bluuebunny/crossref_metadata_2025 huggingface dataset:
A proximal distance algorithm for likelihood-based sparse covariance estimation
Authors: Xu Jason , Lange Kenneth
Published: February 2022

This paper addresses the task of estimating a covariance matrix under a patternless sparsity assumption. In contrast to existing approaches based on thresholding or shrinkage penalties, we propose a likelihood-based method that regularizes the distance from the covariance estimate to a symmetric sparsity set. This formulation avoids unwanted shrinkage induced by more common norm penalties, and enables optimization of the resulting nonconvex objective by solving a sequence of smooth, unconstrained subproblems. These subproblems are generated and solved via the proximal distance version of the majorization-minimization principle. The resulting algorithm executes rapidly, gracefully handles settings where the number of parameters exceeds the number of cases, yields a positive-definite solution, and enjoys desirable convergence properties. Empirically, we demonstrate that our approach outperforms competing methods across several metrics, for a suite of simulated experiments. Its merits are illustrated on international migration data and a case study on flow cytometry. Our findings suggest that the marginal and conditional dependency networks for the cell signalling data are more similar than previously concluded.
Blood pressure targets in CKD 2021: the never-ending guidelines debacle
Authors: Carriazo Sol , Sarafidis Pantelis , Ferro Charles J , Ortiz Alberto
Published: February 2022

In 2021, two updated clinical guidelines were published, providing guidance on blood pressure (BP) targets for people with chronic kidney disease (CKD). Kidney Disease: Improving Global Outcomes (KDIGO) updated its 2012 Clinical Practice Guideline for the Management of BP in CKD. Different systolic blood pressure (SBP) and diastolic blood pressure (DBP) targets for CKD (<130/80 and <140/90 mmHg, respectively, for people with a urinary albumin: creatinine ratio >30 mg/g or without pathological albuminuria) were replaced by a single number: an SBP target of <120 mmHg is suggested, when tolerated. This represents a major decrease in the SBP target and the abandonment of DBP targets. The European Society of Cardiology (ESC) also published a 2021 Clinical Guideline on Cardiovascular Disease Prevention in Clinical Practice that updates a prior 2016 guideline on prevention and the 2018 ESC/European Society of Hypertension Clinical Practice Guidelines for the Management of Arterial Hypertension. The 2021 ESC guideline was endorsed by 12 European scientific societies. The recommended office BP targets for people with CKD are <140–130 mmHg SBP (lower SBP is acceptable if tolerated) and <80 mmHg DBP. The question is: What should the practicing physician do now: treat hypertension in people with CKD to an SBP target of <120 mmHg or to a target of <140–130 mmHg? Major guideline bodies are aware of the activities of other major players. There is an urgent need for guideline bodies to establish communication channels, search consensus on major issues that impact the health of hundreds of millions of people worldwide and end individualism in guidelines generation.
Towards the integration of ecophysiology with fisheries stock assessment for conservation policy and evaluating the status of the Mediterranean Sea
Authors: Falco F , Bottari T , Ragonese S , Killen S S
Published: February 2022

Recent European Union (EU) regulations have been introduced to discourage the capture of undersized specimens with the aim of reducing the bycatch mortality imposed by commercial fisheries. We argue that we still lack accurate data regarding basic information required to properly implement these regulations for most Mediterranean ecosystems, including the true mortality imposed by fisheries, escape rates from fishing gears and the capability of specimens to survive following discard. We suggest that additional reliance on physiological biomarkers could assist in all aspects of the data collection required to support implementation of the EU discard ban (aka landing obligation), particularly in determining which species should receive special dispensation from this policy. Ideally, this new approach, here termed the ‘Fisheries Environmental and Physiological Stress Analysis’ (FEPSA), would become an important step for any fish stock assessment within the ecosystem approach to fisheries management and the recognition of Good Environmental Status, as established by the EU in the Marine Strategy Framework Directive (2008/56/EC). In particular, the main goal of FEPSA would be applying the study of physiological stressors to exploited stocks to estimate the so-called collateral fishing mortality, which includes the mortality experienced by fish that escape after interacting with fishing gears or that are discarded, with some degree of injury or physiological stress. The approach outlined here, which is described for bottom trawls but adaptable to any other type of fishing gear, is not a trivial undertaking but is a requirement for collecting the data required by recent EU fisheries policies. While we agree that the threats to marine biodiversity posed by fishing and associated discard practices require strong policy interventions, we emphasize that the research programs needed to support such initiatives, including the landing obligation, should be given equal priority. This is particularly true for Mediterranean fisheries, which are at a complex intersection of jurisdictional boundaries, numerous additional ecosystem threats including widespread pollution, thermal variation and hypoxia, and are historically understudied as compared to fisheries and species in more northern climates.
Identifying the limitations of cardiopulmonary exercise testing prior to esophagectomy using a pooled analysis of patient-level data
Authors: Sivakumar Jonathan , Forshaw Matthew J , Lam Stephen , Peters Christopher J , Allum William H , Whibley Jessica , Sinclair Rhona C F , Snowden Christopher P , Hii Michael W , Sivakumar Harry , Read Matthew
Published: February 2022

