bluuebunny/crossref_metadata_2025 huggingface dataset:
Does economic growth reduce childhood stunting? A multicountry analysis of 89 Demographic and Health Surveys in sub-Saharan Africa
Authors: Yaya Sanni , Uthman Olalekan A , Kunnuji Michael , Navaneetham Kannan , Akinyemi Joshua O , Kananura Rornald Muhumuza , Adjiwanou Visseho , Adetokunboh Olatunji , Bishwajit Ghose
Published: January 2020

Background

There is mixed evidence and lack of consensus on the impact of economic development on stunting, and likewise there is a dearth of empirical studies on this relationship in the case of sub-Saharan Africa. Thus, this paper examines whether economic growth is associated with childhood stunting in low-income and middle-income sub-Saharan African countries.

Methods

We analysed data from 89 Demographic and Health Surveys conducted between 1987 and 2016 available as of October 2018 using multivariable multilevel logistic regression models to show the association between gross domestic product (GDP) per capita and stunting. We adjusted the models for child’s age, survey year, child’s sex, birth order and country random effect, and presented adjusted and unadjusted ORs.

Results

We included data from 490 526 children. We found that the prevalence of stunting decreased with increasing GDP per capita (correlation coefficient=−0.606, p<0.0001). In the unadjusted model for full sample, for every US$1000 increase in GDP per capita, the odds of stunting decreased by 23% (OR=0.77, 95% CI 0.76 to 0.78). The magnitude of the association between GDP per capita and stunting was stronger among children in the richest quintile. After adjustment was made, the association was not significant among children from the poorest quintile. However, the magnitude of the association was more pronounced among children from low-income countries, such that, in the model adjusted for child’s age, survey year, child’s sex, birth order and country random effect, the association between GDP per capita and stunting remained statistically significant; for every US$1000 increase in GDP per capita, the odds of stunting decreased by 12% (OR=0.88, 95% CI 0.87 to 0.90).

Conclusion

There was no significant association between economic growth and child nutritional status. The prevalence of stunting decreased with increasing GDP per capita. This was more pronounced among children from the richest quintile. The magnitude of the association was higher among children from low-income countries, suggesting that households in the poorest quintile were typically the least likely to benefit from economic gains. The findings could serve as a building block needed to modify current policy as per child nutrition-related programmes in Africa.
A study of the nature and level of trust between patients and healthcare providers, its dimensions and determinants: a scoping review protocol
Authors: Rasiah Supathiratheavy , Jaafar Safurah , Yusof Safiah , Ponnudurai Gnanajothy , Chung Katrina Pooi Yin , Amirthalingam Sasikala Devi
Published: January 2020

Introduction

The aim of this scoping review is to systematically search the literature to identify the nature and or level of trust between the patient, the users of health services (eg, clients seeking health promotion and preventive healthcare services) and the individual healthcare providers (doctors, nurses and physiotherapists/ occupational therapists), across public and private healthcare sectors, at all levels of care from primary through secondary to tertiary care. It also aims to identify the factors that influence trust between patients, users of health services (clients) and providers of healthcare at all levels of care from primary care to tertiary care, and across all health sectors (public and private). The study will also identify the tools used to measure trust in the healthcare provider.

Methods and analysis

The scoping review will be conducted based on the methodology developed by Arksey and O’Malley’s scoping review methodology, and Levacet al’s methodological enhancement. An experienced information specialist (HM) searched the following databases MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature. The search terms were both keywords in the title and/or abstract and subject headings (eg, MeSH, EMTREE) as appropriate. Search results were downloaded, imported and stored into a ‘Refworks’ folder specifically created for reference management. The preliminary search was conducted between 7 December 2017 and 14 December 2017. Quantitative methods using content analysis will be used to categorise study findings on factors associated with trust between patients, clients and healthcare providers. The collection of studies will be also examined for heterogeneity. Qualitative analysis on peer reviewed articles of qualitative interviews and focus group discussion will be conducted; it allows clear identification of themes arising from the data, facilitating prioritisation, higher order abstraction and theory development. A consultation exercise with stakeholders may be incorporated as a knowledge translation component of the scoping study methodology.

Ethics and dissemination

Ethical approval will be obtained for the research project from the Institutional Review Board. The International Medical University will use the findings of this scoping review research to improve the understanding of trust in healthcare, in its endeavour to improve health services delivery in its healthcare clinics and hospitals, and in its teaching and learning curriculum. The findings will also help faculty make evidence based decisions to focus resources and research as well as help to advance the science in this area. Dissemination of the results of the scoping review will be made through peer-reviewed publications, research reports and presentations at conferences and seminars.
Zinc acetate lozenges for the treatment of the common cold: a randomised controlled trial
Authors: Hemilä Harri , Haukka Jari , Alho Marianne , Vahtera Jussi , Kivimäki Mika
Published: January 2020

Objective

To examine a commercially available zinc acetate lozenge for treating the common cold.

Design

Randomised, double-blinded, placebo-controlled trial.

Setting

Working population in Finland.

Participants

We included men and women aged ≥18 years who usually had ≥1 cold per winter. Exclusions were pregnancy, lactation, chronic runny nose or chronic cough.

