Greater Incidence Research Articles

Risk factors, transcriptomics, and outcomes of myocardial injury following lower extremity revascularization

Myocardial injury after non-cardiac surgery (MINS) is common. We investigated the incidence and outcomes of MINS, and mechanistic underpinnings using pre-operative whole blood gene expression profiling in a prospective cohort study of individuals undergoing lower extremity revascularization (LER) for peripheral artery disease (PAD). Major adverse cardiovascular and limb events (MACLE) were defined as a composite of death, myocardial infarction, stroke, major lower extremity amputation or reoperation. Among 226 participants undergoing LER, MINS occurred in 53 (23.5%). Patients with MINS had a greater incidence of major adverse cardiovascular events (49.1% vs. 22.0%, adjusted HR 1.87, 95% CI 1.07–3.26) and MACLE (67.9% vs. 44.5%; adjusted HR 1.66, 95% CI 1.08–2.55) at median 20-month follow-up. Pre-operative whole blood transcriptome profiling of a nested matched MINS case–control cohort (n = 41) identified upregulation of pathways related to platelet alpha granules and coagulation in patients who subsequently developed MINS. Thrombospondin 1 (THBS1) mRNA expression was 60% higher at baseline in patients who later developed MINS, and was independently associated with long-term cardiovascular events in the Duke Catheterization Genetics biorepository cohort. In conclusion, pre-operative THBS1 mRNA expression is higher in patients who subsequently develop MINS and is associated with incident cardiovascular events. Pathways related to platelet activity and coagulation associated with MINS provide novel insights into mechanisms of myocardial injury.

Association of Race and Ethnicity With Incidence of Dementia Among Older Adults

The racial and ethnic diversity of the US, including among patients receiving their care at the Veterans Health Administration (VHA), is increasing. Dementia is a significant public health challenge and may have greater incidence among older adults from underrepresented racial and ethnic minority groups. To determine dementia incidence across 5 racial and ethnic groups and by US geographical region within a large, diverse, national cohort of older veterans who received care in the largest integrated health care system in the US. Retrospective cohort study within the VHA of a random sample (5% sample selected for each fiscal year) of 1 869 090 participants aged 55 years or older evaluated from October 1, 1999, to September 30, 2019 (the date of final follow-up). Self-reported racial and ethnic data were obtained from the National Patient Care Database. US region was determined using Centers for Disease Control and Prevention (CDC) regions from residential zip codes. Incident diagnosis of dementia (9th and 10th editions of the International Classification of Diseases). Fine-Gray proportional hazards models were used to examine time to diagnosis, with age as the time scale and accounting for competing risk of death. Among the 1 869 090 study participants (mean age, 69.4 [SD, 7.9] years; 42 870 women [2%]; 6865 American Indian or Alaska Native [0.4%], 9391 Asian [0.5%], 176 795 Black [9.5%], 20 663 Hispanic [1.0%], and 1 655 376 White [88.6%]), 13% received a diagnosis of dementia over a mean follow-up of 10.1 years. Age-adjusted incidence of dementia per 1000 person-years was 14.2 (95% CI, 13.3-15.1) for American Indian or Alaska Native participants, 12.4 (95% CI, 11.7-13.1) for Asian participants, 19.4 (95% CI, 19.2-19.6) for Black participants, 20.7 (95% CI, 20.1-21.3) for Hispanic participants, and 11.5 (95% CI, 11.4-11.6) for White participants. Compared with White participants, the fully adjusted hazard ratios were 1.05 (95% CI, 0.98-1.13) for American Indian or Alaska Native participants, 1.20 (95% CI, 1.13-1.28) for Asian participants, 1.54 (95% CI, 1.51-1.57) for Black participants, and 1.92 (95% CI, 1.82-2.02) for Hispanic participants. Across most US regions, age-adjusted dementia incidence rates were highest for Black and Hispanic participants, with rates similar among American Indian or Alaska Native, Asian, and White participants. Among older adults who received care at VHA medical centers, there were significant differences in dementia incidence based on race and ethnicity. Further research is needed to understand the mechanisms responsible for these differences.

