bluuebunny/crossref_metadata_2025 huggingface dataset:
Integration of a Quantum Voting Scheme into Grayscale Images Using the Novel Enhanced Quantum Representation and Qiskit Framework
Authors: Tudorache Alexandru-Gabriel , Manta Vasile , Caraiman Simona
Published: April 2022

This paper illustrates the way a proposed quantum voting scheme can be designed in combination with a steganography technique called Least Significant Bit (LSB), by modifying a small number of pixels in multiple grayscale images. It combines the voting scheme with the novel enhanced quantum representation (NEQR) of an image, where the LSBs of these pixels represent the vote for each entity that takes part in the voting process. A server is also used, not only to count but also to guarantee the integrity of the votes (which is done inherently, by its design and quantum properties). The superdense coding circuit is part of the design, allowing each voter to use one qubit in order to transmit two classical bits (the vote value). The selected platform for testing this scheme is IBM Quantum Experience, together with the open-source framework called Qiskit (written in Python). This framework allows users to create various quantum circuits, using a wide selection of quantum gates, and then to simulate them, either on a simulator or on a real quantum device. The quantum circuits and the measurement results are also presented in this paper.
MiR-129-5p Inactivates NF-κB Pathway to Block Rheumatoid Arthritis Development via Targeting BRD4
Authors: Wu Zhaoli , Chen Disi
Published: April 2022

Object. Rheumatoid arthritis (RA) is an osteoarticular disease which seriously affects the motor abilities of the patients. MicroRNA disorder has been confirmed as a biomarker event in RA development, and several studies have identified that miR-129-5p is related with the progression of multiple bone diseases. The study attempted to investigate the regulation mechanism of miR-129-5p in RA development. Methods. The abundance of miR-129-5p was detected in the samples including normal tissues and RA tissues and cell lines including human fibroblast-like synoviocytes (hFLSs) and human rheumatoid arthritis fibroblast-like synoviocytes (RA-FLSs). The CCK-8 assay, flow cytometry, Transwell, and ELISA were used to observe the effects of miR-129-5p on the phenotype of RA-FLSs. Moreover, the potential targets of miR-129-5p were identified with TargetScan and dual-luciferase reporter gene assay. Besides, the abundances of the proteins were analyzed with western blot. Results. Decreased miR-129-5p was observed in RA tissues and cells. Increased miR-129-5p obviously blocked the proliferation, inflammatory stress, and migration and remarkably promoted cellular apoptosis. Moreover, BRD4 was confirmed as targets of miR-129-5p, and BRD4 upregulation could partly rescue the inhibition of miR-129-5p on aggressive behaviors of RA-FLSs. Besides, the finding of this study also proved that upregulated miR-129-5p could impede the NF-κB pathway via targeting BRD4. Conclusion. This study suggests that miR-129-5p suppresses the activation of NF-κB pathway to block the progression of RA via targeting BRD4.
Optimization of AES-128 Encryption Algorithm for Security Layer in ZigBee Networking of Internet of Things
Authors: Luo Zhonghua , Shen Keyong , Hu Rongqun , Yang Yuhan , Deng Rongchun
Published: April 2022

With the rapid development of network and communication technology, the interaction of various information data is more and more frequent, and people pay more and more attention to information security. The information encryption algorithm is a research hotspot in the field of information security. The Advanced Encryption Standard (AES) algorithm has been widely used in the field of information security with its high security and encryption efficiency. This paper mainly introduces the optimization of the AES-128 encryption algorithm of the security layer in ZigBee networking of the Internet of Things. By analyzing the principles of ZigBee networking and the AES encryption algorithm, the changes are optimized. In this paper, the new S-box cryptographic properties are used after analysis and calculation. The affine transformation period, the number of iteration cycles, and the algebraic expression of the S-box are improved. Its cryptographic properties are better than the S-box of the original algorithm, and the security of the algorithm is improved. In the theory of column hybrid algorithm, the computational complexity is reduced by changing the fixed polynomial, and the efficiency of the column hybrid algorithm is improved. In this paper, the performance of the improved AES algorithm is tested. The results show that, in the power consumption curve experiment, the recovery success rate of the original algorithm is about 42%, and the recovery success rate of the improved algorithm is nearly 60%. The improved algorithm is faster than the original algorithm in achieving a recovery success rate of 100%. Experimental results show that the design can accurately complete the encryption and decryption of the AES algorithm, and the performance is better than the original algorithm, which proves the overall superiority of the algorithm.
Distributed Connectivity Restoration Algorithm with Optimal Repair Path in Wireless Sensor and Actor Networks
Authors: Liu Shangdong , Liu Donghui , Feng Yujian , Ji Yimu
Published: April 2022

The actor nodes in wireless sensor and actor network (WSAN) are responsible for receiving the perceived data, processing and collaborating with each other. In most scenarios, maintaining the connectivity of the interactor network is necessary to plan the optimal coordinated response. However, actors are vulnerable to damage due to their limited energy and harsh environment. At worst, such failure can split the interactor network, which is affecting network performance. To restore the network connectivity, the existing methods replace the failed node by selecting a redundant node in the network. Multiple nodes may be involved in moving from the redundant node to the failed node, thus forming a repair path. However, the repair paths generated by such methods are often not optimal. In this paper, we use the gradient generation and diffusion mechanism to restore the connectivity of the interactor network and propose a gradient-based distributed connectivity recovery (GDCR) algorithm. GDCR selects an optimal repair path from the global network based on the generated gradient distribution under fully distributed and localized conditions. GDCR can timely respond to the repair and minimize the recovery range and movement overhead. Simulation results verify the performance of the proposed algorithm.
[Retracted] Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures
Authors: Kashyap Dharambir , Pal Deeksha , Sharma Riya , Garg Vivek Kumar , Goel Neelam , Koundal Deepika , Zaguia Atef , Koundal Shubham , Belay Assaye
Published: April 2022

