bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and feasibility of transradial use of 8F balloon guide catheter Flowgate2 for endovascular thrombectomy in acute ischemic stroke
Authors: Martínez-Galdámez Mario , Schüller Miguel , Galvan Jorge , de Lera Mercedes , Kalousek Vladimir , Ortega-Gutierrez Santiago , Arenillas Juan F
Published: April 2021

Background

While Balloon Guide Catheters (BGC) have been shown to increase the rate of reperfusion during mechanical thrombectomy (MT), its implementation with transfemoral approach is at times limited due to unfavorable vascular anatomy.

Objective

to determine safety, feasibility and performance of the transradial use of 8 F BGC Flowgate 2 during mechanical thrombectomy procedures in patients with unfavorable vascular anatomies (type 3 or bovine arch) Material/Methods: We performed a retrospective cohort study of consecutive transradial mechanical thrombectomies performed with BGC Flowgate 2 between January and December 2019. Patient demographics, procedural and radiographic metrics, and clinical data were analyzed.

Results

20 (8.7%) out of 230 overall thrombectomy procedures underwent transradial approach using an 8 F BGC Flowgate. 2 Successful approach was achieved in 17/20 cases, and in 3 cases radial was switched to femoral, after failure. TICI 2 C/3 was achieved in 18 cases (90%), followed by TICI 2 b and 2a in 1 (5%) case respectively. The average number of passes was 1.8. The average radial puncture-to-first pass time was 22 min. Radial vasospasm was observed in 3/20 cases. The Flowgate 2 was found kinked in 4/20 cases (20%), all of them during right internal carotid procedures. There were no postprocedural complications at puncture site, as hematoma, pseudoaneurysm or local ischemic events

Conclusion

The use of 8 F Balloon Guide Catheter during MT via transradial approach might represent an alternative in selected cases with unfavorable vascular anatomies. Its use in right ICA catheterizations was associated with a high rate of catheter kinking.
Test Batteries After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review
Authors: Roe Chelsey , Jacobs Cale , Hoch Johanna , Johnson Darren L. , Noehren Brian
Published: April 2021

Context:

There is a lack of consensus regarding test batteries for return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR).

Objective:

To report the RTS test batteries for individuals after ACLR and to examine alignment with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC). Finally, to examine how published RTS batteries prior to the AAOS AUC (2010-2015) compared with those after publication of the AUC (2016-2020).

Data Source:

A systematic search of PubMed (2010-2020).

Study Selection:

Studies were included if they were published from 2010 to 2020, patients underwent primary ACLR and were tested between 6 months and 2 years postoperatively and included a minimum of 2 assessments. Studies were excluded if patients were tested outside the designated time; had undergone a revision, contralateral, or multiligament injury; included healthy participants; were level 5 evidence or the study was a systematic review. A total of 1012 articles were reviewed and 63 met the criteria.

Study Design:

Systematic review.

Level of Evidence:

Level 4.

Data Extraction:

Information regarding the RTS batteries and patient demographics were extracted from the included articles.

Results:

A total of 63 studies met the inclusion and exclusion criteria (22 from 2010-2015 and 41 from 2016-2020). The most common RTS batteries included the hop test, quadriceps strength test, and patient-reported outcome measures. No study met all 7 AUC; the most common criteria met were functional skills (98.4%), followed by confidence (22.2%), then range of motion and knee stability (20.6%).

Conclusion:

The test batteries in the current literature show high variability and a lack of essential components necessary for RTS. No study met the AUC guidelines, suggesting a disconnect between recommended guidelines and clinical practice. Test battery research has expanded over the past decade; however, standardized, clinically applicable batteries that encompass all criteria are needed.
MicroRNA-21 from bone marrow mesenchymal stem cell-derived extracellular vesicles targets TET1 to suppress KLF4 and alleviate rheumatoid arthritis
Authors: Li Guo-Qing , Fang Yu-Xuan , Liu Ying , Meng Fan-Ru , Wu Xia , Zhang Chun-Wang , Zhang Yu , Liu Yan-Qing , Liu Dan
Published: April 2021

Background:

Accumulating evidence has demonstrated that bone marrow mesenchymal stem cells (BMSCs)-derived extracellular vesicles (EVs) can be used effectively to transfer drugs and biomolecules to target lesions. Meanwhile, BMSCs have been reported to be beneficial in the treatment of rheumatoid arthritis (RA). In this study, we employ gain- and loss-of-function experiments to determine how BMSCs-derived EVs alleviate RA in vitro and in vivo.

Methods:

We isolated EVs from BMSCs and characterized them by transmission electron microscopy and western blot analysis. The regulatory relationship between miR-21 and TET1 was predicted by bioinformatics analysis and validated by dual luciferase assay. Next, we utilized bisulfite sequencing PCR to decipher how TET1 promoted KLF4 transcription. Then, we established an RA mouse model and determined the role of miR-21 in RA progression. Functional assays were used to validate the role the miR-21-TET1-KLF4 regulatory axis in controlling mouse fibroblast-like synoviocytes (mFLS) cell proliferation and inflammatory cytokines secretion in vitro.

