bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 71: Evaluating The Factors Associated With Patient Adherence And Persistence To Pharmacological Therapies After An Acute Coronary Syndrome
Authors: Korjian Serge , Shaunik Alka , Nara Paul , Pourrahmat Mir-Masoud , Breznen Boris , Gibson C Michael
Published: May 2022

Adherence to guideline-recommended, long-term, secondary preventative therapies among patients with acute coronary syndromes (ACS) is fundamental to improving long-term outcomes. This review identified factors that influence medication adherence among patients following an ACS. A targeted literature review was conducted on September 7, 2021 using predefined search strategies to identify studies that investigated adherence to secondary preventative oral therapies post-ACS. Embase and MEDLINE® were searched using the Ovid platform. A total of 58 studies were identified. Adherence to secondary prevention was moderate to low and steadily decreased over time. Nearly 30% of patients discontinued one or more medications within 90 days of their primary ACS, and adherence decreased to 50-60% at one-year post-discharge. There were no major differences in adherence between drug classes. Three key factors influenced adherence: clinical, psychological, and follow-up care. Patients managed with percutaneous coronary interventions were more adherent to follow-up treatment than medically-managed patients. Depression was reported as a major psychological factor that negatively affected adherence. Improved adherence was observed when higher levels of patient education and provider engagement were delivered during post-discharge follow-up. Notably, early follow-up visits were associated with high adherence. In a US study, two-year major adverse cardiovascular event incidence was lower in hospitals with high 90-day medication adherence than those with moderate or low adherence. Patient non-adherence to guideline-recommended long-term pharmacological secondary preventative therapies post-ACS is a multi-factorial problem. A comprehensive multi-disciplinary approach, with key interventions such as early follow-up visits, patient engagement and education, should be implemented to improve adherence and clinical outcomes. Additionally, novel therapies with a short treatment course that can be completed within 90 days, while possessing patient and provider preferred attributes such as good tolerability, convenient dosing and administration, may help to improve patient adherence and clinical outcomes.
Abstract 72: What Leads To Optimal Use Of Noninvasive Cardiac Testing? A Qualitative Study Of Top-performing Hospitals
Authors: Kini Vinay , Reedy Julia , Devereux Richard B , Dorsey-Holliman Brooke , Ho Michael
Published: May 2022

Background:
There is wide variation in rates of both “high-value” noninvasive cardiovascular testing that is recommended by guidelines and “low-value” testing that provides minimal patient benefit. Little is known about what makes hospitals successful in maximizing high-value and minimizing low-value testing.

Methods:
We used the Colorado all-payer claims database from 2016-2019 to identify hospital use of 1) high-value tests including assessment of left ventricular ejection fraction in patients hospitalized with acute myocardial infarction or incident heart failure, and 2) low-value tests including preoperative stress testing prior to low-risk surgery and routine stress testing within 2 years of coronary revascularization. We identified two “top-performing” hospitals with optimal testing rates (i.e., high-value testing rates in the highest quintile and low-value testing rates in the lowest quintile of hospitals in the state). We performed a qualitative study using in-depth, semi-structured interviews (n=19) with clinical and administrative staff (quality officers, lab directors, and ordering clinicians) at these two “top-performing” hospitals. We examined interview transcripts using directed content analysis to develop our codebook, and analyzed data using a matrix analysis to identify themes that may lead to optimal use of testing.

Results:
Four main themes were identified: 1) cardiologist involvement (either through screening programs or through direct contact with primary care clinicians); 2) open and direct communication between noninvasive cardiologists and ordering clinicians; 3) a strong sense of mission to deliver high quality and individualized patient care by clinical and administrative staff; and 4) an organizational and leadership culture of approachability and responsiveness to quality improvement initiatives.

Conclusions:
We identified four themes that characterized the experiences of two hospitals that have optimized use of noninvasive testing. Given the complexity of organizational change to improve care quality, these themes may help hospitals focus future efforts to improve value in testing.
Abstract 74: Healthcare Utilization Among Cardiovascular Disease Patients Switching To A High-deductible Health Plan
Authors: Gupta Ravi , Yang Lin , Lewey Jennifer , Navathe Amol , Groeneveld Peter W , Khatana Sameed A
Published: May 2022

Background:
The majority of commercially insured individuals in the US are enrolled in high-deductible health plans (HDHPs). HDHPs aim to reduce healthcare spending by disincentivizing expensive care utilization and are associated with lower inpatient and outpatient care utilization. The association of HDHPs with healthcare utilization in patients with chronic cardiovascular (CV) disease is unclear. We studied the association of employer-mandated switching to HDHPs with inpatient and outpatient care utilization in patients with chronic CV disease.

Methods:
Data were extracted from a national commercial health insurance claims data set (Optum® Clinformatics® Data Mart). We identified employers that mandated switching from a traditional plan to an HDHP versus those that remained in traditional plans from 2011 to 2019 to reduce selection bias. We created a cohort of patients aged 18-64 with heart failure, coronary artery disease, peripheral artery disease, or stroke who were enrolled in these employer plans. Our primary outcomes were rates of all-cause hospitalizations and outpatient visits. We estimated the difference-in-differences in these outcomes between persons who switched to an HDHP after at least 1 year of enrollment in a traditional plan, compared to those who remained in a traditional plan, using a negative binomial regression model with inverse probability of treatment weighting to balance baseline patient characteristics.

