bluuebunny/crossref_metadata_2025 huggingface dataset:
P193 The value of 12-lead electrocardiogram in secundum atrial defect with pulmonary hypertension
Authors: Santoso J O S , Prakoso R P , Simamora R S , Muliawan H S M , Siswanto B B S
Published: January 2020

Background

Pulmonary hypertension is a serious complication that can develop in patients with secundum Atrial Septal Defect (ASD) and based on Euro Heart Survey, 24,77% of ASD patients develop PH. The gold-standard for the diagnosis of pulmonary hypertension in ASD is right heart catheterization. However, in low-middle income country like Indonesia, right heart catheterization only available in a few centers while Indonesia is often referred as the world’s largest archipelago. Thus, there is a huge number of undiagnosed and untreated patients with ASD-PH in Indonesia, especially in patients who lives in rural and isolated area. This research was initiated to investigate the diagnostic value of simple 12-lead ECG in the diagnosis of pulmonary hypertension in ASD with the intention to help doctors in isolated area.

Method

We performed a cross-sectional study analyzing the 12-lead ECG and mean arterial pressure collected from right heart catheterization from 120 patients with secundum ASD aged > 18 years old. The 12-lead ECG collected within 24 hours before RHC procedure.

Results

We analyzed the ECG and RHC from 60 subjects diagnosed with pulmonary hypertension and 60 subjects without pulmonary hypertension. We found that R in lead V1 + S in lead V6> 12,5 mV, right axis deviation (RAD), and RV strain were independent predictors of pulmonary hypertension in secundum ASD. Based on Receiver Operator Characteristics (ROC), we obtained that R in V1 + S in V6> 12,5 mm, right axis deviation (RAD), and RV strain has an Area Under of Curve (AUC) of 80,8%, 70,5%, and 85,6% respectively. We developed a scoring system and a score of >5 have a sensitivity of 90%, specificity of 84,4%, positive predictive value of 84,4%, negative predictive value of 90%, and accuracy of 87,1%. We also developed a predictor for pulmonary vascular disease (low flow and high resistance PH) to predict wether the defect can be closed. We obtained that R in V6 + S in V6 > 27,5 mm can predict a low flow high resistance pulmonary hypertension in secundum ASD with an AUC of 77,1% (CI 95% 58-96,1%)

Conclusion

ECG score of 12-lead ECG derived from this study can be used to predict PH in secundum ASD. It may help cardiologists or general practitioners in rural and isolated area to diagnose pulmonary hypertension in ASD and plan the best management for the patients.
P204 Automated detection of atrial fibrillation based on stationary wavelet transform and artificial neural network targeted for embedded system-on-chip technology
Authors: Hau Y W , Lim H W , Lim C W , Kasim S
Published: January 2020

Stroke is one of the most severe cardiovascular disease which can potentially cause permanent disability. Atrial Fibrillation (AF) is one of the major risk factors of stroke that can be detected from electrocardiogram (ECG) monitoring. 

Objective

This study proposed an AF detection algorithm based on stationary wavelet transform (SWT) and artificial neural network (ANN) for screening purpose. The algorithm is aimed for embedded System-on-Chip (SoC) technology deployment as a standalone AF classifier for community in rural area where the internet infrastructure may not well established.

Methods

After standard ECG signal pre-processing, SWT is applied to filtered ECG and produces 12 sets of primary features in time-frequency domain. The power spectral density (PSD) and log energy entropy (LogEn) were calculated from these 12 sets of primary features, to measure atrial activity fall in frequency range of 4 to 9 Hz, and the randomness of an ECG signal caused by AF, respectively. Finally, the ANN classifier recognizes the pattern of AF based on high atrial activity and randomness of ECG signal. Algorithm exploration is carried out to determine the optimum parameter value which can yield the best classification and suitable to be implemented in embedded SoC technology for real-time computation performance. ECG training and testing datasets of the proposed AF detection algorithm were extracted from MIT-BIH Atrial Fibrillation Database which consists of 23 ECG record with each record contains a 10 hours ECG data. 

Results

AF detection accuracy is 95.3% which was able to classify an ECG signal into categories of AF, sinus rhythm, and other arrhythmia. 

Conclusion

The proposed AF detection algorithm based on combination of SWT and ANN can achieve high accuracy and is suitable to be implemented as a standalone AF classifier based on embedded SoC technology targeted for early detection of AF in the community.
P253 Withdrawal of beta- blockers and ACE inhibitors after left ventricular systolic function recovery in patient with dilated cardiomyopathy randomized control trial
Authors: Bakhsh A , Thanassoulis G , Engert J C , Elstein E , Huynh T , Giannetti N
Published: January 2020

Funding Acknowledgements

The Rosenfeld Heart Fund

Introduction

recovery of left ventricle (LV) systolic function with normalization of ejection fraction (LVEF) occurs in 10 - 27% of patients with 80% maintaining recovery. However, the need for medical therapy after recovery is often questioned. Previous randomized studies of treatment withdrawal were small, not selected for non-ischemic dilated cardiomyopathy (DCM) and had a reference of improved or recovered EF to > 40% or > 10% change from LVEF at time of diagnosis.  Hypothesis: In patients with DCM with recovery of the LV systolic function to an EF (>50%), medical therapy withdrawal is possible without rebound LV systolic dysfunction. Method: This was a pilot randomized control open-label trial with 2:1 randomization for withdrawal of b-blockers and ACE inhibitors in patients with recovered LV systolic function. Patients’ medication discontinuation occurred in 2 phases with a six-month interval and patients were followed for one year. The primary endpoint was LVEF reduction (< 40%). Results: There were 22 patients (10 females) enrolled. The mean age was 60 ± 12y. The mean LVEF at enrollment was 58 ± 5% with no significant difference in the mean LVEF in both groups. Sixteen patients were assigned to the withdrawal group and 6 assigned to the control group. The primary endpoint occurred in 31% of the withdrawal group compared to none of the control. The rate of 1ry outcome after withdrawal of medical therapy was 19%, p-value 0.15. The mean LVEF at 1 year for the treatment withdrawal group was 46.8 ± 12% and control 55 ± 6%, p-value 0.15. In the medication withdrawal group, the mean LVEF reduction was 10.6 ± 11% and the difference between the mean LVEF at enrollment and at 1 year was 10.6 ± 11% with 95% CI (4.6,16.49), p-value 0.0017. Conclusion: In DCM patients with recovery of LV systolic function, we observed worsening of LVEF after withdrawal of b-blockers and ACE inhibitors.

