that for ventricular fibrillation.

Method

This study included 79 patients (57 men [72%]; age, 45 ± 12 years) aged less than 60 years who had paroxysmal lone atrial fibrillation and 395 age‐ and sex‐matched healthy controls (patient:control ratio, 1:5). Patients who had structural heart disease, hypertension, diabetes, hyperthyroidism, history of successful resuscitation, or the Brugada type ECG were excluded. ECGs recorded during sinus rhythm were compared between patients with atrial fibrillation and healthy controls.

Results

Early repolarization in the inferior and/or lateral leads was more common in patients with atrial fibrillation (25%) than controls (10%; P = 0.001). The location and magnitude of early repolarization were similar between the two groups. Other electrocardiographic measurements were not different between the two groups. Among patients with atrial fibrillation, there was no difference in clinical characteristics including age at atrial fibrillation development, sex, and body mass index between patients with early repolarization and those without early repolarization. Electrocardiographic measurements were not different between patients with early repolarization and those without early repolarization.

Conclusion

Early repolarization was associated with lone atrial fibrillation. Early repolarization may indicate increased susceptibility to atrial fibrillation.
Effects of dofetilide and ranolazine on atrial fibrillatory rate in a horse model of acutely induced atrial fibrillation
Authors: Carstensen Helena , Hesselkilde Eva Zander , Haugaard Maria Mathilde , Flethøj Mette , Carlson Jonas , Pehrson Steen , Jespersen Thomas , Platonov Pyotr G. , Buhl Rikke
Published: January 2019

Introduction

The atrial fibrillatory rate is a potential biomarker in the study of antiarrhythmic drug effects on atrial fibrillation (AF). The purpose of this study was to evaluate whether dose‐dependent changes in the atrial fibrillatory rate can be monitored on surface electrocardiography (ECG) following treatment with dofetilide, ranolazine, and a combination of the two in an acute model of AF in horses.

Methods and Results

Eight horses were subjected to pacing‐induced AF on 4 separate days. Saline (control), dofetilide, ranolazine, or a combination of dofetilide and ranolazine was administered in four incremental doses. Atrial fibrillatory activity was extracted from surface ECGs using spatiotemporal QRST cancellation. The mean atrial fibrillatory rate before drug infusion was 297 ± 27 fpm. Dofetilide reduced the atrial fibrillatory rate following the infusion of low doses (0.89 µg/kg, P < 0.05) and within 5 minutes preceding cardioversion (P < 0.05). Cardioversion with ranolazine was preceded by a reduction in the atrial fibrillatory rate in the last minute (P < 0.05). The combination of drugs reduced the atrial fibrillatory rate in a similar manner to dofetilide used alone. A trend toward a lower atrial fibrillatory rate before drug infusion was found among horses cardioverting on low doses of the drugs.

Conclusion

The atrial fibrillatory rate derived from surface ECGs showed a difference in the mode of action on AF between dofetilide and ranolazine. Dofetilide reduced the atrial fibrillatory rate, whereas ranolazine displayed a cardioverting mechanism that was distinct from a slowing of the fibrillatory process.
Pacing prescription for cardiac resynchronization therapy: When RV stimulation matters
Authors: Varma Niraj , Ghanem Raja , Jia Ping
Published: January 2019

Background

Cardiac resynchronization therapy (CRT) aims to correct delayed left ventricle (LV) activation resulting from left bundle branch block (LBBB). The source of LV activation delay resides in the septum and/or anterior LV. LV pacing, timed with intrinsic right bundle branch (RBB) conduction, may restore “physiological” biventricular activation. This is not assured because LV paced wavefronts themselves propagate unpredictably. Less studied are effects of right ventricle (RV) pacing on LV activation in heart failure (HF) patients with LBBB.

Methods and Results

In this case RV pacing pre‐excited precisely the region left behind during LV pacing. Consequently, biventricular pacing produced confluent LV depolarization (the patient “responded” to this with reverse remodeling).

Conclusion

Successful electrical resynchronization requires best combination and timing of paced/intrinsic wavefront(s). This demands individualization. Sometimes, an RV paced wavefront may be valuable to resynchronization.
Leadless pacemaker implant in patients with pre‐existing infections: Results from the Micra postapproval registry
Authors: El‐Chami Mikhael F. , Johansen Jens Brock , Zaidi Amir , Faerestrand Svein , Reynolds Dwight , Garcia‐Seara Javier , Mansourati Jacques , Pasquie Jean‐Luc , McElderry Hugh Thomas , Roberts Paul R. , Soejima Kyoko , Stromberg Kurt , Piccini Jonathan P.
Published: January 2019

Introduction

Leadless pacemakers may provide a safe and attractive pacing option to patients with cardiac implantable electronic device (CIED) infection. We describe the characteristics and outcomes of patients with a recent CIED infection undergoing Micra implant attempt.

