bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility and Techniques of Securing 3D-Safety Margin in Superselective Transarterial Chemoembolization to Improve Local Tumor Control for Small Hepatocellular Carcinoma: An Intend-to-Treat Analysis
Authors: Charoenvisal Ching , Tanaka Toshihiro , Nishiofuku Hideyuki , Anai Hiroshi , Sato Takeshi , Matsumoto Takeshi , Marugami Nagaaki , Kichikawa Kimihiko
Published: January 2021

Introduction: The aim of this study was to investigate the technical success rate of obtaining 3D-safety margin in superselective conventional transarterial chemoembolization (cTACE) using 3D images for small hepatocellular carcinoma (HCC). Methods: Consecutive 48 HCC nodules (diameter, 1–3 cm) in 44 patients were intentionally treated by superselective cTACE in an attempt to achieve 3D-safety margin. Superselective CT during hepatic arteriography (CTHA) was obtained before cTACE. When negative 3D-safety margin was found, branches supplied into the margin area were detected by using a 3D workstation. The technical success rate to obtain 3D-safety margin was investigated by intend-to-treat analysis. Local tumor recurrence rate and adverse events were also evaluated. Result: Nine of 48 tumors (18.8%) had 3D-safety margin in the initial superselective CTHA. After pulling back of the catheter and/or selection of another branch based on 3D images, 3D-safety margin was finally achieved in 45 (93.8%). There were 8 of 46 tumors (17.4%) with local recurrence after 5-year follow-up. Grade 3–4 of aspartate aminotransferase, alanine aminotransferase, and total bilirubin were found in 38.6, 36.4, and 2.3%, respectively. One portal vein thrombus and 3 biliary dilation or biloma were developed. Conclusion: Superselective cTACE obtaining 3D-safety margin in small HCC was feasible with a high success rate by using 3D images, which could be tolerable and prevent local tumor recurrence.
Influence of Including Patients with Premorbid Disability in Acute Stroke Trials: The HeadPoST Experience
Authors: Wang Xia , Moullaali Tom J. , Ouyang Menglu , Billot Laurent , Sandset Else Charlotte , Song Lili , Delcourt Candice , Hackett Maree L. , Watkins Caroline L. , Robinson Thompson G. , Yang Jie , Lavados Pablo M. , Brunser Alejandro , Olavarría Verónica V. , Muñoz-Venturelli Paula , Arima Hisatomi , Middleton Sandy , Pontes-Neto Octávio M. , Pandian Jeyaraj Durai , Rogers Kris , Anderson Craig S.
Published: January 2021

Background: Patients with premorbid functional impairment are generally excluded from acute stroke trials. We aimed to determine the impact of including such patients in the Head Positioning in acute Stroke Trial (HeadPoST) and early additional impairment on outcomes. Methods: Post hoc analyses of HeadPoST, an international, cluster-randomized crossover trial of lying-flat versus sitting-up head positioning in acute stroke. Associations of early additional impairment, defined as change in modified Rankin scale (mRS) scores from premorbid levels (estimated at baseline) to Day 7 (“early ΔmRS”), and poor outcome (mRS score 3–6) at Day 90 were determined with generalized linear mixed model. Heterogeneity of the trial treatment effect was tested according to premorbid mRS scores 0–1 versus 2–5. Results: Of 8,285 patients (38.9% female, mean age 68 ± 13 years) with complete data, there were 1,984 (23.9%) with premorbid functional impairment (mRS 2–5). A significant linear association was evident for early ∆mRS and poor outcome (per 1-point increase in ΔmRS, adjusted odds ratio 1.20, 95% confidence interval 1.14–1.27; p < 0.0001). Patients with greater premorbid functional impairment were less likely to develop additional impairment, but their risk of poor 90-day outcome significantly increased with increasing (worse) premorbid mRS scores (linear trend p < 0.0001). There was no heterogeneity of the trial treatment effect by level of premorbid function. Conclusions: Early poststroke functional impairment that exceeded premorbid levels was associated with worse 90-day outcome, and this association increased with greater premorbid functional impairment. Yet, including premorbid impaired patients in the HeadPoST did not materially affect the subsequent treatment effect. Clinical Trial Registration: HeadPoST is registered at http://www.ClinicalTrials.gov (NCT02162017).
Territorialidade e ecótonos urbanos: limites em tensionamento
Authors: Miyamoto James Shoiti
Published: January 2021

This work consists in the search for an understanding of the concerns of urban relations that characterize the “urban ecotones”, based on a bibliographic review of the territorial expression that marks and distinguishes ecosystems. The expression “ecotone” is discussed and recontextualized from an urban perspective, through a transdisciplinary approach. In the sequence, particular situations are presented, associated with propositions of classifications related to the term, within the scope of cities. The same Greek prefix oîkos (eco) present in “ecology”, meaning intimate environment, − the home −, arises in ecotone, added by the Greek suffix tonos (or Latin tonus), indicating tensioning. Therefore ecotone, originally a colloquial expression found in biology, refers to the transition zones between biocenoses. It is the region where neighboring biomes, with different structures and characteristics, converge and interact. In an urban environment, the definition deserves a more specific approach, which stimulates a reflection on the notably anthropic presence. That implies recognizing a coexistence that often leads to social raids and clashes of political, cultural, affective and economic nature. The multidisciplinarity and transdisciplinarity associated with the topic requires, to a certain extent, some transit between the natural sciences and the social sciences, in their different manifestations and approaches.
Zanine, inovação social e móveis de madeira
Authors: Carvalho Amanda Beatriz Palma de , Bartholomeu Clara de Souza , Santos Maria Cecília Loschiavo dos
Published: January 2021