Abstract P253 Figure.
P278 Pharmacokinetics, pharmacodynamics and efficacy of OPC-61815, prodrug of tolvaptan for intravenous administration, in patients with congestive heart failure
Authors: Sato N , Uno S , Yamasaki Y , Watanabe S , Hirano T
Published: January 2020

Funding Acknowledgements

Otsuka Pharmaceutical Co. Ltd.

On Behalf

OPC-61815 phase II investigators

Background/Introduction: Tolvaptan, a vasopression V2-receptor antagonist, is effective for congestion in patients with congestive heart failure (CHF), and hyponatremia in patients with CHF and SIADH. But, this drug is not readily soluble in water and not suited for development as an injection. OPC-61815, a prodrug of tolvaptan having improved water solubility, is suitable for intravenous administration.

Purpose

The phase-II clinical study (ClinicalTrials.gov Identifier: NCT03254108) was conducted to investigate the dose for intravenous administration of OPC-61815 achieving tolvaptan exposure equivalent to that for oral administration of tolvaptan 15-mg tablet in CHF patients.

Methods

This study was a multicenter, a double-blind, randomized, active-controlled, parallel-group comparison clinical pharmacology trial. Sixty patients aged between 20 and 85 years with CHF with volume overload despite the use of conventional diuretics were randomly assigned to four treatment cohorts to receive OPC-61815 at doses of 2, 4, 8, 16 mg (i.v.) or tolvaptan at 15 mg (p.o.). Both drugs were administered once a day for 5 days. The primary endpoint was to assess the dose of OPC-61815 equivalent to tolvaptan at 15 mg using Cmax and AUC24h values after the first administration. Pharmacodynamics (urine volume, urine osmolality, serum electrolyte concentration, biomarkers), efficacy (body weight change, congestive symptoms) and safety were also evaluated.

Results

The mean Cmax and AUC of the metabolite tolvaptan increased dose-dependently following single intravenous administration of OPC-61815 at 2, 4, 8, and 16 mg. Tolvaptan exposure (Cmax and AUC24h) on Day 1 following single intravenous administration of OPC-61815 at 16 mg was the closest and similar to that following single administration of tolvaptan 15-mg tablet. OPC-61815 increased urine volume from baseline, leading to decrease in body weight and improvement of lower limb edema. The incidence of treatment-emergent adverse events was 54.2% (26/48 subjects) in the OPC-61815 2 to 16-mg, and 83.3% (10/12 subjects) in the tolvaptan 15-mg groups. No clinically relevant changes from baseline were found in laboratory parameters, vital signs, or ECG findings.

Conclusions

Tolvaptan exposure on Day 1 following single intravenous administration of OPC-61815 at 16 mg was the most similar to that following single administration of tolvaptan 15-mg tablet. There was no marked difference in tolerability between OPC-61815 at 16 mg and tolvaptan 15-mg tablet, and no clinically significant problems were observed.
A case report of an acute coronary syndrome in a 10-year-old boy with homozygous familial hypercholesterolaemia
Authors: Leclercq Thibault , Falcon-Eicher Sylvie , Farnier Michel , Le Bret Emmanuel , Maudinas Raphaëlle , Litzler-Renault Stéphanie , Mousson Christiane , Lorgis Luc , Cottin Yves
Published: January 2020

Background

Familial hypercholesterolaemia is a well-known disorder, but clinical diagnoses tend to be delayed. Acute coronary syndrome may occur in childhood.

Case summary

Our patient, a young boy with homozygous familial hypercholesterolaemia, complained of persistent chest pain at rest and suffered a non-ST-elevation myocardial infarction (NSTEMI). The diagnosis of NSTEMI was made on the basis of his clinical features, dynamic electrocardiogram changes, troponin elevation, and cardiac computed tomography findings. The patient was managed surgically by intrathoracic artery (ITA) bypass graft. During post-operative follow-up, the young patient suffered from angina pectoris from unexpected and exceptional atheroma stenosis on the ITA.

Discussion

Familial hypercholesterolaemia needs to be identified quickly in young patients and lipid lowering therapies should be started without delay.
Comparison of P2Y12 receptor inhibitors in patients with ST-elevation myocardial infarction in clinical practice: a propensity score analysis of five contemporary European registries
Authors: De Luca Leonardo , Zeymer Uwe , Claeys Marc J , Dörler Jakob , Erne Paul , Matter Christian M , Radovanovic Dragana , Weidinger Franz , Lüscher Thomas F , Jukema Johan Wouter ,   the PIRAEUS group
Published: January 2020

Aims

Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. Recent randomized clinical trials have demonstrated that novel antithrombotic therapies improve in-hospital outcomes in STEMI patients. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in clinical practice in patients with STEMI based on data from contemporary European ACS registries.

