bluuebunny/crossref_metadata_2025 huggingface dataset:
0963 Everyday Discrimination Is Associated with Sleep-Related Impairments Among Blacks During the COVID-19 Pandemic
Authors: Alfonso Ana Gabriela Sanchez , Blanc Judite , Oliveira Bruno , Chery Maurice , Locklear Clarence , Seixas Azizi , Jean-Louis Girardin
Published: May 2023

Introduction

Sleep is influenced by a set of multilevel factors including race and ethnicity. There is overwhelming evidence supporting that sleep quality is poorer within nonwhite groups. Race-based stressors and discrimination are believed to be among the logical explanation of these widespread racial/ethnic disparities in sleep health. This study aimed to highlight the effects of discrimination on sleep related impairments among Black adults.

Methods

Our sample included 280 Blacks and African Americans enrolled in two NIH-funded community-based sleep studies: ESSENTIAL and MOSAIC. Participants were recruited between January 2020 and April 2022 in the New York City or Tri-State area (n=101; 36%) and South Florida (n=179; 64%). Data were gathered on demographics, sleep disturbance, activity, stress, and support using the Insomnia Severity Index (ISI), PROMIS Sleep-Related Impairment (SRI) questionnaire (short form 8a), Godin Leisure-Time Exercise questionnaire, Everyday Discrimination Scale, stressful life events experienced within the past year, and the Multidimensional Scale of Perceived Social Support (MSPSS). Correlation analyses were conducted among continuous variables to explore associations among sleep, activity, support, discrimination, and stress. Controlling for age, race/ethnicity, and sex, multilinear regression analysis was conducted to examine the relationship between stressful life event exposure, discrimination, social support, and activity on sleep impairment.

Results

Of the 280 participants, 63% were female (n = 177) and the mean age was 43.4 years. A total of 36% (n = 101) were from the New York City/Tri-State area, while 64% (n = 179) were from the South Florida region. Controlling for age, race/ethnicity, physical activity, non-race related stressors, social support, and sex, everyday discrimination was the strongest predictor of sleep related impairments (SRI) [β = -0.198, p < 0.05]. Sex was positively associated with SRI scores [β = 0.167, p = 0.05]. On average, women reported higher SRI scores.

Conclusion

In this study, we found that among Blacks and African Americans in the New York City, Tri-State areas, and South Florida areas, during the Covid-19 pandemic, greater discrimination experience was associated with higher level of sleep-related impairments.

Support (if any)

K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007
Feeding incremental amounts of ground flaxseed: effects on diversity and relative abundance of ruminal microbiota and enteric methane emissions in lactating dairy cows
Authors: Almeida Kleves V , Resende Tales L , Silva Luiz Henrique P , Dorich Christopher D , Pereira Andre B D , Soder Kathy J , Brito Andre F
Published: May 2023

We evaluated the effects of incremental amounts of ground flaxseed (GFX) on diversity and relative abundance of ruminal microbiota taxa, enteric methane (CH4) emissions, and urinary excretion of purine derivatives (PD) in lactating dairy cows in a replicated 4 × 4 Latin square design. Twenty mid-lactation Jersey cows were used in the study. Of these 20 cows, 12 were used for ruminal sampling, 16 for enteric CH4 measurements, and all for spot urine collection. Each period lasted 21 d with 14 d for diet adaptation and 7 d for data and sample collection. Diets were formulated by replacing corn meal and soybean meal with 0%, 5%, 10%, and 15% of GFX in the diet’s dry matter. Ruminal fluid samples obtained via stomach tubing were used for DNA extraction. Enteric CH4 production was measured using the sulfur hexafluoride tracer technique. Diets had no effect on ruminal microbiota diversity. Similarly, the relative abundance of ruminal archaea genera was not affected by diets. In contrast, GFX decreased or increased linearly the relative abundance of Firmicutes (P < 0.01) and Bacteroidetes (P < 0.01), respectively. The relative abundance of the ruminal bacteria Ruminococcus (P < 0.01) and Clostridium (P < 0.01) decreased linearly, and that of Prevotella (P < 0.01) and Pseudobutyrivibrio (P < 0.01) increased linearly with feeding GFX. A tendency for a linear reduction (P = 0.055) in enteric CH4 production (from 304 to 256 g/d) was observed in cows fed increasing amounts of GFX. However, neither CH4 yield nor CH4 intensity was affected by treatments. Diets had no effect on the urinary excretion of uric acid, allantoin, and total PD. Overall, feeding GFX decreased linearly the relative abundance of the ruminal bacterial genera Ruminococcus and Clostridium and enteric CH4 production, but no change was seen for CH4 yield and CH4 intensity, or urinary excretion of total PD, suggesting no detrimental effect of GFX on microbial protein synthesis in the rumen.
Bovine neonatal microbiome origins: a review of proposed microbial community presence from conception to colostrum
Authors: Messman Riley D , Lemley Caleb O
Published: May 2023