Effects of an Inpatient Physical Rehabilitation Program Designed for Persons with Amputations of Traumatic or Vascular Etiologies

ABSTRACT Introduction Rehabilitation after amputation is essential, and descriptions of inpatient rehabilitation programs for individuals with amputation are scarce. Therefore, the objective of this study was to describe the effects of an inpatient physical rehabilitation program on mobility, balance, function, and gait of individuals with unilateral lower-limb amputations. Materials and Methods This was a retrospective before-after study. Data were extracted from medical records of individuals with lower-limb amputation admitted for inpatient intensive rehabilitation programs. Data on etiology, functional mobility (by timed up and go [TUG]), balance and functionality (amputee mobility predictor [AMP]), and gait (2-minute walk test [2MWT]) were collected before and after prosthetic fitting phase of an inpatient rehabilitation program. Patient information was stratified as traumatic and vascular etiologies, and after descriptive analysis, general outcomes and intragroup results were compared with t-test and followed by linear regressions analysis for a better understanding of the demographic and clinical roles on treatment evolution. Results Group comparison evidenced differences of age between traumatic and vascular groups, as traumatic amputations had greater incidence among younger individuals, regardless of the prosthesis phase. Before the prosthesis fitting and regardless of the groups, there were significant improvements on AMP, 2MWT, and TUG, and the differences between both groups were influenced by their baseline conditions. After prosthesis fitting, significant improvements were identified, regardless of the etiology. Conclusions This study provides evidence that individuals with amputation who are admitted to an intensive hospitalized physical rehabilitation program experience benefits in mobility, balance, functionality, and gait capacity irrespective of causality or if the prosthesis was provided. Gains evidenced in the preprosthetic phase were continued in the postprosthetic phase. Clinical Relevance Inpatient rehabilitation programs for individuals with amputation are beneficial for improving the functionality of these individuals. This type of multidisciplinary rehabilitation provides functional improvements to the patient from the preprosthetic to the prosthetic phases, favoring global rehabilitation in a short period, which can reduce treatment time and provide better living conditions for the patient.

Consanguineous Marriages and Dental Anomalies: A Cross-Sectional Analytical Study.

Objective To determine the correlation between consanguineous marriages and dental anomalies. Study Design. A cross-sectional analytical study. Materials and Methods This cross-sectional analytical multicentered study was carried out at Foundation University College of Dentistry after approval of the Ethical Research Committee (ERC) from September 2021 to November 2021 in Pakistan. All pediatric patients (4–10 years old) with dental malformations undergoing dental procedures or examinations and born with spontaneous vaginal delivery and uncomplicated cesarean section participated in the study. First, second, and third-degree relatives' marriages of parents were used to define consanguinity. The Basic Pay Scale was the reference of estimation of socioeconomic status. Participants with a history of orofacial trauma, pertinent parental history (infertility, hormonal treatment, or infectious diseases during pregnancy, conception with assisted reproductive techniques, prolonged complicated labor, premature deliveries, and twin births), and prolonged hospital admission immediately after birth were excluded from the study. Results The mean maternal and paternal age was recorded to be 23.86 ± 5.4 and 27.07 ± 9.6, respectively, whereas the mean age of participants was 6.60 ± 1.67. There were 297 children with congenital abnormalities, with 203 (68.4%) males and 94 (31.6%) females. The prevalence of consanguineous marriage was found to be in 210 (70.7%) participants. Congenital dental anomalies correlation was found to be significant with consanguineous marriages (p value <0.001). Consanguineous marriages were more frequent in the lower socioeconomic group when compared with the middle and upper socioeconomic groups, respectively (74.7% vs. 8.1% vs. 17.2%, p value 0.007). Conclusion Congenital dental anomalies were significantly prevalent in consanguineous marriages with greater incidence in lower socioeconomic groups. Consanguineous marriages have the propensity to transmute population conformation, but due to religious and social beliefs, literature is hesitant to ascribe congenital dental anomalies persuasive relevance with consanguinity.