Preoperative cardiopulmonary exercise testing (CPET) provides an objective assessment of aerobic fitness in patients undergoing surgery. While peak oxygen uptake during exercise (VO2peak) and anaerobic threshold have demonstrated a moderate correlation with the development of complications following esophagectomy, no clinically useful threshold values have been defined. By pooling patient level data from existing studies, we aimed to define optimal thresholds for preoperative CPET parameters to predict patients at high risk of postoperative complications. Studies reporting on the relationship between preoperative CPET variables and post-esophagectomy complications were determined from a comprehensive literature search. Patient-level data were obtained from six contributing centers for pooled-analyses. Outcomes of interest included cardiopulmonary and non-cardiopulmonary complications, unplanned intensive care unit readmission, and 90-day and 12-month all-cause mortality. Receiver operating characteristic curves and logistic regression models estimated the predictive value of CPET parameters for each individual outcome of interest. This analysis comprised of 621 patients who underwent CPET prior to esophagectomy during the period from January 2004 to March 2017. For both anaerobic threshold and VO2peak, none of the receiver operating characteristic curves achieved an area under the curve value > 0.66 for the outcomes of interest. The discriminatory ability of CPET for determining high-risk patients was found to be poor in patients undergoing an esophagectomy. CPET may only carry an adjunct role to clinical decision-making.
Real world evaluation of artificial intelligence echocardiography image guidance and acquisition with novice scanners in multiple clinical settings
Authors: Burke DA , Corrigan N , Herlihy M , Nasaj O , Dickson J , Delaney D , Westrup J
Published: February 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Caption Health, US

OnBehalf

Beacon Hospital Research Institute

Background

Cardiac echocardiographic scanning requires significant training and experience. The FDA approved Caption Echocardiography system uses a deep learning artificial intelligence software that guides novice scanners to optimal position and then automatically acquires the highest quality image. Further advances to this novel technology have allowed for immediate calculation of left ventricular ejection fraction directly from these images.

Methods

Following only brief training, we sought to evaluate study quality by novice scanners in four clinical settings, both acute and ambulatory – the Emergency Department, Intensive Care Unit, Heart Failure clinic, and the Oncology Day Unit. 120 patients (30 per clinical area) were recruited and underwent 2 echo scans – one by a novice scanner using the Caption AI system, and one by an expert scanner using the same ultrasound system but without AI guidance. Both studies were evaluated blindly and independently side by side by 3 accredited experts judging diagnostic quality. ‘AutoEF’ measurements were compared with expert scanners measurements by Simpson’s biplane technique.

Results

120 patients with mean age 62.04 years old (range 18 – 92)  were enrolled, consisting of 30 from each clinical area. 8 novice scanners – nursing staff and junior doctors – scanned 15 patients each, allowing their first 3 cases to be excluded. 75% of patients were male. BMI ranged from 18 – 37 with mean 27.48. Image quality allowed left ventricular function to be sufficiently captured in 97.5% of studies, right ventricular function in 95% and outrule of pericardial effusion in 97.5%. ‘AutoEF’ was determined in 88.3% of studies and matched the expert measurement in 84% of cases. Blinded expert assessment found that 60% of Caption studies were of equal or better quality than the experienced sonographer scan.

Conclusion

The Caption AI technology safely allows novice users to provide efficient and accurate point of care echo in differing clinical settings to a standard comparable to expert scanners, and automatically determines left ventricular ejection fraction.
Prevention of stroke and atrial arrhythmia consequences in hypertrophic cardiomyopathies: a clinical challenge that could be best managed by a better echocardiographic left atrial characterization
Authors: Al Wazzan A , Galli E , Panis V , Paven E , L"official G , Schnell F , Oger E , Donal E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

There is a need to better predict the risk of atrial arrhythmia (AA) and stroke in patients with hypertrophic cardiomyopathy (HCM).

Purpose

We sought to look at atrial remodeling and atrial function by echocardiography in a HCM-cohort to assess the association with occurrence of AA and stroke.

Methods

We retrospectively studied 216 patients diagnosed for HCM (mean age 52 ± 16 years) from 2015 to 2020. All patients underwent transthoracic echocardiography with the assessment of left atrial volume (LAV) and peak left atrial strain (PLAS). Patients were followed-up for 2,9 years for the development of a composite endpoint comprising occurrence of atrial arrhythmias and/or stroke.

Results

78 patients had an event (24 stroke and 54 documented atrial arrhythmia). Univariate comparison analysis showed that LAV (37.2 ± 15.7 vs. 47 ± 20 ml/m², p = 0.0001) and anteroposterior LA diameter (41.7 ±7.58 vs. 45.8 ± 8.9 mm; p = 0.0006) were significantly higher in patients who met the composite endpoint, whereas PLAS was significantly impaired (27.1 ± 9.77 vs. 20.4 ± 10.5%; p < 0.0001). Other echographic parameters associated with the composite endpoint were mean E/e" ratio (0.65 [0.55-0.85] vs. 0.60 [0.45-0.75]; p = 0.0204) and tricuspid annular peak systolic velocity (S") (cm/s) (13.3 ± 2.92 vs. 12.2 ± 3.26; p = 0.0148). NTproBNP level (216 vs. 818 ; p < 0.0001), history of hypertension (42.3% vs. 62.3%; p = 0.005) and age at diagnosis (50.3 ± 16.7 vs. 57.1 ± 14.4; p = 0.0035) were the clinical parameters different between groups.

In a multivariable analysis, PLAS was the only independent maker associated with the occurrence of AA and stroke, particularly for stroke with an odd ratio of 0.53 ([0.32-0.86]; p = 0.00097). 

Interestingly, 19 of 28 stroke patients (67%) did not experience any documented AA. 

