bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between the prevalence of Dibothriocephalus latus (Cestoda: Diphyllobothriidea) and the load of Escherichia coli: New findings in a neglected fish‐borne parasitic zoonosis
Authors: Menconi Vasco , Zoppi Simona , Pastorino Paolo , Di Blasio Alessia , Tedeschi Roberta , Pizzul Elisabetta , Mugetti Davide , Tomasoni Mattia , Dondo Alessandro , Prearo Marino
Published: September 2021

The sub‐Alpine lakes of Switzerland, Italy and France have long been reported as an endemic area of diphyllobothriosis, a parasitic zoonosis caused by Dibothriocephalus latus. With this study, we explored the hypothesis for a relationship between the prevalence of D. latus in Perca fluviatilis and the Escherichia coli load in lake water. To do this, we identified eleven sampling sites in three areas (north, centre and south) of Lake Iseo (north Italy) to determine E. coli load and the prevalence of D. latus in P. fluviatilis. Prevalence and 95% confidence interval (CI) of D. latus infestation ranged from 0% (95% CI: 0.71–0.0) in Sarnico (southern area) to 20% (95% CI: 33.0–11.2) in Pisogne (northern area). There were significant differences in prevalence between the sites (χ2 = 31.12; p‐value = .0006) and in E. coli load (Kruskal–Wallis test; p‐value = .0005). There was decreasing gradient of E. coli load and prevalence of D. latus infestation from north to south. A significant positive correlation (r = .881; p‐value = .003) was found between E. coli load and prevalence of D. latus. Also, linear regression showed a significant relationship between E. coli load and prevalence of infestation (R2 = .775). Our findings offer an explanation for the link between E. coli load in water and D. latus prevalence. The potential factors in this link are the efficiency of the local wastewater treatment plant, the bathymetric profile of the lake and the life cycle of D. latus, which is mainly affected by light and water temperature.
Selection pressure at altitude for genes related to alcohol metabolism: A role for endogenous enteric ethanol synthesis?
Authors: Sturgess Connie , Montgomery Hugh
Published: September 2021

New Findings

What is the topic of this review?

Highland natives have undergone natural selection for genetic variants advantageous in adaptation to the hypobaric hypoxia experienced at high altitude. Why genes related to alcohol metabolism appear consistently selected for has not been greatly considered. We hypothesize that altitude‐related changes in the gut microbiome offer one possible explanation.

What advances does it highlight?

Low intestinal oxygen tension might favour the production of ethanol through anaerobic fermentation by the gut microbiome. Subsequent increases in endogenous ethanol absorption could therefore provide a selection pressure for gene variants favouring its increased degradation, or perhaps reduced degradation if endogenously synthesized ethanol acts as a metabolic signalling molecule.

Reduced tissue availability of oxygen results from ascent to high altitude, where atmospheric pressure, and thus the partial pressure of inspired oxygen, fall (hypobaric hypoxia). In humans, adaptation to such hypoxia is necessary for survival. These functional changes remain incompletely characterized, although metabolic adaptation (rather than simple increases in convective oxygen delivery) appears to play a fundamental role. Those populations that have remained native to high altitude have undergone natural selection for genetic variants associated with advantageous phenotypic traits. Interestingly, a consistent genetic signal has implicated alcohol metabolism in the human adaptive response to hypobaric hypoxia. The reasons for this remain unclear. One possibility is that increased alcohol synthesis occurs through fermentation by gut bacteria in response to enteric hypoxia. There is growing evidence that anaerobes capable of producing ethanol become increasingly prevalent with high‐altitude exposure. We hypothesize that: (1) ascent to high altitude renders the gut luminal environment increasingly hypoxic, favouring (2) an increase in the population of enteric fermenting anaerobes, hence (3) the synthesis of alcohol which, through systemic absorption, leads to (4) selection pressure on genes relating to alcohol metabolism. In theory, alcohol could be viewed as a toxic product, leading to selection of gene variants favouring its metabolism. On the contrary, alcohol is a metabolic substrate that might be beneficial. This mechanism could also account for some of the interindividual differences of lowlanders in acclimatization to altitude. Future research should be aimed at determining any shifts to favour ethanol‐producing anaerobes after ascent to altitude.
Effects of Exercise in the Treatment of Alzheimer’s Disease: An Umbrella Review of Systematic Reviews and Meta-Analyses
Authors: Andrade Alexandro , Siqueira Thais Cristina , D’Oliveira Anderson , Dominski Fábio Hech
Published: September 2021

