bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct carotid exposure approach in the treatment of anterior circulation unruptured intracranial aneurysms for elderly patients
Authors: Maruyama Fumiaki , Ishibashi Toshihiro , Kato Naoki , Karagiozov Kostadin , Kan Issei , Kodama Tomonobu , Murayama Yuichi
Published: January 2021

Background and purpose

The direct carotid exposure approach (DCEA) is a technical option for elderly patients with severe vessel tortuosity due to arteriosclerosis. We evaluated complications related to antiplatelet/anticoagulant management and compared the DCEA to standard transfemoral/transbrachial approaches (TFBA) in the treatment of unruptured intracranial aneurysms for elderly patients.

Methods

From August 2017 to August 2020, 52 patients (53 procedures) aged over 75 years with unruptured aneurysms in the anterior circulation were treated at our institution. All patients received dual antiplatelet drugs before the procedure. Eleven patients (21.2%) (12 procedures) were treated with the DCEA. The rest were treated with TFBA. The main indication of the DCEA was an unfavorable aortic arch or vessel tortuosity. Complications and the duration of the procedure were compared between the two groups.

Results

There were no significant differences between the two groups in age, aneurysm location, preoperative antiplatelet use, heparin use, or maximum activated clotting time (ACT) values. All endovascular treatments were successfully performed by DCEA. Among all parameters, the DCEA group had only bigger average aneurysm diameter (14 mm) and higher number of pipeline embolic device (PED) placement (58%). Time to the guiding-catheter placement was not significantly different between the groups (DCEA vs TFBA = 31.0 min vs 24.7 min, p = 0.178).　No significant complications of DCEA, such as subcutaneous hematomas, were observed.　

Conclusion

Even with the use of antiplatelet and anticoagulation therapy, the DCEA can be performed safely for unruptured aneurysms in elderly patients.
School middle leadership: A systematic review
Authors: Lipscombe Kylie , Tindall-Ford Sharon , Lamanna Jodi
Published: January 2021

School middle leadership is a complex and increasingly important school leadership position, with research showing the significance of middle leadership to school improvement and teacher development. The purpose of this article is to identify and analyse empirical peer reviewed articles on middle leadership from 2006 to 2020, to understand how middle leaders are defined, the responsibilities they hold, the impact and professional development they are afforded, and to discover lacunae in studies to support further research. The review was conducted using Scopus and ERIC; a total of 35 articles across 14 countries were selected. Using Nvivo, narrative synthesis was utilised to analyse the articles resulting in four conclusions: 1) middle leadership is difficult to define; 2) middle leadership positions and responsibilities vary considerably and are best understood in context; 3) middle leaders directly and indirectly impact teacher practice, team development, school reform and professional learning, although there is limited direct research into their impact; and 4) middle leadership professional learning has not progressed to the point to adequately equip middle leaders for the complexity of their positions. The article highlights two distinguishable differences to separate teachers and middle leaders, and provides an operational definition, elaborated description and set of middle leadership characteristics to guide future research and policy advancement.
Correct responses alleviate the negative evaluation of conflict
Authors: Ivanchei Ivan I , Braem Senne , Vermeylen Luc , Notebaert Wim
Published: January 2021

Recent studies have demonstrated that cognitive conflict, as experienced during incongruent Stroop trials, is automatically evaluated as negative in line with theories emphasising the aversive nature of conflict. However, while this is well replicated when people only see the conflict stimuli, results are mixed when participants also respond to stimuli before evaluating them. Potentially, the positive surprise people feel when overcoming the conflict allows them to evaluate the experience as more positive. In this study, we investigated whether task experience can account for contradictory findings in the literature. Across three experiments, we observed that responding to incongruent stimuli was evaluated as negative on the first trials, but this effect disappeared after 32 trials. This contrasted with the results of a fourth experiment showing that the negative evaluation of incongruent trials did not disappear, when participants could not respond to the conflict. A re-analysis of three older experiments corroborated these results by showing that a positive evaluation of conflict only occurred after participants had some experience with the task. These results show that responding to conflict clearly changes its affective evaluation fitting with the idea that creating outcome expectancies (lower expectancies for being correct on incongruent trials) makes the experience of conflict less negative.
Highly active carbon nanotube–promoted Rh-Mn-Li/SiO2 catalysts for the synthesis of C2+ oxygenates from syngas
Authors: Yu Jun , Han Ying , Chen Guoqing , Xiao Xiuzhen , Mao Haifang , Mao Dongsen
Published: January 2021

The effect of carbon nanotubes on the catalytic properties of Rh-Mn-Li/SiO2 catalysts was investigated for CO hydrogenation. The catalysts were comprehensively characterized by means of X-ray power diffraction, N2 sorption, transmission electron microscope, H2–temperature-programmed reduction, CO–temperature-programmed desorption, temperature-programmed surface reaction, and X-ray photoelectron spectroscopy. The results showed that an appropriate amount of carbon nanotubes can be attached to the surface of the SiO2 sphere and can improve the Rh dispersion. Moderate Rh-Mn interaction can be obtained by doping with the appropriate amount of carbon nanotubes, which promotes the formation of strongly adsorbed CO and facilitates the progress of CO insertion, resulting in the increase in the selectivity of C2+ oxygenate synthesis.
Journalism in conflict-affected societies: Professional roles and influences in Cyprus
Authors: Şahin Sanem
Published: January 2021