Results:
A total of 1,038 individuals with chronic CV disease switched to an HDHP and 56,756 remained in a traditional plan. Switching to an HDHP was associated with a 10.4% (95% CI 4.3% to 16.2%; p=0.001) lower annual rate of outpatient visits, i.e., 0.66 (95% CI 0.25 to 1.05) fewer visits per person per year. The change in annual all-cause hospitalizations after switching to an HDHP was not statistically significant: -16.4% (95% CI -45.2% to 27.4%; p=0.41).

Conclusion:
Among patients with chronic CV disease, switching to an HDHP was associated with a significant reduction in outpatient visits and no significant change in all-cause hospitalizations. These findings suggest that HDHPs are associated with lower outpatient care utilization without significant change in utilization of inpatient services.
Abstract 83: 7 C's In Preventing Stroke Complicating Coronary Angioplasty
Authors: Wilbert Lisa , Dogar Muhammad , Gumersell Kellie , Leippert Yvonne , Pyo Robert , Lawson William E
Published: May 2022

Introduction:
Despite advances in angioplasty equipment and technique, reducing the incidence of CVA has remained an elusive target. Strokes increase mortality, cost and length of stay, residual disability.

Hypothesis:
1. Monitor and benchmark CVAs, 2. Drill down for predictors, lapses in care, 3. Form a multidisciplinary group to identify failure modes, process controls.

Methods:
CVAs complicating coronary PCI from 2017 to present were reviewed.

Results:
There were 32 CVAs [5 hemorrhagic; 27 thrombotic] occurring in 6410 PCI by 18 operators [0.5%] & 9 deaths [0.28] CVA pts were high acuity: 2 [0.06] post Cardiac arrest, 11 [.34] STEMIs, 8 [.25] Non-STEMIs, 12 [.38] ACS. Age > 65 years in 22 [0.69]. Comorbidity: CVA/TIA/Carotid disease 8 [0.25], PAD 6 [0.19], CKD 4/5 in 3 [0.09], Atrial fib 4 [0.13], LVEF < 35% 12 [0.38]. Ventricular support for cardiogenic shock in 5 [0.16]. Access changed from femoral to radial with 7 CVA [0.22] associated with radial, 22 [0.69] with femoral, and 3 [0.09] with both. Anticoagulation: heparin alone 5 [0.16] and bivalirudin ± heparin in 27 [0.84]. Most interventions utilized bivalirudin. PCI with Heparin & Aspiration thrombectomy, in 5 [0.16] had a higher thrombotic CVA risk. Multidisciplinary review concerns included: 1. pt factors [bleeding/clotting history, current meds and side effects, risk factors for CVA/TIA {e.g. STEMI/non-STEMI, cardiogenic shock, atrial fibrillation, age, carotid disease}, 2. Equipment {e.g. access sheath size and length, catheter preshaped/shaped/multiple, wire [e.g. straight, curved tip, shapeable, hydrophilic, exchange], thrombectomy, angioplasty [balloon, rotoblator, stent], 3. Personnel [experience, volume, trainees], 4. Process [Anticoagulation {timing, heparin,/bivalirudin, dose, monitoring}, Cleaning hands/wires/bowl, Catheter exchanges, Case Duration. Patient monitoring, Brain attack protocol activation and response.

Conclusions:
The multidisciplinary group formulated a7 C’s Chain of prevention to lessen the risk of CVA:
Continuous monitoring
,
Contributing factor
identification,
Consensus development
of best practices,
Cleanliness
,
Compulsive attention to detail
/ technique,
Communication
,
Controversies in Care
[notably DOACs].
Abstract 85: Evaluation Of Guideline-Directed Medical Therapy Prescribing In Patients Undergoing Transcatheter Edge-to-Edge Repair
Authors: Ambalavanan Manoj , Dwyer Kaluzna Stephanie , Nasrollahi Farrah , Patel Keshav , Twing Aamir , Dohse Carlos , Ramsis Ramsis , Benitez-Burke Jessica , Hammad Laila , Do Daniel , Long Matthew , Zayyad Zaid , Tiu David , Ibrahim Khalil , Kansal Mayank M , Shroff Adhir R , Groo Vicki L
Published: May 2022

Background:
The benefits of guideline-directed medical therapy (GDMT) in heart failure (HF) are well established, but the optimization of GDMT prior to and following transcatheter edge-to-edge repair (TEER) remains understudied. The purpose of this study was to evaluate GDMT use pre-and post-TEER.

Methods:
We performed a retrospective analysis of the electronic health records from 2019 to 2021 at the University of Illinois at Chicago of patients that underwent TEER. Patients were included if they had follow-up records within 6 months and a baseline ejection fraction (EF) < 50%. Demographic information, vitals, labs, and pertinent echocardiogram information were obtained at baseline and 6 months. GDMT doses were collected at baseline, discharge, 30 days, 3, and 6 months.

Results:
In total, 20 patients were included: 15 were male (75%) and 19 were non-white (95%). The average age was 66.8 years old (range 32.8-86.5). Past medical history was significant for 19 with hypertension (95%) and 15 with hyperlipidemia, coronary artery disease, and smoking history, respectively (75%). Pre-procedure mean blood pressure and heart rate were 123/74 mmHg and 81 bpm. Average creatinine was 1.66 ± 0.94 mg/dL and 1.10 ± 0.97 mg/dL at baseline and 6 months, respectively. A total of 9 patients (45%) had functional mitral regurgitation, 11 (65%) had primary or degenerative mitral regurgitation. A total of 6 patients (30%) had 11 readmissions for acute decompensated HF, 2 patients died, and 1 patient’s EF improved to > 50% by 6 months. GDMT is described in Table 1. No patients were prescribed SGLT2 inhibitors.

