bluuebunny/crossref_metadata_2025 huggingface dataset:
O35 The impact of COVID-19 on access and availability of radiological imaging and surgical intervention at the east Midlands major trauma centre: an icon trauma study
Authors: Seehra J K , Lewis-Lloyd C , Gida G , Adiamah A , Brooks A
Published: July 2021

Introduction

During the COVID-19 pandemic, Major Trauma services were subject to significant challenges including reduced access to Computed Tomography (CT) scanning and restrictions on operative intervention due to limited intensive care beds. This study evaluated the pandemic’s impact on access and timeliness of imaging and surgical intervention.

Method

This observational study compared 2 cohorts of patients admitted in a 10-week period during the COVID-19 pandemic and a similar time period in 2019. Variables included demographics, time to CT scan and to surgery and operative characteristics. Statistical comparisons were undertaken using Mann Whitney U, Fisher’s exact and Chi-squared tests.

Result

Of 642 patients, 405 were admitted in 2019 and 237 in 2020 representing a 41.5% absolute reduction in trauma admissions during the pandemic. There were no statistical differences (P = 0.2585) between arrival to the Emergency Department and time to CT scan across both years (median 42 minutes) or between operative approach (P = 0.728) and level of post-operative care (P = 0.788). However, there were statistical differences in time to surgery (P = 0.0193) and operative length (P = 0.0141) with a 2-fold increase in overnight operating, 31.2% increase in patients operated on < 24 hours from admission, and 42.9% reduction in surgery lasting >120 minutes during the COVID-19 pandemic.

Conclusion

Early robust restructuring of trauma services during the COVID-19 pandemic ensured timely access to appropriate imaging and surgery for major trauma injured patients. The higher rates of overnight surgery and shorter duration of procedure were likely explained by the increased onsite availability of suitably trained trauma surgical teams.

Take-home Message

COVID-19 had the potential to significantly impact Major Trauma services, however excellence in patient care was maintained by quick restructuring to staff, space and services Improvements to the Major Trauma pathway have become ingrained into daily practice and optimised for future outbreaks.
O40 Predictive models of individual risk of elective caesarean section complications: a systematic review
Authors: Ahmeidat A , Kotts W J , McLernon D J , Black M
Published: July 2021

Introduction

With increasing caesarean section (c-section) rates, personalised communication of risk has become paramount. A reliable tool to predict complications would support evidence-based discussion around planned mode of birth.

Method

MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Library were searched on 27th January with the terms relating to c-section, prognostic models, and complications such as infection. Any study developing and/or validating a prognostic model for maternal complications of c-section in the English language after January 1995 was included. Data extracted encompassed: source of data, participant criteria, outcome to be predicted, candidate predictors, actual predictors, sample size, model development, and model performance. PROBAST (Prediction model Risk Of Bias Assessment Tool) was utilised for risk of bias analysis and applicability concern in the prognostic model studies.

Result

7,752 studies were identified, of which 16 were reviewed producing 3 studies where 3 prognostic models were identified which predicted risk of: blood transfusion, spinal hypotension, and postpartum haemorrhage. From the 3 studies, a total of 29 unique candidate predictors were identified and 15 predictors in the final model. Study authors deemed their studies to be exploratory, exploratory, and confirmatory respectively. None were externally validated and all had a high risk of bias due to analysis technique.

Conclusion

Few models have been developed to predict complications of elective c-section. Existing models predicting blood transfusion, spinal hypotension, and postpartum haemorrhage cannot be recommended for clinical practice. Future research should focus on identifying predictors known before surgery and validating resulting models.

Take-home Message

Systematic review of prediction models for planned C-section complications found none suitable for practice.
O42 Evaluation of risk prediction models for postoperative pulmonary complications in adults undergoing major abdominal surgery: a systematic review and external validation study in the respiratory complications after abdominal surgery (RECON) cohort
Authors:   Student Audit and Research in Surgery (STARSurg) Collaborative
Published: July 2021

Introduction

Postoperative pulmonary complications (PPCs) following major abdominal surgery result in substantial morbidity and mortality, yet stratifying patients for risk-modifying interventions remains challenging. This study aimed to systematically review and externally validate existing PPC risk prediction models in an international, prospective cohort.

Method

A systematic search of the MEDLINE and EMBASE databases according to PRISMA guidelines was performed to identify original risk prediction models for PPC following abdominal surgery. Subsequent external validation was performed based on a prospective dataset (REspiratory COmplications after abdomiNal surgery) which encompassed adult patients undergoing major abdominal surgery from January to April 2019 across the UK, Ireland and Australia. The primary outcome was 30-day PPC (StEP-COMPAC criteria definition), and multivariable logistic regression model discrimination were compared (with an area under the curve (AUC) ≥0.7 considered “good”).

Result

Thirty original risk prediction models were identified from 2819 records, with notable heterogeneity in risk factors considered. Within the validation dataset, the 30-day PPC rate was 7.8% (n = 903/11591), and 6 scores had all variables represented to enable external validation. No score demonstrated statistically significant “good” discrimination for identifying pulmonary complications, with no significant differences between scores. However, the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score achieved the highest discrimination (AUC = 0.709, 95% CI = 0.692–0.727).

