bluuebunny/crossref_metadata_2025 huggingface dataset:
Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block
Authors: Huang Hui‐Chun , Chien Kuo‐Liong , Chang Yi‐Chung , Lin Lian‐Yu , Wang Jui , Liu Yen‐Bin
Published: April 2020

Introduction

This study aimed to investigate the association between T‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (CRT).

Methods and Results

We enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS‐to‐T angle (TCRT), T‐wave morphology dispersion (TMD), T‐wave loop area (PL), and T‐wave residuum (TWR), were reconstructed from digital standard 12‐lead electrocardiograms by T‐wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end‐systolic volume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all independently associated with LVEF < 40%. Among 40 patients who underwent CRT, those with a larger TMD (P = .007), larger PL (P = .025), and more negative TCRT (P = .015) had better response to CRT. A large TMD (P = .018) and large PL (P = .003) were also independent predictors of the clinical outcome endpoint.

Conclusions

Increases in repolarization heterogeneity in patients with cLBBB are associated with impaired LVEF. A large TMD and large PL may be useful as additional predictors of response to CRT, improving patient selection for CRT.
Guest Editorial: Clarifications on the use of the new classification of periodontitis
Authors: Sanz Mariano , Papapanou Panos N. , Tonetti Maurizio S. , Greenwell Henry , Kornman Kenneth
Published: April 2020

This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: (1) how to apply the extent criterion to the defined Stage of the disease; and (2) how to calculate tooth loss because of periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to treat) teeth with a clinical definition of such teeth.
Adult blacktip sharks (Carcharhinus limbatus) use shallow water as a refuge from great hammerheads (Sphyrna mokarran)
Authors: Doan Melanie D. , Kajiura Stephen M.
Published: April 2020

A refuge can be any space that keeps an organism safe from danger. Prey usually seek protection in the closest refuge available to minimize cost while maximizing survival. Aerial drone footage of blacktip sharks, Carcharhinus limbatus, along the coast of southeast Florida, USA, shows adult blacktips fleeing to the shallow water adjacent to the beach when confronted with or chased by a predatory great hammerhead shark, Sphyrna mokarran. To authors’ knowledge, this is the first evidence of adult C. limbatus using shallow waters as a refuge.
Shati/Nat8l deficiency disrupts adult neurogenesis and causes attentional impairment through dopaminergic neuronal dysfunction in the dentate gyrus
Authors: Wulaer Bolati , Kunisawa Kazuo , Hada Kazuhiro , Jaya Suento Willy , Kubota Hisayoshi , Iida Tsubasa , Kosuge Aika , Nagai Taku , Yamada Kiyofumi , Nitta Atsumi , Yamamoto Yasuko , Saito Kuniaki , Mouri Akihiro , Nabeshima Toshitaka
Published: April 2020

Successful completion of daily activities relies on the ability to select the relevant features of the environment for memory and recall. Disruption to these processes can lead to various disorders, such as attention‐deficit hyperactivity disorder (ADHD). Dopamine is a neurotransmitter implicated in the regulation of several processes, including attention. In addition to the higher‐order brain function, dopamine is implicated in the regulation of adult neurogenesis. Previously, we generated mice lacking Shati, an N‐acetyltransferase‐8‐like protein on a C57BL/6J genetic background (Shati/Nat8l−/−). These mice showed a series of changes in the dopamine system and ADHD‐like behavioral phenotypes. Therefore, we hypothesized that deficiency of Shati/Nat8l would affect neurogenesis and attentional behavior in mice. We found aberrant morphology of neurons and impaired neurogenesis in the dentate gyrus of Shati/Nat8l−/− mice. Additionally, research has suggested that impaired neurogenesis might be because of the reduction of dopamine in the hippocampus. Galantamine (GAL) attenuated the attentional impairment observed in the object‐based attention test via increasing the dopamine release in the hippocampus of Shati/Nat8l−/− mice. The α7 nicotinic acetylcholine receptor antagonist, methyllycaconitine, and dopamine D1 receptor antagonist, SCH23390, blocked the ameliorating effect of GAL on attentional impairment in Shati/Nat8l−/− mice. These results suggest that the ameliorating effect of GAL on Shati/Nat8l−/− attentional impairment is associated with activation of D1 receptors following increased dopamine release in the hippocampus via α7 nicotinic acetylcholine receptor. In summary, Shati/Nat8l is important in both morphogenesis and neurogenesis in the dentate gyrus and attention, possible via modulation of dopaminergic transmission.

image

Cover Image for this issue: https://doi.org/10.1111/jnc.15061.
Reliability and comparability of methods for assessing oral function: Chewing, tongue pressure and lip force
Authors: Arakawa Itsuka , Abou‐Ayash Samir , Genton Laurence , Tsuga Kazuhiro , Leles Cláudio Rodrigues , Schimmel Martin
Published: April 2020

Background

Quantitative clinical assessment tests for oral function have become popular in patient assessment; however, their comparability remains unclear.

Objective

To assess the reliability and comparability of pairs of different instruments for measuring maximum tongue pressure (MTP), chewing function (CF) and maximum lip force (MLF), and to analyse the influence of subjects’ characteristics on the applied instruments.

