bluuebunny/crossref_metadata_2025 huggingface dataset:
IDH-Mutant Astrocytoma With Chromosome 19q13 Deletion Manifesting as an Oligodendroglioma-Like Morphology
Authors: Miyake Yohei , Fujii Keita , Nakamaura Taishi , Ikegaya Naoki , Matsushita Yuko , Gobayashi Yuko , Iwashita Hiromichi , Udaka Naoko , Kumagai Jiro , Murata Hidetoshi , Takemoto Yasunori , Yamanaka Shoji , Ichimura Koichi , Tateishi Kensuke , Yamamoto Tetsuya
Published: February 2021

Partial deletions in chromosomes 1p and 19q are found in a subset of astrocytic tumors; however, it remains unclear how these alterations affect their histological features and prognosis. Herein, we present 3 cases of isocitrate dehydrogenase (IDH)-mutant astrocytoma with chromosome 19q13 deletion. In the first case, the primary tumor harbored an IDH1 mutation with chromosome 1p/19q partial deletions, which covered 19q13 and exhibited a durable initial response to radiotherapy and temozolomide (TMZ) treatment. However, the tumor lost the chromosome 1p/19q partial deletions at recurrence and became resistant to TMZ. Histologically, an oligodendroglioma-like feature was found in the primary tumor but not in the recurrent tumor. Capicua transcriptional repressor (CIC), located on 19q13, was less expressed in the primary tumor but was highly expressed in the recurrent tumor. Similar histological findings were observed in 2 other astrocytic tumors with IDH1 or IDH2 mutations. These tumors also had chromosome 19q13 deletion, including the CIC gene, weakly expressed CIC, and oligodendroglioma-like morphology. These tumors recurred at 6 and 32 months, respectively. These findings suggest that IDH-mutant astrocytoma with chromosome 19q13 partial deletion, including the CIC gene, may induce an oligodendroglioma-like phenotype, but the clinical prognosis may not be similar to that of genetically defined oligodendroglioma.
TDP-43 Vasculopathy in the Spinal Cord in Sporadic Amyotrophic Lateral Sclerosis (sALS) and Frontal Cortex in sALS/FTLD-TDP
Authors: Ferrer Isidro , Andrés-Benito Pol , Carmona Margarita , Assialioui Abdelilah , Povedano Mónica
Published: February 2021

Sporadic amyotrophic lateral sclerosis (sALS) and FTLD-TDP are neurodegenerative diseases within the spectrum of TDP-43 proteinopathies. Since abnormal blood vessels and altered blood-brain barrier have been described in sALS, we wanted to know whether TDP-43 pathology also occurs in blood vessels in sALS/FTLD-TDP. TDP-43 deposits were identified in association with small blood vessels of the spinal cord in 7 of 14 cases of sALS and in small blood vessels of frontal cortex area 8 in 6 of 11 FTLD-TDP and sALS cases, one of them carrying a GRN mutation. This was achieved using single and double-labeling immunohistochemistry, and double-labeling immunofluorescence and confocal microscopy. In the sALS spinal cord, P-TDP43 Ser403-404 deposits were elongated and parallel to the lumen, whereas others were granular, seldom forming clusters. In the frontal cortex, the inclusions were granular, or elongated and parallel to the lumen, or forming small globules within or in the external surface of the blood vessel wall. Other deposits were localized in the perivascular space. The present findings are in line with previous observations of TDP-43 vasculopathy in a subset of FTLD-TDP cases and identify this pathology in the spinal cord and frontal cortex in a subset of cases within the sALS/FTLD-TDP spectrum.
Observations of a radio-bright, X-ray obscured GRS 1915+105
Authors: Motta S E , Kajava J J E , Giustini M , Williams D R A , Del Santo M , Fender R , Green D A , Heywood I , Rhodes L , Segreto A , Sivakoff G , Woudt P A
Published: February 2021

The Galactic black hole transient GRS 1915+105 is famous for its markedly variable X-ray and radio behaviour, and for being the archetypal galactic source of relativistic jets. It entered an X-ray outburst in 1992 and has been active ever since. Since 2018 GRS 1915+105 has declined into an extended low-flux X-ray plateau, occasionally interrupted by multiwavelength flares. Here, we report the radio and X-ray properties of GRS 1915+105 collected in this new phase, and compare the recent data to historic observations. We find that while the X-ray emission remained unprecedentedly low for most of the time following the decline in 2018, the radio emission shows a clear mode change half way through the extended X-ray plateau in 2019 June: from low flux (∼3 mJy) and limited variability, to marked flaring with fluxes two orders of magnitude larger. GRS 1915+105 appears to have entered a low-luminosity canonical hard state, and then transitioned to an unusual accretion phase, characterized by heavy X-ray absorption/obscuration. Hence, we argue that a local absorber hides from the observer the accretion processes feeding the variable jet responsible for the radio flaring. The radio–X-ray correlation suggests that the current low X-ray flux state may be a signature of a super-Eddington state akin to the X-ray binaries SS433 or V404 Cyg.
High-resolution imaging follow-up of doubly imaged quasars
Authors: Shajib Anowar J , Molina Eden , Agnello Adriano , Williams Peter R , Birrer Simon , Treu Tommaso , Fassnacht Christopher D , Morishita Takahiro , Abramson Louis , Schechter Paul L , Wisotzki Lutz
Published: February 2021