Covering a conflict for journalists when they are members of one of the conflicting parties has some professional and moral dilemmas. It creates tensions between their professionalism and sense of belonging to their community. This article, focusing on journalism on both sides of Cyprus, explores how journalists think of their role in conflict-affected societies. Based on semi-structured, face-to-face interviews with journalists from the Turkish Cypriot media and Greek Cypriot media, it explores journalists’ self-reflection of their roles and the forces they believe that affect their work when reporting on the Cyprus conflict. The findings show journalists do not have a fixed identity but a changeable one. They renegotiate and reproduce the meaning and role of journalism in society, and move between professional and ethnic identities depending on the state of the conflict.
Like daughter, like grandson: Queering post-traumatic memory
Authors: Moskowitz Golan
Published: January 2021

Queer and trauma theory both concern internal experiences that challenge normative social frameworks. Considering the roles of queerness within trauma and memory studies opens interpretive pathways for otherwise discredited or inaccessible meanings. It also relates survivors’ receding knowledge to those currently “queered” or endangered. With a focus on childhood and mother-child relationships, this article maps intersections of memory studies, queer theory, and trauma theory, applying subsequent insights to an “autotheoretical” analysis of the author’s own transnational, post-Holocaust family across four generations. It explores the possibility through queer studies of excavating new post-traumatic meanings and relating those meanings to present contexts.
‘I remember little. Almost nothing’. Participatory theatre as a means to access subjugated memories
Authors: Niziołek Katarzyna
Published: January 2021

The article presents and discusses the interdisciplinary, collaborative and participatory research project Bieżenki. Thematically, the project is devoted to the history of the so-called bieżeństwo – a migration of people from eastern Poland during the First World War, forced by the retreating Russian Army, when the Germans broke through the eastern frontline in 1915. The stories of those refugees, among whom were a number of Rus’ peasants, and within that group, women with children (the term bieżenki signifies female war refugees), make up a crucial part of the regional history that has been largely absent from public knowledge and historical discourse. Methodologically, the project is based on participatory theatre that engages non-artists both as content providers, and on-stage performers. Theatrical practice has been used to collect the marginalised memories of bieżeństwo (as they are often kept and transmitted within family circles), and present them to the wider public in the form of theatrical performance. The project has also resulted in a theoretical concept of the assemblage of memory, inspired by and grounded in the creative process, which is briefly sketched out at the end of the article.
Making and contesting far right sites of memory. A case study on Romania
Authors: Zavatti Francesco
Published: January 2021

Among the strategies followed by far right groups for normalising their messages of intolerance in contemporary Europe, sites of memory play a pivotal role. Adopting an actor-centred and instrumentalist perspective of memory work and memory politics, the article considers sites of memory as products of the framing and staging of the past by the memory entrepreneurs, leading figures within the community of remembrance who, mastering the art of memorialisation, strive to establish their revisionist history within the state-endorsed memory politics. The far right memory entrepreneurs spatialise their memory work in sites of memory that downplay the history of violence of their group and present its heroic and patriotic side. The degree of success in contesting such sites shows whether the memory entrepreneurs have succeeded in normalising their messages. The article analyses the making and the contestation of a site of memory established by the far right in post-communist in Romania.
Ripretinib in gastrointestinal stromal tumor: the long-awaited step forward
Authors: Lostes-Bardaji M. Julia , García-Illescas David , Valverde Claudia , Serrano César
Published: January 2021

Gastrointestinal stromal tumor (GIST) represents a paradigm for clinically effective targeted inhibition of oncogenic driver mutations in cancer. Five drugs are currently positioned as the standard of care for the treatment of advanced or metastatic GIST patients. This is the result of continuous, deep understanding of KIT and PDGFRA GIST oncogenic drivers as well as the resistance mechanisms associated to tumor progression. However, the complexity of GIST molecular heterogeneity is an evolving field, and critical questions remain open. Specifically, the clinical benefit of approved and/or investigated targeted agents is strikingly modest at advanced stages of the disease when compared with the activity of first-line imatinib. Ripretinib is a novel switch-pocket inhibitor with broad activity against KIT and PDGFRA oncoproteins and has recently demonstrated antitumoral activity across phase I to phase III clinical trials. Therefore, ripretinib has emerged as a new standard of care for advanced, multi-resistant GIST patients. Based on this data, the Food and Drug Administration has granted in 2020 the approval of ripretinib for GIST patients after progression to imatinib, sunitinib and regorafenib. This, in turn, constitutes a major breakthrough in sarcoma drug development, as there have not been new treatment approvals in GIST for nearly a decade. Herein, we provide a critical review on the preclinical and clinical development of ripretinib in GIST. Furthermore, we seek to assess the biological and clinical impact of this new standard of care on the course of the disease, aiming to provide an insight on future treatments strategies for the next coming years.
Timing of Acute Stroke in COVID-19—A Health System Registry Study
Authors: Migdady Ibrahim , Shoskes Aaron , Hasan Leen Z. , Hassett Catherine , George Pravin , Newey Christopher , Cho Sung-Min , Rae-Grant Alexander , Uchino Ken
Published: January 2021

Background and Purpose:

The association between SARS-CoV-2 infection and stroke remains unknown. We aimed to compare the characteristics of stroke patients who were hospitalized with Coronavirus Disease 2019 (COVID-19) based on the timing of stroke diagnosis.