Methods

Each pair of instruments, as well as a single device measuring the maximum voluntary bite force (MBF), was assessed across 26 healthy volunteers. The respective pairs of devices were compared using Bland‐Altman plots and linear regression analysis. Furthermore, the influence of age, occlusal support zones, number of functional occlusal units, MBF, MTP and MLF were investigated as predictors on CF using a generalised estimating equation model.

Results

Neither the two assessments of CF, nor of MLF were correlated to each other, but there was a significant correlation between the assessments of MTP. Hue‐Check Gum was able to demonstrate a significantly higher CF in younger compared to older individuals (P = .004) and individuals with high numbers compared to low numbers of occlusal units (P < .001). Those differences could not be demonstrated with the Vivident chewing gum.

Conclusion

The absolute values of MTP assessed by the two applied devices cannot directly be compared, although normalised values may be directly comparable. Moreover, our observations suggest that the Hue‐Check Gum was able to discriminate the effects of age and the number of occlusal units on CF. Our observations suggest that the two gums cannot be used interchangeably.
Translucency of Monolithic Zirconia after Hydrothermal Aging: A Review of In Vitro Studies
Authors: Papageorgiou‐Kyrana Katerina , Fasoula Maria , Kontonasaki Eleana
Published: April 2020

Purpose

Recent modifications in composition, structure, and fabrication methods have led to monolithic zirconia ceramics of superior translucency. However, during aging, intrinsic microstructural features, such as grain boundaries and pores, may affect light scattering and consequently the translucency of zirconia. The aim of this study was to systematically review if hydrothermal aging affects the translucency of monolithic zirconia.

Materials and Methods

An electronic search in Medline and Scopus was conducted to identify the effect of hydrothermal aging on the translucency of zirconia. The search was limited to English‐language publications and in vitro studies. The following search terms were used alone or in combination: “monolithic zirconia,” “full contour zirconia,” “Y‐TZP zirconia,” “tetragonal zirconia,” “cubic zirconia,” “aging,” “hydrothermal aging,” “steam autoclave,” “translucency,” “translucency parameter,” and “contrast ratio.” From the titles found after searching the electronic databases, only 10 articles met the inclusion criteria and were included in this review. The translucency parameter or total transmittance was used to extract data from the studies.

Results

Aging reduced the translucency of monolithic zirconia in most of the studies; however, the differences varied according to the brand tested and the microstructure and thickness of the specimens. The thinner specimens presented higher translucency alterations. Although in all studies a change in translucency was recorded, its mean values suggest that the differences are within the acceptability threshold in most cases, independent of the color system used to calculate translucent parameter, so they are clinically undetectable. For longer aging times, beyond the perspective clinical life of the restorations, the change in translucency is higher than the acceptability threshold.

Conclusions

There is a controversy regarding how aging affects the translucency of monolithic zirconia ceramics; however, this may not be clinically important, as in most cases, changes (either decrease or increase) in translucency were within the acceptability thresholds.
Maternal hepatitis B or hepatitis C virus carrier status and long‐term infectious morbidity of the offspring: A population‐based cohort study
Authors: Abu Freha Naim , Wainstock Tamar , Poupko Liat , Yonat Shemer Avni , Sergienko Ruslan , Sheiner Eyal
Published: April 2020

The objective of the study was to investigate the long‐term effects of maternal hepatitis B virus (HBV) or hepatitis C virus (HCV) carrier status on the long‐term infectious morbidity of their offspring. A population‐based cohort study was conducted, including all singleton deliveries between the years 1991 and 2014 at a tertiary medical centre. The mothers were subdivided into three groups: HBV carriers, HCV carriers and non‐carriers. Data on demographics, maternal, perinatal and long‐term hospitalization for infectious morbidity were compared between the groups. During the study period, 242 905 (99.7%) non‐carrier mothers, 591 (0.2%) HBV carriers and 186 (0.1%) HCV carriers were observed. Hospitalizations related to infectious morbidity was significantly higher in the offspring of HBV carriers compared with HCV and non‐carriers (15.6% vs 11.3% vs 11.0%; P = .002, respectively; Kaplan‐Meier, log‐rank P < .001). Specifically, a significantly higher rate of hospitalizations gastrointestinal infectious morbidity was noted among the offspring of HBV carrier mothers (3.6% in the HBV carrier group, 1.6% in the HCV carrier group and 1.6% in the non‐carrier group [P = .001]). There was a respiratory infectious morbidity of 8.1% among the offspring of HBV carriers, 8.6% among HCV carriers and 5.5% in non‐carriers (P = .005). Using a Cox multivariable model, controlling for confounding variables, maternal HBV carrier status was associated with a significantly increased long‐term infectious morbidity of the offspring, with an adjusted HR of 1.7 (95% CI, 1.388‐2.077, P < .001). Maternal HBV carrier status is an independent risk factor for long‐term infectious morbidity of the offspring, particularly for gastrointestinal and respiratory infections.
Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study
Authors: Ala‐Houhala Mari , Anttila Veli‐Jukka
Published: April 2020

Objectives

Persistent candidaemia (PC) is a recognised complication of candidaemia. Our objective was to evaluate risk factors and clinical significance of PC in adult patients.