Conclusion:
GDMT for patients pre-and post-TEER procedure is neither prescribed nor titrated effectively. Further investigation will focus on confounding factors affecting prescribing patterns and titrations. Our findings demonstrate a continued opportunity for quality improvement in GDMT optimization during TEER hospital admission and follow-up visits.
Abstract 86: Anterior-lateral Vs Anterior-posterior Electrode Positioning For Cardioversion Of Atrial Fibrillation And Atrial Arrythmias: A Systematic Review And Meta-analysis
Authors: Bajwa Awais , Parmar Miloni , Imran Sana , Truong Derek , Agarwal Siddharth , Clifton Shari , Reese Jessica , Asad Zain Ul Abideen
Published: May 2022

Anterior-lateral Vs Anterior-posterior Electrode Positioning for Cardioversion of Atrial Fibrillation and Atrial Arrhythmias: A Systematic Review and Meta-analysis

Introduction:
Multiple randomized controlled trials (RCTs) have compared the efficacy of anterolateral (AL) and anteroposterior (AP) electrode positioning for cardioversion of atrial fibrillation and other atrial arrhythmias with conflicting results. We hypothesized that AP electrode positioning will have a superior efficacy for cardioversion due to better alignment of the energy vector with the atria.

Methods:
A systematic search was conducted in the MEDLINE and Embase databases utilizing the Ovid interface. Results were screened to identify RCTs comparing AL and AP position of electrodes for cardioversion for atrial arrhythmias. Studied outcomes included the success of cardioversion, number of shocks, and mean shock energy required for successful cardioversion to sinus rhythm. Mantel-Haenszel aggregated risk ratios (RR) with 95% CIs were calculated.

Results:
A total of 14 RCTs were included comprising 2445 patients (1329 AL, 1116 AP). There was no statistically significant difference between the two groups with respect to successful cardioversion (RR 1.02 [0.97-1.06]; p = 0.43), first shock success (RR 1.14 [0.99-1.32]; p = 0.06), second shock success (RR1.08 [0.94-1.23]; p = 0.29), mean shock energies (mean difference 6.49 [17.33-30.31]; p = 0.59). We additionally compared success at high; >150 J (RR 1.02 [0.92-1.14] and low; <150 J (RR 1.09 [0.97-1.22]; p = 0.64) cardioversion energies which also did not show any significant difference.

Conclusions:
There is no significant difference in the efficacy between AL vs. AP electrode position for cardioversion of atrial arrhythmias.
Corrigendum: Measuring Uncertainty and Its Impact on the Economy
Authors: Carriero Andrea , Clark Todd E. , Marcellino Massimiliano
Published: May 2022

Carriero, Clark, and Marcellino (2018, CCM2018) used a large BVAR model with a factor structure to stochastic volatility to produce an estimate of time-varying macroeconomic and financial uncertainty and assess the effects of uncertainty on the economy. The results in CCM2018 were based on an estimation algorithm that has recently been shown to be incorrect by Bognanni (2022) and fixed by Carriero et al. (2022). In this corrigendum we use the algorithm correction of Carriero et al. (2022) to correct the estimates of CCM2018. Although the correction has some impact on the original results, the changes are small and the key findings of CCM2018 are upheld.
Spontaneous nocturnal erections and masturbation in captive male chimpanzees (Pan troglodytes)
Authors: Havercamp Kristin , Brindle Matilda , Sommer Volker , Hirata Satoshi
Published: May 2022

Nocturnal penile tumescence (NPT) has been reported for males of only a few mammalian species, including humans, albeit this scarcity might be an artefact of the difficulty of documenting it. We investigated NPT in 12 adult male chimpanzees living in an all-male group at Kumamoto Sanctuary, Japan. Recorded non-invasively with infrared video cameras across 72 nights (6 per individual), we observed NPT in two thirds of the individuals (8/12), with events in total. More than three quarters occurred during a transition from sleep to wakefulness, suggesting NPT may be associated with rapid eye movement sleep, similar to humans. Masturbation occurred in conjunction with NPT, including the likely consumption of ejaculate, in 4–6 individuals. While detailing nocturnal erections in chimpanzees may help us to better understand this robust physiological phenomenon in humans, further comparative research is necessary to reconstruct its phylogenetic history. At present, our findings support hypothetical functional explanations such as the facilitation of nocturnal emissions in order to increase ejaculate quality or an increase in tissue oxygenation to prevent erectile dysfunction.
Triumfetta decaglandulata (Grewioideae, Malvaceae), a new species from the Cerrado-Amazon ecotone, Northern Brazil
Authors: CARDOSO JESIANE MIRANDA , FERNANDES-JÚNIOR ALUÍSIO JOSÉ , DOS SANTOS BRAGANÇA GIL ANDRÉ
Published: May 2022

Triumfetta decaglandulata is described and illustrated as a new species from Brazil. This species is mainly featured as having ten glands on the androgynophore, which is a unique trait among species belonging to genus Triumfetta, as well as lack of membranaceous urceolus and petals. Triumfetta decaglandulata was found in the transition zone between the Cerrado and Amazon biomes, in Northern Brazil, where it grew on the roadside of an anthropogenic pasture area. Taxonomic comments, geographic distribution, habitat, conservation status and an updated identification key of all Brazilian species belonging to genus Triumfetta are also provided.
Cognitive Flexibility Through the Path of Yoga
Authors: Pandey Manya Pandey , Dagar Chirag
Published: May 2022