Methods and results

Five registries from the PIRAEUS initiative (AAPCI/ADPAT, ALKK-PIC, AMIS Plus, Belgium STEMI, and EYESHOT) provided data for the assessment of P2Y12 receptor inhibitor-based dual antiplatelet therapy. Registries were heterogeneous in terms of setting, patient characteristics, and treatment selection. Matched pair analysis and propensity score matching were used to assess all-cause in-hospital death rates based on data from 25 250 patients (8577 patients on prasugrel, 5995 on ticagrelor, and 10 678 on clopidogrel). The odds ratio (OR) for the death of any cause when compared with clopidogrel was 0.72 [95% confidence interval (CI) 0.62–0.84, P < 0.001] in favour of the new P2Y12 receptor inhibitors (prasugrel and ticagrelor combined). In the comparison between prasugrel and ticagrelor, there were no relevant differences (OR 0.97, 95% CI 0.77–1.23; P = 0.81). Event rates of cardiovascular death and stroke were also substantially lower for the new P2Y12 receptor inhibitors. The differences between clopidogrel and prasugrel or ticagrelor on major bleeding were numerically in the same order as for death of any cause but were not statistically significant. No differences in ischaemic and bleeding outcomes were observed between prasugrel and ticagrelor.

Conclusion

This analysis suggests that the prasugrel or ticagrelor compared with clopidogrel have favourable outcomes in clinical practice while not being inferior in terms of safety.
Integrating mathematical models with experimental data to investigate the within-host dynamics of bacterial infections
Authors: Vlazaki Myrto , Huber John , Restif Olivier
Published: January 2020

Bacterial infections still constitute a major cause of mortality and morbidity worldwide. The unavailability of therapeutics, antimicrobial resistance and the chronicity of infections due to incomplete clearance contribute to this phenomenon. Despite the progress in antimicrobial and vaccine development, knowledge about the effect that therapeutics have on the host–bacteria interactions remains incomplete. Insights into the characteristics of bacterial colonization and migration between tissues and the relationship between replication and host- or therapeutically induced killing can enable efficient design of treatment approaches. Recently, innovative experimental techniques have generated data enabling the qualitative characterization of aspects of bacterial dynamics. Here, we argue that mathematical modeling as an adjunct to experimental data can enrich the biological insight that these data provide. However, due to limited interdisciplinary training, efforts to combine the two remain limited. To promote this dialogue, we provide a categorization of modeling approaches highlighting their relationship to data generated by a range of experimental techniques in the area of in vivo bacterial dynamics. We outline common biological themes explored using mathematical models with case studies across all pathogen classes. Finally, this review advocates multidisciplinary integration to improve our mechanistic understanding of bacterial infections and guide the use of existing or new therapies.
Effects of diet type on nutrient utilization and energy balance in drylot heifers1
Authors: Baber Jessica R , Wickersham Tryon A , Sawyer Jason E , Freetly Harvey C , Brown-Brandl Tami M , Hales Kristin E
Published: January 2020

Feeding cattle in intensified settings allows cow-calf producers to decrease their reliance on grazed forage and utilize alternative feedstuffs. During times of intense management, diet type may alter energy utilization. Fourteen pregnant MARC III heifers (405 ± 44 kg BW) were used in a 180 d experiment to determine effects of diet type on nutrient and energy utilization. Heifers were randomly assigned to one of two treatments, a forage diet (FOR; 2.10 Mcal metabolizable energy [ME]/kg; 95.75% forage) or a concentrate diet (CONC; 2.94 Mcal ME/kg; 71% concentrate), and individually fed to meet maintenance energy requirements (0.135 Mcal ME/kg BW0.75). The CONC diet contained dry-rolled corn, corn stalks (10.16 cm grind size), soybean meal, corn silage (approximately 45% corn grain; stored in a plastic bag), dicalcium phosphate, urea, and a premix pellet; FOR contained alfalfa hay (harvested at mid-bloom), corn silage, dicalcium phosphate, and a premix pellet. Measurements of energy intake and digestibility were measured over a 4-d period on days 116, 172, and 235 of gestation. Using portable headbox calorimeters, measurements of O2, CO2, and CH4 gases were collected over a period of 24 h. Data were analyzed in a completely randomized design with diet as fixed effect. Dry matter and organic matter digestibility were greater for CONC than FOR (P < 0.01). Intake of gross energy (GE) and digestible energy (DE) were greater for FOR (P < 0.01), but by design, ME intake was not different between treatments (P = 0.26). Energy lost as methane (% of GE intake) was not different between treatments (P = 0.49). The ratio of ME to DE was greater for CONC (86.8 vs. 82.8; P = 0.01) than FOR. Heat production relative to ME was not different between treatments (P = 0.85). Maternal tissue energy did not differ and was 1.2 Mcal/d for CONC and 0.9 Mcal/d for FOR (P = 0.73). Greater nitrogen (N) consumption was observed for FOR (192.2 g/d) than CONC (134.0 g/d; P < 0.01), and retained N was greater for FOR than CONC (P < 0.01) on days 116 and 235 of gestation. Neither concentrate-based or forage-based diets affected body condition score (P = 0.26). Heifers fed concentrate-based diets retained more energy in part because they had larger calves, but this energy was not recovered in maternal tissue.
Efficacy of statistical process control procedures to identify deviations in continuously measured physiologic and behavioral variables in beef steers experimentally challenged with Mannheimia haemolytica
Authors: Kayser William C , Carstens Gordon E , Parsons Ira L , Washburn Kevin E , Lawhon Sara D , Pinchak William E , Chevaux Eric , Skidmore Andrew L
Published: January 2020