José Zanine Caldas (1919-2001), designer e arquiteto autodidata brasileiro, foi responsável pelo desenvolvimento de produtos e casas icônicas em madeira e também de processos projetuais com artesãos com os quais trabalhava. Na área de design, seus dois momentos produtivos mais importantes apresentam significativas diferenças em relação à técnica utilizada, à inclusão do conhecimento técnico autóctone dos trabalhadores no processo produtivo, ao público-alvo dos produtos realizados e à preocupação com o meio-ambiente. Para demonstrar o desenvolvimento do pensamento de Zanine, compararemos seu trabalho nesses dois momentos diferentes: a época em que esteve à frente da Fábrica Móveis Artísticos Z, década de 1950, usando tecnologia importada e trabalho pouco especializado; e a produção de seus "Móveis-Denúncia", na década de 1970, em que fez móveis no sul da Bahia a partir do conhecimento dos construtores de canoas, de técnicas e ferramentas tradicionais. O artigo visa contribuir com a discussão sobre a função do designer e da produção material em um grupo de trabalhadores responsáveis pela confecção dos produtos a partir de diferentes metodologias projetuais adotadas pelo mesmo autor.
Proteomic and Functional Studies Reveal Detyrosinated Tubulin as Treatment Target in Sarcomere Mutation-Induced Hypertrophic Cardiomyopathy
Authors: Schuldt Maike , Pei Jiayi , Harakalova Magdalena , Dorsch Larissa M. , Schlossarek Saskia , Mokry Michal , Knol Jaco C. , Pham Thang V. , Schelfhorst Tim , Piersma Sander R. , dos Remedios Cris , Dalinghaus Michiel , Michels Michelle , Asselbergs Folkert W. , Moutin Marie-Jo , Carrier Lucie , Jimenez Connie R. , van der Velden Jolanda , Kuster Diederik W.D.
Published: January 2021

Background:

Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease. While ≈50% of patients with HCM carry a sarcomere gene mutation (sarcomere mutation-positive, HCM
SMP
), the genetic background is unknown in the other half of the patients (sarcomere mutation-negative, HCM
SMN
). Genotype-specific differences have been reported in cardiac function. Moreover, HCM
SMN
patients have later disease onset and a better prognosis than HCM
SMP
patients. To define if genotype-specific derailments at the protein level may explain the heterogeneity in disease development, we performed a proteomic analysis in cardiac tissue from a clinically well-phenotyped HCM patient group.

Methods:

A proteomics screen was performed in cardiac tissue from 39 HCM
SMP
patients, 11HCM
SMN
patients, and 8 nonfailing controls. Patients with HCM had obstructive cardiomyopathy with left ventricular outflow tract obstruction and diastolic dysfunction. A novel
MYBPC3
2373insG
mouse model was used to confirm functional relevance of our proteomic findings.

Results:

In all HCM patient samples, we found lower levels of metabolic pathway proteins and higher levels of extracellular matrix proteins. Levels of total and detyrosinated α-tubulin were markedly higher in HCM
SMP
than in HCM
SMN
and controls. Higher tubulin detyrosination was also found in 2 unrelated
MYBPC3
mouse models and its inhibition with parthenolide normalized contraction and relaxation time of isolated cardiomyocytes.

Conclusions:

Our findings indicate that microtubules and especially its detyrosination contribute to the pathomechanism of patients with HCM
SMP
. This is of clinical importance since it represents a potential treatment target to improve cardiac function in patients with HCM
SMP
, whereas a beneficial effect may be limited in patients with HCM
SMN
.
Higher Emergency Physician Chest Pain Hospitalization Rates Do Not Lead to Improved Patient Outcomes
Authors: Natsui Shaw , Sun Benjamin C. , Shen Ernest , Redberg Rita F. , Ferencik Maros , Lee Ming-Sum , Musigdilok Visanee , Wu Yi-Lin , Zheng Chengyi , Kawatkar Aniket A. , Sharp Adam L.
Published: January 2021

Background:

Wide variation exists for hospital admission rates for the evaluation of possible acute coronary syndrome, but there are limited data on physician-level variation. Our aim is to describe physicians’ rates of admission for suspected acute coronary syndrome and associated 30-day major adverse events.

Methods:

We conducted a retrospective analysis of adult emergency department chest pain encounters from January 2016 to December 2017 across 15 community emergency departments within an integrated health system in Southern California. The unit of analysis was the Emergency physician. The primary outcome was the proportion of patients admitted/observed in the hospital. Secondary analysis described the 30-day incidence of death or acute myocardial infarction.

