bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical care outcomes in patients with pre-existing pulmonary hypertension: insights from the ASPIRE registry
Authors: Bauchmuller Kris , Condliffe Robin , Southern Jennifer , Billings Catherine , Charalampopoulos Athanasios , Elliot Charlie A. , Hameed Abdul , Kiely David G. , Sabroe Ian , Thompson A.A. Roger , Raithatha Ajay , Mills Gary H.
Published: February 2021

Pulmonary hypertension (PH) is a life-shortening condition characterised by episodes of decompensation precipitated by factors such as disease progression, arrhythmias and sepsis. Surgery and pregnancy also place additional strain on the right ventricle. Data on critical care management in patients with pre-existing PH are scarce.

We conducted a retrospective observational study of a large cohort of patients admitted to the critical care unit of a national referral centre between 2000–2017 to establish acute mortality, evaluate predictors of in-hospital mortality and establish longer term outcomes in survivors to hospital discharge.

242 critical care admissions involving 206 patients were identified. Hospital survival was 59.3%, 94% and 92% for patients admitted for medical, surgical or obstetric reasons, respectively. Medical patients had more severe physiological and laboratory perturbations than patients admitted following surgical or obstetric interventions. Higher APACHE II (Acute Physiology and Chronic Health Evaluation) score, age and lactate, and lower oxygen saturation measure by pulse oximetry/inspiratory oxygen fraction (SpO2/FiO2) ratio, platelet count and sodium level were identified as independent predictors of hospital mortality. An exploratory risk score, OPALS (oxygen (SpO2/FiO2) ≤185; platelets ≤196×109·L−1; age ≥37.5 years; lactate ≥2.45 mmol·L−1; sodium ≤130.5 mmol·L−1), identified medical patients at increasing risk of hospital mortality. One (11%) out of nine patients who were invasively ventilated for medical decompensation and 50% of patients receiving renal replacement therapy left hospital alive. There was no significant difference in exercise capacity or functional class between follow-up and pre-admission in patients who survived to discharge.

These data have clinical utility in guiding critical care management of patients with known PH. The exploratory OPALS score requires validation.
Comparison of inhalation technique with the Diskus and Autohaler in asthmatic children at home
Authors: van der Kolk Annelies , Lammers Natasja , Brusse-Keizer Marjolein , van der Palen Job , Faber Joyce , Spenkelink-Visser Reina , Thio Bernard J.
Published: February 2021

Objective

Asthma is the most common chronic disease in childhood and anti-inflammatory medication is the cornerstone of treatment. Inhalers are frequently used incorrectly when demonstrated in the hospital, suggesting poor technique at home. We aimed to 1) compare daily inhalation technique with the Diskus and Autohaler in asthmatic children by filming inhalations at home and 2) compare daily inhalation technique with technique demonstrated in the hospital.

Methods

We performed a randomised study in asthmatic children (aged 6–18 years) from the outpatient clinic of Medisch Spectrum Twente hospital (Enschede, The Netherlands) from July 2014 to April 2016. Children received inhalation instructions for the Diskus and Autohaler and were randomised to use one device in the morning and the other in the evening. During the 28-day study period, inhalations were filmed at home and subsequently demonstrated in the hospital. All inhalations were checked for seven critical errors per device.

Results

636 videos with the Diskus and 663 with the Autohaler were provided by 27 children. The most common critical error in daily life was an incorrect device position during preparation of the Diskus (n=271) and an insufficiently deep inhalation (n=39) using the Autohaler. Percentage of correct days using the Diskus was 44%, compared to 96% with the Autohaler (p<0.001). The two most common errors with the Diskus were made at least twice as often at home than in the hospital.

Conclusion

Inhalation technique at home was markedly better with the Autohaler than with the Diskus. Paediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus.
Cystic fibrosis airway microbiota associated with outcomes of nontuberculous mycobacterial infection
Authors: Caverly Lindsay J. , Zimbric Madsen , Azar Michelle , Opron Kristopher , LiPuma John J.
Published: February 2021

Rationale

Pulmonary infections with nontuberculous mycobacteria (NTM) are increasingly prevalent in people with cystic fibrosis (CF). Clinical outcomes following NTM acquisition are highly variable, ranging from transient self-resolving infection to NTM pulmonary disease associated with significant morbidity. Relationships between airway microbiota and variability of NTM outcomes in CF are unclear.

Objective

To identify features of CF airway microbiota associated with outcomes of NTM infection.

Methods

188 sputum samples, obtained from 24 subjects with CF, each with three or more samples collected from 3.5 years prior to, and up to 6 months following incident NTM infection, were selected from a sample repository. Sputum DNA underwent bacterial 16S rRNA gene sequencing. Airway microbiota were compared based on the primary outcome, a diagnosis of NTM pulmonary disease, using Wilcoxon rank-sum testing, autoregressive integrated moving average modelling and network analyses.

Measurements and main results

Subjects with and without NTM pulmonary disease were similar in clinical characteristics, including age and lung function at the time of incident NTM infection. Time-series analyses of sputum samples prior to incident NTM infection identified positive correlations betweenPseudomonas,Streptococcus,Veillonella,PrevotellaandRothiawith diagnosis of NTM pulmonary disease and with persistent NTM infection. Network analyses identified differences in clustering of taxa between subjects with and without NTM pulmonary disease, and between subjects with persistentversustransient NTM infection.

