bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute transient psychotic disorder precipitated by Brexit vote
Authors: Katshu Mohammad Zia Ul Haq
Published: October 2019

A man in his 40s was brought to the accident and emergency department in an acute psychotic state, 3 weeks after the European Union referendum results in the UK were declared. His mental health had deteriorated rapidly following the announcement of the results, with significant concerns about Brexit. He presented as agitated, confused and thought disordered. He had auditory hallucinations, and paranoid, referential, misidentification and bizarre delusions. He recovered completely within 2 weeks after a brief admission and treatment with olanzapine. He had experienced a similar episode of much less severity 13 years previously after major work related stress which resolved completely within a few days. He was experiencing stress related to work and family prior to the current episode which could potentially have been a contributory factor. Political events can act as major psychological stressors and have a significant impact on the mental health of people, especially those with a predisposition to develop mental illness.
Pharmacovigilance assessment of the association between Fournier’s gangrene and other severe genital adverse events with SGLT-2 inhibitors
Authors: Fadini Gian Paolo , Sarangdhar Mayur , De Ponti Fabrizio , Avogaro Angelo , Raschi Emanuel
Published: October 2019

Objective

Sodium glucose cotransporter-2 inhibitors (SGLT2i) exert cardiorenal protection in people with diabetes. By inducing glycosuria, SGLT2i predispose to genital infections. In addition, rare occurrence of Fournier’s gangrene (FG) has been reported. We aimed to investigate such association through the U.S. Food and Drug Administration (FDA) adverse event (AE) reporting system (FAERS).

Research design and methods

We mined the FAERS up to 2018q3 (before FDA warning about SGLT2i-associated FG) to retrieve reports including FG as an AE and SGLT2i as suspect or concomitant drugs, and calculated proportional reporting ratios (PRR).

Results

We retrieved 47 cases of FG and 17 cases of other severe AEs of the genital area associated with SGLT2i. Patients with FG were ~10 years older than those with other severe genital AEs. Overall, 77% occurred in men. Three patients were concomitantly treated with systemic immunosuppressive drugs. Increased reporting frequency emerged for SGLT2i compared with other drugs, with a PRR ranging from 5 to 10. The disproportional reporting of FG with SGLT2i remained robust and consistently significant when restricting to the period when SGLT2i were available, to reports filed for glucose-lowering medications or for drugs with the diabetes indication, and after refining the definition of FG. FG was disproportionally associated with psoriasis and with the combination of immunosuppressants and SGLT2i.

Conclusions

Although causality cannot be demonstrated, SGLT2i may predispose to FG and other severe genital AEs. Since the use of SGLT2i is expected to increase significantly, clinicians should be aware of these severe, although rare, AEs and their predisposing factors.
Systematic identification and referral of smokers attending HIV ambulatory care highlights the failure of current service provision in an at-risk population
Authors: Brown James , Kyriacou Christianna , Pickett Elisha , Edwards Kelly , Joshi Hemal , Stewart Nafeesah , Melville Andrew , Johnson Margaret , Flint Jan , Bartley Angela , Rodger Alison , Lipman Marc
Published: October 2019

Introduction

People living with HIV (PLWH) are more likely to smoke than the general population and are at greater risk of smoking-related illness. Healthcare services need to address this burden of preventable disease.

Methods

We evaluated the impact of a brief intervention that asked service users about smoking when they attended for ambulatory HIV care in London, UK, and offered referral to smoking cessation.

Results

Overall, 1548 HIV-positive individuals were asked about their smoking status over a 12-month period. Of this group, 385 (25%) reported that they were current smokers, 372 (97%) were offered referral to smoking cessation services and 154 (40%) accepted this. We established an outcome of referral for 114 (74%) individuals. A total of 36 (10% of smokers) attended stop smoking clinics and 16 (4%) individuals were recorded as having quit smoking.

Discussion

The simple intervention of asking PLWH about tobacco smoking and offering referral to smoking cessation services rapidly identified current smokers, 40% of whom accepted referral to smoking cessation services. This highlights the importance of promoting behaviour and lifestyle changes with every contact with health services. However, a large proportion of those referred were either not seen in local services or the outcome of referral could not be ascertained. If the risk of smoking-related morbidity among PLWH is to be reduced, more sustainable referral pathways and ways of improving uptake of smoking cessation services must be developed.
Role of the lymphatic vasculature in cardiovascular medicine
Authors: Telinius Niklas , Hjortdal Vibeke Elisabeth
Published: October 2019

The lymphatic vasculature has traditionally been considered important for removal of excessive fluid from the interstitial space, absorption of fat from the intestine and the immune system. Advances in molecular medicine and imaging have provided us with new tools to study the lymphatics. This has revealed that the vessels are actively involved in regulation of immune cell trafficking and inflammation. We now know much about how new lymphatic vessels are created (lymphangiogenesis) and that this is important in, for example, wound healing and tissue repair. The best characterised pathway for lymphangiogenesis is the vascular endothelial growth factor C (VEGF-C)/VEGFR3 pathway. Over recent years, there has been an increasing interest in the role of the lymphatics in cardiovascular medicine. Preclinical studies have shown that lymphangiogenesis and immune cell trafficking play a role in cardiovascular conditions such as atherosclerosis, recovery after myocardial infarction and rejection of cardiac allografts. Targeting the VEGF-C/VEGFR3 pathway can be beneficial in these conditions. The clinical spectrum of lymphatic abnormalities and lymphoedema is wide and overlaps with congenital heart disease. Important long-term complications to the Fontan circulation involves the lymphatics. New and improved imaging modalities has improved our understanding and management of these patients. Lymphatic leaks and flow abnormalities can be successfully treated, minimally invasively, with percutaneous embolisation. Future research will prove if the preclinical findings that point to a role of the lymphatics in several cardiovascular conditions will result in new treatment options.
Balloon-expandable transfemoral transcatheter aortic valve implantation with or without predilation: findings from the prospective EASE-IT TF multicentre registry
Authors: Schymik Gerhard , Rudolph Tanja , Jacobshagen Claudius , Rothe Jürgen , Treede Hendrik , Kerber Sebastian , Frank Derk , Sykorova Lenka , Okamoto Maki , Thoenes Martin , Deutsch Cornelia , Bramlage Peter , Butter Christian
Published: October 2019