Methods

This is a retrospective, cohort study. We compared PC with non‐PC. All patients with blood cultures positive for Candida species were identified from a microbiological database in the hospital district of Helsinki and Uusimaa from 2007 to 2016. PC was defined as an isolation of the same Candida species from positive blood culture for ≥5 days.

Results

PC criteria were fulfilled by 75/350 patients (21.4%). No significant difference emerged between persistent and non‐persistent cases caused by non‐albicans Candida species (37.3% vs 35.1%, P = .742). The length of hospital stay before onset of candidaemia was longer before PC (hospital stay > 7 days; 73.3% vs 59.6%, P = .043). No significant impact on 30‐day mortality was observed (20.0% vs 15.5%, P = .422). Using multivariable regression analysis, we found the presence of central venous catheter (CVC) (OR = 2.71, 95% CI 1.31‐5.59), metastatic infection foci (OR 3.60, 95% CI 1.66‐7.79) and ineffective empirical treatment (OR = 3.31, 95% CI 1.43‐7.65) to be independent risk factors for PC. In subgroup analysis, early source control was identified as a protective factor against PC (30.5% vs 57.7%, P = .002).

Conclusion

The presence of CVC, metastatic infection foci and ineffective empirical treatment were independently associated with PC in adult patients. Active search for and treatment of metastatic infection foci and removal of CVC are key elements for preventing PC.
Cumulative distribution function of daily rainfall in the Tocantins–Araguaia hydrographic region, Amazon, Brazil
Authors: Progênio Mayke F. , Blanco Claudio J. C.
Published: April 2020

Knowing the temporal and spatial variability of the probability of rainfall occurrence is indispensable for the planning and management of agricultural and agroindustrial activities. This study aims to evaluate the applicability of four cumulative distribution functions (CDFs; exponential, two‐parameter exponential, mixed exponential, and gamma) to estimate the probability of daily rainfall in the Tocantins–Araguaia hydrographic region (TAHR). The CDFs were applied to 196 rainfall gauge stations distributed in three homogeneous regions (HRs) of rainfall in the TAHR. In relation to the CDFs, the Kolmogorov–Smirnov test and the probability–probability plot showed that the mixed exponential best adhered to the observed data for most of the months of the year in the three HRs that were analyzed. In the few months that this function did not have a good statistical performance, the gamma function was the one with the best fit quality. This study can be used as a guide for studies in other river basins in Brazil and around the world to estimate CDFs of daily rainfall.

Recommendations for Resource Managers

Stochastic models using cumulative distribution functions (CDFs) allow the simulation of rainfall data by means of their frequency of occurrence. Some CDFs have been used to verify the behavior and variability of precipitation over the years. For example, the mixed exponential, the Weibull with two parameters, the generalized Pareto, the lognormal, and the gamma with two parameters.

Daily rainfall modeling is important to recognize the occurrence patterns for the prediction of the climatic behavior of a region. Sectors such as agriculture, flood control, and human supply projects need knowledge of precipitation for planning, management, and operation.

The knowledge of the rainfall behavior is very important in Tocantins–Araguaia hydrographic region because it is located in the arc of deforestation in the Amazon. In this case, the dry season and temperatures have been increasing due to global climate change and deforestation itself.
When ESKD complicates disease management: GI bleeding and other GI illnesses
Authors: Salani Megha , Golper Thomas
Published: April 2020

The presentation of gastrointestinal (GI) illnesses is similar in patients with end‐stage kidney disease (ESKD) and in the general population. However, there are several instances where kidney failure and renal replacement therapy (RRT) can affect the course of the disease and its management. In this section, we will focus on unique factors of GI illnesses that should be considered in the ESKD population with and without residual kidney function (RKF). We will also discuss the role of RRT modalities in the occurrence and treatment of GI disease.
When ESKD complicates cancer screening and cancer treatment
Authors: Yasin Saddam , Holley Jean L.
Published: April 2020

End‐stage kidney disease (ESKD) affects the recommended screening, incidence, treatment, and mortality of cancer. Cancer occurring in a patient with ESKD can influence candidacy for kidney transplantation as well as dialysis decision‐making and cancer treatment. Certain cancers are more common among ESKD patients, notably, viral‐mediated cancers that are associated with human papilloma or hepatitis viruses, and urothelial cancers associated with analgesic and Balkan nephropathies. Solid tumors are not believed to occur more frequently in ESKD patients. The presence of ESKD may confer a higher risk of post‐surgical complications as well as mortality. The cost‐effectiveness of cancer screening depends upon individual cancer risk and estimated overall survival. The high mortality associated with ESKD argues against routine cancer screening in dialysis patients. Cancer treatment in ESKD may be complicated by the need to avoid, adjust doses of and/or coordinate the timing of administration of imaging contrast, chemotherapy, and immunotherapy with dialysis treatments. There is a general dearth of information on the treatment of cancer in ESKD patients. These issues will be discussed, and some general guidelines presented based upon the current literature.
Date of birth and selective schooling: Some lessons from the 1944 education reforms in England and Wales
Authors: Hart Robert A. , Moro Mirko
Published: April 2020

