Difference In Occurrence Rate Research Articles

The Value of Adjunctive Left Atrial Posterior Wall Isolation on Clinical Outcomes in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis.

Although pulmonary vein isolation (PVI) remains the mainstream way of atrial fibrillation (AF) ablation. The left atrial posterior wall (LAPW) may contributes to the development of AF as an arrhythmogenic substrate. The efficacy of additional left atrial posterior wall isolation (LAPWI) beyond PVI is in AF patients remains undefined. This study explored the influence of posterior wall isolation (PWI) on clinical outcomes in AF patients. PubMed, EMBASE, and Cochrane Library databases were searched for studies comparing the outcomes of AF with and without PWI. The efficacy outcomes were recurrence of all atrial arrhythmia (AA), atrial fibrillation (AF), and atrial flutter (AFL)/atrial tachycardia (AT). The safety outcomes were mainly focused on procedural adverse events. A total of 16 studies (7 randomized controlled trials (RCTs), 3 prospective studies and 6 retrospective analyses) with 3340 AF patients were enrolled (1550 patients in PVI with PWI group and 1790 in PVI alone group). 12 studies included persistent atrial fibrillation patients, 3 studies with paroxysmal AF patients and 1 study with paroxysmal AF and persistent AF concurrently. Mean follow-up period was 16.56 months. In AF patients, adjunctive PWI obviously reduced the recurrence of all atrial arrhythmias (risk ratio (RR) 0.78 [95% CI 0.64-0.95], = 79%, p = 0.01) and the recurrence of AF (RR 0.68 [95% CI 0.53-0.88], = 75%, p = 0.004); Meanwhile, additional PWI left no impact substantially on lower recurrence of AFL/AT (RR 1.23 [95% CI 0.94-1.60], = 49%, p = 0.12). The results seemed to be no significant differences in occurrence rate of procedural complications between the PVI only and PWI+PVI (RR 1.19 [95% CI 0.80-1.79], = 0%, p = 0.39). In subgroup analyses, the benefit of adjunctive PWI compared with PVI only was more distinct in persistent AF group and cryoballoon ablation group. Notably, adjunctive PWI with radiofrequency ablation may induce a slight increase of recurrent AFL/AT compared with PVI only (RR 1.56 [95% CI 1.02-2.39], = 30%, p = 0.04). Compared with PVI alone, additional PWI to PVI appeared to be associated with decreased recurrence of AF and atrial arrhythmias without an increased occurrence of procedural complications, especially in persistent AF patients. Cryoballoon ablation seemed more suitable for PWI compared with radiofrequency ablation. More RCTs are needed to verify the conclusion.

Atmospheric Ducts and Their Electromagnetic Propagation Characteristics in the Northwestern South China Sea

The propagation of electromagnetic waves beyond the line of sight can be caused by atmospheric ducts, which are significant concerns in the fields of radar and communication. This paper utilizes data from seven automatic weather stations and five radio-sounding stations to statistically analyze the characteristics of the atmospheric ducts in the northwest region of the South China Sea (SCS). After verifying the practicality of numerical analysis data from NCEP CFSv2 and ECMWF in studying atmospheric ducts using measured data, we analyzed the spatial–temporal distribution characteristics of the height of the regional evaporation duct and the bottom height of the elevated duct. The study found that the NCEP CFSv2 data accurately capture the evaporation duct height and duct occurrence rate in the study area, and the elevated duct bottom height calculated from ERA5 and the measured data have good consistency. The occurrence rate and height of the evaporation duct in coastal stations in the northwest of the SCS vary significantly by month, demonstrating clear monthly distribution patterns; conversely, changes in the Xisha station are minimal, indicating good temporal uniformity. For lower atmospheric ducts, the difference in occurrence rates between 00:00 and 12:00 (UTC) is negligible. The occurrence probability of elevated ducts in the Beibu Gulf area is relatively high, mainly concentrated from January to April, and the Xisha area is dominated by surface ducts without foundation layers, mainly concentrated from June to August. Monsoons play a critical role in the generation and evolution of atmospheric ducts in the northwest of the SCS, with the height of the evaporation duct increasing and the bottom height of the elevated duct decreasing after the onset of the summer monsoon. In the end, we simulated electromagnetic propagation loss under different frequencies and radiation elevation angles in various duct environments within a typical atmospheric duct structure.