Background

Predilation of the native valve has long been deemed necessary in transfemoral transcatheter aortic valve implantation (TF-TAVI), despite little trial evidence to support its clinical use. As most evidence is derived from retrospective analyses of observational studies, we conducted a two-armed, prospective multicentre registry.

Methods

Patients undergoing TF-TAVI with the Edwards SAPIEN 3 valve, with or without balloon aortic valvuloplasty (BAV), were included and their procedural characteristics, short-term safety and short-term efficacy outcomes compared. We hypothesised that BAV may be safely omitted in many patients and omission could be associated with procedural benefits.

Results

Overall, 196 consecutive patients underwent TF-TAVI, 56 with BAV and 140 without. The mean age was 81.2±6.2 years, and the mean logistic EuroSCORE I was 17.1±13.6. Device success according to Valve Academic Research Consortium-2 (VARC-2) was achieved in 96.4%. The median procedural duration was shorter without BAV (56 min vs 90 min; p=0.001), as was fluoroscopy time (10 min vs 13 min; p=0.001). The need for balloon postdilation was less frequent in patients without BAV (15.7% vs 30.4%, p=0.029). There was no difference in the proportion of patients meeting the VARC-2 defined composite safety endpoint at 30 days (9.3% without vs 8.9% with BAV; adjusted OR (adjOR) 2.55; 95% CI 0.56 to 18.84) and at 6 months (15.2% without vs 16.4% with BAV; adjOR 1.66; 95% CI 0.49 to 6.55).

Conclusions

In the majority of patients, BAV can be safely omitted from the TAVI procedure without adverse effects. The omission of BAV is associated with shorter procedural duration and could be advantageous for the majority of patients.

Trial registration number

NCT02760771.
On the effect of resonances in the quark-photon vertex
Authors: Miramontes Ángel S. , Sanchis-Alepuz Hèlios
Published: October 2019

A calculation of hadronic timelike form factors in the Poincaré-covariant Bethe-Salpeter formalism necessitates knowing the analytic structure of the non-perturbative quark-photon vertex in the context of the Poincaré-covariant Bethe-Salpeter formalism. We include, in the interaction between quark and antiquark, the possibility of non-valence effects by introducing pions as explicit degrees of freedom. These encode the presence of intermediate resonances in the Bethe-Salpeter interaction kernel. We calculate the vertex for real as well as complex photon momentum. We show how the vertex reflects now the correct physical picture, with the rho resonance appearing as a pole in the complex momentum plane. A multiparticle branch cut for values of the photon momentum from $ -4m_{\pi}^{2}$-4mπ2 to $ -\infty$-∞ develops. This calculation represents an essential step towards the calculation of timelike form factors in the Bethe-Salpeter approach.
Contraction of cold neutron star due to in the presence a quark core
Authors: Eslam Panah B. , Yazdizadeh T. , Bordbar G. H.
Published: October 2019

Motivated by importance of the existence of quark matter on structure of neutron star. For this purpose, we use a suitable equation of state (EoS) which include three different parts: (i) a layer of hadronic matter, (ii) a mixed phase of quarks and hadrons, and, (iii) a strange quark matter in the core. For this system, in order to do more investigation of the EoS, we evaluate energy, Le Chatelier’s principle and stability conditions. Our results show that the EoS satisfies these conditions. Considering this EoS, we study the effect of quark matter on the structure of neutron stars such as maximum mass and the corresponding radius, average density, compactness, Kretschmann scalar, Schwarzschild radius, gravitational redshift and dynamical stability. Also, considering the mentioned EoS in this paper, we find that the maximum mass of hybrid stars is a little smaller than that of the corresponding pure neutron star. Indeed the maximum mass of hybrid stars can be quite close to the pure neutron stars. Our calculations about the dynamical stability show that these stars are stable against the radial adiabatic infinitesimal perturbations. In addition, our analyze indicates that neutron stars are under a contraction due to the existence of quark core.
An introduction to a supersymmetric graph algebra
Authors: Radler Katherine , Srivastava Ashish K.
Published: October 2019

In this paper, we propose a graph superalgebra which is the supersymmetric analogue of Leavitt path algebras. We find a basis for these superalgebras and characterize when they have polynomial growth.
Increasing the complexity of oxoporphyrinogen colorimetric sensing chromophores: N-alkylation and β-substitution
Authors: Chahal Mandeep K. , Velychkivska Nadiia , Webre Whitney A. , Labuta Jan , Ishihara Shinsuke , Ariga Katsuhiko , D’Souza Francis , Hill Jonathan P.
Published: October 2019