We report upon 3 years of follow-up and confirmation of doubly imaged quasar lenses through imaging campaigns from 2016 to 2018 with the Near-Infrared Camera2 (NIRC2) on the W. M. Keck Observatory. A sample of 57 quasar lens candidates are imaged in adaptive-optics-assisted or seeing-limited K′-band observations. Out of these 57 candidates, 15 are confirmed as lenses. We form a sample of 20 lenses adding in a number of previously known lenses that were imaged with NIRC2 in 2013–14 as part of a pilot study. By modelling these 20 lenses, we obtain K′-band relative photometry and astrometry of the quasar images and the lens galaxy. We also provide the lens properties and predicted time delays to aid planning of follow-up observations necessary for various astrophysical applications, e.g. spectroscopic follow-up to obtain the deflector redshifts for the newly confirmed systems. We compare the departure of the observed flux ratios from the smooth-model predictions between doubly and quadruply imaged quasar systems. We find that the departure is consistent between these two types of lenses if the modelling uncertainty is comparable.
Ethidium bromide interactions with DNA: an exploration of a classic DNA–ligand complex with unbiased molecular dynamics simulations
Authors: Galindo-Murillo Rodrigo , Cheatham Thomas E
Published: February 2021

Visualization of double stranded DNA in gels with the binding of the fluorescent dye ethidium bromide has been a basic experimental technique in any molecular biology laboratory for >40 years. The interaction between ethidium and double stranded DNA has been observed to be an intercalation between base pairs with strong experimental evidence. This presents a unique opportunity for computational chemistry and biomolecular simulation techniques to benchmark and assess their models in order to see if the theory can reproduce experiments and ultimately provide new insights. We present molecular dynamics simulations of the interaction of ethidium with two different double stranded DNA models. The first model system is the classic sequence d(CGCGAATTCGCG)2 also known as the Drew–Dickerson dodecamer. We found that the ethidium ligand binds mainly stacked on, or intercalated between, the terminal base pairs of the DNA with little to no interaction with the inner base pairs. As the intercalation at the terminal CpG steps is relatively rapid, the resultant DNA unwinding, rigidification, and increased stability of the internal base pair steps inhibits further intercalation. In order to reduce these interactions and to provide a larger groove space, a second 18-mer DNA duplex system with the sequence d(GCATGAACGAACGAACGC) was tested. We computed molecular dynamics simulations for 20 independent replicas with this sequence, each with ∼27 μs of sampling time. Results show several spontaneous intercalation and base-pair eversion events that are consistent with experimental observations. The present work suggests that extended MD simulations with modern DNA force fields and optimized simulation codes are allowing the ability to reproduce unbiased intercalation events that we were not able to previously reach due to limits in computing power and the lack of extensively tested force fields and analysis tools.
Physical functional capacity of patients with glioma prior to adjuvant radiation: preliminary descriptive study
Authors: Dulfikar Ali , Koh Eng-Siew , Lwin Zarnie , Hovey Elizabeth , Dhillon Haryana , Arundell Jesica , Pinkham Elizabeth , Pinkham Mark B , Holland Justin , Trajano Gabriel , Naumann Fiona
Published: February 2021

Background

Few studies have assessed physical functioning in glioma patients with grade II, III, and IV glioma prior to undergoing adjuvant radiation with or without chemotherapy. The aim of this study was to describe the baseline physical functioning capacity of patients with glioma prior to adjuvant therapy compared to validated cutoffs required to maintain independence.

Methods

This study is a cross-sectional study that recruited patients with grade II, III, and IV glioma (n = 33) undergoing adjuvant radiation with or without chemotherapy. The six-minute walk, thirty-second sit-to-stand, and timed “Up & Go” assessments were used to describe baseline physical functioning. Perceived quality of life from the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C30) version 3.0 was used to quantify the quality of life.

Results

Mean distance walked in the six-minute walk test was 416.2 m (SD 137.6 m) with a mean of 12.2 stands (SD 3.4 stands) achieved during the thirty-second sit-to-stand. Median time to complete the timed “Up & Go” assessment was 7 s (interquartile range: 3 s). One-sample t tests suggest walking distance and chair stands were significantly lower than cutoff criterions to maintain independent living, t(32) = −5.96, P < .001, bias-corrected accelerated 95% CI [370.7-460.4], and t(32) = −4.60, P < .01, bias-corrected accelerated 95% CI [11.0-13.4], respectively. Wilcoxon signed-rank test identified significantly shorter median time taken to complete the timed “Up & Go” test compared to the cutoff criterion (z = −4.43, n = 33, P < .01).

Conclusion

This study suggests glioma patient’s aerobic endurance and lower limb strength are below criterion cutoffs recommended to maintain independent living. Timed “Up & Go” scores did not exceed the criterion cutoff, indicating respectable levels of mobility.
Vascularized Bone Grafts for Spinal Fusion—Part 4: The Scapula
Authors: Reece Edward M , Davis Matthew J , Abu-Ghname Amjed , Chamata Edward , Holmes Scott , Winocour Sebastian , Hansen Scott L , Xu David S , Bohl Michael A , Ropper Alexander E
Published: February 2021

BACKGROUND

Solid arthrodesis is the long-term goal of most spinal reconstruction surgeries. A multitube of biologics as well as autograft is commonly used to augment the bony fusion. Medial scapular vascularized bone grafts (S-VBGs) are a novel approach to supplement cervicothoracic arthrodesis in patients at high risk for failed fusion.

