bluuebunny/crossref_metadata_2025 huggingface dataset:
Interaction between veno-arterial extracorporeal membrane oxygenation and the right ventricle
Authors: Elena Puerto EP , Guido Tavazzi GT , Alessia Gambaro AG , Chiara Cirillo CC , Alessandro Pecoraro AP , Roberto Martin-Asenjo RMA , Juan Delgado JD , Hector Bueno HB , Susanna Price SP
Published: April 2021

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Fundación Alfonso Martín Escudero

The response of the right ventricle (RV) to the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is unpredictable. We hypothesized if presence of uni- or bi-ventricular failure before implantation and cannulation strategy may influence. We assessed RV performance during VA-ECMO support and identify RV-related predictors of weaning.  Methods. Changes of RV size and function during VA-ECMO by echocardiography were retrospectively analyzed in 87 patients. Predictors of weaning were evaluated by logistic regression. Results. RV echocardiographic parameters did not vary significantly during VA-ECMO, neither after stratification by cannulation type or presence of isolated or biventriular failure. Succesful weaning was conditioned by absence of RV dysfunction before implantation (OR 14.7,95%CI 13.3-140.3;p = 0.025) or in the last day of support (OR 9.5; 95%CI 1.6-54;p = 0.011) and was favored by a total or partial recovery of RV function during the assistance (OR 6.2; 95%CI 1.7-22.4;p = 0.005). RV improvement was more often observed in patients with acute RV failure, while VA-ECMO configuration had no effect. Conclusions. Preservation or improvement of RV function during VA-ECMO support is essential for weaning. RV echocardiographic performance does not change significantly during VA-ECMO  and is not influenced by cannulation type or presence of uni- or bi-ventricular failure before implantation. Echo parameters evolution during VA-ECMOPre-ECMO< 24h on ECMO> 24h on ECMOpNn = 68n = 68n = 63LV diastolic diameter, mm (mean ± SD)53.34 ± 15.5954.86 ± 13.8956.18 ± 14.620.317LV systolic diameter, mm45.28 ± 11.6745.17 ± 14.5846.07 ± 15.590.963LVEF, n (%)20 (10-38.75)17.5 (10-30)25 (10-40)0.102RV basal diameter, mm (mean ± SD)41.05 ± 9.7938.92± 9.1740.05 ± 9.560.484RV systolic disfunction, n (%)65 (95.6)65 (95.5)43 (68.2)0.073Tricuspid regurgitation, n (%)50 (73.4)37 (54.3)49 (77.8)0.146Pulmonary systolic pressure, mmHg (mean ± SD)41.54 ± 24.1339.09 ± 20.2445.29 ± 25.730.783Aortic regurgitation, n (%)47 (69.1)39 (57.4)35 (55.5)0.775Mitral regurgitation, n (%)64 (94.1)48 (70.5)44 (69.8)0.591Dd diastolic diameter; EF: ejection fraction; LV: left ventricle; LVOT: left ventricle outflow tract; RV: right ventricle; RVOT: right ventricle outflow tract; VTI: velocity time integralAbstract Figure. Right ventricular function predictors
Assessment of left ventricular myocardial deformation according to Speckle-tracking echocardiography in the long-term period in patients with takotsubo syndrome
Authors: Evdokimov DS , Boldueva SA
Published: April 2021

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): North-Western State Medical University named after I.I. Mechnikov

Complete improvement of left ventricle systolic function is an essential feature of takotsubo syndrome (TTS). Speckle -tracking echocardiography (STE) provides quantitative information about myocardial deformation, more accurately than conventional echocardiography.

Objective

to assess the global longitudinal strain (GLS) and global circumferential strain (GCS) by speckle-tracking echocardiography in patients with TTS in the long-term period.

Materials and methods

14 female with TTS were monitored, average age 57.5 ± 28.5. The diagnosis was verified by ventriculography and echocardiography. 1 year after the attack, complaints of the patients, cardiovascular events (CE) and signs of heart failure were evaluated. All patients underwent echocardiography using a Vivid-4 (General Electric) with a Speckle-tracking function. The ejection fraction (EF) of the left ventricle (LV), the zone of disorders  of local contractility, the level of GLS and GCS were evaluated.

Results

after an 1 year of observation, all patients had a good clinical condition, there were no CE, and heart failure was absent. The EF level was 56.3 ± 3.45%; no zones of disorders of local contractility were found in any patient. A GLS level below normal was observed in 7 patients (-12.05% ± 5.15%), and was normal in 7 patients (less than -18%), GCS level was reduced in 3 (21.4%) patients (- 9.7 ± 3.4%) at a normal level of -18 and below.

Conclusions

despite the absence of global and local contractility disorders in echocardiography, GLS was revealed in 50% of patients, GCS in 20% of patients. Thus, speckle-tracking shows that in some patients changes in LV contractility persist in the long term. It can be explained by a change in the orientation of the myocardial fibers due to remodeling, but this requires further evaluation.
Long-term mortality predictors in pulmonary embolism
Authors: Caldeira Da Rocha R , Fernandes R , Carrington M , Claudio F , Pais J , Trinca M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Acute Pulmonary embolism(PE)is a common and potentially fatal medical condition.In contemporary adult population,PE is associated with increased long-term mortality.

Purpose

Identify predictors of long-term all-cause mortality in patients(pts)admitted due to pulmonary embolism.