Conclusions

CF airway microbiota prior to incident NTM infection are associated with subsequent outcomes, including diagnosis of NTM pulmonary disease, and persistence of NTM infection. Associations between airway microbiota and NTM outcomes represent targets for validation as predictive markers and for future therapies.
Airflow limitation and tongue microbiota in community-dwelling elderly individuals
Authors: Takeshita Toru , Matsumoto Koichiro , Furuta Michiko , Fukuyama Satoru , Takeuchi Kenji , Ogata Hiroaki , Asakawa Mikari , Kageyama Shinya , Hata Jun , Ninomiya Toshiharu , Inoue Hiromasa , Yamashita Yoshihisa
Published: February 2021

Numerous oral indigenous microorganisms are constantly introduced into the stomachviathe laryngopharynx, and a portion of these microorganisms irregularly reaches the lower airways and lungs. This study investigated the association between airflow limitation and the status of tongue microbiota, which is a primary source of ingested oral bacterial populations.

The study population consisted of 484 community-dwelling adults aged 70–80 years inhabiting Hisayama town, Japan, who underwent a regular health examination including dental examination and spirometry test in 2016. The bacterial density and composition of their tongue microbiota were determined using a previously used 16S rRNA gene to understand their relationship with oral health conditions. The present cross-sectional study compared the tongue microbiota status between elderly individuals with airflow limitation and those with normal airflow.

The total bacterial density of the tongue microbiota of individuals with airflow limitation was significantly higher than that of individuals with normal airflow. Logistic regression analysis demonstrated that a high-biomass tongue microbiota was significantly associated with airflow limitation after adjustment for smoking intensity and other covariates (adjusted OR 1.61, 95% CI 1.01–2.60). Of the predominant commensals, higher amounts ofPrevotella melaninogenicaandActinomyces odontolyticuswere associated with a higher prevalence of airflow limitation.

These results indicate that increased bacterial burden in the tongue microbiota is associated with a higher prevalence of airflow limitation.
Anti-HSP47 siRNA lipid nanoparticle ND-L02-s0201 reverses interstitial pulmonary fibrosis in preclinical rat models
Authors: Liu Yun , Liu Jian , Quimbo Alistair , Xia Fengcheng , Yao Jiping , Clamme Jean-Pierre , Zabludoff Sonya , Zhang Jun , Ying Wenbin
Published: February 2021

ND-L02-s0201 is a lipid nanoparticle encapsulating an siRNA which inhibits expression of heat shock protein 47 (HSP47), a collagen-specific chaperone. Accumulated evidence demonstrates a close association between increased level of HSP47 and excessive accumulation of collagen in fibrotic diseases. Our objective was to test ND-L02-s0201 efficacy in preclinical lung fibrosis models and characterise the downstream histological and functional consequences of inhibiting the expression of HSP47.

Comprehensive optimisation and characterisation of bleomycin (BLM) and silica-induced rat lung fibrosis models were conducted, which ensured progressive pathological changes were sustained throughout the study during evaluation of the anti-fibrotic potential of ND-L02-s0201.

In the BLM model, we demonstrated dose-dependent and statistically significant reduction in the relative lung weight, collagen deposition and histology, and fibrosis scores following ND-L02-s0201 treatment. Lung tissue mRNA profiling demonstrated that 11 out of 84 fibrosis-relevant genes were upregulated following BLM induction and were downregulated by approximately 4.5-fold following ND-L02-s0201 treatment. Epithelial–mesenchymal transition was characterised in the BLM model following ND-L02-s0201 treatment. Cell enrichment demonstrated that myofibroblasts contained the highest HSP47 mRNA expression. BLM led to more than a five-fold increase in myofibroblasts and ND-L02-s0201 treatment reduced the myofibroblasts to sham levels. Statistically significant improvement in lung function was noted in the BLM model which was determined by running endurance capacity using a 7-minute treadmill test. Comparable anti-fibrotic efficacy was also observed in the silica model.

Results from two robust chronic rodent models of pulmonary fibrosis demonstrated significant anti-fibrotic effects and improved lung function which support the evaluation of ND-L02-s0201 in subjects with idiopathic pulmonary fibrosis.
Chest computed tomography and alveolar–arterial oxygen gradient as rapid tools to diagnose and triage mildly symptomatic COVID-19 pneumonia patients
Authors: de Roos Marlise P. , Kilsdonk Iris D. , Hekking Pieter-Paul W. , Peringa Jan , Dijkstra Nynke G. , Kunst Peter W.A. , Bresser Paul , Reesink Herre J.
Published: February 2021

Background

In the coronavirus disease 2019 (COVID-19) pandemic, rapid clinical triage is crucial to determine which patients need hospitalisation. We hypothesised that chest computed tomography (CT) and alveolar-arterial oxygen tension ratio (A-a) gradient may be useful to triage these patients, since they reflect the severity of the pneumonia-associated ventilation/perfusion abnormalities.

Methods

A retrospective analysis was performed in 235 consecutive patients suspected for COVID-19. The diagnostic protocol included low-dose chest CT and arterial blood gas analysis. In patients with CT-based COVID-19 pneumonia, the association between “need for hospitalisation” and A-a gradient was investigated by a multivariable logistic regression model. The A-a gradient was tested as a predictor for need for hospitalisation using receiver operating characteristic curve analysis and a logistic regression model.