Effect of Dietary Supplementation of Turmeric (Curcuma Longa) on Health Status of Young Pigs During Pre and Post Weaning Periods

The present research programme was conducted to study the effect of turmeric (Curcuma longa) powder supplementation on the growth performance and health status of Large White Yorkshire young pigs. A total number of 128 (12 litters) young pigs weaned at 28 days old were taken for the study period of 56 days. The young pigs in their respective litters were randomly divided into three groups viz., Control (C) fed basal diet, Treatment-1 (T1) fed basal diet+0.5% turmeric powder and Treatment-2 (T2) fed basal diet+1% turmeric powder in such a way that there were 4 replicates in each group with 1 litter as one replicate. Parameters recorded were general appearance, occurrence rate of diarrhea and faecal consistency. Statistical analysis revealed significant (p<0.05) differences in general appearance score during the post-weaning periods. Statistical analysis also revealed significant (p<0.05) differences in occurrence rate of diarrhoea (%) on 5th week under three different groups and significant (p<0.05) differences between the different groups during the post weaning (5th to 8th week) period, highly significant (p<0.01) differences in faecal consistency score between the groups during post weaning (5th to 8th week) and overall (1st to 8th week) periods. It may be concluded that dietary inclusion of dry turmeric powder at 1.0% level in pre and post weaning diets is beneficial - for growth performance of LWY young pigs especially during post weaning period.

Dexamethasone for the treatment of acute respiratory distress syndrome: A systematic review and meta-analysis.

Background:This meta-analysis aimed to evaluate the efficacy and safety of dexamethasone in the treatment of acute respiratory distress syndrome (ARDS).Methods:A systematic search of electronic databases was carried out from inception to May 1, 2022, including PUBMED, EMBASE, Cochrane Library, Wangfang, VIP, and CNKI. Other searches were also checked for dissertations/theses and the reference lists of the included studies. Two team members examined all citations and selected eligible articles. Randomized controlled trials (RCTs) reporting the efficacy and safety of dexamethasone for the treatment of ARDS were included, and the quality of eligible RCTs was assessed using the Cochrane Risk of Bias Tool. If necessary, we conducted data synthesis and meta-analysis. The primary outcome was all-cause mortality. Secondary outcomes were mechanical ventilation duration (day), ventilator-free status at 28 days; intensive care unit (ICU) free (day), ICU mortality, hospital mortality, sequential organ failure assessment (SOFA) as mean and range, SOFA as No. of patients, peak airway pressure (cmH2O), arterial oxygen pressure (mm Hg), days with PaO2 > 10kPa, PaO2, and the occurrence rate of adverse events.Results:Four studies involving 702 patients were included in this analysis. This study showed that dexamethasone could significantly reduce all-cause mortality (odds ratio (OR) = 0.62, 95% confidence interval (CI) [0.44, 0.88], I2 = 30%, P < .001), and decrease ventilator-free status at 28 days (MD = 3.65, 95% CI [1.49, 5.80], I2 = 51%, P < .001). No significant differences in occurrence rates of adverse events were found between dexamethasone and routine or standard care.Conclusions:Evidence from the meta-analysis suggests that dexamethasone is an effective and relatively safe treatment for all-cause mortality and ventilator-free status at 28 days in patients with ARDS. Owning to the small number of eligible RCTs, the conclusions of present study are warranted in the future study.

Prognosis and Efficacy of Laparoscopic Surgery on Patients with Endometrial Carcinoma: Systematic Evaluation and Meta-Analysis.