Methods

Retrospective single-center study of hospitalized pts with acute PE between 2015 and 2018.We evaluated comorbidities, admission(AD)presentation such as vitals(with hypotension defined as systolic blood pressure(SBP)<90mmHg,and tachycardia as >100ppm),lab analyses during in-hospital period,imaging features. Mortality(long-term >3months)was also assessed using national registry of citizens.We performed uni and multivariate analysis to compare clinical characteristics of pts who died and who survived,using Cox regression and Kaplan-Meier methods.For the predictor age we assessed discrimination power and defined the best cut-off using area under the ROC curve(AUC)method.

Results

From 2015 to 2018,182 pts were admitted with diagnosis of pulmonary embolism,60% female with a mean age of 74 ± 13years old.Seventy-one(39%)pts died after a median follow-up of 26[10-41]months.Pts who died were older(80 ± 8 vs71 ± 14,p < 0.001).The best cut-off value of age to predict mortality with 70%sensitivity and 61%specificity was 77years old(AUC 0.703;CI95% 0.63-0.78).Pts who died had more frequently history of neoplasia (21%vs 9%,p = 0.009).The remaining comorbidities were similar in both groups.Pts who did not survive were more frequently hypotensive(28% vs 13%, p = 0.008),had higher creatinine(1.1[0.8-1.4] vs 1.0[0.8-1.2], p = 0.002), lactate(2.3[1.8-2.8]vs 1.8[1.5-2.0],p = 0.007)and NT-proBNP(4694[1498-12300]vs2070[492-6660], p < 0.001)at AD.Maximum troponin I (0.176[0.037-0.727]vs0.126[0.050-0.365]ng/mL,p = 0.012) was also higher than in pts who survived. After adjusting for history of neoplasia,ADcreatinine and maximum troponin I,we found that age (HR1.057;95%CI 1.01-1.11,p = 0.021),AD SBP < 90(HR 2.215;95%CI 1.03-4.76,p = 0.041),lactate(HR 1.17;95%CI 1.01-1.36,p = 0.035)and NT-proBNP(HR 1.510;95%CI 1.250-1.780,p < 0.001)were independent predictors of all-cause mortality.

Conclusion

In our cohort,the long-term all-cause mortality was 39%over a median  follow-up of 26[10-41]months.In patients with pulmonary embolism,aside from already identified age(especially when ≥70 years old)and NT-proBNP,lactate should also be considered when evaluating long-term prognosis. Furthermore,hypotension at admission increases by 2fold long-term mortality in patients who suffered acute PE.
Coronary angioplasty and COVID-19: are heparin requirements and thrombotic complications increasing?
Authors: Crane H , Malik A , Ssemugabi E , Sevier L , Ileka J , Clottey C , Bestwick J , Wald DS
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Covid-19 infection is associated with coagulopathy and possible heparin resistance, raising concerns that routine heparin during percutaneous coronary intervention (PCI) is failing to achieve adequate anticoagulation. We examined heparin requirements and efficacy in patients treated by PCI before and after the first reported UK case of Covid-19 (January 31st 2020).

Methods

We retrospectively compared heparin dose, Activated Clotting Time (ACT) and coronary flow (TIMI grade) for PCI procedures at a London cardiac centre in the 3 months before the UK pandemic and the three months afterwards. Testing for COVID was not routinely performed. Pre-specified analyses in patients with STEMI, NSTEMI and Stable angina were undertaken.

Results

Of 1227 PCI procedures performed over the period of observation, 690 were pre-pandemic and 537 were afterwards. Overall median heparin dose per case was 11000units versus 11500units (p = 0.137) and maximum ACTs were 291s versus 305s, respectively (p = 0.135). Pre-PCI TIMI 3 flow was lower during the pandemic than before (60% v 65%, p = 0.005) but Post-PCI flow was similar (96% versus 96%, p = 0.839). There were no statistically significant differences in heparin dose or achieved ACT among patients with STEMI, NSTEMI or Stable presentations.

Conclusion

In spite of the increasing evidence that COVID-19 infection causes thrombosis, it appears that standard heparin management during PCI is sufficient to achieve effective anticoagulation and avoid peri-procedural thrombotic complications. Group 1 Pre PandemicGroup 2 PandemicP valueNumber of doses given3 (3 to 4)3 (3 to 4)0.952Total Heparin dose (units)11000 (8000 to 14000)11500 (9000 to 14000)0.137Number of ACTs measured2 (1 to 2)2 (1 to 2)0.194First ACT (seconds)240 (199 to 318)248 (206 to 326)0.256Maximum ACT (seconds)291 (230 to 368)305 (239 to 369)0.135Heparin dose and Activated Clotting Times (ACT) in patients undergoing PCI before Covid-19 pandemic (Group 1) and during pandemic (Group 2); median and interquartile rangesAbstract Figure. Clinical Presentation
Trends in contrast-induced acute kidney injury rate after percutaneous coronary interventions in coronary artery disease
Authors: Mironova O , Sivakova OA , Fomin VV
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background.

Contrast-induced acute kidney injury remains one of the dangerous complications of percutaneous coronary interventions, in spite of the evolution of contrast media and prevention strategies. Many researchers assume that this syndrome is not as frequent as it used to be and its clinical importance is overestimated.

Purpose.

The aim of the study was to assess the rates of contrast-induced acute kidney injury in a prospective study in patients with chronic coronary syndromes after percutaneous coronary interventions in 2012 and 2017 respectively.

