bluuebunny/crossref_metadata_2025 huggingface dataset:
New safe approach to target symptomatic Hisian ectopy/tachycardia
Authors: Chaumont Corentin , Savouré Arnaud , Godin Bénédicte , Mirolo Adrian , Rivron Simon , Anselme Frédéric
Published: March 2021

Aims

Although cryoenergy safety profile is appropriate for the ablation of arrhythmogenic foci near the conduction system, mapping using the cryoablation catheter is of limited precision. Combining the safety of cryoenergy and the high precision of a 3D mapping system therefore appears the most appropriate set-up for ablation in the vicinity of the His bundle.

Methods and results

A 29-year-old woman with a 3-year history of increasing shortness of breath and palpitations refractory to medical treatment was sent to the electrophysiology (EP) laboratory for catheter ablation. Surface electrocardiogram showed sinus rhythm and frequent ectopic beats with narrow QRS complexes similar to those of the sinus beats. The left ventricular ejection fraction was impaired (38%) with no other aetiology found, apart from frequent ectopies. Detailed intracardiac mapping, using a 3D electroanatomical system, revealed that the ectopy originated from the distal His bundle, which was indicated by both antegrade and reversed His bundle activation sequence during ectopy compared to that during sinus rhythm. Due to the proximity of the conduction system, cryoenergy rather than radiofrequency was chosen to target this Hisian ectopy. A special set-up was made in order to allow the cryoablation catheter to be visualized into the 3D mapping system. Cryoenergy delivered to the site of earliest Hisian ectopy activation completely abolished it.

Conclusion

Such a combined approach may help to improve the therapeutic strategy for ablation procedures with a high risk of injury to the conduction system. It could notably be extended to the ablation of para-Hisian ectopy or accessory pathways.
An update of the unceasingly growing and diverse AraC/XylS family of transcriptional activators
Authors: Cortés-Avalos Daniel , Martínez-Pérez Noemy , Ortiz-Moncada Mario A , Juárez-González Aylin , Baños-Vargas Arturo A , Estrada-de los Santos Paulina , Pérez-Rueda Ernesto , Ibarra J Antonio
Published: March 2021

Transcriptional factors play an important role in gene regulation in all organisms, especially in Bacteria. Here special emphasis is placed in the AraC/XylS family of transcriptional regulators. This is one of the most abundant as many predicted members have been identified and more members are added because more bacterial genomes are sequenced. Given the way more experimental evidence has mounded in the past decades, we decided to update the information about this captivating family of proteins. Using bioinformatics tools on all the data available for experimentally characterized members of this family, we found that many members that display a similar functional classification can be clustered together and in some cases they have a similar regulatory scheme. A proposal for grouping these proteins is also discussed. Additionally, an analysis of surveyed proteins in bacterial genomes is presented. Altogether, the current review presents a panoramic view into this family and we hope it helps to stimulate future research in the field.
Genomes of the willow-galling sawflies Euura lappo and Eupontania aestiva (Hymenoptera: Tenthredinidae): a resource for research on ecological speciation, adaptation, and gall induction
Authors: Michell Craig , Wutke Saskia , Aranda Manuel , Nyman Tommi
Published: March 2021

Hymenoptera is a hyperdiverse insect order represented by over 153,000 different species. As many hymenopteran species perform various crucial roles for our environments, such as pollination, herbivory, and parasitism, they are of high economic and ecological importance. There are 99 hymenopteran genomes in the NCBI database, yet only five are representative of the paraphyletic suborder Symphyta (sawflies, woodwasps, and horntails), while the rest represent the suborder Apocrita (bees, wasps, and ants). Here, using a combination of 10X Genomics linked-read sequencing, Oxford Nanopore long-read technology, and Illumina short-read data, we assembled the genomes of two willow-galling sawflies (Hymenoptera: Tenthredinidae: Nematinae: Euurina): the bud-galling species Euura lappo and the leaf-galling species Eupontania aestiva. The final assembly for E. lappo is 259.85 Mbp in size, with a contig N50 of 209.0 kbp and a BUSCO score of 93.5%. The E. aestiva genome is 222.23 Mbp in size, with a contig N50 of 49.7 kbp and a 90.2% complete BUSCO score. De novo annotation of repetitive elements showed that 27.45% of the genome was composed of repetitive elements in E. lappo and 16.89% in E. aestiva, which is a marked increase compared to previously published hymenopteran genomes. The genomes presented here provide a resource for inferring phylogenetic relationships among basal hymenopterans, comparative studies on host-related genomic adaptation in plant-feeding insects, and research on the mechanisms of plant manipulation by gall-inducing insects.
Impact of Delaying Antiretroviral Treatment During Primary Human Immunodeficiency Virus Infection on Telomere Length
Authors: Raffenberg Marieke , Engel Tanja , Schoepf Isabella C , Kootstra Neeltje A , Reiss Peter , Braun Dominique L , Thorball Christian W , Fellay Jacques , Kouyos Roger D , Ledergerber Bruno , Günthard Huldrych F , Tarr Philip E ,   Zurich Primary HIV Infection Study,   Swiss HIV Cohort Study
Published: March 2021

Background

Telomere length (TL) shortens during aging, HIV seroconversion, and untreated chronic HIV infection. It is unknown whether early antiretroviral therapy (ART) start is associated with less TL shortening during primary HIV infection (PHI).

