bluuebunny/crossref_metadata_2025 huggingface dataset:
Red Blood Cell Distribution Width as a Predictor of 28‐Day Mortality in Critically Ill Patients With Alcohol Use Disorder
Authors: Liao Lin , Pinhu Liao
Published: October 2020

Background

Patients with alcohol use disorder (AUD) are common attendees of the intensive care unit (ICU). Early assessment of the prognosis for critically ill patients with AUD is conducive for formulating comprehensive treatment measures and improving survival rates. The purpose of this study was to explore the predictive value of red blood cell distribution width (RDW) for 28‐day mortality in critically ill patients with AUD.

Methods

2,884 patients with AUD were recruited retrospectively. Data from the MIMIC‐III database were collected and analyzed. A receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of RDW. The Kaplan–Meier method and Cox regression models were used to evaluate prognostic factors.

Results

Of the 2,884 patients, there were 344 nonsurvivors (11.9%). The nonsurvivors had a higher RDW than the survivors (p < 0.001). According to ROC curve analysis, the area under the curve predicted by RDW for 28‐day mortality was 0.728 (95% CI, 0.700 to 0.755) and the optimal cutoff value was 15.45% (sensitivity: 67.2%; specificity: 67.3%). Length of stay in ICU, length of stay in hospital, in‐hospital mortality, and 28‐day mortality in patients with an RDW > 15.45% were significantly higher than in those with an RDW ≤ 15.45% (p < 0.001). Cox regression analysis showed that an RDW > 15.45% was an independent prognostic indicator for 28‐day mortality in critically ill patients with AUD (HR = 1.964, 95% CI: 1.429 to 2.698).

Conclusions

High RDW was associated with increased short‐term mortality risks in critically ill patients with AUD.
The Effect of Chronic Ethanol Exposure and Thiamine Deficiency on Myelin‐related Genes in the Cortex and the Cerebellum
Authors: Chatterton Bradley J. , Nunes Polliana T. , Savage Lisa M.
Published: October 2020

Background

Long‐term alcohol consumption has been linked to structural and functional brain abnormalities. Furthermore, with persistent exposure to ethanol (EtOH), nutrient deficiencies often develop. Thiamine deficiency is a key contributor to alcohol‐related brain damage and is suspected to contribute to white matter pathology. The expression of genes encoding myelin proteins in several cortical brain regions is altered with EtOH exposure. However, there is limited research regarding the impact of thiamine deficiency on myelin dysfunction.

Methods

A rat model was used to assess the impact of moderate chronic EtOH exposure (CET; 20% EtOH in drinking water for 1 or 6 months), pyrithiamine‐induced thiamine deficiency treatment (PTD), both conditions combined (CET‐PTD), or CET with thiamine injections (CET + T) on myelin‐related gene expression (Olig1, Olig2, MBP, MAG, and MOG) in the frontal and parietal cortices and the cerebellum.

Results

The CET‐PTD treatments caused the greatest suppression in myelin‐related genes in the cortex. Specifically, the parietal cortex was the region that was most susceptible to PTD‐CET‐induced alterations in myelin‐related genes. In addition, PTD treatment, with and without CET, caused minor fluctuations in the expression of several myelin‐related genes in the frontal cortex. In contrast, CET alone and PTD alone suppressed several myelin‐related genes in the cerebellum. Regardless of the region, there was significant recovery of myelin‐related genes with extended abstinence and/or thiamine restoration.

Conclusion

Moderate chronic EtOH alone had a minor effect on the suppression of myelin‐related genes in the cortex; however, when combined with thiamine deficiency, the reduction was amplified. There was a suppression of myelin‐related genes following long‐term EtOH and thiamine deficiency in the cerebellum. However, the suppression in the myelin‐related genes mostly occurred 24 h after EtOH removal or following thiamine restoration; within 3 weeks of abstinence or thiamine recovery, gene expression rebounded.
Changes in Circulating Metabolome Precede Alcohol‐Related Diseases in Middle‐Aged Men: A Prospective Population‐Based Study With a 30‐Year Follow‐Up
Authors: Kärkkäinen Olli , Klåvus Anton , Voutilainen Ari , Virtanen Jyrki , Lehtonen Marko , Auriola Seppo , Kauhanen Jussi , Rysä Jaana
Published: October 2020

Background

Heavy alcohol use has been associated with altered circulating metabolome. We investigated whether changes in the circulating metabolome precede incident diagnoses of alcohol‐related diseases.

Methods

This is a prospective population‐based cohort study where the participants were 42‐ to 60‐year‐old males at baseline (years 1984 to 1989). Subjects who received a diagnosis for an alcohol‐related disease during the follow‐up were defined as cases (n = 92, mean follow‐up of 13.6 years before diagnosis). Diagnoses were obtained through linkage with national health registries. We used 2 control groups: controls who self‐reported similar levels of alcohol use as compared to cases at baseline (alcohol‐controls, n = 92), and controls who self‐reported only light drinking at baseline (control‐controls, n = 90). A nontargeted metabolomics analysis of baseline serum samples was performed.