Breast cancer is a global cause for concern owing to its high incidence around the world. The alarming increase in breast cancer cases emphasizes the management of disease at multiple levels. The management should start from the beginning that includes stringent cancer screening or cancer registry to effective diagnostic and treatment strategies. Breast cancer is highly heterogeneous at morphology as well as molecular levels and needs different therapeutic regimens based on the molecular subtype. Breast cancer patients with respective subtype have different clinical outcome prognoses. Breast cancer heterogeneity emphasizes the advanced molecular testing that will help on‐time diagnosis and improved survival. Emerging fields such as liquid biopsy and artificial intelligence would help to under the complexity of breast cancer disease and decide the therapeutic regimen that helps in breast cancer management. In this review, we have discussed various risk factors and advanced technology available for breast cancer diagnosis to combat the worst breast cancer status and areas that need to be focused for the better management of breast cancer.
Simulation of Mechanical Heart Valve Dysfunction and the Non-Newtonian Blood Model Approach
Authors: Chen Aolin , Basri Adi Azriff Bin , Ismail Norzian Bin , Tamagawa Masaaki , Zhu Di , Ahmad Kamarul Arifin
Published: April 2022

The mechanical heart valve (MHV) is commonly used for the treatment of cardiovascular diseases. Nonphysiological hemodynamic in the MHV may cause hemolysis, platelet activation, and an increased risk of thromboembolism. Thromboembolism may cause severe complications and valve dysfunction. This paper thoroughly reviewed the simulation of physical quantities (velocity distribution, vortex formation, and shear stress) in healthy and dysfunctional MHV and reviewed the non-Newtonian blood flow characteristics in MHV. In the MHV numerical study, the dysfunction will affect the simulation results, increase the pressure gradient and shear stress, and change the blood flow patterns, increasing the risks of hemolysis and platelet activation. The blood flow passes downstream and has obvious recirculation and stagnation region with the increased dysfunction severity. Due to the complex structure of the MHV, the non-Newtonian shear-thinning viscosity blood characteristics become apparent in MHV simulations. The comparative study between Newtonian and non-Newtonian always shows the difference. The shear-thinning blood viscosity model is the basics to build the blood, also the blood exhibiting viscoelastic properties. More details are needed to establish a complete and more realistic simulation.
The Role of Socioeconomic Status and Race/Ethnicity in Malignant Peripheral Nerve Sheath Tumor Survival: A Surveillance, Epidemiology, and End Results–Based Analysis
Authors: Domingues Allison M. , Moertel Christopher L. , Marcotte Erin L.
Published: April 2022

Background:

Recent investigations of malignant peripheral nerve sheath tumor (MPNST) survival have reported higher mortality among non-White individuals. However, previous analyses have not examined the impact of socioeconomic status (SES) on these observations. This study aims to characterize factors associated with cause-specific MPNST survival, including information related to census-tract-level SES (CT-SES).

Methods:

We identified 2,432 primary MPNSTs using the Surveillance, Epidemiology, and End Results (SEER) 18 (2000–2016) database. We used Cox proportional hazards modeling to estimate the effects of sex, race/ethnicity, CT-SES quintile, metastasis at diagnosis, tumor site, age at diagnosis, and treatment by surgery on survival. Models were fit in both the full population and, separately, stratified by race/ethnicity and age at diagnosis (<40 vs. ≥40).

Results:

In adjusted models, age at diagnosis, CT-SES, and metastasis at diagnosis were associated with mortality. In race/ethnicity-stratified analysis, higher CT-SES was found to improve survival only in the White population. Among those diagnosed before age 40, metastasis at diagnosis and American Indian/Alaska Native race/ethnicity were associated with mortality, and both Hispanic ethnicity and Asian/Pacific Islander race were suggestive for increased mortality. Among cases, diagnoses at age 40 and above, age at diagnosis, male sex, and CT-SES were associated with mortality.

Conclusions:

This analysis provides evidence that among pediatric and young adult patients, non-White populations experience inferior survival compared with Whites, independent of CT-SES. Our findings also suggest that the effect of CT-SES on MPNST survival may differ by racial/ethnic group.

Impact:

These findings suggest that barriers to healthcare for certain racial/ethnic groups extend beyond SES.
A Review of Ethical and Legal Aspects of Gender-Neutral Human Papillomavirus Vaccination
Authors: Logel Margaret , Laurie Cassandra , El-Zein Mariam , Guichon Juliet , Franco Eduardo L.
Published: April 2022