In recent years, there has been an influx of research evaluating the roles of the reproductive tract microbiota in modulating reproductive performance. These efforts have resulted in a breadth of research exploring the bovine reproductive tract microbiota. The female reproductive tract microbiota has been characterized during the estrus cycle, at timed artificial insemination, during gestation, and postpartum. Additionally, there are recently published studies investigating in-utero inoculation of the bovine fetus. However, critical review of the literature to understand how the microbial shifts during a dam’s lifecycle could impact neonatal outcomes is limited. This review demonstrates a consistency at the phyla level throughout both the maternal, paternal, and neonatal microbiomes. Moreover, this review challenges the current gestational inoculation hypothesis and suggests instead a maturation of the resident uterine microbiota throughout gestation to parturition. Recent literature is indicative of microbial composition influencing metabolomic parameters that have developmental programming effects in feed utilization and metabolic performance later in life. Thus, this review enumerates the potential origins of neonatal microbial inoculation from conception, through gestation, parturition, and colostrum consumption while introducing clear paucities where future research is needed to better understand the ramifications of the reproductive microbiome on neonates.
Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials*
Authors: Jones Jennifer R. A. , Karahalios Amalia , Puthucheary Zudin A. , Berry Michael J. , Files D. Clark , Griffith David M. , McDonald Luke A. , Morris Peter E. , Moss Marc , Nordon-Craft Amy , Walsh Timothy , Berney Sue , Denehy Linda
Published: May 2023

OBJECTIVE:

To explore if patient characteristics (pre-existing comorbidity, age, sex, and illness severity) modify the effect of physical rehabilitation (intervention vs control) for the coprimary outcomes health-related quality of life (HRQoL) and objective physical performance using pooled individual patient data from randomized controlled trials (RCTs).

DATA SOURCES:

Data of individual patients from four critical care physical rehabilitation RCTs.

STUDY SELECTION:

Eligible trials were identified from a published systematic review.

DATA EXTRACTION:

Data sharing agreements were executed permitting transfer of anonymized data of individual patients from four trials to form one large, combined dataset. The pooled trial data were analyzed with linear mixed models fitted with fixed effects for treatment group, time, and trial.

DATA SYNTHESIS:

Four trials contributed data resulting in a combined total of 810 patients (intervention n = 403, control n = 407). After receiving trial rehabilitation interventions, patients with two or more comorbidities had HRQoL scores that were significantly higher and exceeded the minimal important difference at 3 and 6 months compared with the similarly comorbid control group (based on the Physical Component Summary score (Wald test p = 0.041). Patients with one or no comorbidities who received intervention had no HRQoL outcome differences at 3 and 6 months when compared with similarly comorbid control patients. No patient characteristic modified the physical performance outcome in patients who received physical rehabilitation.

CONCLUSIONS:

The identification of a target group with two or more comorbidities who derived benefits from the trial interventions is an important finding and provides direction for future investigations into the effect of rehabilitation. The multimorbid post-ICU population may be a select population for future prospective investigations into the effect of physical rehabilitation.
Metformin may be a viable adjunctive therapeutic option to potentially enhance immune reconstitution in HIV-positive immunological non-responders
Authors: Zaongo Silvere D. , Chen Yaokai
Published: May 2023

Incomplete immune reconstitution remains a global challenge for human immunodeficiency virus (HIV) treatment in the present era of potent antiretroviral therapy (ART), especially for those individuals referred to as immunological non-responders (INRs), who exhibit dramatically low CD4+ T-cell counts despite the use of effective antiretroviral therapy, with long-term inhibition of viral replication. In this review, we provide a critical overview of the concept of ART-treated HIV-positive immunological non-response, and also explain the known mechanisms which could potentially account for the emergence of immunological non-response in some HIV-infected individuals treated with appropriate and effective ART. We found that immune cell exhaustion, combined with chronic inflammation and the HIV-associated dysbiosis syndrome, may represent strategic aspects of the immune response that may be fundamental to incomplete immune recovery. Interestingly, we noted from the literature that metformin exhibits properties and characteristics that may potentially be useful to specifically target immune cell exhaustion, chronic inflammation, and HIV-associated gut dysbiosis syndrome, mechanisms which are now recognized for their critically important complicity in HIV disease-related incomplete immune recovery. In light of evidence discussed in this review, it can be seen that metformin may be of particularly favorable use if utilized as adjunctive treatment in INRs to potentially enhance immune reconstitution. The approach described herein may represent a promising area of therapeutic intervention, aiding in significantly reducing the risk of HIV disease progression and mortality in a particularly vulnerable subgroup of HIV-positive individuals.
Spray Cryotherapy for Benign Large Airway Stenosis
Authors: Ratwani Ankush P. , Lentz Robert J. , Chen Heidi , Schwartz Evan , Roller Lance , Shojaee Samira , Shepherd Wes , Noor ul Husnain Shaikh M. , Senitko Michal , Guo Yanglin , Cumbo-Nacheli Gustavo , Raziq Fazal I. , Sachdeva Ashutosh , Holden Van , Gharaibeh Kamel , Benn Bryan S. , Ferguson J. Scott , Rickman Otis B. , Yarmus Lonny , Maldonado Fabien ,   on behalf of the Interventional Pulmonary Outcomes Group (IPOG)
Published: May 2023

Background:

Benign airway stenosis (BAS) represents a significant burden on patients, providers, and healthcare systems. Spray cryotherapy (SCT) has been proposed as an adjunctive treatment to reduce BAS recurrence. We sought to examine safety and practice variations of the latest SCT system when used for BAS.

Methods:

We conducted a retrospective multicenter cohort study in seven academic institutions within the Interventional Pulmonary Outcomes Group. All patients who underwent at least one SCT session with a diagnosis of BAS at the time of procedure at these institutions were included. Demographics, procedure characteristics, and adverse events were captured through each center’s procedural database and electronic health record.