Methods

We measured TL in peripheral blood mononuclear cells by quantitative polymerase chain reaction in participants of the Zurich PHI Study with samples available for ≥6 years. We obtained univariable/multivariable estimates from mixed-effects models and evaluated the association of delaying ART start or interrupting ART with baseline and longitudinal TL.

Results

In 105 participants with PHI (median age 36 years, 9% women), median ART delay was 25, 42, and 60 days, respectively, in the first (shortest), second, and third (longest) ART delay tertile. First ART delay tertile was associated with longer baseline TL (P for trend = .034), and longer TL over 6 years, but only with continuous ART (P < .001), not if ART was interrupted ≥12 months (P = .408). In multivariable analysis, participants in the second and third ART delay tertile had 17.6% (5.4%–29.7%; P = .004) and 21.5% (9.4%–33.5%; P < .001) shorter TL, after adjustment for age, with limited effect modification by clinical variables.

Conclusions

In PHI, delaying ART start for even a matter of weeks was associated with significant and sustained TL shortening.
Reduced effectiveness among β-lactam antibiotics: a population-based cohort study in primary care in Italy
Authors: Lapi Francesco , Marconi Ettore , Pecchioli Serena , Lagolio Erik , Rossi Alessandro , Concia Ercole , Cricelli Claudio
Published: March 2021

Background

There are few data comparing the relative effectiveness of the individual β-lactams.

Objectives

To quantify the reduced effectiveness, defined as switching to a different antibiotic being prescribed for the same indication, among new users of β-lactam antibiotics in primary care.

Methods

A retrospective cohort study was conducted using the Health Search Database, an Italian primary care data source. Patients newly prescribed with β-lactams for a specific indication between 1 January 2013 and 31 December 2017 were identified. A switch to a different antibiotic for the same indication occurring during a 30day follow-up was the study outcome. Cox regression was adopted to assess the risk of switching between the different β-lactams.

Results

Among 178 256 patients newly treated with β-lactam antibiotics, 1172 (0.65%) switched to a different antibiotic. Amoxicillin/clavulanate (co-amoxiclav: n = 104 891) and amoxicillin (n = 21 699) were the most frequently prescribed β-lactams. The other antibiotics showed significantly higher risk of switching when compared with co-amoxiclav for lower respiratory tract [e.g. ceftriaxone, hazard ratio (HR): 1.6, 95% CI: 1.2–2.0], dental [e.g. amoxicillin, HR: 4.2, 95% CI: 2.9–5.9], and middle ear infections [e.g. amoxicillin, HR: 1.8, 95% CI: 1.1–2.7]. The same results were gathered when parenteral formulations were excluded.

Conclusions

The prevalence of reduced effectiveness of newly prescribed β-lactam antibiotics was lower than 1%. Specifically, the rate of switch to another antibiotic, when it was prescribed to treat low respiratory tract, dental, and middle ear infections, was lower among users of co-amoxiclav than those prescribed with other β-lactams.
Presence–Absence Sampling Plans for Stink Bugs (Hemiptera: Pentatomidae) in the Midwest Region of the United States
Authors: Aita Rafael Carlesso , Pezzini Daniela T , Burkness Eric C , DiFonzo Christina D , Finke Deborah L , Hunt Thomas E , Knodel Janet J , Krupke Christian H , Marchi-Werle Lia , McCornack Brian , Michel Andrew P , Philips Christopher R , Seiter Nicholas J , Varenhorst Adam J , Wright Robert J , Hutchison William D , Koch Robert L
Published: March 2021

Stink bugs represent an increasing risk to soybean production in the Midwest region of the United States. The current sampling protocol for stink bugs in this region is tailored for population density estimation and thus is more relevant to research purposes. A practical decision-making framework with more efficient sampling effort for management of herbivorous stink bugs is needed. Therefore, a binomial sequential sampling plan was developed for herbivorous stink bugs in the Midwest region. A total of 146 soybean fields were sampled across 11 states using sweep nets in 2016, 2017, and 2018. The binomial sequential sampling plans were developed using combinations of five tally thresholds at two proportion infested action thresholds to identify those that provided the best sampling outcomes. Final assessment of the operating characteristic curves for each plan indicated that a tally threshold of 3 stink bugs per 25 sweeps, and proportion infested action thresholds of 0.75 and 0.95 corresponding to the action thresholds of 5 and 10 stink bugs per 25 sweeps, provided the optimal balance between highest probability of correct decisions (≥ 99%) and lowest probability of incorrect decisions (≤ 1%). In addition, the average sample size for both plans (18 and 12 sets of 25 sweeps, respectively) was lower than that for the other proposed plans. The binomial sequential sampling plan can reduce the number of sample units required to achieve a management decision, which is important because it can potentially reduce risk/cost of management for stink bugs in soybean in this region.
Unification with parameters in the implication fragment of classical propositional logic
Authors: Balbiani Philippe , Mojtahedi Mojtaba
Published: March 2021

In this paper, we show that the implication fragment of classical propositional logic is finitary for unification with parameters.
Labelled calculi for quantified modal logics with definite descriptions
Authors: Orlandelli Eugenio
Published: March 2021

We introduce labelled sequent calculi for quantified modal logics with definite descriptions. We prove that these calculi have the good structural properties of G3-style calculi. In particular, all rules are height-preserving invertible, weakening and contraction are height-preserving admissible and cut is syntactically admissible. Finally, we show that each calculus gives a proof-theoretic characterization of validity in the corresponding class of models.
AB Aurigae: possible evidence of planet formation through the gravitational instability
Authors: Cadman James , Rice Ken , Hall Cassandra
Published: March 2021

