bluuebunny/crossref_metadata_2025_split huggingface dataset:
An unusual cause of a haemothorax following pacemaker implantation: A case report
Authors: Saunderson Christopher E. D. , Hogarth Andrew J. , Papaspyros Sotiris , Tingerides Costa , Tayebjee Muzahir H. 
Published: May 2022

Abstract

Background
Haemothoraces are a reported but extremely rare complication of pacemaker implantation. Haemothoraces can be a consequence of lead perforation through the right ventricle (RV) and pericardium into the pleural space, direct lung or vascular injury during access.

Case summary
A 72-year-old woman presented 24 h after a pacemaker implantation with chest pain and shortness of breath. Computed tomography of the chest confirmed perforation of the RV lead into the left pleural cavity with a large left sided haemothorax. Following percutaneous drainage of the left sided haemothorax, the patient became haemodynamically unstable necessitating emergent sternotomy. During surgery, the extra-cardiac portion of the pacing lead was cut, the RV repaired and a large haematoma evacuated from the left pleural space. Despite this, the patient remained hypotensive, and further exploration showed a bleeding intercostal artery that had been lacerated by the pacing lead. This was treated by electrocautery, and the patient’s haemodynamic status improved. The RV lead remnant was removed transvenously via the subclavian vein, and the patient was left with a single chamber atrial pacemaker.

Discussion
Prompt recognition of RV lead perforation and its associated sequalae, often utilising multi-modality imaging, is vital to enable transfer to a centre with cardiac surgical expertise. In this case, the perforating RV lead lacerated an intercostal artery, and this was only identified at the time of surgery. In order to minimize the risk of perforation, multiple fluoroscopic views should be used, and care should be taken during helix deployment.
Transient injection site reaction to alirocumab during immune system activation: a case series
Authors: Bär Sarah , Räber Irene , Koskinas Konstantinos C. , Schlapbach Christoph , Räber Lorenz 
Published: May 2022

Abstract

Background
Injection site reactions (ISRs) are known side effects of the proprotein convertase subtilisin kexin 9 (PCSK9) inhibitor alirocumab. Transient ISR to alirocumab after a long phase of good tolerability have not been reported previously.

Case summary
A 55-year-old woman (Patient 1) and a 77-year-old man (Patient 2) were treated with alirocumab for the management of dyslipidaemia. Both patients tolerated the treatment without side effects for 7 and 2 months, respectively. After an upper respiratory tract infection in Patient 1 and a first COVID-19 vaccination in Patient 2, both patients suddenly developed ISR with erythema, calor, and itching upon 2 (Patient 1) and 1 (Patient 2) subsequent injection(s), respectively. Symptoms resolved with local steroids, oral antihistamines, and cooling. After termination of the presumed immune system activated state, alirocumab was well tolerated again in both patients without recurrence of any ISR upon repeated applications.

Discussion
These are the first cases to report transient ISR to a PCSK9 inhibitor, possibly triggered by activation of the immune system, after prolonged good tolerability. Based on the transient and benign nature of the reaction, such patients should be encouraged to continue supervised treatment, as tolerability may return after resolution of the pro-inflammatory state.
A case report of profound atrioventricular block in an endurance athlete: how far do you go?
Authors: Abela Mark , Bonello John , Sammut Mark Adrian 
Published: May 2022

Abstract

Background
Athletes presenting with 1st-degree atrioventricular block (AVB) on 12-lead electrocardiogram (ECG) may present a diagnostic conundrum, especially when significantly prolonged and associated with higher degrees of block. A pragmatic stepwise approach to the evaluation of these patients is, therefore, crucial.

Case summary
A 19-year-old waterpolo player was referred for assessment of a 1st-degree heart block and one isolated episode of syncope. All other cardiac investigations were within normal limits except for a 24-h ambulatory ECG which showed Mobitz 1 AVB and episodes of 2:1 block occurring in the context of Wenchebach. An electrophysiological study (EPS) was performed which effectively excluded infranodal conductive tissue disease, confirming physiological intranodal block.