Cognitive flexibility plays a crucial role in an individual’s ability to adapt to the ever-changing situations and is associated with effective problem-solving and decision-making. Given the wide range of the impact of Yoga on physiological and psychological aspects of health, the purpose of the study was to examine the impact of Yoga-based practices (YBP) on cognitive flexibility among school students. The performance in digit letter substitution test (DLST) was assessed with 80 school students of fifth-grade and 78 students of ninth-grade immediately before and after participating in a single Yoga class and a control session of equal duration. The intervention comprised of YBP focusing on pranayama and relaxation meditation. Data were analysed using mixed-method ANOVA by comparing effect sizes between the two conditions supplemented by a within-group analysis. Most outcome measures exhibited a pattern of worsening in the control group over time, whereas changes in the Yoga group over time were either consistent or showed slight improvements. The findings suggest, at a preliminary level, that YBP are effective in improving students’ cognitive flexibility as well as their academic school readiness. This information is important to consider as it aims at developing students’ executive functions, thereby impacting their future.
Gold and aurostibite from the metaturbidite-hosted Au–Zn–Pb–Ag Hera deposit, southern Cobar Basin, central NSW, Australia: geochemical and textural evidence for gold remobilisation
Authors: Graham Ian T , McKinnon Adam , Lay Angela , Privat Karen , Schellen Khalid , Burrows Lachlan , Liepa Elizabeth , Quan Hongyan
Published: May 2022

The Devonian Hera metaturbidite-hosted polymetallic Au–Zn–Pb–Ag deposit of central NSW, Australia, contained a total undepleted resource of 3.6 Mt @ 3.3 g/t Au, 25 g/t Ag, 2.6% Pb and 3.8% Zn. The deposit comprises a number of distinctive lodes with each containing a distinctive ore and alteration/gangue mineralogy, though generally the sulfide ore comprises various mixtures of sphalerite, galena, chalcopyrite, pyrrhotite and relatively common visible gold–electrum. The North Pod and Far West lodes are distinctly Sb rich and contain a more diverse ore mineralogy with arsenopyrite, native silver, native antimony, gudmundite, tetrahedrite-(Fe), argentotetrahedrite-(Fe), acanthite, dyscrasite, nisbite and breithauptite. From analysis of 52,760 assays from across the deposit it was found that there was a very poor correlation between gold and each of Fe, Zn, S, Pb, Cu, As and Ag, whereas Ag correlated reasonably well with both Pb and Zn. Results from EPMA shows that gold varies widely in composition from host-rock associated gold (96 wt.% Au) through more intermediate compositions (88–73 wt.% Au) to electrum (46–27 wt.% Au), commonly associated with Sb-phases and containing significant Sb within the gold itself (1.05–2.58 wt.% Sb). From the Far West lense, aurostibite occurs as distinctive rims around gold. Although aurostibite associated with gold contains no silver, the gold itself contains constant moderate amounts (10.87–12.27 wt.% Ag). We suggest that the aurostibite and other Sb phases formed from a late-stage Sb-rich hydrothermal during low-temperature retrograde skarn alteration. There is abundant evidence for both chemical and physical remobilisation at Hera and this remobilisation is largely responsible for the spectrum of gold compositions observed. The source for these fluids may be an underlying magmatic body, evidence for which occurs as granite pegmatite dykes in various locations throughout the deposit. Furthermore, gold with a moderate to high Sb content may be indicative of a low temperature of formation.
Mitochondrial composition of and diffusion limiting factors of three social wasp genera Polistes, Ropalidia, and parapolybia (Hymenoptera: Vespidae)
Authors: Luo Li , Huang Pan , Chen Bin , Li Ting-Jing
Published: May 2022

Background

Social wasps Polistes, Ropalidia, and Parapolybia, belonging to the subfamily Polistinae, have obviously different distribution patterns, yet the factors leading to this difference remain unknown.

Results

The 17 newly sequenced mitogenomes of Polistes, Ropalidia, and Parapolybia contain 37 genes, and there are obvious differences among the compositions of the three genera. The monophyly of the genus Polistes and a monophyletic Ropalidiini: (Ropalidia + Parapolybia) are concordant with previous morphological analysis of the subfamily Polistinae. Our inferred divergence time demonstrates Polistes (at around 69 Ma) was diverged earlier than Ropalidia and Parapolybia (at around 61 Ma). The rearrangement of both trnY and trnL1 are shared by all the Polistinae. In addition, the unique rearrangement of TDRL derived at 69 Ma is detected in Polistes, and Ropalidia contains a Reversal which may derive at 61 Ma. Hereafter, the possibility is elaborated that Polistes originated in Aisa and then dispersed from Africa to South America, and Polistes and Ropalidia spread from Southeast Asia to Australia. At last, continental drift and Quaternary Ice Ages are inferred to be two main limiting factors in the current distributions of the three genera.