Intervention

We randomised 253 participants to receive a package of lozenges to be taken if they caught the common cold. Of the 253 participants, 88 contracted the common cold and 87 were included in our primary analysis. Zinc acetate lozenges contained 13 mg elemental zinc and placebo lozenges contained sucrose octa-acetate to camouflage the taste of zinc. Instruction to use was six times per day for the maximum of 5 days.

Primary outcome

Rate of recovery from the common cold analysed by Cox regression.

Results

There was no difference in the recovery rate between zinc and placebo participants during the 10-day follow-up (rate ratio for zinc vs placebo=0.68, 95% CI 0.42 to 1.08; p=0.10). The recovery rate for the two groups was similar during the 5-day intervention, but for 2 days after the end of zinc/placebo use, the zinc participants recovered significantly slower compared with the placebo participants (p=0.003). In the zinc group, 37% did not report adverse effects, the corresponding proportion being 69% in the placebo group.

Conclusions

A commercially available zinc acetate lozenge was not effective in treating the common cold when instructed to be used for 5 days after the first symptoms. Taste has been a common problem in previous zinc lozenge trials, but a third of zinc participants did not complain of any adverse effects. More research is needed to evaluate the characteristics of zinc lozenges that may be clinically efficacious before zinc lozenges can be widely promoted for common cold treatment.

Trial registration number

NCT03309995.
Guidelines about physical activity and exercise to reduce cardiometabolic risk factors: protocol for a systematic review and critical appraisal
Authors: Siedler Madelin , Murad M Hassan , Falck-Ytter Yngve , Dahm Philipp , Mustafa Reem A , Sultan Shahnaz , Morgan Rebecca L
Published: January 2020

Introduction

Physical activity can prevent a wide range of diseases, including highly prevalent conditions such as heart disease, diabetes and associated cardiometabolic disorders. Numerous guidelines for the prescription of physical activity and exercise to promote general health and prevent disease are released each year, but the quality of these guidelines is currently unknown. This systematic review and critical appraisal of physical activity and exercise guidelines aims to summarise the current status and quality of these guidelines to provide suggestions to improve the development of future guidelines in this area.

Methods and analysis

We will conduct a systematic review of guidelines in Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus databases published from database 2000 through 23 October 2019, written in English for the use of physical activity and exercise for the prevention of cardiometabolic disease and related risk factors in otherwise healthy individuals. We will also search the grey literature for additional eligible documents. We will use the Appraisal of Guidelines for Research and Evaluation II tool to assess the quality of eligible recommendations from all included guidelines, as well as perform exploratory analyses on guideline development variables.

Ethics and dissemination

As a protocol for the review and critical appraisal of published documents, no potential ethical considerations are discussed. The protocol will guide the development of the review, which will be disseminated to relevant journals for publication.

PROSPERO registration number

CRD42019126364
Exploring the lived experiences of pregnancy and early motherhood in Italian women with congenital heart disease: an interpretative phenomenological analysis
Authors: Flocco Serena Francesca , Caruso Rosario , Barello Serena , Nania Tiziana , Simeone Silvio , Dellafiore Federica
Published: January 2020

Objective

This study explored the lived experiences of women with congenital heart disease (CHD) during pregnancy and early motherhood.

Design

Qualitative study using semistructured interviews. Data were analysed according to interpretative phenomenological analysis.

Setting

San Donato Milanese, Italy.

Participants

12 adult women during pregnancy or early motherhood.

Results

Three main themes emerged from the analysis that were labelled as follows: ‘Being a woman with CHD’; ‘Being a mother with CHD’; and ‘Don’t be alone’. Mothers described both positive and negative feelings about their pregnancies and transitions from childless women to mothers with CHD. They needed supportive care to improve the management of their health during pregnancy and early motherhood.

Conclusion

This study explored the lived experiences of women with CHD during pregnancy and early motherhood. The emerged themes represent an initial framework for implementing theory-grounded educational and supportive strategies that improve self-care, engagement and quality of life for women with CHD. Furthermore, the study’s results provide guidance for operationalising the described experiences into items and domains for future cross-national surveys.
Blood pressure monitoring in high-risk pregnancy to improve the detection and monitoring of hypertension (the BUMP 1 and 2 trials): protocol for two linked randomised controlled trials
Authors: Dougall Greig , Franssen Marloes , Tucker Katherine Louise , Yu Ly-Mee , Hinton Lisa , Rivero-Arias Oliver , Abel Lucy , Allen Julie , Band Rebecca Jane , Chisholm Alison , Crawford Carole , Green Marcus , Greenfield Sheila , Hodgkinson James , Leeson Paul , McCourt Christine , MacKillop Lucy , Nickless Alecia , Sandall Jane , Santos Mauro , Tarassenko Lionel , Velardo Carmelo , Wilson Hannah , Yardley Lucy , Chappell Lucy , McManus Richard J
Published: January 2020

Introduction

Self-monitoring of blood pressure (BP) in pregnancy could improve the detection and management of pregnancy hypertension, while also empowering and engaging women in their own care. Two linked trials aim to evaluate whether BP self-monitoring in pregnancy improves the detection of raised BP during higher risk pregnancies (BUMP 1) and whether self-monitoring reduces systolic BP during hypertensive pregnancy (BUMP 2).

