bluuebunny/crossref_metadata_2025 huggingface dataset:
9. Natural resources, security, and conflicts
Authors: Morin Jean-Frédéric , Orsini Amandine , Jinnah Sikina
Published: August 2020

This chapter discusses the relationship between the environment and security. The concept of ‘environmental security’ is omnipresent, but is nonetheless ambiguous and contested. What exactly needs to be secured, and what are the security threats? Is environmental security about state security, faced with the loss of natural resources? Or is it about protecting individuals and communities from environmental degradation and reduced access to key environmental resources? A first step in clarifying these questions is to disentangle two related but distinct causal arguments. In the relationship between environment and security, environmental degradation can be analysed either as a cause or as a consequence of security issues. A second step needed to clarify these debates is to adopt clear definitions. In the context of international relations, security has traditionally been understood in relation to the survival of the state, and the main threats to state security are armed conflicts. For the purpose of this chapter, conflicts are defined as any type of disagreement. The chapter also examines the impact of conflicts on the environment.
Fine-mapping genetic associations
Authors: Hutchinson Anna , Asimit Jennifer , Wallace Chris
Published: August 2020

Whilst thousands of genetic variants have been associated with human traits, identifying the subset of those variants that are causal requires a further ‘fine-mapping’ step. We review the basic fine-mapping approach, which is computationally fast and requires only summary data, but depends on an assumption of a single causal variant per associated region which is recognized as biologically unrealistic. We discuss different ways that the approach has been built upon to accommodate multiple causal variants in a region and to incorporate additional layers of functional annotation data. We further review methods for simultaneous fine-mapping of multiple datasets, either exploiting different linkage disequilibrium (LD) structures across ancestries or borrowing information between distinct but related traits. Finally, we look to the future and the opportunities that will be offered by increasingly accurate maps of causal variants for a multitude of human traits.
The role of the stem cell epigenome in normal aging and rejuvenative therapy
Authors: Jayarajan Jeyan , Milsom Michael D
Published: August 2020

Adult stem cells are ultimately responsible for the lifelong maintenance of regenerating of tissues during both homeostasis and following injury. Hence, the functional attrition of adult stem cells is thought to be an important driving factor behind the progressive functional decline of tissues and organs that is observed during aging. The mechanistic cause underlying this age-associated exhaustion of functional stem cells is likely to be complex and multifactorial. However, it is clear that progressive remodeling of the epigenome and the resulting deregulation of gene expression programs can be considered a hallmark of aging, and is likely a key factor in mediating altered biological function of aged stem cells. In this review, we outline cell intrinsic and extrinsic mediators of epigenome remodeling during aging; discuss how such changes can impact on stem cell function; and describe how resetting the aged epigenome may rejuvenate some of the biological characteristics of stem cells.
A Drosophila model of Friedreich ataxia with CRISPR/Cas9 insertion of GAA repeats in the frataxin gene reveals in vivo protection by N-acetyl cysteine
Authors: Russi Maria , Martin Elodie , D’Autréaux Benoit , Tixier Laura , Tricoire Hervé , Monnier Véronique
Published: August 2020

Friedreich ataxia (FA) is caused by GAA repeat expansions in the first intron of FXN, the gene encoding frataxin, which results in decreased gene expression. Thanks to the high degree of frataxin conservation, the Drosophila melanogaster fruitfly appears as an adequate animal model to study this disease and to evaluate therapeutic interventions. Here, we generated a Drosophila model of FA with CRISPR/Cas9 insertion of approximately 200 GAA in the intron of the fly frataxin gene fh. These flies exhibit a developmental delay and lethality associated with decreased frataxin expression. We were able to bypass preadult lethality using genetic tools to overexpress frataxin only during the developmental period. These frataxin-deficient adults are short-lived and present strong locomotor defects. RNA-Seq analysis identified deregulation of genes involved in amino-acid metabolism and transcriptomic signatures of oxidative stress. In particular, we observed a progressive increase of Tspo expression, fully rescued by adult frataxin expression. Thus, Tspo expression constitutes a molecular marker of the disease progression in our fly model and might be of interest in other animal models or in patients. Finally, in a candidate drug screening, we observed that N-acetyl cysteine improved the survival, locomotor function, resistance to oxidative stress and aconitase activity of frataxin-deficient flies. Therefore, our model provides the opportunity to elucidate in vivo, the protective mechanisms of this molecule of therapeutic potential. This study also highlights the strength of the CRISPR/Cas9 technology to introduce human mutations in endogenous orthologous genes, leading to Drosophila models of human diseases with improved physiological relevance.
Examining the robustness of observational associations to model, measurement and sampling uncertainty with the vibration of effects framework
Authors: Klau Simon , Hoffmann Sabine , Patel Chirag J , Ioannidis John PA , Boulesteix Anne-Laure
Published: August 2020

Background

The results of studies on observational associations may vary depending on the study design and analysis choices as well as due to measurement error. It is important to understand the relative contribution of different factors towards generating variable results, including low sample sizes, researchers’ flexibility in model choices, and measurement error in variables of interest and adjustment variables.

Methods

We define sampling, model and measurement uncertainty, and extend the concept of vibration of effects in order to study these three types of uncertainty in a common framework. In a practical application, we examine these types of uncertainty in a Cox model using data from the National Health and Nutrition Examination Survey. In addition, we analyse the behaviour of sampling, model and measurement uncertainty for varying sample sizes in a simulation study.

