bluuebunny/crossref_metadata_2025 huggingface dataset:
Reassessment of clinical variables in cardiac resynchronization defibrillator patients at the time of first replacement: Death after replacement of CRT (DARC) score
Authors: Theuns Dominic A. M. J. , Niazi Kaijbar , Schaer Beat A. , Sticherling Christian , Yap Sing‐Chien , Caliskan Kadir
Published: April 2021

Introduction

Cardiac resynchronization defibrillator (CRT‐D) as primary prevention is known to reduce mortality. At the time of replacement, higher age and comorbidities may attenuate the benefit of implantable cardioverter‐defibrillator (ICD) therapy. The purpose of this study was to evaluate the progression of comorbidities after implantation and their association with mortality following CRT‐D generator replacement. In addition, a risk score was developed to identify patients at high risk for mortality after replacement.

Methods and Results

We identified patients implanted with a primary prevention CRT‐D (n = 648) who subsequently underwent elective generator replacement (n = 218) from two prospective ICD registries. The cohort consisted of 218 patients (median age: 70 years, male gender: 73%, mean left ventricular ejection fraction [LVEF]: 36 ± 11% at replacement). Median follow‐up after the replacement was 4.2 years during which 64 patients (29%) died and 11 patients (5%) received appropriate ICD shocks. An increase in comorbidities was observed in 77 patients (35%). The 5‐year mortality rate was 41% in patients with ≥2 comorbidities at the time of replacement. A risk score incorporating age, gender, LVEF, atrial fibrillation, anemia, chronic kidney disease, and history of appropriate ICD shocks at time of replacement accurately predicted 5‐year mortality (C‐statistic 0.829). Patients with a risk score of greater than 2.5 had excess mortality at 5‐year postreplacement compared with patients with a risk score less than 1.5 (57% vs. 6%; p < .001).

Conclusion

A simple risk score accurately predicts 5‐year mortality after replacement in CRT‐D patients, as patients with a risk score of greater than 2.5 are at high risk of dying despite ICD protection.
Optimal substrate modification strategies using catheter ablation in patients with persistent atrial fibrillation: 3‐year follow‐up outcomes
Authors: Hsieh Yu‐Cheng , Lin Yenn‐Jiang , Lo Men‐Tzung , Chen Yun‐Yu , Lin Chin‐Yu , Lin Chen , Chung Fa‐Po , Lo Li‐Wei , Chang Shih‐Lin , Chao Tze‐Fan , Hu Yu‐Feng , Tuan Ta‐Chuan , Liao Jo‐Nan , Wu Cheng‐I , Liu Chih‐Min , Vicera Jennifer‐Jeanne B. , Chen Chun‐Chao , Chin Chye‐Gen , Lugtu Isaiah C. , Chen Shih‐Ann
Published: April 2021

Objectives

This study aimed to assess the comparative efficacy of four ablation strategies on the incidence rates of freedom from atrial fibrillation (AF) or atrial tachycardia (AT) through a 3‐year follow‐up in patients with persistent AF.

Background

The optimal substrate modification strategies using catheter ablation for patients with persistent AF remain unclear.

Methods

Patients with persistent AF were enrolled consecutively to undergo each of four ablation strategies: (a) Group 1 (Gp 1, n = 69), pulmonary vein isolation (PVI) plus rotor ablation assisted by similarity index and phase mapping; (b) Gp 2 (n = 75), PVI plus linear ablations at the left atrium; (c) Gp 3 (n = 42), PVI plus the elimination of complex fractionated atrial electrograms; (d) Gp 4 (n = 67), PVI only. Potential confounders were adjusted via a multivariate survival parametric model.

Results

Baseline characteristics were similar across the four groups. At a follow‐up period of 34.9 ± 38.6 months, patients in Gp 1 showed the highest rate of freedom from AF compared with the other three groups (p = .002), while patients in Gp 3 and 4 showed lower rates of freedom from AT than those of the other two groups (p = .006). Independent predictors of recurrence of AF were the ablation strategy (p = .002) and left atrial diameter (LAD) (p = .01).

Conclusion

In patients with persistent AF, a substrate modification strategy using rotor ablation assisted by similarity index and phase mapping provided a benefit for maintaining sinus rhythm compared with the other strategies. Both ablation strategy and baseline LAD predicted the 3‐year outcomes of freedom from AT/AF
Sociotechnical Imaginaries of EU Defence: The Past and the Future in the European Defence Fund
Authors: Martins Bruno Oliveira , Mawdsley Jocelyn
Published: April 2021

In this article we investigate how a particular vision of the future of EU defence has embedded itself into different arenas of EU politics over decades, and is currently gaining material expression in the European Defence Fund (EDF). Through an historiographic approach, we traced the development of a particular narrative on security, innovation, research, and economic growth based on fears of technology gaps and dependence on the US, and a belief in the potential of military R&D to produce civilian benefits. We provide an alternative reading of the emergence of the EDF by drawing on literature within Science and Technology Studies, in particular the concept of sociotechnical imaginaries, to highlight wider socio‐political dimensions of defence technologies and expand debates on EU defence.
Frailty implications for exercise participation and outcomes in patients with heart failure
Authors: Mudge Alison M. , Pelecanos Anita , Adsett Julie A.
Published: April 2021

Background/Objectives

Frailty is common in people with heart failure (HF) and associated with poorer outcomes. The aim of this study was to describe the characteristics, exercise participation, and outcomes of frail and not‐frail participants enrolled in a randomized trial of exercise training (ET) within a cardiac rehabilitation (CR) program.