Methods:

We performed a retrospective analysis of adult patients in a health system registry of COVID-19 who were hospitalized and had imaging-confirmed acute stroke during hospitalization. Baseline characteristics and hospital outcomes were collected and analyzed.

Results:

Out of 882 COVID-19 patients who were hospitalized between March 9 to May 17, 2020, 14 patients (2% of all COVID-19 patients and 21% of those who underwent imaging) presented with stroke or developed stroke during hospitalization. Eleven had acute ischemic stroke (AIS) and 3 had acute hemorrhagic stroke. Six patients (43%) presented to the hospital with acute stroke symptoms and were found to have SARS-CoV-2. Compared to patients who presented with AIS, more patients with AIS during hospitalization were male, of older age, had pneumonia and acute respiratory distress syndrome, were severely ill, and had high inflammatory and thrombotic markers (including C reactive protein, D dimer, ferritin, and fibrinogen). Among all patients, hospital mortality was high (50%) and the majority of patients who were discharged had poor neurological outcome.

Conclusions:

A distinction should be made between patients who present with acute stroke with concurrent SARS-CoV-2 infection and those who develop stroke as a complication of severe COVID-19. It is likely that a subset of stroke patients will incidentally test positive for the virus given the widespread pandemic.
Agile or waterfall development: The Clementon Company dilemma
Authors: Chandran Karthikeyan , Das Aundhe Madhuchhanda
Published: January 2021

This case study documents the challenges faced by Iota Consultancy Services, an IT Service organization, as it simultaneously developed and deployed an IT Services Management software product for one of its premier clients, The Clementon Company. A leading market research firm, The Clementon Company had its footprints across the globe. Its recent acquisition of several smaller research agencies had created a complex IT landscape, in terms of the technologies adopted and the processes followed. In Iota Consultancy Services’ 10-year-old history, this engagement with The Clementon Company was a significant milestone, consisting of two parts—(1) Streamlining and standardizing The Clementon Company’s IT processes and (2) maintaining The Clementon Company’s organization-wide IT infrastructure. Iota Consultancy Services began this crucial assignment with an initial study to identify a product for the The Clementon Company’s IT department. Iota Consultancy Services, a rapidly growing player in the sector, had indigenously developed a few IT products, as well. It had an IT Services Management product called Helpdesk Management. Being the sole service provider for maintaining The Clementon Company’s entire IT infrastructure, Iota Consultancy Services felt that Helpdesk Management could be deployed as a single tool across the organization. However, until now, Helpdesk Management had never been deployed as a comprehensive IT Services Management product for any organization. This meant that Iota Consultancy Services needed to simultaneously enhance its Helpdesk Management tool by developing new features, and also deploy it for The Clementon Company. This was Iota Consultancy Services’ chance to earn a reputation as a successful product company, which would result in increased revenue. However, if things did not go well, Iota Consultancy Services could lose face forever. Iota Consultancy Services’ dilemma was whether it should propose Helpdesk Management as a tool for The Clementon Company, or not. At this juncture, everything depended on whether Iota Consultancy Services could successfully customize the Helpdesk Management tool to suit The Clementon Company’s requirements.
Learning Outcomes for Improving Science Entrepreneurship in Higher Education
Authors: Chen Kun-Dang , Wan Xiaojie , Chen Ping-Kuo
Published: January 2021

This study’s purpose was to investigate the relationships among learning through experience, learning for stress resistance, learning cognition, learning outcomes, the entrepreneurial mindset, and the discrimination of social information. The main research methods adopted in the study were the partial least squares (PLS) and the Sobel test. We adopted PLS to test the relationships between six variables, including mediating and moderating effects. In addition to PLS, this study used the Sobel test to verify the mediating effects. Large samples may cause a mediating effect testing error when PLS is used; however, the Sobel test can resolve this issue. According to our test results, learning through experience and learning for stress resistance can change students’ learning cognition and improve their learning outcomes. In addition, an entrepreneurial mindset has a mediating effect on the relationship between learning through experience, learning for stress resistance, and learning cognition. That is, for the student, having an entrepreneurial mindset strengthens the effect of learning through experience, as well as learning for stress resistance, and improves learning cognition. However, the discrimination of social information has a moderating effect on the relationship between learning cognition and learning outcomes. That is, a lower discrimination capability with respect to social information changes learning cognition and results in poor learning outcomes.
How Do Capital Ratios Affect Bank Risk-Taking: New Evidence From the United States
Authors: Abbas Faisal , Masood Omar , Ali Shoaib , Rizwan Sohail
Published: January 2021