Results

All types of uncertainty are associated with a potentially large variability in effect estimates. Measurement error in the variable of interest attenuates the true effect in most cases, but can occasionally lead to overestimation. When we consider measurement error in both the variable of interest and adjustment variables, the vibration of effects are even less predictable as both systematic under- and over-estimation of the true effect can be observed. The results on simulated data show that measurement and model vibration remain non-negligible even for large sample sizes.

Conclusion

Sampling, model and measurement uncertainty can have important consequences for the stability of observational associations. We recommend systematically studying and reporting these types of uncertainty, and comparing them in a common framework.
Population-based organized screening by faecal immunochemical testing and colorectal cancer mortality: a natural experiment
Authors: Keys Matthew T , Serra-Burriel Miquel , Martínez-Lizaga Natalia , Pellisé Maria , Balaguer Francesc , Sánchez Ariadna , Bernal-Delgado Enrique , Castells Antoni
Published: August 2020

Background

Population-based organized screening programmes for colorectal cancer (CRC) are underway worldwide, with many based on the faecal immunochemical test (FIT). No clinical trials assessing FIT compared with no screening are planned, and few studies have assessed the population impact of such programmes.

Methods

Before 2010, 11 out of 50 Spanish provinces initiated population-based organized screening programmes with FIT for an average-risk population aged 50–69 years. We used a quasi-experimental design across Spanish provinces between 1999 and 2016 to evaluate their impact on population age-standardized mortality and incidence rates due to CRC. Difference-in-differences and synthetic control analyses were performed to test for validation of statistical assumptions and to assess the dynamics of screening-associated changes in outcomes over time.

Results

No differences in outcome trends between exposed (n = 11) and control (n = 36) provinces were observed for up to 7 years preceding the implementation of screening. Relative to controls, exposed provinces experienced a mean increase in age-standardized incidence of 10.08% [95% confidence interval (CI) (5.09, 15.07)] 2 years after implementation, followed by a reduction in age-standardized mortality rates due to CRC of 8.82% [95% CI (3.77, 13.86)] after 7 years. Results were similar for both women and men. No associated changes were observed in adjacent age bands not targeted by screening, nor for 10 other major causes of death in the exposed provinces.

Conclusions

FIT-based organized screening in Spain was associated with reductions in population colorectal cancer mortality. Further research is warranted in order to assess the replicability and external validity of our findings, and on gender-specific use of FIT in organized screening.
Culture, meat, and cultured meat
Authors: Bryant Christopher J
Published: August 2020

Cultured meat grown in vitro from animal cells has the potential to address many of the ethical, environmental, and public health issues associated with conventional meat production. However, as well as overcoming technical challenges to producing cultured meat, producers and advocates of the technology must consider a range of social issues, including consumer appeal and acceptance, media coverage, religious status, regulation, and potential economic impacts. Whilst much has been written on the prospects for consumer appeal and acceptance of cultured meat, less consideration has been given to the other aspects of the social world that will interact with this new technology. Here, each of these issues is considered in turn, forming a view of cultured meat as a technology with a diverse set of societal considerations and far-reaching social implications. It is argued that the potential gains from a transition to cultured meat are vast, but that cultural phenomena and institutions must be navigated carefully for this nascent industry to meet its potential.
Demography and Mass Rearing ofAmblyseius swirskii(Acari: Phytoseiidae) Fed on Two Species of Stored-Product Mites and Their Mixture
Authors: Asgari Faeze , Moayeri Hamid Reza Sarraf , Kavousi Aurang , Enkegaard Annie , Chi Hsin
Published: August 2020

Amblyseius swirskii (Athias-Henriot) is one of the most important biological control agents and has been used in many countries. In this study, the suitability of Carpoglyphus lactis L. (Acari: Carpoglyphidae), Tyrophagus putrescentiae (Schrank), and their mixture for rearing A. swirskii was evaluated by using the two-sex life table. When reared on C. lactis, the durations of egg, deutonymph, total preadult, total preoviposition period, and adult male longevity of A. swirskii (1.95, 1.17, 6.13, 6.30, and 10.09 d, respectively) were significantly shorter than those reared on the mixed prey (2.05, 1.45, 6.55, 6.64, and 15.56 d, respectively). When reared on the mixed prey, however, the fecundity (110.21 eggs/female) of A. swirskii was significantly higher in comparison with those solely reared on C. lactis (82.17 eggs/female) or on T. putrescentiae (98.23 eggs/female). When reared on the mixed diet, the intrinsic rate of increase (r = 0.3792 d−1), finite rate of population increase (λ = 1.4611 d−1), and net reproductive rate (R0 = 79.69 offspring) of A. swirskii were significantly higher than those on single-species diets. For a daily production of 10,000 eggs of A. swirskii, a smaller population size (2,626 individuals) of A. swirskii is needed when reared on the mixed diet, in contrast to the 4,332 individuals on C. lactis and 3,778 individuals on T. putrescentiae. The population projection and mass-rearing analysis based on life table showed that the mixed diet was the most suitable and economical diet for the mass-rearing of A. swirskii.
Effects of Storage Periods of an Artificial Larval Diet on the Yield and Quality of Mass-Reared West Indian Sweet Potato Weevil (Coleoptera: Curculionidae)
Authors: Misa Kinjo , Himuro Chihiro , Honma Atsushi , Ikegawa Yusuke , Ohishi Tsuyoshi
Published: August 2020