Conclusion

The decrease of PLAS is strongly associated with the risk of stroke, even in patients without documented atrial arrhythmia. Its use to guide the indication for an implantable holter monitoring and perhaps a prophylactic oral anticoagulation in HCM requires further investigation. Abstract Figure. Impaired PLAS in an HCM patient
Can 2D speckle tracking echocardiography be useful in venesection therapy monitoring in hereditary hemochromatosis patients?
Authors: Wabich E , Swiatczak M , Sikorska K , Lipinski P , Raczak G , Danilowicz - Szymanowicz L
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Hereditary hemochromatosis (HH) is a widespread genetic disease. Abnormally increased intestinal iron absorption and accelerated recycling of iron lead to progressive body iron accumulation and the generation of oxidative stress in tissues. Venesection is the primary treatment of such patients. Based on the fact that two-dimensional speckle tracking echocardiography (2D STE) can evaluate left ventricle (LV) dysfunction more accurately and earlier than conventional echocardiography, the purpose of our study was to check whether it could be helpful in venesection therapy monitoring.

Methods. We prospectively enrolled 20 patients with genetically confirmed HH. Classic echocardiographic and 2D STE parameters (GE VIVID E9, EchoPAC v202) were analyzed at the moment of diagnosis, and after three years of treatment with venesection; 20 healthy age- and sex-matched persons constituted the control group.

Results. The HH patients had all standard echo parameters within the normal range at the first and second examinations. The rotation parameters were initially worse than in healthy people at the first visit and significantly increased after three years of treatment. The radial strain after the treatment was significantly better for the apex but not for basal LV, apart from the epicardial layer (known as the layer of iron overload in the heart). Global longitudinal strain (GLS), significantly lower than in healthy people at the first visit, did not change within the treatment (Table).

Conclusions. Venesection leads to significant improvement in the rotation function of LV and increases radial strain mainly in the epicardium, which seems to help monitor the treatment and guide the intensity of venesections. GLS, which is known as a parameter for early detection of heart abnormalities in asymptomatic HH patients, did not increase within the treatment and could reveal irreversible changes in LV. Abstract Figure.
Comprehensive stress echocardiography in hypertrophic cardiomyopathy
Authors: Palinkas ED , Ciampi Q , Tesic M , Palinkas A , Torres MAR , Djordievic-Dikic A , Beleslin B , Sepp R , Mori F , Picano E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging

Background

Stress echocardiography (SE) in hypertrophic cardiomyopathy (HCM) has more to offer beyond dynamic left ventricular outflow obstruction (LVOTO) to capture the functional heterogeneity of the disease.

Objectives

To determine the feasibility of comprehensive SE in HCM.

Methods

We prospectively enrolled 235 HCM patients (age = 48 ± 15 years, 113 men) assessed with exercise stress echocardiography (ESE) in 4 centers. ESE modality was semi-supine bicycle in 29 patients in one center, and treadmill in 206 (followed by same-day, same session, adenosine for step D) in another centers. During SE, we assessed stress-induced new regional wall motion abnormalities (RWMA, step A), coronary flow velocity reserve (CFVR) in left anterior descending coronary artery with Doppler (step D) by semi-supine exercise or adenosine, heart rate reserve (peak/rest heart rate) for EKG-based step E, mitral regurgitation (MR) flow for step F, and LVOTO (step G for gradient). A comprehensive SE score was generated from 0 (all parameters normal) to 5 (all abnormal).

Results

 Technical success rate was 100% for all steps, except step D (80% with semi-supine, 100% with adenosine after treadmill) and F (232/235, 99%).  Extra-analysis time was < 3 minutes for steps A + D + E + F + G. Rate of abnormal results ranged from 73% for step E (peak/rest heart rate reserve < 1.80) to 1% for step A (inducible RWMA), with intermediate values for step D (CFVR < 2.0, 44%), step F (at least moderate MR, 32%) and step G (LVOTG > 50 mm Hg, 26%): see figure. SE score was 0 in 14 pts (6%), 1 or 2 in 202 patients (86%) and ≥ 3 in 19 patients (8%).

Conclusions

 Comprehensive SE is feasible in HCM with single stress (semi-supine exercise) or hybrid treadmill exercise followed by adenosine for step D. Phenotyping of the multiform manifestations of HCM with a personalized functional blueprint is now possible. Abstract Figure.
Microvascular coronary dysfunction affects global longitudinal strain after stress echocardiography
Authors: Tagliamonte E , Sperlongano S , Montuori C , Riegler L , Scarafile R , Carbone A , Iodice F , Gioia R , Di Vilio A , Serio A , Radmilovic J , Ricciardi S , D"andrea A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND. Coronary microvascular dysfunction (CMD) is a potential cause of myocardial ischemia and may affect myocardial function at rest and during stress. CMD can be identified, in patients with non-obstructive coronary artery disease (CAD), by a reduced transthoracic Doppler-derived coronary flow reserve (CFR), which is an index of coronary arterial reactivity, and can be impaired in both obstructive CAD and CMD.

The aim of this study was to investigate the dipyridamole-induced changes of left ventricular (LV) global longitudinal strain (GLS) in patients with CMD.

METHODS. 59 patients (39% women, mean age 65.6 ± 6.1 years) with history of chest pain and without obstructive coronary artery disease (CAD) underwent dipyridamole stress echocardiography. Coronary flow was assessed in the left anterior descending coronary artery. Coronary flow reserve (CFR) was determined as the ratio of hyperaemic to baseline diastolic coronary flow velocity. CMD was defined as CFR < 2. GLS was measured at rest and at peak dose, using automated function imaging, through the positioning of three endocardial markers (two markers at the mitral annulus and one at the apex) in each apical view. Subsequently, the obtained segmental values of GLS were visualized as a bull’s-eye map in a quick and feasible manner. We had optimal left ventricular endocardial tracking in the overall population.