Methods and analyses

Both are multicentre, non-masked, parallel group, randomised controlled trials. Participants will be randomised to self-monitoring with telemonitoring or usual care. BUMP 1 will recruit a minimum of 2262 pregnant women at higher risk of pregnancy hypertension and BUMP 2 will recruit a minimum of 512 pregnant women with either gestational or chronic hypertension. The BUMP 1 primary outcome is the time to the first recording of raised BP by a healthcare professional. The BUMP 2 primary outcome is mean systolic BP between baseline and delivery recorded by healthcare professionals. Other outcomes will include maternal and perinatal outcomes, quality of life and adverse events. An economic evaluation of BP self-monitoring in addition to usual care compared with usual care alone will be assessed across both study populations within trial and with modelling to estimate long-term cost-effectiveness. A linked process evaluation will combine quantitative and qualitative data to examine how BP self-monitoring in pregnancy is implemented and accepted in both daily life and routine clinical practice.

Ethics and dissemination

The trials have been approved by a Research Ethics Committee (17/WM/0241) and relevant research authorities. They will be published in peer-reviewed journals and presented at national and international conferences. If shown to be effective, BP self-monitoring would be applicable to a large population of pregnant women.

Trial registration number

NCT03334149
Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study
Authors: McCartney Gerry , Fenton Lynda , Minton Jon , Fischbacher Colin , Taulbut Martin , Little Kirsty , Humphreys Ciaran , Cumbers Andrew , Popham Frank , McMaster Robert
Published: January 2020

Introduction

Mortality rates in many high-income countries have changed from their long-term trends since around 2011. This paper sets out a protocol for testing the extent to which economic austerity can explain the variance in recent mortality trends across high-income countries.

Methods and analysis

This is an ecological natural experiment study, which will use regression adjustment to account for differences in exposure, outcomes and confounding. All high-income countries with available data will be included in the sample. The timing of any changes in the trends for four measures of austerity (the Alesina-Ardagna Fiscal Index, real per capita government expenditure, public social spending and the cyclically adjusted primary balance) will be identified and the cumulative difference in exposure to these measures thereafter will be calculated. These will be regressed against the difference in the mean annual change in life expectancy, mortality rates and lifespan variation compared with the previous trends, with an initial lag of 2 years after the identified change point in the exposure measure. The role of underemployment and individual incomes as outcomes in their own right and as mediating any relationship between austerity and mortality will also be considered. Sensitivity analyses varying the lag period to 0 and 5 years, and adjusting for recession, will be undertaken.

Ethics and dissemination

All of the data used for this study are publicly available, aggregated datasets with no individuals identifiable. There is, therefore, no requirement for ethical committee approval for the study. The study will be lodged within the National Health Service research governance system. All results of the study will be published following sharing with partner agencies. No new datasets will be created as part of this work for deposition or curation.
Atorvastatin for prevention of disease progression and hospitalisation in liver cirrhosis: protocol for a randomised, double-blind, placebo-controlled trial
Authors: Kimer Nina , Grønbæk Henning , Fred Rikard Gøran , Hansen Torben , Deshmukh Atul Shahaji , Mann Mathias , Bendtsen Flemming
Published: January 2020

Introduction

Patients with liver cirrhosis are often diagnosed late and once complications are present, the 2-year survival is 50%. Increasing evidence supports systemic inflammation and metabolic dysfunction in the hepatic stellate cell as key drivers of progression of cirrhosis. However, there is no registered medication, that targets inflammation and cellular dysfunction in the liver.

Methods and analysis

In a randomised double-blind and placebo-controlled trial with atorvastatin for liver cirrhosis, we aim to investigate clinical endpoints of survival, hospitalisations and safety, but also exploratory endpoints of genomics and protein functions in the liver.

Ethics and dissemination

There is no registered medication that actively prevents development of complications or systemic inflammation in liver cirrhosis. All patients continue regular clinical management during the trial period. Atorvastatin has been on the market for several years with a safety profile that is acceptable even in patients with liver disease. A beneficial effect of atorvastatin on clinical outcomes in cirrhosis will provide cheap and effective causal treatment for chronic liver disease. The trial is registered by the Danish Data Protection Agency (P-2019–635) and approved by the Danish Medicines Agency (EudraCT 2019-001806-40) and the Scientific Ethics Committee of the Capital Region of Denmark (H-19030643) before initiation. Reporting of the trial will follow the Consolidated Standards of Reporting Trials guidelines for reporting of randomised clinical trials.