Artificial diets have been employed for the mass-rearing of numerous insects because of their ease of use and standardized quality. An ability to store artificial diets under nonrefrigerated conditions over the long term could improve the efficacy of mass-rearing systems considerably. However, it remains largely unknown how long artificial diets can be stored at such temperatures without any adverse effects on the insects reared. In this study, we investigated yield, body size, and reproductive potential of West Indian sweet potato weevil, Euscepes postfasciatus (Fairmaire), which is a major sweet potato pest, under management using the sterile-insect technique in Japan and reared using artificial diets with different storage periods (14, 28, and 42 d) at nonrefrigerated temperatures (25 ± 1°C), and compared them with those of the control (0 d). Notably, E. postfasciatus yield and reproductive potential increased significantly with an increase in storage period (28 and 42 d). Conversely, male body size decreased significantly following feeding with artificial diet stored for 42 d, when compared with the control, while there were no significant differences in female body size between the control and all the treatments. We discuss the potential causes of such varying effects between yield and body size and conclude that E. postfasciatus artificial diet can be stored for at least 28 d without any adverse effects on weevil yield and weevil quality. To the best of our knowledge, this is the first report revealing the positive effects of long-term storage of the artificial diet on mass-reared insects.
Culicoides (Diptera: Ceratopogonidae) Communities Differ Between a Game Preserve and Nearby Natural Areas in Northern Florida
Authors: McGregor Bethany L , Blackburn Jason K , Wisely Samantha M , Burkett-Cadena Nathan D
Published: August 2020

Culicoides Latreille biting midges are small hematophagous flies that feed on a variety of vertebrate animals. White-tailed deer (Odocoileus virginianus), a farmed species in the United States, can occur at high densities on farms. This elevated density of available hosts may result in greater abundance of midges and greater potential for disease transmission on farms than natural ecosystems. This research aimed to determine whether Culicoides abundance varied between a game preserve in Gadsden County, Florida, a site bordering the preserve (‘adjacent’), a site 3.5 km away (‘moderate’), and a site 13 km away (‘distant’). CDC light traps were set one night per week at the preserve, adjacent site, and moderate site in 2016 and at all four sites in 2017. Total abundance was greatest at the preserve and second greatest at the adjacent site both years. Average abundance of female Culicoides stellifer (Coquillett) was an order of magnitude greater on the preserve (x¯=24.59 in 2016, 17.95 in 2017) than at any other site (x¯≤1.68 in 2016, x¯≤1.03 in 2017), whereas the greatest average abundance of Culicoides venustus Hoffman was found at the adjacent site (x¯=5.15 in 2016, x¯=1.92 in 2017). Distance from the preserve significantly affected overall average abundance for both species (P < 0.001), although pairwise significance varied. Species diversity was lowest on the preserve and highest at the moderate site both years. These data suggest that high densities of animals may increase transmission potential on high fence preserves and in adjacent areas by contributing to high densities of vector species.
Experimental evidence for weakened tree nutrient use and resorption efficiencies under severe drought in a subtropical monsoon forest
Authors: Xu Xiao-Ni , Xia Jian-Yang , Zhou Xu-Hui , Yan Li-Ming
Published: August 2020

Aims

The functions of global forests are threatened by the increasing frequency of severe drought. Due to drought inducing reductions in soil nutrient availability, efficiencies of nutrient use and resorption of trees become crucial for forest functions and biogeochemical cycles. However, understanding the dynamics of responses of foliar nutrient use and resorption efficiencies to drought, especially in tropical or subtropical forests, is still limited. Our goal was to detect whether and how the importance of leaf nutrient use and resorption changes across different species in the hot and wet forests when suffering drought stress in different months.

Methods

Based on a 70% throughfall exclusion experiment in a subtropical forest, we collected green and senesced leaves of Schima superba and Lithocarpus glaber in different months from October 2016 to May 2019, to estimate the effects of drought on leaf nitrogen (N) and phosphorus (P) use and resorption efficiencies (i.e. NUE and PUE, NRE and PRE).

Important Findings

The effects of drought on nutrient use and resorption efficiencies varied between species and months. Based on a 2-year observation, drought had no effect on S. superba, but significantly decreased NUE, NRE and PRE of L. glaber by 3.4%, 20.2% and 7.1%, respectively. Furthermore, the negative drought effects were aggravated by the natural summer drying in 2017. As a result, NUE and PUE of L. glaber were significantly depressed by 17.2% and 58.1%, while NRE and PRE were significantly reduced by 56.5% and 53.8% in August 2017. Moreover, the responses of NRE, PRE and NUE to drought were related with soil moisture (SM) for L. glaber, and when SM decreased to a threshold near 9 v/v%, drought effects were shifted from unresponsive to negative. Our results highlight a species-specific threshold response of nutrient use under drought in a subtropical forest.
The balancing act of organizing professionals and managers: An ethnographic account of nursing role development and unfolding nurse-manager relationships
Authors: van Schothorst-van Roekel Jannine , Weggelaar-Jansen Anne Marie J W M , de Bont Antoinette A , Wallenburg Iris
Published: August 2020