Conclusions

Obvious differences occur in the mitochondrial composition of Polistes, Ropalidia, and Parapolybia. According to the reconstructed time-calibrated framework, it is inquired that the continental drifts and the climate are mainly diffusion limiting factors of the three genera.
HPLC and high-throughput sequencing revealed higher tea-leaves quality, soil fertility and microbial community diversity in ancient tea plantations: compared with modern tea plantations
Authors: Yang Guangrong , Zhou Dapeng , Wan Renyuan , Wang Conglian , Xie Jin , Ma Cunqiang , Li Yongmei
Published: May 2022

Background

Ancient tea plantations with an age over 100 years still reserved at Mengku Town in Lincang Region of Yunan Province, China. However, the characteristic of soil chemicophysical properties and microbial ecosystem in the ancient tea plantations and their correlation with tea-leaves chemical components remained unclear. Tea-leaves chemical components including free amino acids, phenolic compounds and purine alkaloids collected from modern and ancient tea plantations in five geographic sites (i.e. Bingdao, Baqishan, Banuo, Dongguo and Jiulong) were determined by high performance liquid chromatography (HPLC), while their soil microbial community structure was analyzed by high-throughput sequencing, respectively. Additionally, soil microbial quantity and chemicophysical properties including pH, cation exchange capacity (CEC), soil organic matter (SOM), soil organic carbon (SOC), total nitrogen (TN), total phosphorus (TP), total potassium (TK), alkali-hydrolyzable nitrogen (AN), available phosphorous (AP) and available potassium (AK) were determined in modern and ancient tea plantations.

Results

Tea-leaves chemical components, soil chemicophysical properties and microbial community structures including bacterial and fungal community abundance and diversity evaluated by Chao 1 and Shannon varied with geographic location and tea plantation type. Ancient tea plantations were observed to possess significantly (P < 0.05) higher free amino acids, gallic acid, caffeine and epigallocatechin (EGC) in tea-leaves, as well as soil fertility. The bacterial community structure kept stable, while fungal community abundance and diversity significantly (P < 0.05) increased in ancient tea plantation because of higher soil fertility and lower pH. The long-term plantation in natural cultivation way might significantly (P < 0.05) improve the abundances of Nitrospirota, Methylomirabilota, Ascomycota and Mortierellomycota phyla.

Conclusions

Due to the natural cultivation way, the ancient tea plantations still maintained relatively higher soil fertility and soil microbial ecosystem, which contributed to the sustainable development of tea-leaves with higher quality.
Immunohistochemical identification and assessment of the location of leptin, visfatin and chemerin in the liver of men with different body mass index
Authors: Kasacka I. , Piotrowska Ż. , Domian N. , Lewandowska A. , Acewicz M.
Published: May 2022

Background

Adipokines such as leptin, visfatin and chemerin play a pivotal role not only in the pathogenesis of excessive weight gain but also impact on hepatic metabolism. However, alterations in the production of these peptides in the liver of overweight individuals have not been fully elucidated yet. The aim of the study was to evaluate changes in leptin, visfatin and chemerin biosynthesis in the liver of men with different BMI.

Methods

Fourteen adult men without symptoms from the digestive system were recruited. Research material consisted of liver samples. Study participants were divided into two groups: lean (BMI ≤ 25 kg/m2) and overweight subjects (BMI > 25 kg/m2). Paraffin liver sections were processed by immunohistochemistry for detection of leptin, visfatin and chemerin. Hepatic expression of leptin, visfatin and chemerin genes was determined by qRT-PCR method.

Results

Increased immunoreactivity for leptin and chemerin, and decreased immunoreaction for visfatin were observed in the liver of overweight men in comparison to lean subjects. Overweight subjects with hepatic steatosis displayed increased immunoreactivity for leptin and weaker immunoreaction against visfatin and chemerin in the liver, compared to individuals with normal organ structure. Expression of leptin and chemerin was enhanced in the liver of overweight individuals, with the highest expression observed in subjects with hepatic steatosis. Conversely, expression of visfatin in the male liver was decreased in overweight subjects and those with and liver steatosis.

Conclusions

The present study proves that the expression of leptin, visfatin and chemerin in the male liver is altered in overweight individuals. Our report also indicates the potential importance of these peptides in hepatic steatosis associated with overweight.
Improving individualized prescription in patients with multimorbidity through medication review
Authors: Molist-Brunet Núria , Sevilla-Sánchez Daniel , Puigoriol-Juvanteny Emma , Barneto-Soto Matilde , González-Bueno Javier , Espaulella-Panicot Joan
Published: May 2022

Background

Older patients tend to have multimorbidity, represented by multiple chronic diseases or geriatric conditions, which leads to a growing number of prescribed medications. As a result, pharmacological prescription has become a major concern because of the increased difficulties to ensure appropriate prescription in older adults. The study’s main objectives were to characterize a cohort of older adults with multimorbidity, carry out a medication review and compare the pharmacological data before and after the medication review globally and according to the frailty index.

Methods

This was a quasi-experimental (uncontrolled pre-post) study with a cohort of patients ≥ 65 years old with multimorbidity. Data were collected from June 2019 to October 2020. Variables assessed included demographic, clinical, and pharmacological data, degree of frailty (Frail-VIG index), medication regimen complexity index, anticholinergic and or sedative burden index, and monthly drug expenditure. Finally, a medication review was carried out by an interdisciplinary team (primary care team and a consultant team with a geriatrician and a clinical pharmacist) by applying the Patient-Centered Prescription model to align the treatment with care goals.