Design

Secondary analysis of EJECTION‐HF randomized trial (ACTRN12608000263392).

Setting

Five HF‐specific CR programs in Queensland, Australia.

Participants

Adults recently hospitalized with HF.

Intervention

All participated in CR including home exercise prescription and monitoring; half were randomized to center‐based ET.

Measurements

A frailty index (FI) was constructed at randomization and 6‐month follow‐up. Outcomes included ET attendance, change in 6‐min walk distance (6MWD), improved FI (>0.09 units) at 6 months, achieving physical activity (PA) guidelines at 6 months, and 12 month all‐cause death or readmission.

Results

The FI was measured in 256 participants at randomization: 110 (43%) were not‐frail (FI 0.2 or less), 119 (46%) were frail (FI >0.2 to 0.39), and 27 (11%) were very frail (FI ≥0.4). Frailty was more common with older age, female gender, decompensated HF, worse HF symptoms, and preserved ejection fraction. ET attendance did not differ by frailty group. Participants who were more frail had lower 6WMD at enrollment, but similar improvement over 6 months. Mean FI improved by 0.03 units at 6 months (95% CI 0.02–0.04, p < 0.001). Participants who were more frail had significantly greater improvements in FI compared with not‐frail participants and were often able to achieve PA guidelines, both in intervention and control groups. Neither baseline frailty nor intervention was significantly associated with 12‐month death or readmission.

Conclusion

Frail people with HF participating in CR that includes home and/or center‐based ET often achieve PA guidelines, and some may have meaningful reductions in frailty.
Aligning POLST orders with wishes: Time to put evidence into practice
Authors: Tolle Susan W.
Published: April 2021

This editorial comments on the article by Hickman et al. in this issue.
Preliminary data demonstrate the Geriatric Surgery Verification program reduces postoperative length of stay
Authors: Jones Teresa S. , Jones Edward L. , Richardson Vanessa , Finley Julie B. , Franklin Jennifer L. , Gore Deborah L. , Horney Carolyn P. , Kovar Alexandra , Morin Theresa L. , Robinson Thomas N.
Published: April 2021

Objectives/Background

The Geriatric Surgery Verification (GSV) Program promotes clinical standards aimed to optimize the quality of surgical care delivered to older adults. The purpose of this study was to determine if preliminary implementation of the GSV Program standards improves surgical outcomes.

Design

Prospective study with cohort matching.

Setting

Data from a single institution compared with a national data set cohort.

Participants

All patients aged ≥75 years undergoing inpatient operations between January 2018 and December 2019 were included. Cohort matching by age and procedure code was performed using a national data set.

Measurements

Baseline pre‐ and intraoperative characteristics prospectively recorded using Veterans Affairs Surgical Quality Improvement Program (VASQIP) variable definitions. Postoperative outcomes were recorded including complications as defined by VASQIP, 30‐day mortality, and length of stay.

Results

A total of 162 patients participated in the GSV program, and 308 patients comprised the matched comparison group. There was no difference in postoperative occurrence of one or more complications (p = 0.81) or 30‐day mortality (p = 0.61). Patients cared for by the GSV Program had a reduced postoperative length of stay (median 4 days [range 1,31] vs. 5 days [range 1,86]; p < 0.01; and mean 5.4 ± 4.8 vs. 8.8 ± 11.8 days; p < 0.01) compared with the matched cohort. In a multivariable regression model, the GSV Program's reduced length of stay was independent of other associated covariates including age, operative time, and comorbidities (p < 0.01).

Conclusion

Preliminary implementation of the GSV Program standards reduces length of stay in older adults undergoing inpatient operations. This finding demonstrates both the clinical and financial value of the GSV Program.
Evaluation of classification methods for identifying multiwalled carbon nanotubes collected on mixed cellulose ester filter media
Authors: Smith Devin , Neu‐Baker Nicole M. , Eastlake Adrienne C. , Zurbenko Igor G. , Brenner Sara A.
Published: April 2021

Enhanced darkfield microscopy (EDFM) and hyperspectral imaging (HSI) are being evaluated as a potential rapid screening modality to reduce the time‐to‐knowledge for direct visualisation and analysis of filter media used to sample nanoparticulate from work environments, as compared to the current analytical gold standard of transmission electron microscopy (TEM). Here, we compare accuracy, specificity, and sensitivity of several hyperspectral classification models and data preprocessing techniques to determine how to most effectively identify multiwalled carbon nanotubes (MWCNTs) in hyperspectral images. Several classification schemes were identified that are capable of classifying pixels as MWCNT(+) or MWCNT(–) in hyperspectral images with specificity and sensitivity over 99% on the test dataset. Functional principal component analysis (FPCA) was identified as an appropriate data preprocessing technique, testing optimally when coupled with a quadratic discriminant analysis (QDA) model with forward stepwise variable selection and with a support vector machines (SVM) model. The success of these methods suggests that EDFM‐HSI may be reliably employed to assess filter media exposed to MWCNTs. Future work will evaluate the ability of EDFM‐HSI to quantify MWCNTs collected on filter media using this classification algorithm framework using the best‐performing model identified here – quadratic discriminant analysis with forward stepwise selection on functional principal component data – on an expanded sample set.
A through‐focus scanning optical microscopy dimensional measurement method based on deep‐learning classification model
Authors: Nie Haitao , Peng Renju , Ren Jiajun , Qu Yufu
Published: April 2021

