bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of Echoradiography Pulmonary to Left Atrial Ratio (ePLAR) with Right Heart Catheterization Parameters in Pulmonal Arterial Hypertension
Authors: Fernando H , Yanni M , Hariyanto D
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Until now, right heart catheterization is still the gold standard for pulmonary hypertension examination, but this examination is invasive, has a risk of action, and is limited. Echocardiography provides an alternative examination that is easier, safer, cheaper, and more effective in evaluating pulmonary hypertension. Various echocardiographic parameters have been used to assess pulmonary hypertension but no parameter can distinguish the hemodynamics of pulmonary hypertension. Echocardiography pulmonary to left atrial ratio (ePLAR) is a new echocardiographic parameter that is formulated by the maximal tricuspid regurgitation velocity (TR Vmax) divided by the mitral E/e'. This simple parameter can determine precapillary pulmonary hypertension

Purpose

The aim of this study is to determine the correlation of ePLAR with right heart catheterization parameters in pulmonary arterial hypertension patients.

Methods

This is a cross-sectional study in the pulmonary arterial hypertension group conducted at M. Djamil Hospital from August 2021 to May 2022. Respondents underwent an echocardiography and right heart catheterization prosedure. The correlation of ePLAR with right heart catheterization parameters was assessed using the Spearman correlation test.

Result

The research subjects were 32 patients with pulmonary arterial hypertension, 20 women and 12 men, the median age was 21.50 (8-54) years and the most common cause of pulmonary arterial hypertension was congenital heart disease. The median value of ePLAR was 0.44(0.30-0.77) m/s, while the mean value of mPAP was 54.40 ± 16.24 mmHg and the median value of PVR was 8.39 (3.21-29.50) WU. Based on the Spearman correlation test, it was found that the ePLAR had a moderate positive correlation (r=0.554) with the mPAP and was statistically significant (p=0.001). The ePLAR had a strong positive correlation (r=0.779) with the PVR and was statistically significant (p<0.001)

Conclusion

There was a moderate and significant positive correlation between ePLAR and mPAP, there was a strong and significant positive correlation between ePLAR and PVR in patients with pulmonary arterial hypertension.
Ambient heat exposure after the rainy season is associated with an increased risk of Stroke
Authors: Fujimoto R , Suzuki E , Kashima S , Kazufumi N , Oka T , Ito H , Yorifuji T
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Stroke is a major global health issue and Climate change is the biggest and most urgent challenges. The Asia and Pacific region have been more vulnerable to climate change and extreme heat exposure than other regions of the world. Despite the growing concern for heat waves, few studies have investigated heat exposure and the risk of Stroke in the elderly considering effect of Asian meteorological factors.

Purpose

We aimed to examine the association between heat exposure and the risk of Stroke in the elderly and to evaluate possible effect-measure modifications by the rainy season, which is a characteristic climatic occurrence in East Asia.

Methods

Our study was designed as a time-stratified case-crossover. The study included 3367 residents in the city, Japan, aged 65 years or older who were dispatched to emergency hospitals between 2012 and 2019 for the onset of Stroke during and a few months after the rainy seasons (Picture 1). We examined the association between temperature and Stroke onset during and a few months after the rainy seasons with conditional logistic analysis adjusted for relative humidity, barometric pressure, and particulate matter less than 2.5 µm in diameter (pm 2.5). Furthermore, we examined analyses on effect-measure modification where is the exposure of a 1°C increase in temperature and potential effect modifier as stratified during and after the rainy seasons.

Results

Heat exposure during one month after the rainy season was associated with Stroke risk; the adjusted odds ratio (OR) for a 1°C increase in temperature was 1.34 (95% confidence interval [CI]: 1.29-1.39). In stratified type of the stroke, Hemorrhagic stroke (OR: 1.37, 95% CI: 1.24-1.51), Ischemic stroke (OR: 1.37, 95% CI: 1.24-1.53), and Transient ischemic attack (OR: 1.43, 95%CI: 1.23-1.68) were significantly associated with heat exposure during one month after the rainy season respectively (Picture 2). In the results of analyses on effect modification, one month after the rainy season group was highest than other groups when reference was during the rainy seasons (OR: 1.34, 95% CI: 1.3-1.39, P<0.001 [Measure of effect modification on additive scale]).

Conclusions

The present study suggests that heat exposure increases the risk of Stroke onset during the month after the end of the rainy season in the elderly. We propose that public health measures, such as maintenance designed high-insulated housing and improved air conditioning control, be implemented in the Asia and Pacific region to address heat exposure during one month after the rainy season, which can affect the incidence of stroke in the elderly.
Modified STEMI protocol for Primary PCI during COVID-19 Pandemic:Does it prolong Door-To-Balloon performance?
Authors: Putranto A Y , Haykal Putra T M , Soedarsono W A
Published: January 2023

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Jakarta Heart Center

Background

COVID-19 became a main health problem and causes heavy impact, especially for healthcare system. Managing ST-Segment Elevation Myocardial Infarction (STEMI) patients before COVID-19 pandemic was already challenging enough for Healthcare Professionals (HCP) to pursue time-sensitive treatment. After COVID-19 pandemic, the time-sensitive treatment of pursuing door-to-balloon (DTB) time put a lot more burden to HCP. In this study, We sought to analyze how a change in protocol of Primary PCI (PPCI) in STEMI patients before and during the pandemic influence the performance of DTB in the hospital.

Methods

This is a single-centered retrospective observational study among STEMI patients which was treated by PPCI. Secondary data from the medical record were collected consecutively from April 2018 to January 2022 (46 months). We compared DTB performances before and during the pandemic.