In each patient, we used a frame rate of 70 frames/sec for adequate 2D strain analysis. We analyzed GLS at each step of stress test and compared peak-dose values with baseline.

RESULTS. Nineteen patients (32%) among the overall population showed CMD. Baseline GLS was significantly lower in patients with CMD (-16.8 ± 2.7 vs. -19.1 ± 3.1, p < 0.01). A different contractile response to dipyridamole infusion was observed between the two groups: GLS significantly increased up to peak dose in patients without CMD (from -19.1 ± 3.1 to -20.2 ± 3.1, p < 0.01), and significantly decreased in patients with CMD (from -16.8 ± 2.7 to -15.8 ± 2.7, p < 0.01). There was a significant inverse correlation between CFR and DGLS (r = -0.82, p < 0.01).

CONCLUSIONS. GLS analysis, particularly performed by comparing dipyridamole peak-dose with baseline values, shows that in patients with CMD there is a different response of LV myocardium to stress test. It could be assumed that the inverse correlation between CFR and delta GLS reflects a progressive subclinical worsening of LV myocardial function and lack of LV contractile reserve due to underlying myocardial ischemia. Larger studies could confirm our data. Abstract Figure.  Abstract Figure.
Systolic shear wave propagation speed as a novel non-invasive marker of myocardial contractility
Authors: Bezy S , Caenen A , Duchenne J , Orlowska M , D"hooge J , Voigt JU
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders - FWO

Background

Shear wave elastography is a novel echocardiographic method that tracks shear wave propagation in the cardiac wall using high frame rate ultrasound. Shear waves can be induced by e.g. aortic valve closure (AVC). The propagation speed of these waves is related to the stiffness of the myocardium. Previous work has suggested that systolic shear wave speed is related to myocardial contractility. The current gold standard reference method for the evaluation of left ventricular (LV) contractility is pressure-volume loop analysis. However, the invasive nature of this method limits its clinical applicability.

Purpose

To compare non-invasively assessed shear wave propagation speed after AVC to invasive pressure-volume loop-derived measurements of contractility.

Methods

In 12 pigs (31.9 ± 4.3 kg), dobutamine was administered intravenously. Conventional and high frame rate echocardiographic images were acquired simultaneously with invasively measured pressure-volume loops before and after the administration of dobutamine. High frame rate echocardiographic datasets were acquired with an experimental ultrasound scanner at an average frame rate of 1304 ± 115 frames per second. Shear waves after AVC were visualized on M-mode displays along the interventricular septum which were colour coded for tissue acceleration (Figure 1A). The propagation speed was calculated by semi-automatically measuring the spatiotemporal slope of the shear wave. A set of pressure-volume loops were acquired during preload reduction by balloon occlusion of the vena cava inferior. The end-systolic elastance (Ees) of the ESPVR and preload recruitable stroke work (PRSW) were used as measures of contractility.

Results

Heart rate (72 ± 20 bpm vs. 105 ± 25 bpm; p < 0.05) and LV ejection fraction (61 ± 4% vs. 74 ± 7%; p < 0.001) significantly increased after the administration of dobutamine, while the LV end-systolic pressure remained similar (92 ± 21 mmHg vs. 106 ± 23 mmHg; p = 0.08). Pressure-volume loop-derived measures of contractility increased during dobutamine infusion (Ees: 1.3 ± 0.5 mmHg/ml vs. 2.1 ±  1.0 mmHg/ml; p < 0.01 and PRSW: 41 ± 25 mmHg vs. 86 ± 23 mmHg; p < 0.01). Likewise, shear wave propagation speed after AVC increased after dobutamine administration compared to baseline (3.1 ± 0.6 m/s vs. 5.3 ± 1.1 m/s; p < 0.001). Shear wave speed after AVC had a strong positive correlation with Ees (r = 0.68; p < 0.001) (Figure 1B) and PRSW (r = 0.65; p = 0.001) (Figure 1C).

Conclusions

Systolic shear wave propagation speed is related to invasively determined measurements of LV contractility. The results of this study indicate the potential of shear wave speed after AVC as a novel non-invasive parameter for the assessment of LV contractile function. Abstract Figure.
The MIDA quantitative international registry: prognostic implications of moderately elevated pulmonary artery pressure
Authors: Essayagh B , Benfari G , Antoine C , Grigioni F , Le Tourneau T , Roussel JC , Ajmone N , Van Wijngaarden A , Delgado V , Bax J , Tribouilloy C , Hochstadt A , Topilsky Y , Michelena H , Enriquez-Sarano M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

  Pulmonary hypertension is a frequent complication of severe degenerative mitral regurgitation (DMR) associated with major outcome implications. However, whether pulmonary hypertension is linked with worse outcome in less that severe MR is uncertain and even more unsubstantiated is the link of elevated systolic pulmonary artery pressure (sPAP) < 50mmHg with clinical presentation and outcome.

Purpose

To assess the outcome implication of sPAP elevation, even moderate, among mitral regurgitation severity subgroups.

Methods

The MIDA-Quantitative (MIDA-Q) unprecedented registries included 7373 consecutive patients (age 64 ± 17 years, 45% women, follow-up 5.5 ± 3.4 years) with isolated DMR diagnosed at tertiary (European/North-American/Middle East) centers in which systolic pulmonary artery pressure (sPAP) was measured prospectively at baseline. Long-term survival overall, under medical management and post-mitral surgery was analyzed.