Meso-5,10,15,20-tetrakis-3,5-di-tert-butyl-4-oxocyclohexadienylideneporphyrinogen, OxP, is a versatile, highly colored chromophore derived from meso-5,10,15,20-tetrakis(3,5-di-tert-butyl-4-hydroxyphenyl)porphyrin. It exhibits a wide range of chromogenic responses to solvents (solvatochromism), anions and acidic media (halochromism) making it potentially useful as an analytical reagent. The chromogenic responses of OxP can be modulated by varying its chemical structure, and this is reviewed here based on the introduction of substituents at central nitrogen atoms or pyrrolic [Formula: see text]-positions. OxP and its N-alkylated derivates Bn2OxP and Bn4OxP have been used to estimate acidity in non-polar solvents. Bn2OxP can also be used to determine enantiomeric excesses of chiral substances. N-alkylation has also been used to introduce higher functional groups such as porphyrins to prepare self-assembling systems. [Formula: see text]-Substitution has been used to introduce selectivity of anion interactions including towards basic anions (fluoride, cyanide) and polyoxoanions (nitrate, perchlorate, etc.). These aspects make OxP a highly adaptable tetrapyrrole molecule for sensing and other applications.
Climate-dependent malaria disease transmission model and its analysis
Authors: Gashaw Kassahun Workalemahu , Kassa Semu Mitiku , Ouifki Rachid
Published: October 2019

Malaria infection continues to be a major problem in many parts of the world including Africa. Environmental variables are known to significantly affect the population dynamics and abundance of insects, major catalysts of vector-borne diseases, but the exact extent and consequences of this sensitivity are not yet well established. To assess the impact of the variability in temperature and rainfall on the transmission dynamics of malaria in a population, we propose a model consisting of a system of non-autonomous deterministic equations that incorporate the effect of both temperature and rainfall to the dispersion and mortality rate of adult mosquitoes. The model has been validated using epidemiological data collected from the western region of Ethiopia by considering the trends for the cases of malaria and the climate variation in the region. Further, a mathematical analysis is performed to assess the impact of temperature and rainfall change on the transmission dynamics of the model. The periodic variation of seasonal variables as well as the non-periodic variation due to the long-term climate variation have been incorporated and analyzed. In both periodic and non-periodic cases, it has been shown that the disease-free solution of the model is globally asymptotically stable when the basic reproduction ratio is less than unity in the periodic system and when the threshold function is less than unity in the non-periodic system. The disease is uniformly persistent when the basic reproduction ratio is greater than unity in the periodic system and when the threshold function is greater than unity in the non-periodic system.
Super-resolution microscopy based on parallel detection
Authors: Zhang Zhimin , Liu Shaocong , Xu Liang , Han Yubing , Kuang Cuifang , Liu Yong , Hao Xiang , Yang Hongqin , Liu Xu
Published: October 2019

Image scanning microscopy based on pixel reassignment can improve the confocal resolution limit without losing the image signal-to-noise ratio (SNR) greatly [C. J. R. Sheppard, “Super-resolution in confocal imaging,” Optik 80(2) 53–54 (1988). C. B. Müller, E. Jörg, “Image scanning microscopy, “Phys. Rev. Lett. 104(19) 198101 (2010). C. J. R. Sheppard, S. B. Mehta, R. Heintzmann, “Superresolution by image scanning microscopy using pixel reassignment,” Opt. Lett. 38(15) 2889–2892 (2013)]. Here, we use a tailor-made optical fiber and 19 avalanche photodiodes (APDs) as parallel detectors to upgrade our existing confocal microscopy, termed as parallel-detection super-resolution (PDSR) microscopy. In order to obtain the correct shift value, we use the normalized 2D cross correlation to calculate the shifting value of each image. We characterized our system performance by imaging fluorescence beads and applied this system to observing the 3D structure of biological specimen.
The Economic Value of Biodiversity
Authors: Hanley Nick , Perrings Charles
Published: October 2019

Biodiversity is declining worldwide, and the costs of biodiversity losses are increasingly being recognized by economists. In this article, we first review the multiple meanings of biodiversity, moving from species richness and simple abundance-weighted species counts to more complex measures that take account of taxonomic distance and functionality. We then explain the ways in which protecting biodiversity generates economic benefits in terms of direct and indirect values. Empirical approaches to estimating direct and indirect values are presented, along with a selection of recent evidence on how substantial these values are. The use of asset accounting approaches to track biodiversity values over time is discussed, in the context of sustainable development paths. Finally, we review some important challenges in valuing biodiversity that remain to be solved.
Salt restriction lowers blood pressure at rest and during exercise without altering peripheral hemodynamics in hypertensive individuals
Authors: Ratchford Stephen M. , Broxterman Ryan M. , La Salle D. Taylor , Kwon Oh Sung , Park Song-Young , Hopkins Paul N. , Richardson Russell S. , Trinity Joel D.
Published: October 2019

Dietary salt restriction is a well-established approach to lower blood pressure and reduce cardiovascular disease risk in hypertensive individuals. However, little is currently known regarding the effects of salt restriction on central and peripheral hemodynamic responses to exercise in those with hypertension. Therefore, this study sought to determine the impact of salt restriction on the central and peripheral hemodynamic responses to static-intermittent handgrip (HG) and dynamic single-leg knee extension (KE) exercise in individuals with hypertension. Twenty-two subjects (14 men and 8 women, 51 ± 10 yr, 173 ± 11 cm, 99 ± 23 kg) forewent their antihypertensive medication use for at least 2 wk before embarking on a 5-day liberal salt (LS: 200 mmol/day) diet followed by a 5-day restricted salt (RS: 10 mmol/day) diet. Subjects were studied at rest and during static intermittent HG exercise at 15, 30, and 45% of maximal voluntary contraction and KE exercise at 40, 60, and 80% of maximum KE work rate. Salt restriction lowered resting systolic blood pressure (supine: −12 ± 12 mmHg, seated: −17 ± 12 mmHg) and diastolic blood pressure (supine: −3 ± 9 mmHg, seated: −5 ± 7 mmHg, P < 0.05). Despite an ~8 mmHg lower mean arterial blood pressure during both HG and KE exercise following salt restriction, neither central nor peripheral hemodynamics were altered. Therefore, salt restriction can lower blood pressure during exercise in subjects with hypertension, reducing the risk of cardiovascular events, without impacting central and peripheral hemodynamics during either arm or leg exercise.