Results:

RT-qPCR results revealed that miR-21 was highly expressed in BMSCs-derived EVs, and confirmed that BMSCs-derived EVs transferred miR-21 into mFLS cells. Bioinformatic analysis predicted that TET1 was the directly downstream target of miR-21, which was further validated by dual luciferase assay. TET1 promoted KLF4 promoter methylation to increase its expression. Collectively, BMSCs-derived EVs relieved RA by delivering miR-21, while the exosomal miR-21 alleviated RA through targeting the TET1/KLF4 regulatory axis.

Conclusion:

miR-21 from BMSCs-derived EVs suppresses KLF4 to relive RA by targeting TET1.
Patient experiences with videoconferencing as social contact and in follow-up from oncology nurses in primary health care
Authors: Nordtug Bente , Brataas Hildfrid Vikkelsmo , Rygg Lisbeth Ostgaard
Published: April 2021

Patients with various forms of cancer often have unmet psychosocial support needs. By interpretative phenomenological approach, this study aimed to acquire a deeper understanding of home-living patients with cancer’s experience and meaning from videoconferencing in oncological nursing follow-up in primary healthcare and contact with networks. Six patients from rural Norway participated. Three themes emerged: (1) From skepticism to videoconferencing-enthusiasm; (2) Oncology nurses ensured tablet mastery and delivered close follow-up; and (3) Oncology nurses helped ensure general social support using videoconferencing. Oncology follow-up care in rural areas using videoconferencing may enhance care availability and provision of psychosocial support meeting patients’ needs.
Determinants of Small-Scale Commercial Vegetable Farming Among Vegetable Growers in Nepal
Authors: Joshi Niraj Prakash , Piya Luni
Published: April 2021

Various socio-economic factors play important roles in the adoption of commercial vegetable farming. Understanding these factors is crucial in enhancing the existing low rate of vegetable commercialization in Nepal, thereby achieving the overall development goal of poverty reduction. This article analyzes the personal, technical, and business factors associated with the adoption using Nepal Vegetable Crops Survey 2009–2010 data. A probit analysis is carried out. Caste/ethnicity is a critical factor hindering the adoption in Nepal. An awareness program to facilitate marketing of vegetables produced by the socially disadvantaged caste/ethnic groups and targeting them in interventions would be helpful in enhancing the rate of vegetable commercialization. Similarly, facilitating access to technical factors, mainly technical assistance, chemical fertilizers, pesticides, and improved seeds, would promote commercial vegetable farming. Such interventions can be introduced in vegetable production potential areas of Hills and Tarai. Land consolidation might not be important. Rather, any program or policies to facilitate secure land-tenure, which encourages farmers to invest in land development, would boost vegetable commercialization. Similarly, identification of vegetable cultivation areas and provision of irrigation in those land parcels would be vital.
Alcohol Consumption in the Australian Mining Industry: The Role of Workplace, Social, and Individual Factors
Authors: James Carole L. , Tynan Ross J. , Bezzina Aaron T. , Rahman Md Mijanur , Kelly Brian J.
Published: April 2021

Background:

Coal miners have been reported to have higher rates of risky/harmful alcohol misuse; however, it is not known if metalliferous mining employees whose working conditions differ in workplace practices, also have increased rates of risky/harmful alcohol misuse. This study aimed to examine alcohol consumption in a sample of Australian metalliferous mining workers and to examine the demographic and workplace factors associated with risky/harmful alcohol use.

Methods:

All employees from a convenience sample of four Australian mine sites were invited to complete a paper-based cross-sectional survey between June 2015 and May 2017. The survey contained questions relating to social networks, health behaviors, psychological distress, demographic characteristics, and risky/harmful drinking. Current alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT), a validated measure of risky and/or harmful drinking. Factors associated with risky/harmful drinking were investigated using univariate and multivariable logistic regression.

Findings:

A total of 1,799 participants completed the survey (average site response rate 95%). Overall, 94.8% of males and 92.1% of females reported using alcohol in the preceding 12 months. The odds of risky/harmful alcohol use were significantly higher in those who were male, younger, and reported higher psychological distress.