Results

There were significant differences between the study groups in the baseline serum levels of 64 metabolites: in amino acids (e.g., glutamine [FDR‐corrected q‐value = 0.0012]), glycerophospholipids (e.g., lysophosphatidylcholine 16:1 [q = 0.0008]), steroids (e.g., cortisone [q = 0.00001]), and fatty acids (e.g., palmitoleic acid [q = 0.0031]). The main finding was that after controlling for baseline levels of self‐reported alcohol use and the biomarker of alcohol use, gamma‐glutamyl transferase, and when compared to both alcohol‐control and control‐control group, the alcohol‐case group had lower serum levels of asparagine (Cohen’s d = −0.48 [95% CI −0.78 to −0.19] and d = −0.49 [−0.78 to −0.19], respectively) and serotonin (d = −0.45 [−0.74 to −0.15], and d = −0.46 [−0.75 to −0.16], respectively), with no difference between the two control groups (asparagine d = 0.00 [−0.29 to 0.29] and serotonin d = −0.01 [−0.30 to 0.29]).

Conclusions

Changes in the circulating metabolome, especially lower serum levels of asparagine and serotonin, are associated with later diagnoses of alcohol‐related diseases, even after adjustment for the baseline level of alcohol use.
Changes in Drinking Contexts over the Night Course: Concurrent and Lagged Associations with Adolescents’ Nightly Alcohol Use
Authors: Finan Laura J. , Lipperman‐Kreda Sharon
Published: October 2020

Background

Examining underage drinking contexts can advance the field of adolescent substance use prevention by supporting and informing interventions that can target adolescents in specific contexts. The current study examines how concurrent and lagged situational (i.e., alcohol availability and adult supervision), social (i.e., the number of people and presence of friends), and location (i.e., home vs other location) context characteristics change risks for alcohol use over the night course.

Methods

Text messages with links to online surveys were used to collect ecological momentary assessment (EMA) data over 2 weekends from adolescents in California. Data were collected using adolescents’ personal cell phones early and late in the evening and the following morning. Analyses were limited to adolescents with at least 1 drinking occasion during EMA (N = 58; Mage = 16.64, SD = 0.74; 48% female; 83% White).

Results

Drinking earlier in the evening was positively associated with continued drinking over the night course. Context characteristics were found to play important concurrent and lagged roles in increasing the likelihood of alcohol use over evening hours.

Conclusions

Findings indicated substantive concurrent and lagged social, situational, and location‐based contextual effects on adolescent alcohol use over the course of an evening. Importantly, context characteristics were differentially associated with alcohol use over the course of the evening. The fact that these contextual factors are modifiable suggests that the use of prevention strategies delivered to adolescents throughout the evening may reduce adolescents’ drinking and related problems over the evening hours.
Evaluating the effectiveness of the smartphone app, Drink Less, compared with the NHS alcohol advice webpage, for the reduction of alcohol consumption among hazardous and harmful adult drinkers in the UK at 6‐month follow‐up: protocol for a randomised controlled trial
Authors: Garnett Claire , Oldham Melissa , Angus Colin , Beard Emma , Burton Robyn , Field Matt , Greaves Felix , Hickman Matthew , Kaner Eileen , Loebenberg Gemma , Michie Susan , Munafò Marcus , Pizzo Elena , Brown Jamie
Published: October 2020

Background and Aims

Digital interventions are effective for reducing alcohol consumption but evidence is limited regarding smartphone apps. Drink Less is a theory‐ and evidence‐informed app to help people reduce their alcohol consumption that has been refined in terms of its content and design for usability across the sociodemographic spectrum. We aim to evaluate the effectiveness and cost‐effectiveness of recommending Drink Less at reducing alcohol consumption compared with usual digital care.

Design

Two‐arm individually randomised controlled trial.

Setting

Online trial in the United Kingdom (UK).

Participants

Hazardous or harmful drinkers (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) aged 18+ who want to drink less alcohol (n = 5562). Participants will be recruited from July 2020 to May 2022 using multiple strategies with a focus on remote digital methods.

Intervention and comparator

Participants will be randomised to receive either an email recommending that they use Drink Less (intervention) or view the National Health Service (NHS) webpage on alcohol advice (comparator).

Measurements

The primary outcome is change in self‐reported weekly alcohol consumption, assessed using the extended AUDIT‐Consumption, between baseline and 6‐month follow‐up. Secondary outcomes include change in self‐reported weekly alcohol consumption assessed at 1‐ and 3‐month follow‐ups, and the proportion of hazardous drinkers; alcohol‐related problems and injury; health‐related quality of life; and use of health services assessed at 6‐month follow‐up. Effectiveness will be examined with adjusted regression models, adjusting for baseline alcohol consumption and using an intention‐to‐treat approach. A mixed‐methods process evaluation will assess engagement, acceptability and mechanism of action. Economic evaluations will be conducted using both a short‐ and longer‐term time horizon.

Comments

This study will establish the effectiveness and cost‐effectiveness of the Drink Less app at reducing alcohol consumption among hazardous and harmful adult drinkers and will be the first randomised controlled trial of an alcohol reduction app for the general population in the United Kingdom. This study will inform the decision on whether it is worth investing resources in large‐scale implementation.
Are psychosocial interventions effective in reducing alcohol consumption during pregnancy and motherhood? A systematic review and meta‐analysis
Authors: Ujhelyi Gomez Katalin , Goodwin Laura , Jackson Leanne , Jones Andrew , Chisholm Anna , Rose Abigail K.
Published: October 2020

Background and Aims

Alcohol use by pregnant and parenting women can have serious and long‐lasting consequences for both the mother and offspring. We reviewed the evidence for psychosocial interventions to reduce maternal drinking.