OBJECTIVE

To discuss the benefits of using a vascularized scapular graft, pedicled to the rhomboid minor, compared to both nonvascularized bone grafts and free vascularized bone grafts, as well as the surgical technique, feasibility, and nuances of the surgical experience with an S-VBG.

METHODS

The anatomic feasibility of this procedure has been established in cadaver studies. This technical note details the operative steps and presents the first surgery in which a vascularized scapular graft was used to supplement cervicothoracic arthrodesis.

RESULTS

A single patient with complex cervical deformity was successfully treated with this novel arthrodesis approach.

CONCLUSION

Vascularized scapula grafts, pedicled on the rhomboid minor, provides both structural support and a source of vascularized autograft to a cervicothoracic arthrodesis. It leverages the benefits of a free-flap bone with less operative time and morbidity.
Effects of Pulsed Radiofrequency with Different Temperature on Model Rats of Chronic Constriction Injury
Authors: Chen Xun , Dai Jianbo , Li Dan , Huang Xingliang , Ou Cehua
Published: February 2021

Objectives

The treatment for neuropathic pain is still a big challenge. Pulsed radiofrequency technique has been widely used to relieve neuropathic pain in recent years. The purpose of this study is to optimize the temperature for pulsed radiofrequency therapy.

Design

Animal, experimental study.

Methods

Seventy-five male SD rats were randomly divided into five groups: Sham operation group (Sham group), chronic constriction injury group (CCI group), PRF 42°C group (P42 group), PRF 50°C group (P50 group), and PRF 60°C group (P60 group). The hindpaw withdrawal threshold (HWT), paw thermal withdrawal latency (PTWL), sciatic nerve structure, and the concentration of spinal methionine enkephalin(M-ENK) were detected to identify which temperature is the best for PRF treatment.

Results

PRF at 42°C, 50°C and 60°C significantly alleviated the pain in CCI rats. The therapeutic effects of 50°C and 60°C were similar, and both were better than 42°C. In addition, PRF using 42°C, 50°C, and 60°C mediated nerve injury to sciatic nerve were grade 1, 1, and 2, respectively. The concentration of M-ENK in spinal cord increased accompanying with the increasing of the temperature of PRF.

Conclusions

PRF using 50°C could induce less damage while achieving better improvement of mechanical and thermal pain threshold than 42°C and 60°C in CCI rats, which may be achieved by promoting the expression of M-ENK in spinal cord.
Improving Management with Individual and Group-Based Consulting: Results from a Randomized Experiment in Colombia
Authors: Iacovone Leonardo , Maloney William , McKenzie David
Published: February 2021

Differences in management quality are an important contributor to productivity differences across countries. A key question is how to best improve poor management in developing countries. We test two different approaches to improving management in Colombian auto parts firms. The first uses intensive and expensive one-on-one consulting, while the second draws on agricultural extension approaches to provide consulting to small groups of firms at approximately one-third the cost of the individual approach. Both approaches lead to improvements in management practices of a similar magnitude (8–10 percentage points). The group-based intervention leads to significant increases in firm sales, profits, and labour productivity, while the impacts on firm performance are smaller in magnitude and less robust from the individual consulting. The results point to the potential of group-based approaches as a pathway to scaling up management improvements.
Sexual Shaming and Violent Commands in Schizophrenia: Cultural Differences in Distressing Voices in India and the United States
Authors: Lebovitz Julia G , Padmavati R , Tharoor Hema , Luhrmann T M
Published: February 2021

In a side-by-side comparison, we found that the voices of patients who met the criteria for schizophrenia in Chennai, Tamil Nadu, India and in San Mateo, CA, United States were different. Both groups heard commands. In San Mateo, those commands were often violent, but in Chennai, commands often seemed more to do with everyday activities. Both groups heard voices that spoke about sexual activities. In Chennai, participants reported more voices that talked about sex, and they often experienced intense shame and guilt around these sexual voices. In San Mateo, sexual voices seemed to have less shaming content and were more often described with enjoyment. In San Mateo, voices were also more violent in general. We suggest that the content of voices may reflect local cultural ideas about voices and local cultural responses to specific features of the voice-hearing experience.
Transgenic Rice Expressing Isoflavone Synthase Gene from Soybean Shows Resistance Against Blast Fungus (Magnaporthe oryzae)
Authors: Pokhrel Suresh , Ponniah Sathish K. , Jia Yulin , Yu Oliver , Manoharan Muthusamy
Published: February 2021

The isoflavones are a group of plant secondary metabolites primarily synthesized in legumes and are known for their role in improving human health and plant disease resistance. The isoflavones, especially genistein, act as precursors for the production of phytoalexins, which may induce broad-spectrum disease resistance in plants. In this study, we screened transgenic rice lines expressing the isoflavone synthase (GmIFS1) gene from soybean for rice blast (Magnaporthe oryzae) resistance. Two homozygous transgenic lines (I2 and I10), based on single copy gene integration, were identified. The expression of GmIFS1 in transgenic lines was confirmed by quantitative real-time PCR. Genistein was detected in the transgenic lines using liquid chromatography with tandem mass spectrometry. Subsequently, the transgenic lines were evaluated against the rice blast pathogen, isolate YJ54 (race IB-54). The results indicated that >60% of the plants in both the lines (I2 and I10) showed resistance against the blast pathogen. The progenies of one of the resistant transgenic lines (I10) also showed >65% resistance against rice blast. The resistance of these transgenic lines against rice blast may be attributed to the synthesis of isoflavone (genistein) in rice.
Spectral and Thermal Responses of Peanut to Infection and Colonization with Athelia rolfsii
Authors: Wei Xing , Langston David B. , Mehl Hillary L.
Published: February 2021