Conclusion

The risk of PPC for patients following major abdominal surgery in the pre-covid era is not well described by existing prediction tools. New prediction tools are required to account for additional variation introduced for patients affected by SARS-CoV-2 infection.

Take-home Message

The risk of PPC for patients following major abdominal surgery in the pre-covid era is not well described by existing prediction tools. New prediction tools are required to account for additional variation introduced for patients affected by SARS-CoV-2 infection.
O43 Virtual: virtual interactive surgical skills classroom: a randomized controlled trial (protocol)
Authors: Nathan A , Fricker M , Hanna N , Asif A , Patel S , Georgi M , Hang K , Sinha A , Mullins W , Shea J , Lamb B , Sridhar A , Kelly J , Collins J
Published: July 2021

Introduction

High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.

Method

72 medical students will be randomly assigned to three equal intervention groups based on surgical skills experience and confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention. Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts.

Result

Change in confidence, time to completion and a novel granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.

Conclusion

This will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and beyond.

Take-home Message

This is the first RCT assessing virtual basic surgical skill classroom training and serves as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
O45 Gender representation in the authorship of surgical journals
Authors: Arshad S R , Gallivan E R , Skinner H , Burke J R , Young A L
Published: July 2021

Introduction

Despite the increase in female doctors graduating from medical schools internationally, gender disparity in surgery remains. This disparity is also evident in academic surgery. This study aims to quantify the extent of gender disparity in the authorship of articles in major surgical journals.

Method

The Top 10 Surgical Journals were identified using SCImago Journal Rank indicator. Authorship details for papers published in 2019 were collected. Authors were assigned as female, male or unknown using Gender API software (Gender API, Germany). For each journal, the percentage of first author, last author, corresponding author and all authors split by gender was interrogated. Gender differences by publication type were also identified.

Result

9 of the 10 journals had full names publicly available. Overall, 2414 manuscripts were interrogated which included 16,277 number of authors. Respectively, females and males accounted for 29.8% [22.9–34.9%] (N = 655) and 62.4% [56.3–70.2%] (N = 1419) of first authors, 20.6% [11.8–27.1%] (N = 453) and 74.2% [65.6–84.1%] (N = 1706) of last authors, 23.9% [14.9–29.6%] (N = 510) and 69.9% [60.5–79.3%] (N = 2341) of corresponding authors and in total 27% [19.4–31.6%] (N = 4298) and 65.5% [58.6–73.4%] (N = 9982) of all authors. The wide range in these results could be a result of various factors.

Conclusion

This study has identified a gender imbalance in authorship positions, with the greatest difference observed in the most senior author position. Whether this is reflective of the current disparity observed in senior academic surgery positions or due to gender discrimination is unclear.

Take-home Message

This study identified a gender imbalance in authorship positions of major surgical journals, which has implications for women who choose to pursue a career in academic surgery.
O46 Differences in ARCP outcome by surgical specialty: a longitudinal cohort study
Authors: Hope C , Lund J , Griffiths G , Humes D
Published: July 2021

Introduction

Surgical training in the UK is comprised of ten specialties: cardiothoracic, general, neurosurgery, oral and maxillofacial (OMFS), otolaryngology, paediatric, plastic, trauma and orthopaedics, urology and vascular surgery. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). The aim is to examine ARCP outcomes within UK surgical specialty training and identify differences between specialties.

Method

A longitudinal cohort study using data from United Kingdom Medical Education Database (UKMED) was performed across surgical specialities. ARCP outcome was the primary outcome measure. Multi-level univariate and multiple ordinal regression analyses were performed.

Result

8,220 trainees with an ARCP outcome between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest 12.4%. After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard outcome compared to T&O trainees (OR 1.33 95% CI 1.21–1.45). Urology trainees were 36% less likely to receive a non-standard outcome compared to T&O trainees (OR 0.64 95% CI 0.54–0.75). Female trainees and older age were associated with non-standard outcomes (OR 1.11 95% CI 1.02–1.22; OR 1.04 95% CI 1.03–1.05).

Conclusion

There is wide variation in the outcomes of surgical ARCP’s across specialties. General surgery has higher rates of non-standard ARCP outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes. Further studies are required to explore these associations.

Take-home Message

There is significant variation in ARCP outcomes between specialities. Women and older trainees receive significantly more non-standard outcomes.
O53 Faecal immunochemical testing: cost effective way stratifying symptomatic patients for urgent straight to test investigation
Authors: Seehra J K , Khasawneh F , Singh B
Published: July 2021

Introduction

Quantitative faecal immunochemical test (FIT) offers the opportunity to stratify symptomatic ‘high risk’ colorectal patients for further investigation.