The objective of this experiment was to determine if statistical process control (SPC) procedures coupled with the remote continuous collection of feeding behavior patterns, accelerometer-based behaviors, and rumen temperature can accurately differentiate between animals experimentally inoculated with Mannheimia haemolytica (MH) or PBS. Thirty-six crossbred steers (BW = 352 ± 23 kg) seronegative for MH were randomly assigned to bronchoselective endoscopic inoculation with MH (n = 18) or PBS (n = 18). Electronic feed bunks were used to measure DMI and feeding behavior traits, accelerometer-based neck collars measured feeding- and activity-behavior traits, and ruminal thermo-boluses measured rumen temperature. Data were collected for 28 d prior to and following inoculation. Steers inoculated with MH exhibited elevated (P < 0.02) levels of neutrophils and rumen temperature indicating that MH challenge effectively stimulated immunologic responses. However, only nine of the MH steers exhibited increased serum haptoglobin concentrations indicative of an acute-phase protein response and one displayed clinical signs of disease. Shewhart charts (SPC procedure) were used for two analyses, and sensitivity was computed using all MH-challenged steers (n = 18), and a subset that included only MH-challenged haptoglobin-responsive steers (n = 9). Specificity was calculated using all PBS steers in both analyses. In the haptoglobin-responsive only analysis, DMI and bunk visit (BV) duration had the greatest accuracy (89%), with accuracies for head-down (HD) duration, BV frequency, time to bunk, and eating rate being less (83%, 69%, 53%, and 61%, respectively). To address the diurnal nature of rumen temperature, data were averaged over 6-h intervals, and quarterly temperature models were evaluated separately. Accuracy for the fourth quarter rumen temperature was higher (78%) than the other quarterly temperature periods (first = 56%, second = 50%, and third = 67%). In general, the accelerometer-based behavior traits were highly specific ranging from 82% for ingestion to 100% for rest, rumination, and standing. However, the sensitivity of these traits was low (0% to 50%), such that the accuracies were moderate compared with feeding behavior and rumen temperature response variables. These results indicate that Shewhart procedures can effectively identify deviations in feeding behavior and rumen temperature patterns to enable subclinical detection of BRD in beef cattle.
Viral Tropism in Human Immunodeficiency Virus Type 1–Infected Children and Adolescents in Thailand
Authors: Arayapong Natt , Pasomsub Ekawat , Kanlayanadonkit Rujikorn , Keatkla Jiraporn , Techasaensiri Chonnamet , Phuphuakrat Angsana , Sungkanuparph Somnuek , Apiwattanakul Nopporn , Chaisavaneeyakorn Sujittra
Published: January 2020

Background

Maraviroc, a C-C chemokine receptor 5 (CCR5) antagonist, has been used as an alternative antiretroviral drug in treatment-experienced adults and children infected by CCR5-tropic human immunodeficiency virus type 1 (HIV-1) isolates. Prior to widespread use of this drug, rates of HIV-1 coreceptor tropism and factors associated with coreceptor tropism had to be determined.

Methods

HIV-1–infected individuals aged <20 years with HIV-1 viral loads >1000 RNA copies/mL who were treatment-experienced or treatment-naive were enrolled. HIV-1 coreceptor tropism was determined using a genotypic test in which V3 sequences were analyzed with GENO2PHENO version 2.5 and a false discovery rate of 5%.

Results

Fifty-two HIV-1–infected patients were recruited. The median age of participants was 14.9 years (interquartile range [IQR], 8.9–16.8 years). The median CD4 cell count was 396.0 cells/µL (IQR, 72.0–630.3 cells/µL). The median HIV-1 viral load was 43 339 RNA copies/mL (IQR, 8874–197 055 copies/mL). Thirty-nine patients (75%) were treatment-experienced. The most prevalent HIV-1 subtype in this population was CRF01_AE (36 patients, 69.2%). Based on analyses of V3 loop sequences, 5 of 13 treatment-naive patients (38.5%) and 11 of 39 treatment-experienced patients (28.2%) were infected by R5 viruses, while 7 of 13 treatment-naive patients (53.8%) and 19 of 39 treatment-experienced patients (48.7%) were infected by X4 viruses. The only factor associated with the presence of X4 viruses was HIV-1 subtype CRF01_AE.

Conclusions

X4-tropic viruses are associated with the CRF01_AE subtype. Hence, testing of HIV tropism should be performed before treatment with CCR5 inhibitors in children in areas where CRF01_AE predominates.
Live-cell imaging of early events following pollen perception in self-incompatible Arabidopsis thaliana
Authors: Rozier Frédérique , Riglet Lucie , Kodera Chie , Bayle Vincent , Durand Eléonore , Schnabel Jonathan , Gaude Thierry , Fobis-Loisy Isabelle
Published: January 2020

Early events occurring at the surface of the female organ are critical for plant reproduction, especially in species with a dry stigma. After landing on the stigmatic papilla cells, the pollen hydrates and germinates a tube, which penetrates the cell wall and grows towards the ovules to convey the male gametes to the embryo sac. In self-incompatible species within the Brassicaceae, these processes are blocked when the stigma encounters an incompatible pollen. Based on the generation of self-incompatible Arabidopsis lines and by setting up a live imaging system, we showed that control of pollen hydration has a central role in pollen selectivity. The faster the pollen pumps water from the papilla during an initial period of 10 min, the faster it germinates. Furthermore, we found that the self-incompatibility barriers act to block the proper hydration of incompatible pollen and, when hydration is promoted by high humidity, an additional control prevents pollen tube penetration into the stigmatic wall. In papilla cells, actin bundles focalize at the contact site with the compatible pollen but not with the incompatible pollen, raising the possibility that stigmatic cells react to the mechanical pressure applied by the invading growing tube.
The non-photochemical quenching protein LHCSR3 prevents oxygen-dependent photoinhibition in Chlamydomonas reinhardtii
Authors: Roach Thomas , Na Chae Sun , Stöggl Wolfgang , Krieger-Liszkay Anja
Published: January 2020