Design

Literature searches of PsycINFO, PubMed and Scopus identified randomised controlled trials of interventions with an aim of reduced drinking or abstinence in mothers or pregnant women.

Setting

Interventions were delivered in healthcare settings and homes.

Participants

Pregnant women and mothers with dependent children.

Interventions

Psychosocial interventions were compared with usual care or no intervention.

Measurements

The revised Cochrane risk‐of‐bias tool for randomised trials was used for quality assessments. Narrative synthesis summarised the findings of the studies with a subset of trials eligible for random‐effects meta‐analysis. General and alcohol‐specific behaviour change techniques (BCTs) were identified to investigate potential mechanism of change.

Results

Twenty‐four studies were included (20 pregnancy, four motherhood). Because of quality of reporting, data from only six pregnancy and four motherhood studies could be pooled. A significant treatment effect was revealed by the meta‐analyses of pregnancy studies regarding abstinence (OR = 2.31, 95% CI = 1.61, 3.32; P < 0.001) and motherhood studies regarding a reduction in drinking (standardised mean difference [SMD] = −0.20, 95% CI = −0.38, −0.02; P = 0.03). Narrative synthesis of the remaining trials yielded inconsistent results regarding intervention effectiveness. A wide range of BCTs were used, present in both effective and ineffective interventions. The most commonly used general and alcohol‐specific BCTs included information about consequences, social support, goal setting and action planning.

Conclusions

In pregnant women identified as consuming alcohol, psychosocial interventions appear to increase abstinence rates compared with usual care or no intervention. Similarly, such interventions appear to lead to a reduction in alcohol consumption in mothers with dependent children. It is unclear that behaviour change techniques are contributing to these effects. Conclusions from randomised controlled trials are only meaningful if the behavioural outcome, population, setting, intervention and comparator are clearly reported. An important barrier when it comes to identifying effective behaviour change techniques is a widespread failure to provide enough information in study reports.
Relational mobility promotes subjective well‐being through control over interpersonal relationships among the Chinese
Authors: Zhang Xiaoxiao , Zhao Xian
Published: October 2020

The present research investigated the relationship between relational mobility (RM) and subjective well‐being and revealed its psychological mechanism among the Chinese. Study 1 demonstrated that RM positively predicted subjective well‐being. In Study 2, imagined ecology with high RM led to higher expected subjective well‐being relative to that observed in low RM. In Study 3, a correlational study, interpersonal relationship mastery mediated the relationship between RM and subjective well‐being. This result was replicated by an experiment in Study 4. These findings highlight a socioecological perspective in understanding people’s subjective well‐being and shed light on understanding the relationship between different types of mobility and subjective well‐being.
Advances and novel developments in mechanisms of allergic inflammation
Authors: Han Xiaorui , Krempski James W. , Nadeau Kari
Published: October 2020

In the past decade, research in the molecular and cellular underpinnings of basic and clinical immunology has significantly advanced our understanding of allergic disorders, allowing scientists and clinicians to diagnose and treat disorders such as asthma, allergic and nonallergic rhinitis, and food allergy. In this review, we discuss several significant recent developments in basic and clinical research as well as important future research directions in allergic inflammation. Certain key regulatory cytokines, genes and molecules have recently been shown to play key roles in allergic disorders. For example, interleukin‐33 (IL‐33) plays an important role in refractory disorders such as asthma, allergic rhinitis and food allergy, mainly by inducing T helper (Th) 2 immune responses and clinical trials with IL‐33 inhibitors are underway in food allergy. We discuss interleukin 4 receptor pathways, which recently have been shown to play a critical role among the allergic inflammatory pathways that drive allergic disorders and pathogenesis. Further, the cytokine thymic stromal lymphopoietin (TSLP) has recently been shown as a factor in maintaining immune homeostasis and regulating type 2 inflammatory responses at mucosal barriers in allergic inflammation and targeting TSLP‐mediated signalling is considered an attractive therapeutic strategy. In addition, new findings establish an important T cell–intrinsic role of mucosa‐associated lymphoid tissue lymphoma translocation protein 1 (MALT1) proteolytic activity in the suppression of autoimmune responses. We have seen how mutations in the filaggrin gene are a significant risk factor for allergic diseases such as atopic dermatitis, asthma, allergic rhinitis, food allergy, contact allergy, and hand eczema. We are only beginning to understand the mechanisms by which the human microbiota may be regulating the immune system, and how sudden changes in the composition of the microbiota may have profound effects, linked with an increased risk of developing chronic inflammatory disorders, including allergies. New research has shown the important but complex role monocytes play in disorders such as food allergies. Finally, we discuss some of the new directions of research in this area, particularly the important use of biologicals in oral immunotherapy, advances in gene therapy, multifood therapy, novel diagnostics in diagnosing allergic disorders and the central role that omics play in creating molecular signatures and biomarkers of allergic disorders such as food allergy. Such exciting new developments and advances have significantly moved forth our ability to understand the mechanisms underlying allergic diseases for improved patient care.
Natives and aliens: Who and what belongs in nature and in the nation?
Authors: Antonsich Marco
Published: October 2020