Result

During 46 months period, the total population of this research was 880 patients. There were total 358 patients underwent PPCI before the pandemic and 522 patients after the pandemic. Modified protocol with the addition step to prevent the spread of COVID-19 had been implemented since April 2020. DTB increased significantly during the pandemic (90 (70-124) minutes vs 97 (76-135) minutes, p 0.002). The proportion of the patients who achieved DTB under 90 min was also significantly decreasing (56.4% vs 47.9%, p 0.0013).

Conclusion

It is necessary for PPCI center to modify PPCI workflow during the pandemic. A decent workflow should consider practicality and simplicity without compromising HCP and patient safety. Implementing modified PPCI workflow during the pandemic significantly increased DTB time but it is still within the limit of being reasonable and acceptable for the benefit of the patients.
Antithrombotics prescription pattern and clinical outcomes in atrial fibrillation patients with type 2 diabetes mellitus
Authors: Hoo Y Y , Mazlan-Kepli W , Habizal N H , Ismail M I , Wong Y P , Rosnan N H , Mohamed S , Abd Ghani A R , Mohd Yusof H , Abdullah Ramaiah A R , Selvaraj K , Abd Malek A M , Abdul Ghapar A K
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) and Diabetes mellitus (DM) often coexist. As DM is considered while calculating the thromboembolic risk for AF patients, little is known about the prescription pattern of antithrombotic therapies in patients with AF and DM and their clinical outcomes.

Purpose

In this subsidiary study, we examined the prescription patterns of antithrombotic therapies and clinical outcomes of AF patients with type 2 DM.

Methods

We analyzed data from a single-center cohort of patients with a primary diagnosis of AF in a tertiary cardiac referral hospital in Malaysia from 1st January 2018 to 31st December 2020. Patients' clinical data and information related to antithrombotic therapy were traced through electronic Hospital Information system. A data collection form was used for data collection. The primary endpoint of the study was a composite cardiovascular (CV) event which consists of all-cause mortality, acute coronary syndrome (ACS), ischemic stroke and transient ischemic attack (TIA). The safety endpoint of the study was a bleeding event, defined as hemoglobin drop more than 2 g/dl, blood transfusion and bleeding at critical area.

Results

Of the 1006 AF patients (59.2% male; mean age 64.2 (12.1) years), 400 (39.8%) had a history of DM. Of these, 45.8% (n=183) were using warfarin; 46.5% (n=159) used direct oral anticoagulant (DOAC), 54.0% (n=216) used a single antiplatelet, 11.5% (n=46) used a double antiplatelet, 8.0% (n=32) used triple therapy which consists of two antiplatelet agents with one anticoagulant. The use of single antiplatelet agent (54.0% vs 46.4%, p=0.018) and double antiplatelet agents (11.5% vs 7.1%, p=0.016) was significantly associated with AF with DM patients, whereas there was no association between anticoagulant use and AF patients with or without DM (85.5% vs 82.5%, p=0.209). There was no association in composite CV events between AF patients with or without DM (12.0% vs 10.4%, p=0.427). The proportion of subjects who reported having bleeding events were also did not differ by the presence of AF patients with or without DM. (4.5% vs 2.8%, p=0.151).

Conclusion

Diabetes was associated with increased use of antiplatelet agents; however, DM was not associated with increased risk of composite CV events and bleeding events in patients with concurrent AF. The lack of an association between diabetes and CV risk contrasts with previous research, which could be due to improved diabetes treatment in this cohort of patients with relatively low fasting sugar readings. Further study on the degree of blood glucose as measured by glycosylated hemoglobin (HbA1c) is needed to confirm the finding.
Comparison of risk of hyperkalemia between SGLT2 inhibitors and DPP4-inhibitors in patients with type 2 diabetes
Authors: Wu M Z , Ren Q W , Huang J Y , Tse Y K , Yu S Y , Cheang L F , Li H L , Chan Y H , Tse H F , Yiu K H
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Hyperkalemia is a common complication and increases the risk of cardiac arrhythmias and mortality in patients with type 2 diabetes (T2DM), especially in those with diabetic nephropathy. We investigated the risk of hyperkalemia in patients initiated on SGLT2 inhibitors versus DPP-4 inhibitors among patients with T2DM.

Methods

This study included patients with T2DM who initiated on SGLT2 inhibitors or DPP-4 inhibitors between January 01, 2015 and December 31, 2019 from a territory-wide clinical registry in Hong Kong (Clinical Data Analysis and Reporting System [CDARS]). A multivariable cox proportional hazards analysis, adjusting for key confounders, was used to compare the risk of central laboratory-determined hyperkalemia (serum potassium ≥6.0mmol/L) and hypokalemia (serum potassium <3.5mmol/L), respectively, between SGLT2 inhibitors and DPP-4 inhibitors.

Results

10193 new users of SGLT2 inhibitors were matched to 17305 new users of DPP-4 inhibitors. During the 2-year follow-up, there were 104 hyperkalemia events (incident rate [IR] = 5.17 per 1000 person-years) among SGLT2 inhibitors and 306 events (IR = 9.09 per 1000 person-years) among DPP-4 inhibitors, of which SGLT2 inhibitors were associated with a lower risk of incident hyperkalemia (Adjusted HR: 0.66 [95%CI 0.53-0.83], p<0.001), compared to DPP-4 inhibitors. The incident hypokalemia was similar between SGLT2 inhibitors and DPP-4 inhibitors (Adjusted HR: 0.91 [95%CI 0.81-1.03], P=0.13).

