Discussion Management of pancreatic trauma with ductal injury has typically been with emergency distal pancreatectomy, which is associated with high morbidity and mortality. The decision to operate should not be purely based on radiological findings, and should take into account clinical status, haemodynamic stability, coexisting injuries and evidence of active haemorrhage or bile leak. Conclusion In select cases, it is reasonable to trial conservative management in isolated traumatic pancreatic body fracture by means of close clinical observation and serial imaging. This may allow the patient to avoid a high-risk emergency distal pancreatectomy.Introduction Leiomyomas are benign tumors that originate from smooth muscles cells. Intratesticular leiomyoma is a very rare type of benign testicular masses. Through the literature, only 11 cases were reported. Presentation of case A 36 years old man presented with painless right scrotal mass. Clinical examination showed right upper polar testicular mass, well circumscribed and highly vascularized on sonography. Serum tumor markers were normal. Patient was explained the possibility of an organ sparing surgery if frozen section shows no sign of malignancy. Midline incision with frozen section was performed, with wide local excision. Pathological examination of the specimen confirmed intratesticular leiomyoma. Two years after the surgery, patient showed no sign of recurrence. Discussion Intratesticular Leiomyoma is usually revealed as a non-tender firm scrotal mass that increases in size. Sonography is the imaging modality of choice for assessing intrascrotal pathology, and cannot distinguish benign from malignant tumor. Surgical management is subject of debate. While some authors recommend radical orchiectomy, others suggest the use of frozen section intraoperatively, and perform conservative treatment by mass excision in the absence of signs of malignancy. Conclusion Intratesticular leiomyoma is a very rare finding. When suspected, conservative management using frozen section followed by mass excision can be done, but final diagnosis remains on pathological examination and immunohistochemistry of the specimen.Background The Coronavirus (COVID-19), (Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)) has been spreading worldwide since its first identification in China. It has been speculated that patients with comorbidities and elderly patients could be at high risk for the pandemic reasoned respiratory insufficiency and death. At first, it was thought that the patients who use immunmodulator therapy could be even at higher risks of disease complications. However, it has been also speculated about that using immunmodulators could be an advantage for the clinical prognosis. Therefore, several immunmodulators are currently being tested as potential treatment for COVID-19. Methods In this paper we report on a patient that has been treated with type 1 interferon for multiple sclerosis who developed COVID-19. Results Despite using immunmodulator, the symptoms of the patient at hospitalization were mild and he did not show elevated D-dimer, and there was no lymphopenia. He was discharged to home-quarantine with no symptoms. https://www.selleckchem.com/products/epacadostat-incb024360.html Discussion This report supports the idea of using type 1 interferon in the treatment could be effective in COVID-19 affected patients.Although graphene oxide (GO) has been widely used to enhance soil quality and crop yield, there is currently little information regarding the effects of foliar application of GO on cadmium (Cd) toxicity to plants. In this study, we investigated the response to GO in lettuce cultivated under Cd stress in hydroponic conditions. Lettuce was grown from seeds in a nutrient solution supplemented with 2 mg/L Cd and the leaves were sprayed with 0, 30, and 60 mg/L GO. The results indicated that application of 30 mg/L GO significantly increased the total length, surface area, average diameter, and hair number of lettuce roots, and effectively alleviated the negative effects of Cd on root growth. Furthermore, foliar application of 30 mg/L GO, but not 60 mg/L GO, significantly improved the quality of lettuce, including reduction in Cd accumulation in leaves and roots and increase in soluble sugar, protein, and vitamin C content. Transmission electron microscopy revealed that GO nanoparticles, which entered the leaves and were subsequently transported to the roots via the vascular system (phloem), reduced the damaging effect of Cd on cellular organelles, including the cell wall and membrane, chloroplasts, and starch granules. The effect may be attributed to the absorption of GO by lettuce cells, where it fixed Cd2+, thus reducing Cd2+ bioavailability, or to the improvement of Cd tolerance through regulation of lettuce metabolic pathways. Gaussian simulation analysis revealed that Cd caused significant changes in the GO molecule, resulting in detachment of an epoxy group from the GO carbon ring and breakage of OH bonds in hydroxyl groups, whereupon the oxygen freed from the OH bond formed a new bond with Cd. Collectively, these results indicate that foliar application of 30 mg/L GO can enhance the tolerance of lettuce to Cd, promote plant growth, and improve nutritional quality.Currently, mRNA profiling is widely investigated for forensic body fluid identification, while it is still required to advance the approach for those casework samples of limited quantity or low quality. The inclusion of circular RNAs (circRNAs) can facilitate the detection of mRNA markers in forensic body fluid identification. In this study, a multiplex assay for forensic body fluid identification (F18plex assay) was developed by incorporating 14 tissue-specific mRNA markers with circRNAs expression, 2 mRNA markers with high abundance and 2 housekeeping markers for the discrimination of the most common forensic body fluids, including blood, menstrual blood, saliva, vaginal secretion, semen and urine. The markers employed in the F18plex assay show similar specificity to previous reports. Additionally, even if all linear transcripts were completely erased, the expected markers in target biofluids could still be identified, which should help the discrimination of those aged biological stains. Results from sensitivity testing and the detection of mixtures demonstrate good sensitivity of the multiplex assay.