This study aims to examine the impact of different capital ratios on Non-Performing loans, Loan Loss Reserves, and Risk-Weighted Assets by studying large commercial banks of the United States. The study employed a two-step system generalized method of movement (GMM) approach by collecting the data over the period ranging from 2002 to 2018. The study finds that using Non-Performing loans and Loan Loss Reserves as a proxy for risk, results support moral hazard hypothesis theory, whereas the results support regulatory hypothesis theory when Risk-Weighted Assets is used as a proxy for risk. The results confirm that the influence of high-quality capital on Non-Performing loans, Loan Loss Reserves, and Risk-Weighted Assets is substantial. The distinctive signs of Non-Performing loans, Loan Loss Reserves, and Risk-Weighted Assets have indications for policymakers. The results are intimate for formulating new guidelines regarding risk mitigation to recognize Non-Performing loans and Loan Loss Reserves and the Risk-Weighted Assets for better results.

JEL Classification: G21, G28, G29
Impact of Adopting Improved Seeds on Access to Broader Food Groups Among Small-Scale Sorghum Producers in Tanzania
Authors: Kaliba Aloyce R. , Gongwe Anne G. , Mazvimavi Kizito , Yigletu Ashagre
Published: January 2021

In this study, we use double-robust estimators (i.e., inverse probability weighting and inverse probability weighting with regression adjustment) to quantify the effect of adopting climate-adaptive improved sorghum varieties on household and women dietary diversity scores in Tanzania. The two indicators, respectively, measure access to broader food groups and micronutrient and macronutrient availability among children and women of reproductive age. The selection of sample households was through a multistage sampling technique, and the population was all households in the sorghum-producing regions of Central, Northern, and Northwestern Tanzania. Before data collection, enumerators took part in a 1-week training workshop and later collected data from 822 respondents using a structured questionnaire. The main results from the study show that the adoption of improved sorghum seeds has a positive effect on both household and women dietary diversity scores. Access to quality food groups improves nutritional status, food security adequacy, and general welfare of small-scale farmers in developing countries. Agricultural projects that enhance access to improved seeds are, therefore, likely to generate a positive and sustainable effect on food security and poverty alleviation in sorghum-producing regions of Tanzania.
How Can Personnel Performance Evaluation Systems Be Improved?
Authors: Yoon Donghun
Published: January 2021

In the same way that it is difficult for individuals to develop a way of evaluating themselves, it is also difficult for organizations and their employees to develop a perfect way of evaluating the performances of their personnel. As such, research on this is still actively being carried out at present, and the personnel performance evaluation methods continue to evolve from the methods that have been developed through research. Discussed in this article are measures of improving personnel performance evaluation. The existing performance evaluation theories and pitfalls are discussed and presented, and the public organizations in South Korea are analyzed to derive practical improvement measures and to improve the personnel performance evaluation methods they are currently employing. The five factors of effectiveness can be considered to encompass the emotional and cognitive responses of the employee, and to cover both the human and the impersonal aspects of evaluation as well as tool usability. Based on the results of the study, a personnel performance evaluation improvement plan was formulated, as presented in this article. It is hoped that this study will be able to make several academic contributions and that the proposed personnel performance evaluation improvement measures will prove useful.
Corporate Ownership Structure and Its Effect on Capital Structure: Evidence from BSE Listed Manufacturing Companies in India
Authors: Gurusamy Palaniappan
Published: January 2021

The study aims to examine the relationship between corporate ownership structure and capital structure of BSE listed manufacturing firms in India. The study has included the sample of 357 companies which covers 16 major sectors during the period of 2006–2015. Considering the dynamic panel nature of the data relating to the capital structure and the ownership structure variables. The analysis undertakes a novel approach of examining the determinants both single equation and reduced equation models. In order to determine the most appropriate model, based on the F test, the Breusch Pagan LM test and finally the Hausman Test is conducted. The Hausman test result has been estimated by the fixed effect model is better than the other two models such as pooled OLS and random effect estimation. Based on the fixed effects results, size, risk and profitability have a highly significant relationship with leverage. Meanwhile, the growth opportunities and tangibility represent insignificant values. The study found that the explanatory variables of the promoters’ ownership and the institutional ownership have a negative impact on leverage, while the corporate ownership has a positive influence on the capital structure decision. The individual or public ownership has a negative and significantly related to the capital structure, whereas the effect of the foreign ownership inversely related to the firm’s leverage.
Arthroscopic-assisted percutaneous fixation of intra-articular calcaneal fractures using an intraoperative distraction device
Authors: Gao Di , Wong Tak Man , Fang Christian , Leung Frankie KL , Li Xiang , Jia Bin , Wang Yu , Yu Bin
Published: January 2021

Purpose:

To evaluate the quality of reduction and clinical outcomes by using Percutaneous Distractor and Subtalar Arthroscopy Closed Reduction followed by Internal Fixation (PDSA-CRIF) in the intra-articular calcaneal fracture.