Soilborne fungal diseases, including southern stem rot (causal agent: Athelia rolfsii), are major constraints to peanut production worldwide. Scouting for disease via visual observation is time and labor intensive but sensor technologies are a promising tool for plant disease detection. Prior research has focused on foliar diseases, and few studies have applied sensor-based tools for early detection of soilborne diseases. This study characterized the temporal progress of spectral and thermal responses of peanut plants during infection and colonization with A. rolfsii under controlled environment. In greenhouse experiments, A. rolfsii-inoculated and mock-inoculated lateral stems of peanut were inspected daily for symptoms, and leaf spectral reflectance and temperature were measured using a handheld spectrometer and thermal camera, respectively. Following onset of visual disease symptoms, leaflets on inoculated stems had greater spectral reflectance in the visible region compared with those on mock-inoculated stems. Leaflets on the inoculated stems also had greater normalized leaf temperatures as compared with leaflets on mock-inoculated stems. Overall, results indicate that signatures of disease development can be detected during peanut infection and colonization with A. rolfsii using spectral reflectance and thermal imaging technologies, and spectral signatures of disease are more consistent and specific compared with thermal ones. Though only one peanut variety, one pathogen isolate, and one single measurement were assessed per evaluation date, temporal progress of spectral and thermal responses on a daily basis characterized in this study can be used to develop sensor-based methods to detect southern stem rot and other soilborne diseases ultimately in the field.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Building Capacity of Health Professionals in Low- and Middle-Income Countries Through Online Continuing Professional Development in Nutrition
Authors: Stark Christina M. , Garner Christine D. , Garg Aashima , Bégin France
Published: February 2021

Continuing professional development (CPD) in low- and middle-income countries (LMICs) can build capacity of health professionals in infant and young child feeding (IYCF). However, travel to in-person workshops can be time-consuming and expensive. Thus, we developed a free online course to provide training in IYCF to health professionals globally; the course received overwhelmingly high numbers of registrations. Our aim was to conduct a program evaluation to assess course satisfaction, learning, and application using surveys administered postcourse and 9 months later. Response rates were 99% (n = 835) and 55% (n = 312), respectively. Among those who only partially completed the course, reasons for noncompletion were assessed (response rate 29%, n = 72). Data within a 1-year period were analyzed. Respondents worked in multiple settings and organizations worldwide. Nearly all (99%) reported postcourse that they learned “a lot” or “some” from all topics, and over 70% applied “a lot” of or “some” information 9 months later. In open-ended questions, respondents reported improved knowledge, skills, and competence to conduct their work; they also desired more similar training courses. Many who did not complete the course reported “not enough time” as the main reason (74%), and most (94%) wanted to continue it. The positive response to the course suggests there is an unmet need for CPD for health professionals in LMICs. Our evaluation found that online training was feasible, acceptable, and increased professionals' knowledge and application of IYCF concepts in nutrition programming. Increased use of online CPD offers the potential for global capacity-building in other health-related topics.
Cardiorespiratory Fitness, Inflammation, and the Incident Risk of Pneumonia
Authors: Jae Sae Young , Heffernan Kevin S. , Kurl Sudhir , Kunutsor Setor K. , Kim Chul-Ho , Johnson Bruce D. , Franklin Barry A. , Laukkanen Jari A.
Published: February 2021

Introduction:

Both inflammation and cardiorespiratory fitness (CRF) are associated with the risk of respiratory infections. To clarify the hypothesis that CRF attenuates the incident risk of pneumonia due to inflammation, we conducted a prospective study examining the independent and joint associations of inflammation and CRF on the risk of pneumonia in a population sample of 2041 middle-aged men.

Methods:

Cardiorespiratory fitness was directly measured as peak oxygen uptake (V˙o
2peak) during progressive exercise testing to volitional fatigue, and categorized into tertiles. Inflammation was defined by high-sensitivity C-reactive protein (hsCRP). Pneumonia cases were identified by internal medicine physicians using the International Classification of Diseases codes in clinical practice.

Results:

During a median follow-up of 27 yr, 432 pneumonia cases were recorded. High hsCRP and CRF were associated with a higher risk (HR = 1.38; 95% CI, 1.02-1.88) and a lower risk of pneumonia (HR = 0.55; CI, 0.39-0.76) after adjusting for potential confounders, respectively. Compared with normal hsCRP-Fit, moderate to high hsCRP-Unfit had an increased risk of pneumonia (HR = 1.63; CI, 1.21-2.20), but moderate to high hsCRP-Fit was not associated with an increased risk of pneumonia (HR = 1.25; CI, 0.93-1.68).

Conclusions:

High CRF attenuates the increased risk of pneumonia due to inflammation. These findings have potential implications for the prevention of respiratory infection characterized by systemic inflammation, such as coronavirus disease-2019 (COVID-19).
Therapeutic inertia in the management of hypertension in primary care
Authors: Ali Dalia H. , Kiliç Birsen , Hart Huberta E. , Bots Michiel L. , Biermans Marion C.J. , Spiering Wilko , Rutten Frans H. , Hollander Monika
Published: February 2021

Background:

Therapeutic inertia is considered to be an obstacle to effective blood pressure (BP) control.