Results:

A total of 102 patients underwent 165 procedures involving SCT from 2013 to 2022. The most frequent etiology of BAS was iatrogenic (n = 36, 35%). In most cases, SCT was used prior to other standard BAS interventions (n = 125; 75%). The most frequent SCT actuation time per cycle was five seconds. Pneumothorax complicated four procedures, requiring tube thoracostomy in two. Significant post-SCT hypoxemia was noted in one case, with recovery by case conclusion and no long-term effects. There were no instances of air embolism, hemodynamic compromise, or procedural or in-hospital mortality.

Conclusion:

SCT as an adjunctive treatment for BAS was associated with a low rate of complications in this retrospective multicenter cohort study. SCT-related procedural aspects varied widely in examined cases, including actuation duration, number of actuations, and timing of actuations relative to other interventions.
Attitudes and knowledge of emergency doctors towards end-of-life care in the emergency department: a national survey
Authors: Saeed Saema , Mulcaire Jeffrey , Umana Etimbuk , Foley James , Browne Leonard , Keane Owen , Chionh Wen Wei , O’Leary Mary Jane , Deasy Conor ,   on behalf of Irish Trainee Emergency Research Network (ITERN) Collaborators
Published: May 2023

Background

Emergency departments (EDs) are seeing an increase in patients requiring end-of-life (EOL) care. There is paucity of data of attitudes and knowledge of physicians providing EOL care in the ED both internationally and in Ireland.

Objective

The aim of this project was to assess the attitudes and knowledge of ED physicians towards EOL care.

Methods

This was a cross-sectional electronic survey of ED physicians working in Irish EDs and was facilitated through the Irish Trainee Emergency Research Network over a 6-week period. The questionnaire covered the following domains: demographic data, awareness of EOL Care, views and attitudes towards EOL care.

Results

Of a potential 679 respondents, 441 responses were received, of which 311 (response rate of 44.8%) had fully completed the survey across 23 participant sites. Majority of the respondents were under the age of 35 (62%), were male (58%) and at Senior House Officer level (36%). In terms of awareness, 32% (98) of respondents were not aware of palliative care services in their hospitals while only 29% (91) were aware of national EOL guidance. Fifty-five percent (172) reported commencing EOL care in the ED, however 75.5% (234) respondents reported their knowledge of EOL care to be limited or non-existent. Only 30.2% respondents felt comfortable commencing EOL care in the ED without speciality team input. There appears to be a lack of clarity on the roles and responsibilities of emergency medicine nurses and doctors in the care of the dying patient in ED with only 31.2% (95) being clear on this role. Significant differences were observed associated with clinical experience and physician grade.

Conclusion

This study has highlighted a lack of awareness and knowledge of EOL care particularly amongst less experienced emergency medicine doctors. Formalized training and education programs in the provision of EOL care in the ED will improve comfort levels and knowledge amongst the emergency medicine doctors and improve the quality of care provided.
Remote Ischemic Conditioning for Motor Recovery after Acute Ischemic Stroke
Authors: Yu Wantong , Ren Changhong , Du Jubao , Zhao Wenbo , Guo Wenting , Ji Xunming
Published: May 2023

Background:

Remote ischemic conditioning (RIC) has shown an impressive neuroprotective effect on acute ischemic stroke (AIS) in animal experiments. But whether chronic RIC improves long-term functional outcomes remains unclear.

Materials and Methods:

We performed a non-randomized controlled trial. Eligible patients (aged 18 –80 y) with hemiplegia caused by AIS were allocated to the RIC group and the control group. All participants received normal protocol rehabilitation therapy. Patients in the RIC group underwent RIC twice daily for 90 days. The outcome included the 90-day Fugl-Meyer Assessment (FMA) scores and modified Rankin’s scale (mRS) scores, as well as changes in angiogenesis-related factors in serum from baseline to 90 days.

Results:

Twenty-seven patients were included in the analysis (13 in the RIC group and 14 in the control group). There was no significant difference in 90-day total FMA scores between the two groups. Lower limb FMA scores at day 90 were significantly higher in the RIC group (32.8±8.7 vs. 24.8±5.4, adjusted P=0.042). The proportion of favorable outcome (mRS<2) was higher in the RIC group than that in the control group, but no significant difference was detected (8 [61.5%] vs. 7 [50%], P=0.705). A significant increase has been found in the level of epidermal growth factor (EGF) in serum (9.4 [1.1 to 25.7] vs. −8.7 [−15.1 to 4.7], P=0.036) after chronic RIC procedure.

Conclusion:

This study investigated the role that RIC plays in AIS recovery, especially in motor function. RIC may have beneficial effects on lower limbs recovery by enhancing the EGF level. The effect of RIC on motor recovery should be further validated in future studies.
Nucleated Red Blood Cells Are Predictive of In-Hospital Mortality for Pediatric Patients
Authors: Gearhart Addison , Esteso Paul , Sperotto Francesca , Elia Eleni G. , Michelson Kenneth A. , Lipsitz Stu , Sun Mingwei , Knoll Christopher , Vanderpluym Christina
Published: May 2023

Purpose

We sought to establish whether nucleated red blood cells (NRBCs) are predictive of disposition, morbidity, and mortality for pediatric patients presenting to the emergency department (ED).

Methods

A single-center retrospective cohort study examining all ED encounters from patients aged younger than 19 years between January 2016 and March 2020, during which a complete blood count was obtained. Univariate analysis and multivariable logistic regression were used to test the presence of NRBCs as an independent predictor of patient-related outcomes.