Conclusion

SGLT2 inhibitors reduced incident hyperkalemia, but without increasing incident hypokalemia compared to DPP-4 inhibitors.
Differential expression of TLR4 in patients of coronary artery disease with and without traditional cardiovascular risk factors
Authors: Biswas N , Roy D , Karmakar S , Bhowmik R , Mazumdar H , Banerjee A , Roy A , Dey S
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atherosclerosis is inherently an inflammatory process, with a complex interplay of inflammatory markers. It is established that these inflammatory markers play an important role in patients of Coronary Artery Disease(CAD) with traditional cardiovascular risk factors. However, the role of inflammation in the atherosclerotic process in patients of CAD without traditional risk factors is still not clearly known.

Purpose

Our purpose was to determine whether in patients of CAD without traditional risk factors, TLR4(Toll like receptor 4) expression as a marker of inflammation is similar to that in patients of CAD with traditional risk factors.

Materials and Methods

This observational cross sectional study was done between July’20 to Dec’21. Equal number of patients of CAD with and without traditional cardiovascular risk factors undergoing Coronary Artery Bypass Grafting (CABG) were enrolled. The risk factors considered were Hypertension, Diabetes, Dyslipidemia, Obesity and Addiction to Tobacco and/or Alcohol. A minimum of two punch biopsy samples of aortic tissue was taken from each subject undergoing CABG. Immunohistochemistry for TLR4, was done in Ventana BenchMark GX System. The primary TLR4 antibody was procured from reputed source.

Results

The presence or absence of TLR4 expression was associated significantly with the Syntax scores (37.40±4.74 vs 29.5±8.71; p value=0.036), total Cholesterol (187±35.06mg/dL vs 130±35.69 mg/dL ;p value 0.010) and LDL cholesterol (118.86±28.12mg/dL vs 64.21±25.61 mg/dL; p value 0.003). TLR4 expression, however, was not significantly associated with the number of coronary vessels involved (p=0.298). TLR4 expression was also not significantly associated with any other individual risk factors. However, when the traditional risk factors were considered in combination, TLR4 expression was associated significantly with the number of risk factors present(p=0.029) the strongest being in those having 4 traditional risk factors. The level of TLR4 expression gradually declined with the decrease in the number of risk factors, having mostly weak or negative expression in patients without any traditional risk factors.

Conclusion

Patients with CAD without any traditional risk factors, had a less severe coronary artery disease as manifested by lower Syntax scores, and had lower degree of TLR4 expression. Patients with CAD with traditional risk factors had more severe coronary artery disease as evidenced by higher Syntax scores, and had higher degree of TLR4 expression proportional to the number of traditional risk factors present. Thus, differential TLR4 expression in CAD patients with and without traditional risk factors indicated a difference in inflammatory state between the two groups and warrants further investigation.
Long-term effects of e-Health secondary prevention on cardiovascular health: a systematic review and meta-analysis
Authors: Su Jing Jing , Liu Justina Yat Wa , Cheung Daphne Sze Ki , Wang Shanshan , Christensen Martin , Kor Patrick Pui Kin , Tyrovolas Stefanos , Leung Angela Yee Man
Published: January 2023

Aims

Despite the well-documented short-to-medium-term effectiveness of e-Health (electronic health) secondary prevention interventions on patients with cardiovascular disease (CVD), there is limited empirical evidence regarding long-term effectiveness. This review aims to evaluate the long-term effects of e-Health secondary prevention interventions on the health outcomes of patients with CVD.

Methods and results

This systematic review and meta-analysis followed Cochrane Handbook for Systematic Reviews of Interventions. EMBASE, Medline, Web of Science, and Scopus were searched from 1990 to May 2022. Randomized controlled trials investigating the effects of e-Health secondary prevention on health outcomes of CVD patients that collected endpoint data at ≥ 12 months were included. RevMan 5.3 was used for risk of bias assessment and meta-analysis. Ten trials with 1559 participants were included. Data pooling suggested that e-Health programmes have significantly reduced LDL cholesterol [n = 6; SMD = −0.26, 95% confidence interval (CI): (−0.38, −0.14), I2 = 17%, P < 0.001]; systolic blood pressure [n = 5; SMD = −0.46, 95% CI: (−0.84, −0.08), I2 = 90%, P = 0.02]; and re-hospitalization, reoccurrence, and mortality [risk ratio = 0.36, 95% CI: (0.17, 0.77), I2 = 0%, P = 0.009]. Effects on behavioural modification, physiological outcomes of body weight and blood glucose, and quality of life were inconclusive.

Conclusion

e-Health secondary prevention is effective in improving long-term management of risk factors and reducing the reoccurrence of cardiac events in patients with CVD. Results are inconclusive for behaviour modification and quality of life. Exploring, implementing, and strengthening strategies in e-Health secondary prevention programmes that focus on maintaining behaviour changes and enhancing psychosocial elements should be undertaken.