Trial registration number

The trial is registered in clinicaltrials.gov (NCT04072601) and in clinicaltrialsregister.eu (EudraCT 2019-001806-40) (Pre-results).
BET 1: is the patient’s perception of shortness of breath a useful triage tool in exacerbations of COPD?
Authors: Anna Mackway-Jones R N , Howard Laura
Published: January 2020

A shortcut review was carried out to establish whether the degree of breathlessness in patients with an acute exacerbation of COPD is indicative of the severity of the exacerbation. Three hundred and forty-seven papers were found using the reported searches, of which five presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these five papers are tabulated. It is concluded that increased shortness of breath is associated with a worse prognosis in patients with acute exacerbations of COPD. Dyspnoea assessment should be included in the triage process.
BET 2: Does topical lidocaine improve oral intake in children with painful mouth ulcers?
Authors: Daniel Ritter M D , Jason Seamon D O , Jeffrey S Jones
Published: January 2020

A shortcut review was carried out to establish whether topical lidocaine was effective at reducing pain and improving oral intake in children with painful oral lesions. 34 papers were found using the reported searches, of which two presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these two papers are tabulated. It is concluded that in otherwise healthy paediatric patients with painful oral ulcers, treatment with viscous lidocaine does not improve oral intake, although it may provide some pain relief.
Abstracts from international emergency medicine journals
Authors: Production EMJ
Published: January 2020

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
Systematic review: the impact of inflammatory bowel disease-related fatigue on health-related quality of life
Authors: Radford Shellie Jean , McGing Jordan , Czuber-Dochan Wladyslawa , Moran Gordon
Published: January 2020

Background

Fatigue is frequently reported in inflammatory bowel disease (IBD) and impacts on health-related quality of life (HRQoL). HRQoL has not been systematically reviewed in IBD fatigue.

Aim

To investigate what impact IBD fatigue has on HRQoL in adults with IBD.

Methods

Systematic searches (CINAHL, EMBASE, PsychINFO, Medline) were conducted on 25 September 2018, restricted to ‘human’, ‘adult’, ‘primary research’ and ‘English language’. Search terms encompassed concepts of ‘fatigue’, ‘IBD’ and ‘HRQoL’. A 5-year time limit (2013–2018) was set to include the most relevant publications. Publications were screened, data extracted and quality appraised by two authors. A narrative synthesis was conducted.

Results

Eleven studies were included, presenting data from 2823 participants. Fatigue experiences were significantly related to three HRQoL areas: symptom acceptance, psychosocial well-being and physical activity. Patients reporting high fatigue levels had low symptom acceptance. Psychosocial factors were strongly associated with both fatigue and HRQoL. Higher social support levels were associated with higher HRQoL. Physical activity was impaired by higher fatigue levels, lowering HRQoL, but it was also used as a means of reducing fatigue and improving HRQoL. Quality appraisal revealed methodological shortcomings in a number of studies. Notably, use of multiple measures, comparison without statistical adjustment and fatigue and HRQoL assessment using the same tool were some of the methodological shortcomings.

Conclusion

Psychosocial factors, symptom management and acceptance and physical activity levels have significant impact on HRQoL. Results support application of psychosocial or exercise interventions for fatigue management. Further exploration of HRQoL factors in IBD fatigue is required, using validated fatigue and HRQoL measures.

PROSPERO registration number

CRD42018110005.
UK National Survey of Gastroenterologists’ attitudes and barriers toward therapeutic drug monitoring of anti-TNF therapy in inflammatory bowel disease
Authors: Nigam Gaurav B , Nayeemuddin Shadab , Kontopantelis Evangelos , Hayee Bu'Hussain , Limdi Jimmy K
Published: January 2020

Background

Evidence supports use of therapeutic drug monitoring (TDM) in improving efficacy and cost-effectiveness of anti-tumour necrosis factor (TNF) therapy in inflammatory bowel disease (IBD). Our objective was to assess attitudes and barriers towards TDM use with anti-TNF’s in the UK.

Methods

A 17-question survey was distributed to members of the British Society of Gastroenterology by email.

Results

Of 243 respondents (51.6% male), 237 respondents met inclusion criteria. Of these, 46% were consultants (gastroenterologist, GI), 39.2% IBD nurse specialists (clinical nurse specialists, CNS), 14.8% registrars. TDM is used by 96.9% for secondary loss of response; 72.5% for primary non-response and 54.1% used TDM proactively. Barriers were time lag in receiving results (49.8%), lack of awareness of guidelines (46.4%) and cost (29.9%). Clinicians working at a teaching hospital (OR 2.6, 95% CI 0.71 to 9.8), IBD CNS and GI registrars (OR 2.6, 95% CI 0.7 to 10 and OR 1.5, 95% CI 0.3 to 7.2, respectively) were more likely to use TDM. Clinicians practising for >20 years (OR 4.1, 95% CI 0.4 to 41.8) and a large volume IBD practice (>50% IBD patients per month) were more likely to use TDM (OR 45.7, 95% CI 7.5 to 275). Proactive TDM, was more likely to be used in tertiary care (OR 2.25, 95% CI 0.84 to 6.1), IBD CNS (OR 1.2, 95% CI 0.7 to 2.1) and clinicians managing >50% IBD patients per month (OR 10.8, 95% CI 1.3 to 90.3). Clinicians with 5–9 years of experience in practice were more likely to use proactive TDM (OR 2.6 and CI 1.04 to 6.4).