Results

The prevalence of NRBCs was 8.9% (4195/46,991 patient encounters). Patient with NRBCs were younger (median age 4.58 vs 8.23 years; P < 0.001). Those with NRBCs had higher rates of in-hospital mortality (30/2465 [1.22%] vs 65/21,741 [0.30%]; P < 0.001), sepsis (19% vs 12%; P < 0.001), shock (7% vs 4%; P < 0.001), and cardiopulmonary resuscitation (CPR) (0.62% vs 0.09%; P < 0.001). They were more likely to be admitted (59% vs 51%; P < 0.001), have longer median hospital length of stay {1.3 (interquartile range [IQR], 0.22–4.14) vs 0.8 days (IQR, 0.23–2.64); P < 0.001}, and median intensive care unit (ICU) length of stay (3.9 [IQR, 1.87–8.72] vs 2.6 days [IQR, 1.27–5.83]; P < 0.001). Multivariable regression revealed presence of NRBCs as an independent predictor for in-hospital mortality (adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.38–3.53; P < 0.001), ICU admission (aOR, 1.30; 95% CI, 1.11–1.51; P < 0.001), CPR (aOR, 3.83; 95% CI, 2.33–6.30; P < 0.001), and 30-day return to the ED (aOR, 1.15; 95% CI, 1.15–1.26; P < 0.001).

Conclusions

The presence of NRBCs is an independent predictor for mortality, including in-hospital mortality, ICU admission, CPR, and readmission within 30 days for children presenting to the ED.
Retrospective Evaluation of a Novel Nasal Tip Suture Technique
Authors: Altun Huseyin , Hanci Deniz , Kumas Ömer , Jafarov Shamkal
Published: May 2023

Nasal tip surgery is a crucial aspect of rhinoplasty in which suture techniques play a significant role. Early suturing techniques focused primarily on repositioning alar cartilage remnants after they had undergone significant resection. The size, contour, and orientation of the medial and lateral crura are primary factors in creating a tip shape. In this review, we retrospectively evaluated obliquely oriented dome sutures with triangular dome resection that was performed in 540 rhinoplasty cases at Yunus Emre Hospital between 2015 and 2020. Dome-defining sutures were placed, and a triangular cartilage resection was performed. Subsequently, oblique sutures were placed to achieve the desired lateral cartilage position. Objective assessment of postoperative results (Objective Rhinoplasty Outcome Score), patient satisfaction assessments, and nasal examinations were conducted. The objective assessments of the esthetic results showed a significant improvement, with a mean score of 3.6, which represents a good to excellent outcome. Most patients were subjectively satisfied with the surgical outcomes of rhinoplasty. No serious complications, such as infection, recurrence of deviation, nasal obstruction, or esthetic problems such as dorsal irregularities, were observed after surgery. Overall, suturing techniques play an important role in determining the nasal tip shape. Our technique is beneficial for maintaining a favorable lateral crural position, leading to improved patient satisfaction.
Brief Clinical Study: An Alternative Method to Prevent Frey Syndrome After Resection of Huge Masses in Parotis: De-epithelialized Skin Flap Use
Authors: Yaşar Emrah Kağan , Polat Batuhan , Alagöz Murat Şahin
Published: May 2023

Frey syndrome is still a significant problem in postparotidectomy patients 6 to 18 months after surgery. The most accepted theory of the pathogenesis of Frey syndrome is the aberrant regeneration theory. Creating a barrier between the remnant parotid gland and the overlying skin prevents Frey syndrome. A 51-year-old female patient who developed pleomorphic adenoma in the parotid gland was operated. After superficial parotidectomy, a barrier between the underlying postganglionic parasympathetic nerves in the deep parotid gland and the overlying cutaneous tissue was created with a local skin flap to prevent Frey syndrome. The patient was successfully treated, and she was followed up to 5 years. No postoperative complications were observed. No signs of Frey syndrome were found in follow-up. This case highlights that local skin flaps can be an innovative natural method as it is a quick and simple method to create this barrier in the presence of expanded skin.
Giant Cell Tumor of the Temporal Bone and Skull Base
Authors: Amoodi Hosam , Al-Domaidat Derar , Danish Adel , Alshaikh Hasan Ro’a
Published: May 2023

Giant cell tumor (GCT) is a benign tumor that originates from undifferentiated mesenchymal cells of the bone marrow. The craniums as well as temporal bone are extremely rare locations for GCTs. Clinical, radiological, and anatomical diagnosis of this locally aggressive disease poses a major challenge in clinical practice. In this article, we present a clinical study for a 35-year-old female who was found to have left-sided temporal bone GCT with extension to middle cranial fossa and temporomandibular joint (TMJ) with its clinical features and management.
Revisiting the Use of Ulysses Contracts in Xenotransplantation
Authors: Hurst Daniel J. , Padilla Luz , Schiff Tamar , Parent Brendan
Published: May 2023

Background.

Xenotransplantation clinical trials may begin soon. A persistent risk of xenotransplantation, known for decades, is the possibility that a xenozoonotic infection could be transferred from a xenograft to its recipient and then to other human contacts. Because of this risk, guidelines and commentators have advocated for xenograft recipients to agree to either long-term or lifelong surveillance mechanisms.

Methods.

For the past few decades, one solution that has been proposed to ensure that xenograft recipients will comply with surveillance protocols is the use of a heavily modified Ulysses contract, which we review.