Non-photochemical quenching (NPQ) helps dissipate surplus light energy, preventing formation of reactive oxygen species (ROS). In Chlamydomonas reinhardtii, the thylakoid membrane protein LHCSR3 is involved in pH-dependent (qE-type) NPQ, lacking in the npq4 mutant. Preventing PSII repair revealed that npq4 lost PSII activity faster than the wild type (WT) in elevated O2, while no difference between strains was observed in O2-depleted conditions. Low Fv/Fm values remained 1.5 h after moving cells out of high light, and this qH-type quenching was independent of LHCSR3 and not accompanied by losses of maximum PSII activity. Culturing cells in historic O2 atmospheres (30–35%) increased the qE of cells, due to increased LHCSR1 and PsbS levels, and LHCSR3 in the WT, showing that atmospheric O2 tensions regulate qE capacity. Colony growth of npq4 was severely restricted at elevated O2, and npq4 accumulated more reactive electrophile species (RES) than the WT, which could damage PSI. Levels of PsaA (PSI) were lower in npq4 grown at 35% O2, while PsbA (PSII) levels remained stable. We conclude that even at high O2 concentrations, the PSII repair cycle is sufficient to maintain net levels of PSII. However, LHCSR3 has an important function in protecting PSI against O2-mediated damage, such as via RES.
Critical length in long-read resequencing
Authors: De Coster Wouter , Strazisar Mojca , De Rijk Peter
Published: January 2020

Long-read sequencing has substantial advantages for structural variant discovery and phasing of variants compared to short-read technologies, but the required and optimal read length has not been assessed. In this work, we used long reads simulated from human genomes and evaluated structural variant discovery and variant phasing using current best practice bioinformatics methods. We determined that optimal discovery of structural variants from human genomes can be obtained with reads of minimally 20 kb. Haplotyping variants across genes only reaches its optimum from reads of 100 kb. These findings are important for the design of future long-read sequencing projects.
Concussion Clinical Profiles Screening (CP Screen) Tool: Preliminary Evidence to Inform a Multidisciplinary Approach
Authors: Kontos Anthony P , Elbin R J , Trbovich Alicia , Womble Melissa , Said Azkya , Sumrok Vanessa Fazio , French Jonathan , Kegel Nathan , Puskar Alicia , Sherry Natalie , Holland Cyndi , Collins Michael
Published: January 2020

BACKGROUND

Current concussion symptom inventories emphasize total number or symptoms and severity and overlap with other conditions, such as mental health disorders, which may limit their specificity and clinical utility.

OBJECTIVE

To develop and test the reliability and validity of a new Concussion Clinical Profiles Screening tool (CP Screen) in both healthy controls and concussed.

METHODS

CP Screen is a 29-item self-report, clinical profile-based symptom inventory that measures the following 5 concussion clinical profiles: 1) anxiety/mood, 2) cognitive/fatigue, 3) migraine, 4) ocular, and 5) vestibular; and the following 2 modifying factors: 1) sleep and 2) neck. Post-Concussion Symptom Scale (PCSS), vestibular/ocular motor screening (VOMS) tool, and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) were conducted. CP Screen was administered in community a concussion surveillance program and 2 sports medicine concussion clinics. Responses include 248 athletes, 121 concussed, and 127 controls, enrolled between 2018 and 2019.

RESULTS

Internal consistency of the CP Screen in the control (Cronbach's alpha = .87) and concussed (Cronbach's alpha = .93) samples was high. Moderate to high correlations among the CP Screen factors and PCSS factors and VOMS items, supporting concurrent validity. ROC curve analysis for identifying concussed from controls was significant (P < .001) for all CP Screen factor and modifier scores with excellent AUCs for migraine (.93), ocular (.88), vestibular (.85), and cognitive (.81) factors, demonstrating predictive validity.

CONCLUSION

The CP Screen demonstrated strong reliability, concurrent validity with commonly used concussion assessment (ie, PCSS, VOMS, and ImPACT), and predictive validity for identifying concussion. The CP Screen extends current symptom inventories by evaluating more specific symptoms that may reflect clinical profiles and inform better clinical care.
Risk of New Fractures in Vertebroplasty for Multiple Myeloma. A Retrospective Study
Authors: Rocha Romero Andrés , Hernández-Porras Berenice Carolina , Plancarte-Sanchez Ricardo , Espinoza-Zamora José Ramiro , Carvajal Gabriel , Ramos Natarén Reyna Guadalupe , De Los Reyes Pacheco Victor Alfonso , Salazar Carrera Ivan Hamiyd
Published: January 2020

Objective

Vertebroplasty is a percutaneous minimally invasive procedure indicated for vertebral collapse pain treatment. Among the known complications of the procedure is the augmented risk of new vertebral fractures. There are no specific studies in this patient population describing the risk of new vertebral fractures after vertebroplasty. This study analyzed risk factors associated with new vertebral fractures after vertebroplasty in patients with multiple myeloma.

Methods

Observational retrospective study in patients with multiple myeloma. The data collection took place from January 1, 2010, to December 30, 2017, at the National Cancer Institute. Clinical data and procedural variables such as cement volume, cement leaks, fracture level, number of treated vertebrae, pedicular disease, and cement distribution pattern, with two years follow-up, were analyzed with the Wilcoxon test, and a logistic regression model was used to identify risk factors related to new vertebral fractures. A confidence interval of 95% was used for analysis.

Results

At one-year follow-up, 30% of fractures were reported after vertebroplasty, most of them at low thoracic and lumbar level (50% adjacent level). Vertebroplasty was most commonly performed at the thoracolumbar and lumbar area. We demonstrated a 70.7% median numerical rating scale reduction at one-year follow-up; a significant decrease in opioid consumption occurred only during the first month.