Results

72 out of 235 patients (mean±sdage 55.5±14.6 years, 40% female) screened by chest CT showed evidence for COVID-19 pneumonia. In these patients, A-a gradient was shown to be a predictor of need for hospitalisation, with an optimal decision level (cut-off) of 36.4 mmHg (95% CI 0.70–0.91, p<0.001). The A-a gradient was shown to be independently associated with need for hospitalisation (OR 1.97 (95% CI 1.23–3.15), p=0.005; A-a gradient per 10 points) from CT severity score (OR 1.13 (95% CI 0.94–1.36), p=0.191), National Early Warning Score (OR 1.19 (95% CI 0.91–1.57), p=0.321) or peripheral oxygen saturation (OR 0.88 (95% CI 0.68–1.14), p=0.345).

Conclusion

Low-dose chest CT and the A-a gradient may serve as rapid and accurate tools to diagnose COVID-19 pneumonia and to select mildly symptomatic patients in need for hospitalisation.
Effect of fexofenadine hydrochloride on allergic rhinitis aggravated by air pollutants
Authors: Ellis Anne K. , Murrieta-Aguttes Margarita , Furey Sandy , Picard Pascaline , Carlsten Christopher
Published: February 2021

In recent decades, seasonal allergic rhinitis (SAR) prevalence has increased and recent studies have shown that air pollutants, such as diesel exhaust particles (DEP), can increase inflammatory and allergic biomarkers. The aim of this study was to investigate the effects of DEP on SAR symptoms induced by ragweed and to evaluate the efficacy and safety of fexofenadine HCl 180 mgversusplacebo.

This phase 3, single-centre, sequential, parallel-group, double-blind, randomised study (NCT03664882) was conducted in an environmental exposure unit (EEU) during sequential exposures: Period 1 (ragweed pollen alone), Period 2 (ragweed pollen+DEP), and Period 3 (ragweed pollen+DEP+single-dose fexofenadine HCl 180 mg or placebo). Efficacy and safety were evaluated in Period 3. Primary endpoints were the area under the curve (AUC) of total nasal symptom score (TNSS) from baseline to hour 12 (AUC0–12) during Period 1 and Period 2; and the AUC of the TNSS from hour 2 to 12 (AUC2–12) during Period 3.

251 out of 257 evaluable subjects were included in the modified intent-to-treat population. Least squares mean difference (95% CI) for TNSS Log AUC0−12in Period 2versusPeriod 1 was 0.13 (0.081–0.182; p<0.0001). Least squares mean difference in TNSS Log AUC2−12for fexofenadine HClversusplacebo during Period 3 was −0.24 (−0.425–−0.047; p=0.0148). One fexofenadine HCl-related adverse event was observed.

SAR symptoms evoked by ragweed were aggravated by DEP. Fexofenadine HCl 180 mg was effective in relieving pollen-induced, air pollution-aggravated allergic rhinitis symptoms.
Participation in physical activity is associated with reduced nocturnal hypoxaemia in males
Authors: Stevens David , Appleton Sarah , Melaku Yohannes , Martin Sean , Adams Robert , Wittert Gary
Published: February 2021

Moderate to vigorous physical activity (MVPA) interventions reduce the severity of obstructive sleep apnoea (OSA); however, little epidemiological research exists to confirm these findings.

789 participants from the population-based Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent polysomnography. MVPA was assessed using the Active Australia questionnaire, which was completed when participants were first recruited to the MAILES study (2002–2006), and again in 2010. Multinomial logistic regressions established odds ratio between OSA severity categories with MVPA, whilst adjusted linear models determined associations between OSA metrics with MVPA.

Cross-sectionally, each hour of MVPA was associated with reduced severity of mean oxygen desaturation (unstandardised β (B)=−0.002, p=0.043) and reduced time below 90% oxygen saturation (B=−0.03, p=0.034).

Longitudinally, each hour increase in MVPA was associated with a 4% reduction in the odds of severe OSA and less severe mean oxygen desaturation (B=−0.003, p=0.014), time below 90% oxygen saturation (B=−0.02, p=0.02), and mean duration of apnoeas (B=−0.004, p=0.016).

MVPA is associated with reduced hypoxaemia in a cohort of community dwelling males, approximately half of whom had untreated OSA. As nocturnal intermittent hypoxaemia is associated with cardiometabolic disorders, MVPA may offer protection for patients with OSA.
Nasal upregulation ofCST1in dog-sensitised children with severe allergic airway disease
Authors: Käck Ulrika , Einarsdottir Elisabet , van Hage Marianne , Asarnoj Anna , James Anna , Nopp Anna , Krjutškov Kaarel , Katayama Shintaro , Kere Juha , Lilja Gunnar , Söderhäll Cilla , Konradsen Jon R.
Published: February 2021

Background

The clinical presentation of children sensitised to dog dander varies from asymptomatic to severe allergic airway disease, but the genetic mechanisms underlying these differences are not clear. The objective of the present study was to investigate nasal transcriptomic profiles associated with dog dander sensitisation in school children and to reveal clinical symptoms related with these profiles.

Methods

RNA was extracted from nasal epithelial cell brushings of children sensitised to dog dander and healthy controls. Blood sample analyses included IgE against dog dander, dog allergen molecules, other airborne and food allergens, basophil activation and white blood cell counts. Clinical history of asthma and rhinitis was recorded, and lung function was assessed (spirometry, methacholine provocation and exhaled nitric oxide fraction).

Results

The most overexpressed gene in children sensitised to dog dander compared to healthy controls wasCST1, coding for Cystatin 1. A cluster of these children with enhancedCST1expression showed lower forced expiratory volume in 1 s, increased bronchial hyperreactivity, pronounced eosinophilia and higher basophil allergen threshold sensitivity compared with other children sensitised to dog dander. In addition, multi-sensitisation to lipocalins was more common in this group.