Results.

These contracts are most often used in psychiatry, and their application to xenotransplantation has been espoused several times with minimal criticism.

Conclusions.

In this article, we argue against the applicability of Ulysses contracts in xenotransplantation based upon (1) the telos of the advance directive that may not be applicable to this clinical context, (2) the suspect nature of enforcing Ulysses contracts in xenotransplantation, and (3) the ethical and regulatory hurdles that such enforcement would require. Although our focus is on the US regulatory landscape in preparation for clinical trials, there are applications globally.
Medicaid Expansions and Private Insurance ‘Crowd-Out’ (1999-2019)
Authors: Semprini Jason
Published: May 2023

Recent Medicaid expansions have rekindled the debate around private insurance “crowd-out”. Prior research is limited by short-time horizons and state-specific analyses. Our study overcomes these limitations by evaluating twenty years of Medicaid expansions across the entire United States. We obtain data from the U.S. Census Bureau for all U.S. states and D.C. for private insurance coverage rates of adults 18-64, for years 1999-2019. After estimating a naïve, staggered Two-Way Fixed Effects Difference-in-Differences regression model, we implement four novel econometric methods to diagnose and overcome threats of bias from staggered designs. We also test for pre-treatment differential trends and heterogenous effects over time. Our findings suggest that Medicaid expansion was associated with a 1.5%-point decline in private insurance rates (p < 0.001). We also observe significant heterogeneity over time, with estimates peaking four years after expansion. The importance of a 1-2% point crowd-out, we leave for future research and debate.
Multiplex PCR amplicon sequencing revealed community transmission of SARS-CoV-2 lineages on the campus of Sichuan University during the outbreak of infection in Chinese Mainland at the end of 2022
Authors: Tang Langjun , Guo Zhenyu , Lu Xiaoyi , Zhao Junqiao , Li Yonghong , Yang Kun
Published: May 2023

During the pandemic of COVID-19, wastewater-based epidemiology has become a powerful epidemic surveillance tool widely used around the world. However, the development and application of this technology in Chinese Mainland are relatively lagging. Herein, we report the first case of community circulation of SARS-CoV-2 lineages monitored by WBE in Chinese Mainland during the infection outbreak at the end of 2022 after the comprehensive relaxation of epidemic prevention policies. During the peak period of infection, six precious sewage samples were collected from the manhole in the student dormitory area of Wangjiang Campus of Sichuan University. According to the results RT-qPCR, the six sewage samples were all positive for SARS-CoV-2 RNA. Based on multiplex PCR amplicon sequencing, the local transmission of SARS-CoV-2 variants at that time was analyzed. The results show that the main virus lineages in sewage have clear evolutionary genetic correlations. Furthermore, the sampling time is very consistent with the timeline of concern for these virus lineages and consistent with the timeline for uploading the nucleic acid sequences of the corresponding lineages in Sichuan to the database. These results demonstrate the reliability of the sequencing results of SARS-CoV-2 nucleic acid in wastewater. Multiplex PCR amplicon sequencing is by far the most powerful analytical tool of WBE, enabling quantitative monitoring of virus lineage prevalence at the community level.

Highlights

Six sewage samples were collected on Wangjiang Campus of Sichuan university at the end of 2022.

SARS-CoV-2 nucleic acid was detected in all six sewage samples via qPCR.

Multiplex PCR amplicon sequencing reveals the local transmission of SARS-CoV-2 lineages.

Multiplex PCR amplicon sequencing is to date the most powerful WBE tool.

GRAPHICAL ABSTRACT
Left Bundle Branch Pacing Facilitated by Novel Surface Electrocardiography in Comparison with Electrophysiology Recording System
Authors: Su Lan , Zhu Ling , Wang Songjie , Wu Shengjie , Chen Xiao , Huang Zhouqing , Wang Liangping , Xu Lei , Zhou Xiaohong , Huang Weijian
Published: May 2023

Background

Left bundle branch pacing (LBBP) had been proven to be feasible and safe in patients with a pacemaker indication. In this study, we assessed the feasibility and safety of LBBP procedure using simplified ECG monitoring and LBBP criteria in comparison with that by using the conventional EP system and currently adopted LBBP criteria.

Methods

The single-center study included 143 consecutive patients from March 2021 to January 2022. The operator was single-blind to the electrophysiology recording system (EP system), and only observed the electrophysiological characteristics of the four-lead ECG monitor and the pacing system analyzer (PSA) by naked eye. Other researchers kept synchronized records of the EP system, and analyzed whether the data were correct and consistent after the operation. Intraoperative data were collected and the safety of 3-month follow-up after operation were evaluated.

Results

Of 143 patients enrolled, 139 successfully performed LBBP, with a success rate of 97.2%, and the judgement concordance with EP system was 99.3%. The total operation time was 78.9±26.5min, the total fluoroscopy time was 9.5±6.1min, the fluoroscopy time of left bundle branch (LBB) lead deployment 3.0±2.6min, which had no significant difference with previous studies. Ventricular septal perforation occurred in 2 patients during the operation. Pacing parameters were stable and heart function improved during follow-up.