Recent observations of the protoplanetary disc surrounding AB Aurigae have revealed the possible presence of two giant planets in the process of forming. The young measured age of 1–4 Myr for this system allows us to place strict time constraints on the formation histories of the observed planets. Hence, we may be able to make a crucial distinction between formation through core accretion (CA) or the gravitational instability (GI), as CA formation time-scales are typically Myr whilst formation through GI will occur within the first ≈104–105 yr of disc evolution. We focus our analysis on the 4–13MJup planet observed at R ≈ 30 au. We find CA formation time-scales for such a massive planet typically exceed the system’s age. The planet’s high mass and wide orbit may instead be indicative of formation through GI. We use smoothed particle hydrodynamic simulations to determine the system’s critical disc mass for fragmentation, finding Md,crit = 0.3 M⊙. Viscous evolution models of the disc’s mass history indicate that it was likely massive enough to exceed Md,crit in the recent past; thus, it is possible that a young AB Aurigae disc may have fragmented to form multiple giant gaseous protoplanets. Calculations of the Jeans mass in an AB Aurigae-like disc find that fragments may initially form with masses 1.6–13.3MJup, consistent with the planets that have been observed. We therefore propose that the inferred planets in the disc surrounding AB Aurigae may be evidence of planet formation through GI.
GRB160203A: an exploration of lumpy space
Authors: Crisp H , Gendre B , Howell E J , Coward D
Published: March 2021

GRB160203A is a high redshift long gamma-ray burst presenting a collection of unusual features in the afterglow light curve. We study its optical and X-ray data. We find this event to occur within a constant density medium during the first part of the afterglow. However, after 13 ks we spot some flaring activities in the optical and X-ray light curves. We explain these flares by fluctuation of densities of the surrounding medium. Other scenarios, such as energy injection from a magnetar or variation of microphysical parameters are not supported by the data. We tentatively link these fluctuations to an unusual host galaxy, with gas density similar to the Milky Way and a dense cocoon of matter around a stellar progenitor similar to a Wolf–Rayet star. A termination shock scenario is found to be less likely.
Stellar versus Galactic: the intensity of cosmic rays at the evolving Earth and young exoplanets around Sun-like stars
Authors: Rodgers-Lee D , Taylor A M , Vidotto A A , Downes T P
Published: March 2021

Energetic particles, such as stellar cosmic rays, produced at a heightened rate by active stars (like the young Sun) may have been important for the origin of life on Earth and other exoplanets. Here, we compare, as a function of stellar rotation rate (Ω), contributions from two distinct populations of energetic particles: stellar cosmic rays accelerated by impulsive flare events and Galactic cosmic rays. We use a 1.5D stellar wind model combined with a spatially 1D cosmic ray transport model. We formulate the evolution of the stellar cosmic ray spectrum as a function of stellar rotation. The maximum stellar cosmic ray energy increases with increasing rotation, i.e. towards more active/younger stars. We find that stellar cosmic rays dominate over Galactic cosmic rays in the habitable zone at the pion threshold energy for all stellar ages considered ($t_*=0.6\!-\!2.9\,$ Gyr). However, even at the youngest age, $t_*=0.6\,$ Gyr, we estimate that $\gtrsim \, 80$ MeV stellar cosmic ray fluxes may still be transient in time. At ∼1 Gyr when life is thought to have emerged on Earth, we demonstrate that stellar cosmic rays dominate over Galactic cosmic rays up to ∼4 GeV energies during flare events. Our results for t* = 0.6 Gyr (Ω = 4 Ω⊙) indicate that ≲GeV stellar cosmic rays are advected from the star to 1 au and are impacted by adiabatic losses in this region. The properties of the inner solar wind, currently being investigated by the Parker Solar Probe and Solar Orbiter, are thus important for accurate calculations of stellar cosmic rays around young Sun-like stars.
Disc versus wind accretion in X-ray pulsar GX 301-2
Authors: Liu Jiren , Ji Long , Jenke Peter A , Doroshenko Victor , Liao Zhenxuan , Li Xiaobo , Zhang Shuangnan , Orlandini Mauro , Ge Mingyu , Zhang Shu , Santangelo Andrea
Published: March 2021

GX 301-2 provides a rare opportunity to study both disc and wind accretion in a same target. We report Insight-Hard X-ray Modulation Telescope observations of the spin-up event of GX 301-2 that happened in 2019 and compare with those of wind-fed state. The pulse profiles of the initial rapid spin-up period are dominated by one main peak, while those of the later slow spin-up period are composed of two similar peaks, as those of wind-fed state. These behaviours are confirmed by Fermi/Gamma-ray Burst Monitor data, which also show that during the rapid spin-up period, the main peak increases with luminosity up to 8 × 1037 erg s−1, but the faint peak remains almost constant. The absorption column densities during the spin-up period are ∼1.5 × 1023 cm−2, much less than those of wind-fed state at similar luminosity (∼9 × 1023 cm−2), supporting the scenario that most of material is condensed into a disc during the spin-up period. We discuss possible differences between disc and wind accretion that may explain the observed different trends of pulse profiles.
First star survivors as metal-rich halo stars that experienced supernova explosions in binary systems
Authors: Suda Takuma , Saitoh Takayuki R , Moritani Yuki , Matsuno Tadafumi , Shigeyama Toshikazu
Published: March 2021