Methods and Results

Patients with prior CIED infection and device explant with Micra implant within 30 days, were identified from the Micra post approval registry. Procedure characteristics and outcomes were summarized. A total of 105 patients with prior CIED infection underwent Micra implant attempt ≤30 days from prior system explant (84 [80%] pacemakers and 13 [12%] ICD/CRT‐D). All system components were explanted in 93% of patients and explant occurred a median of 6 days before Micra implant, with 37% occurring on the day of Micra implant. Micra was successfully implanted in 99% patients, mean follow‐up duration was 8.5 ± 7.1 months (range 0‐28.5). The majority of patients (91%) received IV antibiotics preimplant, while 42% of patients received IV antibiotics postprocedure. The median length of hospitalization following Micra implant was 2 days (IQR, 1‐7). During follow‐up, two patients died from sepsis and four patients required system upgrade, of which two patients received Micra to provide temporary pacing support. There were no Micra devices explanted due to infection.

Conclusion

Implantation of the Micra transcatheter pacemaker is safe and feasible in patients with a recent CIED infection. No recurrent infections that required Micra device removal were seen. Leadless pacemakers appear to be a safe pacing alternative for patients with CIED infection who undergo extraction.
The efficacy and safety of azithromycin in asthma: A systematic review
Authors: Tian Bao‐Ping , Xuan Nanxia , Wang Yesong , Zhang Gensheng , Cui Wei
Published: January 2019

Azithromycin is a potential therapeutic choice for asthma control, which is a heterogeneous airway inflammatory disease. Because of variable findings, we intend to evaluate the therapeutic effect and safety of azithromycin in asthma. Databases, including PubMed, EMBASE, Cochrane, and CNKI until 31 December 2017, were searched to identify available randomised controlled trials regarding azithromycin treatment for asthma. We identified seven studies involving 1520 cases that met our criteria. The mean difference for lung function (FEV1, FVC, PEF), symptom assessment (ACQ, AQLQ), airway inflammation, and risk ratios for adverse events were extracted. Chi‐square and I2 tests were applied to evaluate the heterogeneity among the studies towards each index with a random effect model or a fixed effect model. Pooled analysis shows that azithromycin administration results in no significant improvement in FEV1 (MD: 0.09, 95% CI −0.10 to 0.29, P = 0.36), PEF (MD: 11.76; 95% CI, −2.86 to 26.38, P = 0.11), total airway inflammatory cells (MD: −0.29; 95% CI, −1.38 to 0.80, P =  0.60), ACQ (MD: 0.05; 95% CI, −0.08 to 0.19, P = 0.44), and AQLQ (MD: 0.12; 95% CI, −0.02 to 0.26, P =  0.10). Moreover, no significant difference was detected in adverse events (Risk ratio 0.99; 95% CI, 0.82‐1.19, P = 0.90). These findings demonstrate no beneficial clinical outcome of azithromycin in asthma control, and we propose that further prospective cohorts are warranted.
RPS15A promotes gastric cancer progression via activation of the Akt/IKK‐β/NF‐κB signalling pathway
Authors: Liu Chenchen , He Xigan , Liu Xiaowen , Yu Jian , Zhang Meng , Yu Fudong , Wang Yanong
Published: January 2019

This study aimed to investigate the clinical significance, potential biological function and underlying mechanism of RPS15A in gastric cancer (GC) progression. RPS15A expression was detected in 40 pairs of GC tissues and matched normal gastric mucosae (MNGM) using qRT‐PCR analysis. Immunohistochemistry assay was conducted using a tissue microarray including 186 primary GC samples to characterize the clinical significance of RPS15A. A series of in vitro and in vivo assays were performed to elucidate the biological function of RPS15A in GC development and underlying molecular mechanisms. The expression of RPS15A was significantly up‐regulated in GC samples compared to MNGM, and its expression was closely related to TNM stage, tumour size, differentiation, lymph node metastasis and poor patient survival. Ectopic expression of RPS15A markedly enhanced the proliferation and metastasis of GC cells both in vitro and in vivo. RPS15A overexpression also promoted the epithelial‐mesenchymal transition (EMT) phenotype formation of GC cells. Investigations of underlying mechanisms found that RPS15A activated the NF‐κB signalling pathway by inducing the nuclear translocation and phosphorylation of the p65 NF‐κB subunit, transactivation of NF‐κB reporter and up‐regulating target genes of this pathway. In addition, RPS15A overexpression activated, while RPS15A knockdown inhibited the Akt/IKK‐β signalling axis in GC cells. And both Akt inhibitor LY294002 and IKK inhibitor Bay117082 neutralized the p65 and p‐p65 nuclear translocation induced by RPS15A overexpression. Collectively, our findings suggest that RPS15A activates the NF‐κB pathway through Akt/IKK‐β signalling axis, and consequently promotes EMT and GC metastasis. This newly identified RPS15A/Akt/IKK‐β/NF‐κB signalling pathway may be a potential therapeutic target to prevent GC progression.
Effect of socket‐shield technique on alveolar ridge soft and hard tissue in dogs
Authors: Zhang Zhengchuan , Dong Yu , Yang Jiamin , Xu Ruogu , Deng Feilong
Published: January 2019