Conclusions/Application to Practice:

This study identified that metalliferous mining employees engage in at-risk levels of alcohol consumption significantly higher than the national average despite workplace policies and practices that restrict alcohol use. Personal and workplace risk factors that may help target specific employee groups and inform the development of tailored, integrated multicomponent intervention strategies for the industry were identified.
Integrated Programmes in Education: Development and Current Status
Authors: Patra Krushna Chandra , Basantia Tapan Kumar
Published: April 2021

To meet the changing demands of the students and many other stakeholders of education in this twenty-first century, the education systems of different nations of the world are in the process of continuous paradigm shifts in their curriculum, methods of instruction, management, evaluation process and other related components. Integrated programmes in education may be considered as a kind of crop of these paradigm shifts. The integrated programmes have many advantages over traditional fragmented programmes in education. Integrated programmes allow the learners to pursue a holistic learning without the restrictions imposed by subject and/or level of learning boundaries. For achieving well-rounded and integrated development among the learners, integrated programmes play a significant role in the field of education. Focusing on these issues, in this present article, discussions are made mostly on conceptual analysis of integrated programmes, the world scenario of development and current status of integrated programmes and Indian scenario of development and current status of integrated programmes. The article is concluded by reflecting on the points that integrated programmes are the latest fashion in programme designing and implementation in education, and these programmes have better implication for achieving multidisciplinary and interdisciplinary skills. Also, in the concluding section of the article, reflections are made regarding measures to be taken at the government level and responsibilities to be shouldered at the level of educational institutions offering integrated programmes to popularize integrated programmes among the stakeholders of education and for establishing integrated programmes as vibrant and leading programmes in education.
A Backward Design Approach to Health Communication: Developing Health Literacy Skills During COVID-19
Authors: Bliss Kadi , Marsh Sabrina
Published: April 2021

This article describes an approach to addressing health literacy and the infodemic surrounding coronavirus disease 2019 (COVID-19) as a way to develop communication skills among students in an undergraduate public health program. The project was designed for an upper-level health communications course, but it could be adapted for any health education or public health course where health communication to address misinformation is an objective. It is well suited for face-to-face, online, and hybrid settings. This project utilizes several evidence-based pedagogical approaches, including backward design, use of open educational resources, and experiential learning. While the project described here focuses on COVID-19 and associated social media infographic development, the instructional strategies have been applied to other health issues in previous terms and can be easily adapted to any current health issue and communication product that will engage learners while developing communication competencies.
Sonographic Assessment of Human Lumbar Intervertebral Disks: A Cadaveric Study
Authors: Winn Naomi , Balain Birender , Ockendon Matthew , Cassar-Pullicino Victor , Lalam Radhesh
Published: April 2021

Objectives:

The intervertebral disk has traditionally been imaged by magnetic resonance imaging (MRI); however, advances in sonography mean it can now be visualized with this modality. The objectives of this human cadaveric study were to visualize the internal structure of the lumbar intervertebral disks and map any defects. Shear wave sonography was explored as a method for assessing the disks.

Materials and Methods:

In a human cadaver, L4-L5 and L5-S1 disks were imaged with sonography through the anterior abdominal wall and directly through the anterior longitudinal ligament. Gray-scale images and shear wave elastography velocities were obtained. An MRI was performed for image comparison.

Results:

Defects in the disks were clearly seen with sonography, imaging through the anterior abdominal wall and also directly through the anterior longitudinal ligament. The defects identified on sonography were less well visualized on MRI. Shear wave velocities could only be obtained from the anterior aspect of the disk and were unreliable, primarily owing to the stiffness of the tissues.

Conclusion:

Sonography can provide an accurate map of defects within the disk, corresponding with MRI. Shear wave elastography should be used with caution in the human cadaveric intervertebral disk, acknowledging the many confounding factors influencing the measurements.
Extracting knowledge networks from plant scientific literature: potato tuber flesh color as an exemplary trait
Authors: Singh Gurnoor , Papoutsoglou Evangelia A. , Keijts-Lalleman Frederique , Vencheva Bilyana , Rice Mark , Visser Richard G.F. , Bachem Christian W.B. , Finkers Richard
Published: April 2021

Background

Scientific literature carries a wealth of information crucial for research, but only a fraction of it is present as structured information in databases and therefore can be analyzed using traditional data analysis tools. Natural language processing (NLP) is often and successfully employed to support humans by distilling relevant information from large corpora of free text and structuring it in a way that lends itself to further computational analyses. For this pilot, we developed a pipeline that uses NLP on biological literature to produce knowledge networks. We focused on the flesh color of potato, a well-studied trait with known associations, and we investigated whether these knowledge networks can assist us in formulating new hypotheses on the underlying biological processes.

Results

We trained an NLP model based on a manually annotated corpus of 34 full-text potato articles, to recognize relevant biological entities and relationships between them in text (genes, proteins, metabolites and traits). This model detected the number of biological entities with a precision of 97.65% and a recall of 88.91% on the training set. We conducted a time series analysis on 4023 PubMed abstract of plant genetics-based articles which focus on 4 major Solanaceous crops (tomato, potato, eggplant and capsicum), to determine that the networks contained both previously known and contemporaneously unknown leads to subsequently discovered biological phenomena relating to flesh color. A novel time-based analysis of these networks indicates a connection between our trait and a candidate gene (zeaxanthin epoxidase) already two years prior to explicit statements of that connection in the literature.