Scholars describe organizing professionalism as ‘the intertwinement of professional and organizational logics in one professional role’. Organizing professionalism bridges the gap between the often-described conflicting relationship between professionals and managers. However, the ways in which professionals shape this organizing role in daily practice, and how it impacts on their relationship with managers has gained little attention. This ethnographic study reveals how nurses shape and differentiate themselves in organizing roles. We show that developing a new nurse organizing role is a balancing act as it involves resolving various tensions concerning professional authority, task prioritization, alignment of both intra- and interprofessional interests, and internal versus external requirements. Managers play an important yet ambiguous role in this development process as they both cooperate with nurses in aligning organizational and nursing professional aims, and sometimes hamper the development of an independent organizing nursing role due to conflicting organizational concerns.
The Supraorbital Eyebrow Craniotomy for Intra- and Extra-Axial Brain Tumors: A Single-Center Series and Technique Modification
Authors: Ansari Shaheryar F , Eisenberg Amy , Rodriguez Amanda , Barkhoudarian Garni , Kelly Daniel F
Published: August 2020

BACKGROUND

The supraorbital (SO) eyebrow craniotomy provides minimally invasive access to the anterior and middle fossae and parasellar region.

OBJECTIVE

To present a series of patients treated with the SO approach to assess outcomes, the impact of endoscopy, and describe a modified pericranial flap aimed at reducing postoperative frontalis paresis and hypesthesia.

METHODS

A retrospective analysis was undertaken of our prospective database of patients who underwent SO craniotomy for tumor/cyst removal. Patients were evaluated based on pathology, utility of endoscopy, extent of resection, complications, and functional/esthetic recovery.

RESULTS

From 2007 to 2018, 129 operations were performed in 117 patients (54% women; mean age 60 ± 16.5 yr). The most common lesions were meningiomas (43%), gliomas (15%), and metastases (15%). Prior surgery and/or radiation had been performed in 37% and 26% of patients, respectively. Endoscopy was used in 76 (61%) operations and allowed more complete tumor removal in 38 (50%). For first-time operations, gross-total removal was achieved in 78%. Major complications included stroke (3%), cranial nerve deficit (3%), acute hematoma (1%), and cerebrospinal fluid leak (1%). The modified pericranial flap technique used in 18 recent patients resulted in a shorter duration of transient frontalis paresis and forehead hypesthesia with complete functional recovery in all 18.

CONCLUSION

The SO craniotomy is an effective keyhole approach for intra- and extra-axial tumors. Endoscopic assistance may allow additional tumor removal in almost 30% of the cases. The modified pericranial flap appears to accelerate functional recovery, although additional patients and follow-up are required to better assess this technique.
Use of Navigated Ultrasonic Bone Cutting Tool for En Bloc Resection of Thoracic Chondrosarcoma: Technical Report
Authors: Vedantam Aditya , Vigneswaran Krishanthan , Rao Ganesh , Walsh Garrett L , Rhines Laurence D , Tatsui Claudio E
Published: August 2020

BACKGROUND

En bloc surgical resection with wide margins offers the best local control rates for chondrosarcoma of the spine.

OBJECTIVE

To describe the surgical technique for en bloc resection of a large thoracic chondrosarcoma using image guidance for a complex osteotomy with an ultrasonic bone cutting device (Misonix, Farmingdale, New York).

METHODS

A 2-stage procedure was performed for resection of a thoracic chondrosarcoma involving the T3-T7 vertebral bodies. During the first stage, a posterior approach, the ultrasonic bone cutter was precisely navigated to perform an intralaminar osteotomy as well as a multilevel split sagittal osteotomy through the vertebral bodies. In the second stage, a transthoracic approach was used to complete the en bloc resection of the specimen. Intraoperative frozen sections from the surgical margins were negative for tumor.

RESULTS

The ultrasonic bone cutting device was navigated based on coregistration of the intraoperative computed tomography (CT) images and preoperative magnetic resonance imaging (MRI). Real-time navigation using coregistered images enabled identification of tumor margins within the bone and adjacent soft tissue allowing precise execution of the intralaminar and multilevel split sagittal vertebral osteotomies. Surgical video demonstrates the utility of real-time navigation to properly identify the tumor margins and guide the ultrasonic bone cutting tool during the osteotomies.

CONCLUSION

We describe the use of image guidance to navigate an ultrasonic bone cutting tool for a complex en bloc resection of a multilevel thoracic spine chondrosarcoma.
Role Variations and Perceptions of Campus Police versus Local and State Law Enforcement
Authors: Youstin Tasha J , Kopp Phillip M
Published: August 2020

The purpose of this article was to explore potential variations in students’ perceptions towards campus police (CP) roles and behaviours as compared with local and state law enforcement (LSLE). This study used a web-based survey to solicit responses from (n = 995) students. Results showed that students perceived traditional policing roles of higher import to LSES while rating campus-specific roles higher for CP. However, rank order of roles revealed remarkable similarities between policing agencies. Additionally, CP were perceived more favourably in terms of their behaviour, with similar participant characteristics predicting perceptions of CP and LSLE. Interactions with LSLE significantly affected perceptions of CP behaviour and vice versa, indicating a lack of distinction between CP and LSLE. While prior research suggests that CP is marginalized, the current analysis offers support that differences in role importance between CP and LSLE may be due to the unique needs of college campuses.
Statistical pattern recognition reveals shared neural signatures for displaying and recognizing specific facial expressions
Authors: Volynets Sofia , Smirnov Dmitry , Saarimäki Heini , Nummenmaa Lauri
Published: August 2020