Aim

To study the soft and hard tissue alterations of the alveolar ridge after socket‐shield technique.

Materials and Methods

In four Beagle dogs, the following treatments (Tx) were randomly assigned to 32 extraction sockets: Tx1: blood clot; Tx2: Bio‐Oss Collagen; Tx3: socket‐shield technique and blood clot; Tx4: socket‐shield technique and Bio‐Oss Collagen. The width and height alterations of the buccal bone plate were calculated by CBCT scans. The dimensional alterations of the buccal aspect of the alveolar ridge at different time points were calculated by impressions using digital imaging analysis. The dogs were sacrificed for micro‐CT and histologic analysis 3 months after surgery.

Results

Width, height and dimensional alterations of Tx3 and Tx4 were significantly lower than those of Tx1 and Tx2. Bone morphological parameters displayed no significant differences among four groups except for the trabecular thickness of Tx1 and Tx2. The quantity and quality of hard tissue containing the residual teeth of Tx3 and Tx4 were much greater than those of Tx1 and Tx2.

Conclusions

Socket‐shield technique may be beneficial in preserving the soft and hard tissue of the alveolar ridge, which is better than simple bone grafting in the extraction socket.
Periorbital pigmentation: An alarming sign of metabolic syndrome
Authors: Zawar Vijay , Daga Snehal , Pawar Manoj , Kumavat Shrikant
Published: January 2019

Periorbital pigmentation is a commonly encountered condition which presents clinically as bilateral round, oval or semicircular homogenous dark brown pigmented macules in the periocular region. It may influence quality of life of an individual with its strong psychological impact. We present a case of middle‐aged female patient, who had periorbital pigmentation as a manifestation of acanthosis nigricans. On evaluation, she was found to have hypertension, hyperglycemia, and dyslipidemia and she fulfilled the criteria for metabolic syndrome. We believe, it is important to evaluate the patients who present as periorbital pigmentation with clinical features of acanthosis nigricans for underlying metabolic syndrome.
Increased synthesis of hyaluronic acid by enhanced penetration of CTP‐EGF recombinant in human keratinocytes
Authors: Jeon Yoon‐Jae , Kim Young‐Hoon , Jeon Ye Ji , Lee Wan‐Won , Bae Il Geun , Yi Ki Wan , Hong Seung Ho
Published: January 2019

Background

Epidermal growth factor (EGF) plays an important role in regeneration and proliferation of skin cells. It synthesizes fibrous proteins, such as collagen, and induces the proliferation of keratinocytes and fibroblasts. It can also induce hyaluronic acid synthesis, which subsequently leads to improved skin elasticity, wrinkle improvement, and moisturizing effects. Thus, the EGF is an attractive cosmetic additive for skin care.

Objectives

We tested the use of cytoplasmic transduction peptide (CTP) as a delivery peptide for EGF into skin cells. Additionally, we characterized the skin permeability of CTP‐EGF for its potential use in skin antiaging and antiwrinkle cosmetics.

Methods

Skin penetration by recombinant CTP‐EGF protein was confirmed using fluorescent imaging techniques. The ability to synthesize hyaluronic acid was confirmed by immunoblotting and ELISA.

Results

CTP‐EGF displayed cell membrane permeability and could penetrate skin cells. Treatment with CTP‐EGF increased collagen protein formation, which is a major regulator of skin elasticity. Further, CTP‐EGF treatment led to increased expression of HAS3 enzyme and subsequently boosted hyaluronic acid synthesis. The CTP‐EGF also performed better than natural EGF in wound healing assays.

Conclusions

CTP‐EGF has a superior ability, compared with natural EGF, to permeate skin and induce hyaluronic acid synthesis and collagen formation. Thus, it has great potential to be used in cosmetics and therapeutic agents to improve wrinkles and health of the skin.
Effects of lactobionic acid peel, aluminum oxide crystal microdermabrasion, and both procedures on skin hydration, elasticity, and transepidermal water loss
Authors: Algiert‐Zielińska Barbara , Mucha Paulina , Rotsztejn Helena
Published: January 2019

Background

Topical applications of alpha‐hydroxy acids and poly hydroxy acids in the form of peels gained popularity. To enhance the effect of these substances, aluminum oxide crystal microdermabrasion can be used in one procedure.