Methods:

A consecutive case series of 453 patients with 507 displaced intra-articular calcaneal fractures was recruited in this retrospective study. We performed PDSA-CRIF to treat intra-articular calcaneal fractures. The quality of reduction was assessed by early postoperative Computed Tomography (CT) scans and measurement of serial Bohler’s angles during follow-ups. Clinical outcomes were evaluated by Visual Analogue Scale (VAS) and the American Foot & Ankle Society ankle-hind foot scale (AOFAS) scoring system.

Results:

Fifty-nine patients (68 fractures) who had complete clinical data and follow-up of at least 12-months (mean: 14 months, range: 12–59 months) were finally included. Anatomical and near-anatomical reduction in subtalar articular surface which had less than 2 mm gap or step-off was found in 93% fractures. Unsatisfactory reduction was found in 7%.

Conclusion:

Arthroscopic-assisted percutaneous fixation using a distraction device is effective in achieving positive short-term results in the displaced intra-articular calcaneal fractures. A multicenter, large sample, randomized control trial is needed to fully evaluate the long-term effects of PDSA-CRIF in comparison to other methods.
Do Board Quality and Promoters’ Holdings Affect Firm Performance? Evidence from Small and Medium-sized Enterprises
Authors: Mehrotra Shweta , Mohanty Birajit , Sharma Tanushree
Published: January 2021

Unlike large businesses, small and medium-sized enterprises (SMEs), being a key growth driver in accomplishing immeasurable socio-economic objectives, possess different governance structures and face unique governance issues. Through the agency perspective, this research endeavours to pore over how the quality of their board affects the performance of SMEs in India. A regression model was run applying heteroscedasticity robust standard errors (RSE) on a sample of 68 BSE-listed SMEs for the period from 2013–2014 to 2017–2018. The results of the regression of the performance of the SMEs against their board attributes showed the prominent contribution of high promoters’ shareholding, signifying that SMEs with a highly concentrated ownership structure demonstrate better performance. Firm leverage and firm performance were shown to have a positive and significant relationship with each other, suggesting that levered firms display substantially better performance. On the other hand, it was found that increasing the number of independent directors and female directors does not necessarily result in improved firm performance. This finding suggests that tokenism, that is, appointing independent directors and female directors merely to comply with norms but not in true spirit, can reduce a firm’s performance. This research effort contributes to the literature constructively through explaining the linkage between board quality and the performance of SMEs, particularly in the Indian context, and has implications for the escalation of governance standards through bringing more clarity to and streamline policy and disclosure.
“The Numbers Are Eye Popping”: Statistical Consciousness as a Discursive Tool to Monitor Same-Sex Demography
Authors: Walther Carol S. , Jones Stephanie D. , Wickens Corrine M. , Martinez Rodrigo
Published: January 2021

In this article, we examine newspaper accounts of same-sex demography to examine how journalists use U.S. Census Bureau statistics to discuss changes in lesbian and gay households from 1990 to 2015. We utilized Foucault’s discussion of discourse and discussed what we call statistical consciousness, the use of statistics in everyday life. We support these findings with qualitative examples of each same-sex household increase to show how journalists present statistical data to exaggerate or misrepresent the number of same-sex households in the United States. We argue that the journalists use dramatic and exaggerated descriptors to characterize and frame U.S. Census Bureau statistics regarding same-sex demography. The dramatic and exaggerated reports of same-sex demography influence how people think about Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) people and the census.
Enhancing Patient Experience in Office‐Based Laryngology Procedures With Passive Virtual Reality
Authors: Chang Joseph , Ninan Sen , Liu Katherine , Iloreta Alfred Marc , Kirke Diana , Courey Mark
Published: January 2021

Objectives

Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office‐based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in‐office laryngotracheal procedures.

Study Design

Randomized controlled trial.

Setting

Tertiary care center.

Methods

Adult patients undergoing office‐based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected.

Results

Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively (P =. 037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively (P =. 770). Average pain scores were 3.53 and 2.64, respectively (P =. 434).

Conclusion

This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office‐based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia.

Level of Evidence

1
Serum and pulmonary uric acid in pulmonary arterial hypertension
Authors: Savale Laurent , Akagi Satoshi , Tu Ly , Cumont Amélie , Thuillet Raphaël , Phan Carole , Le Vely Benjamin , Berrebeh Nihel , Huertas Alice , Jaïs Xavier , Cottin Vincent , Chaouat Ari , Tromeur Cécile , Boucly Athénaïs , Jutant Etienne Marie , Mercier Olaf , Fadel Elie , Montani David , Sitbon Olivier , Humbert Marc , Tamura Yuichi , Guignabert Christophe
Published: January 2021

Previous studies have suggested an association between uric acid (UA) and the severity of pulmonary arterial hypertension (PAH), but it is unknown whether UA contributes to disease pathogenesis.

The aim of this study was to determine the prognostic value of circulating UA in the era of current management of PAH and to investigate the role of UA in pulmonary vascular remodelling.

