bluuebunny/crossref_metadata_2025 huggingface dataset:
The Age-Specific Impact of Cellular Immunity on Long-Term Outcome after Acute Coronary Syndrome
Authors: Kazem Niema , Hofer Felix , Koller Lorenz , Hammer Andreas , Hengstenberg Christian , Niessner Alexander , Sulzgruber Patrick
Published: December 2020

Background Personalized risk stratification after acute coronary syndrome (ACS) remains a challenging field in the aging society. Easily applicable strategies for risk prediction of adverse events from an age-specific perspective are needed. Considering the association of cellular immunity with coronary vessel disease, these cell lines mirror a reasonable value for risk assessment. Therefore, we aimed to elucidate the prognostic value of cellular immunity on long-term outcome after ACS from an age-specific perspective.

Methods Patients presenting with ACS at the Vienna General Hospital admitted between December 1996 and January 2010 were enrolled within a clinical registry including standardized assessment of peripheral blood samples and immune phenotyping. Cox-regression hazards analysis was performed to elucidate the impact of cellular immunity on survival.

Results A total of 832 patients were included within the final analysis and stratified according to age into individuals <65 years (n = 416) and ≥65 years (n = 416). After a median follow-up time of 8.6 years, a total of 516 (62.0%) individuals died. We found that the fraction of lymphocytes (adjusted hazard ratio [HR] of 0.61 [95% confidence interval, CI: 0.45–0.82]; p = 0.001), the fraction of neutrophil granulocytes (adjusted HR of 5.01 [95% CI: 1.62–15.46]; p = 0.005), and the neutrophil-to-lymphocyte ratio (NLR; adjusted HR of 1.47 [95% CI: 1.16–1.87]; p = 0.002) showed a strong and independent association with mortality in individuals ≥65 years. Notably, there was no effect on outcome observed for any of the tested cell lines in patients <65 years.

Conclusion The present investigation highlighted a strong and independent age-specific effect of both the fraction of neutrophil granulocytes and lymphocytes as well as the NLR on outcome. Considering an age-dependent risk stratification, these routinely available values can be easily used to identify patients at risk for fatal events and contribute to proper secondary prevention after ACS.
Medical Student Ophthalmic Knowledge Proficiency after Completing a Clinical Elective or an Online Course
Authors: Abou-Hanna Jacob J. , Yousif Jonah E. , Kaplan Ariane D. , Musch David C. , Trobe Jonathan D.
Published: December 2020

Background As more information is being packed into medical school curricula, mainstream medical topics legitimately receive more attention than specialty topics such as ophthalmology. However, general practitioners, as gatekeepers of specialty care, must attain competency in ophthalmology. We have investigated whether an online ophthalmology course alone would be noninferior to the same online course plus an in-person clinical elective in providing ophthalmic knowledge.

Methods Students at the University of Michigan Medical School voluntarily enrolled in one of two groups: an Online Only group requiring satisfactory completion of an online course entitled “The Eyes Have It” (TEHI) or a Clinical + Online group requiring students to complete a 2-week clinical rotation and the TEHI online course. The outcome metric was the score on an independent 50-question written examination of ophthalmic knowledge. Students also completed a survey assessing confidence in managing ophthalmic problems.

Results Twenty students in the Clinical + Online group and 59 students in the Online Only group completed the study. The Clinical + Online group slightly outscored the Online Only group (86.3 vs. 83.0%, p = 0.004). When the two outlier questions were removed from the analysis, there was no difference in mean scores between the two groups (85.8 vs. 85.4, p = 0.069). Students in the Clinical + Online group devoted 80 more hours to the experience than did the students in the Online Only group. The number of hours devoted to the course and interest in ophthalmology were weakly correlated with examination performance. After completion of the experiment, there was no difference in student-reported comfort in dealing with ophthalmic problems between the two groups.

Conclusion The examination scores of the students who completed the in-person alone were only slightly inferior to those of the students who completed the in-person clinical elective and the online course. These results suggest that an online course alone may provide a satisfactory ophthalmic knowledge base in a more compact timeframe, an alternative that should have appeal to students who do not intend to pursue a career in ophthalmology.
Dexmedetomidine Infusion as a Novel Supportive Therapy for Fluphenazine-Induced Neuroleptic Malignant Syndrome in a 10-Year-Old Boy: A Case Report and Review of Literature
Authors: Yu Caroline , Kaul Rajat , Ostwani Waseem
Published: December 2020

A 10-year-old male child patient developed symptoms of neuroleptic malignant syndrome (NMS) 1 month following initiation of fluphenazine for behavioral therapeutic management. Dexmedetomidine infusion was able to adequately control the symptoms of NMS with resolution of encephalopathy. This was the first report of novel dexmedetomidine utilization for the treatment of NMS. We suggest using dexmedetomidine as an adjunctive agent to control NMS symptomatology without attendant risk of respiratory depression.
Critical Care Course of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 and Response to Immunomodulation
Authors: Richens Nicholas , Kanthimathinathan Hari Krishnan , Sontakke Sanket , Chikermane Ashish , Jyothish Deepthi , Hackett Scott , Welch Steven B. , Al-Abadi Eslam , Duncan Heather P. , Richter Alex G. , Scholefield Barnaby R.
Published: December 2020