Aims:

To identify patient characteristics associated with therapeutic inertia in patients with hypertension managed in primary care and to assess reasons not to intensify therapy.

Methods:

A Dutch cohort study was conducted using electronic health record data of patients registered in the Julius General Practitioners’ Network (n = 530 564). Patients with a diagnosis of hypertension, SBP at least 140 and/or DBP at least 90 mmHg, and one or two BP-lowering drug(s) were included. Therapeutic inertia was defined as not undertaking therapeutic action in follow-up despite uncontrolled BP. Multivariable logistic regression was used to identify characteristics associated with inertia. Furthermore, an exploratory survey was performed in which general practitioners of 114 patients were asked for reasons not to intensify treatment.

Results:

We identified 6400 (10% of all patients with hypertension) uncontrolled patients on one or two BP-lowering drugs. Therapeutic inertia was 87%, similar in men and women. Older age, lower systolic, diastolic and near-target SBP, and diabetes were positively associated, while renal insufficiency and heart failure were inversely related to inertia. General practitioners did not intensify therapy because they first, considered office BP measurements as nonrepresentative (27%); second, waited for next BP readings (21%); third, wanted to optimize lifestyle first (19%). Eleven percent of patients explicitly did not want to change treatment.

Conclusion:

Therapeutic inertia is common in primary care patients with uncontrolled hypertension. Older age, and closer to target BP, but also concurrent diabetes were associated with inertia.
The association between self-perceived walking pace with the incidence of hypertension: the ‘Seguimiento Universidad de Navarra’ cohort
Authors: Etzig Cassandra , Gea Alfredo , Martínez-González Miguel Á. , Sullivan Mark F. , Sullivan Elixabeth , Bes-Rastrollo Maira
Published: February 2021

Objective:

Although available evidence supports the protective effects of walking on hypertension – a major risk factor for cardiovascular disease and stroke – more information is needed in determining whether walking pace independently provides additional hypertension risk reductions. This prospective study determined the association between self-reported walking pace and the incidence of hypertension in the ‘Seguimiento Universidad de Navarra’ (SUN) cohort in Spain.

Methods:

Our population sample consisted of 15 357 university graduates initially free of chronic disease or hypertension. During an average follow-up time of 10.9 years, 1673 incident cases of hypertension were observed. Hazard ratios and 95% confidence intervals (95% CIs) for hypertension risk of each walking pace [slow (reference), normal, brisk and very brisk] were estimated using Cox regression models, adjusted for multiple possible confounders. Data were collected from 1999 to 2019, and analysed in 2020.

Results:

Participants who walked at a very brisk pace at baseline had a substantially lower risk of developing hypertension during follow-up than those who walked at a slow pace (multivariable-adjusted hazard ratio: 0.64; 95% CI: 0.41–0.99). Inverse associations were observed also for normal (HR: 0.64; 95% CI: 0.46–0.90) and brisk walking pace (0.69; 95% CI: 0.50–0.97) as compared to slow pace, independent of other risk factors.

Conclusion:

Our results support that an increase in walking pace, even slightly, is inversely associated with the development of hypertension, independent of total time spent walking and other factors associated with hypertension.
Isolated systolic and diastolic hypertension by the 2017 American College of Cardiology/American Heart Association guidelines and risk of cardiovascular disease: a large prospective cohort study
Authors: Li Fu-Rong , He Yong , Yang Hai-Lian , Liu Hua-Min , Zhou Rui , Chen Guo-Chong , Wu Xiao-Xiang , Zou Meng-Chen , Wang Jing-Ya , Wu Xian-Bo
Published: February 2021

Objective:

The 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines lowered the hypertension threshold from a SBP/DBP level of at least 140/90 mmHg to at least 130/80 mmHg. The cardiovascular impact of isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) under the new definition remains unclear.

Methods:

We used data from the UK Biobank study, which is a prospective population-based cohort study. Participants were categorized into five groups: normal BP, normal high BP, ISH, IDH and systolic and diastolic hypertension. The primary endpoint for this study was the composite of nonfatal myocardial infarction (MI), nonfatal ischaemic stroke, nonfatal haemorrhagic stroke and cardiovascular disease (CVD) death. We also explored the results for the above-mentioned CVD outcomes separately. Baseline BP measurements were obtained twice after the participant had been at rest for at least 5 min in a seated position.

Results:

We included 385 955 participants who were not taking antihypertensive medications, were free of CVD at baseline and had available data on BP measurements. During a median follow-up of 8.1 years, 8959 CVD events were recorded, including 4729 nonfatal MIs, 2287 nonfatal ischaemic strokes, 813 nonfatal haemorrhagic strokes, and 1826 CVD deaths. According to the hypertension threshold of at least 130/80 mmHg by the American College of Cardiology/American Heart Association guidelines, both ISH (hazard ratio 1.39; 95% confidence interval 1.27, 1.15) and IDH (hazard ratio 1.28; 95% confidence interval 1.15, 1.43) were significantly associated with a higher overall CVD risk than normal BP. ISH was associated with most CVD risk, except for ischaemic stroke, while the excess CVD risk associated with IDH appeared to be driven mainly by MI and CVD death. We found heterogeneity by sex and age regarding the effects of IDH on overall CVD risk, with significant associations in younger adults (age <60 years) and women and null associations in men and older adults (age ≥60 years).