Results

 Elevated pulmonary pressure (sPAP >50mmHg) was observed in 1371 patients (19%, mean 63 ± 13mmHg) and moderate increase in pulmonary pressure (35< sPAP < 50mmHg) in 1874 patients (25%, mean 41 ± 14mmHg), with no/mild MR in 4067 (50%), moderate in 2073 (25%), and severe or above in 2047 (25%), mean ERO 0.24 ± 24cm2, RVol 37 ± 35mL and posterior leaflet prolapse in 34%. sPAP severe but also moderate both strongly and independently linked to more severe clinical presentation, with more dyspnea, more AFib, and impaired renal function (P ≤ 0.0001). <SPAP< >By sPAP categories,  35 < sPAP< 50mmHg (vs. 35mmHg) was independently associated with worse outcome under medical management adjusted-HR 1.62[1.40-1/87], with considerable excess-mortality for sPAP > 50mmHg (vs. <35mmHg) adjusted-HR 2.54[2.17-2.96], all P < 0.0001. As continuous variable, sPAP was associated with worse outcome adjusted-HR 1.25[1.21-1.29], P < 0.0001 per 10mmHg-increase. Mitral valve surgery (performed in 2378 patients, 32%) improved outcome without alleviating completely higher mortality associated with sPAP > 50mmHg (P < 0.0001).

Conclusion

In this very large international cohort of patients with DMR of all range and prospective sPAP grading, higher sPAP is associated at diagnosis with more severe clinical presentation. Long term, sPAP > 50mmHg but also 35-50mmHg is independently of all confounders, associated with worse mortality. Thus careful assessment and consideration for mitral surgery/transcatheter therapy is warranted even in patients with sPAP <50mmHg.</SPAP< > Abstract Figure. Survival stratified by sPAP Categories  Abstract Figure. Postop survival by sPAP Categories
The role of echocardiography in the diagnosis of adult patients with myocarditis: a systematic review and meta-analysis
Authors: Khanna S , Amarasekera AT , Li C , Bhat A , Chen HHL , Gan GCH , Tan TC
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Transthoracic echocardiography (TTE) plays a key diagnostic role in the initial work-up of patients presenting with myocarditis. Its utility in myocarditis is for identification of structural and functional changes, which may assist with diagnosis, surveillance and prognostication.

Purpose

The purpose of this systematic review and meta-analysis was to appraise the evidence associated with the use of echocardiography for the diagnosis of myocarditis in adults.

Methods

A systematic literature search of medical databases including Pubmed, Ovid Online, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, ProQuest, Science Direct and grey literature was performed using PRISMA principles to identify all relevant TTE studies on myocarditis in adult patients (1995-2020; English only; PROSPERO registration CRD42021243598). Data for a range of TTE parameters were individually extracted and then meta-analysed using a random-effects model for overall effect size through standard mean difference (SMD).

Results

Of the 13 relevant studies, 6 were included and revealed that myocarditis can be reliably differentiated from healthy controls, both in the acute and sub-acute phase by left ventricular (LV) global longitudinal strain, and less so by LV ejection fraction and LV end-diastolic volume (p < 0.05 for all). See Table. LV-GLS demonstrated the strongest ability to discriminate myocarditis patients from healthy controls when compared to standard two-dimensional measures of LV size and function (p < 0.05).

Conclusions

LV-GLS demonstrated the best discriminatory ability for differentiation of myocarditis from adult healthy controls. Further research is required to characterize the utility of these quantitative parameters in the diagnostic work-up of these patients. Abstract Figure.
Prognostic significance of right ventricle size and function in dilated cardiomyopathy
Authors: Dziewiecka E , Karabinowska A , Wisniowska-Smialek S , Winiarczyk M , Gliniak M , Robak J , Kaciczak M , Rubis P
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Dilated cardiomyopathy (DCM) is diagnosed based on systolic dysfunction and dilatation of the left ventricle (LV). Although the right ventricle (RV) can be also affected, the significance of concomitant RV pathology in DCM is less studied.

Aim

To analyse the prognostic significance of RV dilatation (RVD) and RV systolic dysfunction (RVSD) in DCM.

Methods

Between 2010 and 2020 we retrospectively analysed out- and in-hospital records of 545 DCM patients (age 53 ± 13 years, 89% male, NYHA 2.4 ± 0.9, LV end-diastolic diameter 65 ± 10mm, LV ejection fraction - LVEF 27 ± 11%, RV outflow tract diameter - RVOT 33 ± 7mm, tricuspid annular plane systolic excursion - TAPSE 19 ± 5mm). The RVD was diagnosed as RVOT from parasternal long-axis view >35mm, and RVSD - as TAPSE <17mm.

Results

There were 284 (52%) patients with RV pathology: 192 (35%) PTS with RVD, 175 (32%) patients with RVSD, 83 (15%) patients had both RVD and RVSD (RVD + RVSD). During 47 ± 31months 83 (15%) patients died: 20 (24%) patients with RVD (p = 0.007), 32 (18%) patients with RVSD (p = 0.08), 39 (11%) patients with both RVD and RVSD (p = 0.002). All RV pathologies were found to be significant prognostic factors in DCM (RVD: HR 0.41 [95%CI 0.27-0.65]; RVSD: HR 0.59 [95%CI 0.38-0.93]; RVD + RVSD: HR 0.40 [95%CI 0.24-0.67]) (Fig. 1). However, only RVD was found to be significant prognostic factor irrespectively of LVEF (multivariate: LVEF – HR 0.97 [95%CI 0.94-0.99]; RVD – HR 0.50 [95%CI 0.31-0.79]; RVSD – HR 0.82 [9%CI 0.51-1.32]).