Method

FIT was introduced in primary care to stratify ‘high risk’ symptomatic patients aged 60 years and above with a change in bowel habit to determine whether an urgent straight to test (STT) CT colonography (CTC) was indicated. All FIT tests were analysed in a national bowel screening hub using the OC-Sensor platform. A result of ≥ 4 μgHb/gFaeces, was used as the cut-off. All FIT results were cross referenced with a prospectively maintained colorectal cancer registry to determine the colorectal cancer detection rate (CRC). Data was analysed from February 2018-December 2019.

Result

The mean number of total CTC performed per month pre-FIT was 240 (range 185–278) and reduced to 217 (range 183–264) post-implementation (P < 0.05). The number referred under the STT pathway was 167 (range 119–209) reducing to 131 (range 91–153) (P < 0.05), however there was a corresponding rise in the number of non-STT referrals from outpatients 73 (range 44–105) to 85 (range 60–111) (P < 0.05).

Conclusion

FIT has the potential to reduce the burden on secondary care investigations to exclude bowel cancer. Our experience has shown that a conservative FIT level of < 4ug/ml has reduced numbers of STT referrals by 22%.

Take-home Message

FIT can be used for symptomatic patients with a change in bowel habits to stratify the need for further investigations. Post-implementation, FIT has reduced STT referral rates and reduced the burden placed on secondary care.
Posterior Intraparietal Sulcus Mediates Detection of Salient Stimuli Outside the Endogenous Focus of Attention
Authors: Jamoulle Tarik , Ran Qian , Meersmans Karen , Schaeverbeke Jolien , Dupont Patrick , Vandenberghe Rik
Published: July 2021

Visual consciousness is shaped by the interplay between endogenous selection and exogenous capture. If stimulus saliency is aligned with a subject’s attentional priorities, endogenous selection will be facilitated. In case of a misalignment, endogenous selection may be compromised as attentional capture is a strong and automatic process. We manipulated task-congruent versus -incongruent saliency in a functional magnetic resonance imaging change-detection task and analyzed brain activity patterns in the cortex surrounding the intraparietal sulcus (IPS) within the Julich-Brain probabilistic cytoarchitectonic mapping reference frame. We predicted that exogenous effects would be seen mainly in the posterior regions of the IPS (hIP4–hIP7–hIP8), whereas a conflict between endogenous and exogenous orienting would elicit activity from more anterior cytoarchitectonic areas (hIP1–hIP2–hIP3). Contrary to our hypothesis, a conflict between endogenous and exogenous orienting had an effect early in the IPS (mainly in hIP7 and hIP8). This is strong evidence for an endogenous component in hIP7/8 responses to salient stimuli beyond effects of attentional bottom-up sweep. Our results suggest that hIP7 and hIP8 are implicated in the individuation of attended locations based on saliency as well as endogenous instructions.
Heterogeneity of immune cells in human atherosclerosis revealed by scRNA-Seq
Authors: Vallejo Jenifer , Cochain Clément , Zernecke Alma , Ley Klaus
Published: July 2021

Immune cells in atherosclerosis include T, B, natural killer (NK) and NKT cells, macrophages, monocytes, dendritic cells (DCs), neutrophils, and mast cells. Advances in single-cell RNA sequencing (sRNA-Seq) have refined our understanding of immune cell subsets. Four recent studies have used scRNA-Seq of immune cells in human atherosclerotic lesions and peripheral blood mononuclear cells (PBMCs), some including cell surface phenotypes revealed by oligonucleotide-tagged antibodies, which confirmed known and identified new immune cell subsets and identified genes significantly up-regulated in PBMCs from HIV+ subjects with atherosclerosis compared to PBMCs from matched HIV+ subjects without atherosclerosis. The ability of scRNA-Seq to identify cell types is greatly augmented by adding cell surface phenotype using antibody sequencing. In this review, we summarize the latest data obtained by scRNA-Seq on plaques and human PBMCs in human subjects with atherosclerosis.
Zerynthia polyxenaLocally Monophagous onAristolochia pallidain the Susa Valley
Authors: Piccini Irene , Di Pietro Viviana , Bonelli Simona
Published: July 2021

In insect–plant biology, oviposition choices and larval development on different host plants are crucial factors to be investigated. To design conservation strategies for protected Lepidoptera, which are overall oligophagous but locally monophagous, it is important to understand which host plant species is locally preferred. We thus investigated oviposition choices and larval development of the protected butterfly Zerynthia polyxena in controlled laboratory conditions, using three possible host plant species which are present in the Piedmont region: Aristolochia pallida, A. clematitis, and A. rotunda. We found that laboratory conditions are not favorable for Z. polyxena oviposition, even if the fertility of the females was in normal range for Papilionidae. However, we were able to understand the local monophagy of the species on A. pallida in the Susa Valley through larval survival and development stages. Egg hatching was similar among the three host plant species; however, even if larvae eat and grow similarly on the different host plant species until the third larval stage, the only larvae that reached the pupal stage were those fed with A. pallida. In conclusion, whereas Z. polyxena is oligophagous in the rest of Europe for the genus Aristolochia, the species is locally monophagous on A. pallida in the Susa Valley.
Field Trials With Blends of Pheromones of Native and Invasive Cerambycid Beetle Species
Authors: Millar Jocelyn G , Zou Yunfan , Barringer Lawrence , Hanks Lawrence M
Published: July 2021