Conclusions

Pedicle involvement, disc leakage, cement volume, thoracolumbar and lumbar level, and number of treated vertebrae by intervention are important risk factors when performing vertebroplasty. Prospective randomized studies are needed to evaluate these factors in this specific population.
The Role of Government in Firm Outcomes
Authors: Duchin Ran , Gao Zhenyu , Shu Haibing
Published: January 2020

Using a unique setting in China, where the geographic distance between collective firms and local governments is highly persistent because of legal restrictions on land ownership and mobility, we investigate the role of government involvement in small firms. In our analysis of survey responses, we find that weaker government involvement, measured by greater distance from government, is associated with higher firm autonomy and reduced taxes, protectionism, and anticompetitive behavior. In our analysis of firm-level financial data, we find that distant firms have better operating performance, higher growth, and higher entry rates. We find similar results around exogenous government office relocations.
Comparison of the effect of tildipirosin administered alone or in combination with transdermal flunixin on the performance, health, activity, and well-being of transported feedlot calves on arrival at the feedlot
Authors: Martin Miriam , Kleinhenz Michael , Kleinhenz Katie , Reppert Emily , Blasi Dale , Parks Timothy , Baysinger Angela , Hutcheson John , Coetzee Johann
Published: January 2020

Long distance transportation can be a significant source of stress to cattle and is associated with increased risk of bovine respiratory disease (BRD). The administration of a nonsteroidal anti-inflammatory drug (NSAID) has been shown to reduce stress following long distance transport. The objective of this study was to compare performance, health, accelerometer activity, and well-being between calves receiving either tildipirosin (Zuprevo 18%; Merck Animal Health, Madison, NJ) alone or in combination with transdermal flunixin (BANAMINE Transdermal Pour-on Solution; Merck Animal Health, Madison, NJ) on arrival at the feedlot. Three hundred eighty-four polled, Continental × English, and English crossbred bulls (n = 199) and steers (n = 185) were enrolled into one of two treatments: 1) tildipirosin administered in the neck as a single dose of 4 mg/kg only (PLBO) 2) tildipirosin in combination with transdermal flunixin applied to the dorsal midline at a dose of 3.3 mg/kg (FTD). Outcomes measured were average daily gain (ADG), dry mater intake (DMI), gain to feed, morbidity, mortality, accelerometer activity data, and a daily visual analog scale (VAS) assessment of well-being. Body weight (BW) was determined by weighing individual animals; ADG was calculated as initial BW—final BW / total days on feed; DMI was calculated as daily pen feed allocation—feed remaining at next feeding / number of calves in the pen; and gain to feed was calculated as pen level ADG / pen level DMI. The VAS used was a 100 mm line anchored at each end by descriptors of “no pain” or “severe pain”. Statistical analysis was performed using JMP 13 computer software using pen as the experimental unit, lot number as a random variable, and treatment as a fixed variable. There was no treatment effect on DMI (P = 0.51). During the first 14 d on feed, FTD calves had a lower ADG of 0.90 kg/d compared with 1.33 kg/d in the PLBO group (P = 0.05). There were no differences observed in morbidity and mortality between groups (P = 0.29). There were no treatment differences from activity data (P = 0.19). The VAS assessment showed a significant time × treatment interaction (P < 0.001). During the first 36 h after treatment administration, the FTD-treated calves had lower VAS scores [6.23 (95% CI: 5.27–7.20) compared with 7.28 (95% CI: 6.32–8.24)] than PLBO (P < 0.05). Results suggest that FTD-treated calves showed less signs of pain the first 36 h postdrug application relative to PLBO calves.
Using Clinical Profiles and Complete Blood Counts to Differentiate Causes of Acute Febrile Illness during the 2009–11 Outbreak of Typhoid and Chikungunya in a Dengue Endemic Area
Authors: Laoprasopwattana Kamolwish , Limpitikul Wannee , Geater Alan
Published: January 2020

Background and aims

After the 2009–11 outbreak of typhoid and chikungunya (CHIK) in Thailand, an effort was made to use complete blood counts and clinical profiles to differentiate these diseases to facilitate earlier specific treatment.

Methods

Patients aged 2–15 years having fever on first visit ≤3 days without localizing signs were enrolled retrospectively. Typhoid fever was confirmed by hemoculture, dengue by nonstructural protein-1 or polymerase chain reaction (PCR), and CHIK by PCR. Febrile children with negative results for these infections were classified as other acute febrile illness (AFI).

Results

Of the 264 cases, 56, 164, 25 and 19 had typhoid fever, dengue viral infection (DVI), CHIK and other AFI, respectively. Arthralgia had sensitivity, specificity, positive predictive value (PPV) and negative predictive value of 0.96, 0.97, 0.80 and 0.99, respectively, to differentiate CHIK from the others. After excluding CHIK by arthralgia, the PPV of the WHO 1997 and 2009 criteria for DVI increased from 0.65 and 0.73 to 0.95 and 0.84, respectively. Children with one of myalgia, headache or leukopenia had sensitivity of 0.84, specificity of 0.76 and PPV of 0.92 to differentiate DVI from typhoid and other AFIs. Patients with one of abdominal pain, diarrhea or body temperature >39.5°C were more likely to have typhoid fever than another AFI with PPV of 0.90.