Discussion
The increase in vagal tone is one of the physiological adaptations to an increased demand in cardiac output in athletes, which explains the presence of 1st-degree AVB in up to 7.5% of athletes. The presence of 2:1 AVB on 24 h ECG raises doubts whether the 1st-degree AVB on resting ECG is pathological or physiological, especially considering this particular patient had suffered an episode of syncope. When this diagnostic uncertainty persists despite non-invasive investigations, including cardiopulmonary exercise testing, invasive EPS may be required to assess the refractoriness of the AV node and at what level within the cardiac conductive system block occurs. The electrophysiological study can effectively rule out infranodal disease by confirming physiological intranodal block using incremental atrial pacing.
Transcatheter aortic valve implantation with a balloon-expandable prosthesis in a patient with single coronary artery: a case report
Authors: Furugen Makoto , Furugen Azusa , Yamazaki Kenji , Doi Hirosato 
Published: May 2022

Abstract

Background
Single coronary artery is a rare coronary artery anomaly with an incidence of &lt;0.03%. The coexistence of coronary artery anomalies with severe aortic stenosis is extremely rare. Due to the singularity of the coronary artery orifice, the most concerning risk of transcatheter aortic valve implantation (TAVI) in such patients is coronary occlusion, which may very well be life-threatening.

Case summary
An 83-year-old female complaining of chest pain was referred to our hospital for severe aortic stenosis. The multi-slice computed tomography showed a congenital single coronary artery originating from the right sinus of Valsalva. The left coronary artery branched off of the right coronary artery, and passed between the aorta and main pulmonary artery. The heart team of the hospital decided to perform TAVI via femoral artery with a balloon-expandable prosthesis, with coronary angioplasty devices on standby in case of coronary occlusion. The TAVI procedure was performed successfully without coronary occlusion.

Discussion
Although there have been some case reports of TAVI in patients with single coronary artery, little is known about the safety of TAVI in such cases, and which device (such as the balloon-expandable or the self-expandable prosthesis) is preferable. From this particular case, and accumulation of past and various TAVI experience, the balloon-expandable prosthesis can be a safe device choice in carefully selected patients with coronary artery anomalies.
Bilateral mini-thoracotomy for combined minimally invasive direct coronary artery bypass and mitral valve repair
Authors: Squiccimarro Enrico , Margari Vito , Paparella Domenico 
Published: May 2022

Abstract
Consistent evidence recognizes minimally invasive valve surgery as the top-tier surgical approach for heart valve pathology. Conversely, the overall adoption of minimally invasive coronary surgery remains low. Notwithstanding, excellent clinical outcomes have been recently reported, further consolidating a technique that addresses major concerns associated with the traditional approach for the most frequently performed cardiac operation, including sternal dehiscence (i.e sternal sparing) and stroke (i.e. no-touch aorta), but that also guarantees a reduced resort to blood transfusions, diminished pain and faster recovery. More to the point, the suitability of minimally invasive strategies for combined coronary and valve procedures remains debateable. Almost no reports of such combined procedures are available in literature and the very few published experiences appear scarce and heterogeneous about the surgical access (i.e. single versus bilateral mini-thoracotomy). However, bilateral mini-thoracotomy has been proposed as a feasible and safe strategy for different cardiac operations like surgical ablation and left ventricular assist device implantation, but also for isolated multivessel minimally invasive coronary surgery. Here, we describe the feasibility of combined minimally invasive mitral valve and coronary surgery performed through bilateral mini-thoracotomy and we report outcomes of our initial series of 3 cases.
Subcellular Propagation of Cardiomyocyte β-Adrenergic Activation of Calcium Uptake Involves Internal β-Receptors and AKAP7
Authors: Shannon Thomas R , Bare Dan J , Van Dijk Sabine , Raofi Shayan , Huynh Tiffany N-M , Xiang Yang K , Bossuyt Julie , Dodge-Kafka Kimberly L , Ginsburg Kenneth S , Bers Donald M 
Published: May 2022