We describe the critical care course of children with a novel hyperinflammatory syndrome associated with coronavirus disease 2019 (COVID-19) pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with focus on trajectory before and after immunomodulation. Overall, 10 patients who met the U.K. Royal College of Pediatrics and Child Health case definition during a 2-month study period were analyzed. All tested positive for SARS-CoV-2 IgG antibody. Although only 20% were ventilated, 100% required inotropic or vasopressor support. All children had significantly raised inflammatory markers with a median C-reactive protein of 248 (175–263) mg/L, ferritin of 1,561 (726–2,255) µg/L, and troponin-I of 723 (351–2,235) ng/L. Six patients had moderately impaired myocardial function and two had severe impairment. None needed extracorporeal membrane oxygenation. Despite severe illness only a brief period of critical care support of 3 to 5 days was required. Eight received at least one dose of intravenous immunoglobulin. Six received high-dose steroids. Clinical improvement including cardiovascular stability and reduction in inflammatory markers may have occurred with and without immunomodulation.
Neomarica caerulea (walking iris).
Authors: Rojas-Sandoval Julissa
Published: December 2020

Neomarica caerulea is a clumping perennial herb often cultivated as an ornamental for its attractive, light green leaves and colourful flowers. It is native to Brazil and also widely cultivated. It has escaped from cultivation and can be found naturalized along roadsides, in abandoned farms and pastures and in disturbed sites in Central America, the Caribbean and South Africa. This species propagates by seed, but also by rhizomes and plantlets. Once established it can form dense colonies that prevent the regeneration of native vegetation and displace native species reducing native plant species richness. Currently it is listed as invasive in Cuba, though its impact is unknown.
Chapter 1 how did he get it?
Authors: Trollope Anthony
Published: December 2020

‘I can never bring myself to believe it, John,’ said Mary Walker, the pretty daughter of Mr George Walker, attorney of Silverbridge. Walker and Winthrop was the name of the firm, and they were respectable people, who did all the solicitors’ business that...
Chapter 10 dinner at framley court
Authors: Trollope Anthony
Published: December 2020

Lord Lufton, as he drove home to Framley after the meeting of the magistrates at Silverbridge, discussed the matter with his brother-in-law, Mark Robarts, the clergyman. Lord Lufton was driving a dog-cart, and went along the road at the rate of twelve miles an...
Chapter 21 mr robarts on his embassy
Authors: Trollope Anthony
Published: December 2020

Mr Robarts was not altogether easy in his mind as he approached Mr Crawley’s house. He was aware that the task before him was a very difficult one, and he had not confidence in himself,—that he was exactly the man fitted for the performance...
Chapter 24 mrs dobbs broughton’s dinner-party
Authors: Trollope Anthony
Published: December 2020

Mr John Eames, of the Income-tax Office, had in these days risen so high in the world that people in the west end of town, and very respectable people too,—people living in South Kensington, in neighbourhoods not far from Belgravia, and in very handsome...
Chapter 26 the picture
Authors: Trollope Anthony
Published: December 2020

On that same afternoon Conway Dalrymple rolled up his sketch of Jael and Sisera, put it into his pocket, dressed himself with some considerable care, putting on a velvet coat which he was in the habit of wearing out of doors when he did...
Chapter 33 the plumstead foxes
Authors: Trollope Anthony
Published: December 2020

The letters had been brought into the breakfast-parlour at Plumstead Rectory one morning, and the archdeacon had inspected them all, and then thrown over to his wife her share of the spoil,—as was the custom of the house. As to most of Mrs Grantly’s...
Chapter 47 dr tempest at the palace
Authors: Trollope Anthony
Published: December 2020

Intimation had been sent from the palace to Dr Tempest of Silverbridge of the bishop’s intention that a commission should be held by him as rural dean, with other neighbouring clergymen, as assessors with him, that inquiry might be made on the part of...
Chapter 62 mr crawley’s letter to the dean
Authors: Trollope Anthony
Published: December 2020

Mr Crawley, when he got home after his walk to Silverbridge, denied that he was at all tired. ‘The man at Silverbridge whom I went to see administered refreshment to me;—nay, he administered it with salutary violence,’ he said, affecting even to laugh. ‘And...
Chapter 67 in memoriam
Authors: Trollope Anthony
Published: December 2020

The bishop when he had heard the tidings of his wife’s death walked back to his seat over the fire, and Mrs Draper, the housekeeper, came and stood over him without speaking. Thus she stood for ten minutes looking down at him and listening....
Chapter 80 miss demolines desires to become a finger-post
Authors: Trollope Anthony
Published: December 2020

John Eames had passed Mrs Thorne in the hall of her own house almost without noticing her as he took his departure from Lily Dale. She had told him as plainly as words could speak that she could not bring herself to be his...
Site-specific conjugation of native antibody
Authors: Sadiki Amissi , Vaidya Shefali R , Abdollahi Mina , Bhardwaj Gunjan , Dolan Michael E , Turna Harpreet , Arora Varnika , Sanjeev Athul , Robinson Timothy D , Koid Andrea , Amin Aashka , Zhou Zhaohui Sunny
Published: December 2020