Methods.

1023 patients with chronic coronary syndromes and indications for the interventions with intra-arterial contrast media administration were included in the prospective open cohort study. 561 patients were enrolled in 2012 and 462 in 2017 respectively. The contrast media remained the same both in 2012 and 2017. Preventive measures included the administration of 0,9% saline 1 ml/kg/h intravenously and 0,5 kg/ml/h for the patients with heart failure before and after procedure. The primary endpoint was the development of contrast-induced acute kidney injury. 

Results.

The incidence of contrast-induced acute kidney injury decreased more than 3 times in 2017 than in 2012 (6% vs. 18,5%, 28 patients vs 104 patients respectively). The difference was statistically significant (p < 0,0001). The patients included in the study in 2017 were older, had higher body mass index and had more risk factors, than the ones enrolled in 2012. We organised several conferences for all the cardiologist involved in the treatment of patients undergoing percutaneous coronary intervention, as well as were printing materials describing the risk assessment and preventive measures that should be done in patients with chronic coronary syndromes before percutaneous coronary interventions (eg, stopping metformin and nephrotoxic drugs).

Conclusion.

The prevalence of contrast-induced acute kidney injury is decreasing not only due to the evolution of contrast media and preventive strategies, but also due to the higher level of education of all the doctors about the syndrome and its prognosis, as well as available preventive measures and treatment options.
Outcomes after cardiac transplantation: a new tertiary centre experience
Authors: Ali U , Pavey W , Slimani K , Merry C , Larbalestier R
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Our hospital is one of the most remote transplant centres in the world. We evaluated the short- and long-term outcomes after cardiac transplantation at a new Tertiary Centre hospital in Western Australia.

Methods

A retrospective study of all patients undergoing cardiac transplantation since February 2015 until November 2020 was conducted. De-identified data was collected using hospital medical records and the ANZSCTS database. Primary outcome measure was mortality at any time point and acute rejection. Secondary outcome measures included new renal failure, post-operative blood product use and readmission rate.

Results

A total of 59 cardiac transplantations were conducted, with the mean age of recipients being 52 (±15) years and the majority being male (64.4%). Ischaemic cardiomyopathy and dilated cardiomyopathy were the most common indications for transplantation, accounting for 71.2% of all transplants. The mean age of donors was 35.29 (±11.11) years with the majority being male (69.5%). There were no mortalities and acute rejection within 3 months of transplant occurred in 16 (27.1%) patients. New renal failure was the most common complication occurring in 16 (27.1%) patients. After multivariate analysis, donor ischaemia time >200minutes was associated with an increased risk of renal failure (OR 1.2, P = 0.044).

Conclusions

Over a five-year period at a new cardiac transplant centre in one of the most remote locations of the world, we report no mortalities.
Intraprocedural high degree atrioventricular block after transcatheter aortic valve replacement in patients with native versus bioprosthetic aortic valves
Authors: Alvarez Velasco R , Pascual Calleja I , Avanzas Fernandez P , Almendarez Lacayo M , Adeba Garcia A , Persia Paulino YR , Vigil-Escalera Diaz M , Moris De La Tassa C
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

One of the most frequent intraprocedural complication of patients undergoing transcatheter aortic valve replacement (TAVR) is high degree atrioventricular block (HDAVB). The incidence varies from 5-20% depending on the type of valve, previous surgical valve replacement (SVR) and basal conduction disturbances.

Purpose

 

The purpose of this study was to evaluate the incidence of intraprocedural HDAVB in patients undergoing TAVR in native valves versus patients with previous SVR derived for valve-in-valve TAVR (VIV-TAVR).

Methods

 

Data was collected from all the patients undergoing TAVI in a single center from December 2007 to July 2019. The primary endpoint was to compare the incidence of HDAVB in patients undergoing TAVR versus patients undergoing VIV-TAVI. The secondary endpoint was to describe the differences in the baseline characteristics of patients that presented with HDAVB vs patients without HDAVB.

Results

A total of 661 patients were derived for TAVR and separated into 2 groups for analysis. 596 patients with native valves treated with TAVR and 65 patients with previous SVR treated with VIV-TAVI. The primary outcome was present in 87 patients (14,6%) in the TAVR group vs 1 patient (1,54%) in the VIV-TAVR group (p: 0,0033).

Patients with HDAVB (n = 88) had a mean age of 83,1 ± 6,26 years. The baseline EKG showed a conduction disturbance in 47,6% of the cases (50% of right bundle branch block; 21,8% of first degree AVB; 15,09% of left bundle branch block and 35,85% of left anterior fascicular block).  A new permanent pacemaker was implanted in 77 (87,5%) patients.

Patients without HDAVB (n = 573) had a mean age of 82,5 ± 6,14 years. The baseline EKG showed a conduction disturbance in 28,91% of the cases (22,73% of Right bundle branch block; 25,68% of first degree AVB; 31,70% of left bundle branch block and 21,25% of left anterior fascicular block).  A new permanent pacemaker was implanted in 59 (10,30%) patients.