Human neuroimaging and behavioural studies suggest that somatomotor ‘mirroring’ of seen facial expressions may support their recognition. Here we show that viewing specific facial expressions triggers the representation corresponding to that expression in the observer’s brain. Twelve healthy female volunteers underwent two separate fMRI sessions: one where they observed and another where they displayed three types of facial expressions (joy, anger and disgust). Pattern classifier based on Bayesian logistic regression was trained to classify facial expressions (i) within modality (trained and tested with data recorded while observing or displaying expressions) and (ii) between modalities (trained with data recorded while displaying expressions and tested with data recorded while observing the expressions). Cross-modal classification was performed in two ways: with and without functional realignment of the data across observing/displaying conditions. All expressions could be accurately classified within and also across modalities. Brain regions contributing most to cross-modal classification accuracy included primary motor and somatosensory cortices. Functional realignment led to only minor increases in cross-modal classification accuracy for most of the examined ROIs. Substantial improvement was observed in the occipito-ventral components of the core system for facial expression recognition. Altogether these results support the embodied emotion recognition model and show that expression-specific somatomotor neural signatures could support facial expression recognition.
Modulation of TASK-1/3 channels at the hypoglossal motoneuron pool and effects on tongue motor output and responses to excitatory inputs in vivo: implications for strategies for obstructive sleep apnea pharmacotherapy
Authors: Gurges Patrick , Liu Hattie , Horner Richard L
Published: August 2020

Obstructive sleep apnea (OSA) occurs exclusively during sleep due to reduced tongue motor activity. Withdrawal of excitatory inputs to the hypoglossal motor nucleus (HMN) from wake to sleep contributes to this reduced activity. Several awake–active neurotransmitters with inputs to the HMN (e.g. serotonin [5-HT]) inhibit K+ leak mediated by TASK-1/3 channels on hypoglossal motoneurons, leading to increased neuronal activity in vitro. We hypothesize that TASK channel inhibition at the HMN will increase tongue muscle activity in vivo and modulate responses to 5-HT. We first microperfused the HMN of anesthetized rats with TASK channel inhibitors: doxapram (75 μM, n = 9), A1899 (25 μM, n = 9), ML365 (25 μM, n = 9), acidified artificial cerebrospinal fluid (ACSF, pH = 6.25, n = 9); and a TASK channel activator terbinafine (50 μM, n = 9); all with and without co-applied 5-HT (10 mM). 5-HT alone at the HMN increased tongue motor activity (202.8% ± 45.9%, p < 0.001). However, neither the TASK channel inhibitors, nor activator, at the HMN changed baseline tongue activity (p > 0.716) or responses to 5-HT (p > 0.127). Tonic tongue motor responses to 5-HT at the HMN were also not different (p > 0.05) between ChAT-Cre:TASKf/f mice (n = 8) lacking TASK-1/3 channels on cholinergic neurons versus controls (n = 10). In freely behaving rats (n = 9), microperfusion of A1899 into the HMN increased within-breath phasic tongue motor activity in wakefulness only (p = 0.005) but not sleep, with no effects on tonic activity across all sleep–wake states. Together, the findings suggest robust maintenance of tongue motor activity despite various strategies for TASK channel manipulation targeting the HMN in vivo, and thus currently do not support this target and direction for potential OSA pharmacotherapy.
Imaging of the mitral valve: role of echocardiography, cardiac magnetic resonance, and cardiac computed tomography
Authors: Namazi Farnaz , Vo N. Mai , Delgado Victoria
Published: August 2020

Purpose of review

This article reviews the role of multimodality imaging in the in evaluation of patients with mitral regurgitation referred for transcatheter interventions.

Recent findings

Transcatheter therapies for mitral regurgitation in patients with high surgical risk or contraindications for surgery are evolving rapidly. Three-dimensional imaging techniques (transesophageal echocardiography, computed tomography, and cardiovascular magnetic resonance) are key to determine the anatomical suitability for each transcatheter therapy, to accurately quantify mitral regurgitation, and to plan and guide the procedure. Fusion imaging is being implemented in catheterization laboratories to precisely guide the procedure and to maximize safety and optimal results. Transcatheter edge-to-edge mitral valve repair with the MitraClip device (Abbott Vascular, Santa Clara, CA) provides the largest evidence on the safety and efficacy of this minimally invasive therapy and the importance of accurate patient selection to improve outcomes has been recently shown in two randomized trials.

Multimodality imaging is key in the work-up of patient with mitral regurgitation undergoing transcatheter therapies. Preprocedural imaging with three-dimensional echocardiography, computed tomography, and cardiac magnetic resonance is important to evaluate the eligibility of patients for transcatheter interventions, whilst three-dimensional transesophageal echocardiography provides soft-tissue information that can be overlaid onto fluoroscopy allowing more accurate guidance of transcatheter interventions.
Effect of direct renin inhibition on vascular function after long-term treatment with aliskiren in hypertensive and diabetic patients
Authors: Savoia Carmine , De Ciuceis Carolina , Paini Anna , Carletti Raffaella , Arrabito Emanuele , Nicoletti Carmine , Mercantini Paolo , Di Gioia Cira , Battistoni Allegra , Ucci Sarassunta , Filippini Antonio , Agabiti Rosei Enrico , Volpe Massimo , Muiesan Maria L. , Rizzoni Damiano , Salvetti Massimo
Published: August 2020

Objective:

We tested the hypothesis that chronic treatment with the direct renin inhibitor aliskiren improves vascular function in resistance and conduit arteries of type two diabetic and hypertensive patients.