The paper offers a brief genealogy of the native/alien divide, both in the natural and social realm, and argues that central to this binary is a national thinking that divides the world into distinct (national) units, enclosed by (natural) borders, with a unique (native) population. It looks at two interrelated processes: the nationalisation of nature, by which the national thinking intervenes as an organising principle in determining ecological inclusion/exclusion, and the naturalisation of the nation, through which the nation is given an ontological status. Taken together, these two processes confirm the continuing salience of the nation as a b‐ordering principle actively constituting both the social and natural world, also in times of anthropogenic changes and increasing people’s mobility.
Commensurability, COVID, and the domestic: A note on scalarity
Authors: Linder Benjamin
Published: October 2020

This commentary offers a note on scalarity and rescaling during the COVID‐19 pandemic. It argues that while plurality is pivotal for distinguishing scale from other geographic concepts, vertical relationality is only one axis along which this might be sufficiently accomplished. I raise the issue of scale's horizontal commensurability as a complementary means of approaching the domestic scale in the dramatic upheavals wrought by the current pandemic.
Development of a physiologically based pharmacokinetic (PBPK) population model for Chinese elderly subjects
Authors: Cui Cheng , Valerie Sia Jie En , Tu Siqi , Li Xiaobei , Dong Zhongqi , Yu Zhiheng , Yao Xueting , Hatley Oliver , Li Haiyan , Liu Dongyang
Published: October 2020

Aims

This study aims to develop and verify a physiologically based pharmacokinetic (PBPK) population model for the Chinese geriatric population in Simcyp.

Methods

Firstly, physiological information for the Chinese geriatric population was collected and later employed to develop the Chinese geriatric population model by recalibration of corresponding physiological parameters in the Chinese adult population model available in Simcyp (i.e., Chinese healthy volunteer model). Secondly, drug‐dependent parameters were collected for six drugs with different elimination pathways (i.e., metabolized by CYP1A2, CYP3A4 or renal excretion). The drug models were then developed and verified by clinical data from Chinese adults, Caucasian adults and Caucasian elderly subjects to ensure that drug‐dependent parameters are correctly inputted. Finally, the tested drug models in combination with the newly developed Chinese geriatric population model were applied to simulate drug concentration in Chinese elderly subjects. The predicted results were then compared with the observations to evaluate model prediction performance.

Results

Ninety‐eight per cent of predicted AUC, 95% of predicted Cmax, and 100% of predicted CL values were within two‐fold of the observed values, indicating all drug models were properly developed. The drug models, combined with the newly developed population model, were then used to predict pharmacokinetics in Chinese elderly subjects aged 60–93. The predicted AUC, Cmax, and CL values were all within two‐fold of the observed values.

Conclusion

The population model for the Chinese elderly subjects appears to adequately predict the concentration of the drug that was metabolized by CYP1A2, CYP3A4 or eliminated by renal clearance.
Concomitant oral potassium chloride and anticholinergic therapy is associated with upper gastrointestinal bleeding: A cohort study
Authors: Gueta Itai , Markovits Noa , Halkin Hillel , Loebstein Ronen
Published: October 2020

Aim

To determine whether oral potassium chloride (KCI) therapy with concomitant anticholinergic exposure among hospitalized patients is associated with an excess risk for upper gastrointestinal bleeding (UGIB).

Methods

A retrospective controlled study among hospitalized patients between January 2007 and April 2019 who were treated with oral KCI. Patients were divided into two groups: with or without concomitant exposure to agents with anticholinergic activity. Outcome was defined as any UGIB.

Results

The final sample included 13 728 subjects who received oral KCI treatment, of them 3542 (25.8%) had at least one documented overlap with an anticholinergic agent. Mean age was 67.6 (±17.2) and 6893 (50.2%) were females. Median KCI dose was 2.4 g (interquartile range [IQR] 1.2‐5.4, n = 9416) with the majority (90.4%) being treated with the wax‐matrix form (Slow‐K). Twenty‐six (0.2%) patients experienced an UGIB event. Univariate analysis demonstrated a significantly higher rate of UGIB among patients concomitantly treated with oral KCI and anticholinergics (0.3%) compared to those without anticholinergic exposure (0.1%, P = 0.018), with median 7 days (IQR 3‐16.8) from first KCI dose to bleeding event. Multivariate analysis demonstrated that concomitant anticholinergic exposure (Odds Ratio 2.48, 95% Confidence Interval 1.11‐6.51, P = 0.022) and anticoagulation treatment among patients with hemato‐oncologic disease (OR 6.61, 95% CI 1.96‐22.25, P = 0.002) were significantly associated with UGIB.

Conclusion

Hospitalized patients treated concomitantly with oral KCI and anticholinergic agents have significantly increased risk for UGIB.
The role of executive function in reading comprehension among beginning readers
Authors: Hung Cathy On‐Ying
Published: October 2020