Registration

PROSPERO CRD42022300551.
Detection efficiency of an autonomous underwater glider carrying an integrated acoustic receiver for acoustically tagged Pacific herring
Authors: Cypher Alysha D , Statscewich Hank , Campbell Robert , Danielson Seth L , Eiler John , Bishop Mary Anne
Published: January 2023

Autonomous underwater vehicles (AUVs) or gliders are increasingly being used with acoustic telemetry to elucidate fish movements while collecting simultaneous environmental data. We assessed the utility of an AUV equipped with an integrated acoustic receiver to detect Pacific herring (Clupea pallasii) in Prince William Sound, AK, USA. A range test evaluated the effect of glider flight characteristics and environmental conditions on the detection efficiency of transmitters at varying depths. While distance from transmitters was the strongest predictor of detections, glider depth had a variable effect on detection efficiency which depended on transmitter depth and dive orientation. The detection efficiency of the glider-mounted acoustic receiver was less affected by wind speed and water level than that of stationary acoustic receivers deployed within the study area. The AUV also performed repeated, adaptive transects in an area of ∼630 km2 area and detected 30 Pacific herring transmitters without a priori knowledge of their locations. Of these herring transmitters, 14 were presumed shed after repeated detections within the same area, and 2 were detected at multiple locations. This study is the first to demonstrate that glider-mounted acoustic receivers have high detection efficiency for transmitters at varying depths and can detect movements of migratory forage fish in large search areas.
Preschool Pain Management Program for Young Children with Sickle Cell Disease: A Pre–Post Feasibility Study
Authors: Johnston Julia D , Schatz Jeffrey , Bills Sarah E , Frye Bridgett G , Carrara Gabriela C
Published: January 2023

Objective

Vaso-occlusive pain crises in sickle cell disease (SCD) often begin in early childhood. We developed an online pain management intervention to teach caregivers of preschool-aged children with SCD behavioral pain management strategies. The feasibility study goals were to examine response to recruitment, barriers to participation, engagement, acceptability and perceived usefulness of the intervention, and suitability of outcome measures.

Methods

Caregivers of children aged 2.0–5.9 years with access to text messaging and a device to access online videos were recruited from a Southeastern outpatient hematology clinic for a 12-week intervention consisting of pain management videos. Videos taught caregivers behavioral pain management strategies and adaptive responses to pain. Workbook activities helped tailor strategies to their child. Caregivers completed process measures as well as baseline and follow-up measures of pain catastrophizing (Pain Catastrophizing Scale—Parent Report) and responses to their child’s pain (Adult Response to Children’s Symptoms).

Results

Fifty percent (10 of 20) of eligible parents enrolled. Caregivers partially completed (N = 6), completed (N = 3), or did not engage (N = 1) in the intervention. Caregivers who engaged in the program reported implementing the pain management strategies. The intervention was rated as high quality, relevant, and useful. Measures of pain catastrophizing and responses to their child’s pain appeared sensitive to change.

Conclusions

The intervention to promote adaptive coping to pain was acceptable and feasible for caregivers though we found barriers to delivering the intervention to parents. Evaluation of a modified version of the program is indicated to assess implementation issues and effectiveness.
Non-Rabl chromosome organization in endoreduplicated nuclei of barley embryo and endosperm tissues
Authors: Nowicka Anna , Ferková Ľuboslava , Said Mahmoud , Kovacik Martin , Zwyrtková Jana , Baroux Célia , Pecinka Ales
Published: January 2023

Rabl organization is a type of interphase chromosome arrangement with centromeres and telomeres clustering at opposite nuclear poles. Here, we analyzed nuclear morphology and chromosome organization in cycling and endoreduplicated nuclei isolated from embryo and endosperm tissues of developing barley seeds. We show that endoreduplicated nuclei have an irregular shape, less sister chromatid cohesion at 5S rDNA loci, and a reduced amount of centromeric histone CENH3. While the chromosomes of the embryo and endosperm nuclei are initially organized in Rabl configuration, the centromeres and telomeres are intermingled within the nuclear space in the endoreduplicated nuclei with an increasing endoreduplication level. Such a loss of chromosome organization suggests that Rabl configuration is introduced and further reinforced by mitotic divisions in barley cell nuclei in a tissue- and seed age-dependent manner.
Anu Taila, an herbal nasal-drop, delays spore germination in Cunninghamella bertholletiae by reducing cAMP-PKA dependent ROS in mucorale pathogen and extrinsic ROS in human host cells
Authors: Balkrishna Acharya , Sengupta Sohan , Kumari Priya , Dev Rishabh , Haldar Swati , Varshney Anurag
Published: January 2023

The rare, fastest-germinating, frequently invasive mucorale, Cunninghamella bertholletiae, is intractable due to its imprecise etiology. Cunninghamella bertholletiae spores can infect both immunocompromised and immunocompetent individuals to cause mucormycosis. Sub-optimal drug-susceptibility further limits its treatment options. The classical nasal drop, Anu Taila, is reported to be effective against the rather prevalent mucorales, Mucor spp., making its anti-mucormycotic effect against C. bertholletiae worth testing. The inhibitory effect of Anu Taila against C. bertholletiae was manifested as microstructural alterations of the spores and their delayed germination. Anu Taila reduced the germination-promoting reactive oxygen species (ROS) levels in both the pathogen, C. bertholletiae, and the human host lung epithelial A549 cells. Expressions of structural (chitin synthase, trehalose synthase) and functional (cAMP-PKA) markers of spore germination were regulated by Anu Taila. cAMP-PKA expression and ROS generation are well-correlated, implicating the role of Anu Taila in delaying C. bertholletiae spore germination by targeting cAMP-PKA-mediated ROS generation. In conclusion, this study demonstrates that Anu Taila can create an opportunity for the host immune system to tackle the onset of C. bertholletiae infection by delaying its pathogenesis. This can be further leveraged to reinforce the host immune system through combinatorial treatment to prevent the establishment of the mucormycosis infection.
Detection of the Crab Nebula using a randomforest analysis of the first TAIGA IACT data
Authors: Blank M , Tluczykont M , Porelli A , Mirzoyan R , Wischnewski R , Awad A K , Brückner M
Published: January 2023