Objective The prognosis and efficacy of laparoscopic surgery (LPS) and open surgery or robotic surgery (RS) on endometrial carcinoma (EC) patients were compared. Methods Data as of May 2021 were retrieved from databases like PubMed, Embase, Cochrane Library, and Web of Science. The study involved randomized controlled trials (RCTs), cohort studies, or case-control studies for comparing the effects of LPS and open surgery or robotic surgery (RS) on EC treatment. The primary outcomes included duration of operation, blood loss, length of stay (LOS), postoperative complications, and recurrence rate. Secondary outcomes included 3-year progression-free survival (PFS) rate/disease-free survival (DFS) rate and 3-year overall survival (OS) rate. Results A total of 24 studies were involved, and all of them were cohort studies except 1 RCT and 1 case-control study. There was no significant difference in duration of operation between LPS and open surgery (MD = −0.06, 95% CI: -0.37 to 0.25) or RS (MD = −0.15, 95% CI: -1.27 to 0.96). In comparison with the open surgery, LPS remarkably reduced blood loss (MD = −0.43, 95% CI: -0.58 to -0.29), LOS (MD = −0.71, 95% CI: -0.92 to -0.50), and the complication occurrence rate (RR = 0.83, 95% CI: 0.73 to 0.95). However, LPS and RS saw no difference in blood loss (MD = 0.01, 95% CI: -0.77 to 0.79). Besides, in comparison with RS, LPS prominently shortened the LOS (MD = 0.26, 95% CI: 0.12 to 0.40) but increased the complication occurrence rate (RR = 1.74, 95% CI: 1.57 to 1.92). In contrast to open surgery or RS, LPS saw no difference in occurrence rate (RR = 0.75, 95% CI: 0.56 to 1.01; RR = 0.97, 95% CI: 0.62 to 1.53), 3-year PFS/DFS (RR = 0.99, 95% CI: 0.90 to 1.09; RR = 1.30, 95% CI: 0.87 to 1.96), and 3-year OS (RR = 0.97, 95% CI: 0.91 to 1.04; RR = 1.21, 95% CI: 0.91 to 1.60). Conclusion In sum, LPS was better than open surgery, which manifested in the aspects of less blood loss, shorter LOS, and fewer complications. LPS, therefore, was the most suitable option for EC patients. Nevertheless, LPS had no advantage over RS, and sufficient prospective RCTs are needed to further confirm its strengths.

Cancer survivors and neurotoxic chemotherapy: hearing loss and tinnitus

ObjectivesLittle is known about hearing loss and tinnitus associated with neurotoxic chemotherapy. Study evaluated for differences in occurrence rates and effects of hearing loss and tinnitus in survivors who received...

The Disproportionality of Poverty, Race, and Ethnicity With Child Maltreatment Reporting.

In this issue of Pediatrics, Rebbe et al1 used a population-based linked administrative data set to analyze data on nearly 4000 children <3 years of age who were hospitalized for child maltreatment. The study used diagnostic codes that were specific for, or suggestive of, maltreatment. The main findings identified that a disproportionate number of children with public health insurance (used as a proxy for poverty) were reported to Child Protective Services (CPS) as compared to children with private insurance, and this was true within each maternal race and ethnicity category. Findings regarding race and ethnicity showed that fewer children of Asian or Pacific islander mothers were reported to CPS as compared to White mothers, and children with American Indian mothers were more likely to have a diagnostic code specific (rather than suggestive) for maltreatment as comparted to all other groups. The authors interpreted these findings of disproportionality to indicate that children and families of lower socioeconomic status (SES) may be more closely scrutinized for maltreatment than those of higher SES, and that race and ethnicity is also a likely factor in CPS reporting and diagnosing abuse. The authors speculate that clinician implicit bias was a key driver behind the disproportionalities. They conclude that programs and policies are needed to prevent the inequitable way children receive protective interventions so that race and poverty “do not impact these crucial decision points regarding the intervention of child maltreatment.”Whether race and ethnicity or SES biases (implicit or otherwise) were the drivers behind the disproportionality cannot be ascertained directly from this data set because of key limitations. As stated by the authors, “it is difficult to ascertain from the available data whether the decision to assign a specific maltreatment code had more to do with the characteristics of the presenting medical problem or with racial bias.” It is highly likely, however, that biases are at play on many levels. Other studies support that underresourced families are disproportionality evaluated for maltreatment and that biased decision-making results in overinvestigations and reporting of abuse in children from Black, Hispanic, and American Indian families.2–7 Thus, efforts to tackle the impact of implicit and explicit biases on diagnosis and reporting of maltreatment are critical to decrease disparities that are adding to these disproportionalities.However, the impact of social factors on outcomes is not limited to bias at the time of diagnosis or decision-making to refer to CPS. Interacting social determinants of health such as racism, poverty, and classism, may cause some groups to be more structurally vulnerable to adverse health outcomes, including child maltreatment.8,9 Evidence indicates that the higher rates of identified and reported maltreatment among impoverished children in this study are likely influenced by real differences in rates of occurrence.3,10–15 Poverty is a known risk factor for child maltreatment,10–15 particularly in combination with other risk factors such as parental depression, substance use, and social isolation that are known to cotravel with poverty.13,16 Other low-resource factors also place children at increased risk. For example, for lower-income single parents to work, the parent may sometimes be forced to resort to less-than-optimal child care, which increases their children’s risk for maltreatment.11,13,17–19 Evidence shows that financial and social supports mitigate the increased risks of maltreatment for children in poverty.19–23 Conversely, decreased supports (ie, welfare benefits) are associated with increased rates of foster care placement (a proxy for maltreatment).24 This highlights why solutions to address maltreatment must also target economic inequities that deepen the problem.The disproportionalities of maltreatment diagnoses and reporting to CPS found in this study serve as a sentinel and likely reflect a combination of biases and true increased risk of maltreatment associated with poverty. It is critical that medical decision-makers do not conflate lower SES status or race and ethnicity with assumptions of maltreatment, because this implicit conflation is causing direct harm and further deepening existing disproportionalities as well as disparities. We must also recognize that underresourced and distressed families may have needs and stressors that contribute to a child’s increased risk of negative outcomes, including maltreatment. The effects of compounded bias, oppression, injustice, and resource scarcity for certain communities are, unfortunately, enduring problems. A public health approach is required to address these injustices at the community-level, along with simultaneous work toward behavior change at the individual level to mitigate impacts of bias, and policy change at the institutional level to reduce the harms of unjust systems. Strategies for opening our eyes to our own biases, while not turning a blind eye to the risk to children that poverty brings, are critical to achieve equitable care for all.9,25