Successful Radiofrequency Ablation of the Right Lateral Accessory Pathway with Modified Carpentier Reconstruction Surgery in a Patient with Ebstein Anomaly Concomitant of Secundum Atrial Septal Defect, Atrial Fibrillation, and Wolff–Parkinson–White Syndrome

Ebstein anomaly (EA) results from the failure of proper delamination of the tricuspid valve leaflets from the right ventricle (RV) myocardium. The severity of EA occurs on a spectrum that results in varying degrees of tricuspid regurgitation, atrial dilation, RV dilation, and dysfunction. These effects have the potential to create substrates that can give rise to atrial arrhythmia, ventricular arrhythmia, and a greater incidence of Wolff–Parkinson–White (WPW) syndrome Wackel et al. (2018) accounting for 0.5% of all congenital heart diseases (Oh et al. 1985). In the case of atrial fibrillation and WPW, it is very dangerous for the patient because of hemodynamic compromise, syncope, and sudden death. In this case report, we share our experience in using radiofrequency ablation to ablate right lateral accessory pathway, with modified Carpentier technique in operation to treat an adult patient diagnosed with Ebstein anomaly, atrial septal defect, atrial fibrillation, and WPW syndrome.

Clinicopathological and Gene Mutation Analysis of 27 Cases with Extranodal Rosai-Dorfman Disease.

ObjectiveTo investigate the clinicopathological features, and mutations of NRAS, KRAS, BRAF and MAP2K1 genes in extranodal Rosai–Dorfman disease (RDD).MethodsThe clinic opathological features of 27 patients with extranodal RDD were retrospectively analyzed, and the NRAS, KRAS, BRAF and MAP2K1 genes mutation were detected by Sanger sequencing.ResultsThe male to female ratio was 1.7:1. The average age was 46.9 years. There were skin lesions in 12 cases (44.4%) and head and neck lesions in 8 cases (29.6%). Microscopically, those patients with skin RDD had lesions characterized by clear and dark intervals and obvious emperipolesis, while in other parts, the background was more complex. About 21.1% (4/19) had mutations, including 3 mutations in NRAS 2 exon and 1 mutation in KRAS 2 exon. Two of the three NRAS mutations were located in the skin, accounting for 20% (2/10) of skin RDD.ConclusionExtranodal RDD was more common in males than in females, and might occur in all ages, with a greater incidence in skin, head, and neck. Besides the obvious microscopic characteristics in those with skin RDD, the background of other parts was complex and easily missed or misdiagnosed. Some RDD with gene mutations, mainly in NRAS 2 exon, especially in skin RDD, support partial RDD is a clonal disease.

A survey and bibliometric analysis of different communication technologies available for smart meters

A smart energy meter is one of the most significant smart grid products. The smart energy meter (SEM) is an advanced energy meter that collects data from end users' load devices, monitors energy usage, and then sends the data to the smart grid. Advanced Metering Infrastructure (AMI) is used by smart energy meters to send real-time consumption data to utilities and customers. It is made possible by the Internet of Things (IoT), which expands the internet's capabilities to enable machine-to-machine or machine-to-server communication. Smart meters can communicate with each other using a variety of communication technologies. This paper presents a survey on communication technologies to determine the suitable technology based on a few parameters like cost-effectiveness, security, long-range, low power consumption, and data rate that are pre-requisite for smart meter communication. Firstly, a short literature survey is conducted to investigate the previous researches and challenges associated with communication technologies. The findings and future work of these articles are then summarized in a separate table for a clear understanding for the readers. Following that, an overview of communication technologies and their pros and cons are presented to understand critical aspects of each technology. A bibliometric analysis is also done to find the top countries, universities, and authors with greater incidence in this subject area worldwide by extracting citation data from Scopus and Web of Science. Besides, a comparison of major communication technologies is made in the discussion. Additionally, based on the parameters and literature reviewed, this paper suggests some suitable communication technologies for smart meters. It presents a model of a cost-effective hybrid communication system for smart metering and AMI. Finally, the possible issues and challenges related to communication technologies are discussed. Based on the challenges, several future research directions are also provided, which may lead to promising findings in the near future.