Traditionally, non-specific chemical conjugations, such as acylation of amines on lysine or alkylation of thiols on cysteines, are widely used; however, they have several shortcomings. First, the lack of site-specificity results in heterogeneous products and irreproducible processes. Second, potential modifications near the complementarity-determining region may reduce binding affinity and specificity. Conversely, site-specific methods produce well-defined and more homogenous antibody conjugates, ensuring developability and clinical applications. Moreover, several recent side-by-side comparisons of site-specific and stochastic methods have demonstrated that site-specific approaches are more likely to achieve their desired properties and functions, such as increased plasma stability, less variability in dose-dependent studies (particularly at low concentrations), enhanced binding efficiency, as well as increased tumor uptake. Herein, we review several standard and practical site-specific bioconjugation methods for native antibodies, i.e., those without recombinant engineering. First, chemo-enzymatic techniques, namely transglutaminase (TGase)-mediated transamidation of a conserved glutamine residue and glycan remodeling of a conserved asparagine N-glycan (GlyCLICK), both in the Fc region. Second, chemical approaches such as selective reduction of disulfides (ThioBridge) and N-terminal amine modifications. Furthermore, we list site-specific antibody–drug conjugates in clinical trials along with the future perspectives of these site-specific methods.
You Name It: On the Cross-Border Regulation of Names
Authors: Shakargy Sharon
Published: December 2020

Is your name “yours”? Are you free to choose a name for yourself? Does a name withstand border crossing and even the acquisition of new citizenships? In the common law world, the unequivocal answer is yes. However, in civil law, this answer is not so clear. While the global tendency over the last few decades has been towards relaxing the norms governing names, old traditions die hard, and in some cases now re-emerge in other parts of the world. In an ever more globalized world, given widespread immigration, refugees, and people with dual (or even multiple) citizenship, the different national attitudes towards names and the lack of proper cross-border regulation of names is becoming a relevant and pressing question. This Article maps out and conceptualizes the challenge of names by demonstrating the different approaches toward names and suggesting possible cross-border regulation (i.e., choice-of-law rules) that would address this issue for the benefit of the individuals and countries involved.
All or nothing belief updating in patients with schizophrenia reduces precision and flexibility of beliefs
Authors: Nassar Matthew R , Waltz James A , Albrecht Matthew A , Gold James M , Frank Michael J
Published: December 2020

Schizophrenia is characterized by abnormal perceptions and beliefs, but the computational mechanisms through which these abnormalities emerge remain unclear. One prominent hypothesis asserts that such abnormalities result from overly precise representations of prior knowledge, which in turn lead beliefs to become insensitive to feedback. In contrast, another prominent hypothesis asserts that such abnormalities result from a tendency to interpret prediction errors as indicating meaningful change, leading to the assignment of aberrant salience to noisy or misleading information. Here we examine behaviour of patients and control subjects in a behavioural paradigm capable of adjudicating between these competing hypotheses and characterizing belief updates directly on individual trials. We show that patients are more prone to completely ignoring new information and perseverating on previous responses, but when they do update, tend to do so completely. This updating strategy limits the integration of information over time, reducing both the flexibility and precision of beliefs and provides a potential explanation for how patients could simultaneously show over-sensitivity and under-sensitivity to feedback in different paradigms.
B4GALNT1 promotes progression and metastasis in lung adenocarcinoma through JNK/c-Jun/Slug pathway
Authors: Jiang Tian , Wu Hao , Lin Miao , Yin Jun , Tan Lijie , Ruan Yuanyuan , Feng Mingxiang
Published: December 2020

Lung adenocarcinoma (LUAD) is one of the most common types of cancer and has a low survival rate. β-1,4-N-Acetyl galactosaminyltransferase 1 (B4GALNT1), which is involved in the synthesis of complex gangliosides, is highly expressed in the progression of various cancers. This study aimed to elucidate the biological functions of B4GALNT1 in LUAD progression and metastasis. We observed that B4GALNT1 overexpression showed enhanced cell migration and invasion in vitro, and promoted tumor metastasis, with reduced survival in mice. Mechanistically, B4GALNT1 regulated metastatic potential of LUAD through activating the JNK/c-Jun/Slug pathway, and with the form of its enzymatic activity. Clinical samples confirmed that B4GALNT1 expression was upregulated in LUAD, and B4GALNT1 was correlated with c-Jun/Slug expression, lymph node involvement, advanced clinical stage, and reduced overall survival. Collectively, our results suggest that B4GALNT1 promotes progression and metastasis of LUAD through activating JNK/c-Jun/Slug signaling, and with the form of its enzymatic activity.
Risk Factors for Maternal Chagas Disease and Vertical Transmission in a Bolivian Hospital
Authors: Klein Melissa D , Tinajeros Freddy , del Carmen Menduiña María , Málaga Edith , Condori Beth J , Verástegui Manuela , Urquizu Federico , Gilman Robert H , Bowman Natalie M
Published: December 2020

Background

Vertical transmission of Trypanosoma cruzi infection accounts for a growing proportion of new cases of Chagas disease. Better risk stratification is needed to predict which women are more likely to transmit the infection.

Methods

This study enrolled women and their infants at the Percy Boland Women’s Hospital in Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease by rapid test and received confirmatory serology. Infants of seropositive mothers underwent diagnostic testing with quantitative polymerase chain reaction (qPCR).

Results

Among 5828 enrolled women, 1271 (21.8%) screened positive for Chagas disease. Older maternal age, family history of Chagas disease, home conditions, lower educational level, and history of living in a rural area were significantly associated with higher adjusted odds of maternal infection. Of the 1325 infants of seropositive mothers, 65 infants (4.9%) were diagnosed with congenital Chagas disease. Protective factors against transmission included cesarean delivery (adjusted odds ratio [aOR]: .60; 95% confidence interval [CI]: .36–.99) and family history of Chagas disease (aOR: .58; 95% CI: .34–.99). Twins were significantly more likely to be congenitally infected than singleton births (OR: 3.32; 95% CI: 1.60–6.90). Among congenitally infected infants, 32.3% had low birth weight, and 30.8% required hospitalization after birth.