Results

Four hundred twenty-eight patients were recruited [66.6% women; mean age 85.5 (SD 7.67)]. The mean frail index was 0.39 (SD 0.13), corresponding with moderate frailty. Up to 90% of patients presented at least one inappropriate prescription, and the mean of inappropriate prescriptions per patient was 3.14 (SD 2.27). At the three-month follow-up [mortality of 17.7% (n = 76)], the mean chronic medications per patient decreased by 17.96%, varying from 8.13 (SD 3.87) to 6.67 (SD 3.72) (p < 0.001). The medication regimen complexity index decreased by 19.03%, from 31.0 (SD 16.2) to 25.1 (SD 15.1), and the drug burden index mean decreased by 8.40%, from 1.19 (SD 0.82) to 1.09 (SD 0.82) (p < 0.001). A decrease in polypharmacy, medication regimen complexity index, and drug burden index was more frequent among frail patients, especially those with severe frailty (p < 0.001).

Conclusions

An individualized medication review in frail older patients, applying the Patient-Centered Prescription model, decreases pharmacological parameters related to adverse drug effects, such as polypharmacy, therapeutical complexity, and anticholinergic and, or sedative burden. The benefits are for patients with frailty.
Continued effectiveness of COVID-19 vaccination among urban healthcare workers during delta variant predominance
Authors: Lan Fan-Yun , Sidossis Amalia , Iliaki Eirini , Buley Jane , Nathan Neetha , Bruno-Murtha Lou Ann , Kales Stefanos N.
Published: May 2022

Background

Data on COVID-19 vaccine effectiveness (VE) among healthcare workers (HCWs) during periods of delta variant predominance are limited.

Methods

We followed a population of urban Massachusetts HCWs (45% non-White) subject to epidemiologic surveillance. We accounted for covariates such as demographics and community background infection incidence, as well as information bias regarding COVID-19 diagnosis and vaccination status.

Results

During the study period (December 16, 2020 to September 30, 2021), 4615 HCWs contributed to a total of 1,152,486 person-days at risk (excluding 309 HCWs with prior infection) and had a COVID-19 incidence rate of 5.2/10,000 (114 infections out of 219,842 person-days) for unvaccinated person-days and 0.6/10,000 (49 infections out of 830,084 person-days) for fully vaccinated person-days, resulting in an adjusted VE of 82.3% (95% CI 75.1–87.4%). For the secondary analysis limited to the period of delta variant predominance in Massachusetts (i.e., July 1 to September 30, 2021), we observed an adjusted VE of 76.5% (95% CI 40.9–90.6%). Independently, we found no re-infection among those with prior COVID-19, contributing to 74,557 re-infection-free person-days, adding to the evidence base for the robustness of naturally acquired immunity.

Conclusions

We found a VE of 76.5% against the delta variant. Our work also provides further evidence of naturally acquired immunity.
The severity of portal hypertension by a non-invasive assessment: acoustic structure quantification analysis of liver parenchyma
Authors: Cai Wen-Bin , Yin Ji-Kai , Li Qiao-ying , Yang Yi-Lin , Duan Yun-You , Zhang Li
Published: May 2022

Background

Acoustic structure quantification (ASQ) has been applied to evaluate liver histologic changes by analyzing the speckle pattern seen on B-mode ultrasound. We aimed to assess the severity of portal hypertension (PHT) through hepatic ultrasonography.

Methods

Sixty patients diagnosed with PHT and underwent surgical treatment with portosystemic shunts were enrolled. Portal pressure (PP) was measured intraoperatively. Patients were divided into subgroups according to the severity of gastroesophageal varices and Child–Pugh class. Three difference ratio (Cm2) values on ASQ histogram mode were analyzed for their relationships with PP, degree of gastroesophageal varices and Child–Pugh liver function. Thirty healthy volunteers matched with the patients for gender and age were enrolled as controls. Comparisons among groups and correlation of the parameters with PP were analyzed. Area under the receive operating characteristic curve was used to evaluate the predicting value of ASQ parameters.

Results

In the patients, the ASQ parameters peak Cm2 (Cm2max), mean Cm2 (Cm2mean) and the highest occurred Cm2 value of the obtained red curve (RmaxCm2) were all greatly increased (P < 0.0001, P < 0.0001, P = 0.027). Multiple comparisons indicated that, regardless of Child–Pugh class and degree of gastroesophageal varices, the patients had significantly increased Cm2max and Cm2mean compared with the controls (all P < 0.0001). No differences among subgroups were observed. Cm2max was significantly statistically correlated with PP (r = 0.3505, P < 0.01), degree of varices (r = 0.4998, P < 0.0001). Youden’s index for Cm2max with a cut-off value of 140.3 for predicting the presence of PHT, gastroesophageal varices and liver function equal to or worse than Child–Pugh class B were 0.8, 0.91 and 0.84, respectively.

Conclusions

ASQ analysis of ultrasonographic images may have a role in the evaluation of the severity of PHT by detecting liver histologic changes in the speckle pattern caused by cirrhosis.
miR-107 is involved in the regulation of NEDD9-mediated invasion and metastasis in breast cancer
Authors: Zhou Jiamin , Sun Xianglin , Zhang Xinyu , Yang Huan , Jiang Zhenglin , Luo Qianqian , Liu Yifei , Wang Guohua
Published: May 2022

Background

As a metastasis-related protein, NEDD9 has been reported in breast cancer (BC) metastasis research. However, there are few studies on the upstream regulators of NEDD9, especially involving the potential role of miRNAs. The purpose of this study was to explain whether miR-107 potentially regulates NEDD9, which may lead to invasion and metastasis of BC.