The Tunka Advanced Instrument for Gamma- and cosmic-ray Astronomy (TAIGA) is a multicomponent experiment for the measurement of TeV to PeV gamma- and cosmic rays. Our goal is to establish a novel hybrid direct air shower technique, sufficient to access the energy domain of the long-sought Pevatrons. The hybrid air Cherenkov light detection technique combines the strengths of the HiSCORE shower front sampling array, and two ∼4 m class, ∼9.6° field of view Imaging Air Cherenkov Telescopes (IACTs). The HiSCORE array provides good angular and shower core position resolution, while the IACTs provide the image shape and orientation for gamma-hadron separation. In future, an additional muon detector will be used for hadron tagging at ≥100 TeV energies. Here, only data from the first IACT of the TAIGA experiment are used. A randomforest algorithm was trained using Monte Carlo (MC) simulations and real data, and applied to $85\, \mathrm{h}$ of selected observational data tracking the Crab Nebula at a mean zenith angle of 33.5°, resulting in a threshold energy of 6 TeV for this data set. The analysis was performed using the gammapy package. A total of 163.5 excess events were detected, with a statistical significance of 8.5 σ. The observed spectrum of the Crab Nebula is best fit with a power law above 6 TeV with a flux normalization of (3.20 ± 0.42) · 10−10 TeV−1 cm−2 s−1at a reference energy of $13\, \mathrm{TeV}$ and a spectral index of −2.74 ± 0.16.
Thermal and reionization history within a large-volume semi-analytic galaxy formation simulation
Authors: Balu Sreedhar , Greig Bradley , Qiu Yisheng , Power Chris , Qin Yuxiang , Mutch Simon , Wyithe J Stuart B
Published: January 2023

We predict the 21-cm global signal and power spectra during the Epoch of Reionization using the meraxes semi-analytic galaxy formation and reionization model, updated to include X-ray heating and thermal evolution of the intergalactic medium. Studying the formation and evolution of galaxies together with the reionization of cosmic hydrogen using semi-analytic models (such as M eraxes) requires N-body simulations within large volumes and high-mass resolutions. For this, we use a simulation of side-length 210 h−1 Mpc with 43203 particles resolving dark matter haloes to masses of $5\times 10^8 \rm{ }h^{-1}\, \mathrm{M_\odot }$. To reach the mass resolution of atomically cooled galaxies, thought to be the dominant population contributing to reionization, at z = 20 of $\sim 2\times 10^7 \text{ }h^{-1}\, \mathrm{M_\odot }$, we augment this simulation using the darkforest Monte Carlo merger tree algorithm (achieving an effective particle count of ∼1012). Using this augmented simulation, we explore the impact of mass resolution on the predicted reionization history as well as the impact of X-ray heating on the 21-cm global signal and the 21-cm power spectra. We also explore the cosmic variance of 21-cm statistics within 703 h−3 Mpc3 sub-volumes. We find that the midpoint of reionization varies by Δz ∼ 0.8 and that the cosmic variance on the power spectrum is underestimated by a factor of 2–4 at k ∼ 0.1–0.4 Mpc−1 due to the non-Gaussian nature of the 21-cm signal. To our knowledge, this work represents the first model of both reionization and galaxy formation which resolves low-mass atomically cooled galaxies while simultaneously sampling sufficiently large scales necessary for exploring the effects of X-rays in the early Universe.
Hepatic and pulmonary involvement in a patient with PR3-ANCA vasculitis following SARS-CoV-2 vaccination: A case report
Authors: Tonutti Antonio , Simonetta Edoardo , Stainer Anna , Suigo Giulia , De Santis Maria , Selmi Carlo , Masetti Chiara , Lleo Ana , Terracciano Luigi Maria , Aliberti Stefano , Amati Francesco
Published: January 2023

We here report the first case of anti-proteinase 3–positive anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis following the severe acute respiratory syndrome coronavirus 2 Pfizer-BioNTech vaccine presenting with prominent liver involvement and alveolar haemorrhage. Two weeks after vaccination, a 49-year-old man developed inflammatory arthralgias and hypertransaminasaemia. Two months later, fever and haemoptysis appeared; the patient tested positive for anti-proteinase 3 autoantibodies. High-dose steroids and rituximab were started, and complete remission was achieved. Systemic autoimmune diseases, including ANCA-associated vasculitis, should always be considered in the differential diagnosis of hypertransaminasaemia, especially when the clinical context is suspicious.
Mitochondrial ferredoxin-like is essential for forming complex I-containing supercomplexes in Arabidopsis
Authors: Röhricht Helene , Przybyla-Toscano Jonathan , Forner Joachim , Boussardon Clément , Keech Olivier , Rouhier Nicolas , Meyer Etienne H
Published: January 2023