We compare the probabilities of selective (grammar) school entry in England and Wales before and after the 1944 Education Act. The Act had direct and indirect influences on the costs of grammar education and on entry‐exam coverage, design and marking methodology. Post‐1944, grammar school entry among children born in the middle of the school year improved considerably. We argue that age‐adjusted group standardized testing was an important contributory factor. The youngest pupils remained significantly disadvantaged. We produce evidence that this is consistent with the practice of streaming (tracking) junior school children at age 7 into classes delineated by average ability.
Detection of the novel HLA‐B allele, HLA‐B*27:199, in a Korean individual
Authors: Lee Seung Yeob , Kim Soo Hyun , Shin Myung Geun , Choi Hyun Jung
Published: April 2020

HLA‐B*27:199 differs from HLA‐B*27:05:02:01 by one nucleotide substitution (c.814G>T) with one amino acid change (p.V248L).
Identification of a novel HLA‐DQB1*05 variant allele, HLA‐DQB1*05:247 by next‐generation sequencing
Authors: Yu Shinae , Bae Hae Jung , Choi So‐Jung , Jun Kyung Ran
Published: April 2020

The new allele, HLA‐DQB1*05:247 differs from HLA‐DQB1*05:02:01:01 by one nucleotide substitution at codon 35.
Financial analysis of large‐volume delayed sampling to reduce bacterial contamination of platelets
Authors: Kacker Seema , Katz Louis M. , Ness Paul M. , Bloch Evan M. , Goel Ruchika , Gehrie Eric A. , Lokhandwala Parvez M. , Tobian Aaron A.R.
Published: April 2020

BACKGROUND

Effective and financially viable mitigation approaches are needed to reduce bacterial contamination of platelets in the US. Expected costs of large‐volume delayed sampling (LVDS), which would be performed by a blood center prior to shipment to a hospital, were compared to those of pathogen reduction (PR), point‐of‐release testing (PORt), and secondary bacterial culture (SBC).

METHODS

Using a Markov‐based decision‐tree model, the financial and clinical impact of implementing all variants of LVDS, PR, PORt, and SBC described in FDA guidance were evaluated from a hospital perspective. Hospitals were assumed to acquire leukoreduced apheresis platelets, with LVDS adding $30 per unit. Monte Carlo simulations were run to estimate the direct medical costs for platelet acquisition, testing, transfusion, and possible complications associated with each approach. Input parameters, including test sensitivity and specificity, were drawn from existing literature and costs (2018US$) were based on a hospital perspective. A one‐way sensitivity analysis varied the assumed additional cost of LVDS.

RESULTS

Under an approach of LVDS (7‐day), the total cost per transfused unit is $735.78, which falls between estimates for SBC (7‐day) and PORt. Assuming 20,000 transfusions each year, LVDS would cost $14.72 million annually. Per‐unit LVDS costs would need to be less than $22.32 to be cheaper per transfusion than all other strategies, less than $32.02 to be cheaper than SBC (7‐day), and less than $196.19 to be cheaper than PR (5‐day).

CONCLUSIONS

LVDS is an effective and cost‐competitive approach, assuming additional costs to blood centers and associated charges to hospitals are modest.
Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression
Authors: Patterson Brooke , Culvenor Adam Geoffrey , Barton Christian J , Guermazi Ali , Stefanik Joshua , Morris Hayden G , Whitehead Timothy S , Crossley Kay M
Published: April 2020

Background

Not meeting functional performance criteria increases reinjury risk after ACL reconstruction (ACLR), but the implications for osteoarthritis are not well known.

Objective

To determine if poor functional performance post-ACLR is associated with risk of worsening early osteoarthritis features, knee symptoms, function and quality of life (QoL).

Methods

Seventy-eight participants (48 men) aged 28±15 years completed a functional performance test battery (three hop tests, one-leg-rise) 1 year post-ACLR. Poor functional performance was defined as <90% limb symmetry index (LSI) on each test. At 1 and 5 years, MRI, Knee injury Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective form were completed. Primary outcomes were: (i) worsening patellofemoral and tibiofemoral MRI-osteoarthritis features (cartilage, bone marrow lesions (BMLs) and meniscus) and (ii) change in KOOS and IKDC scores, between 1 and 5 years.

Results

Only 14 (18%) passed (≥90% LSI on all tests) the functional test battery. Poor functional performance on the battery (all four tests <90% LSI) 1 year post-ACLR was associated with 3.66 times (95% CI 1.12 to 12.01) greater risk of worsening patellofemoral BMLs. A triple-crossover hop <90% LSI was associated with 2.09 (95% CI 1.15 to 3.81) times greater risk of worsening patellofemoral cartilage. There was generally no association between functional performance and tibiofemoral MRI-osteoarthritis features, or KOOS/IKDC scores.

Conclusion

Only one in five participants met common functional performance criteria (≥90% LSI all four tests) 1 year post-ACLR. Poor function on all four tests was associated with a 3.66 times increased risk of worsening patellofemoral BMLs, and generally not associated with decline in self-reported outcomes.
Volunteers as members of the stroke rehabilitation team: a qualitative case study
Authors: Nelson Michelle L A , Thombs Rachel , Yi Juliana
Published: April 2020

Objectives

Clinicians are facing increasing demands on their time, exacerbated by fiscal constraints and increasing patient complexity. Volunteers are an essential part of the many healthcare systems, and are one resource to support improved patient experience and a mechanism through which to address unmet needs. Hospitals rely on volunteers for a variety of tasks and services, but there are varying perceptions about volunteers’ place within the healthcare team. This study aimed to understand the role of volunteers in stroke rehabilitation, as well as the barriers to volunteer engagement.