The search for the first stars formed from metal-free gas in the universe is one of the key issues in astronomy because it relates to many fields, such as the formation of stars and galaxies, the evolution of the universe, and the origin of elements. It is not still clear if metal-free first stars can be found in the present universe. These first stars are thought to exist among extremely metal-poor stars in the halo of our Galaxy. Here we propose a new scenario for the formation of low-mass first stars that have survived until today and observational counterparts in our Galaxy. The first stars in binary systems, consisting of massive- and low-mass stars, are examined using stellar evolution models, simulations of supernova ejecta colliding with low-mass companions, and comparisons with observed data. These first star survivors will be observed as metal-rich halo stars in our Galaxy. We may have identified a candidate star in the observational database where elemental abundances and kinematic data are available. Our models also account for the existence in the literature of several solar-metallicity stars that have space velocities equivalent to the halo population. The proposed scenario demands a new channel of star formation in the early universe and is a supplementary scenario for the origin of the known metal-poor stars.
The distinct effect of titanium dioxide nanoparticles in primary and immortalized cell lines
Authors: Fayer Leonara , Zanette Rafaella S S , Siqueira Juliana T C , Oliveira Eduarda R , Almeida Camila G , Gern Juliana C , Sousa Saulo M , de Oliveira Luiz F C , Brandão Humberto M , Munk Michele
Published: March 2021

The titanium dioxide nanoparticles (NPs) have been applied to biomedical, pharmaceutical, and food additive fields. However, the effect on health and the environment are conflicting; thus, it has been reviewing several times. In this context, establishing standard robust protocols for detecting cytotoxicity and genotoxicity of nanomaterials became essential for nanotechnology development. The cell type and the intrinsic characteristics of titanium dioxide NPs can influence nanotoxicity. In this work, the cyto- and genotoxicity effects of standard reference material titanium dioxide NPs in primary bovine fibroblasts and immortalized Chinese hamster ovary epithelial (CHO) cells were determined and compared for the first time. Titanium dioxide NPs exposure revealed no cytotoxicity for primary bovine fibroblasts, while only higher concentrations tested (10 μg/ml) induce genotoxic effects in this cell model. In contrast, the lower concentrations of the titanium dioxide NPs cause the cyto- and genotoxic effects in CHO cells. Therefore, our finding indicates that the CHO line was more sensitive toward the effects of titanium dioxide NPs than the primary bovine fibroblast, which should be valuable for their environmental risk assessment.
The Effect of Applied Salinity and Water Stress on Chemical Suppression of Phytophthora ramorum from Soilborne Inoculum in Rhododendron
Authors: Bostock Richard M. , Roubtsova Tatiana V.
Published: March 2021

A serious concern for nurseries is the potential for Phytophthora ramorum and other Phytophthora species to colonize roots without inducing aboveground symptoms in plants that then serve as cryptic reservoirs of inoculum. Episodic abiotic stresses that reduce plant water potential can compromise the host resistance to trigger disease development from root and crown infections during many Phytophthora–plant interactions. We conducted a series of experiments with root-inoculated Rhododendron plants in a potting soil mix to assess the influence of excess salt or water deficit on ramorum blight development and the potential for these abiotic stresses to affect the efficacy of oomycete-suppressive chemical soil treatments. During growth chamber trials, P. ramorum colonized roots of both nonsalt-treated and salt-treated plants. However, salt treatment offset the benefit realized from soil treatment with mefanoxam (Subdue Maxx) and mandipropamid (Micora), as evidenced by the enhanced pathogen colonization of roots. A 3-week episode of water stress imposed after chemical treatment but before inoculation eliminated protection against P. ramorum root colonization conferred by fosetyl-Al (Aliette). At an outdoor experimental nursery, foliar symptoms were apparent in 23% of root-inoculated plants during two trials and absent during one trial. However, the majority of inoculated plants in all trials had colonized roots with little or no aboveground symptoms. A single application of Subdue Maxx or Aliette reduced root colonization by P. ramorum in Rhododendron plants. Although salt stress did not enhance ramorum blight symptom expression at the nursery, salt partially offset protection from P. ramorum root colonization obtained by Subdue Maxx.
Development of Novel Wheat–Aegilops longissima 3S1 Translocations Conferring Powdery Mildew Resistance and Specific Molecular Markers for Chromosome 3S1
Authors: Li Huanhuan , Tian Xiubin , Pei Shaolong , Men Wenqiang , Ma Chao , Sehgal Sunish K. , Zhao Yue , Chen Qifan , Wang Beilin , Dong Zhenjie , Xiang Zhiguo , Friebe Bernd , Liu Wenxuan
Published: March 2021