Radioiodine remnant ablation in stage I adult papillary thyroid carcinoma: does it improve postoperative outcome?

ObjectiveTo determine whether radioiodine remnant ablation (RRA) reduces cause-specific mortality (CSM) or tumor recurrence rates (TRR) after potentially curative bilateral thyroidectomy (BT) in low-risk adult papillary thyroid carcinoma (APTC) patients, we compared postoperative outcomes in 1836 pTNM stage I APTC patients having BT alone with 832 having BT+RRA during two consecutive 25-year periods.MethodsThe THEN cohort (consecutively managed during 1966–1990) comprised 809 patients (36% having BT+RRA) and the NOW cohort (1991–2015) comprised 1859 patients (29% BT+RRA). Analyses of differences in occurrence rates between BT alone and BT+RRA patients were performed with SAS software.ResultsDuring 1966–1990, when RRA rates rose ten-fold, 20-year CSM after BT alone was 0.6% and after BT+RRA was 1.2% (P = 0.66); during 1991–2015, when RRA rates progressively fell, no PTC deaths occurred in 1859 patients. In the THEN cohort, RRA did not significantly improve TRR at local, regional, or distant sites (P > 0.1), when compared to BT alone. RRA in NOW cohort was administered to 49% of node-positive (pN1) patients and 17% of node-negative (pN0/NX) patients (P < 0.0001); TRR therefore, were examined separately for pN0/NX and pN1 patients. In 1157 pN0/NX cases, 20-year locoregional TRR were 3.1% after BT and were higher (P = 0.049) at 8.6% after BT+RRA. In four pN1 groups, stratified by metastatic nodal burden, RRA did not significantly reduce the locoregional TRR observed after BT with curative intent (P > 0.5).ConclusionsIn a 5-decade experience, RRA administered postoperatively to stage I APTC patients did not reduce either CSM or TRR and should probably not be indicated when such patients undergo potentially curative BT.

Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty.

BackgroundThere is little evidence on outcomes of tourniquet use during bilateral total knee arthroplasty (BTKA). Tourniquet use in BTKA effects postoperative outcomes and efficiency inside the operating room. This study evaluates the safety and efficacy of simultaneous tourniquet inflation in BTKA.Materials and MethodsA retrospective review was performed on BTKA patients between March 2013 and May 2018. A total of 285 patients were divided into 2 cohorts. Patients in the simultaneous cohort had concomitant elevation of both tourniquets, but the sequential cohort did not. Perioperative variables were collected, and postoperative complications were tracked for a minimum of 90 days. Patients followed a uniform postoperative protocol. Complications were grouped by category to increase statistical power and compared using a noninferiority test. “Clinically noninferior” was defined as a margin ≤5%.ResultsThe simultaneous cohort had significantly (P < .05) higher American Society of Anesthesiologists class and smokers. Tourniquet time, delta hemoglobin, and surgical time were significantly lower. For the complication categories of “Any Thrombotic Event”, “Respiratory”, and “Soft Tissue/Wound”, the difference in occurrence rates was no more than 2.8%, 2.8%, and 5.2% between cohorts, respectively. The “Cardiovascular (non-MI)” group was no more than 9.3% different, that is, authors are 95% confident that 3 of 4 complication categories meet the clinically noninferior threshold.ConclusionThe study demonstrates the noninferiority of simultaneous as compared to sequential tourniquet inflation in BTKA. Patients with cardiac history may need sequential inflation or staged TKA. The information presented in the study assists surgeons in safely and efficiently performing BTKA.