Results:

Thirty-eight thousand seven hundred seventy-eight patients encounters were included among 327 managing physicians. The median number of encounters per physician was 123 (interquartile range, 82–157) with an overall admission/observation rate of 14.0%. Wide variation in individual physician admission rates were observed (unadjusted, 1.5%–68.9%) and persisted after case-mix adjustments (adjusted, 5.5%–27.8%). More clinical experience was associated with a higher likelihood of hospital care. There was no difference in 30-day death or acute myocardial infarction between high- and low-admitting physician quartiles (unadjusted, 1.70% versus 0.82% and adjusted, 1.33% versus 1.29%).

Conclusions:

Wide variation persists in physician-level admission rates for emergency department chest pain evaluation, even in a well-integrated health system. There was no associated benefit in 30-day death or acute myocardial infarction for patients evaluated by high-admitting physicians. This suggests an additional opportunity to investigate the safe reduction of physician-level variation in the use of hospital care.
Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study
Authors: Benderly Michal , Buber Jonathan , Kalter‐Leibovici Ofra , Blieden Leonard , Dadashev Alexander , Lorber Avraham , Nir Amiram , Yalonetsky Sergei , Chodick Gabriel , Weitzman Dahlia , Balicer Ran , Mazor Dray Efrat , Murad Havi , Razon Yaron , Hirsch Rafael ,   for the Israeli Adult Congenital Heart Disease Research Group
Published: January 2021

Background

Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD.

Methods and Results

We identified 11 653 patients with ACHD aged ≥18 years (median, 47 years), through electronic records of 2 large Israeli healthcare providers (2007–2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standardized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47–1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69–5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82–7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61–16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: primary care (HR, 1.14; 95% CI, 1.06–1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24–1.59); emergency department visits (HR, 1.19; 95% CI, 1.02–1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49–2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84–0.94]) and periphery (HR, 0.72 [95% CI, 0.58–0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients.

Conclusions

Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and ethnicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.
Pharmacotherapy in the Management of Anxiety and Pain During Acute Coronary Syndromes and the Risk of Developing Symptoms of Posttraumatic Stress Disorder
Authors: von Känel Roland , Schmid Jean‐Paul , Meister‐Langraf Rebecca E. , Barth Jürgen , Znoj Hansjörg , Schnyder Ulrich , Princip Mary , Pazhenkottil Aju P.
Published: January 2021

Background

Benzodiazepines and morphine are given during acute coronary syndromes (ACSs) to alleviate anxiety and pain, and β‐blockers may also reduce pain. ACS may induce posttraumatic stress disorder (PTSD) symptoms (PTSS). When taken during trauma other than ACS, benzodiazepines increase the risk of PTSS, but it is unknown if benzodiazepines increase the risk of PTSS in ACS. We examined the effects of drug exposure during ACS on the development of PTSS.

Methods and Results

Study participants were 154 patients with a verified ACS. Baseline demographics, clinical variables, and psychological measures were obtained through a medical history, through a psychometric assessment, and from patient records, and used as covariates in linear regression analysis. Three months after ACS, the severity of PTSS was assessed with the Clinician‐Administered PTSD Scale. During ACS, 37.7% of patients were exposed to benzodiazepines, whereas 72.1% were exposed to morphine and 88.3% were exposed to β‐blockers, but only 7.1% were exposed to antidepressants. Eighteen (11.7%) patients developed clinical PTSD. Adjusting for all covariates, benzodiazepine use was significantly associated with the Clinician‐Administered PTSD Scale total severity score (unstandardized coefficient B [SE], 0.589 [0.274]; partial
r
=0.18;
P
=0.032) and the reexperiencing subscore (B [SE], 0.433 [0.217]; partial
r
=0.17;
P
=0.047). Patients exposed to benzodiazepines had an almost 4‐fold increased relative risk of developing clinical PTSD, adjusting for acute stress disorder symptoms (odds ratio, 3.75; 95% CI, 1.31–10.77). Morphine, β‐blockers, and antidepressants showed no predictive value.

Conclusions

Notwithstanding short‐term antianxiety effects during ACS, benzodiazepine use might increase the risk of ACS‐induced PTSS with clinical significance, thereby compromising patients' quality of life and prognosis.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01781247.
Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows
Authors: Nogueira Raul G. , Haussen Diogo C. , Liebeskind David , Jovin Tudor G. , Gupta Rishi , Jadhav Ashutov , Budzik Ron F. , Baxter Blaise , Krajina Antonin , Bonafe Alain , Malek Ali , Narata Ana Paula , Shields Ryan , Zhang Yanchang , Morgan Patricia , Bartolini Bruno , English Joey , Frankel Michael R. , Veznedaroglu Erol ,   for the Trevo Registry and DAWN Trial Investigators
Published: January 2021

Background and Purpose:

Advanced imaging has been increasingly used for patient selection in endovascular stroke therapy. The impact of imaging selection modality on endovascular stroke therapy clinical outcomes in extended time window remains to be defined. We aimed to study this relationship and compare it to that noted in early-treated patients.

Methods:

Patients from a prospective multicentric registry (n=2008) with occlusions involving the intracranial internal carotid or the M1- or M2-segments of the middle cerebral arteries, premorbid modified Rankin Scale score 0 to 2 and time to treatment 0 to 24 hours were categorized according to treatment times within the early (0–6 hour) or extended (6–24 hour) window as well as imaging modality with noncontrast computed tomography (NCCT)±CT angiography (CTA) or NCCT±CTA and CT perfusion (CTP). The association between imaging modality and 90-day modified Rankin Scale, analyzed in ordinal (modified Rankin Scale shift) and dichotomized (functional independence, modified Rankin Scale score 0–2) manner, was evaluated and compared within and across the extended and early windows.