A number of recent studies have demonstrated the potential for using blends of pheromones of cerambycid beetles to attract several species simultaneously. Here, we tested the effects of adding the pheromones of two invasive species, Trichoferus campestris (Faldermann) and Aromia bungii (Faldermann), on the attraction of native species to a generic blend of synthesized pheromones, in season-long field trials at 12 sites in Pennsylvania. Of the four species attracted in significant numbers, Megacyllene caryae (Gahan), Phymatodes amoenus (Say), and P. testaceus (L.) (all subfamily Cerambycinae) were not significantly affected by the addition of the T. campestris pheromone trichoferone and the A. bungii pheromone (E)-2-cis-6,7-epoxynonenal to the generic blend. In contrast, trap catches of Sternidius alpha (Say) (subfamily Lamiinae) were completely shut down by addition of the pheromones of the two exotic species. In addition, there was no indication that any native species were attracted to trichoferone or (E)-2-cis-6,7-epoxynonenal, suggesting that these pheromones are probably not used by species native to eastern North America.
Case report: echocardiographic detection of rare single coronary artery anomaly in a child with an atrial septal defect
Authors: Hazaert Rachel , Wilson Nigel , Rice Kathryn
Published: July 2021

Background

A single right coronary artery (RCA) with the left anterior descending (LAD) and circumflex coronary arteries located in the usual anatomic position and supplied by collaterals is the rarest variant of single RCA.

Case summary

We report a paediatric patient with an incidental finding of single RCA Lipton type RI pattern during assessment for transcatheter device closure of an ostium secundum atrial septal defect (secASD). Transthoracic echocardiography (TTE) revealed a dilated RCA, abnormal flow in the LAD, and no identifiable left main coronary artery. Diagnosis of a single RCA was confirmed with angiography. Dobutamine stress echocardiography revealed no inducible ischaemia. Transcatheter device closure of the secASD was subsequently successfully performed.

Discussion

TTE in paediatric patients can raise suspicion of coronary artery origin anomalies. Additional modalities, such as computed tomography and angiography, are required to comprehensively determine coronary artery anatomy. Functional assessment of ventricular function is also indicated. Coronary artery anatomy is important to delineate prior to transcatheter device closure of a secASD and should be part of the pre-procedure assessment.
Patent foramen ovale closure in a patient with vena cava filter: a case report
Authors: Omedè Pierluigi , Bocchino Pier Paolo , De Filippo Ovidio , D’Ascenzo Fabrizio
Published: July 2021

Background

The presence of a patent foramen ovale (PFO) is associated with several medical conditions, including cryptogenic left circulation thromboembolism. PFO closure was demonstrated to reduce recurrent ischaemic stroke in patients with prior cryptogenic stroke. The presence of an inferior vena cava filter (IVCF), however, may impede a transfemoral PFO closure procedure.

Case summary

We describe the case of a 50-year-old man with a PFO suffering from ischaemic stroke from paradoxical thromboembolism originating from deep vein thrombosis and requiring an IVCF. After deep vein thrombosis resolution, due to the high risk of stroke recurrences, the patient was recommended PFO closure. IVCF retrieval by the interventional radiologist was first attempted but failed. A transfemoral PFO closure procedure was thus endeavoured with the IVCF in place and was successful. The patient was then discharged in good clinical status and no stroke recurrences were reported at 5 months follow-up.

Discussion

Albeit an IVCF provides benefit in patients with recurrent thromboembolic events despite adequate anticoagulation therapy, its presence may hinder interventional procedures necessitating delivery systems to advance through the inferior vena cava. We reported on a successful PFO closure procedure via a femoral venous access in a patient with an IVCF in place, thus demonstrating the feasibility of advancing delivery systems through an IVCF. As interventional procedures requiring the advancement of delivery systems through the inferior vena cava are becoming increasingly common, the feasibility of IVCF crossing with catheters and delivery systems alike paves the way for novel interventional possibilities.
Apixaban use in an atrial fibrillation patient with double mechanical heart valves: a case report
Authors: Eom Jae Young , Shin Je Kyoun , Kwon Chang Hee
Published: July 2021

Background

Warfarin is the only approved oral anticoagulant for long-term prophylaxis against valve thrombosis and thromboembolism in patients with mechanical heart valves. To date, apixaban for patients with double (aortic and mitral) mechanical heart valves has not been reported in the literature.