Aims

The assessment of skin hydration, elasticity, and TEWL after using lactobionic acid in the form of 20% peel and lactobionic acid in the form of 20% peel combined with aluminum oxide crystal microdermabrasion.

Material and methods

The study involved 20 Caucasian female subjects. Six treatments were performed at weekly intervals, using the Split face method—20% LA was used on the left side of the face and aluminum oxide crystal microdermabrasion followed by 20% LA application on the right side of the face.

Results

Corneometric measurement showed statistically significant differences between the hydration level for sessions 1 and 3 and 1 and 6. A higher hydration level was found on the side with the combined procedure. Tewametric measurement showed that the TEWL values were different for sessions 1 and 3 and 1 and 6—they decreased. There were no statistically significant differences between the two procedures. The cutometric measurement indicated statistically significant differences between skin elasticity for pairs in session 1 and 3 and 1 and 6.

Conclusions

The results of the study indicate that the combination of LA peel with microdermabrasion increases its moisturizing effect and improves skin elasticity. The use of both procedures also contributed to the decrease in TEWL; however, greater exfoliation of the epidermis in combined procedures resulted in slightly higher TEWL values.
A comparison of infection rates during skin cancer excisions using nonsterile vs sterile gloves: A prospective randomized pilot study
Authors: Michener Michael , Xia Yang , Larrymore David , McGraw Timothy , McCarthy Sean
Published: January 2019

Background

Standard surgical skin excision is a routine outpatient procedure commonly performed in Dermatology practice to treat nonmelanoma and melanoma skin cancer. Use of sterile gloves during this procedure has been the standard of care in most Dermatology offices.

Objective

To determine whether the incidence of infection rates was affected when using nonsterile gloves (NSG) instead of sterile gloves (SG) during standard skin excisions in an outpatient Dermatology clinic setting.

Methods

This prospective, subject‐blinded, single‐center trial randomized 93 patients presenting for routine skin cancer excisions into two groups. In the first group, 53 excisions were performed with NSG and in the second group 53 excisions were performed with sterile gloves. Degree of wound inflammation and wound infection at 48‐72 hours postprocedure was measured.

Results

One hundred and six total wounds were included. Zero of 53 were infected in the NSG group, and 0/53 were infected in the SG at the initial screening 48‐72 hours postexcision procedure (P = 0.99). The average wound inflammation score was 0.321 for the NSG group and 0.245 for the SG group.

Conclusions

Our study suggests that NSG are safe to use for simple excisions of cutaneous skin cancers in an outpatient dermatology clinic setting.
Modified phenol peels for treatment‐refractory hyperpigmentation of lichen planus pigmentosus: A retrospective clinico‐dermoscopic analysis
Authors: Sonthalia Sidharth , Vedamurthy Maya , Thomas Mary , Goldust Mohamad , Jha Abhijeet K. , Srivastava Sakshi , Aggarwal Ishad
Published: January 2019

Background

Lichen Planus Pigmentosus (LPP), a disorder with stubborn treatment‐refractory hyperpigmentation predominantly affects the darker skin. Deep dermal pigmentary incontinence of LPP renders the condition treatment‐refractory.

Objectives

Lack of a consistently effective depigmenting treatment protocol of inactive LPP mandates exploration of novel approaches. We analyzed the effect of six sessions of modified phenol peel on reduction of pigmentation of LPP in Indian patients.

Methods

The results of a retrospective analysis of the efficacy and safety of six sessions of Croton oil free phenol combination (CFPC) peel done every 3 weeks, for inactive LPP‐associated hyperpigmentation in 17 patients are presented. Efficacy evaluation was done with patient‐reported improvement, physician‐evaluated improvement (photographic comparison of baseline and post‐treatment clinical images), and pre‐ and posttreatment comparison of dermoscopic images using a simple scale.

Results

Out of 17, 5 (29%) patients sustained excellent improvement with >75% reduction of pigmentation. Overall 13 (76%) patients had moderate to excellent improvement, that is, at least 25% or more reduction in pigmentation. The patient‐reported improvement, physician‐graded improvement, and dermoscopic changes—all three measures showed harmonious overlap. Lightening of the background color and reduction in density and color intensity of pigmented structures was observed on dermoscopy in majority of patients. The treatment was well tolerated with no serious local/systemic adverse effects.

Conclusions

Modified phenol peels seem effective in reduction of hyperpigmentation of LPP. They are safe and well tolerated. Thorough priming, stringent sun protection and use of post‐peel adjuvant topicals boost the peel effect and aid in maintaining the effect for up to a year.