Results:

In the early window, 332 patients were selected with NCCT±CTA alone while 373 also underwent CTP. After adjusting for identifiable confounders, there were no significant differences in terms of 90-day functional disability (ordinal shift: adjusted odd ratio [aOR], 0.936 [95% CI, 0.709–1.238],
P
=0.644) or independence (aOR, 1.178 [95% CI, 0.833–1.666],
P
=0.355) across the CTP and NCCT±CTA groups. In the extended window, 67 patients were selected with NCCT±CTA alone while 180 also underwent CTP. No significant differences in 90-day functional disability (aOR, 0.983 [95% CI, 0.81–1.662],
P
=0.949) or independence (aOR, 0.640 [95% CI, 0.318–1.289],
P
=0.212) were seen across the CTP and NCCT±CTA groups. There was no interaction between the treatment time window (0–6 versus 6–24 hours) and CT selection modality (CTP versus NCCT±CTA) in terms of functional disability at 90 days (
P
=0.45).

Conclusions:

CTP acquisition was not associated with better outcomes in patients treated in the early or extended time windows. While confirmatory data is needed, our data suggests that extended window endovascular stroke therapy may remain beneficial even in the absence of advanced imaging.
Minimalist Phenomenology and Van der Leeuw’s Phenomenology of Religion
Authors: Harding Brian
Published: January 2021

Beginning with a brief discussion of Dominique Janicaud’s proposal for a minimalist phenomenology, I turn to the work G. van der Leeuw and argue that his work in the phenomenology of religion can be profitably read as a minimalist phenomenology. I do this by focusing mainly on his methodological remarks, but do occasionally refer to his analyses of particular religious phenomena. Finally, the paper closes with some suggestions about how to think of the relationship between minimalist phenomenology and religious belief.
Antisemitism among Adolescents in Germany
Authors: Schröder Carl Philipp
Published: January 2021

Europe is facing a new wave of antisemitism, which has grown in recent years. In 2019, the number of reported antisemitic crimes has increased in Germany. On the one hand, Muslim immigrants are suspected of so-called “imported Antisemitism”. On the other hand, right-wing extremism still appears to be the main cause of most antisemitic crimes. Moreover, antisemitism may also be rooted in the left-wing spectrum hiding behind the criticism of Israel and its policies. To analyze the connections of antisemitic attitudes, data from a school survey of 6,715 ninth-graders are used. The results indicate a strong connection between right-wing attitudes and antisemitism as well as left-wing and Islamist attitudes and antisemitism. Higher values of antisemitism are also found among Muslims, but the main predictor of antisemitic attitudes is by far right-wing attitudes.
Anatomy of a Violent Protest Wave: Understanding the Mechanisms of Escalation and De-Escalation in Far-Right and Anti-Fascist Street Clashes
Authors: Serbulo Leanne C.
Published: January 2021

With the rise of right-wing populist ideologies and ensuing social polarization, political violence has become more widespread. Between 2017 and 2019, far-right extremists and anti-fascists engaged in more than twenty violent protest clashes in Portland, Oregon, USA. Through a protest event analysis of those clashes supplemented with a case study of the protest wave, this paper explores how the mechanisms of radicalization and de-radicalization operate when two violent protest movements collide and interact with state security forces. The three-way interaction among a movement, counter-movement, and the police can produce unanticipated outcomes. For example, rather than de-escalating the situation, police underbidding resulted in an increase in violence between the two movements. Understanding how the mechanisms of radicalization and de-radicalization function in a movement/counter-movement protest cycle can provide insight into the ways in which a movement’s strategy and their adversaries’ responses to it can increase or decrease levels of violence.
Disobeying in Time of Disaster: Radicalism in the French Climate Mobilizations
Authors: Gaborit Maxime
Published: January 2021

Since 2018, climate mobilizations have been shaping political life in Europe. Young people are at the heart of this mobilization, both because of their massive nationwide presence in intergenerational demonstrations, but also because of their own modes of action, such as the climate strikes that have been emerging since January 2019. Within these mobilizations, forms of radicalism are expressed through an important support for civil disobedience, such as blocking actions, as well as support – for a significant part of protestors – for material damage. This paper analyzes the new forms of youth radicalism in their link to the social determinations of the awareness of the climate catastrophe. Based on a demonstration survey concerning three French cities for the strike of March 15, 2019, and in Paris for the strike of September 20th, which collected more than 1,800 questionnaires, this paper sets out to show the sociological profiles of radical individuals, which distinguish themselves by significant cultural capital and left-wing familial political socialization. The exploitation of the data collected shows that these new forms of radicalism are conditioned by an awareness of the climate emergency, deeply linked to family legacies and specific academic curricula. The radicalization of inherited dispositions leads these individuals to go beyond the legality/illegality framework, and to favor a debate on the effectiveness of the means of action, in which the link with conventional democratic participation is constantly questioned.
“We Are Radical In Our Kindness”: The Political Socialisation, Motivations, Demands and Protest Actions of Young Environmental Activists in Britain
Authors: Pickard Sarah , Bowman Benjamin , Arya Dena
Published: January 2021

The year 2018 was a watershed in environmental activism, especially regarding young activists. Greta Thunberg started her School Strikes for Climate and the environmental movement Extinction Rebellion was founded. This article deals with young people’s involvement in these two global movements. It draws on 60 semi-structured interviews carried out with young environmental activists before, during and after protest actions under the auspices of the climate strikes and/or Extinction Rebellion in five British locations.