Through‐focus scanning optical microscopy (TSOM) is an economical, non‐contact and nondestructive method for rapid measurement of three‐dimensional nanostructures. There are two methods using TSOM image to measure the dimensions of one sample, including the library‐matching method and the machine‐learning regression method. The first has the defects of small measurement range and strict environmental requirements; the other has the disadvantages of feature extraction method greatly influenced by human subjectivity and low measurement accuracy. To solve the problems above, a TSOM dimensional measurement method based on deep‐learning classification model is proposed. TSOM images are used to train the ResNet50 and DenseNet121 classification model respectively in this paper, and the test images are used to test the model, the classification result of which is taken as the measurement value. The test results showed that with the number of training linewidths increasing, the mean square error (MSE) of the test images is 21.05 nm² for DenseNet121 model and 31.84 nm² for ResNet50 model, both far lower than machine‐learning regression method, and the measurement accuracy is significantly improved. The feasibility of using deep‐learning classification model, instead of machine‐learning regression model, for dimensional measurement is verified, providing a theoretical basis for further improvement on the accuracy of dimensional measurement.
Efficacy of intra‐arterial thrombolytic therapy for vision loss resulting from hyaluronic acid filler embolization
Authors: Xu Xiao , Zhou Guiwen , Fu Qiang , Zhang Lixia , Yu Youtao , Dong Ying , Liang Liming , Chen Minliang
Published: April 2021

Background

The incidence of hyaluronic acid (HA) embolism has increased markedly in recent years. HA embolism can lead to serious complications such as blindness, eye and eyelid movement disorders, skin necrosis, and cerebral embolism. However, there is a lack of robust clinical evidence regarding the benefits of treatment of HA embolism with intra‐arterial thrombolytic therapy (IATT).

Methods

In the present study, we enrolled 45 patients with decreased visual acuity, including 40 patients with symptoms of vision loss and eight patients with symptoms of intracranial embolism. The patients underwent emergency IATT via hyaluronidase and papaverine injections, followed by conventional sequential therapy.

Results

In the 45 patients with symptoms of vision loss, 16 (36%) exhibited improvements in final visual acuity, even when the clinical application of the thrombolytic treatments was performed beyond the recommended window for optimal treatment. The facial skin necrosis of all patients was restored to near normal appearance. Notably, for eight patients with suspected symptoms of intracranial infarction we performed cerebral angiography and IATT, and in two patients obtained partial recanalization of the obstruction, the symptoms of heavy headache and binocular distension pain were improved in one patient with intracranial embolism after IATT treatment.

Conclusion

Our results indicate that IATT is feasible for patients with vision loss induced by HA embolism. IATT combined with conventional sequential therapy was beneficial in the recovery from other serious HA embolism complications. Nevertheless, the underlying pathophysiological mechanism needs to be clarified in future animal experiments.
Oral tranexamic acid, hydroquinone 4% and low‐fluence 1064 nm Q‐switched Nd:YAG laser for mixed melasma: Clinical and dermoscopic evaluation
Authors: Elkamshoushi Abdelaal M. , Romisy Doaa , Omar Salma S.
Published: April 2021

Background

Tranexamic acid (TA) can prevent melanocyte activation by various stimuli. Combining TA with either hydroquinone 4% or Q‐switched Nd:YAG laser may be associated with greater improvement of melasma.

Objectives

We aimed to evaluate the efficacy and safety of oral TA alone and combined with either topical hydroquinone 4% or low‐fluence 1064 nm Q‐switched Nd:YAG laser in treatment of mixed melasma.

Patients & Methods

Patients were randomly divided into three groups of 20 patients each. Group A were treated with oral TA 250 mg twice daily for three months; group B were treated with TA similarly combined with topical hydroquinone 4% cream; group C were treated with TA combined with two sessions of 1064 nm low‐fluence Q‐switched ND:YAG laser (850–1200 mJ/cm2, 4–5 Hz,spot size 4 mm) spaced 4 weeks apart. Patients were followed monthly for 9 months.

Results

After cessation of therapy, the mean mMASI score was lowest in group B (2.34 ± 2.37) followed by groups A (6.38 ± 4.04) and C (7.24 ± 4.95).Mean percentage of mMASI score improvement was 35.91 ± 24.13, 77.47 ± 19.07, and 24.94 ± 27.79 in groups A, B, and C (p < 0.001). There was a significant reduction of telangiectasia in the three groups. Reported side effects were itching & irritation, post‐inflammatory hyperpigmentation, and gastritis.

Conclusion

Oral TA is a tolerable effective treatment modality for melasma. Combining hydroquinone 4% with oral TA is associated with a relatively earlier and better cosmetic outcome.
Membrane vesicles from periodontal pathogens and their potential roles in periodontal disease and systemic illnesses
Authors: Ma Li , Cao Zhengguo
Published: April 2021

Periodontium is an ordered ecological system where a dynamic equilibrium exists between oral microorganisms and the host defense system, and periodontal disease occurs whenever the balance is broken. Periodontal pathogens mainly include gram‐negative anaerobic bacteria and emerging gram‐positive microbes, which have a large variety of virulence factors and influence disease initiation and progression. Recently, different types of bacterial membrane vesicles (MVs), formed by bubbling of membrane materials from living cells or in conditions of endolysin‐triggered cell death, have gained interests as a novel virulence factor for periodontopathogens. MVs load multiple sorted cargo molecules, such as proteins, lipids, and genetic materials, and actively participate in toxin transport, signal delivery, and periodontal disease pathogenesis. Since periodontitis is recognized as a risk factor for many systemic diseases, periodontal MVs could work as a bridge for periodontal diseases and systemic illnesses. Furthermore, MVs with unique nature and advantages are promising candidates as vaccines and drug delivery vehicles. In this review, we provided an overview of different types and compositions of periodontal MVs, described their involvements in the pathogenesis of periodontitis and several general diseases, and discussed potential applications of periodontal MVs in vaccination and drug delivery.
Sleep scoring based on video‐electroencephalography monitoring in an Epileptology Unit: Comparison with polysomnography
Authors: Nguyen‐Michel Vi‐Huong , Herlin Bastien , Gales Ana , Vaz Soraia , Levy Pierre , Dupont Sophie , Adam Claude , Navarro Vincent , Frazzini Valerio
Published: April 2021