CLINICAL PROFILE AND EVALUATION OF SERUM PROLACTIN LEVEL IN CIRRHOSIS OF LIVER WITH SPECIAL REFERENCE TO CHILD PUGH SCORE

Clinical profile and evaluation of serum prolactin level in cirrhosis of liver with special reference to Child Pugh Score. Abstract Background: With the increasing incidence of liver cirrhosis the use of a biomarker such as prolactin, indicates the severity of the disease, its complications and serves as a tool for early intervention. Aim: To study the clinical profile and evaluation of serum Prolactin level in Cirrhosis of Liver with special reference to Child Pugh Score. Materials and Methods: A observational cross sectional study on 70 patients admitted under Department of Medicine, JMCH from July 2020 to June 2021. All the patients are subjected to the routine work up for chronic liver disease including serum prolactin level. Results: A total of 70 Patients analyzed in the study. The mean age is found to be 47 years with SD ±13 years, the male and female ratio is 4:1 with mean prolactin levels among the males, it is 36.9 ng/dl with SD ±15.3 ng/dl and in females it is 42.8 ng/dl with SD ±14.2 ng/dl . Of the 70 patients in this study, 59 (84.3%) of them had serum prolactin levels elevated above 19 ng/ml with various clinical profiles . The various clinical presentations noted in our study included ascites in 69 (98.5%) patients, portal hypertension in 63( 90 %) of the patients , oesophageal varices in 44 (62.85%) with upper GI bleed in 31 (44.3%) patients, hepatic encephalopathy (grades 1-4) in 50 (71.42%) patients. Out of 70 patients 55(78.5%) were of class C in child pugh score and the mean prolactin level is found to be 43.638 ng/ml while normal serum prolactin levels is seen in all patients with Class A of Child Pugh Class with p value &lt; 0.001 . The Spearmen coefficient value i.e. the r-value was 0.830 which is a strong positive correlation between the child pugh scoring system and serum prolactin level. Conclusion: Serum prolactin level correlated with the Child Pugh score in predicting the severity of the disease. Patients with a higher serum prolactin have a greater incidence of complications of cirrhosis like PHTN, HE and Esophageal varices.

Growth and Carcass Characteristics of Beef-Cross-Dairy-Breed Heifers and Steers Born to Different Dam Breeds

Simple SummaryThe dairy industry is an important source of animals for the beef industry in New Zealand. Since 1998, the proportion of Friesian–Jersey cows in dairy herds has increased from 19% to 49%. The aim of this study was to investigate the effect of dam breed on growth and carcass characteristics of beef-cross-dairy-breed progeny born to Friesian, Friesian-cross, Friesian–Jersey and Jersey-cross cows. Dam breed had an effect on all growth traits, as well as carcass weight, fat colour, fat depth, and ossification score. An increase in Jersey genetics in calves retained for beef finishing would result in calves that take a longer time to reach weaning weight and have a lighter carcass and yellower fat.Approximately two thirds of the annual beef kill in New Zealand originates from the dairy industry. The recent increase in Jersey genetics in the dairy herd will inevitably result in an increase in Jersey genetics entering the beef herd from retention of dairy-origin calves for finishing. Limited literature is available on the effect of dam breed on the performance of beef-cross-dairy-breed progeny. The aim of this study was to investigate the effect of dam breed from dams with varying proportions of Friesian and Jersey genetics on growth traits and carcass characteristics of their 24-month-old beef-cross-dairy-breed heifer and steer progeny. Liveweights of 142 heifers and 203 steers from Friesian (F), Friesian-cross (FX), Friesian–Jersey (FJ) and Jersey-cross (JX) dams were recorded at birth, weaning, as yearlings and at slaughter. Carcass characteristics were also recorded. At each point measured, liveweight was greatest for calves born to F dams. Calves born to F dams took 93 days to reach a weaning weight of 100 kg, whereas those from FX, FJ and JX dams took 99, 101 and 102 days, respectively. Carcass weight was greatest for progeny of F dams (286 kg, compared with 279, 275 and 276 for progeny of FX, FJ and JX dams, respectively). The progeny of JX dams had yellower fat than all other dam breed groups and a greater incidence of excessively yellow fat (fat score ≥ 5).

Peripartum cardiomyopathy: A 2022 update

Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition defined by left ventricular dysfunction and heart failure (HF), occurring in late pregnancy or, more commonly, the early postpartum period. In African American women, women with pre-eclampsia, advanced maternal age, and numerous gestation pregnancies, there is a greater incidence. Although the pathophysiology of PPCM is still undetermined, the importance of vasculo-hormonal pathways has been suggested in research over the past decades. Sarcomere genetic polymorphisms are found in at least some women with the disorder. More than 50% of the patients recover systolic function, albeit some are left with chronic cardiomyopathy, and a small minority of patients requires mechanical support or cardiac transplantation, or both. For the diagnosis of PPCM, electrocardiographic findings of decreased myocardial function are essential. Currently, the management of PPCM is limited to standard treatments for HF with reduced ejection fraction, with attention to minimizing the potential adverse effects on the fetus in women who are still pregnant. As a result, the outcome might range from full recovery to persistent HF, arrhythmia, thromboembolic events, or death. Research on PPCM is examined in this review, as are potential future paths for further study.