In skeletal muscle, Ca2+ release from the sarcoplasmic reticulum (SR) triggers contraction. In this study we develop a two compartment model to account for the Ca2+ dynamics in frog skeletal muscle fibers. The two compartments in the model correspond to the SR and the cytoplasm, where the myofibrils are placed. We use a detailed model for the several Ca2+ binding proteins in the cytoplasm in line with previous models. As a new feature, Ca2+ binding sites within the SR, attributed to calsequestrin, are modeled based on experimentally obtained properties. The intra SR Ca2+ buffer shows cooperativity, well represented by a Hill equation with parameters that depend on the initial [Ca2+] in the SR ([Ca2+]SR). The number of total sites as well as the [Ca2+]SR of half saturation are reduced as the resting [Ca2+]SR is reduced, on the other hand the Hill number is not changed. The buffer power remained roughly constant. The release process is activated by a voltage dependent mechanism that increases the Ca2+ permeability of the SR. We use the permeability time course and amplitude experimentally obtained during a voltage clamp pulse to drive the simulations. This model successfully reproduces the SR and cytoplasmic transients observed. Additionally, we simulate [Ca2+] SR transients in the case of high concentration of extrinsic Ca2+ buffers added to the cytoplasm to explore what properties of the permeability are necessary to account for the experimentally observed [Ca2+]SR transients. The main novelty of the model, the intra SR Ca2+ buffer, is crucial for reproducing the experimental observations and it would be of use in future theoretical studies of excitation contraction coupling in skeletal muscle.Objective This study aims to investigate the correlation between the expression of miR-210 in peripheral blood and the number of peripheral endothelial progenitor cells (EPCs) in patients with type 2 diabetes mellitus (T2DM). We also determined the effect of miR-210 on EPC proliferation, adhesion, migration, tube formation, and apoptosis. Methods A total of 32 patients with newly diagnosed T2DM (T2DM group) and 32 control subjects with normal glucose tolerance (NC group) were included. Peripheral blood samples were collected from each subject. The miR-210 level was determined by quantitative real-time polymerase chain reaction (qRT-PCR), and the number of positive EPCs indicated by CD34, CD133, and KDR expressions was detected by flow cytometry. After isolation, culture, and identification by fluorescent staining, EPCs were divided into four groups NC group, untransfected type 2 diabetic group, miR-210 inhibitor NC group, and miR-210 inhibitor group. The expression of miR-120 in each group was detected by qRTgroup were higher than those in untransfected type 2 diabetic group and miR-210 inhibitor NC group, whereas the apoptosis rate was lower than that in these groups, and these results were statistically significant (P less then 0.05). Conclusion The increased expression of miR-210 in patients with T2DM may be related to the decreased number and function of EPCs in peripheral blood.The emergence of novel venom extraction techniques over the last half-century has greatly facilitated advances in the field of cnidarian research. A new recovery protocol utilizing ethanol as the primary stimulant in nematocyst discharge was recently published, however in vitro examination of the venom on organic models was not performed. This present study reports an original comparison of the chemically-induced discharge technique in vitro with a commonly used saltwater extraction method. https://www.selleckchem.com/products/decursin.html Size-exclusion chromatography revealed distinct differences in venom profiles between the two methods the saltwater recovery method FPLC profile and SDS-PAGE gel were similar to previously published results, whereas the ethanol-induced method was not. SDS-PAGE gel revealed distinct 40-55 kDa bands of previously identified cardiotoxic proteins recovered from the saltwater method, whereas the ethanol-induced method yielded degraded venom protein bands. A concentration-response curve generated through xCELLigence Real-Time Cell Analysis (RTCA) revealed a dramatic decrease in human cardiomyocyte activity when venom recovered via saltwater discharge was applied to these cells. With the exception of one sample, all ethanol-induced recovered venom failed to prompt a concentration-dependent decrease in cell survival when applied to human cardiomyocytes, resulting in a significant difference in IC50 concentrations between the compared venom samples. The data presented here facilitates an improved understanding of the parameters and analyses that are essential when developing and utilizing novel techniques for future cnidarian venom extraction research and supports the conclusion that recovery of venom from the tentacles of the box jellyfish Chironex fleckeri by ethanol is not an effective, efficient, or comprehensive extraction method compared to the published method of saltwater degradation of tentacles and bead mill extraction.Millions of women worldwide use oral contraceptives (i.e., birth control pill; OCs), often starting during puberty/adolescence; however, it is unknown how OC use during this critical period of development affects the brain, especially with regard to emotional working memory. Here, we examined stress reactivity, and brain structure and function in OC users using the Trier Social Stress Test and structural and functional magnetic resonance imaging (MRI). Our results show that OC use during puberty/adolescence gives rise to a blunted stress response and alters brain activation during working memory processing. OC use, in general, is also linked to increased prefrontal brain activation during working memory processing for negatively arousing stimuli. OC use is also related to significant structural changes in brain regions implicated in memory and emotional processing. Together, these findings highlight that OC use induces changes to brain structure and function and alters stress reactivity. These findings may provide a mechanistic insight for the increased vulnerability to mood-related mental illness in women after OC use.

Inhibition of either UA or IL-1β during RSV infection led to chronic reductions in pulmonary immune cell composition and reduced type 2 immune responses and reduced similar responses after challenge with cockroach antigen. CONCLUSIONS Inhibiting UA and IL-1β during RSV infection ameliorates RSV immunopathology, reduces the consequences of allergen-induced asthma, and presents new therapeutic targets to reduce early-life viral-induced asthma development. This article is protected by copyright. All rights reserved.AIM To describe the clinical and neurogenetic spectrum of paediatric-onset hereditary spastic paraplegias (HSPs) diagnosed in our unit. METHOD We report on 47 patients (30 males, 17 females; mean [SD] age 12y 7mo [6y 2mo], range 4-34y) clinically diagnosed with an HSP at the Child Neurology Unit, IRCCS-ASMN (Reggio Emilia, Italy) between 1990 and 2018, who were genetically investigated by means of single-gene direct sequencing and/or next-generation sequencing technologies (targeted panels, whole-exome sequencing [WES]). RESULTS Complex forms prevailed slightly (n=26), autosomal dominant being the main inheritance pattern (n=11), followed by recessive (n=5) and X-linked (n=1). A definite genetic diagnosis was achieved in 17 patients. Spastic paraplegia 3A (n=4) was the most frequent cause of autosomal dominant HSP in our cohort, while no genetic variant prevailed in autosomal recessive forms and pathogenic/likely pathogenic variants were disclosed in a wide range of different genes. INTERPRETATION We found wide phenotypic and genetic heterogeneity. With increasing accessibility to WES, a higher number of patients receive a diagnosis, allowing detection of variants in ultra-rare disease-causing genes and refining genotype-phenotype correlations. WHAT THIS PAPER ADDS A genetic diagnosis of paediatric-onset hereditary spastic paraplegia was achieved in one-third of patients. Pathogenic/likely pathogenic variants in rare genes were found. Genotypic and phenotypic heterogeneity favours targeted panel/whole-exome sequencing for diagnosis. © 2020 Mac Keith Press.This review and synthesis discusses recent work that has utilized brain imaging methods, such as the electroencephalogram (EEG) and magnetoencephalogram, to provide insights into the ways that the body is represented in the infant brain. One aspect of body representation concerns somatotopic maps of the body