Conclusions

Our time-based analysis indicates that network-assisted hypothesis generation shows promise for knowledge discovery, data integration and hypothesis generation in scientific research.
Direct modelling of age standardized marginal relative survival through incorporation of time-dependent weights
Authors: Lambert Paul C. , Syriopoulou Elisavet , Rutherford Mark R.
Published: April 2021

Background

When quantifying the probability of survival in cancer patients using cancer registration data, it is common to estimate marginal relative survival, which under assumptions can be interpreted as marginal net survival. Net survival is a hypothetical construct giving the probability of being alive if it was only possible to die of the cancer under study, enabling comparisons between populations with differential mortality rates due to causes other the cancer under study. Marginal relative survival can be estimated non-parametrically (Pohar Perme estimator) or in a modeling framework. In a modeling framework, even when just interested in marginal relative survival it is necessary to model covariates that affect the expected mortality rates (e.g. age, sex and calendar year). The marginal relative survival function is then obtained through regression standardization. Given that these covariates will generally have non-proportional effects, the model can become complex before other exposure variables are even considered.

Methods

We propose a flexible parametric model incorporating restricted cubic splines that directly estimates marginal relative survival and thus removes the need to model covariates that affect the expected mortality rates. In order to do this the likelihood needs to incorporate the marginal expected mortality rates at each event time taking account of informative censoring. In addition time-dependent weights are incorporated into the likelihood. An approximation is proposed through splitting the time scale into intervals, which enables the marginal relative survival model to be fitted using standard software. Additional weights can be incorporated when standardizing to an external reference population.

Results

The methods are illustrated using national cancer registry data. In addition, a simulation study is performed to compare different estimators; a non-parametric approach, regression-standardization and the new marginal relative model. The simulations study shows the new approach is unbiased and has good relative precision compared to the non-parametric estimator.

Conclusion

The approach enables estimation of standardized marginal relative survival without the need to model covariates that affect expected mortality rates and thus reduces the chance of model misspecification.
Validation of the Framingham hypertension risk score in a middle eastern population: Tehran lipid and glucose study (TLGS)
Authors: Koohi Fatemeh , Steyerberg Ewout W. , Cheraghi Leila , Abdshah Alireza , Azizi Fereidoun , Khalili Davood
Published: April 2021

Background

The Framingham hypertension risk score is a well-known and simple model for predicting hypertension in adults. In the current study, we aimed to assess the predictive ability of this model in a Middle Eastern population.

Methods

We studied 5423 participants, aged 20–69 years, without hypertension, who participated in two consecutive examination cycles of the Tehran Lipid and Glucose Study (TLGS). We assessed discrimination based on Harrell’s concordance statistic (c-index) and calibration (graphical comparison of predicted vs. observed). We evaluated the original, recalibrated (for intercept and slope), and revised (for beta coefficients) models.

Results

Over the 3-year follow-up period, 319 participants developed hypertension. The Framingham hypertension risk score performed well in discriminating between individuals who developed hypertension and those who did not (c-index = 0.81, 95% CI: 0.79–0.83). Initially, there was a systematic underestimation of the original risk score (events predicted), which was readily corrected by a simple model revision.

Conclusions

The revised Framingham hypertension risk score can be used as a screening tool in public health and clinical practice to facilitate the targeting of preventive interventions in high-risk Middle Eastern people.
Comparing malaria early detection methods in a declining transmission setting in northwestern Ethiopia
Authors: Nekorchuk Dawn M. , Gebrehiwot Teklehaimanot , Lake Mastewal , Awoke Worku , Mihretie Abere , Wimberly Michael C.
Published: April 2021

Background

Despite remarkable progress in the reduction of malaria incidence, this disease remains a public health threat to a significant portion of the world’s population. Surveillance, combined with early detection algorithms, can be an effective intervention strategy to inform timely public health responses to potential outbreaks. Our main objective was to compare the potential for detecting malaria outbreaks by selected event detection methods.

Methods

We used historical surveillance data with weekly counts of confirmed Plasmodium falciparum (including mixed) cases from the Amhara region of Ethiopia, where there was a resurgence of malaria in 2019 following several years of declining cases. We evaluated three methods for early detection of the 2019 malaria events: 1) the Centers for Disease Prevention and Control (CDC) Early Aberration Reporting System (EARS), 2) methods based on weekly statistical thresholds, including the WHO and Cullen methods, and 3) the Farrington methods.

Results

All of the methods evaluated performed better than a naïve random alarm generator. We also found distinct trade-offs between the percent of events detected and the percent of true positive alarms. CDC EARS and weekly statistical threshold methods had high event sensitivities (80–100% CDC; 57–100% weekly statistical) and low to moderate alarm specificities (25–40% CDC; 16–61% weekly statistical). Farrington variants had a wide range of scores (20–100% sensitivities; 16–100% specificities) and could achieve various balances between sensitivity and specificity.