Powdery mildew of wheat, caused by Blumeria graminis f. sp. tritici, is a destructive disease of common wheat. Cultivation of resistant varieties is the most cost-effective disease management strategy. Previous studies reported that chromosome 3Sl#2 present in Chinese Spring (CS)–Aegilops longissima 3Sl#2(3B) disomic substitution line TA3575 conferred resistance to powdery mildew. In this study, we further located the powdery mildew resistance gene(s) to the short arm of chromosome 3Sl#2 (3Sl#2S) by evaluating for B. graminis f. sp. tritici resistance of newly developed CS–Ae. longissima 3Sl#2 translocation lines. Meanwhile, TA7545, a previously designated CS–Ae. longissima 3Sl#3 disomic addition line, was reidentified as an isochromosome 3Sl#3S addition line and evaluated to confer resistance to powdery mildew, thus locating the resistance gene(s) to the short arm of chromosome 3Sl#3 (3Sl#3S). Based on transcriptome sequences of TA3575, 10 novel chromosome 3SlS-specific markers were developed, of which 5 could be used to distinguish between 3Sl#2S and 3Sl#3S derived from Ae. longissima accessions TL20 and TA1910 (TAM4) and the remaining 5 could identify both 3Sl#2S and 3Sl#3S. Also, CL897, one of five markers specific to both 3Sl#2S and 3Sl#3S, could be used to detect Pm13 located at chromosome 3Sl#1S from Ae. longissima accession TL01 in diverse wheat genetic backgrounds. The powdery mildew resistance genes on chromosomes 3Sl#2S and 3Sl#3S, the CS–Ae. longissima 3Sl#2 translocation lines, and the 3SlS-specific markers developed in this study will facilitate the transfer of B. graminis f. sp. tritici resistance genes into common wheat and provide new germplasm resources for powdery mildew resistance breeding.
Effects of Mowing, Seeding Rate, and Foliar Fungicide on Soybean Sclerotinia Stem Rot and Yield
Authors: Carpenter Kurt A. , Sisson Adam J. , Kandel Yuba R. , Ortiz Viviana , Chilvers Martin I. , Smith Damon L. , Mueller Daren S.
Published: March 2021

Sclerotinia stem rot (SSR or white mold), caused by Sclerotinia sclerotiorum (Lib.) DeBary, is an economically important fungal disease of soybean. SSR routinely causes yield loss in the upper Corn Belt of the United States due to wet, humid conditions that coincide with moderate temperatures. This study investigated the novel cultural practice of mechanical cutting, or mowing, as an SSR management practice across multiple seeding rates. Mowing soybean during early vegetative growth alters plant architecture and growth habit. This results in a microclimate within the canopy less suitable for disease development. Field trials were conducted in Iowa, Illinois, Michigan, and Wisconsin in 2017 and 2018. Experimental design was a randomized complete block with four replications. Treatments included mowing (mowing and no mowing), seeding rate (197,684, 271,816, and 345,947 seeds/ha), and fungicide application (boscalid, Endura, and no fungicide). Soybean was mowed at approximately the V4 (four unfolded trifoliate leaves) growth stage. Mowing reduced disease in multiple locations; however, it also reduced yield in most of the locations. In general, there was less SSR in plots with lower seeding rates. Fungicide significantly reduced SSR in two of the five site-years for which disease was observed. Significant yield response to fungicide was also observed in two of the nine total field trials. Results indicate cultural practices such as mowing and reduced seeding rate can decrease SSR severity but also can impact potential yield. Additionally, yield response to SSR management practices may not be observed if disease is absent or at low levels.
The Lived Experiences of Nurses Working During the COVID-19 Pandemic
Authors: Robinson Ruthie , Stinson Cynthia Kellam
Published: March 2021

Background

Previous research on nurses during pandemics has focused on nurses working in one facility or type of unit; this study focuses on nurses caring for COVID-19 patients in a variety of units in different sites across the United States.

Objective

The aim of this study was to understand the experiences of registered nurses working with hospitalized COVID-19 patients.

Methods

This study used a hermeneutic phenomenology design. Semistructured interviews via telephone were conducted and then transcribed verbatim. Colaizzi's method of analysis was used. Data saturation was achieved with 14 participants.

Results

Three major themes were evident. They were “the human connection,” “the nursing burden,” and “coping.” Subthemes were identified under each major theme.

Discussion

This study depicted nurses who are caring, empathetic, and resilient. They had many recommendations for fellow nurses, the public, and health care organizations.
Hemodynamic Response to Device Titration in the Shunted Single Ventricle Circulation: A Patient Cohort Modeling Study
Authors: Villa Chet , Zafar Farhan , Lorts Angela , Kung Ethan
Published: March 2021

Clinical outcomes of ventricular assist device (VAD) support for shunted single ventricle patients trail the larger population due in part to the challenges in optimizing VAD support and balancing systemic and pulmonary circulations. We sought to understand the response to VAD titration in the shunted circulation using a lumped-parameter network modeling six patient-specific clinical cases. Hemodynamic data from six patients (mean body surface area = 0.30 m2) with a systemic-to-pulmonary shunt was used to construct simulated cases of heart failure and hemodynamic response to increasing VAD flow from 5 to 10 L/min/m2. With increasing VAD flow, the pulmonary arterial pressure stayed relatively constant in five patient cases and increased in one patient case. The mean VAD flow needed to attain an arterial-venous O2 saturation difference of 30% was 6.5 ± 1.2 L/min/m2, which is higher than that in the equivalent nonshunted scenario due to the partial diversion of flow to the pulmonary circulation. The hemodynamic responses to VAD support can vary significantly between specific patient cases; therefore hemodynamic modeling may help guide an individualized approach to perioperative VAD management in the shunted single-ventricle circulation and to understand the patients who may benefit the most from VAD support.
Rheumatoid arthritis coexisting with ankylosing spondylitis
Authors: Zhang Yuanyuan , Feng Bo , Dong Jing , Zhong Yanyan , Wang Liqin , Zhao Lei
Published: March 2021

Coexisting rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in the same patient is often thought to be rare, and thus misdiagnosis is common. The aim of our study was to describe the main characteristics of RA coexisting with AS in patients with delayed diagnoses and improve awareness of the disease association.