Methods

MCF-7 and MDA-MB-231 cells were transduced with lentiviruses to construct stably transduced cells with miR-107 overexpression, miR-107 silencing or empty vectors. A luciferase reporter assay was performed to verify the binding of miR-107 and NEDD9. The scratch test and Transwell assay were used to measure cell migration and invasion ability, respectively. For the study of metastasis in vivo, we injected MDA-MB-231 cells into the fat pad of nude mice to develop an orthotopic breast cancer model.

Results

We found that NEDD9 expression correlates with the prognosis of BC patients. In BC cell lines, NEDD9 was positively correlated with cell migration ability. Further research revealed that miR-107 inhibited NEDD9 expression by targeting the 3′-untranslated region of NEDD9. Overexpression of miR-107 suppressed the expression of NEDD9, thereby inhibiting the invasion, migration and proliferation of BC cells, but interference with miR-107 promoted the expression of NEDD9 as well as invasion, migration and proliferation. In an in vivo model, overexpression of miR-107 decreased the expression of NEDD9 and inhibited tumour growth, invasion and metastasis; however, these effects were reversed by inhibiting miR-107.

Conclusions

These findings indicated the potential role of miR-107 in regulating NEDD9 in the invasion, migration and proliferation of BC.
Randomized single-blind comparative study of the midazolam/pethidine combination and midazolam alone during bronchoscopy
Authors: Katsurada Masahiro , Tachihara Motoko , Katsurada Naoko , Takata Naoya , Sato Hiroki , Mimura Chihiro , Yoshioka Junya , Furukawa Koichi , Yumura Masako , Otoshi Takehiro , Yasuda Yuichiro , Kiriu Tatsunori , Hazama Daisuke , Nagano Tatsuya , Yamamoto Masatsugu , Nishimura Yoshihiro , Kobayashi Kazuyuki
Published: May 2022

Background

Bronchoscopy can be a distress for the patient. There have been few studies on the combination of sedatives and opioids. The aim of this study was to demonstrate the usefulness and safety of administration of the combination of midazolam and pethidine during bronchoscopy.

Methods

In this prospective randomized single (patient)-blind study, we randomly assigned 100 patients who were scheduled to undergo bronchoscopy biopsy to receive treatment with either the midazolam/pethidine combination (combination group) or midazolam alone (midazolam group) during examinations. After the end of bronchoscopy, patients completed a questionnaire and the visual analogue scale was measured. The primary outcome was the patients’ acceptance of re-examination assessed by visual analogue scale. We also assessed pain levels, vital signs, midazolam use, xylocaine use, and adverse events. Univariate analyses were performed using Fisher’s exact test for categorical data, and the t-test or Mann-Whitney test was carried out for analysis of numeric data. All P-values were two-sided, and values < 0.05 were considered statistically significant.

Results

We analyzed 47 patients in the combination group and 49 patients in the midazolam group. The primary outcome was a good trend in the combination group, but not significantly different (3.82 ± 2.3 in combination group versus 4.17 ± 2.75 in midazolam alone, P = 0.400). In the combination group, the visual analog scale score for pain during bronchoscopy was significantly lower (1.10 ± 1.88 versus 2.13 ± 2.42, P = 0.022), and the sedation level score per the modified observer’s assessment of alertness/sedation scale was significantly deeper (3.49 ± 0.98 versus 3.94 ± 1.03, P = 0.031). Maximal systolic blood pressure during testing was significantly lower (162.39 ± 23.45 mmHg versus 178.24 ± 30.24 mmHg, P = 0.005), and the number of additional administrations of midazolam was significantly lower (2.06 ± 1.45 versus 2.63 ± 1.35, P = 0.049). There were also significantly fewer adverse events (30 versus 41, P = 0.036).

Conclusions

The combination uses of midazolam and pethidine for sedation resulted in significant improvements in the pain, blood pressure, additional use of midazolam, and safety during bronchoscopy among patients.

Trial registration

This study was registered in the University Medical Hospital Information Network in Japan (UMINCTR Registration number: UMIN000032230, Registered: 13/April/2018).
A very rare case report of glycogen storage disease type IXc with novel PHKG2 variants
Authors: Shao Yongxian , Li Taolin , Jiang Minyan , Xu Jianan , Huang Yonglan , Li Xiuzhen , Zheng Ruidan , Liu Li
Published: May 2022

Background

Pathogenic mutations in the PHKG2 are associated with a very rare disease—glycogen storage disease IXc (GSD-IXc)—and are characterized by severe liver disease.

Case presentation

Here, we report a patient with jaundice, hypoglycaemia, growth retardation, progressive increase in liver transaminase and prominent hepatomegaly from the neonatal period. Genetic testing revealed two novel, previously unreported PHKG2 mutations (F233S and R320DfsX5). Functional experiments indicated that both F223S and R320DfsX5 lead to a decrease in key phosphorylase b kinase enzyme activity. With raw cornstarch therapy, hypoglycaemia and lactic acidosis were ameliorated and serum aminotransferases decreased.

Conclusion

These findings expand the gene spectrum and contribute to the interpretation of clinical presentations of these two novel PHKG2 mutations.
Changes from 1986 to 2018 in the prevalence of obesity and overweight, metabolic control and treatment in children with type 1 diabetes mellitus in a Mediterranean area of Southeast Spain
Authors: Pastor-Fajardo María Teresa , Fajardo-Giménez María Teresa , Bosch-Giménez Vicente María , Pastor-Rosado José
Published: May 2022

Background

In recent decades, a global increase in the prevalence of childhood overweight and obesity has been observed in children and adolescents with type 1 diabetes.