Conclusions

Of the methods tested, we found that the Farrington improved method was most effective at maximizing both the percent of events detected and true positive alarms for our dataset (> 70% sensitivity and > 70% specificity). This method uses statistical models to establish thresholds while controlling for seasonality and multi-year trends, and we suggest that it and other model-based approaches should be considered more broadly for malaria early detection.
Relationship between parents’ health literacy and children’s sleep problems in Japan
Authors: Ono Sae , Ogi Hiroto , Ogawa Masato , Nakamura Daisuke , Nakamura Teruhiko , Izawa Kazuhiro P.
Published: April 2021

Background

Sleep problems in preschool children can stunt their health and growth. However, the factors that cause sleep problems in children are not well understood. The aim of this study was to determine the relationship between parents’ health literacy (HL) and children’s sleep problems. The study was conducted at two kindergartens, two nursery schools, and a center for early childhood education in Chitose-city, Hokkaido, Japan.

Method

This study used a multicenter cross-sectional design. The sample comprised 354 preschoolers (aged 3–6 years) and their parents. In families with two or more children attending the same facility, only the oldest child was asked to participate in the study. Exclusion criteria included participants whose completed questionnaires had missing values. Children’s sleep problems were assessed using the Japanese version of the Children’s Sleep Habits Questionnaire (CSHQ-J). Parents’ HL was assessed using the 14-item Health Literacy Scale (HLS-14). The parents were classified into two groups (high HL group and low HL group). Multiple regression modelling was used to determine the association between HLS-14 and CSHQ-J scores.

Results

Of the 354 parents, 255 (72%) were in the high HL group and 99 (28%) in the low HL group. The mean CSHQ-J score was significantly lower in the high HL group than in the low HL group (45.3 ± 6.0 points vs. 46.8 ± 5.9 points, p = 0.043). In multiple regression analyses, parents’ HL was independently associated with their CSHQ-J score after adjusting for all confounding factors (adjusted R2 = 0.22, β = − 0.11; p = 0.043).

Conclusions

Parents’ HL appears to affect their children’s sleep problems. This finding suggests that parents’ HL may be a target for intervention to improve children’s sleep problems.
Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study
Authors: Maruyama Tetsuji , Mizuno Kentaro , Nishio Hidenori , Kato Taiki , Hamakawa Takashi , Ikegami Yosuke , Yasui Takahiro , Hayashi Yutaro
Published: April 2021

Background

To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in post-pubertal patients with dilated ureteral orifice via modified hydrodistension implantation techniques.

Methods

We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer/hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively.

Results

From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range 15–61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in 1 ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Median follow-up duration was 23 (range 13–63) months long. Although, 3 patients were experienced f-UTI 1–2 times, repeated VCUG showed no VUR recurrence.

Conclusions

According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in post-pubertal female patients with dilated ureteral orifice. While ureteral deformities or a history of anti-reflux surgery may increase the risks, these can be managed with appropriate methods that ensure sufficient mound appearance and height.
Real-world data on metabolic effects of PCSK9 inhibitors in a tertiary care center in patients with and without diabetes mellitus
Authors: Fischer Laurenz T. , Hochfellner Daniel A. , Knoll Lisa , Pöttler Tina , Mader Julia K. , Aberer Felix
Published: April 2021

Background

The lipid-lowering and positive cardiovascular effect of proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors was shown in several studies, hence, they are more widely used in the lipid-lowering management of individuals with high cardiovascular risk. As real-world data are still scarce, specifically in patients with type 2 diabetes (T2D), the aim of this retrospective analysis was to investigate the efficacy of PCSK9 inhibitors in lowering low-density lipoprotein cholesterol (LDL-C) in an outpatient clinic of a tertiary care center in routine care.

Methods

A retrospective analysis of data extracted from the electronic patient record was performed. Patients who were routinely prescribed with PCSK9 inhibitor therapy (alirocumab or evolocumab) during the years 2016 and 2019 were included in the analysis. Characteristics of the patient population, the effects on LDL-C and HbA1c levels as well as subsequent cardiovascular events were assessed over an observation period of 18 months.

Results

We identified 237 patients treated with PCSK9 inhibitors between January 2016 and September 2019. Almost all patients (97.5%) received PCSK9 inhibitors for secondary prevention. 26.2% of the population had a concomitant diabetes diagnosis. Intolerance to statins (83.1%), ezetimibe (44.7%) or both agents (42.6%) was reported frequently. Three months after initiation of PCSK9 inhibitor therapy, 61.2% of the patients achieved LDL-C levels < 70 mg/dl, and 44.1% LDL-C levels < 55 mg/dl. The median LDL-C was lowered from 141 mg/dl at baseline, to 60 mg/dl after 3 months and 66 mg/dl after 12 months indicating a reduction of LDL-C as follows: 57.5% after 3 months and 53.6% after 12 months. After 3 months of observation, target achievement of LDL-C was higher in patients with T2D compared to non-diabetes patients; < 55 mg/dl: 51% vs. 41.5%; < 70 mg/dl 69.4 vs. 58.5%. After 12 months even more pronounced target LDL achievement in T2D was demonstrated < 55 mg/dl: 58.8% vs. 30.1%; < 70 mg/dl 70.6 vs. 49.6%. Patients with insufficiently controlled T2D (HbA1c > 54 mmol/mol) had a higher reduction in LDL-C but still were more likely to subsequent cardiovascular events.