The aim of the study was to compare the performance of video‐ electroencephalography (EEG) monitoring and standard polysomnography for sleep scoring in an Epileptology Unit. We calculated the level of agreement between two methods of sleep scoring, using either 27‐electrode video‐EEG or polysomnography for 1 night in 22 patients admitted to our Epileptology Unit. Independent experts manually scored sleep using the American Academy of Sleep Medicine 2017 guidelines. We evaluated the number of sleep cycles and their distribution on hypnogram, total sleep time, sleep efficiency, sleep and rapid eye movement sleep‐onset latency, wake after sleep‐onset, and sleep stages. We then extracted sub‐samples of recordings to examine the agreement in microarousal and rapid eye movement scoring. We used Bland and Altman plots and Cohen’s kappa test to measure agreement. Bland and Altman plots showed at least 95% agreement for all studied sleep parameters with the exception of wake after sleep onset, where there was an 11 min difference. Cohen’s kappa test showed an agreement for the recognition of microarousal (0.89) and of rapid eye movements (0.96) in sub‐samples. Video‐EEG represents an acceptable alternative tool for sleep architecture study in patients admitted to an Epileptology Unit.
Imaging and histopathologic features of reversible nerve root and peripheral nerve edema secondary to disc herniation in a cat
Authors: Herzig Robert , Wang‐Leandro Adriano , Steffen Frank , Matiasek Kaspar , Beckmann Katrin M.
Published: April 2021

Nerve root enlargement with increased contrast uptake has been reported in dogs and humans secondary to nerve root compression. In cats, nerve root enlargement and contrast uptake only have been reported in association with inflammatory and neoplastic diseases, but not as a sequela to nerve root compression. An 8‐year‐old oriental short hair cat was presented with acute neurologic deficits consistent with left‐sided sciatic nerve deficit and possible L6‐S1 myelopathy. Magnetic resonance imaging (MRI) was performed and identified compression of the cauda equina and L7 nerve root associated with intervertebral disc herniation (IVDH) at L6‐L7 as well as widespread sciatic nerve enlargement with moderate rim enhancement. A hemilaminectomy was performed to evacuate herniated disc material. The nerve root was biopsied and submitted for histological evaluation. Interstitial nerve edema was diagnosed. Follow‐up MRI 3 months postoperatively showed complete remission of the changes. Nerve root thickening together with contrast enhancement may represent nerve edema in cats secondary to IVDH.
Thirteen dogs and a cat with ultrasonographically detected gallbladder wall edema associated with cardiac disease
Authors: Lisciandro Gregory R. , Gambino Jennifer M. , Lisciandro Stephanie C.
Published: April 2021

Background

Ultrasonographically detected gallbladder wall edema (GBWE) is a marker for anaphylaxis in dogs. Cardiac disease can cause GBWE with similar signs and should be included as a differential diagnosis to prevent interpretation errors.

Hypothesis/Objectives

Document GBWE associated with cardiac disease.

Animals

Fourteen client‐owned animals.

Methods

Prospective case series with abdominal focused assessment with abdominal sonography in trauma, triage and tracking (AFAST), and thoracic focused assessment with abdominal sonography in trauma, triage, and tracking (TFAST) performed at triage. Animals with GBWE and cardiac disease were enrolled. A board‐certified radiologist reviewed images to confirm cardiac disease, GBWE, and characterize the caudal vena cava (CVC) and hepatic veins.

Results

Thirteen dogs and 1 cat had GBWE associated with cardiac disease. Gallbladder findings included mural thickness ranging from 3 to 5 mm, mild to moderate sludge (n = 3), and mild to moderate luminal distension (n = 6). CVC and hepatic venous distension were found in 5/6. Cardiac diagnoses in dogs included 11 with pericardial effusion (PCE) and 1 each with dilated cardiomyopathy and right‐sided myocardial failure. Severity of PCE was rated as mild (n = 1), moderate (n = 6), or severe (n = 4). Seven of 11 had pericardiocentesis performed. Nine of 13 had ascites with 4 having abdominal fluid scores of 1 (n = 2), 2 (n = 2), 3 (n = 1), and 4 (n = 0). Lung ultrasound findings were as follows: dry lung (n = 6), B‐lines (n = 4), and nodules (n = 1). The cat had moderate PCE, ascites scored as 1, and severe right‐sided ventricular enlargement associated with a ventricular septal defect. Primary presenting complaints included acute weakness (n = 9), acute collapse (n = 5), gastrointestinal signs (n = 3), respiratory distress (n = 2), and need for cardiopulmonary resuscitation (n = 1).