The authors aimed to provide an overview of the evidence on the effects of exercise in people with Alzheimer’s disease through a comprehensive review of the existing systematic reviews and meta-analyses. A literature search was performed in CINAHL, Cochrane Library, EMBASE, PubMed, SPORTDiscus, Scopus, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The AMSTAR-2-Tool was used for the quality assessment. Twenty-three reviews fulfilled the criteria. Most of the reviews investigated the effects of aerobic exercise on Alzheimer’s disease symptoms. The largest effects of exercise were seen in terms of improved cognition by multiple exercises. The majority of the reviews were rated as being of moderate quality and none were classified as having high quality. Exercise is an effective way to treat Alzheimer’s disease symptoms and has a low incidence of related adverse events. As most reviews were evaluated as low-moderate quality, caution is needed in the interpretation of the results.
Exploring the Relationship Between Sleep Quality, Sleep Hygiene, and Psychological Distress in a Sample of Canadian Varsity Athletes
Authors: Murphy Jessica , Gladney Christopher , Sullivan Philip
Published: September 2021

Student athletes balance academic, social, and athletic demands, often leading to increased levels of stress and poor sleep. This study explores the relationship between sleep quality, sleep hygiene, and psychological distress in a sample of student athletes. Ninety-four student athletes completed the six-item Kessler Psychological Distress Scale (K6), Sleep Hygiene Practice Scale, and four components from the Pittsburgh Sleep Quality Index. Age, gender, and sport were also collected. The Pittsburgh Sleep Quality Index revealed that 44.7% of student athletes received ≥6.5 hr of sleep each night; 31% of athletes showed signs of severe mental illness according to the K6. Stepwise regression predicted K6 scores with the Pittsburgh Sleep Quality Index and the Sleep Hygiene Practice Scale scores as independent variables. A significant model accounting for 26% of the variation in K6 scores emerged; sleep schedule and sleep disturbances were significant predictors. Athletic staff should highlight the importance of sleep for mental health; suggestions on how to help athletes are provided.
Perspectives on the Future of Burnout in Sport
Authors: Madigan Daniel J. , Gustafsson Henrik , Hill Andrew P. , Mellano Kathleen T. , Pacewicz Christine E. , Raedeke Thomas D. , Smith Alan L.
Published: September 2021

The present editorial provides a series of perspectives on the future of burnout in sport. Specifically, for the first time, seven burnout researchers have offered their opinions and suggestions for how, as a field, we can progress our understanding of this important topic. A broad range of ideas are discussed, including the relevance of the social context, the value of theory and collaboration, and the use of public health frameworks in future work. It is hoped that these perspectives will help stimulate debate, reinforce and renew priorities, and guide research in this area over the coming years.
Participation and Physical Activity in Recreovia of Bucaramanga, Colombia
Authors: Prada Erika Tatiana Paredes , Camargo-Lemos Diana Marina , Férmino Rogério César
Published: September 2021

Background: Open Streets initiatives have allowed for physical activity (PA) in cities worldwide. However, few studies have evaluated the use of small Open Streets in low- and middle-income countries, such as those in Latin America. Thus, this study aimed to describe participation and PA level of users in the Recreovia program in Bucaramanga, Colombia. Methods: A cross-sectional study was conducted during 5 Sundays from September to November 2017. Recreovia use was evaluated at 4 strategic points according to street accessibility (2 points) and aerobics class areas (2 points), using the System for Observing Play and Recreation in Communities. Results: A total of 38,577 observations were made (34,969 on streets and 3608 in aerobics class areas). Men (63%) and adults (62%), with moderate to vigorous PA (MVPA) (98%) were observed on streets. The most common PAs were biking (50%), walking/dog walking (36%), and jogging (9%). In aerobics class areas, the most common groups were female (65%) and adults (89%). Participants were engaged in moderate to vigorous PA (91%). Conclusion: Measurement of number of participants at moderate to vigorous levels of PA was high. A difference between sexes and age in these street and aerobic class area groups was also observed.
Basketball’s Black Tax? An Examination of Historically Black College and University Men’s Basketball Guarantee Game Compensation
Authors: Jones Willis A. , Black Wayne L.
Published: September 2021

Guarantee games are among the most important revenue streams for historically Black college and university (HBCU) intercollegiate athletics departments. Some scholars, however, have critiqued these games and even questioned their legality. This study examined the contracts of guarantee games in men’s basketball to assess whether HBCUs and non-HBCUs are equally compensated for their participation in these games. The findings point to the existence of a basketball “Black tax” where HBCUs are not given equal compensation for their participation in men’s college basketball guarantee games. The authors discuss the implications of this inequality along with recommendations for future research.
The Non-Sweet Sixteen: Referee Bias Against Historically Black Colleges and Universities in Men’s College Basketball
Authors: Dix Andrew
Published: September 2021