Conclusions

Overexpression ofCST1is associated with more severe allergic airway disease in children sensitised to dog dander.CST1is thus a possible biomarker of the severity of allergic airway disease and a possible therapeutic target for the future treatment of airborne allergy.
Emergency peripartum hysterectomy in a tertiary teaching hospital in Northern Jordan: a 15-year review
Authors: Rawashdeh Hasan , Obeidat Rawan , Masaadeh Lubna
Published: February 2021

Emergency peripartum hysterectomy is a major operation performed when conservative measures fail to stop life-threatening postpartum hemorrhage. It is associated with a high rate of maternal morbidity among survivors. This work aims to evaluate the incidence, indication, and complications of peripartum hysterectomy at King Abdulla University Hospital over 15 years. A retrospective cohort study of emergency peripartum hysterectomy. The incidence was calculated. Risk factors for abnormally adherent placenta were explored. A comparison between total and subtotal hysterectomy in terms of morbidity outcomes was conducted. The chi-square test, Fisher’s exact, and independent sample T test were used for analysis. Statistical significance was declared at α < 0.05. The incidence of peripartum hysterectomy was 1.38 per 1000 births. Fifty-nine were performed after cesarean section and three were performed after vaginal delivery (P<0.001). Abnormally adherent placenta (accreta, increta, and percreta) was the main indication (44.06%). The strongest risk factor for abnormally adherent placenta was placenta previa with previous cesarean section (P=0.001, OR 16.25, 95% CI 1.95-135.01). One maternal and three neonatal deaths were recorded. Urinary bladder injury was the most frequent complication (27.11%). No difference in morbidity was noted between total and subtotal hysterectomy. The incidence of emergency peripartum hysterectomy is increasing steadily over the last two decades in the north of Jordan. Abnormally adherent placenta is the most common indication for emergency peripartum hysterectomy. There is no significant difference between total and subtotal hysterectomy in terms of complications’ development, admission to the intensive care unit, and estimated blood loss. The morbidity associated with emergency peripartum hysterectomy is significant.
Statistical image processing quantifies the changes in cytoplasmic texture associated with aging in Caenorhabditis elegans oocytes
Authors: Imakubo Momoko , Takayama Jun , Okada Hatsumi , Onami Shuichi
Published: February 2021

Background

Oocyte quality decreases with aging, thereby increasing errors in fertilization, chromosome segregation, and embryonic cleavage. Oocyte appearance also changes with aging, suggesting a functional relationship between oocyte quality and appearance. However, no methods are available to objectively quantify age-associated changes in oocyte appearance.

Results

We show that statistical image processing of Nomarski differential interference contrast microscopy images can be used to quantify age-associated changes in oocyte appearance in the nematodeCaenorhabditis elegans. Max–min value (mean difference between the maximum and minimum intensities within each moving window) quantitatively characterized the difference in oocyte cytoplasmic texture between 1- and 3-day-old adults (Day 1 and Day 3 oocytes, respectively). With an appropriate parameter set, the gray level co-occurrence matrix (GLCM)-based texture featureCorrelation(COR) more sensitively characterized this difference than the Max–min Value. Manipulating the smoothness of and/or adding irregular structures to the cytoplasmic texture of Day 1 oocyte images reproduced the difference in Max–min Value but not in COR between Day 1 and Day 3 oocytes. Increasing the size of granules in synthetic images recapitulated the age-associated changes in COR. Manual measurements validated that the cytoplasmic granules in oocytes become larger with aging.

Conclusions

The Max–min value and COR objectively quantify age-related changes inC. elegansoocyte in Nomarski DIC microscopy images. Our methods provide new opportunities for understanding the mechanism underlying oocyte aging.
Assessment of heterosis based on parental genetic distance estimated with SSR and SNP markers in upland cotton (Gossypium hirsutum L.)
Authors: Geng Xiaoli , Qu Yujie , Jia Yinhua , He Shoupu , Pan Zhaoe , Wang Liru , Du Xiongming
Published: February 2021

Background

Heterosis has been extensively utilized in different crops and made a significant contribution to global food security. Genetic distance (GD) is one of the valuable criteria for selecting parents in hybrid breeding. The objectives of this study were to estimate the GD between parents using both simple sequence repeat (SSR) markers and single nucleotide polymorphism (SNP) markers and to investigate the efficiency of the prediction of hybrid performance based on GD. The experiment comprised of four male parents, 282 female parents and 1128 F1, derived from NCII mating scheme. The hybrids, their parents and two check cultivars were evaluated for two years. Performance of F1, mid-parent heterosis (MPH), and best parent heterosis (BPH) were evaluated for ten agronomic and fiber quality traits, including plant height, boll weight, boll number, lint percentage, fiber length, fiber strength, fiber uniformity, fiber elongation ratio, micronaire, and spinning consistent index.

Results

Heterosis was observed in all hybrids and, the traits like plant height, boll number, boll weight and lint percentage exhibited higher heterosis than the fiber quality traits. Correlations were significant between parental and F1 performances. The F1 performances between three hybrid sets (Elite×Elite, Exotic×Elite, and Historic×Elite) showed significant differences in eight traits, including boll number, lint percentage, fiber length, fiber strength, fiber uniformity, fiber elongation ratio, micronaire, and spinning consistent index. The correlation of the GD assessed by both SSR and SNP markers was significantly positive. The cluster analysis based on GD results estimated using SNP showed that all the female parents divided into five groups and the F1 performance between these five groups showed significant differences in four traits, including lint percentage, micronaire, fiber strength, and fiber elongation ratio. The correlation between GD and F1 performance, MPH and BPH were significant for lint percentage and micronaire.