Conclusions and Clinical Importance

Ultrasonographically detected GBWE was associated with PCE in this small cohort of cases.
Neophyte invasions in European grasslands
Authors: Axmanová Irena , Kalusová Veronika , Danihelka Jiří , Dengler Jürgen , Pergl Jan , Pyšek Petr , Večeřa Martin , Attorre Fabio , Biurrun Idoia , Boch Steffen , Conradi Timo , Gavilán Rosario G. , Jiménez‐Alfaro Borja , Knollová Ilona , Kuzemko Anna , Lenoir Jonathan , Leostrin Artem , Medvecká Jana , Moeslund Jesper Erenskjold , Obratov‐Petkovic Dragica , Svenning Jens‐Christian , Tsiripidis Ioannis , Vassilev Kiril , Chytrý Milan
Published: April 2021

Questions

The human‐related spread of alien plants has serious environmental and socioeconomic impacts. Therefore, it is important to know which habitats are most threatened by invasion and why. We studied a wide range of European grasslands to assess: (a) which alien species are the most successful invaders in grasslands; (b) how invasion levels differ across European regions (countries or their parts) and biogeographical regions; and (c) which habitat types are the most invaded.

Location

Europe.

Methods

We selected 97,411 grassland vegetation plots from the European Vegetation Archive (EVA) and assigned a native or alien status to each of the 8,212 vascular plant species found in these plots. We considered only neophytes (alien species introduced after 1500 AD), which we further divided according to their origin. We compared the levels of invasion using relative neophyte richness in the species pool, relative neophyte richness and cover per plot, and percentages of invaded plots among regions and habitats.

Results

Only 536 species, representing 6.5% of all grassland vascular plant species, were classified as neophytes. These were mostly therophytes or hemicryptophytes with low habitat specificity. Most of them were present in very few plots, while only three species were recorded in more than 1% of all plots (Onobrychis viciifolia, Erigeron annuus and Erigeron canadensis). Although invasion levels were generally low, we found more invaded plots in the Boreal and Continental regions. When considering only non‐European neophytes, the Pannonian region was the most invaded. Among different grassland habitats, sandy grasslands were most invaded, and alpine and oromediterranean grasslands least invaded.

Conclusions

In general, natural and semi‐natural European grasslands have relatively low levels of neophyte invasions compared with human‐made habitats or alluvial forests, as well as with grasslands on other continents. The most typical neophytes invading European grasslands are species with broad ecological niches.
Serum vitamin D levels in relation to metabolic syndrome: A systematic review and dose–response meta‐analysis of epidemiologic studies
Authors: Hajhashemy Zahra , Shahdadian Farnaz , Moslemi Elham , Mirenayat Fateme Sadat , Saneei Parvane
Published: April 2021

Several epidemiological studies examined the association of serum vitamin D with metabolic syndrome (MetS), but the findings were inconsistent. We conducted a systematic review and dose–response meta‐analysis to quantify the association between blood vitamin D levels and MetS in adults. A systematic search up to December 2020 was conducted in MEDLINE (PubMed), ISI (Web of Science), Scopus, and Google Scholar databases for epidemiological studies that assessed the relation of serum 25‐hydroxyvitamin D (as the exposure) and MetS (as the outcome) in adults. Eligible cross‐sectional studies were restricted to those with representative populations. Finally, 43 studies were included in the analysis (38 cross‐sectional, one nested case–control, and four cohorts studies). Combining 41 effect sizes from 38 cross‐sectional studies included 298,187 general adult population revealed that the highest level of serum vitamin D, compared with the lowest level, was significantly related to a 43% decreased odds of MetS in developed countries (odds ratio [OR]: 0.57; 95% confidence interval [CI]: 0.49–0.65) and 40% in developing countries (OR: 0.60; 95% CI: 0.52–0.70). Linear dose–response analysis (including 222,175 healthy individuals and 39,308 MetS patients) revealed that each 25 nmol/L increase in serum vitamin D level was significantly associated with a 15% decreased odds of MetS (OR: 0.85; 95% CI: 0.80–0.91); however, we found no significant nonlinear association. Meta‐analysis of five prospective studies with 11,019 participants revealed no significant relation (relative risk [RR]: 0.70; 95% CI: 0.37–1.32). This meta‐analysis indicated an inverse association between serum vitamin D concentrations and risk of MetS in general adult populations in cross‐sectional studies in a dose–response manner. However, no significant association was found in a small number of cohorts. More prospective studies are needed to confirm the causality of this relationship.
Streptococcus mutans in atherosclerotic plaque: Molecular and immunohistochemical evaluations
Authors: Fernandes Forte Clarissa Pessoa , Oliveira Francisco Artur Forte , Lopes Camile de Barros , Alves Ana Paula Negreiros Nunes , Mota Mário Rogério Lima , de Barros Silva Paulo Goberlânio , Montenegro Raquel Carvalho , Campos Ribeiro dos Santos Ândrea Kely , Lobo Filho José Glauco , Sousa Fabrício Bitu
Published: April 2021

Objectives

To verify the presence of Streptococcus mutans (S. mutans) in atherosclerotic plaque (AP) using techniques with different sensitivities, correlating with histological changes in plaque and immunoexpression of inflammatory markers.

Materials and Methods

Thirteen AP samples were subjected to real‐time polymerase chain reaction (qRT‐PCR), histopathological analyses, histochemical analysis by Giemsa staining (GS), and immunohistochemical analysis for S. mutans, IL‐1β, and TNF‐α (streptavidin‐biotin‐peroxidase method). Ten necropsy samples of healthy vessels were used as controls.