Conclusion:

ISH was associated with the risk of most CVD events, while the association between IDH and CVD risk was mainly driven by MI incidence and CVD death. Further research is needed to identify participants with IDH who have a particular risk for developing CVD.
Breakthrough Candidemia in Pediatric Patients With Cancer From a Brazilian Center
Authors: Barrientos Anna Carlota Mott , Nobrega de Almeida Junior João , Litvinov Nadia , Bain Vera , Cristofani Lilian Maria , Badue Pereira Maria Fernanda , Sanson Yoshino de Paula Camila , Lopes Motta Adriana , Rossi Flavia , Bárbaro Del Negro Gilda Maria , Yamamoto Thomaz Danilo , Sousa Marques Heloisa Helena
Published: February 2021

We analyzed 19 cases of breakthrough candidemia from a referral pediatric cancer center in Brazil. All patients had neutropenia and were under antifungal prophylactic regimens, mostly micafungin (68%). Most of the patients were treated with amphotericin B formulations and 30-day mortality was 21%. Candida parapsilosis was the main etiologic agent (63%), and horizontal transmission was not evidenced by microsatellite analysis.
Plateletcrit may predict no-reflow after saphenous vein graft interventions in patients with non-ST elevation myocardial infarction
Authors: Panç Cafer , Derviş Emir , Gürbak İsmail
Published: February 2021

Saphenous vein graft (SVG) percutaneous coronary interventions (PCIs) are procedures with potential complications such as distal embolization, slow or no-reflow phenomenon. Platelets are the main factors in development of thrombus and no-reflow phenomenon. There have been multiple studies that identified the association between plateletcrit (PCT) and cardiovascular outcomes. The aim of the study was to investigate whether PCT can predict the development of no-reflow in patients with non-ST elevation myocardial infarction (NSTEMI) undergoing PCI for SVG disease.

A total of 181 patients who underwent PCI for SVG disease with NSTEMI were included retrospectively. Platelet indices on admission were recorded. Patients were divided into two groups according to the development of no-reflow during the procedure: no-reflow (n = 32; 18%) and normal reflow (n = 149; 82%).

PCT and platelet count were higher in the no-reflow group (0.254 vs. 0.224, P = 0.020; 265.4 vs. 233, P = 0.011, respectively). The PCT cut-off value for predicting no-reflow was calculated as 0.230 by ROC curve analysis with 68.8% sensitivity and 51.0% specificity. Multivariate logistic regression analysis showed that PCT was an independent predictor of no-reflow (odds ratio: 5.091, confidence interval: 1.356–19.116, P = 0.016).

PCT may be useful in identifying patients at risk for developing no-reflow in patient with NSTEMI undergoing SVG PCI.
Prolongation of clot lysis time by a direct thrombin inhibitor melagatran mediated by paradoxical enhancement of thrombin generation: comparison with a direct factor Xa inhibitor edoxaban
Authors: Morishima Yoshiyuki , Kamisato Chikako , Honda Yuko
Published: February 2021

Previously, we reported that a direct thrombin inhibitor melagatran paradoxically increased thrombin generation in human plasma in the presence of thrombomodulin. The aim of this study is to test the hypothesis that melagatran may exert a deleterious effect on tissue-type plasminogen activator (t-PA)-induced fibrinolysis via enhancement of thrombin generation and subsequent activation of thrombin-activatable fibrinolysis inhibitor (TAFI) and factor XIII (FXIII).

Clot formation in human plasma containing t-PA and thrombomodulin was induced by tissue factor. The absorbance at 405 nm was measured to obtain clot lysis time. Effects of melagatran and a factor Xa inhibitor edoxaban on clot lysis time were determined.

In the presence of thrombomodulin, melagatran significantly prolonged clot lysis time, but edoxaban shortened it. In the absence of thrombomodulin, melagatran did not inhibit fibrinolysis. Prolongation of clot lysis time by melagatran was reversed by activated protein C (which suppressed thrombin generation increased by melagatran) and a TAFIa inhibitor. Melagatran significantly suppressed plasmin generation, while edoxaban significantly increased it. However, both melagatran and edoxaban suppressed FXIII activation. In the clot formed in the presence of melagatran and edoxaban, the fibrin fibre was thin compared with control, showing no clear difference in the clot structures between melagatran and edoxaban.

These results indicated that melagatran, not edoxaban, prolonged clot lysis time through the paradoxical enhancement of thrombin generation, and subsequent TAFI activation and inhibition of plasmin generation. Neither FXIII activation nor change in fibrin clot structure contributed to the inhibition of fibrinolysis by melagatran.
Future developments in the imaging of the gastrointestinal tract: the role of ultrasound
Authors: Wong Adrian , Yusuf Gibran Timothy , Malbrain Manu L.N.G.
Published: February 2021

Purpose of review

The purpose of this review is to summarize the utilization and most recent developments with regard to the use of ultrasound when imaging the abdomen and gastrointestinal tract.

Recent findings

Although the use of ultrasound to assess the anatomy of the various abdominal organs is well established within radiology and critical care, its use as part of functional and physiological assessment is still evolving. Recent developments have extended the use of ultrasound beyond standard B-mode/2D imaging techniques to incorporate more functional and haemodynamic assessment. These include the use of contrast-enhanced ultrasound (CEUS), elastography, and colour Doppler techniques.