Abstract
β-adrenergic receptor (β-AR) signaling in cardiac myocytes is central to cardiac function, but spatiotemporal activation within myocytes is unresolved. In rabbit ventricular myocytes, β-AR agonists or high extracellular [Ca] were applied locally at one end, to measure β-AR signal propagation as Ca−transient (CaT) amplitude and sarcoplasmic reticulum (SR) Ca uptake. High local [Ca]o, increased CaT amplitude under the pipette faster than did ISO, but was also more spatially restricted. Local isoproterenol (ISO) or norepinephrine (NE) increased CaT amplitude and SR Ca uptake, that spread along the myocyte to the unexposed end. Thus, local [Ca]i decline kinetics reflect spatio-temporal progression of β-AR end-effects in myocytes. To test whether intracellular β-ARs contribute to this response, we used β-AR-blockers that are membrane permeant (propranolol) or not (sotalol). Propranolol completely blocked NE-dependent CaT effects. However, blocking surface β-ARs only (sotalol) suppressed only ∼50% of the NE-induced increase in CaT peak and rate of [Ca]i decline, but these changes spread more gradually than NE alone. We also tested whether A-kinase anchoring protein 7γ (AKAP7γ; that interacts with phospholamban) is mobile, such that it might contribute to intracellular spatial propagation of β-AR signaling. We found AKAP7γ to be highly mobile using fluorescence recovery after photobleach of GFP tagged AKAP7γ, and that PKA activation accelerated AKAP7γ-GFP wash-out upon myocyte saponin-permeabilization, suggesting increased AKAP7γ mobility. We conclude that local β-AR activation can activate SR Ca uptake at remote myocyte sites, and that intracellular β-AR and AKAP7γ mobility may play a role in this spread of activation.
Disclosing azole resistance mechanisms in resistant Candida glabrata strains encoding wild-type or gain-of-function CgPDR1 alleles through comparative genomics and transcriptomics
Authors: Salazar Sara B , Pinheiro Maria Joana F , Sotti-Novais Danielle , Soares Ana R , Lopes Maria M , Ferreira Teresa , Rodrigues Vitória , Fernandes Fábio , Mira Nuno P 
Published: May 2022

Abstract
The pathogenic yeast Candida glabrata is intrinsically resilient to azoles and rapidly acquires resistance to these antifungals, in vitro and in vivo. In most cases azole-resistant C. glabrata clinical strains encode hyperactive CgPdr1 variants, however, resistant strains encoding wild-type CgPDR1 alleles have also been isolated, although remaining to be disclosed the underlying resistance mechanism. In this study, we scrutinized the mechanisms underlying resistance to azoles of 8 resistant clinical C. glabrata strains, identified along the course of epidemiological surveys undertaken in Portugal. Seven of the strains were found to encode CgPdr1 gain-of-function variants (I392M, E555K, G558C, and I803T) with the substitutions I392M and I803T being herein characterized as hyper-activating mutations for the first time. While cells expressing the wild-type CgPDR1 allele required the mediator subunit Gal11A to enhance tolerance to fluconazole, this was dispensable for cells expressing the I803T variant indicating that the CgPdr1 interactome is shaped by different gain-of-function substitutions. Genomic and transcriptomic profiling of the sole azole-resistant C. glabrata isolate encoding a wild-type CgPDR1 allele (ISTB218) revealed that under fluconazole stress this strain over-expresses various genes described to provide protection against this antifungal, while also showing reduced expression of genes described to increase sensitivity to these drugs. The overall role in driving the azole-resistance phenotype of the ISTB218 C. glabrata isolate played by these changes in the transcriptome and genome of the ISTB218 isolate are discussed shedding light into mechanisms of resistance that go beyond the CgPdr1-signalling pathway and that may alone, or in combination, pave the way for the acquisition of resistance to azoles in vivo.
Promoting Social Capital for Healthy Aging: Towards an Integrative Framework
Authors: Lu Shiyu , Chui Cheryl , Lum Terry 
Published: May 2022

Abstract
There is no theoretical framework to guide society to enhance social capital among older adults in the Decade of Healthy Aging. This article aims to advance scholarship by providing a theoretical framework for promoting social capital for healthy aging using timebanking as a case illustration. We provide an integrated theoretical framework to enhance social capital for healthy aging by incorporating 3 core elements: (a) facilitating emotional meaningfulness via social participation for older adults, (b) incorporating older adults as coproducers in community development, and (c) nurturing an inclusive and equitable society. We further demonstrate the utility of the integrated theoretical framework for gerontologists by conceptualizing timebanking as an intervention for enhancing social capital in an aging society.
Involution and symbiosis: the self-perpetuating conflict in the Democratic Republic of Congo
Authors: Stearns Jason 
Published: May 2022