Design

A qualitative case study was conducted to understand the engagement of volunteers in stroke rehabilitation services within a complex rehabilitation and continuing care hospital in Ontario, Canada.

Participants

28 clinicians, 10 hospital administrators and 22 volunteers participated in concurrent focus groups and interviews. Organisational documents pertaining to volunteer management were retrieved and analysed.

Results

While there was support for volunteer engagement, with a wide range of potential activities for volunteers, several barriers to volunteer engagement were identified. These barriers relate to paid workforce/unionisation, patient safety and confidentiality, volunteer attendance and lack of collaboration between clinical and volunteer resource departments.

Conclusions

An interprofessional approach, specifically emphasising and addressing issues related to key role clarity, may mediate these barriers. Clarity regarding the role of volunteers in hospital settings could support workforce planning and administration.
Effects of brief family psychoeducation for caregivers of people with schizophrenia in Japan provided by visiting nurses: protocol for a cluster randomised controlled trial
Authors: Yasuma Naonori , Sato Sayaka , Yamaguchi Sosei , Matsunaga Asami , Shiozawa Takuma , Tachimori Hisateru , Watanabe Kazuhiro , Imamura Kotaro , Nishi Daisuke , Fujii Chiyo , Kawakami Norito
Published: April 2020

Introduction

Development of a support system for families caring for people with schizophrenia in routine psychiatric care settings is an important issue worldwide. Regional mental health systems are inadequate for delivering effective services to such family members. Despite evidence that family psychoeducation (FPE) alleviates the burden of schizophrenia on families, its dissemination in routine clinical practice remains insufficient, suggesting the need for developing an effective and implementable intervention for family caregivers in the existing mental health system setting. In Japan, the visiting nurse service system would be a practical way of providing family services. Visiting nurses in local communities are involved in the everyday lives of people with schizophrenia and their families. Accordingly, visiting nurses understand their needs and are able to provide family support as a service covered by national health insurance. The purpose of this study is to discover whether a brief FPE programme provided by visiting nurses caring for people with schizophrenia will alleviate family burden through a cluster randomised controlled trial (cRCT).

Methods and analysis

The study will be a two-arm, parallel-group (visiting nurse agency) cRCT. Forty-seven visiting nurse agencies will be randomly allocated to the brief FPE group (intervention group) or treatment as usual group (control group). Caregivers of people with schizophrenia will be recruited by visiting nurses using a randomly ordered list. The primary outcome will be caregiver burden, measured using the Japanese version of Zarit Burden Interview. Outcome assessments will be conducted at baseline, 1-month follow-up and 6-month follow-up. Multiple levels of three-way interactions in mixed models will be used to examine whether the brief FPE programme will alleviate the burden on caregivers relative to treatment as usual.

Ethics and dissemination

The Research Ethics Committee of the Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Japan (No 2019065NI) approved this study. The results will be published in a scientific peer-reviewed journal.

Trial registration number

UMIN000038044.
Influence of socioeconomic status on the referral process to cardiac rehabilitation following acute coronary syndrome: a cross-sectional study
Authors: Graversen Christina Boesgaard , Johansen Martin Berg , Eichhorst Regina , Johnsen Søren Paaske , Riahi Sam , Holmberg Teresa , Larsen Mogens Lytken
Published: April 2020

Objective

To evaluate the association between socioeconomic status (SES) and referral to cardiac rehabilitation (CR) after incident acute coronary syndrome (ACS) by dividing the referral process into three phases: (1) informed about CR, (2) willingness to participate in CR, (3) and assigned CR setting.

Design

Cross-sectional study.

Setting

Department of Cardiology at a Danish University Hospital from 1 January 2011 to 31 December 2014.

Participants

A total of 1229 patients assessed for CR during hospitalisation with ACS were prospectively registered in the Rehab-North Register from 2011 to 2014. SES was assessed using data from national registers, concerning: personal income, occupational status, educational level and civil status. Patients were excluded if one of the following criteria was fulfilled: (1) missing data on SES, or (2) acceptable reason for not informing patients about CR (treatment with coronary artery bypass grafting, transfer to another hospital, still under treatment or death).

Main outcome measures

Outcomes were defined by dividing the referral process into three phases: (1) informed about CR, (2) willingness to participate, and (3) assigned CR setting (in-hospital/community centre) after ACS.

Results

A total of 854 (69.5 %) patients were referred to CR. After adjustment for age, gender, ACS diagnosis (ST-elevated myocardial infarction, non-ST-elevated myocardial infarction, unstable angina pectoris) and comorbidity, high income had the strongest association of referral to CR in all three phases (informed about CR: OR 2.17, 95% CI 1.01 to 4.64; willingness to participate in CR: OR 1.55, 95% CI 1.02 to 2.35; assigned in-hospital CR: OR 1.47, 95% CI 0.91 to 2.36). Educational level showed similar tendencies, however not statistically significant. The results did not vary according to gender.