While launching a campaign to eliminate cervical cancer, the World Health Organization called to halt human papillomavirus (HPV) gender-neutral vaccination (GNV) because of limited vaccine supply, raising ethical and legal questions about female-only vaccination versus GNV. We identified ethical and legal aspects of HPV GNV by searching MEDLINE for records up to February 19, 2021. We also provided an overview of HPV vaccines, the evolution of HPV vaccine recommendations in North America, and a timeline of male HPV vaccination introduction by searching PubMed, Google, and government websites. Four HPV vaccines are available: Cervarix, Gardasil, Gardasil9, and Cecolin. Vaccine recommendations in North America evolved from female only to eventually include males. Following the FDA's approval of the first HPV vaccine for males (2009), 35 countries began vaccinating males (2011–2020). On the basis of 59 eligible records out of 652, we identified the following constructs: lower male awareness of HPV and vaccination (n = 13), limited economic resources (n = 5), shared social responsibility (n = 18), unprotected groups from female-only HPV vaccination (n = 10), limited screening for HPV-associated noncervical cancers (n = 6), consideration of ethical principles (n = 17), and HPV vaccine mandates (n = 5). Ethical and legal aspects must be considered when recommending vaccination for females only or GNV.
Dermoscopic Features of Nail Psoriasis: Revisited
Authors: Yorulmaz Ahu , Aksoy Gunes Gur
Published: April 2022

Introduction: Nail psoriasis poses a diagnostic challenge in a context of clinical findings that are not evident. We aimed at exploring dermoscopic findings of nail psoriasis and assessing the relationship between these features with disease severity and the risk of arthritis. Methods: We enrolled 35 patients (26 men, 9 women) with severe nail psoriasis (Nail Psoriasis Severity Index [NAPSI] score of more than 50). A complete clinical evaluation, including musculoskeletal assessment and videodermoscopic examination of all nails, was carried out for each patient. Results: Splinter haemorrhage was the most common finding (94.3%), followed by distal onycholysis (88.6%) and pitting (74.3%). The presence of subungual hyperkeratosis (SUH) and the absence of mottled lunula were associated with disease severity (p < 0.05). Both SUH and nail plate crumbling (NPC) were observed more in patients with arthritis. The presence of a combination of SUH and NPC was associated to a 15-fold increase in the risk of arthritis (%95 confidence intervals: 1.55–145.2, p < 0.05). Discussion/Conclusion: This study presents preliminary evidence for the use of dermoscopy as a first step in the diagnosis of nail psoriasis. Dermoscopy is an indispensable tool in the primary evaluation of patients with nail psoriasis, which provides predictive information about the course of the disease.
Pathways from Diagnosis to Death from Keratinocyte Cancer in Kidney Transplant Recipients
Authors: Shao Emily Ximin , Khosrotehrani Kiarash , Campbell Scott , Isbel Nicole , Green Adele
Published: April 2022

Background: Kidney transplant recipients are at increased risk of developing and dying from keratinocyte cancer. We aimed to describe the clinical course of keratinocyte cancer-related deaths in a cohort of kidney transplant recipients. Methods: In kidney transplant recipients transplanted between 1995 and 2014 in Queensland, Australia, we ascertained keratinocyte cancer deaths by searching national transplant and state death registries to March 2020. Deceased transplant recipients’ medical records were reviewed to assess features of the primary lesion of the fatal keratinocyte cancer, metastases, and clinical information before death. Results: Of 658 kidney transplant recipient deaths, 49 (7%) were due to keratinocyte cancer, and medical records were available for 36 (73%). One death was due to basal cell carcinoma, and 35 were from squamous cell carcinoma (SCC), primarily from the head and neck (24; 69%). The most common site of metastasis was the lungs (21; 58%). Median time (minimum, maximum) from the diagnosis of primary SCC to metastasis was 5 months (0, 29). After this, the median time to death was 9 months (1, 50). Conclusion: Fatal keratinocyte cancers overwhelmingly arise on the head and neck, with lungs the most common metastasis site. The short time from diagnosis of primary to death indicates the aggressive nature of these keratinocyte cancers.
Criteria for Continuous Kidney Replacement Therapy Cessation in ICU Patients
Authors: Volbeda Meint , Oord Martha , Koeze Jacqueline , Keus Eric , van der Horst Iwan C.C. , Franssen Casper F.M.
Published: April 2022

Introduction: In intensive care unit (ICU) patients with acute kidney injury, specific recommendations to guide the decision to cease continuous kidney replacement therapy (CKRT) are lacking. Methods: We performed a survey to identify criteria currently used to cease CKRT in real-life clinical practice in the Netherlands. We used an online questionnaire with multiple choice questions designed with web-based software from SurveyMonkey. Results: We received 169 completed questionnaires from intensivists (n = 126) and nephrologists (n = 43). Essential determinants for the cessation of CKRT were a spontaneously increasing diuresis (indicated by 92% of the respondents), absence of fluid overload (indicated by 88% of the respondents), and improvement in creatinine clearance (indicated by 61% of the respondents; intensivists 56%; nephrologists 77%, p = 0.03). Most often mentioned cut-off values used for increase in diuresis were 0.25 and 0.5 mL/kg/h (35% and 33%, respectively). Actual CKRT cessation was often postponed until the filter clots or until circuit disconnection is needed because of patient transport for diagnostic or intervention procedures (indicated by 58% of the respondents). Expected discharge from the ICU was the most frequently reported determinant to switch from CKRT to hemodialysis (indicated by 67% of the respondents). Conclusions: CKRT cessation in clinical practice is mostly based on spontaneously increasing diuresis, absence of fluid overload, and improvement in creatinine clearance and is often delayed until filter clotting or disconnection of the circuit because of logistic reasons.
A Composite of Hepatocyte Growth Factor- and 5α-Dihydrotestosterone-Gelatin Microspheres with Adipose-Derived Stem Cells Enhances Wound Healing
Authors: Tao Ke , Bai Xiaozhi , Ji Peng , Zhang Yue , Cao Tao , Han Fu , Zhang Zhi , Guan Hao , Hu Dahai
Published: April 2022