Abstract
Literature on conflict duration emphasizes the importance of material factors, commitment problems and information asymmetries. Using the case study of the Democratic Republic of the Congo, and drawing on interviews with 138 sources involved in the conflict, this article advances a theory of conflict duration that highlights the role that interests, identities and the social anchorage of belligerents play. Together, they explain how the conflict in the Congo has become an end in itself for belligerents, carried forward by its own momentum. This article describes the key factors: a proliferation of actors, the rise of a military bourgeoisie, the involution of interests, and the symbiosis of belligerents. A similar argument can be applied to other protracted conflicts in large and weak states. This understanding of conflict has repercussions for policy, as it suggests that there is no inherent link between elite political settlements and stability. It pushes away from the technocratic approach to institution-building to centre the role of the state and political culture in debates over peacebuilding.
High Attack Rate of Severe Acute Respiratory Syndrome Coronavirus 2 B.1.1.529 Among 2-Dose Vaccinated Populations in 2 Indoor Entertainment Setting Outbreaks
Authors: Liu Bette , Stepien Sandrine , Pye Victoria , Law Charlee , Dalton Craig , Durrheim David N , Macartney Kristine 
Published: May 2022

Abstract
We estimated attack rates of severe acute respiratory syndrome coronavirus 2 Omicron (B.1.1.529) infection among people attending a nightclub and a graduation ball where &gt;95% had at least 2 vaccine doses. Attack rates were 295 of 535 (55.1%) and 102 of 189 (54.0%), respectively (mean, 5 days postevent). At the ball, attack rates increased with time since vaccination: 12.5% among those vaccinated 1–2 months previously and 68.0% among those vaccinated ≥3 months previously; such differences were not found at the nightclub. Recent vaccination prevents Omicron infection, but is time and setting dependent, emphasizing the importance of nonpharmaceutical public health measures in addition to vaccine booster doses to maximize protection in high-risk contexts.
Lung-AdaptedStaphylococcus aureusIsolates With Dysfunctional Agr System Trigger a Proinflammatory Response
Authors: Ramond Elodie , Lepissier Agathe , Ding Xiongqi , Bouvier Clémence , Tan Xin , Euphrasie Daniel , Monbernard Pierre , Dupuis Marion , Saubaméa Bruno , Nemazanyy Ivan , Nassif Xavier , Ferroni Agnès , Sermet-Gaudelus Isabelle , Charbit Alain , Coureuil Mathieu , Jamet Anne 
Published: May 2022

AbstractBackgroundStaphylococcus aureus dominates the lung microbiota of children with cystic fibrosis (CF) and persistent clones are able to establish chronic infection for years, having a direct deleterious impact on lung function. However, in this context, the exact contribution of S. aureus to the decline in respiratory function in children with CF is not elucidated.MethodsTo investigate the contribution of persistent S. aureus clones in CF disease, we undertook the analysis of sequential isogenic isolates recovered from 15 young CF patients.ResultsUsing an air-liquid infection model, we observed a strong correlation between S. aureus adaption in the lung (late isolates), low toxicity, and proinflammatory cytokine secretion. Conversely, early isolates appeared to be highly cytotoxic but did not promote cytokine secretion. We found that cytokine secretion was dependent on staphylococcal protein A (Spa), which was selectively expressed in late compared to early isolates as a consequence of dysfunctional agr quorum-sensing system. Finally, we demonstrated the involvement of TNF-α receptor 1 signaling in the inflammatory response of airway epithelial cells to these lung-adapted S. aureus isolates.ConclusionsOur results suggest an unexpected direct role of bacterial lung adaptation in the progression of chronic lung disease by promoting a proinflammatory response through acquired agr dysfunction.
Sixteen in One: White-Belted Megaselia Rondani (Diptera: Phoridae) From the New World Challenge Species Concepts
Authors: Brown Brian V , Hartop Emily A , Wong Maria A 
Published: May 2022