The period of the political socialisation of this young generation is outlined and how it contributes to young people becoming environmental activists. The article then identifies the “radical” demands made by young environmental activists and their “radical” repertoire of contention in relation to their perceptions of the “radical” compared to hegemonic definitions.

The interviews show that these young environmentalists are part of a generation of activists committed to obtaining significant change from powerholders through the use of deliberately non-violent direct action that challenges academic perceptions of radical repertoires of contention.
The genus Synergus Hartig (Hymenoptera: Cynipidae: Synergini) in the New World: a complete taxonomic revision with a key to species
Authors: LOBATO-VILA IRENE , PUJADE-VILLAR JULI
Published: January 2021

A complete revision of the genus Synergus Hartig (Hymenoptera: Cynipidae: Synergini) in the New World (Nearctic and Neotropical regions) is conducted for the first time in order to stabilize its taxonomy. A total of 11 new species are described from Mexico: S. ashmeadi Lobato-Vila & Pujade-Villar, sp. nov.; S. beutenmulleri Lobato-Vila & Pujade-Villar, sp. nov.; S. compressus Lobato-Vila & Pujade-Villar, sp. nov.; S. diversicolor Lobato-Vila & Pujade-Villar, sp. nov.; S. ebenus Lobato-Vila & Pujade-Villar, sp. nov.; S. linnei Lobato-Vila & Pujade-Villar, sp. nov.; S. macrackenae Lobato-Vila & Pujade-Villar, sp. nov.; S. oaxaquensis Lobato-Vila & Pujade-Villar, sp. nov.; S. personatus Lobato-Vila & Pujade-Villar, sp. nov.; S. ruficephalus Lobato-Vila & Pujade-Villar, sp. nov.; and S. weldi Lobato-Vila & Pujade-Villar, sp. nov. Synergus splendidus Fullaway, 1911 is proposed as a syn. nov. of S. dorsalis (Provacher, 1889); S. garryana Gillette, 1893 and S. oneratus coloradensis Gillette, 1896 as syn. nov. of S. oneratus (Harris, 1841); and S. magnificus Weld, 1957 as a syn. nov. of S. reniformis McCracken & Egbert, 1922. Redescriptions and illustrations are provided for poorly characterized species. A key to species and a summary table including all valid Synergus from the New World, their biology and distribution, are given. Distribution, morphology, and trophic associations are discussed and compared between New World and Palaearctic species.
Association between cervical disc disease and lesions of multiple sclerosis
Authors: Alkrenawi Marwan , Osherov Michael , Simonovich Azaria , Droujin Jonathan , Milo Ron , Appel Shmuel
Published: January 2021

Background

Cervical discopathy and demyelinating lesions often co-exist in patients with multiple sclerosis (MS). Our study examines the possible association between these two pathologies.

Methods

Medical records and cervical magnetic resonance imaging scans of MS patients with cervical discopathy who were seen at our MS clinic during 2018 were retrospectively reviewed. The severity of the disc disease was classified as grade I (no compression), grade II (compression of the dural sac) and grade III (cord compression). The spinal cord in each scan was divided into six segments corresponding to the intervertebral space of the spine (C1–C6). Each segment was defined as containing demyelinating lesion and disc pathology (group 1), demyelinating lesion without disc pathology (group 2), disc pathology without demyelinating lesion (group 3) and no demyelinating lesion or disc pathology (group 4). Fisher’s exact test was used to test the association between demyelinating lesions and disc pathology.

Results

Thirty-four MS patients with cervical discopathy were included in the study (26 females; average age 42.9 ± 13.7 years; average disease duration 8.4 ± 5.4 years). A total of 204 spinal cord segments were evaluated. Twenty-four segments were classified as group 1, 27 segments as group 2, 52 segments as group 3 and 101 segments as group 4. There was no association between demyelinating lesions and the grade of disc disease ( p = 0.1 for grade I, p = 0.3 for grade II and p = 1 for grade III disc disease).

Conclusion

Our study did not find any association between cervical disc disease and demyelinating spinal cord lesion.
Healthcare in transition in the Republic of Armenia: the evolution of emergency medical systems and directions forward
Authors: Chekijian Sharon , Truzyan Nune , Stepanyan Taguhi , Bazarchyan Alexander
Published: January 2021

Armenia, an ex-Soviet Republic in transition since independence in 1991, has made remarkable strides in development. The crisis of prioritization that has plagued many post-Soviet republics in transition has meant differential growth in varied sectors in Armenia. Emergency systems is one of the sectors which is neglected in the current drive to modernize. The legacy of the Soviet Semashko system has left a void in specialized care including emergency care. This manuscript is a descriptive overview of the current state of emergency care in Armenia using in-depth key informant interviews and review of published and unpublished internal United States Agency for International Development (USAID) and Ministry of Health (MOH) documents as well as data from the Yerevan Municipal Ambulance Service and international agencies. The Republic of Artsakh is briefly discussed.