Conclusions

 

There is a very low incidence of intraprocedural HDAVB in patients undergoing VIV-TAVR compared to the rest of TAVR procedures (1,54% vs 14,6% p:0,0033). Moreover, the  only predictors that associated with the development of HDAVB where previous right bundle branch block and left anterior fasicular hemiblock. The development of intraprocedural HDAVB is associated with the need of a new permanent pacemaker. Table 1: Basal CharacteristicsNo HDAVBHDAVBp VALUEAge, yrs82,683,10,453Basal conduction disturbance28,91 %47,62 %<0,0001PPM implantation10,3 %85,2 %<0,0001Basal characteristicsAbstract Figure. Clinical characteristics by groups
Long-term ischemic and bleeding risk with extended dual antiplatelet therapy after PCI in patients with 2018 ESC/EACTS myocardial revascularization guideline-endorsed high thrombotic risk features
Authors: Wang HY , Yin D , Feng L , Zhu CG , Dou KF
Published: April 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Beijing Municipal Health Commission (Grant number: 2020–1-4032)

Background

The ischemic/bleeding trade-off of continuing dual antiplatelet therapy (DAPT) beyond 1 year after PCI for patients with high thrombotic risk (HTR) as endorsed by 2018 ESC/EACTS myocardial revascularization guidelines remain unknown. We sought to evaluate the benefits and harms of DAPT with aspirin and clopidogrel beyond 1 year versus ≤ 1-year DAPT on long-term clinical outcomes after PCI with DES among ESC/EACTS guideline-endorsed HTR patients that are event-free at 1 year follow-up, using a prospective, real-world registry.

Methods

Patients undergoing coronary stenting between January 2013 and December 2013 from the prospective Fuwai registry were defined as HTR if they met at least 1 ESC/EACTS guideline-endorsed HTR criteria with at least 1 of the following characteristics: diffuse (lesion length ≥ 20 mm) multivessel disease in diabetic patients, CKD (estimated glomerular filtration rate < 60 mL/min), ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with 2 stents implanted, total stent length > 60 mm, treatment of CTO, and history of STEMI. A total of 4578 patients who were at HTR and were events free at 1 year after the index procedure were evaluated. The primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE) (composite of all-cause death, myocardial infarction, or stroke).

Results

Median follow-up period was 2.4 years. > 1-year DAPT with clopidogrel and aspirin significantly reduced the risk of MACCE compared with ≤ 1-year DAPT (1.9% vs. 4.6%; hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.27–0.54; P < 0.001), driven by a reduction in all-cause death (0.2% vs. 3.0%; HR, 0.07; 95% CI, 0.03–0.15). Cardiac death and definite/ probable stent thrombosis also occurred less frequently in prolonged DAPT group. Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding occurred similarly between both groups (1.1% vs. 0.9%; HR, 1.11; 95% CI, 0.58–2.13; P = 0.763). Similar results were found using multivariable Cox model, propensity score-matched, and inverse probability of treatment weighting analysis.

Conclusions

Among patients with ESC-endorsed HTR who were free from major ischemic or bleeding events 1 year after coronary stenting, continued DAPT beyond 1 year might offer better effectiveness in terms of atherothrombotic events and comparable safety in terms of clinically relevant bleeding compared with ≤ 1-year DAPT. ESC-HTR criteria is an important parameter to take into account in tailoring DAPT prolongation.
Antiplatelet effects and pharmacokinetics of crushed ticagrelor in resuscitated patients after cardiac arrest
Authors: Verhaeghe C , Peperstraete H , Devuyst S , De Somer F , Gevaert S , Devreese K
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Based on the PLATO-trial and its sub-studies, ticagrelor can be used for patients with an acute coronary syndrome (ACS). Some of these patients are not awake or not able to swallow tablets. Alternatively the tablets can be crushed and given through a nasogastric tube. An extra obstacle for adequate intake is medication-induced gastroparesis caused by sedatives.

Purpose

The first aim of the study was to evaluate the platelet function analyser closure time (CT) in patients treated with crushed ticagrelor, after successful being resuscitated after cardiac arrest of acute ischaemic origin. Either they underwent PCI or urgent CABG, either they were treated conservatively.

The second aim of the study was to determine plasma concentrations of ticagrelor and its main active metabolite AR-C124910XX.

Methods

We included 20 patients after successful resuscitation for cardiac arrest of acute ischaemic origin (16 STEMI + 4 NSTEMI).  Only 1 patient was treated conservatively, 2 patients underwent an urgent CABG, the remainder were treated with PCI. All patients received a loading dose of ticagrelor before starting daily therapy. As patients were not able to swallow, tablets were crushed and given through a nasogastric tube. Measurements for Platelet Function Analysis were done at 0h, 2h, 4h, 8h, 12h, 24h and at day 4 + 4h. Platelet inhibition was tested with Platelet Function Analyser (PFA) activated by Adenosine Di Phosphate (ADP). A closure time (CT) longer than 113 seconds indicates full platelet inhibition by ticagrelor. Plasma concentration were determined at 30min, 1h, 2h, 4h, 8h, 24h and day 4 + 4h. Plasma concentrations were measured after protein precipitation, by using liquid chromatography with mass spectrometry detection.

Results

Out of 20 resuscitated patients enlisted in this study, 13 were still alive at day 4. At 24h, more than 80% of the survivors showed platelet inhibition as proven by a CT >113s. In 92% of the survivors, the PFA showed platelet inhibition at day 4 with a median CT of > 300s. For ticagrelor, the median time to peak plasma concentration (Tmax) was 100h [8; 100] for a median Cmax of 615.5 ng/ml [217.5; 1385.0]. The geometric mean was 467 ng/ml (248.5; 877.4). For the metabolite of ticagrelor, AR-C124910XX, median Tmax was 100h [8; 100] for a Cmax of 131.0 ng/ml [52.1; 177.7]. The geometric mean for the metabolite was 69.5 ng/ml (32.4; 149.0).