Conclusions

Our results suggested that GD between parents could be helpful in heterosis prediction for certain traits. This study reveals that molecular marker analysis can serve as a basis for assigning germplasm into heterotic groups and to provide guidelines for parental selection in hybrid cotton breeding.
Integrated metabolic profiling and transcriptome analysis of pigment accumulation in Lonicera japonica flower petals during colour-transition
Authors: Xia Yan , Chen Weiwei , Xiang Weibo , Wang Dan , Xue Baogui , Liu Xinya , Xing Lehua , Wu Di , Wang Shuming , Guo Qigao , Liang Guolu
Published: February 2021

Background

Plants have remarkable diversity in petal colour through the biosynthesis and accumulation of various pigments. To better understand the mechanisms regulating petal pigmentation inLonicera japonica, we used multiple approaches to investigate the changes in carotenoids, anthocyanins, endogenous hormones and gene expression dynamics during petal colour transitions, i.e., green bud petals (GB_Pe), white flower petals (WF_Pe) and yellow flower petals (YF_Pe).

Results

Metabolome analysis showed that YF_Pe contained a much higher content of carotenoids than GB_Pe and WF_Pe, with α-carotene, zeaxanthin, violaxanthin and γ-carotene identified as the major carotenoid compounds in YF_Pe. Comparative transcriptome analysis revealed that the key differentially expressed genes (DEGs) involved in carotenoid biosynthesis, such asphytoene synthase,phytoene desaturaseandζ-carotene desaturase, were significantly upregulated in YF_Pe. The results indicated that upregulated carotenoid concentrations and carotenoid biosynthesis-related genes predominantly promote colour transition. Meanwhile, two anthocyanins (pelargonidin and cyanidin) were significantly increased in YF_Pe, and the expression level of ananthocyanidin synthasegene was significantly upregulated, suggesting that anthocyanins may contribute to vivid yellow colour in YF_Pe. Furthermore, analyses of changes in indoleacetic acid, zeatin riboside, gibberellic acid, brassinosteroid (BR), methyl jasmonate and abscisic acid (ABA) levels indicated that colour transitions are regulated by endogenous hormones. The DEGs involved in the auxin, cytokinin, gibberellin, BR, jasmonic acid and ABA signalling pathways were enriched and associated with petal colour transitions.

Conclusion

Our results provide global insight into the pigment accumulation and the regulatory mechanisms underlying petal colour transitions during the flower development process inL. japonica.
Aerobic exercise, but not isometric handgrip exercise, improves endothelial function and arterial stiffness in patients with myocardial infarction undergoing coronary intervention: a randomized pilot study
Authors: Kollet Daniel P. , Marenco Ana Beatriz , Bellé Nathan L. , Barbosa Eduardo , Boll Liliana , Eibel Bruna , Waclawovsky Gustavo , Lehnen Alexandre Machado
Published: February 2021

Background

Aerobic exercise improves endothelial function and arterial stiffness after myocardial infarction (MI), but the effects of isometric exercise on cardiovascular parameters are still uncertain. We aimed to assess the effects of one session of aerobic or isometric exercise on flow-mediated dilation (FMD) and pulse wave velocity (PWV) in post-MI volunteers undergoing percutaneous coronary intervention (PCI).

Methods

Twenty post-MI patients undergoing PCI were randomized to aerobic (AE, n = 10) or isometric (IE, n = 10) exercise groups. We evaluated cardiac structure and function (echocardiographic); carotid plaque presence (ultrasound). FMD and PWV were measured 10 min before and 10 min after the intervention: a single session of moderate-intensity AE (30 min; ratings 12–14 on Borg’s scale or 50–60% HRreserve) or handgrip IE (four two-minute bilateral contractions; 30% maximal voluntary contraction; 1-min rest). Generalized estimating equations (Bonferroni post-hoc) was used to assess differences (p ≤ 0.050).

Results

FMD improved only in the AE group (Δ = 4.9%; p = 0.034), with no difference between groups after exercise. Even after adjustment (for baseline brachial artery diameter) the effectiveness of AE remained (p = 0.025) with no change in the IE group. PWV was slightly reduced from baseline in the AE group (Δ = 0.61 m/s; p = 0.044), and no difference when compared to the IE group. Peripheral vascular resistance decreased in AE versus IE (p = 0.050) and from baseline (p = 0.014).

Conclusions

Vascular measurements (FMD and PWV) improved after a single session of AE. There are apparently no benefits following a session of IE.

Trial registration

http://www.clinicaltrials.gov and ID number NCT04000893.
Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study
Authors: Fahimi Daryoosh , Khedmat Leila , Afshin Azadeh , Noparast Zahra , Jafaripor Maryam , Beigi Effat Hosseinali , Ghodsi Maryam , Izadi Anahita , Mojtahedi Sayed Yousef
Published: February 2021

Background

Upper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy.

Objective

A set of clinical symptoms, laboratory markers, and ultrasound findings were assessed to achieve the early diagnosis and prognosis of pyelonephritis in hospitalized pediatrics.