Conclusion

Validation of point of care and lower cost assays, reduced time lag from test to result, lower cost of testing and dissemination of current recommendations may further optimise treatment strategies.
MiR130b from Schlafen4+MDSCs stimulates epithelial proliferation and correlates with preneoplastic changes prior to gastric cancer
Authors: Ding Lin , Li Qian , Chakrabarti Jayati , Munoz Andres , Faure-Kumar Emmanuelle , Ocadiz-Ruiz Ramon , Razumilava Nataliya , Zhang Guiying , Hayes Michael H , Sontz Ricky A , Mendoza Zoe Elena , Mahurkar Swapna , Greenson Joel K , Perez-Perez Guillermo , Hanh Nguyen Thi Hong , Zavros Yana , Samuelson Linda C , Iliopoulos Dimitrios , Merchant Juanita L
Published: January 2020

The myeloid differentiation factor Schlafen4 (Slfn4) marks a subset of myeloid-derived suppressor cells (MDSCs) in the stomach duringHelicobacter-induced spasmolytic polypeptide-expressing metaplasia (SPEM).

Objective

To identify the gene products expressed by Slfn4+-MDSCs and to determine how they promote SPEM.

Design

We performed transcriptome analyses for both coding genes (mRNA by RNA-Seq) and non-coding genes (microRNAs using NanoString nCounter) using flow-sorted SLFN4+and SLFN4–cells fromHelicobacter-infected mice exhibiting metaplasia at 6 months postinfection. Thioglycollate-elicited myeloid cells from the peritoneum were cultured and treated with IFNα to induce the T cell suppressor phenotype, expression of MIR130b and SLFN4. MIR130b expression in human gastric tissue including gastric cancer and patient sera was determined by qPCR and in situ hybridisation. Knockdown of MiR130b in vivo inHelicobacter-infected mice was performed using Invivofectamine. Organoids from primary gastric cancers were used to generate xenografts. ChIP assay and Western blots were performed to demonstrate NFκb p65 activation by MIR130b.

Results

MicroRNA analysis identified an increase in MiR130b in gastric SLFN4+cells. Moreover, MIR130b colocalised with SLFN12L, a human homologue of SLFN4, in gastric cancers. MiR130b was required for the T-cell suppressor phenotype exhibited by the SLFN4+cells and promotedHelicobacter-induced metaplasia. Treating gastric organoids with the MIR130b mimic induced epithelial cell proliferation and promoted xenograft tumour growth.

Conclusion

Taken together, MiR130b plays an essential role in MDSC function and supports metaplastic transformation.
Left atrial cross-sectional area is a novel measure of atrial shape associated with cardioembolic strokes
Authors: Tan Timothy C , Nunes Maria Carmo Pereira , Handschumacher Mark , Pontes-Neto Octavio , Park Yong-Hyun , O’Brien Cashel , Piro Victoria , Kim Gyeong-Moon , Helenius Johanna , Zeng Xin , Padilha da Silva Jose Luiz , Furie Karen , Ay Hakan , Hung Judy
Published: January 2020

Objective

Cardioembolic (CE) stroke carries significant morbidity and mortality. Left atrial (LA) size has been associated with CE risk. We hypothesised that differential LA remodelling impacts on pathophysiological mechanism of major CE strokes.

Methods

A cohort of consecutive patients hospitalised with ischaemic stroke, classified into CE versus non-CE strokes using the Causative Classification System for Ischaemic Stroke were enrolled. LA shape and remodelling was characterised by assessing differences in maximal LA cross-sectional area (LA-CSA) in a cohort of 40 prospectively recruited patients with ischaemic stroke using three-dimensional (3D) echocardiography. Flow velocity profiles were measured in spherical versus ellipsoidal in vitro models to determine if LA shape influences flow dynamics. Two-dimensional (2D) LA-CSA was subsequently derived from standard echocardiographic views and compared with 3D LA-CSA.

Results

A total of 1023 patients with ischaemic stroke were included, 230 (22.5%) of them were classified as major CE. The mean age was 68±16 years, and 464 (45%) were women. The 2D calculated LA-CSA correlated strongly with the LA-CSA measured by 3D in both end-systole and end-diastole. In vitro flow models showed shape-related differences in mid-level flow velocity profiles. Increased LA-CSA was associated with major CE stroke (adjusted relative risk 1.10, 95% CI 1.04 to 1.16; p<0.001), independent of age, gender, atrial fibrillation, left ventricular ejection fraction and CHA2DS2-VASc score. Specifically, the inclusion of LA-CSA in a model with traditional risk factors for CE stroke resulted in signiﬁcant improvement in model performance with the net reclassification improvement of 0.346 (95% CI 0.189 to 0.501; p=0.00001) and the integrated discrimination improvement of 0.013 (95% CI 0.003 to 0.024; p=0.0119).

Conclusions

LA-CSA is a marker of adverse LA shape associated with CE stroke, reflecting importance of differential LA remodelling, not simply LA size, in the mechanism of CE risk.
Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms
Authors: Imamura Hirotoshi , Sakai Nobuyuki , Satow Tetsu , Iihara Koji
Published: January 2020

Background and purpose

The risk factors for adverse events for example, intraprocedural rupture (IPR), ischemic complication within 24 hours, and rebleeding after endovascular coil embolization for a ruptured cerebral aneurysm remain unclear. The aim of this study was to identify significant associated risk factors.

Methods

We retrospectively evaluated data from 5358 patients listed on the Japanese Registry of Neuroendovascular Therapy 3 during 2010–2014.