The development of emergency care systems is an extremely efficient way to provide care across many different conditions in many age groups. Conditions such as traumatic injuries, heart attacks, cardiac arrest, stroke, and respiratory failure are very time-dependent. Armenia has a decent emergency infrastructure in place and has the benefit of an educated and skilled physician workforce. The missing piece of the puzzle appears to be investment in graduate and post-graduate education in emergency care and development of hospital-based emergency care for stabilization of stroke, myocardial infarction, trauma, and sepsis as well as other acute conditions.
Drug perturbation gene set enrichment analysis (dpGSEA): a new transcriptomic drug screening approach
Authors: Fang Mike , Richardson Brian , Cameron Cheryl M. , Dazard Jean-Eudes , Cameron Mark J.
Published: January 2021

Background

In this study, we demonstrate that our modified Gene Set Enrichment Analysis (GSEA) method, drug perturbation GSEA (dpGSEA), can detect phenotypically relevant drug targets through a unique transcriptomic enrichment that emphasizes biological directionality of drug-derived gene sets.

Results

We detail our dpGSEA method and show its effectiveness in detecting specific perturbation of drugs in independent public datasets by confirming fluvastatin, paclitaxel, and rosiglitazone perturbation in gastroenteropancreatic neuroendocrine tumor cells. In drug discovery experiments, we found that dpGSEA was able to detect phenotypically relevant drug targets in previously published differentially expressed genes of CD4+T regulatory cells from immune responders and non-responders to antiviral therapy in HIV-infected individuals, such as those involved with virion replication, cell cycle dysfunction, and mitochondrial dysfunction. dpGSEA is publicly available athttps://github.com/sxf296/drug_targeting.

Conclusions

dpGSEA is an approach that uniquely enriches on drug-defined gene sets while considering directionality of gene modulation. We recommend dpGSEA as an exploratory tool to screen for possible drug targeting molecules.
Postoperative outcomes in surgical COVID-19 patients: a multicenter cohort study
Authors: Carrier François Martin , Amzallag Éva , Lecluyse Vincent , Côté Geneviève , Couture Étienne J. , D’Aragon Frédérick , Kandelman Stanislas , Turgeon Alexis F. , Deschamps Alain , Nitulescu Roy , Djade Codjo Djignefa , Girard Martin , Beaulieu Pierre , Richebé Philippe
Published: January 2021

Background

Data on postoperative outcomes of the COVID-19 patient population is limited. We described COVID-19 patients who underwent a surgery and the pandemic impact on surgical activities.

Methods

We conducted a multicenter cohort study between March 13 and June 192,020. We included all COVID-19 patients who underwent surgery in nine centres of the Province of Québec, the Canadian province most afflicted by the pandemic. We also included concomitant suspected COVID-19 (subsequently confirmed not to have COVID-19) patients and patients who had recovered from it. We collected data on baseline characteristics, postoperative complications and postoperative mortality. Our primary outcome was 30-day mortality. We also collected data on overall surgical activities during this first wave and during the same period in 2019.

Results

We included 44 COVID-19 patients, 18 suspected patients, and 18 patients who had recovered from COVID-19 at time of surgery. Among the 44 COVID-19 patients, 31 surgeries (71%) were urgent and 16 (36%) were major. In these patients, pulmonary complications were frequent (25%) and 30-day mortality was high (15.9%). This mortality was higher in patients with symptoms (23.1%) compared to those without symptoms (5.6%), although not statistically significant (p = 0.118). Of the total 22,616 cases performed among participating centres during the study period, only 0.19% had COVID-19 at the time of surgery. Fewer procedures were performed during the study period compared to the same period in 2019 (44,486 cases).

Conclusion

In this Canadian cohort study, postoperative 30-day mortality in COVID-19 patients undergoing surgery was high (15.9%). Although few surgeries were performed on COVID-19 patients, the pandemic impact on surgical activity volume was important.

Trial registration

ClinicalTrials.gov Identifier:NCT04458337.
Predictors of mortality and adverse events in patients with infective endocarditis: a retrospective real world study in a surgical centre
Authors: Scheggi Valentina , Merilli Irene , Marcucci Rossella , Del Pace Stefano , Olivotto Iacopo , Zoppetti Nicola , Ceschia Nicole , Andrei Valentina , Alterini Bruno , Stefàno Pier Luigi , Marchionni Niccolò
Published: January 2021

Purpose

Mortality in infective endocarditis (IE) is still high, and the long term prognosis remains uncertain. This study aimed to identify predictors of long-term mortality for any cause, adverse event rate, relapse rate, valvular and ventricular dysfunction at follow-up, in a real-world surgical centre.

Methods

We retrospectively analyzed 363 consecutive episodes of IE (123 women, 34%) admitted to our department with a definite diagnosis of non-device-related IE. Median follow-up duration was 2.9 years. Primary endpoints were predictors of mortality, recurrent endocarditis, and major non-fatal adverse events (hospitalization for any cardiovascular cause, pace-maker implantation, new onset of atrial fibrillation, sternal dehiscence), and ventricular and valvular dysfunction at follow-up.