Methods

A cross-sectional study with 104 Iranian children (95 girls and 9 boys) aged 1 month to 12 years with acute pyelonephritis during 2012–2018 was conducted. The ultrasound examination of kidneys and urinary tract during hospitalization, the incidence of clinical symptoms, and laboratory markers in blood and urine were monitored to identify the best predictive factors of early diagnosis of this bacterial infection.

Results

Three-fourth of the patients had one of the four clinical symptoms of abdominal pain, constipation, dysuria, and vomiting, while others were asymptomatic. A much frequency of pyuria (88.46%), Escherichia coli in urine (92.31%), leukocytosis (81.73%), and high ESR (> 10 mm/h, 92.30%) and CRP (> 10 mg/L, 82.82%) was observed. The kidney and urinary tract ultrasonography only in 32.7% of children revealed findings in favor of pyelonephritis (cystitis, ureteral stones, and hydronephrosis).

Conclusion

There was a high frequency of clinical signs and laboratory markers associated with pyelonephritis. Ultrasound alone was not an efficient tool to track febrile UTI as most patients presented normal sonography.
Physical activity, return to work self-efficacy, and work status among employees undergoing chemotherapy for cancer - a prospective study with 12 months follow-up
Authors: Rosbjerg Rikke , Zachariae Robert , Hansen Dorte Gilså , Hoejris Inger , Duijts Saskia , Gehr Nina Lykkegaard , Andersen Irene Dyhrberg , Labriola Merete
Published: February 2021

Background

Numerous studies emphasize the positive effects of physical activity on health and well-being in cancer patients. The effects of physical activity on the working lives of cancer patients have received less attention. The aim of the present study was to examine the association between physical activity and work status in employees with cancer, and the mediating role of return to work self-efficacy (RTWSE) in this association.

Methods

Data from questionnaires (physical activity, RTWSE, performance status, sociodemographic), patient records, and Danish national registries (work status, education) were collected for 217 employees initiating chemotherapy for cancer. The associations of physical activity at baseline with work status at baseline and at twelve months follow-up, respectively, were estimated with logistic regression. The mediating role of RTWSE was investigated using the Sobel Goodmann test.

Results

Employees with moderate (> 30 min/day) or high (> 150 min/day) levels of current daily activity at baseline had significantly increased odds for working at baseline (OR = 2.83, 95%CI = 0.73–10.96 and OR = 6.13, 95%CI = 1.68–22.40, respectively) and at twelve months (OR = 3.90, 95%CI = 1.19–12.77 and OR = 3.43, 95%CI = 1.12–10.51, respectively), compared to sedentary employees. Likewise, employees, physically active in their leisure time (light or vigorous psychical activity) for 2–4 h/week or > 4 h/week of light activity at baseline, had increased odds for working at twelve months (OR range = 1.20 (95%CI = 0.40–3.61)–5.39(95%CI = 0.78–37.32)), compared to sedentary employees. RTWSE was not found to mediate the observed associations.

Conclusions

Physical activity appears positively associated with work status in employees undergoing treatment for cancer in the twelve months period after initiating chemotherapy.
Long-term oncological outcomes of low anterior resection for rectal cancer with and without preservation of the left colic artery: a retrospective cohort study
Authors: Luo Yuwen , Li Rongjiang , Wu Deqing , Zeng Jun , Wang Junjiang , Chen Xianzhe , Huang Chengzhi , Li Yong , Yao Xueqing
Published: February 2021

Background

There is uncertainty in the literature about preserving the left colic artery (LCA) during low anterior resection for rectal cancer. We analyzed the effect of preserving the LCA on long-term oncological outcomes.

Methods

We retrospectively collected clinicopathological and follow-up details of patients who underwent low anterior resection for rectal cancer in the General Surgery Department of Guangdong Provincial People’s Hospital, from January 2014 to December 2015. Cases were divided into low ligation (LL), LCA preserved, or high ligation (HL), LCA not preserved, of the inferior mesenteric artery. The 5-year overall survival (OS) and disease-free survival (DFS) rates were compared between the two groups.

Results

Altogether, there were 221 and 295 cases in the LL group and HL groups, respectively. Operating time in the LL group was significantly longer than in the HL group (224.7 vs. 211.7 min, p = 0.039). Postoperative 30-day mortality, early complications including anastomotic leakage showed no significant differences between the LL and HL groups (postoperative 30-day mortality, 0.9% LL, 1.4% HL, p = 0.884; early complications, 41.2% LL, 38.3% HL, p = 0.509; anastomotic leakage 8.6% LL, 13.2% HL, p = 0.100). The median follow-up periods were 51.4 (7–61) months in the LL group and 51.2 (8–61) months in the HL group. During follow-up, the percentages of patients who died, had local recurrence, or had metastases were 39.8, 7.7, and 38.5%, respectively, in the LL group and 39, 8.5, and 40%, respectively, in the HL group; these differences were not significant (all p > 0.05). The 5-year OS and DFS were 69.6 and 59.6% in the LL group, respectively, and 69.1 and 56.2% in the HL group, respectively; these differences were not significant (all p > 0.05). After stratification by tumor-node-metastasis stage, the difference between the 5-year OS and DFS for stages I, II, and III cancer were not significant (all p > 0.05).

Conclusions

The long-term oncological outcomes of LL group are comparable with HL group. LL cannot be supported due to the absence of lower complication rates and the longer operating times.
Mining prognostic markers of Asian hepatocellular carcinoma patients based on the apoptosis-related genes
Authors: Yan Junbin , Cao Jielu , Chen Zhiyun
Published: February 2021

Background

Apoptosis-related genes(Args)play an essential role in the occurrence and progression of hepatocellular carcinoma(HCC). However, few studies have focused on the prognostic significance of Args in HCC. In the study, we aim to explore an efficient prognostic model of Asian HCC patients based on the Args.