Conclusions

At day 4 of therapy, 92% of the survivors showed a CT longer than 113s, meaning full platelet inhibition by ticagrelor. In more than 80%, this was even the case at 24h.

The median time to reach peak concentrations was 4 days, which is comparable to pharmacokinetic studies with ticagrelor in healthy volunteers. It should be noted that the dispersion in achieving Cmax is wide and can be reached earlier than at 4 days.
Measurement Indicators of Age-Friendly Communities: Findings From the AARP Age-Friendly Community Survey
Authors: Kim Kyeongmo , Buckley Tommy , Burnette Denise , Kim Seon , Cho Sunghwan
Published: April 2021

Background and Objectives

Cities and counties worldwide have adopted the concept of “age-friendly communities.” These communities aspire to promote older adults’ well-being by providing a safe, affordable built environment and a social environment that encourages their participation. A major limitation in this field is the lack of valid and reliable measures that capture the complex dimensionality and dynamic nature of the aging–environment interface.

Research Design and Methods

This study uses data from the AARP 2016 Age-Friendly Community Surveys (N = 3,652 adults aged 65 and older). The survey includes 62 indicators of age-friendliness, for example, outdoor spaces, transportation, housing, social participation, and community and health services. We randomly split the sample into 2 equal subsamples for confirmatory factor analysis (CFA) and structural equation modeling (SEM).

Results

CFA results indicated that both the 5-factor model and the second-order factor model adequately fit the data. In the SEM 5-factor model, outdoor space (β = 0.134; p = .017), social participation (β = 0.307; p < .001), and community and health services (β = −0.149; p = .008) were associated with self-rated health, the outcome of interest. The path coefficients of housing and transportation were not significant. In the second-order factor model, people who lived in more age-friendly communities reported better self-rated health (β = 0.295; p < .001).

Discussion and Implications

Our findings show that the Age-Friendly Community Survey measures demonstrate reliability and concurrent validity. To promote older adults’ well-being, practitioners, policymakers, and researchers should focus on improving their built and social environments. They can use these measures for short- and long-term planning, monitoring, and evaluating age-friendly community initiatives.
Mapping the Evidence on Rapid Diagnosis of Bloodstream Infections: A Scoping Review
Authors: Rubinstein Matthew L , Wolk Donna M , Babady N. Esther , Johnson J. Kristie , Atkinson Bridgette , Makim Roshni , Parrott J. Scott
Published: April 2021

Background

Laboratory and other healthcare professionals participate in developing clinical practice guidelines through systematic review of the evidence. A significant challenge is the identification of areas for analytic focus when the evidence consists of several categories of interventions and outcomes that span both laboratory and clinical processes. The challenge increases when these interventions present as sets of combined interventions. A scoping review may provide a transparent and defensible analytic route forward for systematic reviews challenged in this manner.

Content

A scoping review was carried out to characterize the evidence on rapid identification of bloodstream infections. Fifty-five studies previously identified by the supported systematic review were charted in duplicate. Charted records were analyzed using descriptive content analysis and evidence mapping with a 5-step process.

The 5-step analysis culminated in the characterization of 9 different intervention chain configurations that will facilitate the comparison of complex intervention practices across studies. Furthermore, our evidence map indicates that the current evidence base is strongly centered on 3 specific clinical outcomes, and it links these outcomes to the most represented intervention chain configurations. The scoping review effort generated a route forward for the supported systematic review and meta-analysis.
Evaluation of a Capillary Electrophoresis System for the Separation of Proteins
Authors: Favresse Julien , Yolande Lenga , Gras Jeremie
Published: April 2021

Background

Serum protein electrophoresis is one of the core investigations for screening for monoclonal proteins. Among the available capillary systems, the Helena V8 system has been evaluated in a limited number of studies.

Methods

In total, 310 sera samples were assessed on the Helena V8 system and compared with the Sebia Capillarys instrument. Abnormalities suggestive of monoclonal proteins were confirmed by immunofixation. Imprecision studies and reference intervals were determined.

Results

The imprecision of the Helena V8 was inferior or equal to 5.8%. The mean bias of Helena V8 vs Sebia Capillarys was about −0.9 g/L for albumin; −0.2 g/L for alpha-1; 1.1 g/L for alpha-2; −0.2 g/L for beta; 0.3 g/L for gamma; −0.5 g/L for monoclonal protein in beta; and 0.3 g/L for monoclonal protein in gamma. Among the 56 samples with monoclonal proteins confirmed by immunofixation, all were seen on both methods, with only 1 discordant result at a cutoff of 5.0 g/L. Reference intervals were statistically different between the 2 analyzers, except for the beta fraction.