Serum UA levels were determined in idiopathic, heritable or anorexigen PAH at baseline and first re-evaluation in the French Pulmonary Hypertension Network. We studied protein levels of xanthine oxidase (XO) and the voltage-driven urate transporter 1 (URATv1) in lungs of control and PAH patients and of monocrotaline (MCT) and Sugen/hypoxia (SuHx) rats. Functional studies were performed using human pulmonary artery smooth muscle cells (PA-SMCs) and two animal models of pulmonary hypertension (PH).

High serum UA levels at first follow-up, but not at baseline, were associated with a poor prognosis. Both the generating enzyme XO and URATv1 were upregulated in the wall of remodelled pulmonary arteries in idiopathic PAH patients and MCT and SuHx rats. High UA concentrations promoted a mild increase in cell growth in idiopathic PAH PA-SMCs, but not in control PA-SMCs. Consistent with these observations, oxonic acid-induced hyperuricaemia did not aggravate MCT-induced PH in rats. Finally, chronic treatment of MCT and SuHx rats with benzbromarone mildly attenuated pulmonary vascular remodelling.

UA levels in idiopathic PAH patients were associated with an impaired clinical and haemodynamic profile and might be used as a non-invasive indicator of clinical prognosis during follow-up. Our findings also indicate that UA metabolism is disturbed in remodelled pulmonary vascular walls in both experimental and human PAH.
Exercise training in COPD: muscle O2transport plasticity
Authors: Broxterman Ryan M. , Wagner Peter D. , Richardson Russell S.
Published: January 2021

Both convective oxygen (O2) transport to, and diffusive transport within, skeletal muscle are markedly diminished in patients with COPD. However, it is unknown how these determinants of peak muscle O2uptake (V′mO2peak) respond to exercise training in patients with COPD. Therefore, the purpose of this study was to assess the plasticity of skeletal muscle O2transport determinants ofV′mO2peakin patients with COPD.

Adaptations to 8 weeks of single-leg knee-extensor exercise training were measured in eight patients with severe COPD (mean±semforced expiratory volume in 1 s (FEV1) 0.9±0.1 L) and eight healthy, well-matched controls. Femoral arterial and venous blood samples, and thermodilution-assessed leg blood flow were used to determine muscle O2transport and utilisation at maximal exercise pre- and post-training.

Training increasedV′mO2peakin both COPD (by ∼26% from 271±29 to 342±35 mL·min−1) and controls (by ∼32% from 418±37 to 553±41 mL·min−1), restoringV′mO2peakin COPD to only ∼80% of pre-training controlV′mO2peak. Muscle diffusive O2transport increased similarly in both COPD (by ∼38% from 6.6±0.9 to 9.1±0.9 mL·min−1·mmHg−1) and controls (by ∼36% from 10.4±0.7 to 14.1±0.8 mL·min−1·mmHg−1), with the patients reaching ∼90% of pre-training control values. In contrast, muscle convective O2transport increased significantly only in controls (by ∼26% from 688±57 to 865±69 mL·min−1), leaving patients with COPD (438±45versus491±51 mL·min−1) at ∼70% of pre-training control values.

While muscle diffusive O2transport in COPD was largely restored by exercise training,V′mO2peakremained constrained by limited plasticity in muscle convective O2transport.
Mechanisms associated with increased physical activity in patients undergoing self-management behaviour modification in the randomised PHYSACTO trial
Authors: Bourbeau Jean , Sedeno Maria , Li Pei Zhi , Troosters Thierry , Hamilton Alan , De Sousa Dorothy , Maltais François , Erzen Damijan , Lavoie Kim L.
Published: January 2021

Introduction

In this analysis of the PHYSACTO® study, we assessed the efficacy of a self-management behaviour modification (SMBM) programme to improve physical activity (PA) levels, and the extent to which effects were mediated by readiness to change, motivation and confidence.

Methods

PHYSACTO® was a randomised, partially double-blind, parallel-group, 12-week trial to evaluate the effects of treatment on exercise capacity and PA. COPD patients received placebo, tiotropium 5 µg or tiotropium/olodaterol 5/5 µg, with or without exercise training, all with an SMBM intervention (the Living Well with COPD programme). Changes were assessed in readiness to change (stage of change visual analogue scale [VAS]), motivation (Treatment Self-Regulation Questionnaire [TSRQ]) and confidence (Perceived Competence Scale [PCS]) to engage in PA.

Results

PA was increased in all patients with complete PA data at Week 12 (n=262; +6038 steps·week−1, p<0.001). Significant increases were observed in patients' readiness to change (VAS 0.7 [0.6–0.8]), autonomous regulation (TRSQ 0.2 [0.1–0.3]) and confidence (PCS 0.5 [0.3–0.6]) (all p<0.01). Of note, 23% of the total effect of SMBM on steps·week−1was found to be mediated by increases in readiness to change, 5% by TSRQ autonomous regulation and 12% by PCS.