Conclusions

The simplified LBBP implantation method without an EP system and only relying on a simplified ECG combined with an analyzer is clinically feasible and safe and can be promoted in clinical practice.
The influence of APOE status on cognitive decline
Authors: Morrison Cassandra , Oliver Michael D. , Berry Virginia , Kamal Farooq , Dadar Mahsa
Published: May 2023

INTRODUCTION

Apolipoprotein (APOE) ε4 and subjective cognitive decline (SCD) increase risk of Alzheimer’s disease. However, few studies have examined the relationship between SCD and APOE, especially using longitudinal data. The current study examined whether APOE is associated with the rate of cognitive change in SCD.

METHODS

Linear mixed effects models examined the relationship between APOE status and cognitive change in older adults with SCD (SCD), normal controls (NC), and people with mild cognitive impairment (MCI).

RESULTS

The presence of at least one ε2 allele in SCD and MCI results in cognitive change rates similar to a NC with the ε3ε3 genotype. Older SCD-ε4 individuals exhibited increased cognitive decline compared to all groups, including NC-ε4 and MCI-ε4.

DISCUSSION

People with SCD with at least one ε4 allele will experience increased cognitive decline compared to cognitively healthy older adults and people with MCI. These findings have important implications for treatments and interventions.
Association of Mental Health Treatment on Outcomes in Patients with Heart Failure and Ischemic Heart Disease
Authors: Carmin Cheryl N. , Ownby Raymond L. , Fontanella Cynthia , Steelesmith Danielle , Binkley Philip F.
Published: May 2023

Background

Previous studies have not found an impact of mental health treatment on outcomes in patients with heat disease. The aim of this study was to examine whether individuals who received mental health treatment for anxiety or depression after being hospitalized for ischemic disorders or heart failure had a reduced frequency of re-hospitalizations, emergency department (ED) visits or mortality compared to those who did not receive treatment.

Methods

A population based, retrospective, cohort design was used to examine the association between psychotherapy or antidepressant medication prescription and health service utilization and mortality in patients with coronary artery disease and comorbid anxiety and/or depression. Those receiving versus not receiving mental health treatment were compared based on the frequency of re-hospitalization, emergency department visits, and mortality.

Results

The study sample included 1,563 subjects who had a mean age of 50.1 years. Individuals who received both forms of mental health treatment were 87% less likely to be re-hospitalized, 73% less likely to have an emergency department visit, and 65% less likely to die from any cause.

Conclusions

Mental health treatment has a significant impact on outcomes in patients with cardiovascular disease consisting of reduced hospitalizations, emergency department visits and in some conditions improved survival.
Amyloid Screening and Treatment Drop Off in Patients with Left Ventricular Hypertrophy: Associations with Patient Socio-demographic Characteristics
Authors: Walenczyk Kristie M. , Singh Avinainder , Tong Kimhouy , Burg Matthew M. , Miller Edward J.
Published: May 2023

Background

Compared to estimated population prevalence rates, relatively few patients at risk are ultimately diagnosed with and treated for transthyretin cardiac amyloidosis (ATTR-CA). Where along the clinical imaging and treatment pathway patient drop off occurs, and the association of drop off at each step with patient socio-demographic characteristics remains unknown.

Methods

Using data from a healthcare system-wide cardiovascular imaging repository and specialty pharmacy we characterized the multi-level clinical pathway from screening for left ventricular hypertrophy (LVH) with transthoracic echocardiograms (TTE), diagnosis with technetium-99m pyrophosphate scintigraphy (PYP), and tafamidis prescription, initiation, and adherence. Standardized differences (d≥0.20 indicating a small effect size or larger) were used to compare socio-demographics (age, sex, race, national and state Area Deprivation Index) among patients with TTE-identified LVH by PYP referral status, patients with PYP-identified ATTR-CA by tafamidis prescription status, and patients prescribed tafamidis by initiation status.

Results

A total of 8575 patients had LVH on TTE, with 1.6% referred for PYP. Of 97 patients with PYP-identified ATTR-CA, 58.8% were prescribed tafamidis, with 80.7% of those initiating therapy. Referral from LVH on TTE to PYP was higher among men, older patients, and those of Black/African American or American Indian/Alaskan Native race (alld’s≥0.20). Patients with PYP-identified ATTR-CA prescribed tafamidis were younger than those not prescribed tafamidis (d=-0.30). Utilization of a specialty pharmacy resulted in enrichment of treatment in subgroups traditionally undertreated in cardiovascular medicine, with higher rates of tafamidis initiation among women (100% initiation), patients of Black/African American race (d=0.40), and those living in more economically disadvantaged areas (d’s≥0.30).

Conclusion

These findings highlight the tremendous opportunity for more robust imaging and clinical ATTR-CA screening programs, including potential patient subgroups that should be targeted to reduce disparities. Among patients diagnosed with ATTR-CA, utilization of a specialty pharmacy process appears to ensure the equitable provision of tafamidis therapy.
Penalised neural network with weight correlation descent for predicting polygenic risk score
Authors: Kim Sun bin , Kang Joon Ho , Cheon MyeongJae , Kim Dong Jun , Lee Byung-Chul
Published: May 2023

In this study, we developed a deep neural network (DNN) model with weight correlation descent (WCD) regularization to improve polygenic risk score predictions for complex diseases, specifically gender-specific cancers, using the UK Biobank dataset. Our DNN model with WCD outperformed both conventional PRS models and DNN models without WCD, demonstrating the importance of regularization techniques in enhancing model performance and capturing non-linear effects and interactions in genomic data. These findings contribute to a better understanding of genetic architecture, facilitating personalized interventions based on individual genetic profiles and ultimately benefiting patient care and health outcomes.
Prospective Cohort Study of Surgical Site Infections Following Single Dose Antibiotic Prophylaxis in Caesarean Section at a Tertiary Care Teaching Hospital in Medchal, India
Authors: Basany Kalpana , Chaudhuri Sirshendu , Shailaja Lakshmi , Agiwal Varun , Angaali Neelima , Nirupama AY , Shailendra D , Haggerty Catherine , Reddy PS
Published: May 2023