Introduction: Reconstructing sebaceous glands is one goal of functionally healing patients who have suffered severe burns, instead of the simple pursuit of wound closure. Effective regeneration of skin appendages remains a challenge in skin wound management and research. Objective: The aim of this study was to evaluate the differentiation of adipose-derived stem cells (ADSCs) into sebaceous glands and clarified the involvement of hepatocyte growth factor (HGF) and 5α-dihydrotestosterone (5α-DHT) in this process. Methods: This study used HGF- and 5α-DHT-gelatin microspheres to treat human ADSCs and investigated the reconstruction of sebaceous glands. HGF- and 5α-DHT-gelatin microspheres were constructed using microcapsule slow-release technology. A mice full-thickness skin-wound model was established to evaluate wound healing, and hematoxylin-eosin staining was utilized to determine the skin structure. Results: In vitro analyses found that HGF- and 5α-DHT-gelatin microspheres promoted migration of and tube formation by ADSCs. Furthermore, AKT/ERK signaling, which is related to sebocyte and sweat gland epithelial-cell growth, was activated after HGF and 5α-DHT treatment. An in vivo wound healing model demonstrated that ADSCs primed with amnion-loaded HGF- and 5α-DHT-gelatin microspheres promoted wound healing and increased sebaceous gland formation compared to the control group. Conclusions: This study confirms the efficacy of ADSCs treated with amnion and HGF- and 5α-DHT-gelatin microspheres in accelerating wound healing and effectively restoring sebaceous glands. This engineered tissue provides insight into and a novel therapeutic material for burns and full-thickness skin wounds.
Food-Based Dietary Management of Crohn’s Disease; Are We There Yet?
Authors: Gerasimidis Konstantinos , Gkikas Konstantinos , Svolos Vaios
Published: April 2022

Diet is a key modifier of risk of inflammatory bowel disease development and potentially a treatment option in patients with established disease. International organisations in gastroenterology and inflammatory bowel disease have published guidelines for the role of diet in disease onset and its management. Here, we discuss the major overarching themes arising from these guidelines and appraise recent literature on the role of diet for inflammatory bowel disease prevention, treatment of active disease and maintenance of remission, considering these themes. Except for exclusive enteral nutrition in active Crohn’s disease, we currently possess very little evidence to make any further dietary recommendations for the management of inflammatory bowel disease. There is also currently uncertainty on the extrapolation of epi­demiological dietary signals on risk of disease development and preclinical experiments in animal models to management, once disease is established. Until high-quality evidence from clinical research becomes available, the only specific recommendations for inflammatory bowel disease we might safely give are those of healthy eating which apply for the general population for overall health and well-being.
Malignes Pleuramesotheliom: Künstliche Intelligenz in der Bildanalyse
Authors: Keymel Stefanie
Published: April 2022

Background:Background In malignant pleural mesothelioma (MPM), complex tumour morphology results in inconsistent radiological response assessment. Promising volumetric methods require automation to be practical. We developed a fully automated Convolutional Neural Network (CNN) for this purpose, performed blinded validation and compared CNN and human response classification and survival prediction in patients treated with chemotherapy. Methods: In a multicentre retrospective cohort study; 183 CT datasets were split into training and internal validation (123 datasets (80 fully annotated); 108 patients; 1 centre) and external validation (60 datasets (all fully annotated); 30 patients; 3 centres). Detailed manual annotations were used to train the CNN, which used two-dimensional U-Net architecture. CNN performance was evaluated using correlation, Bland-Altman and Dice agreement. Volumetric response/progression were defined as ≤30%/≥20% change and compared with modified Response Evaluation Criteria In Solid Tumours (mRECIST) by Cohen’s kappa. Survival was assessed using Kaplan-Meier methodology. Results: Human and artificial intelligence (AI) volumes were strongly correlated (validation set r = 0.851, p < 0.0001). Agreement was strong (validation set mean bias +31 cm3 (p = 0.182), 95% limits 345 to +407 cm3). Infrequent AI segmentation errors (4/60 validation cases) were associated with fissural tumour, contralateral pleural thickening and adjacent atelectasis. Human and AI volumetric responses agreed in 20/30 (67%) validation cases κ = 0.439 (0.178 to 0.700). AI and mRECIST agreed in 16/30 (55%) validation cases κ = 0.284 (0.026 to 0.543). Higher baseline tumour volume was associated with shorter survival. Conclusion:We have developed and validated the first fully automated CNN for volumetric MPM segmentation. CNN performance may be further improved by enriching future training sets with morphologically challenging features. Volumetric response thresholds require further calibration in future studies.
Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia
Authors: Malatt Camille , Tagliati Michele
Published: April 2022