surface in somatosensory cortex. A good deal is known about the properties of these maps in adults, but there has been relatively little developmental work. Recent studies have provided new insights into the organization of infant neural body maps and have laid the foundations for examining their plasticity in relation to behavioral development. Other work has suggested that neural body maps may be involved in the registration of correspondences between self and other, with implications for early social development. Here, body representations are discussed in the context of preterm birth and autism spectrum disorder, providing novel perspectives relevant to developmental medicine and child neurology. WHAT THIS PAPER ADDS ●Somatotopic body maps develop prenatally through intrinsic and activity-dependent mechanisms. ●There is increasing interest in understanding postnatal plasticity in body maps. ●Body representations may be involved in the registration of preverbal, interpersonal relationships. © 2020 Mac Keith Press.The effect of selection on female genitalia is poorly studied, but such selection could affect mating success. House et al. (2020) studied the form and strength of selection acting on male and female Tribolium castaneum. They found that the sex organs of both male and female T. castaneum are under multivariate stabilizing selection and that both male and female genitalia interact to influence mating success. © 2020 The Authors. Evolution © 2020 The Society for the Study of Evolution.Epithelial ovarian cancer (EOC) is a complex disease comprising discrete histological and molecular subtypes, for which survival rates remain unacceptably low. Tailored approaches for this deadly heterogeneous disease are urgently needed. Efflux pumps belonging to the ATP-binding cassette (ABC) family of transporters are known for roles in both drug resistance and cancer biology and are also highly targetable. Here we have investigated the association of ABCC4/MRP4 expression to clinical outcome and its biological function in endometrioid and serous tumors, common histological subtypes of EOC. We found high expression of ABCC4/MRP4, previously shown to be directly regulated by c-Myc/N-Myc, was associated with poor prognosis in endometrioid EOC (P = 0.001) as well as in a subset of serous EOC with a "high-MYCN" profile (C5/Proliferative; P = 0.019). Transient siRNA-mediated suppression of MRP4 in EOC cells led to reduced growth, migration and invasion, with the effects being most pronounced in endometrioid and C5-like serous cells compared to non-C5 serous EOC cells. Sustained knockdown of MRP4 also sensitized endometrioid cells to MRP4 substrate drugs. Furthermore, suppression of MRP4 decreased the growth of patient-derived EOC cells in vivo. Together, our findings provide the first evidence that MRP4 plays an important role in the biology of Myc-associated ovarian tumors and highlight this transporter as a potential therapeutic target for EOC. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.PURPOSE Gliomas are the most common primary tumor of the brain and are classified into grades I-IV of the World Health Organization (WHO), based on their invasively histological appearance. Gliomas grading plays an important role to determine the treatment plan and prognosis prediction. In this study we propose two novel methods for automatic, non-invasively distinguishing low-grade (Grades II and III) glioma (LGG) and high-grade (grade IV) glioma (HGG) on conventional MRI images by using deep convolutional neural networks (CNNs). https://www.selleckchem.com/products/cx-5461.html METHODS All MRI images have been preprocessed first by rigid image registration and intensity inhomogeneity correction. Both proposed methods consist of two steps (1) 3D brain tumor segmentation based on a modification of the popular U-Net model; (2) tumor classification on segmented brain tumor. In the first method, the slice with largest area of tumor is determined and the state-of-the-art mask R-CNN model is employed for tumor grading. To improve the performance of the grading model, a 2D data augmentation has been implemented to increase both the amount and the diversity of the training images.

r use in pregnancy, that women of reproductive age considering participation in such trials should be made aware of, so they can make a fully informed decision. This work was supported by funding from the Canadian Institutes of Health Research (CIHR) (PJT-148684 and MOP-130398 to L.S.). C.D. received support from CIHR Foundation (FDN143262 to Stephen Lye). S.K. received a TGHRI postdoctoral fellowship. The authors declare that there are no conflicts of interest. L.S. reports personal fees from ViiV Healthcare for participation in a Women and Transgender Think Tank. This work was supported by funding from the Canadian Institutes of Health Research (CIHR) (PJT-148684 and MOP-130398 to L.S.). C.D. https://www.selleckchem.com/products/ABT-263.html received support from CIHR Foundation (FDN143262 to Stephen Lye). S.K. received a TGHRI postdoctoral fellowship. The authors declare that there are no conflicts of interest. L.S. reports personal fees from ViiV Healthcare for participation in a Women and Transgender Think Tank. To date, clinical trials evaluating baloxavir have excluded patients hospitalized with influenza infection and therefore this study sought to evaluate the efficacy of baloxavir in inpatients with influenza A. This study was a multicentre, retrospective chart review of adult patients admitted to the hospital within the Yale New Haven Health System who received oseltamivir or baloxavir for the treatment of influenza A. Patients were screened for inclusion between January 2018 and April 2018 in the oseltamivir group, while patients in the baloxavir group were screened for inclusion between January 2019 and April 2019. Influenza A diagnosis was confirmed by RT-PCR using a nasopharyngeal swab specimen. Of the 2392 patients assessed, 790 met the inclusion criteria. There were 359 patients who received baloxavir and 431 patients who received oseltamivir. Patients who received baloxavir were younger compared with those who received oseltamivir [median = 69 (IQR = 57-81) years versus 77 (IQR = 62-86) years; P < 0.001]. Patients who received baloxavir had no significant difference in hospital length of stay [median = 4 (IQR = 3-6) days versus 5 (IQR = 3-6)  days; P = 0.45] or 30 day all-cause mortality [12 (3.3%) versus 26 (6%); P = 0.079] compared with those who received oseltamivir. However, patients who received baloxavir had a significantly faster time to hypoxia resolution [median = 51.7 (IQR = 25.3-89.3) h versus 72 (IQR = 37.5-123) h; P < 0.001]. The results of this study support the use of baloxavir for the treatment of influenza A in hospitalized patients with the potential benefit of a faster time to resolution of hypoxia. The results of this study support the use of baloxavir for the treatment of influenza A in hospitalized patients with the potential benefit of a faster time to resolution of hypoxia. Studying the human peri-implantation period remains hindered by the limited accessibility of the in vivo environment and scarcity of research material. As such, continuing efforts have been directed towards developing embryo-like structures (ELS) from pluripotent stem cells (PSCs) that recapitulate aspects of embryogenesis in vitro. While the creation of such models offers immense potential for studying fundamental processes in both pre- and early post-implantation development, it also proves ethically contentious due to wide-ranging views on the moral and legal reverence due to human embryos. Lack of clarity on how to qualify and regulate research with ELS thus presents a challenge in that it may either limit this new field of research without valid grounds or allow it to develop without policies that reflect justified ethical concerns. The aim of this article is to provide a comprehensive overview of the existing scientific approaches to generate ELS from mouse and human PSCs, as well as discuss future practices. To evaluate the pharmacokinetics and clinical effectiveness of IV and oral fosfomycin treatment in patients with recurrent urinary tract infection (rUTI) with Escherichia coli. Patients with rUTI treated with 3 g of oral fosfomycin every 72 h for at least 14 days were included in a prospective open-label single-centre study. Serum samples were taken after oral and IV administration of fosfomycin. Urine was collected for 24 h on 3 consecutive days. Fosfomycin concentrations in serum and urine were analysed using validated