Conclusions

Although improved access to screening and qPCR increased the number of infants diagnosed with congenital Chagas disease, many infants remain undiagnosed. A better understanding of risk factors and improved access to highly sensitive and specific diagnostic techniques for congenital Chagas disease may help improve regional initiatives to reduce disease burden.
Spatial Keynesian policy and the decline of regional income convergence in the USA
Authors: Petach Luke
Published: December 2020

US regional development policy in the early twentieth century was characterised by a centralised, national effort to reallocate economic activity from capacity-constrained regions to those with excess capacity. In the late twentieth century, the USA gradually abandoned its policy of spatial Keynesianism in favour of a decentralised process of regional competition whereby state and local governments superseded the federal government as the loci of a policy agenda focussed on cost competitiveness. This shift was accompanied by a decline in regional income convergence in the USA. The regional competition model of development policy facilitated the decline in convergence in several ways, including: (1) the creation of coordination failures, which (A) make it difficult to implement redistributive policy within regions and (B) contribute to the existence of excess capacity in the aggregate, (2) introducing cost-related inefficiencies and (3) forgoing the opportunity to replicate previously successful spatial Keynesian policies.
Approximate String Matching with SIMD
Authors: Fiori Fernando J , Pakalén Waltteri , Tarhio Jorma
Published: December 2020

We consider the $k$ mismatches version of approximate string matching for a single pattern and multiple patterns. For these problems, we present new algorithms utilizing the single instruction multiple data (SIMD) instruction set extensions for patterns of up to 32 characters. We apply SIMD computation in three ways: in counting of mismatches, in comparison of substrings and in calculation of fingerprints. We show the competitiveness of the new algorithms by practical experiments.
Ustekinumab for Extra-intestinal Manifestations of Inflammatory Bowel Disease: A Systematic Literature Review
Authors: Guillo Lucas , D’Amico Ferdinando , Danese Silvio , Peyrin-Biroulet Laurent
Published: December 2020

Background and Aims

Extra-intestinal manifestations [EIMs] are frequent in patients with inflammatory bowel diseases [IBD] and are challenging conditions to manage. Tumour necrosis factor alpha antagonists [anti-TNFα] are recognised as the primary therapeutic option. We aimed to summarise evidence on the efficacy of ustekinumab for the treatment of EIMs.

Methods

We searched in PubMed, Cochrane Library, and Web of Science, up to October 2020, all interventional and non-interventional studies published in English and assessing ustekinumab efficacy for the treatment of EIMs.

Results

Nine studies [eight retrospective and one prospective] were included, enrolling a total of 254 patients with IBD and EIM. Ustekinumab showed its effectiveness for arthralgia and psoriatic arthritis in 152 patients through three high-quality studies. Conversely, no efficacy was found in axial spondyloarthritis. Psoriasis, pyoderma gangrenosum, and erythema nodosum were assessed in seven studies including 65 patients and showed high response rate to ustekinumab treatment. Promising results for aphthous stomatitis and uveitis were reported, but data were limited to 20 patients from two studies.

Conclusions

Ustekinumab showed to be an effective option for the treatment of EIMs, especially for dermatological and rheumatological manifestations. However, more data are needed to confirm the role of ustekinumab in this setting.
Effects of intensive urate lowering therapy with febuxostat in comparison with allopurinol on pulse wave velocity in patients with gout and increased cardiovascular risk: the FORWARD study
Authors: Desideri Giovambattista , Rajzer Marek , Gerritsen Martijn , Nurmohamed Michael T , Giannattasio Cristina , Tausche Anne-Kathrin , Borghi Claudio
Published: December 2020

Aims

Hyperuricaemia and gout are strongly related with traditional cardiovascular risk factors and vascular damage. This study aimed to assess whether febuxostat and allopurinol could differently influence carotid-femoral pulse wave velocity (cfPWV) in patients with gout and elevated serum uric acid (SUA) levels.

Methods and results

A multi-centre, multinational, phase IV, randomized, parallel-group, active-controlled, open-label trial with blind endpoints evaluation. One hundred and ninety-seven adults with gout and SUA levels ≥8 mg/dL were randomized to febuxostat or allopurinol in a 1:1 ratio for 36 weeks. The primary outcome was the comparison of the effects of febuxostat and allopurinol on changes in cfPWV. The mean cfPWV values at randomization and Week 36 were 8.69 and 9.00 m/s, respectively for subjects randomized to febuxostat and 9.02 and 9.05 m/s for subjects randomized to allopurinol. No statistically significant changes in cfPWV by treatment assignment were observed at any time point for any of the assessed parameters. More subjects who received febuxostat had serum urate concentrations ≤6 mg/dL following treatment (78.3% vs. 61.1% at Week 36, P = 0.0137). Treatment-emergent adverse events were reported by 51 (52.0%) patients randomized to febuxostat and 63 (62.5%) patients randomized to allopurinol. The majority of events were mild in both treatment groups and included gout flares and arthralgia.