Conclusion

This is the first study to investigate the referral process to CR using a three-phase structure. It suggests income and education to influence all phases in the referral process to CR after ACS.
Identification of known and unknown genes associated with mitral valve prolapse using an exome slice methodology
Authors: van Wijngaarden Aniek L , Hiemstra Yasmine L , Koopmann Tamara T , Ruivenkamp Claudia A L , Aten Emmelien , Schalij Martin J , Bax Jeroen J , Delgado Victoria , Barge-Schaapveld Daniela Q C M , Ajmone Marsan Nina
Published: April 2020

Purpose

Although a familial distribution has been documented, the genetic aetiology of mitral valve prolapse (MVP) is largely unknown, with only four genes identified so far:FLNA,DCHS1,DZIP1andPLD1. The aim of this study was to evaluate the genetic yield in known causative genes and to identify possible novel genes associated with MVP using a heart gene panel based on exome sequencing.

Methods

Patients with MVP were referred for genetic counselling when a positive family history for MVP was reported and/or Barlow’s disease was diagnosed. In total, 101 probands were included to identify potentially pathogenic variants in a set of 522 genes associated with cardiac development and/or diseases.

Results

97 (96%) probands were classified as Barlow’s disease and 4 (4%) as fibroelastic deficiency. Only one patient (1%) had a likely pathogenic variant in the known causative genes (DCHS1). However, an interesting finding was that 10 probands (11%) had a variant that was classified as likely pathogenic in six different, mostly cardiomyopathy genes:DSP(1×),HCN4(1×),MYH6(1×),TMEM67(1×),TRPS1(1×) andTTN(5×).

Conclusion

Exome slice sequencing analysis performed in MVP probands reveals a low genetic yield in known causative genes but may expand the cardiac phenotype of other genes. This study suggests for the first time that also genes related to cardiomyopathy may be associated with MVP. This highlights the importance to screen these patients and their family for the presence of arrhythmias and of ‘disproportionate’ LV remodelling as compared with the severity of mitral regurgitation, unravelling a possible coexistent cardiomyopathy.
Whose life to save? Scarce resources allocation in the COVID-19 outbreak
Authors: Mannelli Chiara
Published: April 2020

After initially emerging in China, the coronavirus (COVID-19) outbreak has advanced rapidly. The World Health Organization (WHO) has recently declared it a pandemic, with Europe becoming its new epicentre. Italy has so far been the most severely hit European country and demand for critical care in the northern region currently exceeds its supply. This raises significant ethical concerns, among which is the allocation of scarce resources. Professionals are considering the prioritisation of patients most likely to survive over those with remote chances, and this news has triggered an intense debate about the right of every individual to access healthcare. The proposed analysis suggests that the national emergency framework in which prioritisation criteria are currently enforced should not lead us to perceive scarce resources allocation as something new. From an ethical perspective, the novelty of the current emergency is not grounded in the devastating effects of scarce resources allocation, which is rife in recent and present clinical practice. Rather, it has to do with the extraordinarily high number of people who find themselves personally affected by the implications of scarce resources allocation and who suddenly realise that the principle of ‘equals should be treated equally’ may no longer be applicable. Along with the need to allocate appropriate additional financial resources to support the healthcare system, and thus to mitigate the scarcity of resources, the analysis insists on the relevance of a medical ethics perspective that does not place the burden of care and choice solely on physicians.
Ophthalmic artery catheterization for retinoblastoma treatment: does reflux affect tumor response?
Authors: Sweid Ahmad , Hammoud Batoul , Weinberg Joshua H , Texakalidis Pavlos , Xu Vivian , Shivashankar Kavya , Baldassari Michael P , Das Somnath , Tjoumakaris Stavropoula I , Shields Carol L , Lezama David A , Lim Li-Anne S , Dalvin Lauren A , El Naamani Kareem , Jabbour Pascal
Published: April 2020

Background

Intra-arterial chemotherapy (IAC) for retinoblastoma (Rb) has been established as a primary treatment for the disease. To determine whether the presence of reflux into the ICA is associated with tumor response or with any other adverse events in pediatric retinoblastoma patients.

Methods

A retrospective chart review was performed for patients diagnosed with Rb and managed with ophthalmic artery catheterization (OAC).

Results

The total study cohort included 205 Rb tumors of 205 eyes in 194 consecutive patients who underwent 624 successful intra-arterial chemotherapy infusions using OAC. Of the 205 eyes, 65 eyes (32.7%) underwent 157 OAC procedures constituted group A (no reflux), 64 eyes (31.2%) underwent 236 OAC procedures constituted group B (variable pattern), and 74 eyes (36.1%) underwent 231 OAC procedures constituted group C (reflux). There was no significant difference in baseline characteristics between the three cohorts. Also, there was no significant difference in tumor characteristics between the three groups, except for genetic status. There was no significant difference between the three groups in terms of tumor response at completion of the treatment regimen. Complete tumor response was achieved at 70.2% in Group A, at 83.3% in Group B, and at 78.5% in group C (P=0.39). Similarly, eye enucleation occurred at 38.5% in group A, 31.8% in group B, and 31.5% in group C. None of the patients in both groups had any neurological adverse events or new onset of seizures.