In eukaryotes, mitochondrial ATP is mainly produced by the oxidative phosphorylation (OXPHOS) system, which is composed of 5 multiprotein complexes (complexes I–V). Analyses of the OXPHOS system by native gel electrophoresis have revealed an organization of OXPHOS complexes into supercomplexes, but their roles and assembly pathways remain unclear. In this study, we characterized an atypical mitochondrial ferredoxin (mitochondrial ferredoxin-like, mFDX-like). This protein was previously found to be part of the bridge domain linking the matrix and membrane arms of the complex I. Phylogenetic analysis suggested that the Arabidopsis (Arabidopsis thaliana) mFDX-like evolved from classical mitochondrial ferredoxins (mFDXs) but lost one of the cysteines required for the coordination of the iron-sulfur (Fe-S) cluster, supposedly essential for the electron transfer function of FDXs. Accordingly, our biochemical study showed that AtmFDX-like does not bind an Fe-S cluster and is therefore unlikely to be involved in electron transfer reactions. To study the function of mFDX-like, we created deletion lines in Arabidopsis using a CRISPR/Cas9-based strategy. These lines did not show any abnormal phenotype under standard growth conditions. However, the characterization of the OXPHOS system demonstrated that mFDX-like is important for the assembly of complex I and essential for the formation of complex I-containing supercomplexes. We propose that mFDX-like and the bridge domain are required for the correct conformation of the membrane arm of complex I that is essential for the association of complex I with complex III2 to form supercomplexes.
Psychometric properties and validity of the Menopause Rating Scale in postmenopausal Portuguese women
Authors: Espírito Santo João , Marques de Loureiro Nuno Eduardo , Brandão-Loureiro Vânia , Aibar-Almazán Agustín , Hita-Contreras Fidel
Published: January 2023

Objective

The aim of the study is to analyze the reliability and validity of the Portuguese version of the Menopause Rating Scale (MRS) among postmenopausal Portuguese women.

Methods

A total of 184 postmenopausal women completed the Portuguese MRS. Internal consistency and test-retest reliability were studied. Construct, convergent, and concurrent validity were assessed. The 10-item Cervantes Scale and the Hospital Anxiety and Depression Scale were used to determine convergent and concurrent validity, respectively. The ability and accuracy of the Portuguese MRS to discriminate between women with and without anxiety and depression cases were evaluated, and a receiver operating characteristic curve analysis was used.

Results

The Portuguese MRS showed an appropriate level of internal consistency (Cronbach α, 0.84 for MRS total score) and test-retest reliability (MRS total score; intraclass correlation coefficient, 0.92; 95% confidence interval, 0.85–0.96). Factor analysis (construct validity) revealed a 3-factor structure (explained variance of 62.08%). The MRS total score and its 3 factors showed good convergent (10-item Cervantes Scale) and concurrent (Hospital Anxiety and Depression Scale anxiety and depression) validity (all P < 0.001). The Portuguese MRS total score was significantly able to discriminate between postmenopausal women with and without anxiety (P < 0.001) and depression (P = 0.001), with a cutoff point of 15.50 (80.00% sensitivity and 63.70% specificity) for detecting depression and a cutoff point of 16.50 (82.35% sensitivity and 78.57% specificity) for identifying anxiety.

Conclusions

The Portuguese MRS has been shown to be a valid and reliable questionnaire for assessing the severity of menopausal symptoms and discriminating among postmenopausal women with and without anxiety and depression.
Cytological characteristics of premalignant cervical epithelial lesions in postmenopausal women based on endocrine indices and parakeratosis
Authors: Sugisawa Akiyuki , Toyoda Zensei , Tanabe Yasuka , Uehara Karina , Oshiro Aya , Yamazato Reo , Sakamoto Chiharu , Yogi Shohei , Kurima Kiyoto , Kina Shinichiro , Sakiyama Michiyo , Kinjo Takao
Published: January 2023

Objective

To identify useful cytological findings for detecting premalignant lesions in postmenopausal women, cervicovaginal smear samples were analyzed and compared between women with or without premalignant lesions based on endocrine indices and presence of parakeratosis (PK).

Methods

The cervicovaginal smear samples of postmenopausal women with premalignant lesions (n = 94) and those who were without (n = 344), who were diagnosed between 2012 and 2014 were retrieved and analyzed. Women cytologically diagnosed with malignancy or those with suspicion of malignancy were excluded from this study. Cytological endocrine indices, such as the maturation index (MI) and eosinophilic index (EI) and the prevalence of PK were compared between the groups and analyzed using the 2 × 2 χ2 test. The association of endocrine indices combined with the presence of PK and histological findings was also evaluated.

Results

Postmenopausal women with premalignant lesions had higher endocrine indices (EI of ≥11%; 65% vs. 43%, P < 0.01, f = 0.18) and a higher prevalence of PK positivity (PK ≥ 1; 46% vs. 7%, P < 0.01, f = 0.44) than those without lesions. Further analysis indicated that the combination of high EI and the presence of PK in postmenopausal women with cytological premalignant cases was highly associated with histological squamous intraepithelial lesions (SIL) (86% in women with premalignant lesions vs. 53% in those without; P = 0.01, f = 0.34).

Conclusion

Our research demonstrated that high EI and PK positivity were correlated with SIL in postmenopausal women. These cytological findings could provide potential diagnostic clues for detecting dysplasia.
Salivary Cortisol Dynamics After Mild Traumatic Brain Injury
Authors: Musacchio Sophia , Kallenbach Madeline D. , Huber Daniel L. , Raff Hershel , Johnson Blair D. , Leddy John , McCrea Michael A. , Meier Timothy B. , Nelson Lindsay D.
Published: January 2023

Objective:

To assess mild traumatic brain injury (mTBI)-related alterations in baseline (resting) salivary cortisol and cortisol reactivity to cognitive and exercise stressors, which are frequently encountered during mTBI rehabilitation and recovery.

Setting:

Persons with mTBI were recruited from a level 1 trauma center emergency department. Uninjured controls (UCs) were recruited from the community.