Case summary

We report the case of a 50-year-old female who underwent double (aortic and mitral) mechanical valve replacement in February 2017. Warfarin was prescribed after mechanical valve replacement. However, she complained of side effects of warfarin, including tingling sensation and numbness of legs, urticaria, skin rash, and nausea and voluntarily stopped taking medication. In December 2018, she was admitted to the emergency room due to ongoing chest pain. Coronary angiogram revealed embolic myocardial infarction at the left circumflex coronary artery. Nevertheless, she continued to refuse to take warfarin after anticoagulant therapy for coronary artery embolism. Given the patient’s objection, we prescribed apixaban 5 mg b.i.d. since February 2019. When she was diagnosed with atrial fibrillation in April 2020, no intracardiac thrombosis was confirmed on computed tomography and electrical cardioversion was performed safely. While on apixaban, no evidence of prosthetic valve thrombosis or thrombo-embolic events was observed during a 24-month period.

Conclusion

We report the efficacy and safety of apixaban in a patient with atrial fibrillation and double mechanical heart valves for preventing prosthetic valve thrombus and systemic embolism.
The JAK–STAT pathway: an emerging target for cardiovascular disease in rheumatoid arthritis and myeloproliferative neoplasms
Authors: Baldini Chiara , Moriconi Francesca Romana , Galimberti Sara , Libby Peter , De Caterina Raffaele
Published: July 2021

Inflammation contributes centrally to cardiovascular diseases, and anti-inflammatory treatments can reduce cardiovascular events. The JAK–STAT pathway is an emerging target in inflammation, mainly in rheumatoid arthritis (RA) and chronic myeloproliferative neoplasms (MPNs), disorders that heighten cardiovascular risk. The aim of this study was to review the international literature on the relationship between dysregulation of the JAK–STAT pathway in RA/MPNs and cardiovascular risk and on the potential cardiovascular effects of JAK–STAT inhibitors. The JAK–STAT pathway sustains inflammatory and thrombotic events in autoimmune disorders such as RA and MPNs. Here, an imbalance exists between pro- and anti-inflammatory cytokines [increased levels of interleukin (IL)-6, IL-1-β, tumour necrosis factor-α, decreased levels of IL-10] and the over-expression of some prothrombotic proteins, such as protein kinase Cε, on the surface of activated platelets. This pathway also operates in atherosclerotic cardiovascular disease. JAK–STAT inhibitors may reduce cardiovascular events and related deaths in such conditions, but the potential of these agents requires more studies, especially with regard to cardiovascular safety, and particularly for potential prothrombotic effects. JAK–STAT inhibitors merit consideration to curb heightened cardiovascular risk in patients with RA and MPNs, with rigorous assessment of the potential benefits and risks.
Impaired Stabilization of Orthostatic Cerebral Oxygenation Is Associated With Slower Gait Speed: Evidence From The Irish Longitudinal Study on Ageing
Authors: O’Connor John D , O’Connell Matthew D L , Knight Silvin P , Newman Louise , Donoghue Orna A , Kenny Rose Anne
Published: July 2021

Background

Cerebral autoregulation (CAR) systems maintain blood flow to the brain across a wide range of blood pressures. Deficits in CAR have been linked to gait speed (GS) but previous studies had small sample sizes and used specialized equipment which impede clinical translation. The purpose of this work was to assess the association between GS and orthostatic cerebral oxygenation in a large, community-dwelling sample of older adults.

Method

Data for this study came from the Irish Longitudinal Study on Ageing. A near-infrared spectroscopy (NIRS) device attached to the forehead of each participant (n = 2 708) was used to track tissue saturation index (TSI; the ratio of oxygenated to total hemoglobin) during standing. GS was assessed using a portable walkway.

Results

Recovery was impaired in slower GS participants with a TSI value at 20 seconds (after standing) of −0.55% (95% CI: −0.67, −0.42) below baseline in the slowest GS quartile versus −0.14% (95% CI: −0.25, −0.04) in the fastest quartile. Slower GS predicted a lower TSI throughout the 3-minute monitoring period. Results were not substantially altered by adjusting for orthostatic hypotension. Adjustment for clinical and demographic covariates attenuated the association between but differences remained between GS quartiles from 20 seconds to 3 minutes after standing.

Conclusion

This study reported evidence for impaired recovery of orthostatic cerebral oxygenation depending on GS in community-dwelling older adults. Future work assessing NIRS as a clinical tool for monitoring the relationship between GS and cerebral regulation is warranted.
Statins and Cognitive Decline in the Cardiovascular Health Study: A Comparison of Different Analytical Approaches
Authors: Zeki Al Hazzouri Adina , Jawadekar Neal , Grasset Leslie , Kaiser Paulina , Kezios Katrina , Calonico Sebastian , Glymour Maria , Hirsch Calvin , Arnold Alice M , Varadhan Ravi , Odden Michelle C
Published: July 2021

Background

Despite their well-established benefits for the prevention of cardiovascular disease, robust evidence on the effects of statins on cognition is largely inconclusive. We apply various study designs and analytical approaches to mimic randomized controlled trial effects from observational data.

Methods

We used observational data from 5 580 participants enrolled in the Cardiovascular Health Study from 1989/1990 to 1999/2000. We conceptualized the cohort as an overlapping sequence of nonrandomized trials. We compared multiple selection (eligible population, prevalent users, new users) and analytic approaches (multivariable adjustment, inverse-probability treatment weights, propensity score matching) to evaluate the association between statin use and 5-year change in global cognitive function, assessed using the Modified Mini-Mental State Examination (3MSE).