Conclusion

In patients with gout and elevated SUA levels the arterial stiffness remained stable both with febuxostat and allopurinol. Febuxostat was more effective and faster than allopurinol in achieving the SUA target. Both treatments were safe and well tolerated.
Introduction: comprehensive sexuality education in ELT
Authors: Banegas Dario Luis , Evripidou Dimitris
Published: December 2020

The aim of this article is to introduce the Special Issue on comprehensive sexuality education in ELT. In this brief introduction, gender and sexuality are conceptualised in relation to language education. The main issues and implications found in the articles for this special issue are presented and discussed.
The year in cardiovascular medicine 2020: arrhythmias
Authors: Crijns Harry J G M , Prinzen Frits , Lambiase Pier D , Sanders Prashanthan , Brugada Josep
Published: December 2020

Summary of the progress in arrhythmias in 2020. RACE4 and ALL-IN indicated that integrated nurse-led care improves outcomes in AF patients.3  ,  4 The same was reported for early rhythm control therapy15 and cryoablation as initial AF treatment.25  ,  26 Subcutaneous ICD was non-inferior to classical transvenous ICD therapy in PRAETORIAN.54 One mechanistic study showed that autoantibodies against misexpressed actin, keratin, and connexin-43 proteins create a blood-borne biomarker profile enhancing diagnosis of Brugada syndrome.50 Another mechanistic study indicated that transseptal LV pacing yields similar improvement in contractility as His bundle pacing whilst being more easy to execute.44 In PRE-DETERMINE a simple-to-use ECG risk score improved risk prediction in patients with ischemic heart disease possibly enhancing appropriate ICD therapy in high risk patients.58
241 Delayed onset of ventricular fibrillation after electrical injury in a young patient with asymptomatic mitral valve prolapse
Authors: Benini Annachiara , Ferri Luisa , Marin Federico , Gambaro Alessia , Prati Daniele
Published: December 2020

Aims

The most frequent cardiovascular effects induced by electrical injury (EI) are arrhythmias, which occur mostly early after the electrical shock. A few cases of delayed malignant arrhythmias have been described, raising doubts about the helpfulness of heart monitoring after an EI.

Methods and results

A 46-year-old man experienced an out-of-hospital cardiac arrest four hours after receiving an electrical shock with an alternating voltage of 380 volts from high-pressure water jet cleaner. The out-of-hospital ECG displayed ventricular fibrillation, eight DC shocks were delivered, and return of spontaneous circulation was obtained after 15 minutes. ECG on admission showed bradycardia, HR 55 b.p.m., no clear P waves and prominent T waves in the precordial leads (Figure A). No coronary lesions were detected at the urgent PCI. An ABG on admission revealed lactic acidosis (LAC 18 mmol/L), mild hyperkalaemia (5.19 mmol/L) and mild renal dysfunction (serum creatinine 1.71 mg/dL). Toxicology screen was negative. During the hospital stay, the patient developed a voluminous hematoma and swelling on the right arm, site of the EI. In the following days, blood tests revealed an increase in serum creatinine (peak 4.99 mg/dL), creatine kinase (peak 46186 U/L), liver enzymes (AST peak 2859 U/L and ALT peak 1365 U/L), LDH (peak 2718 U/L) and troponin T (peak 2757 ng/L); these alterations were probably linked to rhabdomyolysis provoked by EI and acute kidney injury was secondary to myoglobinuria. The patient received fluid therapy and furosemide bolus injections. On echocardiography a myxomatous mitral valve with prolapse of both leaflets, mitral annular disjunction and severe mitral regurgitation were displayed (Figure B). Left ventricle was severely dilated with ejection fraction 69%. After improvement in renal function, a cardiac MRI was performed, which ruled out myocardial oedema and displayed subendocardial LGE at the base of the posteromedial papillary muscle (Figure C). The Heart Team opted for mitral valve surgery with P2 resection and mitral valve annuloplasty with 36 mm Carpentier-Edwards Physio II Ring. An ICD was not implanted because the electrical shock and the alteration in electrolytes were considered the primary reasons for cardiac arrest. The patient underwent a cycle of rehabilitation after the intervention and now he does not report any relevant symptom.

Conclusion

Our patient had bileaflet mitral valve prolapse, mitral annular disjunction and myocardial fibrosis of the papillary muscles, all of which are associated with higher risk of sudden cardiac death. This case highlights that patients with an underlying heart condition predisposing to arrhythmias should promptly seek medical care even after a mild EI for appropriate management.
606 Oral anticoagulants in fragile patients with percutaneous endoscopic gastrostomy and atrial fibrillation: the Origami study
Authors: Arcudi Alessandra , D’Amario Domenico , Galli Mattia , Canonico Francesco , Restivo Attilio , Scacciavillani Roberto , Cappannoli Luigi , Riccioni Maria Elena , Annetta Maria Giuseppina , Di Stefano Gaetano , Piccinni Carlo , Vergallo Rocco , Montone Rocco Antonio , Leone Antonio Maria , Niccoli Giampaolo , Sabatelli Mario , Antonelli Massimo , Andreotti Felicita , De Cristofaro Raimondo , Crea Filippo
Published: December 2020

Aims

Randomized trials support the safety and efficacy of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKA) in patients with nonvalvular atrial fibrillation (AF), leading to increased use of these compounds. Crushed forms of DOACs have shown to be reliable, but evidence supporting percutaneous endoscopic gastrostomy (PEG) delivery is lacking. PEG is a long-term option for enteral food and drug delivery in patients unable to maintain oral intake, bypassing the risks and disadvantages of parenteral nutrition. We investigate the safety and efficacy of Edoxaban administered via PEG in patients with atrial fibrillation and a clinical indication for a long-term anticoagulation.