Conclusions

Significant reductions in LDL-C and a high percentage of patients achieving recommended treatment targets were observed. The percentage of patients with T2D meeting recommended LDL-C targets was higher than in those without T2D. Still some patients did not achieve LDL-C levels as recommended in current guidelines. Special attention to the characteristics of these patients is required in the future to enable achievement of treatment goals and avoid adverse cardiovascular outcomes.
Mitral early-diastolic inflow peak velocity (E)-to-left atrial strain ratio as a novel index for predicting elevated left ventricular filling pressures in patients with preserved left ventricular ejection fraction
Authors: Zhou You , Zhao Cai-Ming , Shen Zhen-Ya , Zhao Xin , Zhou Bing-Yuan
Published: April 2021

Objectives

We sought to explore the relationship between an index of left ventricular diastolic function parameters combined with left atrial strain and the diastolic function of patients with preserved ejection fraction.

Methods

We prospectively enrolled 388 patients with left ventricular ejection fraction (LVEF) ≥ 50%, 49 of whom underwent left heart catherization. Transthoracic echocardiography was performed within 12 h before or after the procedure. Left atrial (LA) strain was obtained by speckle tracking echocardiography. These patients served as the test group. The remaining patients (n = 339) were used to validate the diagnostic performance of the mitral early-diastolic inflow peak velocity (E)-to-left atrial reservoir strain ratio (E/LASr) in left ventricular diastolic dysfunction.

Results

Invasive measurements of LV end-diastolic pressure (LVEDP) demonstrated that the E/LASr ratio was increased in patients with elevated LVEDP [ 2.0 (1.8–2.2) vs 3.0 (2.6–4.0),p < 0.001] in the test group (n = 49). After adjusting for age, mitral A, E/e' ratio and β-blocker use, the E/LASr ratio was an independent predictor of elevated LVEDP and showed good diagnostic performance in determining elevated LVEDP [area under the curve (AUC) 0.903, cutoff value 2.7, sensitivity 74.2%, specificity 94.4%]. In the validation group (n = 339), the E/LASr ratio also performed well in diagnosing elevated left atrial pressure (LAP) (AUC 0.904, cutoff value 3.2, sensitivity 76.5%, specificity 89.0%), while with a cut-off value of 2.7, the E/LASr ratio showed high accuracy in discriminating elevated LAP. In addition, E/LASr was a good index of excellent diagnostic utility (AUC: 0.899 to 0.996) in the categorization of diastolic dysfunction grades. Regarding the clinical relevance of this index, the E/LASr ratio could accurately diagnose HF with preserved ejection fraction (HFpEF) (0.781), especially in patients with “indeterminate” status (AUC: 0.829). Furthermore, an elevated E/LASr ratio was significantly associated with the risk of rehospitalization due to major adverse cardiac events (MACEs) within one year (odds ratio: 1.183, 95% confidence interval: 1.067, 1.312).

Conclusions

In patients with EF preservation, the E/LASr ratio is a novel index for assessing elevated left ventricular filling pressure with high accuracy.
Classroom-based cognitive behavioural therapy: a large-scale non-randomised controlled trial of the ‘Journey of the Brave’
Authors: Urao Yuko , Ohira Ikuyo , Koshiba Takako , Ishikawa Shin-ichi , Sato Yasunori , Shimizu Eiji
Published: April 2021

Background

In Japan, ‘Journey of the Brave’, a cognitive behavioural therapy (CBT)-based anxiety preventive education programme, was previously developed and its effectiveness examined in two small-scale controlled trials. These studies had some limitations, including a small number of participants and not having regular classroom teachers as programme facilitators. Therefore, we conducted a large-scale controlled trial, with teachers as programme implementers.

Methods

Twenty-seven elementary schools participated: 1622 and 1123 children were allocated to the intervention and control groups, respectively. The intervention group received a programme comprising ten 45-min sessions, while the control group underwent the regular school curriculum. Anxiety symptoms among participants were assessed using the Spence Children’s Anxiety Scale (SCAS) at three stages (pre-intervention, post-intervention, and follow-up).

Results

Following primary analysis, estimated mean changes in SCAS from baseline to follow-up were − 4.91 (95% CI − 5.91, − 3.90) in the intervention group and − 2.53 (95% CI − 3.52, − 1.54) in the control group; the group difference was 2.37 (95% CI 1.42, 3.33, p < 0.0001). Children in the intervention group showed significant reduction in their anxiety score versus children in the control group.

Conclusions

The results showed a statistically significant anxiety score reduction in the intervention group, thus verifying the programme’s effectiveness.