Conclusions

The presence of reflux, which may complicate the procedure and prolong it, was not associated with poor outcomes in our analysis.
Republished: Monorail microsnare retrieval of cardiac microcatheter tip embolised to the middle cerebral artery after attempted cardiac ablation procedure
Authors: Young Michael , Johnson Ryan , Farhat Hamad
Published: April 2020

We present a case of a 52-year-old man with previous mitral valve replacement who presented to an outside hospital for planned cardiac ablation for atrial fibrillation. During the procedure, while advancing the microcatheter across the mitral valve, the microcatheter was sheared embolising into the right middle cerebral artery. This retained cardiac microcatheter tip was successfully retrieved with the monorail microsnare technique. The patient made a complete recovery without any neurological deficits or evidence of infarct on follow-up imaging.
Prescription opioid overdose and adverse effect hospitalisations among injured workers in eight states (2010–2014)
Authors: Sears Jeanne M , Hogg-Johnson Sheilah , Sterling Ryan A , Fulton-Kehoe Deborah , Franklin Gary M
Published: April 2020

Objective

High-risk opioid prescribing practices in workers’ compensation (WC) settings are associated with excess opioid-related morbidity, longer work disability and higher costs. This study characterises the burden of prescription opioid-related hospitalisations among injured workers.

Methods

Hospital discharge data for eight states (Arizona, Colorado, Michigan, New Jersey, New York, South Carolina, Utah and Washington) were obtained from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We calculated 5-year (2010–2014) average annual rates of prescription opioid overdose/adverse effect (AE) hospitalisations. Injured workers were identified using payer (WC) and external cause codes.

Results

State-level average annual prescription opioid overdose/AE hospitalisation rates ranged from 0.3 to 1.2 per 100 000 employed workers. Rates for workers aged ≥65 years old were two to six times the overall rates. Among those hospitalised with prescription opioid overdose/AEs, injured workers were more likely than other inpatients to have a low back disorder diagnosis, and less likely to have an opioid dependence/abuse or cancer diagnosis, or a fatal outcome. Averaged across states, WC was the primary expected payer for <1% of prescription opioid overdose/AE hospitalisations vs 6% of injury hospitalisations.

Conclusions

Population-based estimates of prescription opioid morbidity are almost nonexistent for injured workers; this study begins to fill that gap. Rates for injured workers increased markedly with age but were low relative to inpatients overall. Research is needed to assess whether WC as payer adequately identifies work-related opioid morbidity for surveillance purposes, and to further quantify the burden of prescription opioid-related morbidity.
Desaturation and hypotension in a dog undergoing balloon valvuloplasty for pulmonic stenosis
Authors: Petruccione Ilaria , Murison Pamela J , McDonald Hayley Rebecca , Pawson Patricia
Published: April 2020

A 4‐year old male miniature schnauzer with severe pulmonic stenosis was presented for percutaneous balloon valvuloplasty. The dog had been managed medically with atenolol for a month prior to the procedure. Clinical examination was unremarkable except for auscultation of a grade V/VI left‐sided systolic murmur. The dog was premedicated with pethidine. Anaesthesia was induced using diazepam and etomidate and maintained using sevoflurane in oxygen. Angiography was uneventful, but when the guidewire was threaded through the right side of the heart to allow insertion of the balloon catheter, marked desaturation with visible cyanosis developed. This resolved on withdrawal of the guidewire and catheter but recurred each time the guidewire and catheter were repositioned. Balloon valvuloplasty was eventually successful in reducing the pressure gradient across the stenotic valve from 102 to 52 mmHg. Hypoxaemia did not recur during recovery and the dog was discharged the following day.
Communication—Edge Quality Contribution on the Electrical Impedance of Lithium-Ion Batteries Electrodes
Authors: Carbonari Gilberto , Müller Verena , Scurtu Rares-George , Memm Michaela , Hoffmann Alice , Wohlfahrt-Mehrens Margret
Published: April 2020

Lithium-ion batteries (LiBs) industrial production requires a large number of skills in many scientific fields. The process starts from the electrodes manufacturing and ends with the battery formation. Electrodes cutting is undoubtedly a crucial step as it could turn out to be one of the bottlenecks for a fast and efficient production. In this paper, we propose a quicker and cheaper method to evaluate the electrical contact resistance between coating and current collector (RContact) by using impedance spectroscopy (EIS) to compare different cutting methods. The results show the existence of a cutting technique—cell performance relationship.
Boundedness of Multidimensional Dunkl-Hausdorff Operators
Authors: Daher Radouan , Saadi Faouaz
Published: April 2020

In the present paper, we introduce the multidimensional Dunkl-Hausdorff operator ℋκ and we give simple sufficient conditions so that these operators be bounded on the weighted lebesgue spaces Lκpℝn and in the Hardy space Hκ1ℝn associated with the Dunkl operators. We also determine the Dunkl-Hausdorff operator ℋκ∗ that is adjoint to ℋκ.
Study on Intelligent Compaction-Equipment Logistics Scheduling and Propagation Characteristics of Vibration Wave in Nonlinear Systems with Multistability Based on Field Test
Authors: Han Yixuan , Yang Changwei , Cai Degou , Yan Hongye , Zeng Hailing
Published: April 2020