Methods and results

In this prospective, single centre observational study, 12 PEG-treated patients with indication to anticoagulation will receive edoxaban via PEG and will be followed-up to 6 months. Plasma anti-Factor Xa activity and edoxaban concentrations will be assessed. Thromboembolic (ischaemic stroke, systemic embolism, venous thromboembolism) and bleeding events (Bleeding Academic Research Consortium and Thrombolysis in Myocardial Infarction) will be recorded at 1 and 6 months. A retrospective analysis of 5 AF cases undergoing PEG-implantation at our Institution, who received edoxaban via PEG, showed plasma anti-FXa levels at steady state of 146 ± 15 ng/ml, without major adverse event at a mean follow-up of 6 months.

Conclusion

We prospectively investigate PEG-administration of edoxaban in PEG-treated patients requiring long term anticoagulation. Our preliminary retrospective data support this route of DOAC administration.
76 Pre-treatment high-sensitivity troponin T for the short-term prediction of cardiac outcomes in patients on immune checkpoint inhibitors
Authors: Petricciuolo Serena , Delle Donne Maria Grazia , Aimo Alberto , Chella Antonio , Guarini Giacinta , De Caterina Raffaele
Published: December 2020

Aims

Immune checkpoint inhibitors (ICIs) are an emerging option for several advanced metastatic cancers, but have been associated with cardiotoxicity. The prognostic value of high-sensitivity troponin T (hs-TnT) measured before treatment start has never been investigated.

Methods and results

Thirty consecutive patients underwent measurement of hs-TnT before starting ICI therapy (pembrolizumab, 23%; nivolumab, 12%; atezolizumab, 6%; durvalumab, 5%). The primary endpoint was a composite of cardiovascular death, stroke or transient ischaemic attack, pulmonary embolism and new-onset heart failure. The secondary endpoint was progression of cardiac involvement according to the CARDIOTOX staging system. Patients (median age 68 years, 77% men, 13% with coronary artery disease, 90% current or former smokers, 67% overweight or obese, and 43% hypertensive) had a median hs-TnT of 12 ng/L (interquartile interval 8-23). At the 3-month timepoint, 7 patients (23%) had experienced the primary endpoint, and 13 (43%) the secondary endpoint. Area under the curve values were 0.909 for the primary, and 0.757 for the secondary endpoint. The best troponin-T cut-off was 14 ng/L for both the primary (100% sensitivity, 73% specificity) and secondary endpoint (sensitivity 75%, specificity 77%). Over a median follow-up duration of 2.6 months (2.0-3.6), survival free from the primary endpoint was shorter in patients with hs-TnT ≥14 ng/L (Log-rank: 10.3, p = 0.001), and all patients developing the primary endpoint had hs-TnT ≥14 ng/L at baseline.

Conclusion

In patients on ICIs, baseline hs-TnT predicts a composite cardiovascular endpoint and the progression of cardiac involvement at 3 months, with 14 ng/L as the best cut-off.
275  Role of right ventricle in acute heart failure with preserved ejection fraction: a comparison between hypertensive pulmonary edema and decompensated heart failure
Authors: Abete Raffaele , Iacovoni Attilio , Vecchi Andrea Lorenzo , Palmieri Vittorio , De Ponti Roberto , Mortara Andrea , Senni Michele
Published: December 2020

Aims

Limited data are available on the pathophysiological role of the right ventricle (RV) in patients with acute heart failure with preserved ejection fraction (AHF-PEF) and its impact on the main clinical manifestation such as pulmonary oedema or peripheral congestion. Mainly through right-to-left stroke volume mismatch and ventricular-arterial decoupling, right chambers size and function may play a key role leading to fluid overload or maldistributed phenotypes.

Methods and results

In this monocenter, prospective, observational study 80 consecutive patients with AHF-PEF were enrolled. A complete echocardiographic examination was performed within 6 hours from emergency department admission; multiparametric RV function was carefully evaluated in the very acute phase. Focusing on hypertensive pulmonary oedema (H-AHF) and decompensated AHF without pulmonary oedema (D-AHF) phenotypes, the study aims to analyze the echocardiographic peculiarities of these clinical entities in the early phase of admission and its modification at discharge (D-AHF n = 58, H-AHF n = 22). Baseline clinical characteristics were comparable in both groups, except for coronary artery disease more prevalent in H-AHF and atrial fibrillation more prevalent in D-AHF. D-AHF patients showed dilated and dysfunctional right chambers compared to H-AHF. Regarding systolic function, normal values of fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) were registered in H-AHF at admission and at discharge. D-AHF showed greater systolic pulmonary artery pressure (sPAP) and lower TAPSE/sPAP ratio. Left ventricular dimensions and function were comparable in both groups. Conversely, E/e’ ratio was significantly higher in H-AHF at admission. Data are summarized in the tables and figures below.