Epidemiological Study of Vitiligo in Damanhour Teaching Hospital

Background: Vitiligo is the most common skin depigmenting disorder resulting from a selective loss of epidermal melanocytes, and affects around 0.5% of the world population. Both sexes are affected, and there are no apparent differences in rates of occurrence according to phototype or race. Aims: This study was doneto evaluate the epidemiology of vitiligo in Damanhour teaching hospital and to assess the clinical presentations of vitiligo. Patients and methods : This is a cross-sectional study on patients of vitiligo among cases who attended the dermatology and andrology outpatient clinic in Damanhour teaching hospital ,El-Behira ,Egypt .A predesigned dermatological sheet was used for data collection from the first 10,000 patients during a period of six months. Patients were clinically examined to determine type of skin diseases they have and those with vitiligo were selected. Results : Out of 10,000 studied patients, there were 86 cases of vitiligo with a prevalence of 0.86%. The results revealed a female predominance. There was a predominance of patients from rural areas. The most common associated disorder was thyroid disease.Conclusion: the prevalence of vitilgo in Damanhour teaching hospital is 0.86% and it is slightly more common among females and in rural areas. The most common exacerbating factor is stress.

Rate of oral frailty and oral hypofunction in rural community-dwelling older Japanese individuals.

To clarify the rate of oral frailty and oral hypofunction in rural community-dwelling older adults in Japan. Recently, the oral function of Japanese older adults has been evaluated multilaterally based on two concepts: oral frailty and oral hypofunction. Oral frailty is defined as a decrease in the oral function accompanied by a decrease in mental and physical functions. Oral hypofunction is a disease where the oral function is comprehensively decreased. However, their rates have not yet been elucidated. Oral frailty and oral hypofunction were evaluated in 679 older adults from rural areas. To investigate the differences in occurrence rates due to the evaluation methods, one of the subordinate symptoms of oral hypofunction, the reduced occlusal force, was evaluated based on both the occlusal force (main method) and the number of teeth (alternative method). The rate of oral frailty was 22.3% in men and 22.7% in women. The rate of oral hypofunction was 39.0% in men and 46.9% in women. The overall rate of oral hypofunction was 43.6% when the reduced occlusal force of oral hypofunction was evaluated using the main method and 46.4% when evaluated using the alternative method. The proportion of participants with decreased occlusal force, the number of present teeth, oral diadochokinesis, tongue pressure and masticatory performance increased with age in both men and women. Among rural community-dwelling older adults, the rate of oral frailty was 22.5% and that of oral hypofunction was 43.6%.

Probiotics for Preventing Upper Respiratory Tract Infections in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background Upper respiratory tract infections (URTIs) are common and burdensome infectious illness. Several trials have reported that probiotics can prevent URTIs in adults. Objectives To evaluate the efficacy and safety of probiotics in the prevention of URTIs in adults. Methods PubMed, Web of Science, Embase, and Cochrane Library were searched for reports published from database inception to May 14, 2020. Randomized controlled trials (RCTs) comparing probiotics with placebo for the prevention of URTIs in adults were included. Results Six RCTs with 1551 participants were included. Compared with the placebo group, the probiotics intervention group significantly reduced the incidence of URTI episodes (RR: 0.77; 95% CI: 0.68 to 0.87; P < 0.0001; I2 = 26%), the episode rate of URTIs (rate ratio: 0.72; 95% CI: 0.60 to 0.86; P = 0.0002; I2 = 99%), and the mean duration of one episode of URTI (MD: −2.66; 95% CI: −4.79 to −0.54; P = 0.01; I2 = 80%). The adverse events of probiotics were mainly mild gastrointestinal symptoms. There were no significant differences in occurrence rate of adverse effects between probiotics intervention and placebo group (rate ratio: 1.01; 95% CI: 0.80 to 1.26; P = 0.96; I2 = 99%). Conclusion Low-quality evidence provides support that probiotics have potential efficacy for preventing URTI episodes in adults. More trials are required to confirm this conclusion.