Conclusion

Using this flow chart can help direct physicians to perform more specific tests to confirm the diagnosis and provide more specific treatment. Nevertheless, clinical follow-up is the most important tool in unknown causes of febrile illness.
Pervasive and non-random recombination in near full-length HIV genomes from Uganda
Authors: Grant Heather E , Hodcroft Emma B , Ssemwanga Deogratius , Kitayimbwa John M , Yebra Gonzalo , Esquivel Gomez Luis Roger , Frampton Dan , Gall Astrid , Kellam Paul , de Oliveira Tulio , Bbosa Nicholas , Nsubuga Rebecca N , Kibengo Freddie , Kwan Tsz Ho , Lycett Samantha , Kao Rowland , Robertson David L , Ratmann Oliver , Fraser Christophe , Pillay Deenan , Kaleebu Pontiano , Leigh Brown Andrew J
Published: January 2020

Recombination is an important feature of HIV evolution, occurring both within and between the major branches of diversity (subtypes). The Ugandan epidemic is primarily composed of two subtypes, A1 and D, that have been co-circulating for 50 years, frequently recombining in dually infected patients. Here, we investigate the frequency of recombinants in this population and the location of breakpoints along the genome. As part of the PANGEA-HIV consortium, 1,472 consensus genome sequences over 5 kb have been obtained from 1,857 samples collected by the MRC/UVRI & LSHTM Research unit in Uganda, 465 (31.6 per cent) of which were near full-length sequences (>8 kb). Using the subtyping tool SCUEAL, we find that of the near full-length dataset, 233 (50.1 per cent) genomes contained only one subtype, 30.8 per cent A1 (n = 143), 17.6 per cent D (n = 82), and 1.7 per cent C (n = 8), while 49.9 per cent (n = 232) contained more than one subtype (including A1/D (n = 164), A1/C (n = 13), C/D (n = 9); A1/C/D (n = 13), and 33 complex types). K-means clustering of the recombinant A1/D genomes revealed a section of envelope (C2gp120-TMgp41) is often inherited intact, whilst a generalized linear model was used to demonstrate significantly fewer breakpoints in the gag–pol and envelope C2-TM regions compared with accessory gene regions. Despite similar recombination patterns in many recombinants, no clearly supported circulating recombinant form (CRF) was found, there was limited evidence of the transmission of breakpoints, and the vast majority (153/164; 93 per cent) of the A1/D recombinants appear to be unique recombinant forms. Thus, recombination is pervasive with clear biases in breakpoint location, but CRFs are not a significant feature, characteristic of a complex, and diverse epidemic.
The Role of a Nascent Polypeptide-Associated Complex Subunit Alpha in Siderophore Biosynthesis, Oxidative Stress Response, and Virulence in Alternaria alternata
Authors: Wang Pin-Hua , Wu Pei-Ching , Huang Richie , Chung Kuang-Ren
Published: January 2020

The present study demonstrates that a nascent polypeptide-associated complex α subunit (Nac1) functions as a transcriptional regulator and plays both positive and negative roles in a vast array of functions in Alternaria alternata. Gain- and loss-of-function studies reveal that Nac1 is required for the formation and germination of conidia, likely via the regulation of Fus3 and Slt2 mitogen-activated protein kinase (MAPK)-coding genes, both implicated in conidiation. Nac1 negatively regulates hyphal branching and the production of cell wall–degrading enzymes. Importantly, Nac1 is required for the biosynthesis of siderophores, a novel phenotype that has not been reported to be associated with a Nac in fungi. The expression of Nac1 is positively regulated by iron, as well as by the Hog1 MAPK and the NADPH-dependent oxidase (Nox) complex. Nac1 confers cellular susceptibility to reactive oxygen species (ROS) likely via negatively regulating the expression of the genes encoding Yap1, Skn7, Hog1, and Nox, all involved in ROS resistance. The involvement of Nac1 in sensitivity to glucose-, mannitol-, or sorbitol-induced osmotic stress could be due to its ability to suppress the expression of Skn7. The requirement of Nac1 in resistance to salts is unlikely mediated through the transcriptional activation of Hog1. Although Nac1 plays no role in toxin production, Nac1 is required for fungal full virulence. All observed deficiencies can be restored by re-expressing a functional copy of Nac1, confirming that Nac1 contributes to the phenotypes. Thus, a dynamic regulation of gene expression via Nac1 is critical for developmental, physiological, and pathological processes of A. alternata.
Assessment of prophylactic antibiotics administration for acute pancreatitis: a meta-analysis of randomized controlled trials
Authors: Ding Nan , Sun Yong-Hui , Wen Li-Mei , Wang Jian-Hua , Yang Jian-Hua , Cheng Kun , Lin Hai , Chen Qi-Long
Published: January 2020

Background:

Recent evidence has shown that prophylactic antibiotic treatment in patients with acute pancreatitis is not associated with a significant decrease in mortality or morbidity. The use and efficacy of prophylactic antibiotic treatment in acute pancreatitis remain controversial. This meta-analysis was conducted to assess whether antibiotic prophylaxis is beneficial in patients with acute pancreatitis.

Methods:

We searched randomized controlled trials (RCTs) of prophylactic use of antibiotics using Medline (PubMed), Embase, the Cochrane Library, and Web of Science. The data were analyzed using Review Manager 5.3 software. We performed pooled analyses for infected pancreatic necrosis, mortality, surgical intervention, and non-pancreatic infection. Odds ratios (ORs) from each trial were pooled using a random or fixed effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary.

Results:

Totally, 11 RCTs involving 747 participants were included, with an intervention group (prophylactic use of antibiotics, n = 376) and control group (n = 371). No significant differences were found regarding antibiotic prophylaxis with respect to incidence of infected pancreatic necrosis (OR, 0.74; 95% confidence interval [CI], 0.50–1.09; P 
= 0.13), surgical intervention (OR, 0.92; 95% CI, 0.62–1.38; P 
= 0.70), and morality (OR, 0.71; 95% CI, 0.44–1.15; P 
= 0.16). However, antibiotic prophylaxis was associated with a statistically significant reduction in the incidence of non-pancreatic infection (OR, 0.59; 95% CI, 0.42–0.84; P 
= 0.004).