Conclusion

Half of DCM patients had RV pathology: dilatation or systolic dysfunction, however, only 15% had both RVD and RVSD. RVD and RVSD were associated with survival, however, only RV dilatation was found to be a prognostic factor irrespectively of LVEF. Abstract Figure 1. RVSD and RVD in DCM.
The dysfunctional right ventricle: the importance of multi-modality imaging
Authors: Surkova Elena , Cosyns Bernard , Gerber Bernhard , Gimelli Alessia , La Gerche Andre , Ajmone Marsan Nina
Published: February 2022

Assessment of right ventricular (RV) function is crucial for the evaluation of the dyspnoeic patient and/or with systemic venous congestion and provides powerful prognostic insights. It can be performed using different imaging modalities including standard and advanced echocardiographic techniques, cardiac magnetic resonance imaging, computed tomography, and radionuclide techniques, which should be used in a complementary fashion. Each modality has strengths and weaknesses based on which the choice of their use and in which combination may vary according to the different clinical scenarios as will be detailed in this review. The conclusions from multiple studies using different imaging techniques are concordant: RV function can be reliably assessed and is a critical predictor of clinical outcomes.
Larval habitat determines the bacterial and fungal microbiota of the mosquito vector Aedes aegypti
Authors: Zouache Karima , Martin Edwige , Rahola Nil , Gangue Marc F , Minard Guillaume , Dubost Audrey , Van Van Tran , Dickson Laura , Ayala Diego , Lambrechts Louis , Moro Claire Valiente
Published: February 2022

Mosquito larvae are naturally exposed to microbial communities present in a variety of larval development sites. Several earlier studies have highlighted that the larval habitat influences the composition of the larval bacterial microbiota. However, little information is available on their fungal microbiota, i.e. the mycobiota. In this study, we provide the first simultaneous characterization of the bacterial and fungal microbiota in field-collected Aedes aegypti larvae and their respective aquatic habitats. We evaluated whether the microbial communities associated with the breeding site may affect the composition of both the bacterial and fungal communities in Ae. aegypti larvae. Our results show a higher similarity in microbial community structure for both bacteria and fungi between larvae and the water in which larvae develop than between larvae from different breeding sites. This supports the hypothesis that larval habitat is a major factor driving microbial composition in mosquito larvae. Since the microbiota plays an important role in mosquito biology, unravelling the network of interactions that operate between bacteria and fungi is essential to better understand the functioning of the mosquito holobiont.
Comparative genomic analysis of Escherichia coli strains obtained from continuous imipenem stress evolution
Authors: Geng Juan , Liu Huiying , Chen Shuaiyin , Long Jinzhao , Jin Yuefei , Yang Haiyan , Duan Guangcai
Published: February 2022

The carbapenem-resistant Escherichia coli has aroused increasing attention worldwide, especially in terms of imipenem (IMP) resistance. The molecular mechanism of IMP resistance remains unclear. This study aimed to explore the resistance mechanisms of IMP in E. coli. Susceptible Sx181-0-1 strain was induced into resistance strains by adaptive laboratory evolution. The drug resistance spectrum was measured using the disk diffusion and microbroth dilution methods. Whole-genome sequencing and resequencing were used to analyze the nonsynonymous single-nucleotide polymorphisms (nsSNPs) between the primary susceptible strain and resistant strains. The expression levels of these genes with nsSNPs were identified by real-time quantitative PCR (RT-qPCR). Resistance phenotype appeared in the induced 15th generation (induction time = 183 h). Sx181-32 and Sx181-256, which had the minimum inhibitory concentrations of IMP of 8 and 64 µg ml–1, were isolated during continuous subculture exposed to increasing concentrations of IMP, respectively. A total of 19 nsSNPs were observed both in Sx181-32 and Sx181-256, distributed in rpsU, sdaC, zwf, ttuC, araJ, dacC, mrdA, secF, dacD, lpxD, mrcB, ftsI, envZ, and two unknown function genes (orf01892 and orf01933). Among these 15 genes, five genes (dacC, mrdA, lpxD, mrcB, and ftsI) were mainly involved in cell wall synthesis. The mrdA (V338A, L378P, and M574I) and mrcB (P784L, A736V, and T708A) had three amino acid substitutions, respectively. The expression levels of rpsU, ttuC, and orf01933 were elevated in both Sx181-32 and Sx181-256 compared to Sx181-0-1. The expression levels of these genes were elevated in Sx181-256, except for araJ. Bacteria developed resistance to antimicrobials by regulating various biological processes, among which the most involved is the cell wall synthesis (dacC, mrdA, lpxD, mrcB, and ftsI). The combination mutations of mrdA, envZ, and ftsI genes may increase the resistance to IMP. Our study could improve the understanding of the molecular mechanism of IMP resistance in E. coli.
Chromosome-Level Genome Assembly ofAnthidium xuezhongiNiu & Zhu, 2020 (Hymenoptera: Apoidea: Megachilidae: Anthidiini)
Authors: Zhang Dan , Jin Jianfeng , Niu Zeqing , Zhang Feng , Orr Michael C , Zhou Qingsong , Luo Arong , Zhu Chaodong
Published: February 2022