Methods

This retrospective, cross-sectional, population study examined three groups (1986, 2007, and 2018) of children and adolescents aged < 16 years diagnosed with type 1 diabetes. Overweight and obesity were defined according to the World Health Organization recommendations.

Results

The prevalence of overweight and obesity in diabetic children and adolescents was 30.2% (95% CI: 23.1–38.3). There was a significant increase from 1986 to 2007 (11.9% to 41.7%, p = 0.002) and from 1986 to 2018 (11.9% to 34.8%, p = 0.012), but no significant differences were found from 2007 to 2018 (41.7% to 34.8%, p = 0.492). The age at diagnosis was lower in the group with excess body mass (p = 0.037). No significant differences were observed in age (p = 0.690), duration of diabetes (p = 0.163), distribution according to sex (p = 0.452), metabolic control (HbA1c, p = 0.909), or insulin units kg/day (p = 0.566), between diabetic patients with overweight or obesity and those with normal weight. From 2007 to 2018, the use of insulin analogs (p = 0.009) and a higher number of insulin doses (p = 0.007) increased significantly, with no increase in the prevalence of overweight and obesity.

Conclusions

The prevalence of overweight and obesity in diabetic children and adolescents increased in the 1990s and the beginning of the twenty-first century, with stabilization in the last decade. Metabolic control and DM1 treatment showed no association with this trend.
Neonatal mortality and associated factors among neonates admitted to neonatal intensive care unit of Gandhi memorial hospital in Addis Ababa, Ethiopia, 2019
Authors: Zelalem Ayichew Metasebiya , Derseh Gezie Lemma , Gelagay Abebaw Addis , Anmut Bitew Desalegn
Published: May 2022

Background

Ethiopia witnessed an unprecedented decline in under-5 and neonatal mortalities since 2000. But, neonatal mortality still accounts for the largest proportion of under-five child mortality. Quality of service at hospitals may vary and determine the magnitude of neonatal mortality.

Objective

To assess the prevalence and associated factors of neonatal mortality among newborns Admitted to the Neonatal intensive care unit of Gandhi Memorial Hospital Addis Ababa, Ethiopia, 2019.

Methods

Institution-based cross-sectional study was conducted from November 1 to December 31, 2019. A sample of one in every 2 admitted patients was included in the study. our exclusion criterion was neonates who had no mothers or guardians and/or neonatal medical records incomplete for status at discharge. We used the Systematic random sampling technique to select the study participants. A pretested structured interviewer-administered questionnaire and a preliminary tested checklist were used to collect primary and secondary data respectively. Descriptive and summary statistics were performed. A binary logistic regression model was fitted and variables that had a P-value of < 0.05 in the multivariable model were considered statistically significant.

Results

A total of 570 neonates who have mothers were involved in the study giving a response rate of 98.8%. The prevalence of neonatal mortality was 7.7% (95% CI: 5.7, 9.8). Mothers' educational status (No education (AOR 3.37, CI 95%, 1.02–11.20), premature rupture of membrane (prolonged PROM) (AOR 5.59, CI 95%, 1.05–29.76), and birth weight less than 2500gm (AOR 3.23, CI 95%, 1.17–8.90) are the significant factors associated with neonatal mortality.

Conclusion

The prevalence of neonatal mortality at Gandhi memorial hospital was generally high. As our finding revealed, neonates who are underweight and whose mothers have no formal education as well as have prolonged PROM have higher odds of neonatal mortality. Thus, clinicians, policymakers, and program managers should give special attention to neonates of none educated mothers, mothers with prolonged PROM, and neonates with low birth weight.
Protecting my injured child: a qualitative study of parents’ experience of caring for a child with a displaced distal radius fracture
Authors: Phelps E. E. , Tutton E. , Costa M. L. , Achten J. , Moscrop A. , Perry D. C.
Published: May 2022

Background

Childhood fractures can have a significant impact on the daily lives of families affecting children’s normal activities and parent’s work. Wrist fractures are the most common childhood fracture. The more serious wrist fractures, that can look visibly bent, are often treated with surgery to realign the bones; but this may not be necessary as bent bones straighten in growing children. The children’s radius acute fracture fixation trial (CRAFFT) is a multicentre randomised trial of surgery versus a cast without surgery for displaced wrist fractures. Little is known about how families experience these wrist fractures and how they manage treatment uncertainty. This study aimed to understand families’ experience of this injury and what it is like to be asked to include their child in a clinical trial.

Methods

Nineteen families (13 mothers, 7 fathers, 2 children) from across the UK participated in telephone interviews. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis.

Results

Our findings highlight parents’ desire to be a good parent through the overarching theme “protecting my injured child”. To protect their child after injury, parents endeavoured to make the right decisions about treatment and provide comfort to their child but they experienced ongoing worry about their child’s recovery. Our findings show that parents felt responsible for the decision about their child’s treatment and their child’s recovery. They also reveal the extent to which parents worried about the look of their child’s wrist and their need for reassurance that the wrist was healing.

Conclusion

Our findings show that protecting their child after injury can be challenging for parents who need support to make decisions about treatment and confidently facilitate their child’s recovery. They also highlight the importance of providing information about treatments, acknowledging parents’ concerns and their desire to do the right thing for their child, reassuring parents that their child’s wrist will heal and ensuring parents understand what to expect as their child recovers.