The Incidence of Agenesis of Palmaris Longus Muscle Among Multiracial Medical Students of University Malaya, Malaysia

Palmaris longus (PL) is the most superficial flexor muscle of the wrist. Agenesis of this muscle does not result in disability but its presence plays a significant role in reconstructive plastic surgery as a donor tendon for grafting. The awareness of the incidence of PL occurrence in a population is therefore desirable. In the present study, 457 multiracial medical students (220 Malays, 198 Chinese and 39 Indians) of University of Malaya, Malaysia, ages between 18 to 22 years, were examined for the presence or absence of the PL tendon using Schaeffer’s test. This study demonstrated the overall difference in occurrence rate of PL among the multiracial students which indirectly represent its overall pattern in Malaysian population, as the students originate from various states of this country. The data collected were then analyzed using non-parametric test to determine pattern of occurrence and incidence of agenesis of this muscle with regard to ethnicity, laterality, and gender. The highest incidence of unilateral and bilateral PL agenesis was observed in Indian students despite being the smallest race among the three groups studied. This study contradicts with previous findings that concluded Malays to be the group with the highest incidence of unilateral PL agenesis. This contradiction therefore justifies the need to construct a larger cohort study, which covers more diverse ethnic groups in Malaysia including the indigenous groups in Sabah and Sarawak to obtain the true incidence rate of PL agenesis in Malaysia.

Early unplanned reoperations after gastrectomy for gastric cancer are different between laparoscopic surgery and open surgery.

To compare the differences in occurrence rates, time intervals, main causes, and management strategies of early unplanned reoperations (EUROs) after gastrectomy for gastric cancer (GC) between laparoscopic and open surgery. From Jan. 2005 to Dec. 2014, 2608 and 1516 patients underwent laparoscopic-assisted gastrectomy (LAG) and open gastrectomy (OG), respectively. Perioperative outcomes and risk factors for EURO were analyzed. The overall EURO rate was 1.3%, and the rate in LAG and OG groups was 1.1% and 1.6%, respectively. The EURO rate after 24h postoperatively was significantly lower in LAG group than in OG group (p = 0.019). No significant correlation was identified between laparoscopic surgery and EURO rate (p = 0.157); age > 70 (p = 0.028), body mass index (BMI) > 25kg/m2 (p = 0.009), and estimated blood loss > 100ml (p = 0.029) were independent risk factors for EURO. The main cause of EURO was intra-abdominal bleeding, anastomotic bleeding, and anastomotic leakage in LAG group; and intra-abdominal bleeding, anastomotic leakage, and intestinal obstruction in OG group. The proportion of patients with intra-abdominal bleeding requiring EURO was markedly higher in LAG group than in OG group (p = 0.043). Transverse mesocolonic vessels and spleen were the most common bleeding sites necessitating EURO in LAG and OG groups, respectively. Six of 28 (21.4%) patients with EUROs in LAG group underwent laparoscopic procedure (p = 0.025). Mortality in patients requiring EURO was 3.6% and 20.8% in LAG and OG groups, respectively (p = 0.084). Compared to open surgery, laparoscopic surgery does not increase the incidence of EURO in patients undergoing gastrectomy for GC; however, laparoscopic surgery is associated with a lower EURO rate after 24h postoperatively and a higher proportion of patients with intra-abdominal bleeding requiring EURO than open surgery. Effective and accurate intraoperative hemostasis for intra-abdominal vessels and anastomotic sites will help further reduce the incidence of EURO following LAG within 24h postoperatively.

Functional Roles of Starch Binding Domains and Surface Binding Sites in Enzymes Involved in Starch Biosynthesis.