Background: Deep brain stimulation (DBS) has been utilized for over two decades to treat medication-refractory dystonia in children. Short-term benefit has been demonstrated for inherited, isolated, and idiopathic cases, with less efficacy in heredodegenerative and acquired dystonia. The ongoing publication of long-term outcomes warrants a critical assessment of available information as pediatric patients are expected to live most of their lives with these implants. Summary: We performed a review of the literature for data describing motor and neuropsychiatric outcomes, in addition to complications, 5 or more years after DBS placement in patients undergoing DBS surgery for dystonia at an age younger than 21. We identified 20 articles including individual data on long-term motor outcomes after DBS for a total of 78 patients. In addition, we found five articles reporting long-term outcomes after DBS in 9 patients with status dystonicus. Most patients were implanted within the globus pallidus internus, with only a few cases targeting the subthalamic nucleus and ventrolateral posterior nucleus of the thalamus. The average follow-up was 8.5 years, with a range of up to 22 years. Long-term outcomes showed a sustained motor benefit, with median Burke-Fahn-Marsden dystonia rating score improvement ranging from 2.5% to 93.2% in different dystonia subtypes. Patients with inherited, isolated, and idiopathic dystonias had greater improvement than those with heredodegenerative and acquired dystonias. Sustained improvements in quality of life were also reported, without the development of significant cognitive or psychiatric comorbidities. Late adverse events tended to be hardware-related, with minimal stimulation-induced effects. Key Messages: While data regarding long-term outcomes is somewhat limited, particularly with regards to neuropsychiatric outcomes and adverse events, improvement in motor outcomes appears to be preserved more than 5 years after DBS placement.
Change in Left Ventricular Ejection Fraction With Coronary Artery Revascularization and Subsequent Risk for Adverse Cardiovascular Outcomes
Authors: Velagaleti Raghava S. , Vetter Joy , Parker Rachel , Kurgansky Katherine E. , Sun Yan V. , Djousse Luc , Gaziano J. Michael , Gagnon David , Joseph Jacob
Published: April 2022

Background:

Coronary revascularization is recommended to treat ischemic cardiomyopathy. However, the relations of revascularization-associated ejection fraction (EF) change to subsequent outcomes have not been elucidated.

Methods:

In 10 071 veterans (mean age 67 years; 1% women; 15% non-White) who underwent a first percutaneous coronary intervention (PCI) or coronary artery bypass grafting between January 1, 1995, and December 31, 2010, and had prerevascularization and postrevascularization EF measured, we calculated delta-EF (postprocedure EF–preprocedure EF). We related delta-EF as a continuous measure and as categories (≤−5, −5<delta-EF<0, delta-EF=0, 0<delta-EF<5, and delta-EF≥5) to death (using Cox regression) and heart failure hospitalization days (using negative binomial regression) in multivariable-adjusted models, for total sample, and PCI and coronary artery bypass grafting strata.

Results:

Over follow-up (mean/maximum 5/14 years) 56% died. Each 5% improvement in delta-EF was associated with statistically significant reductions in death and heart failure hospitalization days of 5% (95% CI, 3%–7%) and 10% (95% CI, 5%–15%), respectively, in the total sample and 6% (95% CI, 4%–8%) and 10% (95% CI, 5%–16%), respectively, in the PCI subgroup. Patients in the highest delta-EF category had 27% (95% CI, 19%–34%) lower mortality (30% [95% CI, 21%–37%] lower in PCI stratum) and ≈40% lower heart failure hospitalization days in total sample and PCI stratum, compared with those in the lowest category. Relations of delta-EF and outcomes in coronary artery bypass grafting subgroup did not reach statistical significance.

Conclusions:

Revascularization-associated EF improvement was associated with significant reductions in mortality and heart failure hospitalization burden, particularly in the PCI subgroup.
Impact of Ticagrelor Versus Clopidogrel on Coronary Microvascular Function After Non–ST-Segment–Elevation Acute Coronary Syndrome
Authors: Xu James , Lo Sidney , Mussap Christian J. , French John K. , Rajaratnam Rohan , Kadappu Krishna , Premawardhana Upul , Nguyen Phong , Juergens Craig P. , Leung Dominic Y.
Published: April 2022

Background:

Coronary microvascular dysfunction after acute coronary syndrome is an important predictor of long-term prognosis. Data is lacking on the effects of oral P2Y
12
-inhibitors on coronary microvascular function in non–ST-segment–elevation acute coronary syndrome. The aim of this study was to compare the acute effects of ticagrelor versus clopidogrel pretreatment on coronary microvascular function in non–ST-segment–elevation acute coronary syndrome patients.

Methods:

Hospitalized non–ST-segment–elevation acute coronary syndrome patients were randomized (1:1) to ticagrelor or clopidogrel. The index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio were obtained using an intracoronary pressure-temperature sensor-tipped wire.

Results:

In total, 128 patients were randomized between March 2018 and July 2020. Mean age 59.2±11.8 years, 84% were male, mean Global Registry of Acute Coronary Events score was 93.7±24.5. Intracoronary physiological measurements were obtained in 118 patients (60 ticagrelor, 58 clopidogrel). In the infarct-related artery, the ticagrelor group had lower baseline index of microcirculatory resistance (22.0 [13.0–34.9] versus 27.7 [19.3–29.8];
P
=0.02) and higher baseline resistive reserve ratio (3.0 [2.3–4.4] versus 2.4 [1.7–3.4];
P
=0.01) compared with the clopidogrel group. A total of 88 patients underwent percutaneous coronary intervention (PCI; 45 ticagrelor, 43 clopidogrel). The ticagrelor group had lower post-PCI index of microcirculatory resistance (22.0 [15.0–29.0] versus 27.0 [18.5–47.5];
P
=0.02) and higher post-PCI resistive reserve ratio (3.0 [1.8–3.8] versus 1.8 [1.5–3.4];
P
=0.006) compared with the clopidogrel group. The coronary flow reserve was not significantly different between the 2 groups at baseline or post-PCI. No between-group differences were seen in any of the indices in the non-infarct-related artery.

Conclusions:

In non–ST-segment–elevation acute coronary syndrome patients, ticagrelor significantly improved coronary microvascular function before and after PCI compared with clopidogrel.