Conclusion

Our study demonstrated that an SMBM programme delivered to COPD patients increased PA, mediated by an improvement of three key hypothesised mechanisms of change: readiness to change, autonomous motivation and confidence. For the first time, this study shows that an SMBM programme can be successful in altering the mechanisms of change targeted by the intervention.
Lumacaftor/ivacaftor changes the lung microbiome and metabolome in cystic fibrosis patients
Authors: Neerincx Anne H. , Whiteson Katrine , Phan Joann L. , Brinkman Paul , Abdel-Aziz Mahmoud I. , Weersink Els J.M. , Altenburg Josje , Majoor Christof J. , Maitland-van der Zee Anke H. , Bos Lieuwe D.J.
Published: January 2021

Rationale

Targeted cystic fibrosis (CF) therapy with lumacaftor/ivacaftor partly restores chloride channel function and improves epithelial fluid transport in the airways. Consequently, changes may occur in the microbiome, which is adapted to CF lungs.

Objectives

To investigate the effects of lumacaftor/ivacaftor on respiratory microbial composition and microbial metabolic activity by repeatedly sampling the lower respiratory tract.

Methods

This was a single-centre longitudinal observational cohort study in adult CF patients with a homozygous Phe508del mutation. Lung function measurements and microbial cultures of sputum were performed as part of routine care. An oral and nasal wash, and a breath sample, were collected before and every 3 months after starting therapy, for up to 12 months.

Results

Twenty patients were included in this study. Amplicon 16S RNA and metagenomics sequencing revealed thatPseudomonas aeruginosawas most abundant in sputum and seemed to decrease after 6 months of treatment, although this did not reach statistical significance after correction for multiple testing. Two types of untargeted metabolomics analyses in sputum showed a change in metabolic composition between 3 and 9 months that almost returned to baseline levels after 12 months of treatment. The volatile metabolic composition of breath was significantly different after 3 months and remained different from baseline until 12 months follow-up.

Conclusions

After starting CF transmembrane conductance regulator (CFTR) modulating treatment in CF patients with a homozygous Phe508del mutation, a temporary and moderate change in the lung microbiome is observed, which is mainly characterised by a reduction in the relative abundance ofPseudomonas aeruginosa.
The International Federation for Emergency Medicine report on emergency department crowding and access block: a brief summary
Authors:   on behalf of the IFEM Task Force on Emergency Department Crowding and Access Block, Javidan A. P. , Hansen K. , Higginson I. , Jones P. , Lang E.
Published: January 2021

Objective

To develop comprehensive guidance that captures international impacts, causes, and solutions related to emergency department crowding and access block

Methods

Emergency physicians representing 15 countries from all IFEM regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020.

Results

A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the Task Force.

Conclusions

The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.
Genetic variation for tolerance to the downy mildew pathogen Peronospora variabilis in genetic resources of quinoa (Chenopodium quinoa)
Authors: Colque-Little Carla , Abondano Miguel Correa , Lund Ole Søgaard , Amby Daniel Buchvaldt , Piepho Hans-Peter , Andreasen Christian , Schmöckel Sandra , Schmid Karl
Published: January 2021

Background

Quinoa (Chenopodium quinoa Willd.) is an ancient grain crop that is tolerant to abiotic stress and has favorable nutritional properties. Downy mildew is the main disease of quinoa and is caused by infections of the biotrophic oomycete Peronospora variabilis Gaüm. Since the disease causes major yield losses, identifying sources of downy mildew tolerance in genetic resources and understanding its genetic basis are important goals in quinoa breeding.

Results

We infected 132 South American genotypes, three Danish cultivars and the weedy relative C. album with a single isolate of P. variabilis under greenhouse conditions and observed a large variation in disease traits like severity of infection, which ranged from 5 to 83%. Linear mixed models revealed a significant effect of genotypes on disease traits with high heritabilities (0.72 to 0.81). Factors like altitude at site of origin or seed saponin content did not correlate with mildew tolerance, but stomatal width was weakly correlated with severity of infection. Despite the strong genotypic effects on mildew tolerance, genome-wide association mapping with 88 genotypes failed to identify significant marker-trait associations indicating a polygenic architecture of mildew tolerance.

Conclusions

The strong genetic effects on mildew tolerance allow to identify genetic resources, which are valuable sources of resistance in future quinoa breeding.
Osteopontin‐induced lncRNA HOTAIR expression is involved in osteoarthritis by regulating cell proliferation
Authors: Liang Quanzhi , Asila Ailijiang , Deng Yingjie , Liao Jun , Liu Zhenfeng , Fang Rui
Published: January 2021

Background

Osteopontin plays critical roles in osteoarthritis (OA) by regulating the functions of osteoclasts. It is known that osteopontin can induce the expression of lncRNA HOX transcript antisense RNA (HOTAIR), indicating the involvement of HOTAIR in OA. This study was carried out to investigate the role of HOTAIR in OA.

Methods

Synovial fluid was extracted from both OA patients (n = 58) and healthy controls (n = 58). Expression of osteopontin and HOTAIR in synovial fluid was determined by RT-qPCR. Osteopontin was used to treat chondrocytes at dosages of 0, 1, 5 and 10 µg/ml, followed by measurement of HOTAIR expression by RT-qPCR. The role of osteopontin and HOTAIR overexpression, as well as HOTAIR knockdown in regulating the proliferation of chondrocytes was analyzed by cck-8 assay.