Factors Affecting Wetland Loss: A Review

Despite occupying an area no greater than 8% of the earth’s surface, natural wetland ecosystems fulfill multiple ecological functions: 1. Soil formation and stabilization support, 2. Food, water, and plant biomass supply, 3. Cultural/recreational services, landscape, and ecological tourism, 4. Climate regulation, and 5. Carbon sequestration; with the last one being its most important function. They are subject to direct and indirect incident factors that affect plant productivity and the sequestration of carbon from the soil. Thus, the objective of this review was to identify the incident factors in the loss of area and carbon sequestration in marine, coastal, and continental wetlands that have had an impact on climate change in the last 14 years, globally. The methodology consisted of conducting a literature review in international databases, analyzing a sample of 134 research studies from 37 countries, organized in tables and figures supported by descriptive statistics and content analysis. Global results indicate that agriculture (25%), urbanization (16.8%), aquaculture (10.7%), and industry (7.6%) are incident factors that promote wetlands effective loss affecting continental wetlands more than coastal and marine ones. Regarding carbon sequestration, this is reduced by vegetation loss since GHG emissions raise because the soil is exposed to sun rays, increasing surface temperature and oxidation, and raising organic matter decomposition and the eutrophication phenomenon caused by the previous incident factors that generate wastewater rich in nutrients in their different activities, thus creating biomass and plant growth imbalances, either at the foliage or root levels and altering the accumulation of organic matter and carbon. It is possible to affirm in conclusion that the most affected types of wetlands are: mangroves (25.7%), lagoons (19.11%), and marine waters (11.7%). Furthermore, it was identified that agriculture has a greater incidence in the loss of wetlands, followed by urbanization and industry in a lower percentage.

Characterization of runs of homozygosity, heterozygosity-enriched regions, and population structure in cattle populations selected for different breeding goals

BackgroundA decline in the level of genetic diversity in livestock can result in reduced response to selection, greater incidence of genetic defects, and inbreeding depression. In this context, various metrics have been proposed to assess the level of genetic diversity in selected populations. Therefore, the main goals of this study were to: 1) investigate the population structure of 16 cattle populations from 15 different pure breeds or composite populations, which have been selected for different breeds goals; and, 2) identify and compare runs of homozygosity (ROH) and heterozygosity-enriched regions (HER) based on different single nucleotide polymorphism (SNP) panels and whole-genome sequence data (WGS), followed by functional genomic analyses.ResultsA total of 24,187 ROH were found across all cattle populations, with 55% classified in the 2-4 Mb size group. Fourteen homozygosity islands were found in five populations, where four ROH islands located on BTA1, BTA5, BTA16, and BTA19 overlapped between the Brahman (BRM) and Gyr (GIR) breeds. A functional analysis of the genes found in these islands revealed candidate genes known to play a role in the melanogenesis, prolactin signaling, and calcium signaling pathways. The correlations between inbreeding metrics ranged from 0.02 to 0.95, where the methods based on homozygous genotypes (FHOM), uniting of gametes (FUNI), and genotype additive variance (FGRM) showed strong correlations among them. All methods yielded low to moderate correlations with the inbreeding coefficients based on runs of homozygosity (FROH). For the HER, 3576 runs and 26 islands, distributed across all autosomal chromosomes, were found in regions containing genes mainly related to the immune system, indicating potential balancing selection. Although the analyses with WGS did not enable detection of the same island patterns, it unraveled novel regions not captured when using SNP panel data.ConclusionsThe cattle populations that showed the largest amount of ROH and HER were Senepol (SEN) and Montana (MON), respectively. Overlapping ROH islands were identified between GIR and BRM breeds, indicating a possible historical connection between the populations. The distribution and pattern of ROH and HER are population specific, indicating that different breeds have experienced divergent selection processes or different genetic processes.