Results

All AP samples showed histopathological characteristics of severe atherosclerosis and were positive for S. mutans (100.0%) in qRT‐PCR and immunohistochemical analyses. GS showed that Streptococcus sp. colonized the lipid‐rich core regions and fibrous tissue, while the control group was negative for Streptococcus sp. IL‐1β and TNF‐α were expressed in 100% and 92.3% of the AP tested, respectively. The control samples were positive for S. mutans in qRT‐PCR analysis, but negative for S. mutans, IL‐1β, and TNF‐α in immunohistochemical analyses.

Conclusion

The detection of S. mutans in AP and the visualization of Streptococcus sp. suggested a possible association between S. mutans and atherosclerosis. The results obtained from the control samples suggested the presence of DNA fragments or innocuous bacteria that were not associated with tissue alteration. However, future studies are necessary to provide more information.
Myopia and glaucoma progression among patients with juvenile onset open angle glaucoma: A retrospective follow up study
Authors: Gupta Shikha , Singh Abhishek , Mahalingam Karthikeyan , Selvan Harathy , Gupta Prasad , Pandey Shivam , Somarajan Bindu I , Gupta Viney
Published: April 2021

Objective

To identify the risk factors for glaucoma progression, especially the association with myopia, among treated juvenile open angle glaucoma (JOAG) patients.

Methods

Glaucomatous progression was analysed in the eyes of JOAG patients with at least 5‐years of follow up in this retrospective study. Baseline variables such as age, inheritance pattern, baseline intraocular pressure (IOP), baseline central corneal thickness, visual acuity, baseline refractive error, spherical equivalent (SE) and duration of follow‐up were noted. Stereoparametric global trend analysis and Moorfields Regression Analysis on confocal scanning laser ophthalmoscopy were used to detect progression. Variables associated with glaucoma progression, with respect to progressors (PG) and non‐progressors (NPG) were analysed. Since both eyes of a patient were taken for analysis, a generalised estimating equation method was used to correct the bias.

Results

Among 74 eyes (37 subjects), glaucoma progression was noted in 11 eyes (14.9%) of 8 patients, with a median time to progression of 7.4 years (range 5–15.5 years). For myopes (SE ≤ −1.00 D), glaucoma progression was 18 times more likely than mild and no myopes (>‐1DS) (p = 0.03, 95% CI: 1.14, 217.44). The prevalence of myopia in the JOAG, PG and NPG cohorts was 70.3%, 87.5%, and 65.5%, respectively. Myopia progression was noted at follow up in 70% patients. One‐unit increase in baseline vertical cup disc ratio, 1 mmHg increase in IOP fluctuations and 1 dB year−1 depression of visual field were associated with 0.44, 0.06 and 0.07 D year−1 increases in the rate of myopia progression, respectively.

Conclusions

JOAG progressors had a greater baseline myopic refraction and a faster myopia development over time. The development of myopia in JOAG eyes could be an indicator of glaucoma progression, and hence progressing myopic (≤−1 D) JOAG patients should be followed up more rigorously.
Outcomes of manual versus remote magnetic navigation for catheter ablation of ventricular tachycardia: a systematic review and updated meta‐analysis
Authors: Blandino Alessandro , Bianchi Francesca , Sibona Masi Andrea , Mazzanti Andrea , D'Ascenzo Fabrizio , Grossi Stefano , Musumeci Giuseppe
Published: April 2021

Purpose

Ventricular tachycardia (VT) ablation is a complex procedure that requires remarkable catheter manipulation skill, great mapping accuracy and catheter stability, and can expose patients to serious complications. Magnetic navigation system (RMN)‐guided ablation and contact force‐sensing (CFS) catheters have the potential to overcome these obstacles. We performed a systematic review and updated meta‐analysis of all available studies evaluating the outcomes of VT ablation by using RMN‐guided compared to manual navigation (MAN)‐guided, with and without CFS catheters.

Methods

MEDLINE/PubMed, Cochrane, and Google Scholar were searched for randomized controlled trials (RCT) or observational studies with multivariate adjustment comparing RMN‐guided versus MAN‐guided VT ablation.

Results

Thirteen studies enrolling 1348 patients (656 RMN‐guided vs. 692 MAN‐guided) were included. CFS catheter were used in 14% of MAN‐guided patients. In comparison to MAN‐guided and CFS‐guided, RMN‐guided VT ablation was associated with a significant higher acute ablation success (OR 2.32, 1.66–3.23 and OR 2.91, 1.29–6.53, respectively) but similar results in term of long‐term VT recurrence (OR 0.75, 0.56–1.01 and OR 0.79, 0.27–2.36, respectively). RMN‐guided showed a better safety profile (for all complications, OR 0.52, 0.34–0.81) and allowed a significant x‐ray reduction compared to MAN‐guided (OR 0.21, 0.14–0.32) and CFS‐guided VT ablation (OR 0.23, 0.11–0.52, all 95% CI).

Conclusions

RMN‐guided was superior to MAN‐guided and CFS‐guided VT ablation in term of acute ablation success, all complications endpoint, and reduction of fluoroscopy exposure, but did not reduce long‐term VT recurrence. Large prospective multicenter randomized trials are needed to confirm these findings.
The association of multimorbidity to mortality in older adults after permanent pacemaker placement
Authors: Krishnaswami Ashok , Liu Taylor I. , Harris Jessica , Prentice Heather A. , Paxton Elizabeth W. , Masoudi Frederick A.
Published: April 2021

Background

In the United States 2018 bradycardia guideline, the current class III recommendation that patients with permanent pacemaker (PPM) indications and high multimorbidity burden may not have meaningful clinical benefit from PPM therapy is based on limited data.