Between 2012 and 2018, data from 22 patients who had RA and AS (RA/AS) were retrospectively reviewed. All patients had a history of delayed diagnosis for RA or AS. The clinical features and radiographic changes of RA and AS patients were obtained at baseline and after 2 years. Disease activity score 28 (DAS28) or bath ankylosing spondylitis disease activity index (BASDAI) were used as outcome measures. The mean age at the time of diagnosis of RA/AS was 51.8 years, while the mean duration of diagnostic delay was 5.5 years. Middle-aged women were the most common subgroup among the RA/AS cohort. The common clinical manifestations were systemic, symmetric, peripheral, and axial arthritis. The erythrocyte sedimentation rate and C-reactive protein levels in RA/AS patients were elevated at the time diagnosis of RA/AS. The typical radiologic changes for the 2 diseases coexisted in RA/AS patients. The DAS28 and BASDAI scores at the 2-year follow-up evaluation were lower than the initial assessment.

Coexisting RA and AS is often misdiagnosed for many years; a lack of recognition of RA and AS together is one of the most common reasons. Systemic, symmetric, peripheral, and axial arthritis in middle-aged women were the most frequent presentations at onset.
Efficacy of rivaroxaban for the treatment of Chinese patients with acute pulmonary embolism
Authors: Wang Lei , Jiang Shuang , Li Chao , Xu Zhi , Chen Ying
Published: March 2021

Pulmonary embolism (PE) is a life-threatening disease, which accounts for the major type of venous thromboembolism. Currently, there is limited understanding and management for PE. Rivaroxaban is reported to treat patients with PE. However, there is still insufficient evidence on rivaroxaban for the treatment of Chinese patients with acute PE. Thus, this retrospective study investigated the benefits and safety of rivaroxaban for Chinese patients with acute PE.

A total of 72 Chinese patient cases with acute PE were analyzed in this study. Of these, 36 cases who received rivaroxaban mono-therapy were assigned to the treatment group, while the remaining 36 cases who received standard therapy were assigned to the control group. The benefits were assessed by the duration of hospital stay, treatment satisfaction, and safety.

After treatment, rivaroxaban mono-therapy showed better benefits in decreasing the duration of hospital stay (P < .01), increasing treatment satisfaction (P < .01), and reducing mild bleeding (P = .02) in Chinese patients with acute PE, than standard therapy.

The results of this study indicated that rivaroxaban may provide more benefits than the standard therapy for Chinese patients with acute PE. Future studies are still needed to warrant the current results.
Prognostic implications of an autophagy-based signature in colorectal cancer
Authors: Wang Liangbin , Jiang Xinlei , Zhang Xingguo , Shu Peng
Published: March 2021

Background:

The heterogeneity of colorectal cancer (CRC) poses a significant challenge to the precise treatment of patients. CRC has been divided into 4 consensus molecular subtypes (CMSs) with distinct biological and clinical characteristics, of which CMS4 has the mesenchymal identity and the highest relapse rate. Autophagy plays a vital role in CRC development and therapeutic response.

Methods:

The gene expression profiles collected from 6 datasets were applied to this study. Network analysis was applied to integrate the subtype-specific molecular modalities and autophagy signature to establish an autophagy-based prognostic signature for CRC (APSCRC).

Results:

Network analysis revealed that 6 prognostic autophagy genes (VAMP7, DLC1, FKBP1B, PEA15, PEX14, and DNAJB1) predominantly regulated the mesenchymal modalities of CRC. The APSCRC was constructed by these 6 core genes and applied for risk calculation. Patients were divided into high- and low-risk groups based on APSCRC score in all cohorts. Patients within the high-risk group showed an unfavorable prognosis. In multivariate analysis, the APSCRC remained an independent predictor of prognosis. Moreover, the APSCRC achieved higher prognostic power than commercialized multigene signatures.

Conclusions:

We proposed and validated an autophagy-based signature, which is a promising prognostic biomarker of CRC patients. Further prospective studies are warranted to test and validate its efficiency for clinical application.
Trends in the incidence and prevalence of end-stage renal disease with hemodialysis in entire Korean population
Authors: Choi Hong Sang , Han Kyung-Do , Oh Tae Ryom , Suh Sang Heon , Kim Minah , Kim Chang Seong , Bae Eun Hui , Ma Seong Kwon , Kim Soo Wan
Published: March 2021

Data on the overall epidemiology and temporal trends of end-stage renal disease (ESRD) requiring hemodialysis in Korea are scarce. We aimed to estimate the prevalence and incidence of ESRD requiring hemodialysis in Korea between 2002 and 2017.

Using the National Health Insurance Service database, we analyzed data from the entire Korean population between 2002 and 2017. Hemodialysis patients were identified using rare incurable disease codes (V001) or prescription of medical fee codes of hemodialysis (O7020 and O7021). We only included patients who had been maintained on hemodialysis for more than 90 days from the date of dialysis initiation, to exclude patients who required short-term dialysis for acute kidney injury, conversion to peritoneal dialysis, or kidney transplantation.