This study focused on historically Black colleges and universities in men’s college basketball. A review of previous literature revealed that referee bias was a recurring phenomenon, while whiteness studies served as the theoretical frame. The data for this analysis centered on a 16-year period of time. The referees called a statistically significant number of personal fouls per game against men’s college basketball teams from historically Black colleges and universities relative to the number of personal fouls per game that referees called against men’s college basketball teams from predominantly White institutions. These findings suggest that men’s college basketball players were judged differently depending on whether the student-athlete played for a historically Black college and university or a predominantly White institution. The implications for critical and social theories were noted in the study discussion.
Fifteen-minute consultation: Bruising in the premobile child
Authors: Wallace Fiona , Collins Julie-Ann , Talawila Da Camara Nishanthi , Kemp Alison Mary , Prosser Ingrid , Mullen Stephen
Published: September 2021

A bruise in a premobile infant is an uncommon finding and often results in referral to the paediatric or emergency departments, acknowledging the potential for physical abuse in this vulnerable cohort. Our role as clinicians is to undertake a thorough assessment, consider potential differentials and organise appropriate investigations, with involvement of the wider multidisciplinary team. In this article, we use a case vignette to discuss how one would approach a bruise in the premobile infant including the evidence base.
Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study
Authors: Cavallin Francesco , Lupi Fiorenzo , Bua Benedetta , Bellutti Marion , Staffler Alex , Trevisanuto Daniele
Published: September 2021

Background and objective

Healthcare providers should use personal protective equipment (PPE) when performing aerosol-generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-COVID-19 transmission.

Methods

A randomised controlled cross-over (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant–nurse teams and 12 resident–nurse teams. The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE and discomfort/limitations using PPE.

Results

There were significant differences in timing of PPV initiation (consultant–nurse teams: mean difference (MD) 6.0 s, 95% CI 1.1 to 10.9 s; resident–nurse teams: MD 11.0 s, 95% CI 1.9 to 20.0 s), duration of tracheal intubation (consultant–nurse teams: MD 22.0 s, 95% CI 7.0 to 36.9 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s) and chest compressions (consultant–nurse teams: MD 32.3 s, 95% CI 14.4 to 50.1 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48).

Conclusions

In a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE.

Trial registration number

NCT04666233.
Down syndrome with bilateral posterior lenticonus
Authors: Jain Mayank , Rambhau Katkar Amol , Shetty Shashikant , Vijayalakshmi Perumalsamy
Published: September 2021

We present a case of bilateral posterior lenticonus in a young boy with Down syndrome. Association of posterior lenticonus in Down syndrome is rarely reported in the literature. We have discussed the clinical features and management of this patient at our hospital.
Symptomatic isolated axillary lymph node sarcoidosis: an unusual presentation
Authors: Ilerhunmwuwa Nosakhare Paul , Thayyil Sheena , Divyateja Hrushikesh , Gouni Ravikanth
Published: September 2021

An 82-year-old woman admitted following a 4-week history of feeling unwell, abdominal pain and constipation. Initial investigations revealed severe hypercalcaemia with suppressed parathyroid hormone and elevated 1,25-dihydroxycholecalciferol. ACE was also raised. CT scans of the head, chest, abdomen and pelvis were normal. Fluorodeoxyglucose-positron emission tomography scan showed metabolically active right axillary lymphadenopathy which when biopsied under ultrasound guidance confirmed sarcoidosis. The patient was started on high-dose prednisolone with resolution of symptoms within 2 weeks. Isolated lymph node sarcoidosis is uncommon, and the reported usual sites are lymph nodes in the head and neck. Rarely has it been reported in the axillary lymph nodes.
Metabolically healthy obesity and the risk of all-cause and cardiovascular disease mortality in a Korean population: a prospective cohort study
Authors: Kim Seong-Ah , Lim Kyungjoon , Lee Jong-Koo , Kang Daehee , Shin Sangah
Published: September 2021

Objectives

This study aimed to examine the association between metabolically healthy obesity and all-cause and cardiovascular disease (CVD) mortality in a Korean population.

Design

A prospective study.

Setting

This study used data from the Korean Genome and Epidemiology Study.

Participants

A total of 140 137 participants were followed up over a median period of 9.2 years. Participants were categorised into four groups according to obesity (obese: body mass index ≥25 kg/m2or non-obese) and metabolic health (metabolically unhealthy: two or more metabolic abnormalities or metabolically healthy).

Primary and secondary outcome measures

All-cause and CVD mortality of the participants until 31 December 2018 were ascertained by the National Health Insurance Service of beneficiary status of Korea.