Methods

Observational study (January 1, 2008–December 31, 2015) of adults ≥65 years (N = 16,678) who underwent PPM implantation. Exposure variable: Elixhauser comorbidity number (ECN, 29 well‐validated conditions). Primary outcome: ≤1‐year mortality; secondary outcome: > 1‐year mortality.

Results

Those who died ≤1‐year were older, had a lower body mass index (BMI), and higher ECN (p < .001). Cumulative survival at 1‐year was 92.3% (95% confidence interval [CI]: 91.9–92.7). One‐year survival decreased by increasing ECN—with a difference at 1‐year between lowest and highest ECN category of 17.3% (ECN 0–1: 97.1% [95% CI: 96.3–97.7]; ECN ≥8: 79.8% [95% CI: 77.9–81.5]). For those who survived the first year, cumulative survival at 8‐years was 51.2% (95% CI = 49.8–52.6) with a difference between ECN 0–1 and ≥8 of 43.4%. Increasing ECN was associated equally with ≤1‐year (HR 1.28 [95% CI: 1.25–1.30]) and >1‐year (HR 1.19 [95% CI: 1.17–1.20]) mortality. A predictive model including age, sex, BMI, PPM type, race, and ECN had greater discriminative ability (p < .0001) than a bedside model (age, sex) for the primary outcome.

Conclusion

Across the heterogeneity of indications for PPM placement, multimorbidity is increasingly common. The association of multimorbidity to mortality (≤1‐year, >1‐year) should be routinely discussed during the shared decision‐making process as an important prognostic geriatric domain variable.
The Contribution of Diffusion to the Fertility Transition in Belgium (1887–1934)
Authors: Costa Rafael , Bocquier Philippe , Eggerickx Thierry
Published: April 2021

The aim of this study is to investigate whether diffusion contributed to the geography and the speed of the fertility transition. To this end, we assembled a new and unique dataset from historical sources in Belgium containing yearly information on fertility at the municipality level and a range of structural and cultural indicators over 47 years (1887–1934). We use this dataset in diffusion models based on multilevel event‐history analysis. We find that diffusion between neighboring places influenced the geography of the fertility transition only in its early stages; and diffusion accelerated the speed at which municipalities initiated fertility decline at the onset of the transition. We argue that, in the early stages of the transition, the bulk of people's interactions was confined to their own communities and neighboring places and, as such, new ideas, attitudes, and information about fertility would spread among adjacent areas. Later on, since the turn of the twentieth century, the way people interacted in space was transformed by the growing urbanization, the development of transportation infrastructure and labor migration. In this new context, opportunities for social learning were less constrained by space.
Association between autistic tendency and mental health for studying abroad
Authors: Takeuchi Jiro , Sakagami Yu
Published: April 2021

Background

To identify the association between autistic tendencies and mental health among university

students who study abroad.

Methods

We conducted a historical cohort study at a Japanese university, targeting students who went overseas from 2012 to 2014 as part of study abroad program. We administered questionnaires to students before and after they completed the overseas study program. These questionnaires included items about sex, age, academic degrees, department affiliations, past experience of studying abroad, type of overseas program, and schedule of departures and returns. To determine students' mental health problems, we considered cross‐cultural maladaptation while studying abroad as the outcome by two reviewers. We also administered the Autism‐Spectrum Quotient, Japanese version (AQ), and the General Health Questionnaire 60 Japanese version. We utilized the logistic regression model after adjusting for the General Health Questionnaire and country or region with programs to estimate odds ratios (OR) for considering outcomes.

Results

Of the 585 who participated in this study excluding two students for cancellations, 352 (60.2%) completed to following‐up. The prevalence of mental health problems was 6.0% (21/406) and categorized when studying abroad. The mean AQ score was 19.3 (standard deviation = ±7.12). High AQ (a score of 33 and more) was prevalent among 3.7% (18/486). Students with high AQ had more mental health problems compared to those without high AQ (adjusted ORs 5.87; 95% confidence interval, 1.24–27.9, P = 0.03).

Conclusions

We clarified the association between autistic tendencies and mental health for students studying abroad.
Trichoderma sp. endochitinase and β‐1,3‐glucanase impede Rhizoctonia solani growth independently, and their combined use does not enhance impediment
Authors: Kaur Ramanjeet , Kalia Anu , Lore Jagjeet S. , Kaur Ajinder , Yadav Inderjit , Sharma Priti , Sandhu Jagdeep S.
Published: April 2021

Rhizoctonia solani causing rice sheath blight is responsible for significant crop yield losses. Trichoderma spp., biological control agents, have been reported to antagonize R. solani through coordinated action of several cell wall‐degrading enzymes including endochitinase and β‐1,3‐glucanase. In this study two antifungal genes, encoding endochitinase and β‐1,3‐glucanase, isolated from Trichoderma sp. antagonistic to R. solani, were cloned individually in His‐tagged expression vectors and mobilized in Escherichia coli for protein expression. The purified proteins assayed in vitro with R. solani impeded pathogen growth independently by causing hyphal distortions revealed through scanning electron microscopy. The combined use of endochitinase and β‐1,3‐glucanase did not enhance the inhibition. The distortions caused by endochitinase were due to catalytic activity of Glu172 and Asp241 residues on glycosidic linkages in chitin polymers, whereas Glu628, Tyr631, and Asp569 in β‐1,3‐glucanase targeted glucan polymers. The distinctions of this study from earlier reports are (a) chitin polymers in the R. solani cell wall are exposed and not embedded within the β‐glucan matrix; (b) chitin and β‐1,3‐glucan are vital polymers in the R. solani cell wall, rather than chitin as the only main polymer; and (c) hyphal tips of R. solani remain unaffected after an antifungal assay with endochitinase and β‐1,3‐glucanase, instead of exhibiting distortion.
Marine microalgae for outdoor biomass production—A laboratory study simulating seasonal light and temperature for the west coast of Sweden
Authors: Cheregi Otilia , Engelbrektsson Johan , Andersson Mats X. , Strömberg Niklas , Ekendahl Susanne , Godhe Anna , Spetea Cornelia
Published: April 2021