Registration:

URL:
https://www.anzctr.org.au
; Unique identifier: ACTRN12618001610224.
Drug-Coated Balloon for Small Coronary Artery Disease in Patients With and Without High-Bleeding Risk in the BASKET-SMALL 2 Trial
Authors: Scheller Bruno , Rissanen Tuomas T. , Farah Ahmed , Ohlow Marc-Alexander , Mangner Norman , Wöhrle Jochen , Möbius-Winkler Sven , Weilenmann Daniel , Leibundgut Gregor , Cuculi Florim , Gilgen Nicole , Coslovsky Michael , Mahfoud Felix , Jeger Raban V. ,   for the BASKET-SMALL 2 Investigators
Published: April 2022

Background:

Patients at high-bleeding risk (HBR) undergoing percutaneous coronary intervention represent a challenging patient population. The use of drug-coated balloon (DCB) allows shorter duration of dual antiplatelet therapy compared with drug-eluting stents (DES) and reduces thrombotic risk due to the absence of a permanent implant. The present analysis aimed to investigate if the effect of DCB versus DES differed between patients with and without HBR treated with percutaneous coronary intervention in small coronary arteries.

Methods:

This prespecified subgroup analysis of a multicenter, randomized, noninferiority trial included 758 patients with de novo lesions in coronary vessels <3 mm and an indication for percutaneous coronary intervention, randomized to DCB (n=382) or second-generation DES (n=376). Patients were followed over 3 years for major adverse cardiac events.

Results:

Of the 758 patients randomized, 155 (20%) had HBR; these patients had higher mortality at 3 years (hazard ratio [95% CI], 3.09 [1.78–5.36];
P
<0.001). Rates of major bleeding events were overall low but tended to be lower after DCB versus DES (1.6% versus 3.7%;
P
=0.064), were similar in patients with HBR (4.5% versus 3.4%) but less frequent in DCB-versus DES-treated patients without HBR (0.9% versus 3.8%). There was no difference in major adverse cardiac events between DCB and DES regardless of bleeding risk (HBR, hazard ratio: 1.16 [0.51–2.62];
P
=0.719 versus non-HBR, 0.96 [0.62–1.49];
P
=0.863).

Conclusions:

DCBs were similarly safe and effective as current-generation DES in the treatment of coronary arteries <3 mm, regardless of bleeding risk. In patients treated with DCB, there was a trend towards a reduction of severe bleeding events at 3 years.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01574534.
The E3 Ligase TRIM16 Is a Key Suppressor of Pathological Cardiac Hypertrophy
Authors: Liu Jiayi , Li Wei , Deng Ke-Qiong , Tian Song , Liu Hui , Shi Hongjie , Fang Qian , Liu Zhen , Chen Ze , Tian Tian , Gan Shanyu , Hu Fengjiao , Hu Manli , Cheng Xu , Ji Yan-Xiao , Zhang Peng , She Zhi-Gang , Zhang Xiao-Jing , Chen Shaoze , Cai Jingjing , Li Hongliang
Published: April 2022

Background:

Pathological cardiac hypertrophy is one of the leading causes of heart failure with highly complicated pathogeneses. The E3 ligase TRIM16 (tripartite motif–containing protein 16) has been recognized as a pivotal regulator to control cell survival, immune response, and oxidativestress. However, the role of Trim16 in cardiac hypertrophy is unknown.

Methods:

We generated cardiac-specific knockout mice and adeno-associated virus serotype 9–Trim16 mice to evaluate the function of Trim16 in pathological myocardial hypertrophy. The direct effect of TRIM16 on cardiomyocyte enlargement was examined using an adenovirus system. Furthermore, we combined RNA-sequencing and interactome analysis that was followed by multiple molecular biological methodologies to identify the direct target and corresponding molecular events contributing to TRIM16 function.

Results:

We found an intimate correlation of Trim16 expression with hypertrophy-related heart failure in both human and mouse. Our functional investigations and unbiased transcriptomic analyses clearly demonstrated that Trim16 deficiency markedly exacerbated cardiomyocyte enlargement in vitro and in transverse aortic constriction–induced cardiac hypertrophy mouse model, whereas Trim16 overexpression attenuated cardiac hypertrophy and remodeling. Mechanistically, Prdx1 (peroxiredoxin 1) is an essential target of Trim16 in cardiac hypertrophy. We found that Trim16 interacts with Prdx1 and inhibits its phosphorylation, leading to a robust enhancement of its downstream Nrf2 (nuclear factor–erythroid 2–related factor 2) pathway to block cardiac hypertrophy. Trim16-blocked Prdx1 phosphorylation was largely dependent on a direct interaction between Trim16 and Src and the resultant Src ubiquitinational degradation. Notably, Prdx1 knockdown largely abolished the anti-hypertrophic effects of Trim16 overexpression.

Conclusions:

Our findings provide the first evidence supporting Trim16 as a novel suppressor of pathological cardiac hypertrophy and indicate that targeting the Trim16-Prdx1 axis represents a promising therapeutic strategy for hypertrophy-related heart failure.
Contrast‐Associated Acute Kidney Injury After Endovascular Therapy for Acute Ischemic Stroke: A Meta‐Analysis
Authors: Jhou Hong‐Jie , Chen Po‐Huang , Yang Li‐Yu , Lee Cho‐Hao
Published: April 2022

Background

This study aimed to investigate the incidence of contrast‐associated acute kidney injury (CA‐AKI) and renal replacement therapy (RRT) after endovascular therapy (EVT) for acute ischemic stroke.