Results

Multivariate analysis independent predictors of mortality showed age (HR per unit 1.031, p < 0.003), drug abuse (HR 3.5, p < 0.002), EUROSCORE II (HR per unit 1.017, p < 0.0006) and double valve infection (HR 2.3, p < 0.001) to be independent predictors of mortality, while streptococcal infection remained associated with a better prognosis (HR 0.5, p < 0.04). Major non-fatal adverse events were associated with age (HR 1.4, p < 0.022). New episodes of infection were correlated with S aureus infection (HR 4.8, p < 0.001), right-sided endocarditis (HR 7.4, p < 0.001), spondylodiscitis (HR 6.8, p < 0.004) and intravenous drug abuse (HR 10.3, p < 0.001). After multivariate analysis, only drug abuse was an independent predictor of new episodes of endocarditis (HR 8.5, p < 0.001). Echocardiographic follow-up, available in 95 cases, showed a worsening of left ventricular systolic function (p < 0.007); severe valvular dysfunction at follow-up was reported only in 4 patients, all of them had mitral IE (p < 0.03).

Conclusions

The present study highlights some clinical, readily available factors that can be useful to stratify the prognosis of patients with IE.
Reaching everyone in general practice? Feasibility of an integrated domestic violence training and support intervention in primary care
Authors: Szilassy Eszter , Roy Jessica , Williamson Emma , Pitt Katherine , Man Mei-See , Feder Gene
Published: January 2021

Background

Primary care needs to respond effectively to patients experiencing or perpetrating domestic violence and abuse (DVA) and their children, but there is uncertainty about the value of integrated programmes. The aim of the study was to develop and test the feasibility of an integrated primary care system-level training and support intervention, called IRIS+ (Enhanced Identification and Referral to Improve Safety), for all patients affected by DVA. IRIS+ was an adaptation of the original IRIS (Identification and Referral to Improve Safety) model designed to reach female survivors of DVA.

Methods

Observation of training; pre/post intervention questionnaires with clinicians and patients; data extracted from medical records and DVA agency; semi-structured interviews with clinicians, service providers and referred adults and children. Data collection took place between May 2017 and April 2018. Mixed method analysis was undertaken to triangulate data from various sources to assess the feasibility and acceptability of the intervention.

Results

Clinicians and service providers believed that the IRIS+ intervention had filled a service gap and was a valuable resource in identifying and referring women, men and children affected by DVA. Despite increased levels of preparedness reported by clinicians after training in managing the complexity of DVA in their practice, the intervention proved to be insufficient to catalyse identification and specialist referral of men and direct identification and referral (without their non-abusive parents) of children and young people. The study also revealed that reports provided to general practice by other agencies are important sources of information about adult and children patients affected by DVA. However, in the absence of guidance about how to use this information in patient care, there are uncertainties and variation in practice.

Conclusions

The study demonstrates that the IRIS+ intervention is not feasible in the form and timeframe we evaluated. Further adaptation is required to achieve identification and referral of men and children in primary care: an enhanced focus on engagement with men, direct engagement with children, and improved guidance and training on responding to reports of DVA received from other agencies.
Amygdalin promotes the activity of T cells to suppress the progression of HBV-related hepatocellular carcinoma via the JAK2/STAT3 signaling pathway
Authors: Wang Ruoyu , Zhang Dong , Sun Kewei , Peng Jianping , Zhu Wenfang , Yin Sihan , Tang Dan , Wu Yunan
Published: January 2021

Background

Hepatitis B virus (HBV) infection is a high-risk factor of hepatocellular carcinoma (HCC). Cellular immune responses are essential for HCC development, and the CD4+ and CD8+ T subtypes are identified as the primary anti-tumor immune cells. In the study, we investigated the effect and mechanism of amygdalin in the cellular immune response in HBV-related HCC and HCC progression.

Methods

The cell proliferation was examined by MTT analysis. Cells metastasis ability was detected by Invasion and migration assays. Quantification of apoptotic cells was performed with Flow cytometer assay. The protein levels of p-STAT3, STAT3, p-JAK2, JAK2, caspase-3, cleaved caspase-3 were detected by performing immunoblotting assays.

Results

We demonstrate that amygdalin treatment could rescue the HBV-T cell viability and IFN-γ and TNF-αproduction. In HBV-T cells, the MFI levels of CD8+ are lower than that in NC-T cells. Moreover, the phosphorylation levels of STAT3 and JAK2 are higher in HBV-T cells, compared to those in NC-T cells, and then reduced by amygdalin treatment. Co-culture with HBV-T cells could reduce IFN-γ and TNF-α, production while increase IL-6 and IL-10 production in HepG2.2.15 cells; these alterations could be partially reversed by amygdalin pretreatment. Finally, co-culture with HBV-T cells significantly promoted the cell viability, inhibited the apoptosis, and promoted the migration of HepG2.2.15 cells, and these alterations could be partially reversed by amygdalin treatment.