The equipment scheduling and propagation characteristics of vibration wave from vibratory roller ⟶ filling material nonlinear systems with multistability are the core problems of subgrade intelligent construction technology, and the logistics scheduling of the equipment is directly related to the construction efficiency. Aiming at the shortages, one typical subgrade located at the Gu’an station of Beijing-Xiong’an city railway is selected to research and finish the field tests; some findings are shown as follows: first, some valuable suggestions about the logistics scheduling of intelligent equipment are proposed, which can break the barriers between the organizations and improve construction efficiency; second, when the vibration wave propagates from the vibratory roller ⟶ surface of filling material ⟶ different buried depths of filling material, the peak acceleration of vibration wave gradually decreases and is hyperbolic distribution approximately. At the same time, the sensitive of attenuation is shown as follows: Z<X ≈ Y, and the critical depth of vibration energy propagation is about 1.0 m. At the same time, the peak acceleration of vibration wave at the interface of different filling material layers exists in steps and is “side clock” distribution approximately with the increase in buried depth. Third, in the propagation process, with the increase in buried depth, the amplitude of fundamental, primary, secondary, until fifth harmonics decreases exponentially (R2>0.9), and the concrete functional relationship among different amplitudes of harmonics can be summarized as y = Ae−BX; fourth, the vibration energy is mainly concentrated near 10–30 Hz in the vibratory roller, but when the vibration wave propagates from vibratory roller⟶filling material, the vibration energy gradually decreases with the increase in depth, and the marginal spectrum gradually changes from one peak to two peaks, that is, 30–50 Hz and 50–100 Hz; fifth, the vibration energy in the vibrational wheel is distributed averagely in the compaction process, and the effective compaction time is two seconds, which will be helpful for revealing the propagation characteristics of vibration wave, optimizing the compaction quality control models and providing some support for the development of intelligent compaction theory of railway subgrade.
Asporin Reduces Adult Aortic Valve Interstitial Cell Mineralization Induced by Osteogenic Media and Wnt Signaling Manipulation In Vitro
Authors: Polley Anisha , Khanam Riffat , Sengupta Arunima , Chakraborty Santanu
Published: April 2020

Worldwide, calcific aortic valve disease is one of the leading causes of morbidity and mortality among patients with cardiac abnormalities. Aortic valve mineralization and calcification are the key events of adult calcific aortic valve disease manifestation and functional insufficiency. Due to heavy mineralization and calcification, adult aortic valvular cusps show disorganized and dispersed stratification concomitant with deposition of calcific nodules with severely compromised adult valve function. Interestingly, shared gene regulatory pathways are identified between bone-forming cells and heart valve cells during development. Asporin, a small leucine-rich proteoglycan (43 kDa), acts to inhibit mineralization in periodontal ligament cells and is also detected in normal murine adult aortic valve leaflets with unknown function. Therefore, to understand the Asporin function in aortic cusp mineralization and calcification, adult avian aortic valvular interstitial cell culture system is established and osteogenesis has been induced in these cells successfully. Upon induction of osteogenesis, reduced expression of Asporin mRNA and increased expression of bone and osteogenesis markers are detected compared to cells maintained without osteogenic induction. Importantly, treatment with human recombinant Asporin protein reduces the mineralization level in osteogenic media-induced aortic valvular interstitial cells with the concomitant decreased level of Wnt/β-catenin signaling. Overall, all these data are highly indicative that Asporin might be a novel biomolecular target to treat patients of calcific aortic valve disease over current cusp replacement surgery.
Study on Fatigue Test and Life Prediction of Polyurethane Cement Composite (PUC) under High or Low Temperature Conditions
Authors: Gao Hongshuai , Sun Quansheng
Published: April 2020

There are many diseases in the deck pavement of long‐span steel bridges under the action of vehicles, rainwater, and freezing. It is necessary to study a new type of pavement material with high waterproof property, light weight, and high bonding performance for steel deck pavement. Polyurethane cement composite (PUC) can be used for steel deck pavement. In order to find out the temperature effect on fatigue properties of PUC, the four‐point bending fatigue test was carried out at different temperatures. In this paper, the optimum mix ratio of PUC was selected by compressive and flexural tests, and then the bending fatigue test was conducted under strain control mode. Under temperature and external force coupling condition, a method for predicting fatigue life of PUC is proposed by the combination of theoretical deduction and experimental research. The results show that the proposed formula can effectively describe the fatigue life and fatigue limit of PUC. Finally, compared with three different asphalt mixtures for steel deck pavement, it is found that the fatigue performance of polyurethane cement is better than that of asphalt mixture.
Improved Generalized Sparsity Adaptive Matching Pursuit Algorithm Based on Compressive Sensing
Authors: Liquan Zhao , Ke Ma , Yanfei Jia
Published: April 2020

The modified adaptive orthogonal matching pursuit algorithm has a lower convergence speed. To overcome this problem, an improved method with faster convergence speed is proposed. In respect of atomic selection, the proposed method computes the correlation between the measurement matrix and residual and then selects the atoms most related to residual to construct the candidate atomic set. The number of selected atoms is the integral multiple of initial step size. In respect of sparsity estimation, the proposed method introduces the exponential function to sparsity estimation. It uses a larger step size to estimate sparsity at the beginning of iteration to accelerate the algorithm convergence speed and a smaller step size to improve the reconstruction accuracy. Simulations show that the proposed method has better performance in terms of convergence speed and reconstruction accuracy for one-dimension signal and two-dimension signal.