Method:

Sixteen patients with mild essential hypertension and with a previous diagnosis of noninsulin-dependent diabetes mellitus were included in the study. Patients were then randomized to aliskiren (150 mg once daily, n = 9), or ramipril (5 mg once daily, n = 7). Each patient underwent a biopsy of the subcutaneous tissue and small arteries were dissected and mounted on a pressurized micromyograph to evaluate endothelium dependent vasorelaxation in response to acetylcholine ± N omega-nitro-l-arginine methyl ester hydrochloride in vessels precontracted with norepinephrine. Endothelial function has been quantified also in large conduit arteries by flow-mediated dilation.

Results:

A similar office blood pressure-lowering effect was observed with the two drugs, although changes in DBP were not statistically significant in the ramipril group. Aliskiren significantly improved endothelium-dependent relaxation in subcutaneous resistance arteries, as well as increased flow-mediated dilation in conduit arteries, whereas the effects induced by ramipril did not reach statistical significance. Only aliskiren significantly increased the expression of p1177-endothelial nitric oxide synthase in the endothelium. Both aliskiren and ramipril had a negligible effect on markers of oxidative stress.

Conclusion:

Aliskiren restored endothelial function and induced a more prompt peripheral vasodilation in hypertensive and diabetic patients possibly through the increased production of nitric oxide via the enhanced expression and function of the active phosphorylated form of endothelial nitric oxide synthase.
Vedolizumab Therapy in Children With Primary Sclerosing Cholangitis
Authors: Laborda Trevor J. , Ricciuto Amanda , Aumar Madeleine , Carman Nicholas , DiGuglielmo Matthew , Draijer Laura G. , Furuya Katryn N. , Gupta Nitika , Koot Bart G.P. , Loomes Kathleen M. , Lytvyak Ellina , Martinez Mercedes , Miloh Tamir , Montano‐Loza Aldo J. , Perito Emily R. , Sathya Pushpa , Shah Uzma , Shteyer Eyal , Singh Ruchi , Taylor Amy , Valentino Pamela L. , Vitola Bernadette , Zerofsky Melissa , Zizzo Andréanne , Deneau Mark R.
Published: August 2020

Objectives:

Most patients with primary sclerosing cholangitis (PSC) also have inflammatory bowel disease (IBD). The liver and colon express MAdCAM‐1, a target of lymphocyte homing integrins. Vedolizumab (VDZ) is an α4β7 integrin antibody used to treat IBD. We investigated liver outcomes in children with PSC‐IBD treated with VDZ.

Methods:

Patients were identified within the Pediatric PSC Consortium, a multicenter research registry. Retrospective demographic, phenotypic, biochemical, radiological, histopathologic and IBD data for up to 1 year of VDZ therapy were collected. Liver biochemical and IBD responses were defined as: a 75% or greater reduction in initial γ‐glutamyltransferase (GGT), or a GGT that fell to <50 IU/L and improved Mayo endoscopy grade or IBD activity scores after 9 to 12 months.

Results:

Thirty‐seven patients were identified from 19 centers. VDZ was initiated at median age of 16 years [IQR 15–18], 69% were male, 65% had large duct involvement, 19% had (Metavir F3/F4) fibrosis and 59% had ulcerative colitis. Of 32 patients with abnormal GGT at baseline, 22% had a liver biochemical response after 9 to 12 months. For IBD, 32% achieved remission, 30% had a clinical response, and 38% had no response. Final GGT after 9 to 12 months was 51 [IQR 28–71] in IBD patients in remission versus 127 [IQR 63–226] in those with active IBD, (P = 0.066).

Conclusions:

Liver biochemistry worsened over time in IBD unresponsive to VDZ but remained unchanged in IBD patients in remission. VDZ did not improve liver biochemistry in pediatric PSC‐IBD. Progressive liver disease may be more common in patients with medically refractory IBD.
COVID-19-associated Multisystem Inflammatory Syndrome in Children Presenting as Acute Pancreatitis
Authors: Stevens James P. , Brownell Jefferson N. , Freeman A. Jay , Bashaw Hillary
Published: August 2020

In April 2020, a newly recognized pediatric disorder associated with COVID-19 characterized by significant inflammation with symptoms resembling Kawasaki disease was described by medical teams in the United States, the United Kingdom, and Italy. Before these reports, data from the initial COVID-19 outbreaks in China had not found the virus to cause significant morbidity or mortality in children. To date, pancreatitis has not yet been reported in either acute SARS-CoV-2 infection in children or the subsequent inflammatory syndrome. We describe a patient who presented with acute pancreatitis before rapidly progressing to multisystem organ dysfunction consistent with multisystem inflammatory syndrome in children due to COVID-19. Clinicians should be aware that in the context of the COVID-19 pandemic, pancreatitis can be an early presentation of multisystem inflammatory syndrome in children.
Psychometrics of the Functional Oral Intake Scale for Children With Dysphagia
Authors: Yi You Gyoung , Shin Hyung-Ik
Published: August 2020

Objectives:

The functional oral intake scale (FOIS), developed for adults based on the categories of consumable food has been adapted for infants. A FOIS for children is necessary as oral motor development continues after 1 year of age. This study proposed a FOIS for children and investigated the reliability and validity of the scale.