Participants:

Participants were 37 individuals with mTBI and 24 UCs. All patients with mTBI were enrolled at 7 ± 3 days post-injury, met the American Congress of Rehabilitation Medicine definition of mTBI, and had no acute intracranial findings on clinical neuroimaging (if performed).

Design:

A prospective cohort study design was used. All participants provided saliva samples 10 times during each of 2 visits spaced 3 weeks apart (1 week and 1 month post-injury for the mTBI group). Each visit included baseline saliva sampling and sampling to evaluate reactivity to a cognitive stressor (Paced Auditory Serial Addition Test) and physical stressor (Buffalo Concussion Treadmill Test [BCTT]).

Main Outcome Measure:

Natural log-transformed salivary cortisol was measured by enzyme immunoassay. Cortisol was predicted using a linear mixed-effects model by group (mTBI and UC), visit (1 week and 1 month), and saliva sample.

Results:

Mean salivary cortisol was higher in the mTBI group (1.67 nmol/L [95% CI 1.42-1.72]) than in controls (1.30 nmol/L [1.12-1.47]), without an mTBI × time interaction. At 1 week, the mTBI group had greater cortisol reactivity in response to the BCTT.

Conclusions:

Higher cortisol in individuals with mTBI at 1 week and 1 month post-injury extends previous findings into the subacute recovery period. Furthermore, the mTBI group demonstrated a greater cortisol response to mild-to-moderate aerobic exercise (BCTT) at 1 week post-injury. Given the increasing role of exercise in mTBI rehabilitation, further research is warranted to replicate these findings and identify the clinical implications, if any, of enhanced hypothalamic-pituitary-adrenal axis responses to exercise in civilians with recent mTBI.
EXCESSIVE GLIOSIS AFTER VITRECTOMY FOR THE HIGHLY MYOPIC MACULAR HOLE
Authors: Ye Xin , Wang Jun , Qiu Wangli , Chen Yiqi , Shen Lijun
Published: January 2023

Purpose:

To investigate different modes of foveal regeneration after the closure of idiopathic macular hole (IMH) or highly myopic macular hole (HMMH) by vitrectomy with internal limiting membranes peeling or flap techniques.

Methods:

This retrospective observational study followed 47 IMH and 50 HMMH eyes for at least 6 months. Twenty four IMH and 25 HMMH eyes underwent internal limiting membrane peeling, whereas 23 IMH and 25 HMMH eyes received inverted internal limiting membrane flap technique. Spectral domain optical coherence tomography was used to analyze macular hole closure, foveal microstructures, and excessive gliosis as a foveal “peak-like” protuberance.

Results:

A single procedure closed all IMH (n = 47). For HMMH, the inverted group (n = 25, 100%) closed more macular hole than the peeling group (n = 14, 56.00%) (P < 0.001). Excessive gliosis only occurred in the inverted group, and there was a significant difference (P = 0.005) in incidence between IMH (three in 23 eyes, 13.04%) and HMMH (13 in 25 eyes, 52.00%). The axial length more than 29.985 mm enhanced the risk of excessive gliosis.

Conclusion:

The inverted internal limiting membrane flap efficiently treated refractory MHs but was prone to cause excessive gliosis in highly myopic eyes. Excessive elongation of the globe (axial length > 29.985 mm) was linked to excessive gliosis growth.
VOLUMETRIC ANALYSIS OF LAMELLAR MACULAR HOLE
Authors: Taşlıpınar Uzel Ayşe Güzin , Gelisken Faik , Kühlewein Laura , Neubauer Jonas
Published: January 2023

Background:

To investigate the cavity of lamellar macular holes (LMH-CV) by using volumetric analysis of optical coherence tomography images.

Methods:

Single-center, retrospective, observational case series. The volume of the LMH-CV and epiretinal proliferation was determined. Best-corrected visual acuity, central macular thickness, maximum horizontal diameter and minimum horizontal diameter, and the presence of foveal bump and ellipsoid zone defect were noted.

Results:

Forty-nine eyes of 46 patients (20 women) were included in the baseline analysis. The natural course group consisted of 25 patients (27 eyes) with a mean follow-up of 19.2 ± 15.7 months. The volume of LMH-CV was found to be a predictive factor for baseline best-corrected visual acuity (P = 0.038, ß-coefficient = 0.338, 95% CI: 0.275–8.893). Whereas no significant change at the last visit was observed in central macular thickness, minimum horizontal diameter, and maximum horizontal diameter, the LMH-CV and epiretinal proliferation volume increased significantly (P = 0.036, P < 0.001, respectively). Eyes with foveal bump had larger minimum horizontal diameter, maximum horizontal diameter, and LMH-CV volume (P = 0.008, P < 0.001, P = 0.024, respectively). Eyes with ellipsoid zone defect showed larger LMH-CV and epiretinal proliferation volume, but thinner central macular thickness (P = 0.038, P = 0.004, P = 0.012, respectively).

Conclusion:

Volumetric analysis of LMH-CV detects changes in the natural course of lamellar macular hole earlier than the measurement of horizontal diameters. Further studies will clarify whether volumetric analysis of the lamellar macular hole is useful as an additional biomarker in the management of lamellar macular hole.
FULL-THICKNESS MACULAR HOLE WITH PERSISTENT BROAD VITREOMACULAR ATTACHMENT
Authors: Uemura Akinori , Yamakiri Keita , Santo Kyoko , Hamada Takuto , Miyake Shoki , Sakamoto Taiji
Published: January 2023

Purpose:

To describe the characteristics and surgical outcomes of full-thickness macular holes (FTMHs) with persistent broad vitreomacular attachment.