Methods

We downloaded mRNA expression profiles and corresponding clinical data of Asian HCC patients from The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) databases. The Args were collected from Deathbase, a database related to cell death, combined with the research results of GeneCards、National Center for Biotechnology Information (NCBI) databases and a lot of literature. We used Wilcoxon-test and univariate Cox analysis to screen the differential expressed genes (DEGs) and the prognostic related genes (PRGs) of HCC. The intersection genes of DEGs and PGGs were seen as crucial Args of HCC. The prognostic model of Asian HCC patients was constructed by least absolute shrinkage and selection operator (lasso)- proportional hazards model (Cox) regression analysis. Kaplan-Meier curve, Principal Component Analysis (PCA) analysis, t-distributed Stochastic Neighbor Embedding (t-SNE) analysis, risk score curve, receiver operating characteristic (ROC) curve, and the HCC data of ICGC database and the data of Asian HCC patients of Kaplan-Meier plotter database were used to verify the model.

Results

A total of 20 of 56 Args were differentially expressed between HCC and adjacent normal tissues (p < 0.05). Univariate Cox regression analysis showed that 10 of 56 Args were associated with survival time and survival status of HCC patients (p < 0.05). There are seven overlapping genes of these 20 and 10 genes, including BAK1, BAX, BNIP3, CRADD, CSE1L, FAS, and SH3GLB1. Through Lasso-Cox analysis, an HCC prognostic model composed of BAK1, BNIP3, CSE1L, and FAS was constructed. Kaplan-Meier curve, PCA, t-SNE analysis, risk score curve, ROC curve, and secondary verification of ICGC database and Kaplan-Meier plotter database all support the reliability of the model.

Conclusions

Lasso-Cox regression analysis identified a 4-gene prognostic model, which integrates clinical and gene expression and has a good effect. The expression of Args is related to the prognosis of HCC patients, but the specific mechanism remains to be further verified.
Influence of painless one-eye blindness on depression, anxiety and quality of life in glaucoma patients with a normal fellow eye
Authors: Holló Gábor , Sándor Nikolett Gabriella , Kóthy Péter , Géczy Anna
Published: February 2021

Background

For clinical practice it is important to evaluate and compare anxiety, depression and quality of life of glaucoma patients with painless one-eye blindness and a normal fellow eye to unaffected age-matched individuals from a similar environment.

Methods

Twenty-eight stable glaucoma patients (age, mean ± SD: 69.0 ± 13.3 years) with one normal and one painless blind eye, and 26 controls (age: 67.0 ± 14.0 years) completed the standard Hungarian adaptations of the Beck Depression Inventory, Beck Anxiety Inventory, Spielberger-Trait Anxiety Inventory, Hopelessness Scale, and Quality of Life Questionnaire SF-36 with the assistance of trained psychologist interviewers within 3 months after a detailed ophthalmological examination.

Results

The groups did not differ in age, gender distribution, number of children, grandchildren and people in their household (p ≥ 0.235). The best corrected visual acuity (BCVA) of the diseased eye was minimal (median: 0.00), while BCVA of their better eye (median: 1.0) did not differ from that of the control group (p ≥ 0.694). Compared to the control group, the patients’ scores were significantly higher for depression (p ≤ 0.01), cognitive and psychophysiological symptoms of anxiety (p ≤ 0.05) and hopelessness (p ≤ 0.013), and lower (worse) for physical function, vitality, general health and bodily pain (p ≤ 0.045). No difference was found between the groups for mental health, physical role functioning, emotional role functioning and social role functioning (p ≥ 0.117).

Conclusion

Our results show that patients with glaucoma-related one-eye blindness may require regular psychological support even when the visual performance of the fellow eye is fully maintained on the long run, and the patients’ everyday functioning is normal.
The effect of L-Carnitine supplementation on clinical symptoms, C-reactive protein and malondialdehyde in obese women with knee osteoarthritis: a double blind randomized controlled trial
Authors: Baghban Farnaz , Hosseinzadeh Mahdieh , Mozaffari-Khosravi Hassan , Dehghan Ali , Fallahzadeh Hossein
Published: February 2021

Backgrounds

L-carnitine decreases oxidation and inflammation by reducing the fatty acid in plasma and using oxygen in ATP synthesis. As such, knee osteoarthritis (KOA) can be improved by reducing apoptotic chondrocytes. This study was designed to compare the effect of L-carnitine supplementation and low-calorie diet on improving KOA among obese women. We further investigated the effect of L- carnitine on improvement of KOA in obese women on low calorie diet.

Methods

To conduct the study, 76 obese women with KOA were randomly assigned into two low-calorie diet groups: the first received 1000 mg of LCG and the second took the placebo (PLG) (n = 38). Anthropometry indices, body composition, lipid profile, C-reactive Protein (CRP), Malondialdehyde (MDA), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were assessed at the baseline condition and after 12 weeks.