Trial registration The University Hospital Medical Information Network (UMIN): UMIN000032517. Registered 10 May 2018—Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037083
Health related quality of life and psychological parameters in different polycystic ovary syndrome phenotypes: a comparative cross-sectional study
Authors: Fatemeh Bahadori , Shahideh Jahanian Sadatmahalleh , Negin Mirzaei
Published: April 2021

Background

Polycystic Ovary Syndrome (PCOS) is associated with high levels of phsychological implications and detriments to Quality of Life (QoL). The aim of this study was to assess Health- Related Quality of Life (HRQoL), depression, and anxiety in Iranian women with different PCOS phenotypes.

Methods

The present observational, cross-sectional study was carried out on 239 PCOS women who were classified on the basis of Rotterdam criteria into four categories: A (n = 77), B (n = 38), C (n = 68), and D (n = 56). They asked to fill out three questionnaires, namely, HRQoL, SF-12, and HADS.

Results

No significant differences were observed between the four PCOS phenotypes for anxiety, depression and QoL, as well as HRQoL domains related to infertiliy, weight and emotional problems (P > 0.05). Phenotypes A and B had worse HRQoL related to hirsutism (13.98 ± 5.22, 14.13 ± 6.23, P < 0.001). In addition, no significant differences were observed between them for HRQoL domains. While the score of acne in phenotype D (19.60 ± 5.12, P = 0.003) and menstrual score in phenotype C were significantly higher comparing to the other PCOS groups (16.82 ± 3.87, P < 0.001).

Conclusion

Presenting similar psychological profiles in all phenotypes unveils the importance of pychological well-being screening, even in milder reproductive phenotypes.
Subtyping Salmonella isolated from pet dogs with multilocus sequence typing (MLST) and clustered regularly interspaced short palindromic repeats (CRISPRs)
Authors: Yang Cheng , Shao Wangfeng , Wei Lingling , Chen Lingxiao , Zhu Aihua , Pan Zhiming
Published: April 2021

Salmonella, as a zoonotic pathogen, has attracted widespread attention worldwide, especially in the transmission between household pets and humans. Therefore, we investigated the epidemic distribution of dog Salmonella from pet hospitals and breeding base in Xuzhou, Jiangsu Province, China, and used multilocus sequence typing (MLST) and clustered regularly interspaced short palindromic repeats (CRISPRs) to subtype Salmonella isolates. From April 2018 to November 2019, a total of 469 samples were collected from pet hospitals and breeding base, including 339 dog samples and 60 cat samples. S. Kentucky (40.74%) was the most prevalent serotype, but other, such as S. Typhimurium (18.52%) and S. Indiana (18.52%), were also widespread. Eight different sequence type (ST) patterns were identified by MLST and ST198 was the highest proportion of these isolates. CRISPRs analysis showed that 9 different Kentucky CRISPR types (KCTs) was identified from ST198. 48 spacers including 29 (6 News) for CRISPR1 and 19 (4 News) for CRISPR2 that proved the polymorphic of Salmonella genes in samples from different sources. The analysis demonstrated that the common serotypes were widely present in pet hosts in the same area. This analysis shows that CRISPR genes have better recognition ability in the same serotype, which has a positive effect on the traceability of Salmonella and the prevention and treatment of salmonellosis.
The impact of the COVID-19 pandemic on mental health in the general population: a comparison between Germany and the UK
Authors: Knolle Franziska , Ronan Lisa , Murray Graham K.
Published: April 2021

Background

The COVID-19 pandemic has led to dramatic social and economic changes in daily life. First studies report an impact on mental health of the general population showing increased levels of anxiety, stress and depression. In this study, we compared the impact of the pandemic on two culturally and economically similar European countries: the UK and Germany.

Methods

Participants (UK = 241, German = 541) completed an online-survey assessing COVID-19 exposure, impact on financial situation and work, substance and media consumption, mental health using the Symptom-Check-List-27 (SCL-27) and the Schizotypal Personality Questionnaire.

Results

We found distinct differences between the two countries. UK responders reported a stronger direct impact on health, financial situation and families. UK responders had higher clinical scores on the SCL-27, and higher prevalence. Interestingly, German responders were less hopeful for an end of the pandemic and more concerned about their life-stability.

Conclusion

As 25% of both German and UK responders reported a subjective worsening of the general psychological symptoms and 20–50% of German and UK responders reached the clinical cut-off for depressive and dysthymic symptoms as well as anxieties, it specifically shows the need for tailored intervention systems to support large proportions of the general public.
Multilocus phylogeography and ecological niche modeling suggest speciation with gene flow between the two Bamboo Partridges
Authors: Wang Pengcheng , Yeh Chiafen , Chang Jiang , Yao Hongyan , Fu Yiqiang , Yao Chengte , Wang Xiao , Li Shouhsien , Zhang Zhengwang
Published: April 2021

Background

Understanding how species diversify is a long-standing question in biology. The allopatric speciation model is a classic hypothesis to explain the speciation process. This model supposes that there is no gene flow during the divergence process of geographically isolated populations. On the contrary, the speciation with gene flow model supposes that gene flow does occur during the speciation process. Whether allopatric species have gene flow during the speciation process is still an open question.