Conclusions:

Prophylactic antibiotics can reduce the incidence of non-pancreatic infection in patients with AP.
Pulsed radiofrequency alleviated neuropathic pain by down-regulating the expression of substance P in chronic constriction injury rat model
Authors: Wang Jing-Ai , Niu Shao-Ning , Luo Fang
Published: January 2020

Background

Pulsed radiofrequency (PRF), as a non-invasive treatment of neuropathic pain (NP), has been widely administered clinically. Previous studies have shown that PRF has the potential to improve hyperalgesia in animal models of NP. However, there have been few reports to clarify whether the mechanism of PRF treatment of NP involves intervention in the expression of substance P (SP). Therefore, this study administered PRF treatment to chronic constriction injury (CCI) model rats and observed the sciatic nerve mechanical pain threshold and SP expression in the spinal cord to explore the mechanism of PRF treatment.

Methods

A total of 96 Sprague-Dawley rats were randomly divided into the sham-surgery-sham-treatment group (S-S group), the sham-surgery-PRF group (S-P group), the CCI-sham-treatment group (C-S group), and the CCI-PRF group (C-P group). The C-S group and the C-P group underwent sciatic nerve CCI, while the other groups received a sham operation. At 14 days after the operation, the C-P group and the S-P group were treated with PRF for 300 s. We recorded the hindpaw withdrawal threshold (HWT) and the thermal withdrawal latency (TWL) of rats in the various groups at baseline, before treatment (0 days), and at 1, 7, 14, and 28 days after treatment. L4 to L6 spinal cord tissues were taken before treatment (0 days) and 1, 7, 14, and 28 days after treatment. The transcription and translation of SP were measured by quantitative polymerase chain reaction and Western blotting, respectively.

Results

The HWT and the TWL in the C-P group 28 days after PRF treatment were significantly higher than those in the C-S group (95% confidence interval [CI]: 5.84–19.50, P < 0.01; 95% CI: 2.58–8.69, P = 0.01). The expression of SP in the C-P group 28 days after PRF treatment was significantly lower than that in the C-S group (95% CI: 1.17–2.48, P < 0.01).

Conclusions

PRF may alleviate CCI-induced NP by down-regulating the expression of SP in the spinal cord of CCI model rats.
Management of Optic Disk Pit-associated Macular Detachment with Human Amniotic Membrane Patch
Authors: Rizzo Stanislao , Caporossi Tomaso , Pacini Bianca , De Angelis Lorenzo , De Vitto Maria Luce , Gainsanti Fabrizio
Published: January 2020

Purpose:

To report a new surgical technique involving a human amniotic membrane patch (hAM) to solve a serous macular detachment associated with optic nerve head pit.

Methods:

Three eyes of three patients affected by macular detachment associated with optic nerve head pit were enrolled. A 23-gauge pars plana vitrectomy were performed. hAM patch was implanted inside the optic nerve pit; air was used as endotamponade. The patients were instructed to maintain face-down position for the first days after surgery.

Results:

The subretinal fluid gradually resolved during 6 months of follow-up, and visual acuity improved to 20/25 at the sixth month after surgery. We did not observe a recurrence of subretinal fluid during the 6 months of follow-up. No postoperative complications were reported during the follow-up.

Conclusion:

Implant of the hAM may be effective to repair optic disk pit maculopathy. All the cases were successful with encouraging visual acuity recovery.
Cytokine Profiles in Human Parechovirus Type 3-induced Sepsis-like Syndrome
Authors: Shimizu Masaki , Shimizu Hiroyuki , Jinkawa Asumi , Yamamiya Mari , Shinozaki Eri , Yokoyama Tadafumi , Ohta Kazuhide , Sakumura Naoto , Takakuwa Maiko , Fujita Shuhei , Fusagawa Shintaro , Nakagishi Yasuo , Nariai Eri , Yachie Akihiro
Published: January 2020

We aimed to assess the kinetics of the release of proinflammatory cytokines and to clarify clinical usefulness as an indicator of the disease activity in human parechovirus type 3 virus (HPeV3)-induced sepsis-like syndrome. We measured serum levels of neopterin, interleukin (IL)-6 and the soluble forms of tumor necrosis factor (TNF) receptor types I (sTNF-RI) and II (sTNF-RII). Serum samples were obtained from 12 patients with HPeV3-induced sepsis-like syndrome and 28 healthy children. Disease course after onset was divided into 3 phases: early (day 1–2), peak (day 3–6) and recovery (day 9–16) phases. Serum IL-6 levels rapidly and markedly elevated in early phase and gradually decreased to those in healthy children in recovery phase. Furthermore, serum neopterin, sTNFR-I and sTNFR-II levels increased rapidly and markedly in onset phase and remained elevated in peak phase. These levels gradually decreased in recovery phase. Serum IL-18 levels increased from onset phase to peak phase and decreased in recovery phase. These results indicate that proinflammatory cytokines, in particular, interferon gamma, TNF-α and IL-18 are closely related to the development of HPeV3-induced sepsis-like syndrome. Serum levels of these cytokines might be a useful indicator of the disease activity.
Vaccine-Strain Herpes Zoster Ophthalmicus in a 14-month-old Boy Prompting an Immunodeficiency Workup: Case Report and Review of Vaccine-strain Herpes Zoster
Authors: Detty Shannon Q. , Peebles J. Klint , Guerrieri John M. , Seroogy Christine M. , Struck Michael C. , Arkin Lisa M. , Henderson Sheryl L.
Published: January 2020

We present a case of herpes zoster ophthalmicus in an otherwise healthy 14-month-old male associated with vaccine-strain varicella-zoster virus 11 weeks after monovalent varicella vaccine administration. Herpes zoster ophthalmicus, especially in the setting of familial immunoglobulin A deficiency, prompted further immunologic workup. A high index of suspicion is necessary for timely diagnosis and treatment of vaccine-strain herpes zoster.