During the 16-year follow-up, the number of hemodialysis patients in Korea has steadily increased from 11,215 in 2002 to 67,486 in 2017. The mean age of these patients has gradually increased from 55.57 ± 13.31 years in 2002 to 62.13 ± 13.23 years in 2017. In 2017, the crude prevalence rate of hemodialysis was 1303.4 per million population. Overall, the number of men tended to be somewhat higher than that of women, and the proportion of men increased slightly from 55.56% in 2002 to 58.45% in 2017. The proportion of diabetic patients increased rapidly from 23.84% to 47.84%, and the percentage of dyslipidemic patients rose from 18.9% to 86.7%. The number of incident hemodialysis patients increased significantly from 4406 in 2003 to 12,134 in 2014, and then decreased to 8090 in 2017. In the incident cases of hemodialysis, the observed increase in the proportion of male patients and in diabetes and dyslipidemia were similar to that of prevalent patients. The more recent era of hemodialysis initiation, the better 5-year survival rates were observed.

The prevalence and incidence of hemodialysis in Korea gradually increased between 2002 and 2017. The proportion of men, and patients with diabetes and dyslipidemia requiring hemodialysis also increased continuously. The survival rate of hemodialysis patients was gradually improving. These findings may serve as a reference for future epidemiological studies on hemodialysis in Korea.
The systemic treatment of uterine leiomyosarcomas
Authors: Kyriazoglou Anastasios , Liontos Michalis , Ntanasis-Stathopoulos Ioannis , Gavriatopoulou Maria
Published: March 2021

Background:

Uterine leiomyosarcomas are rare malignant mesenchymal tumors. The systemic treatment of these tumors includes chemotherapy and radiotherapy. However, there are still a lot of unanswered questions regarding the ideal therapeutic approach.

Methods:

We have conducted a systematic review of the treatment strategies of uterine leiomyosarcomas for the last ten years.

Results:

Adjuvant chemotherapy is still a matter of dilemma. Doxorubicin based chemotherapy or the combination of Gemcitabine-Docetaxel are the regimens of choice for the first line setting. Beyond the first line, there are several options;, including chemotherapy, targeted therapy, and recently efforts of introducing immunotherapy to the therapeutic armamentarium of clinicians treating uterine leiomyosarcomas.

Conclusions:

Despite the efforts of the clinicians dealing with uterine leiomyosarcomas, the optimal therapeutic algorithm is yet to be described.
An Asynchronous Curriculum to Address Substance Use Disorder Training Needs for Medical and Surgical Residents
Authors: Truncali Andrea , Silva Kristen , Stickney Isaac , Johnson Marin , Holt Christina T.
Published: March 2021

Developing substance use (SU) skills in medical training remains a challenge. Residents in teaching hospitals bear a large burden in managing SU sequelae and often lack support. Preventive and addiction medicine faculty defined broadly applicable core knowledge and skills for residents across specialties in a tertiary care center. Three 1-hour online modules were developed and delivered asynchronously to interns, followed by a live skills session at orientation. Topics were (1) Unhealthy SU Screening, Detection, and Intervention; (2) Bias and Communication; and (3) Safer Prescribing in Acute Pain. All 68 interns completed the curriculum. Pre/posttesting showed increased knowledge (52%-83% correct, P < .001) and perceived confidence (10-12.9, maximum 16, P < .001). Attitudes were unchanged (18.4-18.7, maximum 20, P = .07). This process identified and improved core knowledge and skills for SU prevention and treatment in medical and surgical trainees.
The Supply and Distribution of the Preventive Medicine Physician Workforce
Authors: Ricketts Thomas C. , Porterfield Deborah S. , Miller Randall L. , Fraher Erin P.
Published: March 2021

Context:

Preventive medicine physicians work at the intersection of clinical medicine and public health. A previous report on the state of the preventive medicine workforce in 2000 revealed an ongoing decline in preventive medicine physicians and residents, but there have been few updates since.

Objective:

The purpose of this study was to describe trends in both the number of board-certified preventive medicine physicians and those physicians who self-designate preventive medicine as a primary or secondary specialty and examine the age, gender distribution, and geographic distribution of this workforce.

Design:

Analysis of the supply of preventive medicine physicians using data derived from board certification files of the American Board of Preventive Medicine and self-designation data from the American Medical Association Masterfile.

Setting:

The 50 US states and District of Columbia.

Participants:

Board-certified and self-designated preventive medicine physicians in the United States.

Main Outcome Measures:

Number, demographics, and location of preventive medicine physicians in United States.

Results:

From 1999 to 2018, the total number of physicians board certified in preventive medicine increased from 6091 to 9270; the number of self-identified preventive medicine physicians has generally decreased since 2000, with a leveling off in the past 4 years matching the trend of preventive medicine physicians per 100 000 population; there is a recent increase in women in the specialty; the practice locations of preventive medicine physicians do not match the US population in rural or micropolitan areas; and the average age of preventive medicine physicians is increasing.

Conclusions:

The number of preventive medicine physicians is not likely to match population needs in the United States in the near term and beyond. Assessing the preventive medicine physician workforce in the United States is complicated by difficulties in defining the specialty and because less than half of self-designated preventive medicine physicians hold a board certification in the specialty.
Outcomes of an Intervention to Increase Physicians Underrepresented in Medicine in Occupational Medicine Training
Authors: Green-McKenzie Judith , Savul Sajjad
Published: March 2021

Context:

Diversity in the US physician workforce is important. Physicians Underrepresented in Medicine (UIM) are more likely to serve poor, uninsured, and vulnerable populations.

Objective:

To increase the number of UIM physicians in Occupational Medicine.