Methods

We used the genetic information from 31 loci of 24 Chinese Bamboo Partridges (Bambusicola thoracicus) and 23 Taiwan Bamboo Partridges (B. sonorivox) to infer the gene flow model of the two species, using the approximate Bayesian computation (ABC) model. The ecological niche model was used to infer the paleo-distribution during the glacial period. We also tested whether the two species had a conserved ecological niche by means of a background similarity test.

Results

The genetic data suggested that the post-divergence gene flow between the two species was terminated before the mid-Pleistocene. Furthermore, our ecological niche modeling suggested that their ecological niches were highly conserved, and that they shared an overlapping potential distribution range in the last glacial maximum.

Conclusions

The allopatric speciation model cannot explain the speciation process of the two Bamboo Partridges. The results of this study supported a scenario in which speciation with gene flow occurring between the allopatric species and have contributed to our understanding of the speciation process.
Carriage of upper respiratory tract pathogens in rural communities of Sarawak, Malaysian Borneo
Authors:   on behalf of the MYCarriage group, Morris Denise E. , McNeil Hannah , Hocknell Rebecca E. , Anderson Rebecca , Tuck Andrew C. , Tricarico Serena , Norazmi Mohd Nor , Lim Victor , Siang Tan Cheng , Lim Patricia Kim Chooi , Wie Chong Chun , Cleary David W. , Yap Ivan Kok Seng , Clarke Stuart C.
Published: April 2021

Introduction

Pneumonia is a leading cause of death in Malaysia. Whilst many studies have reported the aetiology of pneumonia in Western countries, the epidemiology of pneumonia in Malaysia remains poorly understood. As carriage is a prerequisite for disease, we sought to improve our understanding of the carriage and antimicrobial resistance (AMR) of respiratory tract pathogens in Malaysia. The rural communities of Sarawak are an understudied part of the Malaysian population and were the focus of this study, allowing us to gain a better understanding of bacterial epidemiology in this population.

Methods

A population-based survey of bacterial carriage was undertaken in participants of all ages from rural communities in Sarawak, Malaysia. Nasopharyngeal, nasal, mouth and oropharyngeal swabs were taken. Bacteria were isolated from each swab and identified by culture-based methods and antimicrobial susceptibility testing conducted by disk diffusion or E test.

Results

140 participants were recruited from five rural communities. Klebsiella pneumoniae was most commonly isolated from participants (30.0%), followed by Staphylococcus aureus (20.7%), Streptococcus pneumoniae (10.7%), Haemophilus influenzae (9.3%), Moraxella catarrhalis (6.4%), Pseudomonas aeruginosa (6.4%) and Neisseria meningitidis (5.0%). Of the 21 S. pneumoniae isolated, 33.3 and 14.3% were serotypes included in the 13 valent PCV (PCV13) and 10 valent PCV (PCV10) respectively. 33.8% of all species were resistant to at least one antibiotic, however all bacterial species except S. pneumoniae were susceptible to at least one type of antibiotic.

Conclusion

To our knowledge, this is the first bacterial carriage study undertaken in East Malaysia. We provide valuable and timely data regarding the epidemiology and AMR of respiratory pathogens commonly associated with pneumonia. Further surveillance in Malaysia is necessary to monitor changes in the carriage prevalence of upper respiratory tract pathogens and the emergence of AMR, particularly as PCV is added to the National Immunisation Programme (NIP).
Apoptosis is a generator of Wnt-dependent regeneration and homeostatic cell renewal in the ascidian Ciona
Authors: Jeffery William R. , Gorički Špela
Published: April 2021

In the ascidian Ciona intestinalis, basal body parts regenerate distal structures but distal body parts do not replace basal structures. Regeneration involves the activity of adult stem cells in the branchial sac, which proliferate and produce migratory progenitor cells for tissue and organ replacement. Branchial sac-derived stem cells also replenish recycling cells lining the pharyngeal fissures during homeostatic growth. Apoptosis at injury sites occurs early during regeneration and continuously in the pharyngeal fissures during homeostatic growth. Caspase 1 inhibitor, caspase 3 inhibitor, or pan-caspase inhibitor Z-VAD-FMK treatment blocked apoptosis, prevented regeneration, and suppressed branchial sac growth and function. A pharmacological screen and siRNA-mediated gene knockdown indicated that regeneration requires canonical Wnt signaling. Wnt3a protein rescued both caspase-blocked regeneration and branchial sac growth. Inhibition of apoptosis did not affect branchial sac stem cell proliferation but prevented the survival of progenitor cells. After bisection across the mid-body, apoptosis occurred only in the regenerating basal fragments, although both fragments contained a part of the branchial sac, suggesting that apoptosis is unilateral at the wound site and the presence of branchial sac stem cells is insufficient for regeneration. The results suggest that apoptosis-dependent Wnt signaling mediates regeneration and homeostatic growth in Ciona.