LC-MS/MS. Pharmacokinetics were evaluated using a population model. EudraCT number 2018-000616-25. Twelve patients were included, of whom nine were also administered IV fosfomycin. Data were best described by a two-compartment model with linear elimination and a transit-absorption compartment. Median values for absolute bioavailability and serum half-life were 18% and 2.13 h, respectively. Geometric mean urine concentrations on Days 1, 2 and 3 were above an MIC of 8 mg/L after both oral and IV administration. Quality of life reported on a scale of 1-10 increased from 5.1 to 7.4 (P = 0.001). The average score of UTI symptoms decreased after fosfomycin dosing (by 3.1 points, 95% CI = -0.7 to 7.0, P = 0.10). Oral fosfomycin at 3 g every 72 h provides plasma and urine concentrations of fosfomycin above the MIC for E. coli. This pharmacokinetic model can be used to develop optimal dosing regimens of fosfomycin in patients with UTI. Oral fosfomycin at 3 g every 72 h provides plasma and urine concentrations of fosfomycin above the MIC for E. coli. This pharmacokinetic model can be used to develop optimal dosing regimens of fosfomycin in patients with UTI. Human genetic variation-mostly in the HLA and CCR5 regions-explains 25% of the variability in progression of HIV infection. However, it is also known that viral infections can modify cellular DNA methylation patterns. Therefore, changes in the methylation of CpG islands might modulate progression of HIV infection. 85 samples were analyzed 21 elite controllers (EC), 21 HIV-infected subjects before combination antiretroviral therapy (cART) (viremic, 93,325 HIV-1 RNA copies/ml) and under suppressive cART (cART, median of 17 months, <50 HIV-1 RNA copies/ml), and 22 HIV-negative donors (HIVneg). We analyzed the methylation pattern of 485,577 CpG in DNA from peripheral CD4+ T lymphocytes. We selected the most differentially methylated gene (TNF) and analyzed its specific methylation, mRNA expression, and plasma protein levels in 5 individuals before and after initiation of cART. We observed 129 methylated CpG sites (associated with 43 gene promoters) for which statistically significant differences were recorded in viremic vs HIVneg, 162 CpG sites (55 gene promoters) in viremic vs cART, 441 CpG sites (163 gene promoters) in viremic vs EC, but none in EC vs HIVneg.

The hypnosis-based interventions improved women's emotional experiences and outlook towards birth, with less anxiety, increased satisfaction, fewer birth interventions, more postnatal well-being and better childbirth experience overall. IMPLICATIONS FOR PRACTICE The findings of this review suggest that hypnosis-based interventions improve childbirth experience. Further studies should be undertaken in order to better determine and develop hypnosis-based interventions aiming at improving this experience. Such interventions could enhance several aspects of the childbirth experience by taking into account women's partners, medical and surgical history, narratives of childbirth and specific aspects of complicated pregnancies that women can go through. INTRODUCTION Accident risk is increased for emergency responders driving with warning lights and sirens compared to other road users' driving. Currently no standards for education of ambulance drivers exist. Research shows that high order understanding trainings focusing on insight to avoid critical driving situations might be more helpful than trainings focusing on car handling. The present controlled intervention study evaluates a one-day simulator-based high order training program specifically designed for ambulance drivers. METHODS In a longitudinal design with three measurement times multiple methods were used to evaluate the training holistically targeting the levels of reaction to training, learning, behavior and results of training. Questionnaire, knowledge test and driving profile data were analyzed with repeated measures analysis of variance controlling for age and sex. Data of two intervention groups and one control-waiting group was collected between 2014 and 2017 in two German federal states. RESariables showed positive training effects, no negative training effects were found. Speed was reduced in the long term which underlines the importance of such a training. More research is needed to determine effects on different types of participants and to elicit framework conditions for training integration in formal education. We review research showing that rumination has multiple negative consequences (a) exacerbating psychopathology by magnifying and prolonging negative mood states, interfering with problem-solving and instrumental behaviour and reducing sensitivity to changing contingencies; (b) acting as a transdiagnostic mental health vulnerability impacting anxiety, depression, psychosis, insomnia, and impulsive behaviours; (c) interfering with therapy and limiting the efficacy of psychological interventions; (d) exacerbating and maintaining physiological stress responses. The mechanisms underlying rumination are examined, and a model (H-EX-A-GO-N - Habit development, EXecutive control, Abstract processing, GOal discrepancies, Negative bias) is proposed to account for the onset and maintenance of rumination. H-EX-A-GO-N outlines how rumination results from dwelling on problematic goals developing into a learnt habit that involves the tendency to process negative information in an abstract way, particularly in the context of poor executive control and negative information-processing biases. These proximal factors integrate experimental evidence to provide a partial answer to the critical question of what maintains rumination. They constitute a pathway by which more distal biological and environmental factors increase the likelihood of rumination developing. https://www.selleckchem.com/products/elsubrutinib.html Treatments for rumination are reviewed, with preliminary trials suggesting that psychological interventions designed to specifically target these mechanisms may be effective at reducing rumination. Mental imagery plays a prominent role across psychopathology. However, its quality and role in generalized anxiety disorder (GAD) have not been examined as extensively as in other disorders. The goal of the present study was to obtain a better understanding of general imagery processes and individual differences in people with GAD. Adults with GAD (N = 31) were compared to a Healthy Control (HC) group (N = 32) across mental imagery domains as per Pearson, Deeprose, Wallace-Hadrill, Heyes, and Holmes (2013)'s framework cognitive, general use/experience, and clinical. No differences were found between the GAD and HC groups on cognitive aspects of imagery. Both groups were also similar in their ability to imagine experiences across sensory modalities. No differences were found between groups in their spontaneous use of imagery in everyday situations, or in vividness of sensory-perceptual imagery. For clinical aspects of imagery, between-group differences emerged in the experience of prospective imagery; those with GAD reported greater "pre-experiencing" ("intrusive, prospective, personally-relevant imagery"; Deeprose & Holmes, 2010), rated imagined future negative scenarios as more vivid, more likely, and more personally relevant, and evaluated the experience of these images as more intense than did HCs. Taken together, findings suggest that the presence of intrusive mental imagery distinguishes individuals with GAD from those without psychopathology. Findings could help improve interventions utilizing imagery techniques. Quantification of fear conditioning is paramount to many clinical and translational studies on aversive learning. Various measures of fear conditioning co-exist, including different observables and different methods of pre-processing. Here, we first argue that low measurement error is a rational desideratum for any measurement technique. We then show that measurement error can be approximated in benchmark experiments by how closely intended fear memory relates to measured fear memory, a quantity that we term retrodictive validity. From this perspective, we discuss different approaches commonly used to quantify fear conditioning. One of these is psychophysiological modelling (PsPM). This builds on a measurement model that describes how a psychological variable, such as fear memory, influences a physiological measure. This model is statistically inverted to estimate the most likely value of the psychological variable, given the measured data. We review existing PsPMs for skin conductance, pupil size, heart period, respiration, and startle eye-blink.