Methods:

We adapted the original FOIS into a scale for children by removing 2 item levels to generate a 5-point scale. This retrospective study included 194 children ages 1 to 7 years. Their nutrition records were evaluated separately by 2 raters using the FOIS for children. Dysphagia and aspiration severity were evaluated based on the findings from a videofluoroscopic swallowing study. For children partially dependent on tube feeding, medical records were investigated to determine whether full oral feeding was accomplished within 1 year.

Results:

The inter-rater reliability of FOIS for children had 97.4% agreement (weighted kappa = 0.985, intraclass correlation coefficient = 0.994). Significant associations were identified between the FOIS for children and aspiration severity (P < 0.001, r = 0.315) and dysphagia severity (P < 0.001, r = 0.287). The rate of reaching full oral feeding within 1 year was greater (71.4% vs 30%) in children at the FOIS 3 level (tube and oral feeding in parallel) than for children at FOIS 2 (tube-dependent with minimal oral intake).

Conclusions:

The FOIS for children showed adequate reliability and validity and could be appropriate for documenting children's eating abilities and evaluating the effectiveness of interventions.
Extended Screening for Cystic Fibrosis-related Liver Disease Including Elastography in Children and Adolescents
Authors: Højte Christine , Jørgensen Marianne Hørby , Jensen Flemming , Katzenstein Terese L. , Skov Marianne
Published: August 2020

Objectives:

Advances in treatment of cystic fibrosis (CF) have increased survival and thereby prevalence of patients with liver disease, making chronic liver disease one of the major complications of CF. We describe the prevalence of liver fibrosis, portal hypertension, and liver decompensation by extended screening for cystic fibrosis-related liver disease (CFLD) including ultrasound, elastography, and an extended panel of biochemical markers.

Methods:

A cross sectional study of CFLD in all pediatric CF patients (1–18 years) from the Copenhagen CF Center. Screening for liver disease included physical examination, biochemical analysis, Vibration-Controlled Transient Elastography (FibroScan), conventional ultrasound, and Real-Time Shear Wave elastography (SWE). Patients were scored according to Williams ultrasound scoring scale (WUSS) within 6 months.

Results:

A total of 84 consecutive patients (male sex 46.4%, median age 10.4 years) were included. Eight patients (9.5%) had both ≥2 abnormal results of sonographic methods and ≥2 abnormal biochemical results and were in this study categorized as having manifest CFLD. Manifest CFLD patients were significantly older and had a higher mean value of APRI, but no differences in gender, z-height, z-weight, z-BMI, FEV1%, or mean value of bilirubin or albumin were found.

Conclusions:

In total, 8 patients (9.5%) in this pediatric CF population were categorized as having CFLD according to both biochemical and sonographic tests. Consistency was found among the results of FibroScan and SWE. We suggest WUSS and either FibroScan or SWE, combined with GGT as diagnostic markers for CFLD.
Anti‐TNF‐α Therapy Exerts Intestinal Anti‐inflammatory and Anti‐apoptotic Effects After Massive Bowel Resection in a Rat
Authors: Sukhotnik Igor , Ben‐Shahar Yoav , Pollak Yulia , Cohen Shlomi , Guz‐Mark Anat , Shamir Raanan
Published: August 2020

Objectives:

The aim of this study was to examine the effect of massive small bowel resection on proinflammatory cytokine intestinal expression and the effect of anti‐TNF‐α antibodies (ATA) on intestinal inflammation, epithelial cell turnover, and intestinal adaptation after bowel resection in rats.

Methods:

Male Sprague‐Dawley rats were divided into 4 experimental groups: Sham‐rats underwent bowel transection; Sham‐ATA rats underwent bowel transection and were treated with ATA; SBS‐animals underwent 75% bowel resection; and SBS‐ATA rats underwent bowel resection and were treated with ATA similarly to Group B. Parameters of intestinal adaptation, enterocyte proliferation, and apoptosis were determined at sacrifice. TNF‐α and apoptosis‐related gene and protein levels were determined by Illumina's Digital Gene Expression (DGE) analysis, Real Time PCR, Western blotting, and immunohistochemistry.

Results:

From 25 genes related to TNF‐α signalling that were investigated, 8 genes in the jejunum and 10 genes in the ileum were found to be up‐regulated in resected versus sham animals. SBS rats demonstrated a significant increase in tissue and plasma TNF‐α, IL‐6 levels, intestinal mucosal TNF‐α related gene expression, and microscopic parameters of inflammation. Treatment of resected animals with ATA resulted in a significant decrease in TNF‐α levels, intestinal mucosal TNF‐α‐related gene expression, decreased number of intraepithelial lymphocytes and macrophages, and lower apoptotic index compared with SBS animals.

Conclusions:

In a rat model of SBS, ATA decreased plasma and tissue TNF‐α levels, diminished mucosal inflammation, and inhibited cell apoptosis. Anti‐apoptotic effects of ATA appear to be associated with an inhibited extrinsic apoptotic pathway.
Open Primary Button Versus Laparoscopic Percutaneous Endoscopic Gastrostomy
Authors: Davidson Joseph R. , Lee Do Rae. , Suresh Dhivya , Wright Hannah , Upadhyaya Manasvi , Yardley Iain E.
Published: August 2020

Objectives:

Open primary balloon gastrostomy (PBG) presents a potential alternative to percutaneous endoscopic gastrostomy (PEG) in children as it obviates the need for change under general anaesthetic; however, the complication profile of PBG compared to PEG is not well defined. Previous series comparing the two have been hampered by the groups not being equivalent. Our paediatric surgical centre has offered PBG as an alternative PEG since 2014. We used a matched case‐control study to compare outcomes for PBG and PEG.