Results

The mean change of body mass index (BMI) (− 1.21 ± 0.84 vs. -0.79 ± 0.70; P = 0.02) and weight (− 2.76 ± 1.69 vs. -1.95 ± 1.73; P = 0.05) were significant in the LCG compared with the PLG. Likewise, LCG compared to the PLG showed insignificant improvement in waist circumference (WC) (− 5.65 ± 5.85 vs. -3.64 ± 3.37; P = 0.08). Total cholesterol (P = 0.02), MDA (P = 0.03), fat mass (P = 0.03) and visceral fat (P = 0.001) only showed decreased levels in LCG in comparison to the baseline condition. There was no significant difference between LCG and PLG, in the mean changes of hip circumference, visceral fat, free fat mass, fat mass, lipid profiles, CRP, MDA as well as stiffness, physical function, decrease of pain and total scores (P > 0.05).

Conclusion

The 12-week L-carnitine supplementation could improve BMI, but had no significant effect on other anthropometric and body composition measures as well as clinical symptoms, CRP, MDA, and lipid profile in women with KOA. Further trials with higher doses and longer durations are required. IRCT registration number: IRCT2017011932026N2. Registration date: 2017-04-27.
Surgical treatment for esophageal neurofibroma: report of two cases and review of literature
Authors: Zhang Zhedong , Wang Xun , Zhou Zuli , Wang Jun , Jiang Guanchao
Published: February 2021

Background

Neurofibroma of the esophagus, originated from the nerve sheath cells and fibroblasts of the esophageal submucosal plexus or the intestinal intermuscular plexus, is a very rare mesenchymal tumor. Most of the cases are treated by surgical methods. Due to the technical complexity of video-assisted thoracoscopic surgery (VATS), there are few reports in the literature of VATS for esophageal neurofibroma in recent years.

Case presentation

We report on two rare cases of esophageal neurofibroma, one of which is a 52-year-old male patient diagnosed with a 4.6 × 5.7 cm upper esophageal submucosal tumor in physical examination. He was admitted to our hospital and the tumor was enucleated by VATS combined with intraoperative endoscopy. There were no complications after operation, and the patients was discharged on the 16th postoperative day. The other patient was a 76-year-old man, with the main clinical manifestation of dysphagia for over 1 year, diagnosed with an 8.0 × 6.0 × 8.0 cm giant subepithelial mass in the lower esophagus. As the intraoperative exploration revealed the tumor connected tightly with the wall of the esophagus, this patient treated by transthoracic partial esophagectomy. The patient was discharged on the 14th postoperative day, and no signs of post-operative complication during the 53-month follow-up. The diagnosis of esophageal neurofibroma was based on these patients’ postoperative pathological examination. In the latest follow-up, these two patients had no evidence of long-term postoperative complication and recurrence.

Conclusion

This is the first reported case of 5 cm in diameter esophageal neurofibroma treated by VATS. This technique can be a commendable treatment option for esophageal neurofibroma, and the tumor diameter is not an absolute contraindication for thoracoscopy. To reduce the unnecessary damage, surgical method for complete tumor resection needs to be determined according to preoperative imaging and intraoperative conditions, partial esophagectomy can be performed via thoracotomy or thoracoscopy for removing neurofibroma when necessary.
Challenges and solutions to returning to clinical training after research: a multidisciplinary survey of integrated academic trainees in West Yorkshire, United Kingdom
Authors: Downey C. L. , Bentley J. , Pandit H.
Published: February 2021

Background

Time out of clinical training can impact medical trainees’ skills, competence and confidence. Periods of Out of Programme for Research (OOPR) are often much longer than other approved mechanisms for time of out training. The aim of this survey study was to explore the challenges of returning to clinical training following OOPR, and determine potential solutions.

Methods

All current integrated academic training (IAT) doctors at the University of Leeds (United Kingdom) and previous IAT trainees undertaking OOPR in the local region (West Yorkshire, United Kingdom)(n = 53) were invited to complete a multidisciplinary survey.

Results

The survey was completed by 33 participants (62% response rate). The most relevant challenges identified were completing the thesis whilst transitioning back to clinical work, the rapid transition between full-time research and clinical practice, a diminished confidence in clinical abilities and isolation from colleagues. Potential solutions included dedicated funds allocated for the renewal of lapsed skills, adequate notice of the clinical rotation to which trainees return, informing clinical supervisors about the OOPR trainee returning to practice and a mandatory return to standard clinical days.

Conclusions

Addressing these issues has the potential to improve the trainee experience and encourage future trainees to take time out of training for research activities.
Thyroid cancer patients satisfaction at the management outcome: an analysis of the results of a nationwide survey in 485 subjects
Authors: Díez Juan J. , Galofré Juan C.
Published: February 2021

Background

We aimed to measure satisfaction of patients with thyroid cancer concerning different aspects of healthcare.

Methods

We developed a web-based survey. Questions focused on patient satisfaction with specialists, the health centers and departments, and the information received about their disease. Level of satisfaction was quantified using a scale of 1 to 5. Values ≥4 were considered a high degree of satisfaction.

Results

Four hundred eighty-five patients (aged 43.4 ± 9.9 yrs., 88% females) completed the survey. A high overall satisfaction with the specialists was reported by 52.5% of patients. The most highly valued specialists were surgeons, oncologists, and endocrinologists. 56.5% of respondents reported a high overall satisfaction with the health centers and departments. Lastly, the proportion of patients who were highly satisfied with the information received was only 42.5%. The presence of complications was indirectly related with satisfaction with specialists and information. Satisfaction with health centers and services was directly related with the level of education and inversely related to the time of evolution of the disease.

Conclusion

Our results show a high degree of overall satisfaction of thyroid cancer patients. However, satisfaction can be improved in some areas, such with regards to the information provided to patients.