in English, Spanish TITLE Documento EMCAM (Esclerosis Múltiple Comunidad Autónoma de Madrid) para el manejo de pacientes con esclerosis múltiple durante la pandemia de SARS-CoV-2. Introducción. La pandemia actual por el SARS-CoV-2 está obligando a los neurólogos a una serie de adaptaciones en el manejo de la esclerosis múltiple. Los neurólogos deben sopesar la necesidad de iniciar o continuar los tratamientos modificadores de la enfermedad en función del riesgo de infección, del riesgo de complicaciones de la infección y del riesgo de actividad de la esclerosis múltiple. Dado que ésta es una situación sin precedentes, la mayoría de las decisiones se están tomando sobre la base de un abordaje teórico y del criterio de cada neurólogo. Objetivos. Se pretende, a través de una búsqueda bibliográfica, recopilar la evidencia disponible sobre la relación entre tratamientos modificadores de la enfermedad en la esclerosis múltiple y la infección por el SARS-CoV-2. Esta evidencia, junto con la experiencia de los autores en el manejo de pacientes con esclerosis múltiple durante la pandemia, permitirá brindar algunas propuestas de tratamiento y seguimiento de los pacientes en este contexto epidemiológico. Desarrollo. Después de la búsqueda bibliográfica y de nuestra experiencia en el manejo de pacientes, se establecen unas propuestas de tratamiento sobre cada fármaco que necesariamente han de individualizarse para cada paciente, ya que, en esta circunstancia excepcional, sus peculiaridades pueden marcar el pronóstico. Conclusiones. El neurólogo debe tener conocimiento de la evidencia actual para valorar el riesgo-beneficio de iniciar, mantener y suspender los tratamientos modificadores de la enfermedad en la esclerosis múltiple durante la pandemia.in English, Spanish TITLE Herramientas de salud digital para superar la brecha de atención en epilepsia antes, durante y después de la pandemia de COVID-19. Introducción. La epilepsia es un trastorno neurológico crónico común que afecta alrededor de 50 millones de personas en el mundo y abunda la bibliografía sobre la brecha de atención en salud a este sector de la población. Dicha brecha aumentará con la pandemia actual de COVID-19. Objetivo. Evaluar la disponibilidad actual de herramientas de salud digital para la atención a personas con epilepsia según la literatura médica mundial y su uso durante dicha pandemia. Desarrollo. Se hizo una revisión de las publicaciones en revistas científicas en la última década que tuvieran como tema principal el uso de herramientas de salud digital o telemedicina enfocada a la atención de los pacientes con epilepsia, incluyendo cuatro meses después de las cuarentenas nacionales por la aparición del virus SARS-CoV-2. Se encontraron 17 publicaciones sobre el uso de telemedicina enfocada a la epilepsia. Las herramientas más utilizadas internacionalmente son las plataformas en línea, seguidas de las aplicaciones móviles, videoconferencias, sistemas de captación de crisis epilépticas, listas de verificación, algoritmos de comprensión de datos médicos, llamadas telefónicas, telelectroencefalografía y mensajes de texto. Ninguna se publicó durante la presente pandemia. Conclusiones. Hay poca bibliografía sobre herramientas de salud digital enfocadas a epilepsia, pero existen varias que pueden emplearse para luchar contra la brecha de atención, especialmente en esta pandemia mundial de COVID-19 que obliga a las personas y comunidades a mantenerse en cuarentena por la emergencia sanitaria. Es necesario eliminar barreras y facilitar el pronto acceso de los pacientes a estas nuevas tecnologías de información.in English, Spanish TITLE Complicaciones neurológicas por coronavirus y COVID-19. Introducción. Estudios clínicos y experimentales han demostrado que la familia de los coronavirus tiene un cierto tropismo por el sistema nervioso central. Siete tipos de coronavirus pueden contagiar al ser humano. Desarrollo. Los coronavirus no siempre permanecen confinados en el tracto respiratorio, y en determinadas condiciones pueden invadir el sistema nervioso central y causar patologías neurológicas. La capacidad potencial de neuroinvasión está bien documentada en la mayor parte de los coronavirus humanos (OC-43, 229E, MERS y SARS) y en algunos coronavirus animales (coronavirus de la encefalomielitis hemaglutinante porcina). Se han descrito síntomas neurológicos en pacientes afectos por COVID-19, como cefalea, mareo, mialgias y anosmia, así como casos de encefalopatía, encefalitis, encefalopatía necrotizante hemorrágica, ictus, crisis epilépticas, rabdomiólisis y síndrome de Guillain-Barré, asociados a la infección por el SARS-CoV-2. Conclusiones. Futuros estudios epidemiológicos y registros de casos deben elucidar la incidencia real de estas complicaciones neurológicas, sus mecanismos patogénicos y sus opciones terapéuticas.BACKGROUND Takotsubo syndrome (TTS) is a stress-induced disorder affecting mostly postmenopausal women. The aim of the study was to evaluate isoprenaline (ISO) dependent female rat model and histopathological characteristics in TTS. METHODS Forty-nine Sprague Dawley female rats, 12 weeks old, were injected intraperitoneally with a single dose of ISO at doses 50 (n = 8), 75 (n = 6), 100 (n = 3), 150 (n = 27) and 200 (n = 5) mg/kg body weight (bw). The control group (n = 6) was injected with physiological saline. The echocardiographic examination to assess wall motion abnormalities took place 24, 48, 72 h, and 7 days post-ISO. Histopathological analysis was performed on the basis of hematoxylin-eosin staining. RESULTS The total mortality rate was 3/49 (6.12%). The optimum dose of ISO to induce TTS was 150 mg/kg bw and 21/27 (77.77%) rats showed apical ballooning. Histopathological analysis revealed focal necrosis/apoptosis of cardiomyocytes with inflammatory and fibroblast-like cell infiltration. Foci were the most numerous in the central muscle layer with apical-basal gradient 24,48,72 h post-ISO (p less then 0.05). Significant differences were noted 48 h post-ISO in the central layer in apical vs basal segments (p = 0.0032), in the endocardial layer in apical vs basal segments (0.00024) and in mid-cavital vs. basal segments (p = 0.0483). https://www.selleckchem.com/products/ABT-888.html The number of foci in endocardium of apical region differ 48 h post-ISO in rats with a dose of 150 vs. 200 mg/kg bw (p = 0.0084). CONCLUSIONS The ISO female rat model of TTS is associated with higher optimum dose and lower mortality in comparison with the male TTS model. TTS presents as a singles cardiomyocyte disorder, foci concerned mainly central muscle layer with apical-basal gradient.