Methods

PubMed, the Cochrane Library, and the Web of Science were searched to identify all relevant studies regarding the incidence of CA‐AKI and RRT in patients with acute ischemic stroke receiving EVT until July 2021. To pool the incidence of CA‐AKI and RRT, a random‐effects model with a double arcsine transformation was used. Subgroup analysis and meta‐regression analysis were used to investigate the relationship of individual study‐level covariates with CA‐AKI and RRT.

Results

It was found that 15 studies involving 27 246 patients with acute ischemic stroke receiving EVT met the inclusion criteria. The incidence of CA‐AKI was 5.0% (95% CI, 2.1%–8.9%), and the incidence of RRT was 0.2% (95% CI, 0.0%–0.4%). Subgroup analysis showed that the incidence of CA‐AKI was higher when using the European Society of Urogenital Radiology's criteria (6.6%, 95% CI, 3.8%–10.1%) than when using the Kidney Disease: The Improving Global Outcomes criteria (3.0%, 95% CI, 1.0%–6.1%). Meta‐regression analysis confirmed that the presence of diabetes was associated with increased rates of CA‐AKI (
P
=0.002); however, the rates of CA‐AKI were not elevated because of impaired baseline estimated glomerular filtration rate (
P
=0.518), chronic kidney disease (
P
=0.860), or the volume of contrast (
P
=0.536).

Conclusions

The risk of CA‐AKI and RRT secondary to EVT is low for patients with acute ischemic stroke; therefore, treatment should not be delayed for the patients eligible for EVT by waiting for the results of renal function analysis.
Prediction Skill of GEFSv12 for Southwest Summer Monsoon Rainfall and Associated Extreme Rainfall Events on Extended Range Scale over India
Authors: Nageswararao M. M. , Zhu Yuejian , Tallapragada Vijay
Published: April 2022

Indian summer monsoon rainfall (ISMR) from June to September (JJAS) contributes 80% of the total annual rainfall in India and controls the agricultural productivity and economy of the country. Extreme rainfall (ER) events are responsible for floods that cause widespread destruction of infrastructure, economic damage, and loss of life. A forecast of the ISMR and associated ER events on an extended range (beyond the conventional one-week lead time) is vital for the agronomic economy of the country. In September 2020, NOAA/NCEP implemented Global Ensemble Forecast System, version 12 (GEFSv12) for various risk management applications. It has generated consistent reanalysis and reforecast data for the period 2000–19. In the present study, the Raw-GEFSv12 with day-1–16 lead-time rainfall forecasts are calibrated using the quantile (QQ) mapping technique against Indian Monsoon Data Assimilation and Analysis (IMDAA) for further improvement. The present study evaluated the prediction skill of Raw and QQ-GEFSv12 for ISMR and ER events over India by using standard skill metrics. The results suggest that the ISMR patterns from Raw and QQ-GEFSv12 with (lead) day 1–16 are similar to IMDAA. However, Raw-GEFSv12 has a dry bias in most parts of prominent rainfall regions. The low- to medium-intensity rainfall events from Raw-GEFSv12 is remarkably higher than the IMDAA, while high- to very-high-intensity rainfall events from Raw-GEFSv12 are lower than IMDAA. The prediction skill of Raw-GEFSv12 in depicting ISMR and associated ER events decreased with lead time, while the prediction skill is almost equal for all lead times with marginal improvement after calibration.
Endovascular Intervention in Internal Carotid Artery Blunt Cerebrovascular Injury: An EAST Multicenter Study
Authors: Lauerman Margaret , Esposito Emily , Spalding Chance , Simpson Joshua , Dunn Julie A. , Zier Linda , Burruss Sigrid , Kim Paul , Jacobson Lewis E. , Williams Jamie , Nahmias Jeffry , Grigorian Areg , Harmon Laura , Gergen Anna , Chatoor Matthew , Rattan Rishi , Young Andrew J. , Pascual Jose L. , Murry Jason , Ong Adrian W. , Muller Alison , Sandhu Rovinder S. , Appelbaum Rachel , Bugaev Nikolay , Tatar Antony , Zreik Khaled , Lieser Mark J. , Scalea Thomas M. , Stein Deborah M.
Published: April 2022

Background

Use of endovascular intervention (EI) for blunt cerebrovascular injury (BCVI) is without consensus guidelines. Rates of EI use and radiographic characteristics of BCVI undergoing EI nationally are unknown.

Methods

A post-hoc analysis of a prospective, observational study at 16 U.S. trauma centers from 2018 to 2020 was conducted. Internal carotid artery (ICA) BCVI was included. The primary outcome was EI use. Multivariable logistic regression was performed for predictors of EI use.

Results

From 332 ICA BCVI included, 21 (6.3%) underwent EI. 0/145 (0%) grade 1, 8/101 (7.9%) grade 2, 12/51 (23.5%) grade 3, and 1/20 (5.0%) grade 4 ICA BCVI underwent EI. Stroke occurred in 6/21 (28.6%) ICA BCVI undergoing EI and in 33/311 (10.6%) not undergoing EI ( P = .03), with all strokes with EI use occurring prior to or at the same time as EI. Percentage of luminal stenosis (37.75 vs 20.29%, P = .01) and median pseudoaneurysm size (9.00 mm vs 3.00 mm, P = .01) were greater in ICA BCVI undergoing EI. On logistic regression, only pseudoaneurysm size was associated with EI (odds ratio 1.205, 95% CI 1.035-1.404, P = .02). Of the 8 grade 2 ICA BCVI undergoing EI, 3/8 were grade 2 and 5/8 were grade 3 prior to EI. Of the 12 grade 3 ICA BCVI undergoing EI, 11/12 were grade 3 and 1/12 was a grade 2 ICA BCVI prior to EI.