Conclusions

Our evaluation confirms the good analytical performance of the Helena V8 analyzer as a suitable alternative to the Sebia Capillarys instrument.
Legal Diversity at the International Criminal Court
Authors: Schmitt Bertram
Published: April 2021

The procedural law of the International Criminal Court (ICC) combines common law and civil law concepts in a ‘unique compromise’. It gives the judges broad discretion to determine which adversarial and inquisitorial elements fit best into the overall system of the Rome Statute. In exercising their discretion judges cannot, of course, deny their legal background. However, sticking to the familiar practice is an impediment to the effective procedural functioning of the Court. To find meaningful solutions within the legal framework of the ICC requires instead an attitude based on the assumption that no legal system is superior to the other and the ability to doubt legal concepts that one might consider as self-evident. To this end, it is necessary that judges develop an understanding of the procedural system that they have not experienced in their former professional life. The article discusses nine examples of the procedural law and practice of the ICC — from the role of the prosecutor to victims participation — and examines the reasons for, and implications of, the transfer of adversarial and inquisitorial elements into the ICC`s statutory framework.
The contribution of PIP2-type aquaporins to photosynthetic response to increased vapour pressure deficit
Authors: Israel David , Khan Shanjida , Warren Charles R , Zwiazek Janusz J , Robson T Matthew
Published: April 2021

The roles of different plasma membrane aquaporins (PIPs) in leaf-level gas exchange of Arabidopsis thaliana were examined using knockout mutants. Since multiple Arabidopsis PIPs are implicated in CO2 transport across cell membranes, we focused on identifying the effects of the knockout mutations on photosynthesis, and whether they are mediated through the control of stomatal conductance of water vapour (gs), mesophyll conductance of CO2 (gm), or both. We grew Arabidopsis plants in low and high humidity environments and found that the contribution of PIPs to gs was larger under low air humidity when the evaporative demand was high, whereas any effect of a lack of PIP function was minimal under higher humidity. The pip2;4 knockout mutant had 44% higher gs than wild-type plants under low humidity, which in turn resulted in an increased net photosynthetic rate (Anet). We also observed a 23% increase in whole-plant transpiration (E) for this knockout mutant. The lack of functional plasma membrane aquaporin AtPIP2;5 did not affect gs or E, but resulted in homeostasis of gm despite changes in humidity, indicating a possible role in regulating CO2 membrane permeability. CO2 transport measurements in yeast expressing AtPIP2;5 confirmed that this aquaporin is indeed permeable to CO2.
Hmg1 mutations in Aspergillus fumigatus and their contribution to triazole susceptibility
Authors: Arai Teppei , Umeyama Takashi , Majima Hidetaka , Inukai Tatsuya , Watanabe Akira , Miyazaki Yoshitsugu , Kamei Katsuhiko
Published: April 2021

Triazole-resistant Aspergillus fumigatus is a global health concern. In general, each triazole resistance pattern caused by the specified amino acid substitution of Cyp51A has a typical pattern depending on the mutation site. We evaluated the contribution of both Cyp51A and Hmg1 mutations to atypical triazole resistance in A. fumigatus. We used clinical triazole-resistant A. fumigatus strains collected in Japan and investigated the sequences of cyp51A and hmg1 genes. To delineate the association between the hmg1 mutation and atypical triazole resistance, the mutant hmg1 alleles in clinical multi-azole resistant strains were replaced with the wild-type hmg1 allele by CRISPR/Cas9 system. In our study, the combination of Cyp51A mutation and Hmg1 mutation was shown to additively contribute to triazole resistance. We also demonstrated that the triazole resistance conferred by the Hmg1 mutation showed a different pattern depending on the mutation site, similar to the Cyp51A mutation. Our results indicate that focusing on the phenotypes of multiple genes is essential to clarify the overall picture of the triazole resistance mechanism of A. fumigatus.

Lay Summary

The number of triazole-resistant Aspergillus fumigatus is increasing. We confirmed thatmutation in a hydroxymethylglutaryl-CoA reductase (Hmg1) in the fungus contributesto the resistance separately from Cyp51A mutation, and that susceptibility patterns aredifferent based on mutation site.
Jet properties of XTE J1752−223 during its 2009–2010 outburst
Authors: Debnath Dipak , Chatterjee Kaushik , Chatterjee Debjit , Jana Arghajit , Chakrabarti Sandip K
Published: April 2021

Galactic short orbital period black hole candidate (BHC) XTE J1752−223 was discovered on 2009 October 21 by the Rossi X-ray Timing Explorer (RXTE). We study the spectral properties of this outburst using transonic flow solution based two component advective flow (TCAF) model. TCAF model fitted spectrum gives an estimation of the physical flow parameters, such as the Keplerian disc rate, sub-Keplerian halo rate, properties of the so-called Compton cloud, other than the mass of the source and normalization (N). N is a standardized ratio of emitted to observed photon flux in TCAF that does not include X-ray emission from jets. In the presence of jets, this ratio changes and this deviation is used to obtain the estimation of X-ray contribution from the jets. Nature of the jet is found to be compact during low luminous hard state and discrete or blobby during high luminous intermediate states. We find a correlation between the radio (5.5 GHz) and X-ray (2.5–25 keV) fluxes from different components. The radio (FR) and jet X-ray (Fouf) fluxes are found to be correlated within the acceptable range of the standard correlation (0.6 to 0.7). A similar correlation indices were reported by our group for three other short orbital period transient BHCs (Swift J1753.5−0127, MAXI J1836−194, and XTE J1118+480).
On the use of the local prior on the absolute magnitude of Type Ia supernovae in cosmological inference
Authors: Camarena David , Marra Valerio
Published: April 2021