Conclusion

D-AHF and H-AHF represent different phenotypes of AHF-PEF. Right heart structure and function and ventricular-arterial coupling could play a crucial role in their pathophysiology. Non dilated RV with preserved systolic function seems to be crucial to develop pulmonary oedema without signs of peripheral congestion. Further investigations are needed to corroborate the hypothesis of interventricular stroke volume mismatch in the complex AHF-PEF clinical scenario.
386 Achieving Ldl Cholesterol Target In A Real-World Secondary Prevention Cohort: When Two Is Better Than One
Authors: Casula Matteo , Taietti Ivan , Zeqaj Iris , Fortuni Federico , Cornara Stefano , Somaschini Alberto , Leonardi Sergio , Ferlini Marco , Camporotondo Rita , Totaro Rossana , Gnecchi Massimiliano
Published: December 2020

Aims

Lipid management plays a key role in secondary prevention after acute coronary syndrome. Current European Society of Cardiology guidelines recommend a dual goal: to achieve LDL cholesterol (LDL-C) <55 mg/dL, and to reduce it ≥ 50% form baseline. Currently, data on the reduction of cardiovascular events in patients achieving both goals in a real-world population are missing. Accordingly, the objective of this study was to determine the prognosis in post myocardial infarction (PMI) patients and determine the risk of new events according to the achievement of the optimal goals indicated by the guidelines in terms of LDL-C reduction.

Methods and results

We conducted a retrospective analysis of a monocentric observational registry prospectively enrolling patients admitted to our hospital for ST segment elevation myocardial infarction (STEMI) and followed-up in our dedicated PMI ambulatory. The analysis considered the patients enrolled between 2013 and 2017. Demographical and clinical data were extracted from a dedicated digital database, and the clinical events occurred during follow-up were obtained by telephone interviews or clinical records. We considered a combined endpoint of major adverse cardiovascular events (MACE) of all-cause death, non-fatal MI, non-fatal stroke and unplanned revascularization. LDL-C was collected at baseline and at 1, 6 and 12 months after the event. The lower value collected at follow-up was used to define the achievement of the target goals. We conducted a Kaplan-Meier analysis and log-rank test comparing patients who achieved LDL-C < 55 mg/dL and ≤50% from baseline (group A) vs those with only LDL-C < 55 mg/dL (group B). Continue variable are presented as median (interquartile range). A total of 814 patients (23% female) were included in our analysis. Median age was 63 (55–72) years, 57% had hypertension, 19% diabetes, 36% were smoker and 17% obese. Baseline LDL-C was 124 (97–146) mg/dL, the median LDL-C at follow-up was 63 (52–78) mg/dL, significantly reduced from baseline (P < 0.0001). Between 6 and 12 months 83.3% of patients were treated with statin therapy alone (73% high intensity), 15.3% with the addition of ezetimibe, and 0.5% with ezetimibe alone. LDL-C < 55 mg/dl was achieved in 244 patients (30%), while 175 patients (21%) obtained also LDL-C ≤ 50% from baseline. Median follow-up was 52 (34–66) months. The net incidence of MACE was 12% in group A vs 27.5% in group B (HR 0.35; 95% CI 0.17–0.70; P log-rank = 0.0032; Number Needed to Treat = 6; see Figure).

Conclusion

Our data from a real-world cohort of PMI patients emphasize the importance of achieving both the guideline-recommended secondary prevention goals of LDL-C < 55 mg/dl and ≤50% from baseline in order to reduce MACE.
Disarray at the headquarters: Economists and Central bankers tested by the subprime and the COVID recessions
Authors: Louçã Francisco , Abreu Alexandre , Costa Gonçalo Pessa
Published: December 2020

The article explores the discussions among economic modelers and central banks research staff and decision makers, namely on the adequacy of unconventional monetary policy and fiscal expansionary measures after the subprime crisis and as the COVID recession is developing. First, the article investigates the arguments, models and policy proposals of several mainstream schools of economics that challenged the traditional Chicagoan orthodoxy based on Milton Friedman’s views, and developed the Lucas Critique, the New Classical synthesis and Real Business Cycle approach that replaced monetarism as the main rivals to old-time Keynesianism. Second, the transformation of Real Business Cycle models into Dynamic Stochastic General Equilibrium (DSGE) models is mapped, as it extended the ideas of the iniquity of government intervention and unified academic and central bank research. Yet, a battery of criticism was levied against the DSGE models and, as the debate emerged over quantitative easing and other tools of unconventional monetary policy, the need for policy pragmatism shattered the previous consensus. The article then proceeds to discuss how the leading mainstream academic economists reacted to changes in central banks‘ practices, noticing a visible dissonance within Chicago-school and DSGE economists, as well as major contortions of central bankers in order to justify their new postures. The article concludes with a call for an extensive menu of fiscal, industrial and innovation policies in order to respond to recessions and structural crises.
Recurrence of mesothelioma after a macroscopic complete resection procedure: is a second radical surgery justified?
Authors: Elsayed Hany Hasan , Hassaballa Aly Sherif , Ahmed Taha Aly , Sharkawy Hazem Youssef
Published: December 2020

A best evidence topic was written according to a structured protocol. The question addressed was: In patients with mesothelioma who develop a local recurrence after macroscopic complete resection (MCR) surgery, does performing a second radical surgery lead to improvement in survival? A total of 2076 papers were identified using the reported search, of which 3 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. The 2 largest studies included 16 patients each who underwent a second surgery for radical resection of recurrence after MCR for mesothelioma. One study (with 16 chest wall resections) had no in-hospital mortality, whereas the other study showed 2/16 (12.5%) patients dying in the hospital, both of whom had a contralateral pleurectomy. One study correlated the median survival after the second surgery with the time to recurrence and epithelioid pathology. The other study showed better post-recurrence survival after a second surgery, with patients having a significantly longer median post-recurrence survival (16 months) compared with those who received other types of second-line therapy (9 months) and those who received no therapy at all (2 months) (P < 0.0005), although selection bias is a possibility. The last study included 8 patients who underwent a second surgery for radical intent after MCR for mesothelioma. The median time to recurrence was 29 months and the survival after second surgery was 14.5 months with no correlation to disease-free interval (expected due to the small number of patients). In patients presenting with recurrence of mesothelioma after an MCR procedure, radical surgery to resect the recurrent tumour could have a role in improvement of survival in selected patients. Positive prognostic factors include epithelioid pathology and a longer disease-free interval after the first procedure.
Three-Dimensional Mirror Symmetry and Elliptic Stable Envelopes
Authors: Rimányi Richárd , Smirnov Andrey , Zhou Zijun , Varchenko Alexander
Published: December 2020