Empirical evidence supports the importance of executive function (EF) in reading, but the underlying mechanism through which EF contributes to the reading process is unclear. The present study examined the direct and indirect effects of EF on reading comprehension through the indirect pathway of language and cognitive skills (i.e., syntactic awareness and text‐connecting inferencing) among the beginning readers. The sample included one hundred and sixty‐five 2nd and 3rd grade students. The participants were tested on working memory (visuospatial working memory and verbal working memory) and inhibition (prepotent response inhibition and cognitive inhibition), and their syntactic awareness, inference‐making, and reading comprehension. The unitary EF construct was obtained by means of confirmatory factor analysis based on the structure of EF in middle childhood suggested in developmental studies. Structural equation modelling was used to examine the direct and indirect effects of EF on the reading outcome. The findings indicated that EF has a direct effect on reading comprehension among the beginning readers. The indirect pathway showed that EF supports the ability to evaluate on grammatical structure of sentences (i.e., syntactic awareness) during reading. However, the indirect effect of EF on reading via inference‐making ability is insignificant. The findings highlight the contributions of EF to reading and provide empirical evidence to the hypothetical relation between EF and language skills suggested in DIER (Kim, 2020, Resarch Quarterly, 50, 459). It further extends our knowledge on the roles of EF in the reading process among the beginning readers. Future research directions are implicated as well.
Bleomycin: A novel osteogenesis inhibitor of dental follicle cells via a TGF‐β1/SMAD7/RUNX2 pathway
Authors: Li Zhi‐Zheng , Wang Hai‐Tao , Lee Grace Y. , Yang Ying , Zou Yan‐Ping , Wang Bing , Gong Chu‐Jie , Cai Yu , Ren Jian‐Gang , Zhao Ji‐Hong
Published: October 2020

Background and Purpose

Tooth eruption is a complicated process regulated by the dental follicles (DF). Our recent study discovered that tooth eruption was inhibited upon injection of bleomycin into DF. However, the mechanisms were unknown.

Experimental Approach

Human dental follicle cells (hDFCs) were treated by bleomycin or exogenous TGF‐β1 or transfected by plasmids loading SMAD7 or shRNA targeting SMAD7, followed by osteogenesis induction assay and signalling analysis. Human fresh DF tissues and Wistar rats were used to further confirm bleomycin function.

Key Results

Bleomycin decreased expression of RUNX2 and osteogenic genes in hDFCs, reducing osteogenic capacity. TGF‐β1 expression was up‐regulated in bleomycin‐treated hDFCs. The effects of exogenous TGF‐β1 were similar to those of bleomycin in hDFCs. Additionally, compared to SMAD2/3, SMAD7 expression increased more in bleomycin‐ or TGF‐β1‐treated hDFCs. Overexpression of SMAD7 likewise significantly decreased RUNX2 expression and osteogenic capacity of hDFCs. Knockdown of SMAD7 markedly attenuated the inhibitory effects of bleomycin and TGF‐β1 on osteogenic capacity and RUNX2 expression of hDFCs. Most importantly, changes in TGF‐β1, SMAD7, and RUNX2 expressions were similar in the DF of rats and humans treated with bleomycin.

Conclusion and Implications

SMAD7 was a negative regulator of osteogenic differentiation in DFCs through suppressing RUNX2 expression. Bleomycin or TGF‐β1 inhibited osteogenic differentiation of DFCs via a TGF‐β1/SMAD7/RUNX2 pathway. Our findings might be beneficial for enhancing the osteogenic activity of DFCs or inhibiting the eruption of undesirable teeth.
Adoption of faecal immunochemical testing for 2‐week‐wait colorectal patients during the COVID‐19 pandemic: an observational cohort study reporting a new service at a regional centre
Authors: Maclean William , Limb Chris , Mackenzie Paul , Whyte Martin B. , Benton Sally C. , Rockall Timothy , Jourdan Iain
Published: October 2020

Aim

The COVID‐19 pandemic has resulted in the near‐complete loss of routine endoscopy services. We describe a major reorganization of service at a regional referral centre (Royal Surrey NHS Foundation Trust) to manage the crisis. Faecal immunochemical testing (FIT) was implemented for triage to make optimum use of limited diagnostic resources. Consultations were switched from face‐to‐face to telephone. Our aim was to evaluate the impact FIT had on resource allocation and patient diagnoses in the first 3 months of use.

Method

All colorectal 2‐week‐wait patient referrals were posted a pack requesting FIT and notification of telephone consultation. A prepaid envelope was included for return of the samples. At consultation, FIT was incorporated with the presenting symptoms to guide the choice of investigation and triage urgency. FIT ≥10 μg/g was interpreted as positive. Outcome data were collected prospectively and compared with retrospective audit data from prepandemic levels across 3 months.

Results

From 26 March 2020 to 2 July 381 patients were referred who were invited to provide FIT samples and underwent telephone consultations. Three hundred and fifty eight FIT samples were returned (94%). Onward referral for colonoscopy reduced from 62% to 34% (P < 0.001). There were 14 colorectal cancers (CRC) (3.7%) diagnosed, which was not statistically different from the prepandemic level of 3.9% (P = 0.995). Twelve of the 14 patients with a CRC diagnosis had provided samples; all 12 had FIT ≥10 μg/g and were offered fast‐track investigations.