NEW & NOTEWORTHY This is the first study to examine the potential blood pressure-lowering benefit of a salt-restrictive diet in individuals with hypertension without any deleterious effects of exercising blood flow. While mean arterial pressure decreased by ~8 mmHg following salt restriction, these findings provide evidence for salt restriction to provide protective effects of reducing blood pressure without inhibiting central or peripheral hemodynamics required to sustain arm or leg exercise in subjects with hypertension.
SUMO2 regulates vascular endothelial function and oxidative stress in mice
Authors: Kim Young-Rae , Jacobs Julia S. , Li Qiuxia , Gaddam Ravinder Reddy , Vikram Ajit , Liu Jing , Kassan Modar , Irani Kaikobad , Kumar Santosh
Published: October 2019

SUMOylation is a posttranslational modification of lysine residues. Modification of proteins by small ubiquitin-like modifiers (SUMO)1, -2, and -3 can achieve varied, and often unique, physiological and pathological effects. We looked for SUMO2-specific effects on vascular endothelial function. SUMO2 expression was upregulated in the aortic endothelium of hypercholesterolemic low-density lipoprotein receptor-deficient mice and was responsible for impairment of endothelium-dependent vasorelaxation in these mice. Moreover, overexpression of SUMO2 in aortas ex vivo, in cultured endothelial cells, and transgenically in the endothelium of mice increased vascular oxidative stress and impaired endothelium-dependent vasorelaxation. Conversely, inhibition of SUMO2 impaired physiological endothelium-dependent vasorelaxation in normocholesterolemic mice. These findings indicate that while endogenous SUMO2 is important in maintenance of normal endothelium-dependent vascular function, its upregulation impairs vascular homeostasis and contributes to hypercholesterolemia-induced endothelial dysfunction.

NEW & NOTEWORTHY Sumoylation is known to impair vascular function; however, the role of specific SUMOs in the regulation of vascular function is not known. Using multiple complementary approaches, we show that hyper-SUMO2ylation impairs vascular endothelial function and increases vascular oxidative stress, whereas endogenous SUMO2 is essential for maintenance of normal physiological function of the vascular endothelium.
Aneurysm-type plexiform lesions form in supernumerary arteries in pulmonary arterial hypertension: potential therapeutic implications
Authors: Oshima Kaori , Crockett Edward S. , Joshi Sachindra R. , McLendon Jared M. , Matsumoto Yuri , McMurtry Ivan F. , Abe Kohtaro , Oka Masahiko
Published: October 2019

Histological observations in human pulmonary arterial hypertension (PAH) suggest a link between plexiform lesions and pulmonary supernumerary arteries. Pulmonary microvascular endothelial cells are characterized as hyperproliferative and progenitor-like. This study investigates the hypothesis that aneurysm-type plexiform lesions form in pulmonary supernumerary arteries because of their anatomical properties and endothelial characteristics similar to pulmonary microvascular endothelial cells. To induce PAH, rats were injected with Sugen5416, and exposed to hypoxia (10% O2) for 3 days (early stage) or 3 wk (mid-stage), or 3 wk of hypoxia with an additional 10 wk of normoxia (late-stage PAH). We examined morphology of pulmonary vasculature and vascular remodeling in lung serial sections from PAH and normal rats. Aneurysm-type plexiform lesions formed in small side branches of pulmonary arteries with morphological characteristics similar to supernumerary arteries. Over the course of PAH development, the number of Ki67-positive cells increased in small pulmonary arteries, including supernumerary arteries, whereas the number stayed consistently low in large pulmonary arteries. The increase in Ki67-positive cells was delayed in supernumerary arteries compared with small pulmonary arteries. In late-stage PAH, ~90% of small unconventional side branches that were likely to be supernumerary arteries were nearly closed. These results support our hypothesis that supernumerary arteries are the predominant site for aneurysm-type plexiform lesions in Sugen5416/hypoxia/normoxia-exposed PAH rats partly because of the combination of their unique anatomical properties and the hyperproliferative potential of endothelial cells. We propose that the delayed and extensive occlusive lesion formation in supernumerary arteries could be a preventive therapeutic target in patients with PAH.
Transspinal stimulation decreases corticospinal excitability and alters the function of spinal locomotor networks
Authors: Pulverenti Timothy S. , Islam Md. Anamul , Alsalman Ola , Murray Lynda M. , Harel Noam Y. , Knikou Maria
Published: October 2019