To What Extent is Each Area of Oral-Maxillofacial Surgery Practiced in the United States Today?

To What Extent is Each Area of Oral-Maxillofacial Surgery Practiced in the United States Today?

Cognitive, Emotion and Behavioral Reactions in Pregnant Women Who Have Termination of Pregnancy due to Congenital Fetal Anomaly

Background: Congenital disorders are a global problem with a greater incidence in developing countries. Knowing the presence of congenital abnormalities in pregnancy is a bad experience that is very unpleasant. In fact, it is Bed Breaking News which is very difficult for a pregnant woman to accept. A special approach is needed to inform patients and their families. Especially if the pregnancy termination will be carried out. Methods: A case report of a 26-year-old second pregnant woman, with multiple congenital fetal anomaly Results and Discussion: The mental stress experienced before and after the termination of pregnancy proved to be a serious problem. Knowing that there are congenital and multiple abnormalities in the baby they are carrying, pregnant women experience shock, sadness, and do not want to accept it, let alone termination of pregnancy. The patient even had time to seek a second opinion to reassure him. After the termination of pregnancy, the patient has just entered a recovery period and is gradually improving. Conclusion: Although it takes time, the patient is ready to accept the results of the examination and agrees to terminate the pregnancy.

Editorial acerca de “Esofagectomía con linfadenectomía guiada por fluorescencia con verde de indocianina en cáncer de esófago“

Esophageal cancer is one of the gastrointestinal cancers with the greatest incidence over the past years and is the eighth most common cancer worldwide, affecting more than 450 000 people per year1. Its treatment and prognosis depend on tumor stage, location, histological type, nutritional status and presence of comorbidities2. Although there have been significant advances in the field of oncology in recent years, esophagectomy with lymph node clearance remains the main curative treatment. Total esophagectomy with two-field or three-field lymphadenectomy plays a very important role in the locoregional control of the disease. In recent years, the technological advances and the development of minimally invasive surgical techniques have significantly reduced morbidity and mortality.

The Effects of Malnutrition on the Immune System of Those Living in Food Deserts and Food Swamps

Abstract: Malnutrition is a leading cause of immunodeficiency worldwide; in particular, vitamin A and protein malnutrition seem to wreak devastating effects on various types of white blood cells. This research paper undertakes a primarily qualitative approach, curating and summarizing the most cited published findings on the effects of vitamin A and protein deprivation on leukocytes, neutrophils, eosinophils, lymphocytes, monocytes, macrophages, B cells, and T cells. All were found to be decreased in serum levels and/or have diminished efficacy in those that were malnourished, statistically significant to a p  0.05. This research is relevant as it may provide another compounding variable when regarding why those of lower socioeconomic class – especially those living in food deserts and food swamps – seem to experience disease at a greater incidence and burden than their more affluent age and sex matched counterparts.

Population dynamics of Aedes aegypti (Diptera: Culicidae): Contributions to the prevention of arbovirosis in Villa Clara, Cuba

Emerging and re-emerging infectious diseases constitute one of the main health problems worldwide. The objective of the research consisted of analyzing the development dynamics of adult mosquito populations of the species Ae. aegypti in Villa Clara province, Cuba during the period 2016-2020. The research covered the 13 municipalities of Villa Clara. An observational, descriptive, ecological, retrospective and analytical-statistical (by decision tree/exploratory data analysis) study was conducted. The study was based on the collection of positive samples/number of outbreaks reported in the 13 municipalities of the province, in the different months of the period analyzed, for the mosquito species Ae. aegypti, where each sample point corresponded to the number of specimens collected in one of the years covered, with one of the months of the year in question (12 months), the 13 municipalities, and 9 types of reservoirs. This resulted in 7 020 observations, which constitutes the sample size. The presence of the species under analysis was found in the 13 municipalities of the province, with abundant population densities; on the other hand, the variables with the greatest incidence in the population dynamics were: municipality and type of reservoir, with emphasis on the low tank, as the preferred oviposition and breeding site for this species. It is concluded that Ae. aegypti has a high capacity for adaptation and high ecological plasticity, with a marked correspondence between the ecology and habitat of the species under analysis.