Whilst Doppler techniques are reasonably well established within critical care ultrasound (CCUS), especially in echocardiography, CEUS and elastography are less well known. CEUS utilizes a purely intravascular contrast agent whilst elastography measures the degree of deformation or stiffness in various organs. Whilst their use individually may be limited; they may play a role in a multiparametric assessment. Mirroring the overall trends in critical care ultrasound development, abdominal ultrasound assessment is best integrated in a holistic approach and adapted to the individual patient.
Comparison of stemless and conventional stemmed shoulder arthroplasties in shoulder arthropathy
Authors: Shin Young-Soo , Lee Woo-Seung , Won Jun-Sung
Published: February 2021

Background:

It is unclear whether stemless shoulder prosthesis lead to better clinical outcomes than conventional stemmed shoulder prosthesis. The purpose is to compare clinical outcomes and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis.

Method:

All studies comparing the constant score (CS), range of motion (ROM), and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis were included. The major databases MEDLINE, EMBASE, the Cochrane Library, Web of Science, and SCOPUS were searched for appropriate studies from the earliest available date of indexing through March 31, 2019. No restrictions were placed on language of publication.

Results:

A total of 6 studies met the inclusion criteria and were analyzed in detail. Overall postoperative ROM (95% CI: 3.27 to 11.92; P < .01) was significantly greater for stemless prosthesis compared to conventional stemmed prosthesis. However, postoperative CS (95% CI: −2.98 to 7.13; P = .42) and complication rates (OR 1.22, 95% CI: 0.48–3.08; P = .68) were did not differ significantly between the 2 groups.

Conclusion:

This meta-analysis revealed that postoperative CS and complication rates did not differ significantly between the 2 treatment methods, stemless shoulder prosthesis and conventional stemmed shoulder prosthesis, for shoulder arthropathy. However, stemless shoulder prosthesis resulted in better outcomes than conventional stemmed shoulder prosthesis in terms of postoperative ROM.

Level of evidence:

Level III, Therapeutic study.
Temporomandibular joint dislocation in patients with cleft lip and palate after maxillary distraction osteogenesis
Authors: Wang Binqing , Zhai Junya , Zheng Yilue , Tong Haizhou , Lü Yang , Chen Zhewei , Yin Ningbei , Song Tao
Published: February 2021

Introduction:

Distraction osteogenesis (DO) is a widely used for cleft and palate related maxillary hypoplasia. There has been little research on temporomandibular joint (TMJ) dislocation after maxillary DO. We present these 3 cases and analyze the possible causes for reference by other clinicians.

Patient concerns:

In the late stages of maxillary DO, the patients gradually felt a decrease in mandibular mobility and suffered from limited mouth opening. Case 2 and 3 could open their mouth up to 1 and 2 fingers and Case 1 barely able to open her mouth at the completion of distraction.

Diagnosis:

Case 1 and Case 3 were diagnosed as right TMJ dislocation and Case 2 had a TMJ dislocation on her left side.

Interventions:

Patients with TMJ dislocation were repositioned with manipulation as soon as detected.

Outcomes:

There was no recurrence in all three cases during the postoperative follow-up period.

Conclusions:

Maxillary DO can sufficiently advance the maxilla in cleft lip and palate patients. Clinicians should be mindful of the TMJ dislocations that maxillary DO can exert on patients.
TCM nonpharmacological interventions for ankylosing spondylitis
Authors: Wang Haiyan , Yu Haiyang , Wang Tao , Liu Naijia , Zhang Xiaogang , Wei Qinling , Tian Jiexiang
Published: February 2021

Background:

Ankylosing spondylitis (AS) is a common infammatory rheumatic disease that affects the axial skeleton. Traditional Chinese medicine (TCM) nonpharmacological interventions are gaining an increasing popularity for AS. Nevertheless, the evidence of efficacy and safety of random controlled trials (RCTs) remains controversial. This study aims to evaluate the efficacy and acceptability of different TCM nonpharmacological therapies by systematic review and network meta-analysis.

Methods:

According to the strategy, the authors will retrieve a total of 7 electronic databases by December 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of TCM nonpharmacological interventions for AS. The primary outcome will be the improvement of Pain intensity and functional status/disability and the secondary outcomes will include lobal improvement, health-related quality of life, satisfaction with treatment, and adverse events. Both classical meta-analysis and network meta-analysis will be implemented to investigate direct and indirect evidences on this topic. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument.

Results:

This study will provide a reliable evidence for the selection of TCM nonpharmacological therapies in the treatment of AS.

Conclusion:

This study will generate evidence for different TCM nonpharmacological therapies for AS and provide a decision-making reference for clinical research.

Ethics and dissemination:

This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication.

OSF registration number:

DOI 10.17605/OSF.IO/FHD2U
Improvement of left ventricular systolic function in morbidly obese patients after bariatric surgery
Authors: Liu Yanjun , Guo Pengsen , Zhan Dafang , Fu Luo , Yu Jiahui , Yang Huawu
Published: February 2021

Introduction:

Morbid obesity (body mass index > 40 kg/m2) is a risk factor for the development of left ventricular systolic dysfunction (LVSD) and can complicate the management of LVSD. Bariatric surgery is increasingly recognized as a safe and effective way to achieve marked weight loss, but studies on improving LVSD populations are limited. We retrospectively analyzed the first case of the Asia-Pacific region with morbid obesity and left ventricular ejection fraction (LVEF) < 50% who underwent bariatric surgery at our medical center.