Locomotion requires the continuous integration of descending motor commands and sensory inputs from the legs by spinal central pattern generator circuits. Modulation of spinal neural circuits by transspinal stimulation is well documented, but how transspinal stimulation affects corticospinal excitability during walking in humans remains elusive. We measured the motor evoked potentials (MEPs) at multiple phases of the step cycle conditioned with transspinal stimulation delivered at sub- and suprathreshold intensities of the spinally mediated transspinal evoked potential (TEP). Transspinal stimulation was delivered before or after transcranial magnetic stimulation during which summation between MEP and TEP responses in the surface EMG was absent or present. Relationships between MEP amplitude and background EMG activity, silent period duration, and phase-dependent EMG amplitude modulation during and after stimulation were also determined. Ankle flexor and extensor MEPs were depressed by suprathreshold transspinal stimulation when descending volleys were timed to interact with transspinal stimulation-induced motoneuron depolarization at the spinal cord. MEP depression coincided with decreased MEP gain, unaltered MEP threshold, and unaltered silent period duration. Locomotor EMG activity of bilateral knee and ankle muscles was significantly depressed during the step at which transspinal stimulation was delivered but fully recovered at the subsequent step. The results support a model in which MEP depression by transspinal stimulation occurs via subcortical or spinal mechanisms. Transspinal stimulation disrupts the locomotor output of flexor and extensor motoneurons initially, but the intact nervous system has the ability to rapidly overcome this pronounced locomotor adaptation. In conclusion, transspinal stimulation directly affects spinal locomotor centers in healthy humans.

NEW & NOTEWORTHY Lumbar transspinal stimulation decreases ankle flexor and extensor motor evoked potentials (MEPs) during walking. The MEP depression coincides with decreased MEP gain, unaltered MEP threshold changes, and unaltered silent period duration. These findings indicate that MEP depression is subcortical or spinal in origin. Healthy subjects could rapidly overcome the pronounced depression of muscle activity during the step at which transspinal stimulation was delivered. Thus, transspinal stimulation directly affects the function of spinal locomotor networks in healthy humans.
The Multi-Scale, Three-Dimensional Nature of Skeletal Muscle Contraction
Authors: Roberts Thomas J. , Eng Carolyn M. , Sleboda David A. , Holt Natalie C. , Brainerd Elizabeth L. , Stover Kristin K. , Marsh Richard L. , Azizi Emanuel
Published: October 2019

Muscle contraction is a three-dimensional process, as anyone who has observed a bulging muscle knows. Recent studies suggest that the three-dimensional nature of muscle contraction influences its mechanical output. Shape changes and radial forces appear to be important across scales of organization. Muscle architectural gearing is an emerging example of this process.
Hemorragia digestiva alta
Authors: Chuecas Jofre Joaquín Andrés , Torres Tomás , Cabezas Guillermo , Lara Hernández Bárbara
Published: October 2019

La hemorragia digestiva alta es una patología frecuente en los servicios de urgencia de nuestro país y del mundo. Su forma de presentación es variable y dado su riesgo de mortalidad la hacen una condición que debe ser conocida y manejada por el médico general y especialista en medicina de urgencia. Es necesario protocolizar su manejo, lo que permite el diagnóstico oportuno y tratamiento adecuado de cada paciente. Sin embargo, el manejo caso a caso requiere el conocimiento del verdadero impacto de las distintas medidas disponibles para así obtener el mayor provecho de los recursos limitados en un servicio de urgencia, sobre todo en casos de hemorragia digestiva alta exsanguinante. Objetivo: presentar el enfrentamiento, correcto diagnóstico, categorización de riesgo y manejo terapéutico de la hemorragia digestiva alta desde la perspectiva de la medicina de urgencias. Método: se realizó una revisión bibliográfica de la literatura científica sobre esta condición, presentándose la evidencia actual de las evaluaciones diagnósticas e intervenciones terapéuticas más utilizadas actualmente. Resultados: se presenta la evidencia actual respecto a la sospecha, diagnóstico, manejo inicial y disposición de la hemorragia digestiva alta, en el contexto de la atención en un servicio de urgencia.
Histeropexia vs histerectomía para el tratamiento quirúrgico del prolapso genital: revisión sistemática
Authors: Romero Barra Paz , Viguera Torrealba Sebastián , Pineda Alarcón Rodrigo , MIranda Hermosilla Víctor
Published: October 2019

Resumen: el prolapso de órganos pélvicos es una patología común a nivel mundial. El tratamiento quirúrgico generalmente incluye una histerectomía; sin embargo no existe consenso entre los especialistas sobre su real necesidad. Objetivo: realizar una revisión sistemática de estudios controlados randomizados que comparen histeropexia vs histerectomía, combinada con alguna técnica de corrección del prolapso y proporcionar recomendaciones clínicas. Materiales y Métodos: búsqueda electrónica en  bases de datos Medline, Embase, Cochrane y Clinical Trials, desde su fecha de inicio hasta diciembre 2018 de estudios controlados randomizados que comparan histeropexia vs histerectomía con alguna técnica de reparación del prolapso, sin restricción de idioma. Resultados: se identificaron 339 abstracts utilizando las palabras claves. En base a título y resumen 23 estudios fueron seleccionados y de ellos 7  cumplieron los criterios de inclusión. La calidad de la evidencia fue moderada. Histeropexia  tiene tasas de reintervención y recurrencia de prolapso similares a histerectomía con reparación apical. En cuantificación del prolapso utilizando POP-Q,  histeropexia presenta un punto C más alto y mayor largo vaginal total que histerectomía. No encontramos diferencias significativas en cuanto a complicaciones entre ambas técnicas. Conclusión: histeropexia es una técnica segura, con tasas de éxito y reintervención por recurrencia similares a las de histerectomía con reparación apical. Sin embargo, faltan estudios con seguimiento más prolongado y de mejor calidad.
Diseño, aplicación y control de calidad de un examen OSCE de competencias de cirugía en la revalidación práctica del título de médico cirujano
Authors: Celedón Felipe , Morales Claudia , López Adriana , Daniel Katherine , Lombardic Nebenka , Guiraldes Ernesto
Published: October 2019