Methods:

Patients undergoing PBG were used as “cases” and matched 1:3 by age and diagnosis to patients undergoing PEG, demographics, and clinical data as “controls.” Primary outcome was rate of complications classified according to Clavien‐Dindo (I‐V). Secondary outcomes included time to feed and length of stay. Non‐parametric, categorical and multivariate logistic regression analyses were performed. Data here presented as median with interquartile range (IQR).

Results:

We included 140 patients (35 PBG:105 PEG). The 2 groups were comparable for sex, weight at surgery, and follow‐up duration. Median operative time was longer for PBG (43 min [IQR 36.5–61.5] vs 27.5 min [18.25–47.75], P < 0.001). Multivariate analysis demonstrated a statistically significant, higher incidence of symptomatic granulation tissue in PBG (10 [29%] vs 6 [6%], P = 0.0008), this remained significant on multivariate analysis (OR 7.56 [2.33–23.5], P = 0.001), no other complication remained significant. The overall complication rate was not statistically different.

Conclusions:

PBG and PEG have similar overall complication rates; however, PBG appears to have a higher incidence of granulation tissue. This observation must be weighed against the need for further general anaesthetic which is not insignificant in medically complex children.
The Views of Patients and Partners Toward Patient-Delivered Partner Therapy for Chlamydia: A Systematic Review
Authors: Layton Elly , Vaisey Alaina , Goller Jane L. , Coombe Jacqueline , Temple-Smith Meredith , Hocking Jane
Published: August 2020

Background

The majority of research on patient-delivered partner therapy (PDPT) has focused on its impact on reinfections. This study aimed to systematically review the evidence regarding the acceptability of PDPT by patients and partners for chlamydia infection.

Methods

Three electronic databases were searched in March 2019 using terms related to PDPT. Studies were included if they reported on patient or partner acceptance of PDPT for chlamydia and were conducted in high-income countries. Actual and perceived acceptabilities of PDPT were assessed.

Results

Thirty-three studies were included: 24 quantitative, 3 qualitative, and 6 mixed methods. Most were clinic based. Quantitative data showed that participants' perceived willingness to give PDPT to their partner(s) ranged from 44.7% to 96.3% (median, 84%), and 24% to 71% (median, 65%) of people who offered PDPT for their partner(s) accepted it. Partners' perceived willingness to accept ranged from 42.7% to 67% (median, 62%), and actual acceptance ranged from 44.7% to 80% (median, 77%). Those in longer-term relationships were generally more likely to accept PDPT; however, beyond this, we identified few clear trends. Qualitative studies found that convenience of PDPT and assurance of partner treatment were benefits, whereas partners not seeing a health care professional was viewed as a downside. Packaging that appeared legitimate and coaching on delivering PDPT were facilitators.

Conclusions

Because patients bear responsibility for the success of PDPT, this information is crucial in clinical settings. Acceptance, perceived and real, of PDPT was generally high. Patients are best placed to determine whether PDPT is appropriate for them, and it should be offered as an option.
Further Improving Image Quality of Cardiovascular Computed Tomography Angiography for Children With High Heart Rates Using Second-Generation Motion Correction Algorithm
Authors: Sun Jihang , Okerlund Darin , Cao Yongli , Li Haoyan , Zhu Yaobin , Li Jianying , Peng Yun
Published: August 2020

Background

The state-of-art motion correction algorithm is inadequate for correcting motion artifacts in coronary arteries in cardiovascular computed tomography angiography (CCTA) for children with high heart rates, and even less effective for heart structures beyond coronary arteries.

Purpose

This study aimed to evaluate the effectiveness of a second-generation, whole-heart motion correction algorithm in improving the heart image quality of CCTA for children with high heart rates.

Materials and Methods

Forty-two consecutive symptomatic cardiac patients with high heart rates (122.6 ± 18.8 beats/min) were enrolled. All patients underwent CCTA on a 256-row CT using a prospective electrocardiogram-triggered single-beat protocol. Images were reconstructed using a standard algorithm (STD), state-of-the-art first-generation coronary artery motion correction algorithm (MC1), and second-generation, whole-heart motion correction algorithm (MC2). The image quality of the origin of left coronary, right coronary, aortic valve, pulmonary valve, mitral valve, tricuspid valve, aorta root, pulmonary artery root, ventricular septum (VS), and atrial septum (AS) was assessed by 2 experienced radiologists using a 4-point scale (1, nondiagnostic; 2, detectable; 3, measurable; and 4, excellent); nonparametric test was used to analyze and compare the differences among 3 groups; and post hoc multiple comparisons were used between different methods.

Results

There were group differences for cardiac structures except VS and AS, with MC2 having the best image quality and STD having the worst image quality. Post hoc multiple comparisons showed that MC2 was better than MC1 and STD in all structures except VS and AS where all 3 algorithms performed equally, whereas MC1 was better than STD only in the origin of left coronary, right coronary, and mitral valve.

Conclusions

A second-generation, whole-heart motion correction algorithm further significantly improves cardiac image quality beyond the coronaries in CCTA for pediatric patients with high heart rates.