Background

Caesarean section (CS) is a considered to be a life-saving operative intervention for women and new-borns in certain antepartum and intrapartum conditions. Caesarean delivery may be accompanied by several complications including surgical site infections (SSI). However, there is a significant lack of uniformity in the administration of antibiotics for preventing surgical site infections (SSI) following Caesarean deliveries. The present study was conducted to determine the incidence of post CS SSI following the adoption of single-dose antibiotic prophylaxis as recommended by WHO at a tertiary care teaching hospital in Medchal, India. Also, to identify the risk factors of SSI and reported the bacteriological profiles and the antimicrobial sensitivity and resistance pattern of the culture positive isolates

Main objectives

To estimate the incidence of surgical site infections (SSIs) according to CDC criteria following WHO-recommended single-dose antibiotic prophylaxis for Caesarean section at a tertiary care teaching hospital in Medchal, India.

Methods

A prospective hospital-based study was conducted between June 2017 and December 2019, in which women who underwent Caesarean delivery were followed up for 30 days post-delivery. Clinical details were collected using a structured questionnaire, and participants were followed up weekly after discharge to document any signs and symptoms of SSI. Symptomatic patients were requested to come to the hospital for further investigation and treatment. Standard microbiological tests were conducted to detect microorganisms and their antibiotic sensitivity.

Results

The study included 2,015 participants with a mean age of 24.1 years. The majority were multigravida (n=1,274, 63.2%) and underwent emergency Caesarean delivery (n=1,226, 60.8%). Of these, 92 participants (4.6%, 95% CI: 3.7% to 5.6%) developed surgical site infections, with 91 (98.9%) having superficial and 1 (1.1%) having a deep infection. Among those who developed an SSI, 84 (91.3%) did so during their hospital stay, while 8 (8.7%) developed an SSI at home. The adjusted relative risk (aRR) for developing an SSI was 2.5 (95% CI: 1.4 to 4.6; Power 99.9%) among obese women and 2.3 (95% CI: 1.1 to 4.7; Power 100%) among women aged 25 years or younger. Microbial growth was observed in 75.8% (n=50/66) samples. The most common organisms identified wereStaphylococcus aureus(n=23, 46.0%),Klebsiella sp. (n=13, 26.0%), andEscherichia coli(n=12, 24.0%).

Conclusion

Given the low rate of SSI following Caesarean deliveries subjected to single-dose antibiotic prophylaxis and the increased risk noted with obesity, it is rationale to practice the latest recommendations of WHO including higher dose for obese patients, unless there is compelling evidence to do otherwise in any context.
Glyoxal Acid-Free (GAF) histological fixative is a suitable alternative to formalin – results from an open label comparative non-inferiority study
Authors: Ryska Ales , Sapino Anna , Landolfi Stefania , Valero Irene Sansano , Cajal Santiago Ramon y , Oliveira Pedro , Detillo Paolo , Lianas Luca , Frexia Francesca , Nicolosi Pier Andrea , Monti Tommaso , Bussolati Benedetta , Marchiò Caterina , Bussolati Gianni
Published: May 2023

Formalin, an aqueous solution of formaldehyde, has been the gold standard for fixation of histological samples for over a century. Despite its considerable advantages, growing evidence points to objective toxicity, particularly highlighting its carcinogenicity and mutagenic effects. In 2016, European Union proposed a ban, but a temporary permission was granted in consideration of its fundamental role in the medical-diagnostic field.

In the present study, we tested an innovative fixative, Glyoxal Acid-Free (GAF) (a glyoxal solution deprived of acids), which allows optimal tissue fixation at structural and molecular level combined with the absence of toxicity and carcinogenic activity. An open label, non-inferiority, multicentric trial was performed comparing fixation of histological specimens with GAF fixative vs standard Phosphate Buffered Formalin (PBF), evaluating the morphological preservation and the diagnostic value with four binary score questions answered by both the central pathology reviewer and local centre reviewers. The mean of total score in the GAF vs PBF fixative groups was 3.7 ± 0.5 vs 3.9 ±0.3 for the central reviewer and 3.8 ± 0.5 vs 4.0 ±0.1 for the local pathologist reviewers, respectively. In terms of median value, similar results were observed between the two fixative groups, with a median value of 4.0. Data collected indicate the non-inferiority of GAF as compared to PBF for all organ tested. The present clinical performance study, performed following the international standard for performance evaluation ofin vitrodiagnostic medical devices, highlights the capability of GAF to ensure both, structural preservation and diagnostic value of the preparations.
Optimal Non-Pharmaceutical Interventions Considering Limited Healthcare System Capacity and Economic Costs in the Republic of Korea
Authors: Lim Yuna , Ko Youngsuk , Mendoza Renier , Mendoza Victoria May P. , Lee Jongmin , Jung Eunok
Published: May 2023