Background The aggressive T helper cell responses and regulatory T (Treg) cells dysfunction exist in type 2 diabetes mellitus (T2DM). The co-inhibitory T cell immunoglobulin and ITIM-domain (TIGIT), neuropilin-1 (Nrp-1), and the co-stimulatory CD226 play a critical role in the inhibition or activation of immune responses. In this project, the expression of TIGIT, CD226, Nrp-1, and their ligands, CD155 and semaphorin 3A (Sema-3A) were investigated in T2DM. Methods Peripheral blood mononuclear cells (PBMCs) were collected from 30 patients with T2DM, and 30 healthy controls (HCs). The frequencies of TIGIT and Nrp-1 on CD4+CD25hi Treg cells, CD4+CD25- responder T cells, total CD4+ T cells, and non-CD4+ cells were assessed using flow cytometry. The mRNA levels of TIGIT, CD226, Nrp-1, CD155, and Sema-3A were assessed by real-time PCR. Results The percentage and MFI of TIGIT on CD4+CD25hi T cells, CD4+CD25- T cells, total CD4+ T cells, and non-CD4+ cells were higher in patients versus HCs (p less then 0.05 for all). The mRNA level of TIGIT was increased in patients compared with HCs (p = 0.003). No differences were observed in the expression of CD226, CD155, Nrp-1, and Sema-3A between the groups. Conclusions The expression of TIGIT was enhanced in T2DM and the TIGIT axis could be considered as a new therapeutic purpose for the T2DM.Short-chain acyl-CoA dehydrogenase (SCAD), the rate-limiting enzyme for fatty acid β-oxidation, has a negative regulatory effect on pathological cardiac hypertrophy and fibrosis. Furthermore, flavin adenine dinucleotide (FAD) can enhance the expression and enzyme activity of SCAD. However, whether FAD can inhibit pathological cardiac hypertrophy and fibrosis remains unclear. Therefore, we observed the effect of FAD on pathological cardiac hypertrophy and fibrosis. FAD significantly inhibited PE-induced cardiomyocyte hypertrophy and AngII-induced cardiac fibroblast proliferation. In addition, FAD ameliorated pathological cardiac hypertrophy and fibrosis in SHR. FAD significantly increased the expression and enzyme activity of SCAD. Meanwhile, ATP content was increased, the content of free fatty acids and reactive oxygen species were decreased by FAD in vivo and in vitro. In addition, molecular dynamics simulations were also used to provide insights into the structural stability and dynamic behavior of SCAD. The results demonstrated that FAD may play an important structural role on the SCAD dimer stability and maintenance of substrate catalytic pocket to increase the expression and enzyme activity of SCAD. In conclusion, FAD can inhibit pathological cardiac hypertrophy and fibrosis through activating SCAD, which may be a novel effective treatment for pathological cardiac hypertrophy and fibrosis, thus prevent them from developing into heart failure.Glioblastoma (GBM) remains one of the most uncompromising cancers, with a median survival of 15 months among those receiving maximal therapy. Therefore, new effective approaches are urgently required for the treatment of GBM. In this study, we show that combined treatments with the flavonoid quercetin and chloroquine (CQ), which is a lysosomotropic agent with antimalarial activity, synergistically induce caspase-independent cell death in malignant glioma cells. The combination of quercetin and CQ triggered excessive expansion of autolysosomes and lysosomes due to overloading with undigested cellular components and protein aggregates, leading to cell death, whereas quercetin alone increased autophagic flux. These results suggest that CQ-mediated lysosomal inhibition prolongs quercetin-mediated autophagic flux, resulting in autophagic catastrophe and severe endoplasmic reticulum (ER) stress. Additionally, we found that 1,4,5-triphosphate receptor (IP3R)-mediated Ca2+ release from the ER and the following mitochondrial uniporter (MCU)-mediated Ca2+ influx into mitochondria as well as ROS generation are critically involved in the cytotoxicity by this combination. Collectively, the lysosomal defects induced by quercetin plus CQ may trigger the stress to both the ER and mitochondria and consequently their functional defects, contributing to glioma cell death. https://www.selleckchem.com/products/Cyclopamine.html The combination of quercetin and CQ may be an effective therapeutic option for GBM.There is some recent evidence that cardiac ischemia/reperfusion (I/R) injury induces intestinal damage within days, which contributes to adverse cardiovascular outcomes after myocardial infarction. However, it is not clear whether remote gut injury has any detectable early signs, and whether different interventions aiming to reduce cardiac damage are also effective at protecting the intestine. Previously, we found that chronic treatment with rofecoxib, a selective inhibitor of cyclooxygenase-2 (COX-2), limited myocardial infarct size to a comparable extent as cardiac ischemic preconditioning (IPC) in rats subjected to 30-min coronary artery occlusion and 120-min reperfusion. In the present study, we aimed to analyse the early intestinal alterations caused by cardiac I/R injury, with or without the above-mentioned infart size-limiting interventions. We found that cardiac I/R injury induced histological changes in the small intestine within 2 h, which were accompanied by elevated tissue level of COX-2 and showed positive correlation with the activity of matrix metalloproteinase-2 (MMP-2), but not of MMP-9 in the plasma. All these changes were prevented by rofecoxib treatment. By contrast, cardiac IPC failed to reduce intestinal injury and plasma MMP-2 activity, although it prevented the transient reduction in jejunal blood flow in response to cardiac I/R. Our results demonstrate for the first time that rapid development of intestinal damage follows cardiac I/R, and that two similarly effective infarct size-limiting interventions, rofecoxib treatment and cardiac IPC, have different impacts on cardiac I/R-induced gut injury. Furthermore, intestinal damage correlates with plasma MMP-2 activity, which may be a biomarker for its early diagnosis.Objectives Zinc oxide is used to prevent post-weaning diarrhea in pigs as an alternative to antimicrobial growth promoters. This study aims to determine if the use of zinc oxide selects for Extended Spectrum β-Lactamase (ESBL)-producing E. coli and affects the expression of blaCTX-M-1 in E. coli. Methods Using an in vitro fecal micro-cosmos model, the selective properties of zinc was investigated using an E. coli strain with blaCTX-M-1 encoded by a natural IncI1 resistance plasmid (MG1655/pTF2) and another strain where the same gene was located on the chromosome (MG1655blaCTX-M-1). The micro-cosmos was seeded with fecal material containing an increasing concentration of zinc (0mM to 8mM). Outcome measurements consisted of CFU of the inoculated ESBL E. coli and natural occurring coliforms as determined by plate counting on MacConkey with and without 5mg/L cefotaxime as well as total viable bacteria determined on LA without cefotaxime. Expression of blaCTX-M-1 under the experimental zinc concentrations was determined by qPCR.