Anthidiini, a large bee tribe characterized by light-colored maculations, represents nearly 1,000 pollinator species, but no genomes are yet available for this tribe. Here, we report a chromosome-level genome assembly of Anthidium xuezhongi collected from the Tibetan Plateau. Using PacBio long reads and Hi-C data, we assembled a genome of 189.14 Mb with 99.94% of the assembly located in 16 chromosomes. Our assembly contains 23 scaffolds, with the scaffold N50 length of 12.53 Mb, and BUSCO completeness of 98.70% (n = 1,367). We masked 25.98 Mb (13.74%) of the assembly as repetitive elements, identified 385 noncoding RNAs, and predicted 10,820 protein-coding genes (99.20% BUSCO completeness). Gene family evolution analyses identified 9,251 gene families, of which 31 gene families experienced rapid evolution. Interspecific chromosomal variation among A. xuezhongi, Bombus terrestris, and Apis mellifera showed strong chromosomal syntenic relationships. This high-quality genome assembly is a valuable resource for evolutionary and comparative genomic analyses of bees.
A complex genetic architecture underlies mandibular evolution in big mice from Gough Island
Authors: Parmenter Michelle D , Nelson Jacob P , Gray Melissa M , Weigel Sara , Vinyard Christopher J , Payseur Bret A
Published: February 2022

Some of the most compelling examples of morphological evolution come from island populations. Alterations in the size and shape of the mandible have been repeatedly observed in murid rodents following island colonization. Despite this pattern and the significance of the mandible for dietary adaptation, the genetic basis of island-mainland divergence in mandibular form remains uninvestigated. To fill this gap, we examined mandibular morphology in 609 F2s from a cross between Gough Island mice, the largest wild house mice on record, and mice from a mainland reference strain (WSB). Univariate genetic mapping identifies 3 quantitative trait loci (QTL) for relative length of the temporalis lever arm and 2 distinct QTL for relative condyle length, 2 traits expected to affect mandibular function that differ between Gough Island mice and WSB mice. Multivariate genetic mapping of coordinates from geometric morphometric analyses identifies 27 QTL contributing to overall mandibular shape. Quantitative trait loci show a complex mixture of modest, additive effects dispersed throughout the mandible, with landmarks including the coronoid process and the base of the ascending ramus frequently modulated by QTL. Additive effects of most shape quantitative trait loci do not align with island-mainland divergence, suggesting that directional selection played a limited role in the evolution of mandibular shape. In contrast, Gough Island mouse alleles at QTL for centroid size and QTL for jaw length increase these measures, suggesting selection led to larger mandibles, perhaps as a correlated response to the evolution of larger bodies.
Women, Peace and Security across scales: exclusions and opportunities in Iraq's WPS engagements
Authors: Chilmeran Yasmin
Published: February 2022

While space, positionality, hierarchy and location have been central undercurrents to understanding women's participation and uptake of the Women, Peace and Security (WPS) agenda, there has been little conceptual clarity about how these dynamics play out in post-conflict settings, nor on the impact that this has on women's civil society networks in these locations. In turn, this silence depoliticizes, decontextualizes and flattens the complex and diverse uses of the WPS agenda in post-conflict settings, as well as the diverse civil society arrangements underpinning this activity. This article makes the issue of space and its political nature central (captured through the use of the ‘politics of scale’), with reference to Iraq as a context for unpacking these dynamics. I explore how Iraqi women participate across different scalar contexts linked to the WPS agenda, and navigate exclusions and opportunities within and across them. Drawing on interviews, speeches and policy material from Iraqi women's organizations and their international partners, I argue that grasping how hierarchies related to scale, identity, resourcing and positionality are reproduced in local and national contexts is vital to understanding the uptake and rewriting of the WPS agenda in post-conflict settings. Further, I explore how Iraqi women's organizations are responding to openings and attempting to challenge the spatial arrangements within and across the different scales they work and participate in.
Rethinking strategy and statecraft for the twenty-first century of complexity: a case for strategic diplomacy
Authors: Prantl Jochen , Goh Evelyn
Published: February 2022

Today's most pressing security and policy challenges—great power conflict, economic interdependence, peacebuilding, climate change and other non-traditional threats such as pandemics—are all complex problems. Hyperconnectivity, power diffusion and radical technological transformation are significantly shrinking the policy space available to governments and other international agencies in what has been called the twenty-first century of complexity. Thus, the practice of statecraft requires accentuated strategic rationale: clear emphasis on big-picture and longer-term purposes and priorities. While effective strategy is essential for mobilizing power and winning strategic contests, effective diplomacy is necessary for garnering support for the strategy. This article contributes to stepping up to this challenge in three innovative ways. First, it utilizes key insights from complex adaptive systems thinking to recast the conceptual underpinnings of power, strategy and statecraft. Second, the article advances a ‘strategic diplomacy’ diagnostic and policy framework to maximize policy space in dealing with complex systems problems in international affairs. And third, by applying the framework to three significant international policy challenges, the article demonstrates the utility and implications of the ‘strategic diplomacy’ framework for strategic policy in the twenty-first century.
Impact of Biological Therapies and Tofacitinib on Real-world Work Impairment in Inflammatory Bowel Disease Patients: A Prospective Study
Authors: Thomas Pepijn W A , den Broeder Nathan , Derikx Monique , Kievit Wietske , West Rachel L , Russel Maurice G V M , Jansen Jeroen M , Römkens Tessa E H , Hoentjen Frank
Published: February 2022

Background

There are limited real-world data on the change in total work impairment (TWI) in biological-treated patients with inflammatory bowel disease (IBD). This study aimed to evaluate the real-world effects of initiating biological therapy or tofacitinib on change in TWI in IBD patients.