Results

IPR, ischemic complications, and rebleeding occurred during or after 221 (4.1%), 226 (4.2%), and 63 (1.2%) treatments, respectively. All of the adverse events were significantly associated with the patients’ poor outcomes at 30 days. Multivariate analysis revealed the factors independently related to these adverse events as follows: (1) for IPR: female sex, bifurcation type, <5 mm aneurysm, emergent surgery, local anesthesia, a balloon-assisted technique; (2) for an ischemic complication: poor World Federation World Federation of Neurological Societies (WFNS) grade, wide neck, and stent-assisted technique; (3) for rebleeding: poor WFNS grade, bifurcation type, wide neck, and body filling as the initial result.

Conclusions

Knowledge of the risk factors of endovascular coil embolization and paying attention to them are essential for patients’ safe treatment and good outcomes.
Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio
Authors: Kanno Yoshinori , Hoshino Masahiro , Hamaya Rikuta , Sugiyama Tomoyo , Kanaji Yoshihisa , Usui Eisuke , Yamaguchi Masao , Hada Masahiro , Ohya Hiroaki , Sumino Yohei , Hirano Hidenori , Yuki Haruhito , Horie Tomoki , Murai Tadashi , Lee Tetsumin , Yonetsu Taishi , Kakuta Tsunekazu
Published: January 2020

Background

Measurement of the contrast-flow quantitative flow ratio (cQFR) is a novel method for rapid computational estimation of fractional flow reserve (FFR). Discordance between FFR and cQFR has not been completely characterised.

Methods

We performed a post-hoc analysis of 504 vessels with angiographically intermediate stenosis in 504 patients who underwent measurement of FFR, coronary flow reserve (CFR), the index of microcirculatory resistance (IMR) and Duke jeopardy score.

Results

In total, 396 (78.6%) and 108 (21.4%) lesions showed concordant and discordant FFR and cQFR functional classifications, respectively. Among lesions with a reduced FFR (FFR+), those with a preserved cQFR (cQFR−) showed significantly lower IMR, shorter mean transit time (Tmn), shorter lesion length (all, p<0.01) and similar CFR and Duke jeopardy scores compared with lesions showing a reduced cQFR (cQFR+). Furthermore, lesions with FFR+ and cQFR− had significantly lower IMR and shorter Tmn compared with lesions showing a preserved FFR (FFR−) and cQFR+. Of note, in cQFR+ lesions, higher IMR lesions were associated with decreased diagnostic accuracy (high-IMR; 63.0% and low-IMR; 75.8%, p<0.01). In contrast, in cQFR− lesions, lower IMR lesions was associated with decreased diagnostic accuracy (high-IMR group; 96.8% and low-IMR group; 80.0%, p<0.01). Notably, in total, 31 territories (6.2%; ‘jump out’ group) had an FFR above the upper limit of the grey zone (>0.80) and a cQFR below the lower limit (≤0.75). In contrast, five territories (1.0%; ‘jump in’ group) exhibited opposite results (FFR of ≤0.75 and cQFR of >0.80). The ‘jump out’ territories showed significantly higher IMR values than ‘jump in’ territories (p<0.01).

Conclusions

FFR− with cQFR+ is associated with increased microvascular resistance, and FFR+ with cQFR− showed preservation of microvascular function with high coronary flow. Microvascular function affected diagnostic performance of cQFR in relation to functional stenosis significance.
Performing percutaneous coronary interventions with predilatation using non-compliant balloons at high-pressure versus conventional semi-compliant balloons: insights from two randomised studies using optical coherence tomography
Authors: Cuculi Florim , Bossard Matthias , Zasada Wojciech , Moccetti Federico , Voskuil Michiel , Wolfrum Mathias , Malinowski Krzysztof Piotr , Toggweiler Stefan , Kobza Richard
Published: January 2020

Introduction

Stent underexpansion is a predictor of in-stent-restenosis and stent thrombosis. Semi-compliant balloons (SCBs) are generally used for lesion preparation. It remains unknown whether routine predilatation using non-compliant balloons (NCBs) improves stent expansion in ordinary coronary lesions.

Methods

The PREdilatation by high-pressure NC balloon catheter for better vessel preparation and Optimal lesion preparation with non-compliant balloons for the implantation of bioresorbable vascular scaffolds studies randomised patients presenting with stable coronary artery disease or non-ST-elevation myocardial infarction requiring stent implantation to lesion preparation using NCBs versus SCBs. Stent expansion index (SEI-minimal luminal area/mean luminal area on optical coherence tomography) and periprocedural complications were compared.

Results

We enrolled 104 patients: 53 patients (54 lesions) vs 51 patients (56 lesions) to the NCB and SCB groups, respectively. Predilatation pressure was higher in the NCB group (24±7 atmospheres (atm) vs 14±3 atm, p<0.0001). Postdilatation using NCBs was performed in 41 (76%) lesions vs 46 (82%) lesions pretreated with NCBs versus SCBs (p=0.57). Similar pressures were used for postdilatation with NCB in both groups (23±8 atm vs 23±9 atm, p=0.65). SEI after stent implantation was 0.88±0.13 in the NCB vs 0.85±0.14 in the SCB group (p=0.18). After postdilatation, SEI increased to 0.94±0.13 in the NCB group vs 0.88±0.13 in the SCB group (p=0.02). No relevant complications occurred.