We consider a pair of quiver varieties $(X;X^{\prime})$ related by 3D mirror symmetry, where $X =T^*{Gr}(k,n)$ is the cotangent bundle of the Grassmannian of $k$-planes of $n$-dimensional space. We give formulas for the elliptic stable envelopes on both sides. We show an existence of an equivariant elliptic cohomology class on $X \times X^{\prime} $ (the mother function) whose restrictions to $X$ and $X^{\prime} $ are the elliptic stable envelopes of those varieties. This implies that the restriction matrices of the elliptic stable envelopes for $X$ and $X^{\prime}$ are equal after transposition and identification of the equivariant parameters on one side with the Kähler parameters on the dual side.
Stigma and Whistleblowing: Should Punitive Damages be Available in Retaliation Cases?
Authors: Lewis David
Published: December 2020

This article uses a range of disciplinary perspectives to examine what is meant by stigma and explains that it is a relational concept. It argues that there has been a shift from attributing social stigma to whistleblowing, to regarding whistleblowing as a form of prosocial behaviour, that is, something which contributes to the well-being of others. This shift is evidenced by the attempts to establish supportive organisational cultures through the introduction of specialist employer policies and procedures, the existence of protective legislation and the coverage of whistleblowing in the media. Although it is questioned why stigma should still attach to whistleblowing, it is acknowledged that those who suffer reprisals may well seek stigma damages. Thus the article traces the common law and statutory origins of stigma awards and discusses the appropriateness of exemplary/punitive damages in the employment field. In the conclusion, it is advocated that Parliament expressly provide for exemplary/punitive damages to be awarded in employment cases. In addition, practical suggestions are made about how a more positive attitude to whistleblowing can be achieved, including a possible role for criminal sanctions. The author asserts that a more punitive approach is justified because whistleblowing is an important aspect of the human right to freedom of expression which must be fully protected in order to ensure the proper functioning of a democratic society.
Human Rights: What Does the Future Hold?
Authors: Braaten Daniel
Published: December 2020

There is no shortage of bad human rights news around the world. Human rights are threatened in dictatorships to consolidated democracies. The rise of nationalist demagoguery within countries and the rise of China as a potential hegemon in the international system pose significant challenges for the realization of universal human rights. Concurrently, a new strain of human rights scholarship has emerged to challenge the progress made in human rights protection over the years and the moral foundation of that progress. The future of human rights at this moment in history is precarious, but three new books provide good speculation for what the future may hold. Human Rights Futures edited by Stephen Hopgood, Jack Snyder, and Leslie Vinjamuri; In Defense of Universal Human Rights by Rhoda Howard-Hassmann; and The Future of Human Rights by Allison Brysk are all reviewed in this essay. The three books revive longstanding debates in human rights scholarship but also point the way for different futures of human rights, some positive and some negative. Ultimately, for the human rights movement to sustain itself and build on its successes for the future, it will need to confront the challenges posed by the nationalist demagogues and the Chinese Communist Party. The human rights movement needs a “second wind,” which it can get if it reaffirms and reemphasizes its support for social and economic rights along with liberal democracy and international law.
Clinical and Analytical Verification of an Automated Fecal Calprotectin Immunoassay with Extraction Device
Authors: Wyness Sara P , Lin Leo , Jensen Ryan , Bird Joseph , Norgyal Tenzin , Jensen Gabrielle , Johnson Lisa M
Published: December 2020

Background

Fecal calprotectin (FC) is a screening test for intestinal inflammation, and often used by clinicians to help identify and monitor patients with inflammatory bowel disease (IBD). Improvements in FC assays include moving to more automated immunoassays compared to ELISAs and simple-to-use extraction devices compared to manual weighing for the extraction process.

Methods

A method comparison was performed between the PhiCal ELISA and LIAISON immunoassay for 53 stool samples, and the screening results were compared to the gold standard endoscopy with biopsy results. Clinical accuracy was assessed by comparing the FC results from each assay to the presence or absence of inflammation determined from the biopsy report. The performance of the extraction device was compared to manually weighing. Additional studies were completed to verify the manufacturer’s claims.

Results

The FC results were compared to the biopsy results for detecting inflammation. PhiCal ELISA had a sensitivity of 86% and specificity of 100%, while the LIAISON immunoassay had a sensitivity of 97% with specificity of 94%. Therefore, the LIAISON immunoassay performed better than the PhiCal ELISA. The extraction device performed well compared to manual weighing if stool samples were <800 μg/g, within Bristol stool types 2-6, and did not contain a significant amount of undigested material, fibrous material, or mucus.

Conclusion

The LIAISON immunoassay with extraction device has acceptable performance for clinical use in measuring fecal calprotectin.