Methods

This multicenter prospective cohort study enrolled IBD patients who started treatment with biological therapy or tofacitinib. Subjects completed the work productivity and activity impairment (WPAI) questionnaire and short inflammatory bowel disease questionnaire at therapy initiation and at week 26. Total work impairment comprises working hours missed due to sick leave and impact of disease during working hours (range 0%-100%). Clinical disease activity was assessed using the Harvey-Bradshaw Index and Simple Clinical Colitis Activity Index (SCCAI).

Results

We included 137 IBD patients for analyses (median age 38 years, 58% Crohn’s disease [CD]). The median baseline TWI was 50% and decreased by a median of 10%-points of points after 26 weeks. Patients with continued biological therapy or tofacitinib use, clinical disease activity at baseline, and clinical response or remission at week 26 showed a greater median TWI reduction (22%-points) than the remaining study patients (7%-points; P = .014). Ulcerative colitis (UC) and IBD-unclassified (IBD-U) patients showed a greater median TWI reduction (26%-points) than CD patients (6%-points); P = .041. Correlations were observed between decrease in TWI and decrease in SCCAI, decrease in fatigue and increase in quality of life.

Conclusions

Work impairment in IBD patients decreased following biological therapy or tofacitinib initiation. Patients achieving clinical remission or response showed the greatest improvement, especially UC and IBD-U patients.
Can Men Do Feminist Fieldwork and Research?
Authors: Giri Keshab
Published: February 2022

This article systematically explores key theoretical and political, and epistemological and methodological considerations regarding men undertaking feminist fieldwork and research. This has become increasingly relevant as men working on exploring the gendered analysis of armed conflict and peacebuilding has become relatively routine recently. Yet, there is a dearth of systematic research on this topic. To fill this gap, this article asks two central questions: Can men do feminist fieldwork and research in conflict/post-conflict settings? What are the requirements for this? Drawing from my experience as a heterosexual cis male doing fieldwork on female combatants in a post-conflict setting in Nepal (2017–2018) and building on the long-standing robust scholarly conversation on desirability and possibility of men in feminist research and activism, the article argues that critical self-reflexivity with honesty on limitation and partiality of research, situated knowledge, and positionality and power including ethics of care, moral responsibility, and reciprocity are key considerations for men to engage in feminist fieldwork and research. While gender is a primary concern for men researching on women, there is “multiplex subjectivity” (race, class, caste, ethnicity, nationality, and education) interacting with gender creating complex relational power dynamics before/during/after the fieldwork to influence the research process and outcome.
Maternal supply of a source of omega-3 fatty acids and methionine during late gestation on the offspring’s growth, metabolism, carcass characteristic, and liver’s mRNA expression in sheep
Authors: Rosa-Velazquez Milca , Pinos-Rodriguez Juan Manuel , Parker Anthony J , Relling Alejandro E
Published: February 2022

The objective of the present experiment was to evaluate the effect of maternal supplementation with fatty acids (FAs) and methionine (Met) during late gestation on offspring growth, energy metabolism, plasma resolvin (RvD1) concentration, carcass characteristics, and hepatic mRNA expression. Ewes (5 pens/treatment; 3 ewes/pen) blocked by body weight (BW) were assigned to one of four treatments from day 100 of gestation until lambing. The treatments were: basal diet (NS) without FAs or Met supplementation; FA supplementation (FS; 1.01 % of Ca salts, containing n-3 FA); Met supplementation (MS; 0.1 % of rumen-protected methionine); and FS and MS (FS-MS). At birth (day 0), ewes and lambs were placed in a common pen. On day 60, lambs were weaned, sorted by sex, blocked by BW, and placed on a common finishing diet for 54 d (FP). A lamb per pen was used for a glucose tolerance test (GTT) after the FP. Carcass characteristics were recorded on day 56. Lamb data were analyzed as a randomized complete block design with a 2 × 2 × 2 factorial arrangement, with repeated measurements when needed (SAS 9.4). At weaning, lambs born to MS- or FS-fed ewes were heavier than lambs born from FS-MS ewes (FS × MS × Time; P = 0.02). A marginal significant FS × MS interaction (P = 0.09) was also observed on RvD1; lambs born to ewes in the NS and FS-MS treatments showed a lower RvD1 plasma concentration when compared with lambs born to FS- or MS-fed ewes. Lambs born to dams fed FA showed an increase (P = 0.05) in liver COX-2 mRNA relative expression. Lambs born to ewes supplemented with Met showed an increase (P = 0.03) in liver FABP4 mRNA expression. An FS × MS × Time interaction (P = 0.07) was observed in plasma glucose during the GTT; lambs born from FS-fed ewes showed lower plasma glucose concentration than lambs born to Met-supplemented ewes at 2 min after bolus administration. During the GTT, a marginal significant effect (P = 0.06) was observed for the lamb average insulin concentration due to maternal Met supplementation during late gestation, where these lambs had the lowest plasma concentration. Contrary to our hypothesis, the interaction of FA and Met supplementation during late gestation did not show a greater positive effect on offspring postnatal growth and metabolism. However, the individual supplementation of each nutrient has an effect on offspring development with a concomitant change in markers involved in the inflammatory response and energy metabolism.