Introducción: para revalidar su título en Chile, los médicos graduados en el exterior (MGEs) deben someterse a un examen compuesto de un módulo teórico y otro práctico. Para realizar este último, la Universidad Mayor utiliza la modalidad OSCE. Este formato garantiza apropiados grados de validez, fiabilidad y objetividad si su diseño y aplicación son meticulosos y detallados. Sus resultados deben ser sometidos sistemáticamente a un control de calidad. Este último, un componente crucial de toda evaluación de alta trascendencia, se menciona escasamente en la literatura biomédica nacional. Nuestro objetivo es describir aquí el diseño, administración y análisis psicométrico de un OSCE destinado a evaluar las competencias quirúrgicas generales de (MGEs). Métodos: el OSCE fue diseñado por un equipo multidisciplinario. Se crearon diez estaciones que estaban en correspondencia con las competencias quirúrgicas generales esperadas en un graduado. El análisis psicométrico de los resultados incluyó el uso del coeficiente alfa de Cronbach y la correlación de Pearson. Resultados: los veinte MGEs aprobaron el examen con puntajes entre 64,8 y 96,0%. El coeficiente de Cronbach global fue 0,67. La correlación entre los puntajes de cada estación con el del OSCE global alcanzó significación estadística en todos los casos. Conclusiones: un OSCE que evalúa la competencia quirúrgica general de un médico graduado es factible. Las propiedades psicométricas del examen fueron satisfactorias; sin embargo es aconsejable perfeccionar aún más el proceso de elaboración del examen así como los casos empleados y otros elementos claves.
In vitro Inhibitory Effects of Cynaroside on Human Liver Cytochrome P450 Enzymes
Authors: Wang Lei , Ma Xiuju , Wang Jing , Li Chang
Published: October 2019

Introduction: Cynaroside is a biological component isolated from Lonicera japonica Thunb, and it possesses numerous pharmacological activities. However, whether cynaroside affects the activity of human liver cytochrome P450 (CYP) enzymes remains unclear. The purpose of this study was to investigate the effects of cynaroside on 8 major CYP isoforms in human liver microsomes (HLMs). Methods: In this study, the inhibitory effects of cynaroside on the 8 human liver CYP isoforms (i.e., 1A2, 3A4, 2A6, 2E1, 2D6, 2C9, 2C19, and 2C8) were investigated in vitro using HLMs. Results: The results showed that cynaroside inhibited the activity of CYP1A2, 3A4, and 2C9, with IC50 values of 21.74, 15.88, and 16.58 μmol/L, respectively, but that other CYP isoforms were not affected. Enzyme kinetic studies showed that cynaroside was not only a noncompetitive inhibitor of CYP3A4 but also a competitive inhibitor of CYP1A2 and 2C9, with Ki values of 7.33, 11.60, and 8.09 μmol/L, respectively. In addition, cynaroside is a time-dependent inhibitor for CYP3A4 with Kinact/KI value of 0.049/11.62 μmol/L–1min–1. Conclusion: The in vitro studies of cynaroside with CYP isoforms indicate that cynaroside has the potential to cause pharmacokinetic drug interactions with other coadministered drugs metabolized by CYP1A2, 3A4, and 2C9. Further clinical studies are needed to evaluate the significance of this interaction.
Recombinant Tissue-Type Plasminogen Activator Study of Wake-Up Ischemic Strokes Guided by Rapid MRI
Authors: Guo CuiPing , Bai QingKe , Zhao ZhenGuo , Zhang JianYing
Published: October 2019

Background: rt-PA intravenous thrombolytic therapy and its efficacy have been widely recognized and proved for strokes. However, for patients with wake-up ischemic stroke (WUIS), they lose the opportunity to receive rt-PA intravenous thrombolytic therapy because of the difficulty of determining the onset time window. Aim: This study is aimed at investigating the intravenous thrombolytic therapy of WUIS guided by rapid MRI. Methods: Data were collected from patients with acute ischemic stroke within 4.5 h and from WUIS patients with uncertain onset time window, who received the treatment of rt-PA intravenous thrombolytic therapy in our hospital from November 2006 to April 2018. The improved Rankin scale was used to evaluate neurological function recovery. According to the Rankin scale score, patients were divided into two groups: those with good prognosis (modified Rankin scale [mRS] score 0–1) and those with poor prognosis (mRS score 2–6). Results: A total of 253 patients received rt-PA intravenous thrombolysis after head MRI evaluation; this included 177 cases of acute ischemic stroke and 76 cases of WUIS (which contains 2 death cases, 0.8% mortality; 3 cases of symptomatic bleeding, 1.2% bleeding rate; and 5 cases of aggravation, 2.0% aggravation rate). There was no statistical difference between the baseline data from the acute ischemic stroke patients with 4.5 h onset time window and the baseline data from the WUIS patients with undetermined onset time window, when the treatment was guided by rapid MRI. There were also no significant statistical differences in National Institutes of Health Stroke Scale score, Rankin scale score, symptomatic bleeding, death and aggravation of the disease between the 2 groups at 24 h, 3 days, and 7 days after admission (p < 0.05). Conclusion: According to the characteristic of undetermined onset time window of WUIS, more WUIS patients would be benefited from the rt-PA intravenous thrombolytic treatment when it is conducted under the guidance of rapid MRI.
Impact of Procedural Bleeding in Peripheral Artery Disease
Authors: Kansal Aman , Huang Zhen , Rockhold Frank W. , Baumgartner Iris , Berger Jeffrey S. , Blomster Juuso I. , Fowkes F. Gerry , Katona Brian , Mahaffey Kenneth W. , Norgren Lars , Hiatt William R. , Patel Manesh R. , Jones W. Schuyler
Published: October 2019

Background:

The relationship between invasive vascular procedures and bleeding in patients with peripheral artery disease has not been well described in the literature. This post hoc analysis from the EUCLID trial (Examining Use of Ticagrelor in Peripheral Artery Disease) aimed to describe the incidence of major and minor postprocedural bleeding and characterize the timing and severity of bleeding events relative to the procedure.