The QCA results show that none of the variables is a necessary condition for inducing stress. Nevertheless, different combinations of these variables are sufficient conditions to explain 35% of the high stress levels. The most important combination over high stress levels seems to be the interaction between high levels of EA and low levels of self-efficacy. Regarding the low levels of perceived stress, there are sufficient conditions to explain 50% of them. Mainly, the most important interaction is between low levels of self-efficacy and low levels of EA. The comparison of both methodologies enables the broadening of new horizons at the methodological level applicable to different contexts. Copyright © 2020 Navarro-Mateu, Alonso-Larza, Gómez-Domínguez, Prado-Gascó and Valero-Moreno.This article builds on the conservation of resources (COR) theory and the challenge-hindrance stressors framework to propose a model for understanding and investigating why and when these two distinct categorized stressors similarly promote the display of abusive supervision behavior. The data from 228 supervisors and subordinates are selected by using the time-lagged method. Prior to hypothesis testing, we first conducted confirmatory factor analyses (CFAs) of the proposed models in Lisrel software. Hierarchical regression analysis revealed why and when two distinct categorized stressors positively relate to ego depletion and thus, in turn, promote the display of abusive supervision behavior. The bootstrap methods confirmed the mediating effect of ego depletion and the moderated-mediation role of emotional intelligence (EI). The findings show that both challenge and hindrance stressors are positively related to ego depletion and that ego depletion is positively associated with abusive supervision behavior. Results suggest that challenge and hindrance stressors have similar positive effects on abusive supervision behavior via the mediating effect of ego depletion. In addition, we find that supervisors' EI weakens the positive relationship between challenge stressors and ego depletion, and it also weakens the positive relationship between hindrance stressors and ego depletion. This study extends the current literature by directly testing resource depletion as a mediating mechanism and resource replenishment as a boundary condition of the effect of work stressors. Copyright © 2020 Li, He, Sun and Zhang.Apology and restitution each represents wrongdoers' accountable repair responses that have promoted victims' self-reported empathy and forgiveness in crime scenario research. The current study measured emotional and stress-related dependent variables including physiological measures, to illuminate the links between predictors of forgiveness and health-relevant side effects. Specifically, we tested the independent and interactive effects of apology and restitution on forgiveness, emotion self-reports, and facial responses, as well as cardiac measures associated with stress in 32 males and 29 females. Apology and restitution each independently increased empathy, forgiveness, gratitude, and positive emotions, while reducing unforgiveness, negative emotion, and muscle activity above the brow (corrugator supercilii, CS). The presence of a thorough apology-regardless of whether restitution was present-also calmed heart rate, reduced rate pressure products indicative of cardiac stress, and decreased muscle activity under the eye (orbicularis oculi, OO). Interactions pointed to the more potent effects of restitution compared to apology for reducing unforgiveness and anger, while elevating positivity and gratitude. The findings point to distinctive impacts of apology and restitution as factors that foster forgiveness, along with emotional and embodied changes relevant to health. Copyright © 2020 Witvliet, Root Luna, Worthington and Tsang.The more experienced a climber is, the more friction they can impart on a climbing hold surface. The aim of this research was to investigate how the properties of a hold's surface are perceived and how the perception relates to the amount of friction applied to the hold. The holds' surface properties are roughness/smoothness and grippiness/slippiness. Fourteen different surfaces with a wide range of property combinations were selected and placed on an instrumented climbing hold, mounted on a bouldering wall, and incorporated into a climbing route. Twenty-two climbers participated in the study. The ratio of friction to normal force (denoted friction coefficient or COF subsequently) was obtained from the sensor data, and the subjective ranking of the surface properties was provided by the participants. The average COF applied to the surfaces ranged from 0.53 (Teflon) to 0.84 (rubber). The surfaces with the lowest and highest grippiness and roughness ranking were Teflon and sandpaper, respectively. The correlation between roughness and COF was insignificant, whereas the correlation of grippiness and COF was significant. This applies to the 22 participants at the group level. https://www.selleckchem.com/mTOR.html At the individual level, 50% (11 climbers) of the participants did not show any correlations between surface properties and COF; eight climbers exhibited correlations between the combined grippiness and roughness (multiple regression) and COF, as well as grippiness and COF; only one climber out of the eight showed an additional correlation between roughness and COF. The results are interpreted in a way that climbers assess a hold's surface based on grippiness, and not on the roughness, and apply a COF to the hold that reflects the perception of grippiness. Copyright © 2020 Fuss, Weizman, Niegl and Tan.Emotional intelligence is extremely indispensable in functioning leadership positions as leaders wish everybody to fulfill his/her responsibilities and obligations effectively while job satisfaction has a direct association with the productivity and efficiency of an organization and also to individuals' success. Therefore, this cross-sectional study examined the relationship between emotional intelligence and job satisfaction among secondary schools heads in Khyber Pakhtunkhwa. For this investigation, a total of 402 out of 884 secondary school heads were taken as a sample using a multistage sampling technique. The study was correlative, descriptive, and quantitative in nature, and survey research designed was used for collecting information from the participants. Statistical tools, i.e. mean, standard deviation, Pearson's product-moment correlation, multiple linear regression, and analysis of variance, were applied. The findings showed that there was a moderate positive correlation between emotional intelligence and job satisfaction.

Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) has been accepted as a treatment option for aggressive (acute or lymphoma type) adult T cell leukemia/lymphoma (ATLL) patients with a poor prognosis, when a suitable HLA-matched donor is not available. However, haplo-HSCT carries a potential risk of treatment-related mortality including severe graft-versus-host disease (GVHD). Therefore, we conducted a prospective pilot study in order to evaluate the efficacy and safety of reduced-intensity haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) with low-dose thymoglobulin (2.5 mg/kg only on day -2), fludarabine, melphalan, and total body irradiation 4 Gy for aggressive ATLL. Three consecutive acute type ATLL patients, who were ineligible for conventional myeloablative conditioning due to advanced age or comorbidities, were enrolled. One patient received pretransplant mogamulizumab therapy. All the patients were not in complete remission (CR) at the time of transplantation. Our transplantation protocol was safely carried out. CR was achieved in all the patients after transplantation. HTLV-I viral loads became undetectable after transplantation. No severe adverse events such as grade III-IV GVHD or viral/fungal diseases were observed. At a follow-up of 2 years, they were still in CR. However, T cell receptor repertoire diversities were low 1 year after transplantation in next-generation sequencing. Our results show encouraging therapeutic benefits of this pilot approach using reduced-intensity haplo-PBSCT with low-dose thymoglobulin for aggressive ATLL patients.OBJECTIVE To characterize the audiological findings of a sample of patients with osteogenesis imperfecta (OI) in southern Brazil. METHODS This was a cross-sectional, observational, quantitative study. Research was carried out at a hospital which is considered to offer benchmark treatment for patients with OI in southern Brazil. Seventy-seven patients were recruited, at ages between 5 and 55 years; the mean age was 21.9 ± 14.3 years. Patients were divided into three age groups 10 and under, 10-19 and over 19. During our study, peripheral audiological assessments were performed (pure tone testing and acoustic immittance measurements). The main outcome measures taken into account were airway thresholds, bone conduction, air-bone gap and compliance values between compared frequencies. Data were analyzed per ear. RESULTS Normal hearing thresholds were found in 96 (64.4%) ears of the total sample. When analysis was stratified into age groups, normal hearing thresholds were found in 81.3%, 65%, and 54.4%, of the children, adolescent and adult groups, respectively. Concerning hearing impairments, there was a predominance of mixed type hearing loss in adults (21.1%) whereas adolescents presented conductive hearing loss or a conductive loss factor, while maintaining airway thresholds within the bounds of normality (30%). Ears with hearing loss showed superior compliance means than ears without hearing loss (p = 0.002). CONCLUSIONS Overall, the majority of the subjects in this patient sample presented normal hearing thresholds. When present, hearing impairments were more prevalent in the adult group than in the adolescent or children's groups.Fundamental aspects of brain function, including development, plasticity, learning, and memory, can take place over time scales of days to years. Chronic in vivo imaging of neural activity with cellular resolution is a powerful method for tracking the long-term activity of neural circuits. We review recent advances in our understanding of neural circuit function from diverse brain regions that have been enabled by chronic in vivo cellular imaging. Insight into the neural basis of learning and decision-making, in particular, benefit from the ability to acquire longitudinal data from genetically identified neuronal populations, deep brain areas, and subcellular structures. We propose that combining chronic imaging with further experimental and computational innovations will advance our understanding of the neural circuit mechanisms of brain function.The title of Fig. 6 in the original article was incorrectly published as "normalized cytoplasmic NR2A".Intensive care unit (ICU) patients develop stress induced insulin resistance causing hyperglycemia, large glucose variability and hypoglycemia. These glucose metrics have all been associated with increased rates of morbidity and mortality. The only way to achieve safe glucose control at a lower glucose range (e.g., 4.4-6.6 mmol/L) will be through use of an autonomous closed loop glucose control system (artificial pancreas). Our goal with the present study was to assess the safety and performance of an artificial pancreas system, composed of the EIRUS (Maquet Critical Care AB) continuous glucose monitor (CGM) and novel artificial intelligence-based glucose control software, in a swine model using unannounced hypo- and hyperglycemia challenges. Fourteen piglets (6 control, 8 treated) underwent sequential unannounced hypoglycemic and hyperglycemic challenges with 3 IU of NovoRapid and a glucose infusion at 17 mg/kg/min over the course of 5 h. In the Control animals an experienced ICU physician used every 30-min blood glucose values to maintain control to a range of 4.4-9 mmol/L. In the Treated group the artificial pancreas system attempted to maintain blood glucose control to a range of 4.4-6.6 mmol/L. Five of six Control animals and none of eight Treated animals experienced severe hypoglycemia ( less then  2.22 mmol/L). The area under the curve 3.5 mmol/L was 28.9 (21.1-54.2) for Control and 4.8 (3.1-5.2) for the Treated animals. The total percent time within tight glucose control range, 4.4-6.6 mmol/L, was 32.8% (32.4-47.1) for Controls and 55.4% (52.9-59.4) for Treated (p  less then  0.034). Data are median and quartiles. https://www.selleckchem.com/products/Bortezomib.html The artificial pancreas system abolished severe hypoglycemia and outperformed the experienced ICU physician in avoiding clinically significant hypoglycemic excursions.PURPOSE Although current guidelines recommend ticagrelor in addition to aspirin as the antiplatelet strategy for medically managed acute coronary syndrome (MMACS) patients, clinical evidence specific to this special population is lacking. Whether potent oral P2Y12 inhibitors should be used in MMACS patients is still under debate. METHODS We conducted a comprehensive search in PubMed, Embase, Web of Science, and Cochrane Library to identify studies exploring the efficacy or safety of ticagrelor and prasugrel versus clopidogrel or placebo in MMACS patients. The primary efficacy endpoint was major adverse cardiovascular events (MACE) defined by each study, and the safety endpoint was TIMI non-CABG major bleeding. RESULTS A total of 6102 records were screened, and 4 studies including 46,346 patients were finally included. The use of potent oral P2Y12 inhibitors significantly lowers the risk of MACE compared with clopidogrel (HR 0.90; 95% CI 0.82-0.98; P = .018; I2 = 0%). A significant reduction in risks of all-cause death and myocardial infarction was also observed with the use of potent oral P2Y12 inhibitors compared with clopidogrel.