At Nordic latitudes, year‐round outdoor cultivation of microalgae is debatable due to seasonal variations in productivity. Shall the same species/strains be used throughout the year, or shall seasonal‐adapted ones be used? To elucidate this, a laboratory study was performed where two out of 167 marine microalgal strains were selected for intended cultivation at the west coast of Sweden. The two local strains belong to Nannochloropsis granulata (Ng) and Skeletonema marinoi (Sm142). They were cultivated in photobioreactors and compared in conditions simulating variations in light and temperature of a year divided into three growth seasons (spring, summer and winter). The strains grew similarly well in summer (and also in spring), but Ng produced more biomass (0.225 vs. 0.066 g DW L−1 day−1) which was more energy rich (25.0 vs. 16.6 MJ kg−1 DW). In winter, Sm142 grew faster and produced more biomass (0.017 vs. 0.007 g DW L−1 day−1), having similar energy to the other seasons. The higher energy of the Ng biomass is attributed to a higher lipid content (40 vs. 16% in summer). The biomass of both strains was richest in proteins (65%) in spring. In all seasons, Sm142 was more effective in removing phosphorus from the cultivation medium (6.58 vs. 4.14 mg L−1 day−1 in summer), whereas Ng was more effective in removing nitrogen only in summer (55.0 vs. 30.8 mg L−1 day−1). Our results suggest that, depending on the purpose, either the same or different local species can be cultivated, and are relevant when designing outdoor studies.
Nitro‐oxidative stress induces the formation of roots' cortical aerenchyma in rice under osmotic stress
Authors: Basu Sahana , Kumari Surbhi , Kumar Alok , Shahid Rimsha , Kumar Santosh , Kumar Gautam
Published: April 2021

Drought stress induces the formation of cortical aerenchyma in roots, providing drought tolerance by reducing respiration. However, unrestricted aerenchyma formation impedes the radial transport of water through the root's central cylinder; thereby decreasing the water uptake under drought stress. Therefore, exploring the root architectural and anatomical alterations in rice under drought is essential for targeting crop improvement. Drought stress‐induced accumulation of reactive oxygen species (ROS) plays a key role in the lysigenous aerenchyma development. However, the influence of nitric oxide (NO) and reactive nitrogen species (RNS) in the development of lysigenous aerenchyma under drought has never been studied in rice. The present study examined the effect of ROS and RNS, generated by progressive drought stress, on the lysigenous aerenchyma formation in the roots of contrasting rice genotypes of the Eastern Indo‐Gangetic plains (EIGP). As expected, the PEG‐induced drought stress stimulated the expression of NADPH oxidase (NOX), thereby promoting the ROS generation in roots of the rice seedlings. Excessive ROS and RNS accumulations in roots affected the membrane lipids, promoting the tissue‐specific programmed cell death (PCD) in rice. The activation of the antioxidant defense system played a major role in the ROS and RNS detoxification, thereby restricting the root aerenchyma formation in rice under drought stress. The results also displayed that drought tolerance in rice is associated with the formation of the Casparian strip, which limits the apoplastic flow of water in the water‐deficient roots. Overall, our study revealed the association of nitro‐oxidative metabolism with PCD and lysigenous aerenchyma formation in the cortical cells of root under drought stress in rice.
Different abscisic acid‐deficient mutants show unique morphological and hydraulic responses to high air humidity
Authors: Innes Sheona N. , Solhaug Knut Asbjørn , Torre Sissel , Dodd Ian C.
Published: April 2021

High relative humidity (RH) perturbs plant growth, stomatal functioning and abscisic acid (ABA) homeostasis, but the role of ABA in this physiological regulation is equivocal. To determine the role(s) of ABA in plant responses to high RH, wild‐type (WT) tomato and barley plants and their respective ABA‐deficient mutants flacca and Az34 (which are mutated in the same locus of the ABA biosynthesis pathway) were grown in contrasting RHs (60% and 90%) to measure biomass partitioning, stomatal traits and water relations. Surprisingly, growth RH did not affect foliar ABA levels in either species. While Az34 showed similar stomatal size and density as WT plants, flacca had larger and more abundant stomata. High RH increased stomatal size in tomato, but decreased it in barley, and decreased stomatal density in tomato, but not in barley. Altered stomatal responses in ABA‐deficient plants to high RH had little effect on tomato photosynthesis, but Az34 barley showed lower photosynthesis. ABA deficiency decreased relative shoot growth rate (RGRSHOOT) in both species, yet this was counteracted by high RH increasing leaf water status in tomato, but not in barley. High RH increased RGRSHOOT in flacca, but not in WT tomatoes, while having no effect on RGRSHOOT in barley, but affecting barley net assimilation rate, leaf area ratio (LAR) and specific leaf area in an ABA‐dependent manner. ABA‐RH interaction affected leaf development in tomato only. Thus, different crop species show variable responses to both high RH and ABA deficiency, making it difficult to generalise on the role of ABA in growth regulation at contrasting RHs.