Conclusions

In simple coronary lesions, predilatation/postdilatation with NCBs at high pressures appears to result in better scaffold and stent expansion. Using SCBs only for predilatation might lead to inadequate stent expansion and postdilatation with NCBs might only partially correct this. Predilatation and postdilatation using NCBs at high pressure is safe.

Trial registration number

ClinicalTrials.gov no.NCT03518645.
Least action principle and gravitational double layer
Authors: Berezin Victor , Dokuchaev Vyacheslav , Eroshenko Yury , Smirnov Alexei
Published: January 2020

The higher derivative gravitational theories exhibit new phenomena absent in General Relativity. One of them is the possible formation of the so called double layer which is the pure gravitational phenomenon and can be interpreted, in a sense, as the gravitational shock wave. In this paper we show how some very important features of the double layer equations of motion can be extracted straight from the least action principle.
Proposed experimental test of exotic monopole-dipole interaction at the micrometer range
Authors: Luo Rui , Ren Xiaofang , Wang Jianbo , Jia Xiaofei , Luo Pengshun
Published: January 2020

Here we propose an experiment to test the exotic spin-dependent interaction that can be mediated by axion-like particles. A sensitive cantilever is used to measure the force between a Bi4Ge3O[Formula: see text] (BGO) microsphere and a spin-polarized magnetic structure. The magnetic structure consists of alternate reversely spin-polarized electrons. The magnetic structure is to be driven to oscillate during data acquisition, thus the exotic force signal is modulated to the high harmonics of the drive frequency. This helps to suppress the spurious background signal. The separation between the BGO sphere and the magnetic structure can be as close as 3.5 [Formula: see text]m, and the force sensitivity is expected to be [Formula: see text] 1 fN. If a Null result is obtained, the constraints on the coupling constant could be four orders of magnitude stronger than the current status of the experimental test at [Formula: see text] = 10 [Formula: see text]m.
Dynamics of a test null string in the gravitational field of a null string domain that radially changes its size
Authors: Lelyakov A. P.
Published: January 2020

The motion of a test null string “inside” an axially symmetric domain of null strings which has a layered structure and radially changes its size has been investigated. It is shown that the action of the gravitational field of such a domain on a test null string for any initial conditions leads to oscillations of a test null string inside a region limited in space. The motion (drift) of the region inside which the test null string oscillates depends on the ratio of the initial parameters characterizing the test null string and the null string domain. These regions can be considered as particles localized in space with an effective nonzero rest mass. For these particles, you can enter the concept of “life time”, which depends on the number of layers in the multi-string system. It is also possible to introduce the concept of particle “mass” (energy), which is determined by the size of the region in which the null string oscillates and depends on the trajectory of the null string in this region. Under the influence of changing external conditions one kind of particles can pass into another.
Self-force and the Huygens principle
Authors: Khusnutdinov N.
Published: January 2020

We consider a relation between the Huygens Principle (HP) in gravity and the self-interaction force. We show that the self-force for an electric particle in the plane gravitational wave space-time has no tail term even the vector Green function does not obey the HP. The reason for this observation is that even vector potential does not obey the HP, the electromagnetic field does obey.
Relativistic generalization of the Schrödinger-Newton model for the wavefunction reduction
Authors: Kassandrov Vladimir V. , Markova Nina V.
Published: January 2020

We consider the model of the self-gravity driven spontaneous wavefunction reduction proposed by L. Diosi, R. Penrose et al. and based on a self-consistent system of Schrödinger and Poisson equations. An analogous system of coupled Dirac and Maxwell-like equations is proposed as a relativization. Regular solutions to the latter form a discrete spectrum in which all the “active” gravitational masses are always positive, and approximately equal to inertial masses and to the mass [Formula: see text] of the quanta of Dirac field up to the corrections of order [Formula: see text]. Here [Formula: see text] is the gravitational analogue of the fine structure constant negligibly small for nucleons. In the limit [Formula: see text] the model reduces back to the nonrelativistic Schrödinger-Newton one. The equivalence principle is fulfilled with an extremely high precision. The above solutions correspond to various states of the same (free) particle rather than to different particles. These states possess a negligibly small difference in characteristics but essentially differ in the widths of the wavefunctions. For the ground state the latter is [Formula: see text] times larger the Compton length, so that a nucleon cannot be sufficiently localized to model the reduction process.
Radial instability of trapping polytropic spheres
Authors: Hladík Jan , Posada Camilo , Stuchlík Zdeněk
Published: January 2020