Results

When comparing prevalent users to nonusers (N = 2 772), statin use was associated with slower cognitive decline over 5 years (adjusted annual change in 3MSE = 0.34 points/year; 95% CI: 0.05–0.63). Compared to prevalent user design, estimates from new user designs (eg, comparing eligible statin initiators to noninitiators) were attenuated showing either null or negative association, though not significant. For example, in a propensity score-matched sample of statin-eligible individuals (N = 454), the annual 3MS change comparing statin initiators to noninitiators was −0.21 points/year (95% CI: −0.81 to 0.39).

Conclusions

The association of statin use and cognitive decline is attenuated toward the null when using rigorous analytical approaches that more closely mimic randomized controlled trials. Point estimates, even within the same study, may vary depending on the analytical methods used. Further studies that leverage natural or quasi experiments around statin use are needed to replicate our findings.
NT5E mutation in sisters who underwent aortic valve replacements for aortic stenosis
Authors: Uchida Tetsuro , Yamashita Atsushi , Ishizawa Ai , Sadahiro Mitsuaki , Azuma Nobuyoshi , Kaname Tadashi
Published: July 2021

Mutations of the NT5E gene encoding the cluster of differentiation 73 (CD73) protein have been found in patients with characteristic calcification of joints and arteries (CALJA). CD73 plays a protective role against aortic valve calcification; therefore, its deletion results in aortic valve calcification. However, to date, there are no reports of a patient with CALJA with aortic stenosis. In this study, we describe 2 extremely rare cases of sisters with identical NT5E gene mutation patterns, both of whom developed late-onset severe aortic stenosis and limb ischaemia. Both patients underwent aortic valve replacement and bilateral distal arterial bypass surgeries successfully. They were genetically diagnosed with CALJA based on the NT5E mutation. Our report suggests that NT5E mutations should be considered in patients requiring aortic valve replacement for a calcified aortic valve and bypass surgery for specific calcified and occluded arteries.
HIV Transgenic Rats Demonstrate Impaired Sensorimotor Gating But Are Insensitive to Cannabinoid (Δ9-Tetrahydrocannabinol)-Induced Deficits
Authors: Roberts Benjamin Z , Minassian Arpi , Halberstadt Adam L , He Yinong V , Chatha Muhammad , Geyer Mark A , Grant Igor , Young Jared W
Published: July 2021

Background

HIV-associated neurocognitive disorder (HAND) is commonly observed in persons living with HIV (PWH) and is characterized by cognitive deficits implicating disruptions of fronto-striatal neurocircuitry. Such circuitry is also susceptible to alteration by cannabis and other drugs of abuse. PWH use cannabis at much higher rates than the general population, thus prioritizing the characterization of any interactions between HIV and cannabinoids on cognitively relevant systems. Prepulse inhibition (PPI) of the startle response, the process by which the motor response to a startling stimulus is attenuated by perception of a preceding non-startling stimulus, is an operational assay of fronto-striatal circuit integrity that is translatable across species. PPI is reduced in PWH. The HIV transgenic (HIVtg) rat model of HIV infection mimics numerous aspects of HAND, although to date the PPI deficit observed in PWH has yet to be fully recreated in animals.

Methods

PPI was measured in male and female HIVtg rats and wild-type controls following acute, nonconcurrent treatment with the primary constituents of cannabis: Δ 9-tetrahydrocannabinol (THC; 1 and 3 mg/kg, s.c.) and cannabidiol (1, 10, and 30 mg/kg, i.p.).

Results

HIVtg rats exhibited a significant PPI deficit relative to wild-type controls. THC reduced PPI in controls but not HIVtg rats. Cannabidiol exerted only minor, genotype-independent effects on PPI.

Conclusions

HIVtg rats exhibit a relative insensitivity to the deleterious effects of THC on the fronto-striatal function reflected by PPI, which may partially explain the higher rates of cannabis use among PWH.
Super Duality for Quantum Affine Algebras of Type A
Authors: Kwon Jae-Hoon , Lee Sin-Myung
Published: July 2021