Abstract
We review the species of Megaselia similar to Megaselia sulphurizona Borgmeier. A close examination of M. sulphurizona indicates that its current concept includes at least 16 species, 15 of which— Megaselia albizona, Megaselia borealizona, Megaselia colombizona, Megaselia cryptizona, Megaselia danizona, Megaselia guanizona, Megaselia marizona, Megaselia nivizona, Megaselia oklizona, Megaselia paulizona, Megaselia reductizona, Megaselia solizona, Megaselia tropizona, Megaselia wendizona, and Megaselia winnizona are described as new, based primarily on molecular data. The identity of the holotype of the species M. sulphurizona is clarified through wing vein morphometrics. Two of the new species, M. albizona and M. cryptizona, are the 47th and 48th new species of phorid fly described from the BioSCAN project, an urban biodiversity study in Los Angeles, California, U.S.
Genomic-based transmission analysis of carbapenem-resistant Pseudomonas aeruginosa at a tertiary care centre in Cologne (Germany) from 2015 to 2020
Authors: Wendel Andreas F. , Malecki Monika , Mattner Frauke , Xanthopoulou Kyriaki , Wille Julia , Seifert Harald , Higgins Paul G. 
Published: May 2022

Abstract

Objectives
To describe the propensity of carbapenem-resistant Pseudomonas aeruginosa to spread within a hospital critical care setting.

Methods
The study was conducted in a 700-bed tertiary centre in Cologne, Germany. P. aeruginosa resistant to piperacillin, ceftazidime, cefepime, imipenem, meropenem and ciprofloxacin, isolated from clinical and screening specimens from four critical care units from 2015 to 2020 were analysed. Genotyping was carried out by WGS (Illumina and MinION). MLST, core genome MLST (cgMLST) and resistome analysis was performed and merged with epidemiological data.

Results
Fifty-five out of 79 non-duplicate P. aeruginosa isolates were available, of which 20 were carbapenemase producers as follows: blaVIM-1 (n = 1), blaVIM-2 (n = 17), blaVIM-4 (n = 1), and blaNDM-1/blaGES-5 (n = 1). Forty-two of 55 isolates were hospital-acquired. cgMLST revealed three clusters: Cluster 1 (n = 15, ST111, blaVIM-2, recovered between 2015 and 2020); Cluster 2 (n = 4, ST970, carbapenemase negative); and Cluster 3 (n = 2, ST357, carbapenemase negative). The blaVIM-2 gene of Cluster 1 was integrated on the chromosome in a class 1 integron (type In59). Using conventional epidemiology, we were only able to confirm two patient-to-patient transmissions and one room-to-patient transmission on three different ICUs within Cluster 1. Isolates from Cluster 2 represented an outbreak occurring in 2019.

Conclusions
These data give insight into the epidemiology of carbapenem-resistant P. aeruginosa. Transmission dynamics differed between carbapenemase- and non-carbapenemase-producing isolates. A continuous acquisition of clonally related ST111 VIM-2 P. aeruginosa, being the main carbapenemase-producing strain, was observed over the whole study period, as well as an overall higher genomic diversity among non-carbapenemase-producing P. aeruginosa.
Role of Breath Biopsy in COVID-19
Authors: Shekhawat Jyoti Kanwar , Banerjee Mithu 
Published: May 2022

Abstract

Background
COVID-19 is a highly contagious respiratory disease that can be transmitted through human exhaled breath. It has caused immense loss and has challenged the healthcare sector. It has affected the economy of countries and thereby affected numerous sectors. Analysis of human breath samples is an attractive strategy for rapid diagnosis of COVID-19 by monitoring breath biomarkers.

Content
Breath collection is a noninvasive process. Various technologies are employed for detection of breath biomarkers like mass spectrometry, biosensors, artificial learning, and machine learning. These tools have low turnaround time, robustness, and provide onsite results. Also, MS-based approaches are promising tools with high speed, specificity, sensitivity, reproducibility, and broader coverage, as well as its coupling with various chromatographic separation techniques providing better clinical and biochemical understanding of COVID-19 using breath samples.

Summary
Herein, we have tried to review the MS-based approaches as well as other techniques used for the analysis of breath samples for COVID-19 diagnosis. We have also highlighted the different breath analyzers being developed for COVID-19 detection.
The Human Rights Committee—Challenges and Prospects for Enhanced Effectiveness and Integration: A Comment
Authors: Kadelbach Stefan 
Published: May 2022

AbstractThe comment takes up the discussion by Ivana Jelić and Linus Mührel on the merits and deficits of the UN Human Rights Committee and the options for its reform. It advocates a view that takes contradictions between different perspectives on human rights into account, be they rooted in legal culture or in societal forces. It addresses discourse as the source of legitimacy and normativity of human rights, and therefore agrees with proposals to strengthen the treaty bodies within the framework of existing treaties, but also recalls the conditions of legal and societal discourse on the domestic plane.