Methods:

EUCLID was a multicenter, randomized controlled trial of 13 885 patients with symptomatic peripheral artery disease that tested the efficacy and safety of ticagrelor compared with clopidogrel for the prevention of major adverse cardiovascular events. A total of 2661 patients underwent 3062 coronary revascularization, peripheral revascularization, and amputation during the study. The primary safety end point was Thrombolysis in Myocardial Infarction major or minor bleeding. All bleeding events were formally adjudicated by a clinical end point classification group.

Results:

Major bleeding events most often occurred ≤7 days following the procedure. The incidence of Thrombolysis in Myocardial Infarction major or minor bleeding ≤7 days following peripheral revascularization (3.3%; 95% CI, 2.5%–4.1%) was similar to rates after coronary revascularization (4.0%; 95% CI, 2.6%–5.4%) and lower extremity amputation (2.3%; 95% CI, 0.8%–3.8%). The severity of bleeding events (as graded by drop in hemoglobin, need for transfusion, bleeding in a critical location, and fatal bleeding) was also similar following peripheral, coronary revascularization, and lower extremity amputation.

Conclusions:

The incidence of Thrombolysis in Myocardial Infarction major/minor bleeding following peripheral revascularization is comparable to rates after coronary revascularization and lower extremity amputation, and the majority of bleeding events occur within 7 days following the procedure. The severity of periprocedural bleeding is also similar after procedures, with the most frequently adjudicated reason being a drop in hemoglobin ≥2 g/dL. Future studies should be performed to enhance our understanding of bleeding risk related to revascularization and amputation procedures in peripheral artery disease patients.
Association Between Active Commuting and Incident Cardiovascular Diseases in Chinese: A Prospective Cohort Study
Authors: Fan Mengyu , Lv Jun , Yu Canqing , Guo Yu , Bian Zheng , Yang Songchun , Yang Ling , Chen Yiping , Huang Yuelong , Chen Biyun , Fan Lei , Chen Junshi , Chen Zhengming , Qi Lu , Li Liming ,   the China Kadoorie Biobank Collaborative Group
Published: October 2019

Background

Active commuting is related to a higher level of physical activity but more exposure to ambient air pollutants. With the rather serious air pollution in urban China, we aimed to examine the association between active commuting and risk of incident cardiovascular disease in the Chinese population.

Methods and Results

A total of 104 170 urban commuters without major chronic diseases at baseline were included from China Kadoorie Biobank. Self‐reported commuting mode was defined as nonactive commuting, work at home or near home, walking, and cycling. Multivariable Cox regression was used to examine associations between commuting mode and cardiovascular disease. Overall, 47.2% of the participants reported nonactive commuting, 13.4% reported work at home or work near home, 20.1% reported walking, and 19.4% reported cycling. During a median follow‐up of 10 years, we identified 5374 incidents of ischemic heart disease, 664 events of hemorrhagic stroke, and 4834 events of ischemic stroke. After adjusting for sex, socioeconomic status, lifestyle factors, sedentary time, body mass index, comorbidities, household air pollution, passive smoking, and other domain physical activity, walking (hazard ratio, 0.90; 95%
CI,
0.84–0.96) and cycling (hazard ratio, 0.81; 95%
CI,
0.74–0.88) were associated with a lower risk of ischemic heart disease than nonactive commuting. Cycling was associated with a lower risk of ischemic stroke (hazard ratio, 0.92; 95%
CI,
0.84–1.00). No significant association was found of walking or cycling with hemorrhagic stroke. The associations of commuting mode with major cardiovascular disease were consistent among men and women and across different levels of other domain physical activity.

Conclusions

In urban China, cycling was associated with a lower risk of ischemic heart disease and ischemic stroke. Walking was associated with a lower risk of ischemic heart disease.
Age‐ and Lesion‐Related Comorbidity Burden Among US Adults With Congenital Heart Disease: A Population‐Based Study
Authors: Agarwal Anushree , Thombley Robert , Broberg Craig S. , Harris Ian S. , Foster Elyse , Mahadevan Vaikom S. , John Anitha , Vittinghoff Eric , Marcus Greg M. , Dudley R. Adams
Published: October 2019

Background

As patients with congenital heart disease (
CHD
) are living longer, understanding the comorbidities they develop as they age is increasingly important. However, there are no published population‐based estimates of the comorbidity burden among the US adult patients with CHD.