We introduce a new approach to the study of finite-dimensional representations of the quantum group of the affine Lie superalgebra $ \textrm {L}{\mathfrak {g}\mathfrak {l}}_{M|N}=\mathbb {C}[t,t^{-1}]\otimes \mathfrak {g}\mathfrak {l}_{M|N}$ ($M\neq N$). We explain how the representations of the quantum group of $ \textrm {L}{\mathfrak {g}\mathfrak {l}}_{M|N}$ are directly related to those of the quantum affine algebra of type $A$, using an exact monoidal functor called truncation. This can be viewed as an affine analogue of super duality of type $A$.
Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center
Authors: Kawamoto Kensaku , Kukhareva Polina V , Weir Charlene , Flynn Michael C , Nanjo Claude J , Martin Douglas K , Warner Phillip B , Shields David E , Rodriguez-Loya Salvador , Bradshaw Richard L , Cornia Ryan C , Reese Thomas J , Kramer Heidi S , Taft Teresa , Curran Rebecca L , Morgan Keaton L , Borbolla Damian , Hightower Maia , Turnbull William J , Strong Michael B , Chapman Wendy W , Gregory Travis , Stipelman Carole H , Shakib Julie H , Hess Rachel , Boltax Jonathan P , Habboushe Joseph P , Sakaguchi Farrant , Turner Kyle M , Narus Scott P , Tarumi Shinji , Takeuchi Wataru , Ban Hideyuki , Wetter David W , Lam Cho , Caverly Tanner J , Fagerlin Angela , Norlin Chuck , Malone Daniel C , Kaphingst Kimberly A , Kohlmann Wendy K , Brooke Benjamin S , Del Fiol Guilherme
Published: July 2021

Objective

To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations.

Materials and Methods

We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations.

Results

University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape.

Discussion

Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation.

Conclusion

EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout.
Size-weight relationships and condition factor of the invasive Atlantic blue crab Callinectes sapidus Rathbun, 1896 (Decapoda: Brachyura: Portunidae) from northern Tunisia: a preliminary investigation
Authors: Fassatoui Chiheb , Hatira Sameh , Romdhane Mohamed Salah
Published: July 2021

We determined the condition factor and relative growth patterns of the newly established invasive Atlantic blue crab Callinectes sapidus in the Ghar El Melh Lagoon, northern Tunisia, central Mediterranean Sea using two biometric relationships: carapace width-weight and carapace length-weight. Crabs were sampled during winter and summer 2020. Growth coefficient (slope b) for width-weight relationship ranged from 2.037 to 3.008 according to sex and seasons, indicating an isometry to negative allometry growth patterns. Length-weight relationship, however, demonstrated isometry growth patterns, with the exception of the summer sample, which displayed a positive allometry. The allometry seems to be not affected by seasons, but sex demonstrated a strong effect for the width-weight relationship, as indicated by ANCOVA. The Fulton’s condition factor, however, showed significant variation between seasons, but not between sexes.
Arthroscopic utilization of ChondroFiller gel for the treatment of hip articular cartilage defects: a cohort study with 12- to 60-month follow-up
Authors: Mazek Jacek , Gnatowski Maciej , Salas Antonio Porthos , O’Donnell John M , Domżalski Marcin , Radzimowski Jakub
Published: July 2021

ChondroFiller gel is an absorbable collagen implant. It serves as a protective cover for the cartilage defects, allowing chondrocyte migration into the lesion. The implant consists of collagen (Type I) and is derived from veterinary monitored rats. This study evaluates the use of ChondroFiller gel in the treatment of cartilage lesions during hip joint arthroscopy. A prospective study was conducted on a group of 26 adult patients. All patients had an existing femoroacetabular impingement together with acetabular cartilage lesions >2 cm2. All patients underwent hip arthroscopic surgery and the lesions were treated using ChondroFiller gel. The cartilage tissue healing was evaluated postoperatively using MRI. A total of 26 patients, including 5 females and 21 males, all with articular cartilage lesions, were included in the study. Cartilage healing conditions were evaluated for all patients, and the difference between pre- and post-surgery conditions was statistically significant. The follow-up scores have been acquired from 21 out of initial 26 patients (2 were disqualified after receiving THR, 3 could not be reached by researchers) after 3, 4 and 5 years consecutively with 17/21 patients having good/excellent results. The use of ChondroFiller gel during arthroscopy of the hip for acetabular cartilage lesions is an effective treatment technique. Encouraging long-term results have been observed, but further research on larger group of patient is required to better assess the full value of this technique. Patients with pre-existing osteoarthritis (Tönnis 2–3) have poor results.
Pharmacokinetics, tissue distribution and peritoneal retention of Ag2S quantum dots following intraperitoneal administration to mice
Authors: Mahlooji Iman , Javidi Jaber , Dadashzadeh Simin
Published: July 2021

Objectives

To investigate the pharmacokinetics, biodistribution and peritoneal retention of Ag2S quantum dots (Qds) after intraperitoneal (IP) injection into mice and to compare the results with those reported for the intravenous (IV) injection of these particles.

Methods

Ag2S Qds was prepared by a simple one-step co-precipitation method and was injected intraperitoneally into mice. Six animals were sacrificed at predetermined time points, and blood, peritoneal content and tissue samples were collected. Ag concentration that represents the concentration of Qds was analysed by atomic absorption spectrophotometry.

Key findings

Detectability of Qds in the peritoneal sample up to 2 h indicated that, compared with small drug molecules, the absorption of Ag2S Qds from the peritoneal cavity occurred at a slower rate. The AUC tissue/AUC blood ratio in the liver and intestine after IP injection (0.55 and 0.98, respectively) was considerably lower than those for the bolus injection (217 and 94, respectively), while this ratio in the spleen and lungs was markedly higher than the IV route.