Biosynthesis of starch is catalyzed by a cascade of enzymes. The activity of a large number of these enzymes depends on interaction with polymeric substrates via carbohydrate binding sites, which are situated outside of the catalytic site and its immediate surroundings including the substrate-binding crevice. Such secondary binding sites can belong to distinct starch binding domains (SBDs), classified as carbohydrate binding modules (CBMs), or be surface binding sites (SBSs) exposed on the surface of catalytic domains. Currently in the Carbohydrate-Active enZYmes (CAZy) database SBDs are found in 13 CBM families. Four of these families; CBM20, CBM45, CBM48, and CBM53 are represented in enzymes involved in starch biosynthesis, namely starch synthases, branching enzymes, isoamylases, glucan, water dikinases, and α-glucan phosphatases. A critical role of the SBD in activity has not been demonstrated for any of these enzymes. Among the well-characterized SBDs important for starch biosynthesis are three CBM53s of Arabidopsis thaliana starch synthase III, which have modest affinity. SBSs, which are overall less widespread than SBDs, have been reported in some branching enzymes, isoamylases, synthases, phosphatases, and phosphorylases active in starch biosynthesis. SBSs appear to exert roles similar to CBMs. SBSs, however, have also been shown to modulate specificity for example by discriminating the length of chains transferred by branching enzymes. Notably, the difference in rate of occurrence between SBDs and SBSs may be due to lack of awareness of SBSs. Thus, SBSs as opposed to CBMs are not recognized at the protein sequence level, which hampers their identification. Moreover, only a few SBSs in enzymes involved in starch biosynthesis have been functionally characterized, typically by structure-guided site-directed mutagenesis. The glucan phosphatase Like SEX4 2 from A. thaliana has two SBSs with weak affinity for β-cyclodextrin, amylose and amylopectin, which were indicated by mutational analysis to be more important than the active site for initial substrate recognition. The present review provides an update on occurrence of functional SBDs and SBSs in enzymes involved in starch biosynthesis.

Warming results in advanced spring phenology, delayed leaf fall, and developed abnormal shoots in Pinus densiflora seedlings

Key message In an evergreen species with fixed-growth, warming advanced budburst but not leaf appearance and growth, and the further developed abnormal shoots by warming indicates extended growing season instead of leaf fall. Abstract We investigated the effects of warming and precipitation manipulation on phenology (spring phenology, leaf fall, and abnormal shoot phenology) in Pinus densiflora, which is an evergreen species with fixed-growth. In an open-air nursery, 2-year-old P. densiflora seedlings were planted in April 2013 and treated with 6 treatments (n = 3) [2 temperature levels: + 3 °C (TW) and control (TC); 3 precipitation levels: + 30% (PI), − 30% (PD), and control (PC)]. We observed spring and abnormal shoot phenology in 2014 and 2015, and measured dry weight of fallen leaves in 2015. Phenology was not changed by precipitation manipulation. In spring phenology, budburst was advanced by 9.4–9.6 days under warming, but timing of leaf appearance and growth did not changed. Cumulative weight of fallen leaves was 25.8–28.6% lower in TW plots than in TC plots between July and December 2015. There were no significant differences in occurrence rates of abnormal shoots among plots. 65.7–96.8% of abnormal shoots remained at the budburst stage in TC plots, while abnormal shoots in TW plots further developed to the leaf appearance and growth stages. Abnormal shoot development stopped 10.5–28.8 days later in TW plots than the TC plots in 2014 and 2015. Effects of warming were evident only in budburst, because leaf appearance and growth were affected by fixed-growth characteristics as well as warming. Decreased leaf fall and further developed abnormal shoots could be interpreted as delayed leaf senescence and extended growing season, respectively, for an evergreen species with fixed-growth.

Venous Thromboembolism During Treatment with Antipsychotics: A Review of Current Evidence.

This article summarises the current evidence on the risk of venous thromboembolism (VTE) with the use of antipsychotics. An increasing number of observational studies indicate an elevated risk of VTE in antipsychotic drug users. Although the use of certain antipsychotics has been associated with VTE, current data can neither conclusively verify differences in occurrence rates of VTE between first- and second-generation antipsychotics or between individual compounds, nor identify which antipsychotic drugs have the lowest risk of VTE. The biological mechanisms involved in the pathogenesis of this adverse drug reaction are still to be clarified but hypotheses such as drug-induced sedation, obesity, increased levels of antiphospholipid antibodies, enhanced platelet aggregation, hyperhomocysteinaemia and hyperprolactinaemia have been suggested. Risk factors associated with the underlying psychiatric disorder may at least partly explain the increased risk. Physicians should be aware of this potentially serious and even sometimes fatal adverse drug reaction and should consider discontinuing or switching the antipsychotic treatment in patients experiencing a VTE. Even though supporting evidence is limited, prophylactic antithrombotic treatment should be considered in risk situations for VTE.