Conclusions

The incorporation of FIT optimized the allocation of limited resources to triage those who required urgent colonic investigation for detecting CRC.
A critical analysis of the purported role of hypoxaemia in the comorbidity of obstructive sleep apnoea and epilepsy
Authors: Mishra Priyadarshini , Jaseja Harinder , Goyal Manish
Published: October 2020

Obstructive sleep apnoea (OSA) is a globally prevalent sleep disorder of significant health concern and confounded with several comorbidities resulting in adverse effect(s) on quality of life in patients afflicted with it. Of particular interest is the enigmatic high comorbidity of OSA with epilepsy, the exact underlying pathophysiology of which remains elusive despite a multitude of research performed in the last four decades. Hypoxaemia, which is an important characteristic feature found in OSA during apnoeic spells, has been implicated in the high comorbidity of OSA with epilepsy, the basis of which rests upon hypoxaemia‐mediated brain damage, subcortical release phenomenon, oxidative stress and neuroinflammatory reactions. However, several studies present contradictory evidences that potentially refute the hypoxaemia‐based mechanism. Additionally, the role of hypercapnia thatgenerally accompanies hypoxaemia during apnoeic spells, cannot be overlooked and is known to be potentially protective against neuronal hyperexcitability. Thus, hypoxaemia theory implicated in the high comorbidity of OSA and epilepsy appears weak and refutable. This brief paper studies and critically analyses the role of hypoxaemia in conjunction with hypercapnia in the underlying pathophysiology of the comorbidity.
The effect of antiplatelet therapy on survival and cardiac allograft vasculopathy following heart transplantation: A systematic review and meta‐analysis
Authors: Aleksova Natasha , Brahmbhatt Darshan H. , Kiamanesh Omid , Petropoulos Jo‐Anne , Chang Yaping , Guyatt Gordon , Chih Sharon , Ross Heather J.
Published: October 2020

Cardiac allograft vasculopathy (CAV) is mediated by endothelial inflammation, platelet activation and thrombosis. Antiplatelet therapy may prevent the development of CAV. This systematic review and meta‐analysis summarizes and appraises the evidence on the effect of antiplatelet therapy after heart transplantation (HT). CENTRAL(Ovid), MEDLINE(Ovid), Embase(Ovid) were searched from inception until April 30, 2020. Outcomes included CAV, all‐cause mortality, and CAV‐related mortality. Data were pooled using random‐effects models. Seven observational studies including 2023 patients, mean age 52 years, 22% female, 47% with ischemic cardiomyopathy followed over a mean 7.1 years proved eligible. All studies compared acetylsalicylic acid (ASA) to no treatment and were at serious risk of bias. Data from 1911 patients in 6 studies were pooled in the meta‐analyses. The evidence is very uncertain about the effect of ASA on all‐cause or CAV‐related mortality. ASA may reduce the development of CAV (RR 0.75, 95% CI: 0.44–1.29) based on very low certainty evidence. Two studies that conducted propensity‐weighted analyses showed further reduction in CAV with ASA (HR 0.31, 95% CI: 0.13–0.74). In conclusion, there is limited evidence that ASA may reduce the development of CAV. Definitive resolution of the impact of antiplatelet therapy on CAV and mortality will require randomized clinical trials.
Temporal changes in diabetes prevalence and achievement of care goals in urban South Asia from 2010 to 2016 – The Center for Cardio‐metabolic Risk Reduction in South Asia Study
Authors: Anjana Ranjit Mohan , Deepa Mohan , Subashini Radhakrishnan , Patel Shivani A. , Kondal Dimple , Unnikrishnan Ranjit , Tandon Nikhil , Prabhakaran Dorairaj , Narayan K. M. Venkat , Kadir Muhammad M. , Mohan Viswanathan , Ali Mohammed K.
Published: October 2020

Aim

Achievement of treatment targets among individuals with diabetes remains suboptimal in many parts of the globe. We aimed to assess changes in diabetes prevalence and achievement of diabetes care goals in South Asia using two consecutive cross‐sectional population‐based surveys.

Methods

Two representative samples of South Asian adults were recruited using identical methods from Chennai, Delhi, and Karachi in 2010‐11 (n = 16,288; response rate–94.7%) and 2015‐16 (n = 14,587; response rate–94.0%) through the Center for Cardio‐metabolic Risk Reduction in South Asia (CARRS) Study. Quality of care goals were defined as HbA1c <53 mmol/mol (7.0%), blood pressure (BP) control: <140/90 mmHg, lipid control: LDL cholesterol <2.56 mmol/l (100 mg/dl), and self‐reported non‐smoking.

Results

Weighted prevalence of self‐reported diabetes increased by 9.0% [13% (95%CI: 13–14) to 15% (14–15)] while that of newly diagnosed diabetes decreased by 16% [6.1% (5.7–6.6) to 5.1% (4.6–5.6)]. There were improvements in achieving glycaemic (25% to 30%, p = 0.002) and lipid (34% to 45%, p < 0.001) goals, but no notable improvements in BP control or smoking status. The proportion of individuals with self‐reported diabetes meeting more than one target also increased.

Conclusions

Diabetes prevalence continues to grow among urban South Asians and large gaps still exist in the attainment of treatment targets. Concerted policy, systemic, clinical and individual efforts are needed to close these care gaps.
Barriers to and enablers of attendance at diabetic retinopathy screening experienced by immigrants to Canada from multiple cultural and linguistic minority groups
Authors: van Allen Zack , Dogba Maman Joyce , Brent Michael H. , Bach Catherine , Grimshaw Jeremy M. , Ivers Noah M. , Wang Xiaoqin , McCleary Nicola , Asad Sarah , Chorghay Zahraa , Hakim Hina , Sutakovic Olivera , Drescher Olivia , Légaré France , Witteman Holly O. , Zettl Mary , Squires Janet , Tremblay Marie‐Claude , Randhawa Arshad , Lopez Gladys , Ben Guiza Afifa , Presseau Justin
Published: October 2020

Aim

To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes.