Program:

An Inclusion and Diversity Committee, consisting of the program director, trainees, and graduates, was created with the goal of recruiting and developing UIM residents and increasing Occupational and Environmental Medicine awareness. Outreach to UIM residents and medical students at local, regional, and national meetings, creation and distribution of descriptive brochures, and supervised 1-day observerships were some of the interventions.

Results:

Only 4 Underrepresented Minorities physicians out of 65 (6%) graduated during the first decade of the program 1997-2007; this increased to (16/70) 23% during the following decade subsequent to establishing the Inclusion and Diversity Committee.

Conclusion:

A multifaceted strategic approach can help increase UIM physician participation in graduate training programs, helping address health equity.
Assessment of Bone Mineral Density From a Computed Tomography Topogram of Photon-Counting Detector Computed Tomography—Effect of Phantom Size and Tube Voltage
Authors: Euler André , Nowak Tristan , Bucher Brian , Eberhard Matthias , Schmidt Bernhard , Flohr Thomas G. , Frey Diana , Distler Oliver , Alkadhi Hatem
Published: March 2021

Purpose

The aim of this study was to assess the accuracy and impact of different sizes and tube voltages on bone mineral density (BMD) assessment using a computed tomography (CT) topogram acquired with photon-counting detector CT in an osteopenic ex vivo animal spine.

Materials and Methods

The lumbar back of a piglet was used to simulate osteopenia of the lumbar spine. Five fat layers (each with a thickness of 3 cm) were consecutively placed on top of the excised spine to emulate a total of 5 different sizes. Each size was repeatedly imaged on (A) a conventional dual-energy x-ray absorptiometry scanner as the reference standard, (B) a prototype photon-counting detector CT system at 120 kVp with energy thresholds at 20 and 70 keV, and (C) the same prototype system at 140 kVp with thresholds at 20 and 75 keV. Material-specific data were reconstructed from spectral topograms for B and C. Bone mineral density was measured for 3 lumbar vertebrae (L2–L4). A linear mixed-effects model was used to estimate the impact of vertebra, imaging setup, size, and their interaction term on BMD.

Results

The BMD of the lumbar spine corresponded to a T score in humans between −4.2 and −4.8, which is seen in osteoporosis. Averaged across the 3 vertebrae and 5 sizes, mean BMD was 0.56 ± 0.03, 0.55 ± 0.02, and 0.55 ± 0.02 g/cm2 for setup A, B, and C, respectively. There was no significant influence of imaging setup (P = 0.7), simulated size (P = 0.67), and their interaction term (both P > 0.2) on BMD. Bone mineral density decreased significantly from L2 to L4 for all 3 setups (all P < 0.0001). Bone mineral density was 0.59 ± 0.01, 0.57 ± 0.01, and 0.52 ± 0.02 g/cm2 for L2, L3, and L4, respectively, for setup A; 0.57 ± 0.02, 0.55 ± 0.01, and 0.53 ± 0.01 g/cm2 for setup B; and 0.57 ± 0.01, 0.55 ± 0.01, and 0.53 ± 0.01 g/cm2 for setup C.

Conclusion

A single CT topogram acquired on photon-counting detector CT with 2 energy thresholds enabled BMD quantification with similar accuracy compared with dual-energy x-ray absorptiometry over a range of simulated sizes and tube voltages in an osteopenic ex vivo animal spine.
High-Fidelity Patient Simulation Incorporated Into a Flipped Classroom Improves Students' Long-Term Knowledge Retention of Acute Organophosphorus Pesticide Poisoning
Authors: Zheng Ziyu , Liao Jinli , Zeng Lijin , Tang Hao , Li Hui , Liu Zhihao , Zhan Hong , Yang Zhen , Xiong Yan , Yuan Shiwen
Published: March 2021

Introduction

The flipped classroom (FC) approach and high-fidelity patient simulation (HFPS) training have shown promising effects in short-term acquisition or long-term retention of knowledge in medical education. In this study, we aimed to explore the incorporation of HFPS into the FC and the impact on the long-term (3 months after classes) knowledge retention of medical undergraduate students learning about acute organophosphorus pesticide poisoning (AOPP).

Methods

Eighty-two fifth-year medical students were randomly divided into an HFPS group (HG, n = 40) and an FC group (FG, n = 42). A postclass quiz and preinternship quiz were performed to assess the short-term knowledge acquisition and long-term (3 months after classes) knowledge retention of both groups of students. Feedback questionnaires were administered immediately after the class and before the internship to assess the students' self-perceived competency.

Results

In the postclass quiz, the scores achieved by the students from the HG and FG were 15.58 ± 2.69 and 14.62 ± 2.19, respectively. No significant difference was found between the 2 groups (P = 0.19). In the preinternship quiz, the scores achieved by the students from the HG (14.50 ± 2.16) were significantly higher than those achieved by the students from the FG (11.40 ± 2.07, P < 0.001). There was no significant difference between the postclass quiz and preinternship quiz scores achieved by the HG students (P = 0.05). However, scores in the preinternship quiz showed a significant decline compared with the postclass quiz for the FG students (P < 0.001). Students in the HG gave significantly higher scores for self-perceived confidence in dealing with AOPP patients in the forthcoming internship on the postclass and preinternship questionnaires.

Conclusions

The incorporation of HFPS into the FC approach could improve students' long-term knowledge retention of AOPP and enhance their confidence in caring for these patients in their internship.