\u2018Nebbiolo\u2019 genome assembly allows surveying the occurrence and functional implications of genomic structural variations in grapevines (Vitis vinifera L.)

Background‘Nebbiolo’ is a grapevine cultivar typical of north-western Italy, appreciated for producing high-quality red wines. Grapevine cultivars are characterized by possessing highly heterozygous genomes, including a great incidence of genomic rearrangements larger than 50 bp, so called structural variations (SVs). Even though abundant, SVs are an under-explored source of genetic variation mainly due to methodological limitations at their detection.ResultsWe employed a multiple platform approach to produce long-range genomic data for two different ‘Nebbiolo’ clones, namely: optical mapping, long-reads and linked-reads. We performed a haplotype-resolved de novo assembly for cultivar ‘Nebbiolo’ (clone CVT 71) and used an ab-initio strategy to annotate it. The annotated assembly enhanced our ability to detect SVs, enabling the study of genomic regions not present in the grapevines’ reference genome and accounting for their functional implications. We performed variant calling analyses at three different organizational levels: i) between haplotypes of clone CVT 71 (primary assembly vs haplotigs), ii) between ‘Nebbiolo’ and ‘Cabernet Sauvignon’ assemblies and iii) between clones CVT 71 and CVT 185, representing different ‘Nebbiolo’ biotypes. The cumulative size of non-redundant merged SVs indicated a total of 79.6 Mbp for the first comparison and 136.1 Mbp for the second one, while no SVs were detected for the third comparison. Interestingly, SVs differentiating cultivars and haplotypes affected similar numbers of coding genes.ConclusionsOur results suggest that SVs accumulation rate and their functional implications in ‘Nebbiolo’ genome are highly-dependent on the organizational level under study. SVs are abundant when comparing ‘Nebbiolo’ to a different cultivar or the two haplotypes of the same individual, while they turned absent between the two analysed clones.

Allograft Versus Autograft in Anterior Cervical Discectomy and Fusion: A Propensity-Matched Analysis.

ObjectiveTo compare the 30-day complication rate associated with allograft versus autograft in anterior cervical discectomy and fusion (ACDF) and to determine preoperative factors that may influence complication rate.MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was retrospectively queried from 2014 to 2017 for all procedures with CPT codes for ACDF (22551). Patients undergoing ACDF with either autograft or allograft were matched by propensity scores based on age, sex, body mass index, and comorbidities. The incidence of adverse events in the 30-day postoperative period was compared.ResultsA total of 21,588 patients met the inclusion and exclusion criteria. Following the 10:1 propensity match, 17,061 remained in the study (1,551 autograft and 15,510 allograft). The overall adverse event rate was 3.18%; 3.48% for autograft and 3.15% for allograft (P=0.494). Autograft had a significantly greater incidence of extended length of stay (>2 d) (LOS) (48.9% vs 34.8%; P<0.001). Multivariate analysis suggested that autograft selection was associated with extended LOS (OR 1.4; 95% CI 1.3-1.5).ConclusionThe results of this study provide information regarding how graft selection can relate to extended hospital LOS and influence postoperative complications. Extended LOS may be associated with worse patient outcomes and increase the overall cost of care. Further study should be performed to determine which patients would benefit from autograft versus allograft with regards to long-term outcomes, in consideration of these increased short-term complications.

Mathematical Neural Networks

ANNs succeed in several tasks for real scenarios due to their high learning abilities. This paper focuses on theoretical aspects of ANNs to enhance the capacity of implementing those modifications that make ANNs absorb the defining features of each scenario. This work may be also encompassed within the trend devoted to providing mathematical explanations of ANN performance, with special attention to activation functions. The base algorithm has been mathematically decoded to analyse the required features of activation functions regarding their impact on the training process and on the applicability of the Universal Approximation Theorem. Particularly, significant new results to identify those activation functions which undergo some usual failings (gradient preserving) are presented here. This is the first paper—to the best of the author’s knowledge—that stresses the role of injectivity for activation functions, which has received scant attention in literature but has great incidence on the ANN performance. In this line, a characterization of injective activation functions has been provided related to monotonic functions which satisfy the classical contractive condition as a particular case of Lipschitz functions. A summary table on these is also provided, targeted at documenting how to select the best activation function for each situation.