Results

HOTAIR was upregulated in OA. A positive correlation between HOTAIR and osteopontin was observed. In the primary chondrocytes, osteopontin treatment increased HOTAIR expression, while HOTAIR overexpression and knockdown failed to significantly affect osteopontin expression. In addition, osteopontin and HOTAIR overexpression increased chondrocyte proliferation, while HOTAIRE knockdown decreased chondrocyte proliferation. In addition, HOTAIR knockdown reduced the effects of osteopontin treatment on cell proliferation.

Conclusions

Osteopontin-induced HOTAIR expression is involved in osteoarthritis by regulating cell proliferation.
Life-sustaining treatment preferences in older patients when referred to the emergency department for acute geriatric assessment: a descriptive study in a Dutch hospital
Authors: Ermers Daisy J. M. , van Beuningen-van Wijk Marit P. H. , Rit Evi Peters , Stalpers-Konijnenburg Sonja C. , Taekema Diana G. , Bosch Frank H. , Engels Yvonne , van Mierlo Patricia J. W. B.
Published: January 2021

Background

In many cases, life-sustaining treatment preferences are not timely discussed with older patients. Advance care planning (ACP) offers medical professionals an opportunity to discuss patients’ preferences. We assessed how often these preferences were known when older patients were referred to the emergency department (ED) for an acute geriatric assessment.

Methods

We conducted a descriptive study on patients referred to the ED for an acute geriatric assessment in a Dutch hospital. Patients were referred by general practitioners (GPs), or in the case of nursing home residents, by elderly care physicians. The referring physician was asked if preferences regarding life-sustaining treatments were known. The primary outcome was the number of patients for whom preferences were known. Secondary outcomes included which preferences, and which variables predict known preferences.

Results

Between 2015 and 2017, 348 patients were included in our study. At least one preference regarding life-sustaining treatments was known at referral in 45.4% (158/348) cases. In these cases, cardiopulmonary resuscitation (CPR) policy was always included. Preferences regarding invasive ventilation policy and ICU admission were known in 17% (59/348) and 10.3% (36/348) of the cases respectively. Known preferences were more frequent in cases referred by the elderly care physician than the GP (P < 0.001).

Conclusions

In less than half the patients, at least one preference regarding life-sustaining treatments was known at the time of referral to the ED for an acute geriatric assessment; in most cases it concerned CPR policy. We recommend optimizing ACP conversations in a non-acute setting to provide more appropriate, desired, and personalized care to older patients referred to the ED.
Prevalence, serotypes and virulence genes of Streptococcus agalactiae isolated from pregnant women with 35–37 weeks of gestation
Authors: Bobadilla Fernando J. , Novosak Marina G. , Cortese Iliana J. , Delgado Osvaldo D. , Laczeski Margarita E.
Published: January 2021

Background

In pregnant women Streptococcus agalactiae (GBS) can be transmitted to newborn causing severe infections. It is classified into 10 serotypes (Ia, Ib, II-IX). The severity of neonatal disease is determined by the capsular serotype and virulence factors such as the polysaccharide capsule, encoded by the cps gene, protein C, which includes the Cα surface proteins (bca gene), Rib (rib gene) and Cβ (bac gene); the proteins Lmb (lmb gene), FbsB (fbsB gene), FbsA (fbsA gene), the cyl operon encoding a β-hemolysin (hylB gene), the CAMP factor (cfb gene) and the C5a peptidase (scpB gene). The aim of this work was to determine the degree of GBS colonization in pregnant women, the serotypes distribution and to investigate virulence-associated genes.

Methods

We worked with 3480 samples of vagino-rectal swabs of women with 35–37 weeks of gestation. The identification of the strains was carried out using conventional biochemical tests and group confirmatory serology using a commercial latex particle agglutination kit. Two hundred GBS strains were selected. Their serotype was determined by agglutination tests. The monoplex PCR technique was used to investigate nine virulence-associated genes (cps, bca, rib, bac, lmb, fbsB, fbsA, hylB and scpB).

Results

The maternal colonization was 9.09%. The serotypes found were: Ia (33.50%), III (19.00%), Ib (15.50%), II (14.00%), V (7.00%) and IX (5.50%). 5.50% of strains were found to be non-serotypeable (NT). The nine virulence genes investigated were detected simultaneously in 36.50% of the strains. The genes that were most frequently detected were scpB (100.00%), fbsA (100.00%), fbsB (100.00%), cylB (95.00%), lmb (94.00%) and bca (87.50%). We found associations between serotype and genes bac (p = 0.003), cylB (p = 0.02), rib (p = 0.01) and lmb (p < 0.001).

Conclusions

The frequency of vaginal-rectal colonization, serotypes distribution and associated virulence genes, varies widely among geographical areas. Therefore, epidemiological surveillance is necessary to provide data to guide decision-making and planning of prevention and control strategies.