We complete the stability study of general-relativistic spherically symmetric polytropic perfect fluid spheres, concentrating our attention on the newly discovered polytropes containing region of trapped null geodesics. We compare the methods of treating the dynamical stability based on the equation governing infinitesimal radial pulsations of the polytropes and the related Sturm–Liouville eigenvalue equation for the eigenmodes governing the pulsations, to the methods of stability analysis based on the energetic considerations. Both methods are applied to determine the stability of the polytropes governed by the polytropic index [Formula: see text] in the whole range [Formula: see text], and the relativistic parameter [Formula: see text] given by the ratio of the central pressure and energy density, restricted by the causality limit. The critical values of the adiabatic index for stability are determined, together with the critical values of the relativistic parameter [Formula: see text]. For the dynamical approach, we implemented a numerical method which is independent on the choice of the trial function, and compare its results with the standard trial function approach. We found that the energetic and dynamic method give nearly the same critical values of [Formula: see text]. We found that all the configurations having trapped null geodesics are unstable according to both methods.
The inverse problem of two-state quantum systems with non-adiabatic static linear coupling
Authors: Khrabustovskyi Andrii , Rassas Imen , Soccorsi Éric
Published: January 2020

We consider the inverse problem of determining the coupling coefficients in a two-state Schrödinger system. We prove a Lipschitz stability inequality for the zeroth- and first-order coupling terms by finitely many partial lateral measurements of the solution to the coupled Schrödinger equations.
Perimeter fractal dimension analysis of corrole islands on Au(111) at the solid-water interface
Authors: Bonanni Beatrice , Fanfoni Massimo , Sgarlata Anna , Caroleo Fabrizio , Paolesse Roberto , Goletti Claudio
Published: January 2020

Corrole molecules deposited from aqueous solution on Au(111) arrange flat forming mesa-like clusters (islands), as evidenced by in situ scanning tunneling microscopy (STM). A morphology quantitative assessment of the entire image is given by STM data analysis, evaluating the islands’ fractal dimension as a whole. To this end, two methods are employed: the first exploits the power law that binds the perimeter and the area of all the islands; the second is simply a value of an appropriate average of the fractal dimensions of the islands. In fact the two methods return very close results.
New Discretization Methodology for Three-Dimensional Mechanical Parameters Considering Spatial Variations
Authors: Wang Tao , Wang Di , Xu Daqing , Zhou Guoqing
Published: January 2020

In this paper, the uncertain mechanical parameters are modeled as spatial random fields (RFs). A new tetrahedral discretization methodology of three-dimensional (3D) RF is proposed based on the local average (LA) theory. An analytical formula and a numerical formula of the covariance for any two tetrahedral RF elements are developed. Its main advantage, compared to similar studies employing hexahedral discretization method, is that tetrahedral LA method can perfectly combine with tetrahedral finite element (FE) method. Also, the corresponding relation between RF mesh and FE mesh is clearer and the computer codes are simpler. The accuracy of proposed LA method in this study was verified by comparing with other discretization techniques of RF. Finally, an illustrative example is presented to demonstrate the analysis process. The validity and the advantage of the proposed LA method are proven. Taking the spatial variations of uncertain mechanical parameters into account, the stochastic effects of scale of fluctuation on the RF are estimated. The proposed method can be widely applied to 3D stochastic FE analysis, and the sample results will improve our understanding of the stochastic influence of scale of fluctuation on the RF.
Design and Manufacture of a Smart Macro-Structure with Changeable Effective Stiffness
Authors: Hajighasemi Mohammad Reza , Safarabadi Majid , Sheidaei Azadeh , Baghani Mostafa , Baniassadi Majid
Published: January 2020

Smart materials are being utilized in many fields and different external stimuli are used to change specific properties of these materials. In this research, a novel method was developed to design a structure with the desired nonlinear effective Young’s modulus. This method is geometric based where the structures are designed with a gap between them. These structures exhibit nonlinear elastic response. Wide range of structures with desired stress–strain curve can be generated using this approach. First, a unit cell was designed and later used to create a periodic structure. Numerical simulations have been exploited to prove the efficiency of the method. A prototype was manufactured by the Fused Deposition Modeling (FDM) 3D printing method. The compression test was performed on the structure. Both simulations and experimental results proved that the effective Young’s modulus of the structure can be increased up to 142%. Second, the designed unit cell was optimized using Genetic Algorithm (GA) to achieve a cell with desired nonlinear stress–strain curve. This cell was optimized considering five effective geometric parameters to alter the effective Young’s modulus of the cell. Finally, a periodic structure was created by repeating a cell with two different gap’s distances. A structure with a desired stress–strain curve was designed using the same method.
An Analytical Solution for Nonlinear Vibrations Analysis of Functionally Graded Plate Using Modified Lindstedt–Poincare Method
Authors: Hashemi S. , Jafari A. A.
Published: January 2020

In this research, the nonlinear free vibrations analysis of functionally graded (FG) rectangular plate which simply supported all edges are investigated analytically using modified Lindstedt–Poincare (MLP) method for the first time. For this purpose, with the aid of von Karman nonlinearity strain-displacement relations, the partial differential equations of motion are developed based on first-order shear deformation theory (FSDT). Afterward, by applying Galerkin method, the nonlinear partial differential equations are transformed into the time-dependent nonlinear ordinary differential equations. The nonlinear equation of motion is then solved analytically by MLP method to determine the nonlinear frequencies of the FG rectangular plate. The material properties are assumed to be graded through the direction of plate thickness according to power law distribution. The effects of some system parameters such as vibration amplitude, volume fraction index and aspect ratio on the nonlinear to linear frequency ratio are discussed in detail. To validate the analysis, the results of this paper are compared with both the published data and numerical method, and good agreements are found.