A dark-energy, which behaves as the cosmological constant until a sudden phantom transition at very low redshift (z < 0.1), seems to solve the >4σ disagreement between the local and high-redshift determinations of the Hubble constant, while maintaining the phenomenological success of the Λ cold dark matter model with respect to the other observables. Here, we show that such a hockey-stick dark energy cannot solve the H0 crisis. The basic reason is that the supernova absolute magnitude MB that is used to derive the local H0 constraint is not compatible with the MB that is necessary to fit supernova, baryon acoustic oscillation, and cosmic microwave background data, and this disagreement is not solved by a sudden phantom transition at very low redshift. We make use of this example to show why it is preferable to adopt in the statistical analyses the prior on MB as an alternative to the prior on H0. The three reasons are: (i) one avoids potential double counting of low-redshift supernovae, (ii) one avoids assuming the validity of cosmography, in particular, fixing the deceleration parameter to the standard model value q0 = −0.55, (iii) one includes in the analysis the fact that MB is constrained by local calibration, an information which would otherwise be neglected in the analysis, biasing both model selection and parameter constraints. We provide the priors on MB relative to the recent Pantheon and DES-SN3YR supernova catalogs. We also provide a Gaussian joint prior on H0 and q0 that generalizes the prior on H0 by Supernova H0 for the Equation of State.
Homogeneous analysis of globular clusters from the APOGEE survey with the BACCHUS code – III. ω Cen
Authors: Mészáros Szabolcs , Masseron Thomas , Fernández-Trincado José G , García-Hernández D A , Szigeti László , Cunha Katia , Shetrone Matthew , Smith Verne V , Beaton Rachael L , Beers Timothy C , Brownstein Joel R , Geisler Doug , Hayes Christian R , Jönsson Henrik , Lane Richard R , Majewski Steven R , Minniti Dante , Munoz Ricardo R , Nitschelm Christian , Roman-Lopes Alexandre , Zamora Olga
Published: April 2021

We study the multiple populations of ω Cen by using the abundances of Fe, C, N, O, Mg, Al, Si, K, Ca, and Ce from the high-resolution, high signal-to-noise (S/N > 70) spectra of 982 red giant stars observed by the SDSS-IV/APOGEE-2 survey. We find that the shape of the Al–Mg and N–C anticorrelations changes as a function of metallicity, continuous for the metal-poor groups, but bimodal (or unimodal) at high metallicities. There are four Fe populations, similarly to previous literature findings, but we find seven populations based on Fe, Al, and Mg abundances. The evolution of Al in ω Cen is compared to its evolution in the Milky Way and in five representative globular clusters. We find that the distribution of Al in metal-rich stars of ω Cen closely follows what is observed in the Galaxy. Other α-elements and C, N, O, and Ce are also compared to the Milky Way, and significantly elevated abundances are observed over what is found in the thick disc for almost all elements. However, we also find some stars with high metallicity and low [Al/Fe], suggesting that ω Cen could be the remnant core of a dwarf galaxy, but the existence of these peculiar stars needs an independent confirmation. We also confirm the increase in the sum of CNO as a function of metallicity previously reported in the literature and find that the [C/N] ratio appears to show opposite correlations between Al-poor and Al-rich stars as a function of metallicity.
Free Will for the Long Run
Authors: Huff Benjamin I
Published: April 2021

For beings that have a beginning in time, free will seems impossible, because our choices seem to be a result of past events over which we had no control. Latter-day Saint theology offers what seems a simple solution: the idea that human beings have always existed in the form of spirits or “intelligences.” While this idea solves some key puzzles, contemplating an infinite past also brings the recognition that causal autonomy is not enough for freedom. A crucial feature of humanity is the ability to move beyond past choices and versions of ourselves. Human freedom involves a dynamic process of identification, alienation, and re-identification through which we develop, improve, and mature as agents. Thinking about freedom over the long run, with attention to both the past and the future, casts the traditional debate over free will in a distinctive light, suggesting fresh possibilities.
m6A RNA methylation of major satellite repeat transcripts facilitates chromatin association and RNA:DNA hybrid formation in mouse heterochromatin
Authors: Duda Katarzyna J , Ching Reagan W , Jerabek Lisa , Shukeir Nicholas , Erikson Galina , Engist Bettina , Onishi-Seebacher Megumi , Perrera Valentina , Richter Florian , Mittler Gerhard , Fritz Katharina , Helm Mark , Knuckles Philip , Bühler Marc , Jenuwein Thomas
Published: April 2021

Heterochromatin has essential functions in maintaining chromosome structure, in protecting genome integrity and in stabilizing gene expression programs. Heterochromatin is often nucleated by underlying DNA repeat sequences, such as major satellite repeats (MSR) and long interspersed nuclear elements (LINE). In order to establish heterochromatin, MSR and LINE elements need to be transcriptionally competent and generate non-coding repeat RNA that remain chromatin associated. We explored whether these heterochromatic RNA, similar to DNA and histones, may be methylated, particularly for 5-methylcytosine (5mC) or methyl-6-adenosine (m6A). Our analysis in mouse ES cells identifies only background level of 5mC but significant enrichment for m6A on heterochromatic RNA. Moreover, MSR transcripts are a novel target for m6A RNA modification, and their m6A RNA enrichment is decreased in ES cells that are mutant for Mettl3 or Mettl14, which encode components of a central RNA methyltransferase complex. Importantly, MSR transcripts that are partially deficient in m6A RNA methylation display impaired chromatin association and have a reduced potential to form RNA:DNA hybrids. We propose that m6A modification of MSR RNA will enhance the functions of MSR repeat transcripts to stabilize mouse heterochromatin.
Henry Tye: the future of theoretical physics and advice to young researchers
Authors: Cai Yi-Fu , Yan Sheng-Feng
Published: April 2021