Methods:

This was a retrospective, observational case series. Consecutive patients undergoing pars plana vitrectomy for FTMHs with persistent broad vitreomacular attachment (study group) were reviewed. Clinical charts, optical coherence tomography (OCT) features of macular holes, and surgical outcomes were reviewed and compared with those with typical FTMH with focal vitreomacular traction (control group).

Results:

A total of 15 eyes of 14 consecutive patients (eight males and six females with a mean age of 60.6 years) were included in the study group. OCT showed a zone of at least 1,500 µm all around the circumference of the fovea where the vitreous was attached. On OCT, epiretinal membrane and epiretinal proliferation were observed in 73% and 87% of cases, respectively. Compared with the control group, the study group was younger (P = 0.027) and had better preoperative visual acuity (P = 0.007). All FTMHs closed after one surgery in both groups, and the postoperative visual acuity of the study group was better than that of the control group (P = 0.002).

Conclusion:

Full-thickness macular holes may have developed under the condition that the vitreous cortex was broadly attached around the hole. These FTMHs were associated with younger age, better baseline visual acuity, and a higher incidence of epiretinal membranes and epiretinal proliferations compared with macular hole with focal vitreomacular traction. The surgical outcome was favorable, but the pathogenesis of FTMH development remains unclear.
Review of the National Quality Forum's Measure Endorsement Process
Authors: Ramachandran Sujith , Maharjan Shishir , Nsiah Irene , Urick Benjamin Y. , Carr Alexcia , Foster Matthew
Published: January 2023

The National Quality Forum (NQF) evaluates healthcare performance measures for endorsement based on a broad set of criteria. We extracted data from NQF technical reports released between spring 2018 and spring 2019. Measures were commonly stewarded by federal agencies (44.29%), evaluated for maintenance (67.14%), classified as outcome (42.14%) or process (39.29%) measures, and used a statistical model for risk adjustment (48.57%). For 80% of the measures reviewed, a patient advocate was present on the reviewing committee. Validity was evaluated using face validity (65.00%) or score-level empirical validity (67.14%), and reliability was frequently evaluated using score-level testing (71.43%). Although 91.56% of all reviewed measures were endorsed, most standing committee members voted moderate rather than high support on key assessment criteria like measure validity, measure reliability, feasibility of use, and whether the measure addresses a key performance gap. Results show that although the Consensus Development Process includes multidisciplinary stakeholder input and thorough evaluations of measures, continued work to identify and describe appropriate and robust methods for reliability and validity testing is needed. Further work is needed to study the extent to which stakeholder input is truly representative of diverse viewpoints and improve processes for considering social factors when risk adjusting.
Zeroing a Transducer on an External Ventricular Drain
Authors: Malloy Rachel
Published: January 2023

BACKGROUND: External ventricular drains (EVDs) are commonly used in severely brain-injured patients to diagnose intracranial hypertension. The accuracy of the intracranial pressure reading is dependent on zeroing the external transducer to air. Recent concern about zeroing techniques has been identified in the neuroscience community. The open method requires removing the nonvented cap, and the closed method requires zeroing through the filter at the top of the burette. This critical appraisal seeks to explore whether zeroing a transducer on an EVD through the filter of the burette provides the same baseline zero as opening the transducer to air. METHODS: Independent searches in CINAHL, PubMed, and Web of Science were conducted using “external ventricular drain* OR EVD AND transducer”; secondary search terms included “zero AND transducer” AND “ventric.” RESULTS: Database search produced 1 single observation study and 2 clinical practice guidelines from neuroscience professional organizations. The single observation study provided no evidence of equivalence between the 2 zeroing methods; the 2 clinical practice guidelines reference the open method. The transducer manufacturer's instructions for use direct the clinician to open the transducer to air by removing the nonvented cap. CONCLUSION: The question “Does zeroing the transducer on an EVD through the filter of the burette provide the same baseline zero as opening the transducer to air?” cannot be answered with the results of this appraisal. However, evidence found in the literature does suggest an open method to ensure the most accurate physiological value for treatment decisions.
Stroke Diagnosis Protocol for Children with Ventricular Assist Devices
Authors: Mills Michele G , Reichhold Allison , Maciorowski Kim , Joong Anna , Kurz Jonathan , Pardo Andrea C.
Published: January 2023

Ventricular assist devices (VADs) are increasingly used for end-stage heart failure in children. VAD-associated neurologic dysfunction, including stroke and intracranial hemorrhage, occurs in more than 20% of patients. Starting in 2019, we implemented a protocol to diagnose stroke in relation to VAD to facilitate treatment. A multidisciplinary approach was implemented including targeted education for providers. VAD goals, structured neurologic exam, and frequency of neuromonitoring were incorporated into daily rounds, tailored to patient’s phase of recovery. A protocolized neurocritical team assessment was implemented. A VAD-specific stroke algorithm and order set were implemented to facilitate rapid neuroimaging. We performed a pre- and postimplementation analysis from 2015 to 2020. Forty-six patients had VADs placed, 25 preintervention, and 21 postintervention. We compared the number of patients evaluated for stroke, time to imaging, and documentation of last known normal exam. Preintervention, time to imaging was 7 hours, and documentation was inconsistent. Postintervention, time to imaging decreased to 2.8 hours (p = 0.038) with universal documentation of last known normal (p = 0.009). The use of head computerized tomographies decreased from 11 preintervention to three postintervention. Development of a VAD protocol decreased time to imaging for suspected stroke and reduced unnecessary imaging. Further studies are required to validate these data.