Conclusion

Our findings provide a rationale for further studies on the functions and mechanism of amygdalin inhibiting HBV-related HCC cell proliferation, invasion, and migration via T cell-mediated tumor immunity.
Clinical characteristics and predictive value of lower CD4+T cell level in patients with moderate and severe COVID-19: a multicenter retrospective study
Authors: Wen Xue-song , Jiang Dan , Gao Lei , Zhou Jian-zhong , Xiao Jun , Cheng Xiao-cheng , He Bin , Chen Yue , Lei Peng , Tan Xiao-wei , Qin Shu , Zhang Dong-ying
Published: January 2021

Background

In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. Moreover, it has become a global pandemic. This is of great value in describing the clinical symptoms of COVID-19 patients in detail and looking for markers which are significant to predict the prognosis of COVID-19 patients.

Methods

In this multicenter, retrospective study, 476 patients with COVID-19 were enrolled from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death.

Results

The main symptoms observed in the study included fever on admission, cough, fatigue, and shortness of breath. The most common comorbidities were hypertension and diabetes mellitus. Patients with lower CD4+T cell level were older and more often male compared to those with higher CD4+T cell level. Reduced CD8+T cell level was an indicator of the severity of COVID-19. Both decreased CD4+T [HR:13.659; 95%CI: 3.235–57.671] and CD8+T [HR: 10.883; 95%CI: 3.277–36.145] cell levels were associated with in-hospital death in COVID-19 patients, but only the decrease of CD4+T cell level was an independent predictor of in-hospital death in COVID-19 patients.

Conclusions

Reductions in lymphocytes and lymphocyte subsets were common in COVID-19 patients, especially in severe cases of COVID-19. It was the CD8+T cell level, not the CD4+T cell level, that reflected the severity of the patient’s disease. Only reduced CD4+T cell level was independently associated with increased in-hospital death in COVID-19 patients.

Trial registration

Prognostic Factors of Patients With COVID-19,NCT04292964. Registered 03 March 2020. Retrospectively registered.
A case of recurrent sterile abscesses following tetanus-diphtheria vaccination treated with corticosteroids
Authors: Kaya Abdurrahman , Kaya Sibel Yıldız
Published: January 2021

Background

Vaccinations have been widely used worldwide since their invention to prevent various diseases, but they can also have some adverse effects ranging from mild local reactions to serious side effects. These adverse effects are generally self-limited and resolve within a short time without any treatment. While a sterile abscess following vaccination is a rare condition in adults, many cases have been reported regarding children in the literature. Here, we report a case of recurrent sterile abscesses, which occurred after a Td vaccination, treated with corticosteroids.

Case presentation

A 22-year old woman was admitted to our department with a complaint of swelling at the site of the vaccination. On physical examination, this mass was about 6 × 6 cm in size and fluctuating, but there were no pain complaints and no redness present. She had received her Td vaccination 3 weeks ago and the swelling had started at the site of the injection 4 days following this immunization. Oral amoxicillin/clavulanic acid and local antibiotic cream were administered for 10 days. The laboratory values were unremarkable. Despite the administration of antibiotics, the swelling did not regress, and on the contrary, continued to increase in size. On ultrasound, two interconnected abscesses were observed in the subcutaneous area, and did not involve the muscle tissue. Later, the abscesses were completely drained, and the samples were cultured. The current antibiotics were continued. The gram staining of the samples revealed abundant leukocytes but no microorganisms. The solid and liquid cultures of the materials remained negative. Despite the administration of multiple drainages and antibiotics, the mass recurred. Finally, the patient was considered to have a sterile abscess due to Td immunization. The antimicrobials were stopped. Local and oral corticosteroids were initiated. The swelling regressed significantly, and the treatments continued for 7 days. The patient has been doing well and has had no recurrence for over a year.

Conclusions

Corticosteroids appeared to improve the patient and therefore we suggest that the efficacy and route of administration of steroids in this situation should be explored further.
Foodborne botulism presenting as small bowel obstruction: a case report
Authors: Friziero Alberto , Sperti Cosimo , Da Dalt Gianfranco , Baldan Nicola , Zanchettin Gianpietro , Auricchio Pasquale , Gavagna Laura , Grego Andrea , Capelli Giulia , Merigliano Stefano
Published: January 2021

Background

Small bowel obstruction is one of the leading reasons for accessing to the Emergency Department. Food poisoning from Clostridium botulinum has emerged as a very rare potential cause of small bowel obstruction. The relevance of this case report regards the subtle onset of pathognomonic neurological symptoms, which can delay diagnosis and subsequent life-saving treatment.

Case presentation

A 24-year-old man came to our Emergency Department complaining of abdominal pain, fever and sporadic self-limiting episodes of diplopia, starting 4 days earlier. Clinical presentation and radiological imaging suggested a case of small bowel obstruction. Non-operative management was adopted, which was followed by worsening of neurological signs. On specifically questioning the patient, we discovered that his parents had experienced similar, but milder symptoms. The patient also recalled eating home-made preserves some days earlier. A clinical diagnosis of foodborne botulism was established and antitoxin was promptly administered with rapid clinical resolution.

Conclusions

Though very rare, botulism can mimic small bowel obstruction, and could be associated with a rapid clinical deterioration if misdiagnosed. An accurate family history, frequent clinical reassessments and involvement of different specialists can guide to identify this unexpected diagnosis.