Methods

Using a patient‐oriented research approach leveraging Diabetes Action Canada's patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French‐speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development.

Results

We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group‐specific barriers/enablers included a preference to return to one's country of birth for screening, the impact of winter, and preferences for alternative medicine.

Conclusion

Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.
Differential diagnosis of apical hypertrophic cardiomyopathy and apical displacement of the papillary muscles: a multimodality imaging point of view
Authors: Ünlü Serkan , Özden Tok Özge , Avcı Demir Fulya , Papadopoulos Konstantinos , Monaghan Mark J.
Published: October 2020

Apical hypertrophic cardiomyopathy (ApHCM) and apical displacement of papillary muscles (ADPM) are two different pathologies with a number of similar imaging findings that may hamper adequate diagnosis. While ApHCM is associated with increased rate of mortality, ADPM commonly presents with a benign course and differential diagnosis is of great importance. Clinical assessment and 2D echocardiography cannot sufficiently differentiate these conditions, however, and advanced echocardiographic methods may facilitate diagnosis. Although echocardiography is the first‐line imaging method in the diagnostic algorithm, cardiac magnetic resonance imaging (CMRI) is the gold standard for evaluating patients due to good spatial resolution and myocardial tissue characterization abilities. When CMRI is contraindicated, cardiac computed tomography may be an alternative reliable method that can also give information about the coronary anatomy. Nuclear imaging may also provide supplementary data regarding hypertrophy and coronary arteries when there is a suspicion of ischemia.
The value of high‐flow nasal cannula oxygen therapy in treating novel coronavirus pneumonia
Authors: Teng Xiao‐bao , Shen Ya , Han Ming‐feng , Yang Gang , Zha Lei , Shi Jing‐feng
Published: October 2020

Objective

This study aimed to investigate the value of high‐flow nasal cannula (HNFC) oxygen therapy in treating patients with severe novel coronavirus pneumonia (COVID‐19).

Methods

The clinical data of 22 patients with severe COVID‐19 were collected. The heart rate (HR), respiratory rate (RR) and oxygenation index (PO2/FiO2) at 0, 6, 24 and 72 hours after treatment were compared between the HFNC oxygen therapy group and the conventional oxygen therapy (COT) group. In addition, the white blood cell (WBC) count, lymphocyte (L) count, C‐reactive protein (CRP) and procalcitonin (PCT) were compared before and at 72 hours after oxygen therapy treatment.

Results

The differences at 0 hours between the two groups were not statistically significant. Compared with COT group,in the HFNC oxygen therapy group, HR, RR and PaO2/FiO2 were better at 6 hours after treatment, PaO2/FiO2 was better at 24 and 72 hours. After 72 hours, L and CRP had improved in the HFNC oxygen therapy group compared with the COT group, but the differences in WBC and PCT were not statistically significant. The length of stay in the intensive care unit (ICU) and the total length of hospitalization was shorter in the HFNC oxygen therapy group than in the COT group.

Conclusion

Compared with COT, early application of HFNC oxygen therapy in patients with severe COVID‐19 can improve oxygenation and RR, and HFNC oxygen therapy can improve the infection indexes of patients and reduce the length of stay in the ICU of patients. Therefore, it has high clinical application value.
The relationship among host plant species, egg clutch size, and level of parasitism for the sharpshooter Tapajosa rubromarginata
Authors: Virla Eduardo G. , Aguirre María B. , Van Nieuwenhove Guido A. , Luft Albarracin Erica B. , Logarzo Guillermo A.
Published: October 2020

The sharpshooter Tapajosa rubromarginata (Signoret) (Hemiptera: Cicadellidae, Proconiini), a vector of the bacterium Xylella fastidiosa Wells et al. (Xanthomonadaceae) that causes citrus variegated chlorosis, has more than 30 reported host plant species. The fitness of a phytophagous insect is determined by the host plant suitability, plant resistance, and the natural enemies. The aim of this study was to: (1) identify plant species utilized as oviposition substrate by T. rubromarginata in the field; (2) establish the relationship between plants and clutch size; (3) establish the relationship among host plants, clutch size, and level of parasitism; and (4) establish variations in parasitoid composition and abundance in the various host plants. Egg masses of the sharpshooter were surveyed on plants reported as hosts, or those that were abundant in the study site. The number of eggs of the sharpshooter and emerged parasitoids were recorded for all the collected masses. We found egg masses of T. rubromarginata on 12 out of 21 plant species sampled. The size of the egg masses was greatly influenced by the type of leaf venation and to a lesser extent by the plant species. Parasitism rates were influenced by both leaf venation and host plant. Trichogrammatidae species were mostly associated with egg masses in plants with parallel‐veined leaves, whereas Mymaridae attacked masses laid in reticular‐veined leaves. The choice between a good host plant, but heavily attacked by parasitoids, and the host plants that are less suitable for nymphs but less frequently attacked by natural enemies, was a trade‐off for T. rubromarginata females to increase their fitness. We conclude that the host plant utilization by T. rubromarginata females in the field could be influenced by leaf structure and the strategy to avoid parasitism by selecting plants that were less attractive for parasitoids.
Association of amyloid angiopathy with microbleeds in logopenic progressive aphasia: an imaging‐pathology study
Authors: Buciuc M. , Duffy J. R. , Machulda M. M. , Spychalla A. J. , Gunter J. L. , Jack C. R. , Giannini C. , Raghunathan A. , Dickson D. W. , Josephs K. A. , Whitwell J. L.
Published: October 2020

Background and purpose

Cerebral microbleeds (MB) and superficial siderosis (SS) are frequent neuroimaging findings in patients with logopenic progressive aphasia (LPA), often with frontal lobe predilection. Cerebral amyloid angiopathy (CAA) is hypothesized to be the major pathologic determinant of MB/SS in these patients; however, neuroimaging‐pathologic data are limited.