Patient concerns:

The patient was admitted to the hospital due to progressive weight gain for more than 10 years. The patient used to be in good health. One year before admission, the patient was hospitalized in another hospital due to shortness of breath. After the relevant examination, the patient was diagnosed with dilated cardiomyopathy.

Diagnosis:

The body mass index of the patient was 45.9 kg/m2, and the patient was diagnosed with morbid obesity. He was diagnosed with dilated cardiomyopathy and cardiac function class IV in another hospital. After completing a preoperative examination, the patient was diagnosed with hyperuricemia, hyperlipidemia, fatty liver disease and severe sleep apnea.

Interventions:

The patient successfully underwent laparoscopic sleeve gastrectomy plus jejunal bypass.

Outcomes:

Six months after the surgery, patient weight lost was 33.6 kg, and the LVEF increased from 31% to 55%. The cardiac function of the patient recovered from class IV to class I, and the patient's hyperuricemia, hyperlipidemia and sleep apnea were significantly improved.

Conclusion:

Bariatric surgery may be a safe and effective intervention for morbidly obese patients with LVSD. Bariatric surgery was associated with an improvement in LVEF. However, the specific mechanism still needs further study.
Does chemical shift imaging offer a biomarker for the diagnosis and assessment of disease severity in multiple myeloma?
Authors: Takasu Miyuki , Tanitame Keizo , Baba Yasutaka , Akiyama Yuji , Tamura Takayuki , Kondo Shota , Maeda Shogo , Sakai Akira , Awai Kazuo
Published: February 2021

To investigate whether chemical shift imaging (CSI) is useful for differentiating myelomatous infiltration from hematopoietic bone marrow (BM) and for quantitatively assessing disease severity.

In this retrospective study, spinal MRI, including a sagittal iterative decomposition of water and fat with echo asymmetry and least-squares estimation T2 fast spin-echo sequence, was performed on 76 myeloma patients (45 men, 67.0 ± 11.4 years; 31 women, 66.5 ± 11.0 years) and 30 control subjects (20 men, 67.0 ± 8.4 years; 10 women, 67.0 ± 9.2 years). The fat-signal fraction (FF) and mean signal dropout ratio (DR) were calculated from lumbar BM that contained no focal lesions. The BM plasma cell percentage (BMPC%) and serological data were obtained. As DR is highest when FF = 50%, the patients were divided into 2 groups: a water-dominant group (FF < 50%) and a fat-dominant group (FF > 50%).

Serum monoclonal protein (M protein), β2-microglobulin, and BMPC% were significantly higher in the water-dominant group than in the fat-dominant group. In the water-dominant group, DR correlated significantly with BMPC% and M protein, whereas in the control group, DR showed a weak correlation with age but no correlation with other clinical factors. No significant differences in any clinical data were seen between high and low DR.

CSI proved ineffective for differentiating myelomatous infiltration from hematopoietic BM. For myeloma patients with relatively high BM cellularity, a small signal drop on opposed-phase images indicated a higher tumor burden. For BM with relatively low cellularity, disease severity was not reflected by CSI.
Preoperative platelet count does not predict the occurrence of post-hepatectomy liver failure after partial hepatectomy in a retrospective monocentric cohort study
Authors: Hajji Sofia El , Balaphas Alexandre , Toso Christian , Gonelle-Gispert Carmen , Bühler Léo , Meyer Jeremy
Published: February 2021

In humans, thrombocytopenic patients have increased incidence of post-hepatectomy liver failure (PHLF), but existing evidence is heterogeneous. Our objective was to determine if preoperative platelet count or antiplatelet drugs were associated with PHLF.

Patients who underwent hepatic resection in the University Hospitals of Geneva, Switzerland, from 01.12.2009 to 18.12.2018 were identified. Platelet count at day 0, postoperative days (POD) 1, 3, and 5 were retrieved. Occurrence of PHLF according to the ISGLS definition was determined. Logistic regression was performed to determine if platelet count or antiplatelet drug were predictors for PHLF.

Five hundred ninety seven patients were included. Eighty patients (17.8%) had a preoperative platelet count <150 (G/l) and 24 patients (5.3%) had a platelet count <100 (G/l). Thirty five patients (5.9%) were under antiplatelet drug. Platelet count significantly decreased at POD 1 and POD 3 when compared to preoperative platelet count (182 ± 71.61 (G/l) vs 212 ± 85.26 (G/l), P < .0001; 162 ± 68.5 (G/l) vs 212 ± 85.26 (G/l), P < .0001). At POD 5, post-operative platelet count did not significantly differ from its preoperative value. Forty three patients (11.2%) suffered from PHLF. Their platelet count was not significantly different than patients without PHLF (211 ± 89.7 (G/l) vs 211 ± 83.5 (G/l), P = .671). One patient with PHLF had a platelet count <100 (G/l) and 5 had a count <150 (G/l). Univariate logistic regression did not identify preoperative thrombocytopenia (<100 (G/l) or <150 (G/l)), postoperative thrombocytopenia, or the presence of antiagregant drug, as predictors of PHLF. We did not identify preoperative or postoperative thrombocytopenia as predictor of PHLF in a cohort of 597 patients.