QBO/solar modulation of the boreal winter Madden‐Julian oscillation: A prediction for the coming solar minimum

AbstractThe Madden‐Julian oscillation (MJO), also known as the 30–60 day oscillation, is the strongest of the intraseasonal climate oscillations in the tropics and has significant derivative effects on extratropical circulation and intraseasonal climate. It has recently been shown that the stratospheric quasi‐biennial oscillation (QBO) modulates the amplitude of the boreal winter MJO such that MJO amplitudes are larger on average during the easterly phase (QBOE) than during the westerly phase (QBOW). A major possible mechanism is the decrease in static stability in the lowermost stratosphere under QBOE conditions resulting from relative upwelling associated with the QBO‐induced meridional circulation. Here evidence is presented that tropical upwelling changes related to the 11 year solar cycle also modulate the boreal winter MJO. Based on 37.3 years of MJO amplitude data, the largest amplitudes and occurrence rates, and the weakest static stabilities in the tropical lower stratosphere, occur during the QBOE phase under solar minimum (SMIN) conditions while the smallest amplitudes and strongest static stabilities occur during the QBOW phase under solar maximum (SMAX) conditions. Conversely, when the QBO and solar forcings are opposed (QBOW/SMIN and QBOE/SMAX), the difference in occurrence rates becomes statistically insignificant. During the coming solar minimum, at least one additional winter in the QBOE/SMIN category should occur (possibly as early as 2017/2018) during which especially large MJO amplitudes are expected and an initial test of these results will be possible.

Venous thromboembolism during treatment with antipsychotics: Results of a drug surveillance programme

Objectives: Venous thromboembolism (VTE) can be a life-threatening medical condition that may lead to leg swelling, respiratory distress and death.Methods: The AMSP (Arzneimittelsicherheit in der Psychiatrie) is a continuous multicentre drug surveillance programme that assesses severe adverse drug reactions during treatment of psychiatric inpatients. We report on a total of 264,422 inpatients who were treated with antipsychotics (APs) and monitored from 1993 to 2011 in 99 psychiatric hospitals.Results: During this period VTE events were reported for 89 inpatients, corresponding to an occurrence rate of 34 cases per 100,000 inpatient admissions treated with APs or 43 cases per 10,000 person-years. The occurrence of VTE was greatest in patients over the age of 65 years of age with mood disorders. The chemical class of butyrophenones (48/100,000) followed by atypical APs (36/100,000) showed the highest occurrence rate for VTE compared to thioxanthenes (23/100,000), which were less associated with VTE. If imputed alone, pipamperone (61/100,000) and risperidone (55/100,000) were most frequently associated with VTE. In general, there was no difference in occurrence rate of VTE between high- and low-potency APs.Conclusions: These results suggest that clinicians should consider AP drug exposure as a potential risk factor for VTE for patients older than 65 years. Additionally, the diagnosis of an affective disorder seems to increase the risk for VTE.

Effect of transcutaneous electrical acupoint stimulation combined with palonosetron on chemotherapy-induced nausea and vomiting: a single-blind, randomized, controlled trial

BackgroundChemotherapy-induced nausea and vomiting adversely affects the quality of life of patients who receive chemotherapy via intravenous infusion or transcatheter arterial chemoembolization (TACE). This study aimed to investigate the clinical effects of transcutaneous electrical acupoint stimulation (TEAS) on nausea and vomiting after TACE.MethodsA total of 142 patients who received TACE with cisplatin for primary or metastatic liver cancer were assigned to the active-acupuncture (n = 72) or placebo-acupuncture (n = 70) groups using a covariate-adaptive randomization at a ratio of 1:1. The acupoints Hegu (LI4), Neiguan (P6), and Zusanli (ST36) were stimulated twice daily for 6 days. The effects of TEAS on nausea and vomiting were assessed by using occurrence rate and severity of these symptoms. Anorexia scale and M. D. Anderson Symptom Inventory (MDASI) scores were secondary endpoints and were used to assess the effect of TEAS on patient appetite and quality of life. The safety of the treatments was also monitored.ResultsBetween the two groups, the differences in occurrence rates and severities of nausea and vomiting after TACE were not significant (all P > 0.05). From the second day after TACE, anorexia scores were significantly lower in the active-acupuncture group than in the placebo-acupuncture group and continued to decrease over time with treatment (all P values less than 0.01). On days 0, 1, and 2, the mean MDASI scores for the active-acupuncture group were slightly lower than those for the placebo-acupuncture group, but the differences were not statistically significant (all P > 0.05). No significant differences were found between the two groups in the occurrence rate of any adverse event (P > 0.05).ConclusionTEAS appears to be a safe and effective therapy to relieve patients’ gastrointestinal discomfort after chemotherapy.Trial registration NCT01895010. Registered 21 June 2013