Professor Henry Tye (戴自海) is a world-renowned expert in theoretical particle physics, string theory and cosmology. He was recently the IAS Professor at the Jockey Club Institute for Advanced Study (IAS) and the Hong Kong University of Science and Technology (HKUST), and is the Horace White Professor of Physics (Emeritus) at Cornell University. He has a lot of experience in research status in both China and the United States. Recently, NSR invited Professor Yi-Fu Cai (蔡一夫) from the University of Science and Technology of China (USTC) to interview Prof. Tye on his personal views on the future of theoretical physics, his own experience, and his advice to young researchers.
Positive and Negative Constitutionalism and the Limits of Universalism: A Review Essay
Authors: Stone Adrienne , Weis Lael K
Published: April 2021

Abstract—

In The Principles of Constitutionalism, Nicholas Barber provides a sophisticated yet highly readable introduction to fundamental constitutional principles. At the same time, Barber seeks to reorient constitutional theory scholarship away from a mistaken ‘negative’ understanding of constitutionalism towards a ‘positive’ understanding. This essay examines that argument. We suggest that the idea of ‘positive constitutionalism’ has a weaker and a stronger sense. In its weak form, the argument calls for greater attention to what constitutions enable as well as what they restrict, and thus serves as a welcome reminder of the full potential of constitutional principles. However, it cannot be regarded as the correction of a widespread mistake. In its strong form, the argument calls for greater recognition that the state’s essential function lies in advancing the ‘well-being’ of its members. Although this amounts to a significant reorientation, it weakens the theory’s claim to universalism. These tensions indicate limitations to efforts to construct general theories of constitutionalism.
The Effectiveness of Social Media in the Dissemination of Knowledge About Pain in Dementia
Authors: Castillo Louise I R , Hadjistavropoulos Thomas , Brachaniec Mary
Published: April 2021

Objectives

Traditional knowledge dissemination methods have been ineffective in leading to timely and widespread changes in clinical practice. Social media have the potential to reach broader audiences than more traditional methods that disseminate research findings. We evaluated the effectiveness of using social media to mobilize knowledge about pain in dementia.

Methods

We developed an online repository of evidence-based content (e.g., guidelines, assessment approaches) and a video about pain in dementia. The video was uploaded to YouTube, a video-sharing platform. We collaborated with stakeholder organizations on a 5-month social media campaign (#SeePainMoreClearly) on Twitter, a social networking site, to disseminate digital content about pain in dementia. The response to our initiatives was evaluated with Web and social media metrics, a video questionnaire, and a comparison of the extent of Twitter discussions about pain in dementia before and during the campaign period.

Results

Web metrics showed a great reach of the initiative: The #SeePainMoreClearly hashtag received more than 5,000,000 impressions and was used in 31 countries. The online repository was viewed by 1,218 individuals from 55 countries, and the video resulted in 51,000 views. Comparisons between the pre-campaign and campaign periods demonstrated a higher number of posts about pain in dementia during the campaign period.

Conclusion

The findings have implications for closing the knowledge-to-practice gap in dementia care through faster mobilization of scientific findings. Our campaign compares favorably with other health information dissemination initiatives. The methodologies used in the study could serve as a framework for the development of social media initiatives in other health disciplines.
Increased representation of the non-dominant hand in pianists demonstrated by measurement of 3D morphology of the central sulcus
Authors: Harvey Adam , Hou Lewis , Davidson-Kelly Kirsteen , Schaefer Rebecca S , Hong Sujin , Mangin Jean-François , Overy Katie , Roberts Neil
Published: April 2021

Background

Post-mortem and magnetic resonance imaging (MRI) studies of the central sulcus, as an indicator of motor cortex, have shown that in the general population there is greater representation of the dominant compared to the non-dominant hand. Studies of musicians, who are highly skilled in performing complex finger movements, have suggested this dominance is affected by musical training, but methods and findings have been mixed.

Objective

In the present study, an automated image analysis pipeline using a 3D mesh approach was applied to measure central sulcus (CS) asymmetry on MR images obtained for a cohort of right-handed pianists and matched controls.

Methods

The depth, length, and surface area (SA) of the CS and thickness of the cortical mantle adjacent to the CS were measured in each cerebral hemisphere by applying the BrainVISA Morphologist 2012 software pipeline to 3D T1-weighted MR images of the brain obtained for 15 right-handed pianists and 14 controls, matched with respect to age, sex, and handedness. Asymmetry indices (AIs) were calculated for each parameter and multivariate analysis of covariance (MANCOVA), and post hoc tests were performed to compare differences between the pianist and control groups.

Results

A one-way MANCOVA across the four AIs, controlling for age and sex, revealed a significant main effect of group (P = 0.04), and post hoc analysis revealed that while SA was significantly greater in the left than the right cerebral hemisphere in controls (P < 0.001), there was no significant difference between left and right SA in the pianists (P = 0.634). Independent samples t-tests revealed that the SA of right CS was significantly larger in pianists compared to controls (P = 0.015), with no between-group differences in left CS.

Conclusions

Application of an image analysis pipeline to 3D MR images has provided robust evidence of significantly increased representation of the non-dominant hand in the brain of pianists compared to age-, sex-, and handedness-matched controls. This finding supports prior research showing structural differences in the central sulcus in musicians and is interpreted to reflect the long-term motor training and high skill level of right-handed pianists in using their left hand.