Conclusions

Overall, the obtained results suggest that IP injection of Ag2S Qds could be more effective for drug delivery to/imaging of the spleen and lungs, whereas the IV injection for the drug delivery to/imaging of the liver and intestine.
Identification of ZmNF-YC2 and its regulatory network for maize flowering time
Authors: Su Huihui , Chen Zhihui , Dong Yahui , Ku Lixia , Abou-Elwafa Salah Fatouh , Ren Zhenzhen , Cao Yingying , Dou Dandan , Liu Zhixue , Liu Huafeng , Tian Lei , Zhang Dongling , Zeng Haixia , Han Shengbo , Zhu Fangfang , Du Chunguang , Chen Yanhui
Published: July 2021

Flowering time is an important agronomic trait that determines the distribution and adaptation of plants. The accurate prediction of flowering time in elite germplasm is critical for maize breeding. However, the molecular mechanisms underlying the photoperiod response remain elusive in maize. Here we cloned the flowering time-controlling gene, ZmNF-YC2, by map-based cloning and confirmed that ZmNF-YC2 is the nuclear transcription factor Y subunit C-2 protein and a positive regulator of flowering time in maize under long-day conditions. Our results show that ZmNF-YC2 promotes the expression of ZmNF-YA3. ZmNF-YA3 negatively regulates the transcription of ZmAP2. ZmAP2 suppresses the expression of ZMM4 to delay flowering time. We then developed a gene regulatory model of flowering time in maize using ZmNF-YC2, ZmNF-YA3, ZmAP2, ZMM4, and other key genes. The cascading regulation by ZmNF-YC2 of maize flowering time has not been reported in other species.
Complexing amphotericin B with gold nanoparticles improves fungal clearance from the brains of mice infected with Cryptococcal neoformans
Authors: Chintalacharuvu Koteswara R , Matolek Zlatko A , Pacheco Benny , Carriera Erick M , Beenhouwer David O
Published: July 2021

Amphotericin B (AmB) is used to treat cryptococcal meningoencephalitis. However, the mortality rate remains high. Higher doses of AmB in deoxycholate buffer (AmBd) are toxic to human red blood cells (hRBC) and have no effect on brain organism load in mice. Here we show that while AmBd lysed 96% of hRBC, AmB complexed with gold nanoparticles (AuNP-SA-AmB) lysed only 27% of hRBC. In vitro growth of C. neoformans was inhibited by 0.25 μg/ml AmBd and 0.04 μg/ml of AuNP-SA-AmB. In mice infected with C. neoformans, five daily treatments with AuNP-SA-AmB containing 0.25 mg/kg AmB significantly lowered the fungal burden in the brain tissue compared to either untreated or treatment with 0.25 mg/kg of AmBd. When a single dose of AmBd was injected intravenously into BALB/c mice, 81.61% of AmB cleared in the α-phase and 18.39% cleared in the β-phase at a rate of 0.34% per hour. In contrast, when AuNP-SA-AmB was injected, 49.19% of AmB cleared in the α-phase and 50.81% of AmB cleared in the β-phase at a rate of 0.27% per hour. These results suggest that AmB complexed with gold nanoparticles is less toxic to hRBC, is more effective against C. neoformans and persists longer in blood when injected into mice resulting in more effective clearing of C. neoformans from the brain tissue.

Lay summary

Amphotericin B (AmB) was complexed with gold nanoparticles (AuNP-SA-AmB) to improve brain delivery. AuNP-SA-AmB was more effective than AmB alone in clearing of Cryptococcus neoformans from the brain tissue of infected mice. This may be due to longer plasma half-life of AmB as AuNP-SA-AmB.
Optimized modelling of Gaia–Hipparcos astrometry for the detection of the smallest cold Jupiter and confirmation of seven low-mass companions
Authors: Feng Fabo , Butler R Paul , Jones Hugh R A , Phillips Mark W , Vogt Steven S , Oppenheimer Rebecca , Holden Bradford , Burt Jennifer , Boss Alan P
Published: July 2021

To fully constrain the orbits of low-mass circumstellar companions, we conduct combined analyses of the radial velocity data and the Gaia and Hipparcos astrometric data for eight nearby systems. Our study shows that companion-induced position and proper motion differences between Gaia and Hipparcos are significant enough to constrain orbits of low-mass companions to a precision comparable with previous combined analyses of direct imaging and radial velocity data. We find that our method is robust to whether we use Gaia Data Release 2 or Gaia Early Data Release 3, as well as whether we use all of the data or just proper motion differences. In particular, we fully characterize the orbits of HD 190360 b and HD 16160 C for the first time. With a mass of 1.8 ± 0.2 MJup and an effective temperature of 123–176 K and orbiting around a Sun-like star, HD 190360 b is the smallest Jupiter-like planet with well-constrained mass and orbit, belonging to a small sample of fully characterized Jupiter analogues. It is separated from its primary star by 0.25 arcsec and thus may be suitable for direct imaging by the coronagraph instrument of the Roman Space Telescope.