Methods

All patients who had been prospectively recruited by the Neurodegenerative Research Group at the Mayo Clinic (Rochester, MN) between 2010 and 2015 and met the following inclusion criteria were included: (i) received an antemortem LPA diagnosis, (ii) had a gradient‐recalled echo T2*‐weighted magnetic resonance imaging (MRI) performed, (iii) died and completed a brain autopsy. Demographic, genetic, neuroimaging, and clinical and pathologic characteristics were compared between patients with/without MB/SS. Two‐tailed Fisher exact and Wilcoxon rank sum tests were used for comparison of categorical and continuous variables, respectively.

Results

Thirteen patients met inclusion criteria, six (46%) had MB/SS on MRI. Moderate/severe CAA was associated with the presence of MB/SS (p = 0.029). As expected, MB/SS most frequently involved the frontal lobes, followed by the parietal lobes. No clear associations were found between regional MB/SS distribution and regional distribution of CAA or hypometabolism on [18F]‐fluorodeoxyglucose–positron emission tomography. There was some evidence for a regional association between MB/SS and uptake on Pittsburgh compound B, although not in all patients. No formal statistical analyses to assess topographic relationships were performed due to the small sample size.

Conclusions

The presence of MB/SS is a strong indicator of underlying moderate/severe CAA in LPA, although the biological mechanisms underlying the topographic distribution of MB/SS remain unclear.
Intensive versus guideline‐recommended blood pressure reduction in acute lacunar stroke with intravenous thrombolysis therapy: The ENCHANTED trial
Authors: Zhou Zien , Xia Chao , Carcel Cheryl , Yoshimura Sohei , Wang Xia , Delcourt Candice , Malavera Alejandra , Chen Xiaoying , Mair Grant , Woodward Mark , Chalmers John , Demchuk Andrew M. , Lindley Richard I. , Robinson Thompson G. , Parsons Mark W. , Wardlaw Joanna M. , Anderson Craig S.
Published: October 2020

Background and purpose

This was an investigation of the differential effects of early intensive versus guideline‐recommended blood pressure (BP) lowering between lacunar and non‐lacunar acute ischaemic stroke (AIS) in the BP arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).

Methods

In 1,632 participants classified as having definite or probable lacunar (n = 454 [27.8%]) or non‐lacunar AIS according to pre‐specified definitions based upon clinical and adjudicated imaging findings, mean BP changes over days 0–7 were plotted, and systolic BP differences by treatment between subgroups were estimated in generalized linear models. Logistic regression models were used to estimate the BP treatment effects on 90‐day outcomes (primary, an ordinal shift of modified Rankin scale scores) across lacunar and non‐lacunar AIS after adjustment for baseline covariables.

Results

Most baseline characteristics, acute BP and other management differed between lacunar and non‐lacunar AIS, but mean systolic BP differences by treatment were comparable at each time point (all pinteraction > 0.12) and over 24 h post‐randomization (−5.5, 95% CI −6.5, −4.4 mmHg in lacunar AIS vs. −5.6, 95% CI −6.3, −4.8 mmHg in non‐lacunar AIS, pinteraction = 0.93). The neutral effect of intensive BP lowering on functional outcome and the beneficial effect on intracranial haemorrhage were similar for the two subgroups (all pinteraction > 0.19).

Conclusions

There were no differences in the treatment effect of early intensive versus guideline‐recommended BP lowering across lacunar and non‐lacunar AIS.
Impaired consolidation of visuomotor adaptation in patients with multiple sclerosis
Authors: Nguemeni Carine , Nakchbandi Luis , Homola György , Zeller Daniel
Published: October 2020

Background

Apart from inflammation and neurodegeneration, the individual clinical course of multiple sclerosis (MS) might be determined by differential adaptive capacities of the central nervous system. It has been postulated that the retention of adaptive training effects may be impaired in persons with MS (PwMS).

Objective

To investigate motor adaptation and consolidation capacities of people with MS in a visual motor adaptation task (VAT).

Methods

A total of 23 PwMS (Expanded Disability Status Scale (EDSS) score < 6) and 20 matched healthy controls were recruited. All participants completed three sessions of a VAT where a clockwise rotation angle of 30° was introduced as perturbation during the active learning part of the paradigm. The training session (T0) was repeated after 24 h (T1) and 72 h (T2). Directional errors and parameters of adaptation and retention were evaluated.

Results

PwMS showed similar adaptation and online learning abilities as controls. However, the retention ratio was significantly lower in patients compared to controls at T1 (p = 0.036) and T2 (p = 0.039). There was no significant correlation between the overall adaptation or retention ratio and the EDSS score, respectively.

Conclusion

Our findings indicate intact adaptation, but limited consolidation, in patients with mild‐to‐moderate MS. Future studies are needed to define the neurobiological substrates of this plasticity and the extent to which it can influence clinical outcomes.