Due to the relatively low severity and fatality rates of the omicron variant of COVID-19, strict non-pharmaceutical interventions (NPIs) with high economic costs may not be necessary. We develop a mathematical model of the COVID-19 outbreak in Korea that considers NPIs, variants, medical capacity, and economic costs. Using optimal control theory, we propose an optimal strategy for the omicron period. To suggest a realistic strategy, we consider limited hospital beds for severe cases and incorporate it as a penalty term in the objective functional using a logistic function. This transforms the constrained problem into an unconstrained one. Given that the solution to the optimal control problem is continuous, we propose the adoption of a sub-optimal control as a more practically implementable alternative. Our study demonstrates how to strategically balance the tradeoff between minimizing the economic cost for NPIs and ensuring that the number of severe cases in hospitals is manageable.
Neural Network Models for Sequence-Based TCR and HLA Association Prediction
Authors: Liu Si , Bradley Philip , Sun Wei
Published: May 2023

T cells rely on their T cell receptors (TCRs) to recognize foreign antigens presented by human leukocyte antigen (HLA) proteins. TCRs contain a record of an individual’s past immune activities, and some TCRs are observed only in individuals with certain HLA alleles. As a result, characterising TCRs requires a thorough understanding of TCR-HLA associations. To this end, we propose a neural network method named Deep learning Prediction of TCR-HLA association (DePTH) to predict TCR-HLA associations based on their amino acid sequences. We show that the DePTH can be used to quantify the functional similarities of HLA alleles, and that these HLA similarities are associated with the survival outcomes of cancer patients who received immune checkpoint blockade treatment.
Evolution of transient RNA structure-RNA polymerase interactions in respiratory RNA virus genomes
Authors: Rigby Charlotte , Sabsay Kimberly , Bisht Karishma , Eggink Dirk , Jalal Hamid , te Velthuis Aartjan J.W.
Published: May 2023

RNA viruses are important human pathogens that cause seasonal epidemics and occasional pandemics. Examples are influenza A viruses (IAV) and coronaviruses (CoV). When emerging IAV and CoV spill over to humans, they adapt to evade immune responses and optimize their replication and spread in human cells. In IAV, adaptation occurs in all viral proteins, including the viral ribonucleoprotein (RNP) complex. RNPs consists of a copy of the viral RNA polymerase, a double-helical coil of nucleoprotein, and one of the eight segments of the IAV RNA genome. The RNA segments and their transcripts are partially structured to coordinate the packaging of the viral genome and modulate viral mRNA translation. In addition, RNA structures can affect the efficiency of viral RNA synthesis and the activation of host innate immune response. Here, we investigated if RNA structures that modulate IAV replication processivity, so called template loops (t-loops), vary during the adaptation of pandemic and emerging IAV to humans. Using cell culture-based replication assays andin silicosequence analyses, we find that the sensitivity of the IAV H3N2 RNA polymerase to t-loops increased between isolates from 1968 and 2017, whereas the total free energy of t-loops in the IAV H3N2 genome was reduced. This reduction is particularly prominent in the PB1 gene. In H1N1 IAV, we find two separate reductions in t-loop free energy, one following the 1918 pandemic and one following the 2009 pandemic. No destabilization of t-loops is observed in the IBV genome, whereas analysis of SARS-CoV-2 isolates reveals destabilization of viral RNA structures. Overall, we propose that a loss of free energy in the RNA genome of emerging respiratory RNA viruses may contribute to the adaption of these viruses to the human population.
Single cell transcriptome analysis of cavernous tissues reveals the key roles of pericytes in diabetic erectile dysfunction
Authors: Bae Seo-Gyeong , Yin Guo Nan , Ock Jiyeon , Suh Jun-Kyu , Ryu Ji-Kan , Park Jihwan
Published: May 2023

Erectile dysfunction (ED) affects a significant proportion of men aged 40–70 and is caused by cavernous tissue dysfunction. Presently, the most common treatment for ED is phosphodiesterase 5 inhibitors; however, this is less effective in patients with severe vascular disease such as diabetic ED. Therefore, there is a need for development of new treatment, which requires a better understanding of the cavernous microenvironment and cell-cell communications under diabetic condition. Pericytes are vital in penile erection; however, their dysfunction due to diabetes remains unclear. In this study, we performed single-cell RNA sequencing to understand the cellular landscape of cavernous tissues and cell type-specific transcriptional changes in diabetic ED. We found a decreased expression of genes associated with collagen or extracellular matrix organization and angiogenesis in diabetic fibroblasts, chondrocytes, myofibroblasts, valve-related lymphatic endothelial cells, and pericytes. Moreover, the newly identified pericyte-specific marker, Limb-bud and Heart (Lbh), in mouse and human cavernous tissues, clearly distinguishing pericytes from smooth muscle cells. Cell–cell interaction analysis revealed that pericytes are involved in angiogenesis, adhesion, and migration by communicating with other cell types in the corpus cavernosum; however, these interactions were highly reduced under diabetic conditions. Lbh expression is low in diabetic pericytes, and overexpression of LBH prevents erectile function by regulating neurovascular regeneration. Furthermore, the LBH-interacting proteins (Crystallin Alpha B and Vimentin) were identified in mouse cavernous pericytes through LC-MS/MS analysis, indicating that their interactions were critical for maintaining pericyte function. Thus, our study reveals novel targets and insights into the pathogenesis of ED in patients with diabetes.

Impact statement:

Single-cell RNA sequencing analysis of diabetic mouse cavernous tissue revealed that LBH as a novel pericyte marker and may interact with Crystallin Alpha B and Vimentin to promote neurovascular regeneration.