Discussion

Pseudoaneurysm size is associated with use of EI for ICA BCVI. Stroke is more common in ICA BCVI with EI but did not occur after EI use.
Routine Lower Extremity Screening Ultrasound Protocols in Trauma Patients Are Not Cost Effective
Authors: Miles M. Victoria P. , Brown Caroline N. H. , Webster Cassidy C. , Armistead Charles , Gilchrist S. Austin , Everett Hayley , Wilson Andrew , Maxwell Robert
Published: April 2022

Background

Despite prophylaxis, deep vein thrombosis (DVT) and pulmonary embolism remain dreaded complications following traumatic injury and are associated with significant morbidity and mortality. Screening ultrasound (US) protocols have been employed in trauma centers for early detection of lower extremity (LE) deep venous thrombosis. We hypothesized that screening lower extremity venous duplex US would not prove cost effective in our trauma population who receives early pharmacologic prophylaxis.

Methods

Data was collected for one year on all adult trauma patients admitted to the trauma service from December 2019 to 2020. DVT screening US was obtained at 3 days after admission for patients with long bone or pelvic fracture, spinal cord injury, immobility, and/or spinal fracture requiring surgery. Screening US was obtained at 7 days for all others and repeated weekly until discharge. Data was retrospectively collected and analyzed.

Results

Exactly 1365 patients met inclusion criteria with median ISS 12 (IQR, 9-17), median age 56 (IQR, 36-73 years), and with majority blunt injuries (90.7%). A total of 1369 screening US were performed finding 27 DVTs (2%). The total cost of screening for the year analyzed amounted to over $270,000 with 50.7 screening US needed to detect 1 DVT. This resulted in an average screening cost of over $10,000 for the detection of a single DVT.

Discussion

In trauma patients receiving early pharmacologic prophylaxis, routine LE screening US protocols to detect LE DVT are not cost effective.
Ideal types’ strategies related to handling early stages of the COVID-19 pandemic: A thematic analysis of comments from an international survey
Authors: Glasdam Stinne , Stjernswärd Sigrid
Published: April 2022

People (re)act differently when facing the pandemic. Multiple opinions about COVID-19 and related issues prevail, both in personal meetings and in (social) media. This article aims to illuminate different ideal types and handling strategies in early stages of the pandemic. A thematic Braun and Clark, and Weber inspired analysis of qualitative data from an international web-based survey was carried out in two steps. First, five ideal types related to handling the COVID-19 pandemic were constructed: the Stickler for the rules, the Challenger, the Fact hunter, the Idealist, and the Entertainer. Second, the ideal types were represented throughout four themes: Divided opinions on politico-medico restrictions, Multifaceted picture of the pandemic, Social media as a lookout point and source of insight, and The future between hope and fear. The results illustrated the complexity of people’s understanding of, (re)actions to and handling of the pandemic.
Book review: Pooja Lakhanpal, Jaydeep Mukherjee, Biswajit Nag and Divya Tuteja (Eds.), Trade, Investment and Economic Growth: Issues for India and Emerging Economies
Authors: Bhatia Shipra
Published: April 2022

Pooja Lakhanpal, Jaydeep Mukherjee, Biswajit Nag and Divya Tuteja (Eds.), Trade, Investment and Economic Growth: Issues for India and Emerging Economies, Springer Nature Singapore, 2021, €119, 396 pp. (Hardcover). ISBN: 978-981-33-6972-6.
Camp Draws You Back Into Life Again: Exploring the Impact of a Therapeutic Recreation–Based Bereavement Camp for Families Who Have Lost a Child to Serious Illness
Authors: Hanlon Peter , Kiernan Gemma , Guerin Suzanne
Published: April 2022

This qualitative study explores the perceptions of impact associated with engaging in a therapeutic recreation-based bereavement camp for families whose child has died from serious illness. Interviews were completed with 12 parents who had participated in a three-camp cycle of the program over 12-month period, including a subgroup who had also attended a reunion camp. Interviews were also conducted with program staff. Thematic analysis generated key themes relating to the perceived impact which suggest that those engaged in this program perceived positive contributions associated with participation, including perceptions of positive impact on coping with bereavement, access to support and implications for family functioning. This study highlights the areas of impact associated with engagement in a therapeutic recreation-based bereavement intervention, and the potential contribution of wider access to these programs for families whose child has died from serious illness.
Re-Conceptualizing Bereavement Care Practices: Insights Gained from Service Providers
Authors: Lee Geok Ling , Chee Wai Yee , Teo Irene , Ng Carolyn ,   The Bereavement Workgroup Members
Published: April 2022

The management and delivery of bereavement care and support services present practical challenges. A national-level, qualitative study was conducted to examine the current practices in Singapore. The study’s purpose was to inform bereavement care practices by drawing from perspectives of service providers offering death, dying and bereavement-related services. This qualitative study was undertaken using focused group discussion (FGD) with service providers from the health, social and death-related sectors. Ten FGDs were conducted with a total of 69 participants. Thematic analysis yield two themes – identifying challenging circumstances to provide bereavement care and strategies for dealing with the gaps in service delivery. The service providers’ experiential knowledge could be borrowed to strengthen the current bereavement care practices for the good of the community. The findings have informed the reconceptualization of a local bereavement care and support service model, with the public health model as the recommended underpinning conceptual framework.