Methods and Results

Using the
IBM
MarketScan commercial claims database from 2010 to 2016, we identified adults aged ≥18 years with
CHD
and 2 full years of continuous enrollment. These were frequency matched with adults without
CHD
within categories jointly defined by age, sex, and dates of enrollment in the database. A total of 40 127 patients with CHD met the inclusion criteria (mean [
SD
] age, 36.8 [14.6] years; and 48.2% were women). Adults with
CHD
were nearly twice as likely to have any comorbidity than those without
CHD
(
P
<0.001). After adjusting for covariates, patients with CHD had a higher prevalence risk ratio for “previously recognized to be common in
CHD
” (risk ratio, 9.41; 95%
CI
, 7.99–11.1), “other cardiovascular” (risk ratio, 1.73; 95%
CI
, 1.66–1.80), and “noncardiovascular” (risk ratio, 1.47; 95%
CI
, 1.41–1.52) comorbidities. After adjusting for covariates and considering interaction with age, patients with severe
CHD
had higher risks of previously recognized to be common in
CHD
and lower risks of other cardiovascular comorbidities than age‐stratified patients with nonsevere
CHD
. For noncardiovascular comorbidities, the risk was higher among patients with severe than nonsevere
CHD
before, but not after, the age of 40 years.

Conclusions

Our data underscore the unique clinical needs of adults with
CHD
compared with their peers. Clinicians caring for
CHD
may want to use a multidisciplinary approach, including building close collaborations with internists and specialists, to help provide appropriate care for the highly prevalent noncardiovascular comorbidities.
Turks with a “Wāw”
Authors: Khayyat E.
Published: October 2019

Beginning late nineteenth century Ottoman-Turkish intellectuals fought for an orthographic revolution to change the spelling of the name Türk—which was once used to refer to the “simple folk” or Muslims generally and was written as ‮ترك‬‎ (t-r-k) in Arabic letters—by adding the letter ‘wāw’ (‮و‬‎) to it, spelling the name as ‮تورك‬‎ (t-u-r-k) in print. The additional letter was a necessity in the minds of the revolutionaries to make visible the Turkish nation as opposed to the multitude. The paper interprets these intellectuals’ thoughts and assumptions on scripts, writing and language as they relate to politics and identity and as part of the history of Ottoman-Turkish literary modernity, which would culminate in the adoption of Roman letters in the modern Turkish Republic.
Hylomecon japonica var. dentipetala (Papaveraceae), a new variety from western Hubei, China

Authors: DU WEI , LI YA , TAN FEI
Published: October 2019

Hylomecon japonica var. dentipetala, a new variety of the Papaveraceae from western Hubei in central China, is described and illustrated. The new variety differs from its type variety, var. japonica, by its irregularly dentate or erose petals.
A Climate Classification of China through k-Nearest-Neighbor and Sparse Subspace Representation
Authors: Shi Jiarong , Yang Liu
Published: October 2019

Climate classification aims to divide a given region into distinct groups on the basis of meteorological variables, and it has important applications in fields such as agriculture and buildings. In this paper, we propose a novel spectral clustering–based method to partition 661 meteorological stations in China into several zones. First, the correlations are analyzed among five meteorological variables: daily average temperature, average relative humidity, sunshine hours, diurnal temperature range, and atmospheric pressure. The resulting weak linear correlation supports the classification under multiple views. Next, a similarity matrix/graph is constructed by combining the advantages of k-nearest-neighbor and sparse subspace representation. The blocking effect of the similarity matrix confirms the rationality of the classification. Then, we consider respectively the climate classification under a single view and multiple views. For the single view, atmospheric pressure has the highest imbalance degree, and sunshine hours and diurnal temperature range have the strongest classification consistency. The consistency rates are improved evidently in a multiple-view situation. Afterward, we propose a determining method for the number of clusters and make a sensitivity analysis on various parameters. Finally, we provide a further statistical analysis on the classification results and compare the consistency with another climate dataset. All experimental results show that the proposed classification method is feasible and effective in the climate zoning of China.
Predictors and Contexts of Unsolved and Solved Sexual Offenses
Authors: Chiu Yi-Ning , Leclerc Benoit
Published: October 2019

Drawing from perspectives emphasizing environmental crime event components, this study identifies the predictors and contexts of unsolved and solved sexual offenses against women by strangers. Police data were obtained from 542 cases in Queensland. Hierarchical logistical regression was adopted to analyze variables relating to situational, contextual, and offender–victim interaction elements. Common contexts were examined using conjunctive analysis. Cases were significantly likely to remain unsolved if the offender used minimal force, or if the victim was walking outside at the time of initial contact. Conversely, solved cases were significantly associated with offender prior consumption of alcohol/drugs, bystander presence, and vehicle use. Crimes with higher criminal “effectiveness” and lower levels of victim interaction tended to be associated with unsolved sexual offenses.
A novel arthritis model induced by wind, damp, cold and heat in female rats
Authors: Ge Chuang , Hao Jingchao , Wu Xiaodong , Li Chencheng , Zhi Rui , Yu Pengcheng , Wang Xinmin , Hu Jialiang , Xu Hanmei
Published: October 2019

Animal models are in constant development to benefit scientific research. Rheumatoid arthritis (RA) is considered a very complex disease due to its complicated pathogenesis, and patients with rheumatic disease around the world are still unable to obtain effective, simple and curable treatment. In order to obtain a clear insight into the pathogenesis of RA, a rat model was established based on the concept of Bi syndrome in Traditional Chinese Medicine by simulating the conditions of RA as much as possible via the change in the physical conditions wind, damp, cold and heat (WDCH). For the first time, a new WDCH-induced RA model in female rats was successfully established and evaluated by body-weight change, paw swelling, blood cells analysis, spleen and thymus coefficients, autoantibodies and serum cytokine changes and histopathology. This model is characterised by its objectivity, no exogenous induction, short modelling time, extremely elevated expression level of autoantibodies and obvious histopathological change. The establishment of such a new model may provide more benefits in the research of the pathogenesis of RA.