Results

Metabolically unhealthy non-obese participants were at elevated risk of all-cause mortality (HR, 1.12; 95% CI, 1.04 to 1.21; p=0.0019) and CVD mortality (HR, 1.39; 95% CI, 1.17 to 1.65; p=0.0002), particularly mortality from ischaemic heart disease (IHD) (HR, 1.54; 95% CI, 1.10 to 2.14; p=0.0116) compared with metabolically healthy non-obese participants. Surprisingly, metabolically healthy obese participants were at reduced risk of all-cause mortality (HR, 0.89; 95% CI, 0.81 to 0.98; p=0.0197). Metabolically unhealthy obese participants were at elevated risk of CVD mortality (HR, 1.51; 95% CI, 1.26 to 1.81; p<0.0001) and IHD mortality (HR, 1.88; 95% CI, 1.35 to 2.63; p=0.0002) compared with metabolically healthy non-obese participants.

Conclusions

In a Korean population, metabolically healthy obese participants had reduced risk of all-cause mortality compared with their non-obese counterparts, whereas metabolically unhealthy participants had elevated risk of CVD mortality, in particular mortality from IHD regardless of obesity.
Impact of early life nutrition on gut health in children: a prospective clinical study
Authors: Ley Delphine , Beghin Laurent , Morcel Jules , Flamein Florence , Garabedian Charles , Accart Bertrand , Drumez Elodie , Labreuche Julien , Gottrand Frederic , Hermann Emmanuel
Published: September 2021

Introduction

The first 1000 days of life could contribute to individual susceptibility to the later development of chronic non-communicable diseases. Nutrition in early life appears to be an important determinant factor for a sustainable child’s health. In this study, we propose to investigate the impact of exclusive breast feeding on gut health in children.

Methods and analysis

A prospective cohort of newborns (n=350) will be recruited at birth and followed up to 4 years of age. The main objective is to evaluate the link between exclusive breast feeding for at least 3 months and the gut health of the child at 4 years. The primary endpoint of assessment of gut health will be based on the non-invasive measurement of faecal secretory IgA (sIgA) as a sensitive biomarker of the intestinal ecosystem. The presence of gastrointestinal disorders will be defined according to the clinical criteria of Rome IV. Information on parent’s nutritional habits and life style, breastfeeding duration and child’s complementary feeding will be collected along the follow-up. Cord blood cells and plasma at birth will be purified for further analysis. The meconium and stools collected at birth, 6 months, 2 years and 4 years of age will allow sIgA analysis.

Ethics and dissemination

This clinical study has obtained the approval from the national ethical committee. We plan to publish the results of the study in peer-review journals and by means of national and international conference.

Trial registration number

NCT04195425.
Exploring ethnic minority women’s experiences of maternity care during the SARS-CoV-2 pandemic: a qualitative study
Authors: John Jeeva Reeba , Curry Gwenetta , Cunningham-Burley Sarah
Published: September 2021

Objective

To explore the experiences of pregnancy, childbirth, antenatal and postnatal care in women belonging to ethnic minorities and to identify any specific challenges that these women faced during the SARS-CoV-2 pandemic.

Design

This was a qualitative study using semistructured interviews of pregnant women or those who were 6 weeks postnatal from Black, Asian and minority ethnic backgrounds. The study included 16 women in a predominantly urban Scottish health board area.

Results

The finding are presented in four themes: ‘communication’, ‘interactions with healthcare professionals’, ‘racism’ and ‘the pandemic effect’. Each theme had relevant subthemes. ‘Communication’ encompassed respect, accent bias, language barrier and cultural dissonance; ‘interactions with healthcare professionals’: continuity of care, empathy, informed decision making and dissonance with other healthcare systems; ‘racism’ was deemed to be institutional, interpersonal or internalised; and ‘the pandemic effect’ consisted of isolation, psychological impact and barriers to access of care.

Conclusions

This study provides insight into the specific challenges faced by ethnic minority women in pregnancy, which intersect with the unique problems posed by the ongoing SARS-CoV-2 pandemic to potentially widen existing ethnic disparities in maternal outcomes and experiences of maternity care.
Impact of dietary nitrate supplementation on exercise capacity and cardiovascular parameters in chronic respiratory disease: a systematic review and meta-analysis
Authors: Alsulayyim Abdullah S , Alasmari Ali M , Alghamdi Saeed M , Polkey Michael I , Hopkinson Nicholas S
Published: September 2021

Background

Dietary nitrate supplementation, usually in the form of beetroot juice, may improve exercise performance and endothelial function. We undertook a systematic review and meta-analysis to establish whether this approach has beneficial effects in people with respiratory disease.

Methods

A systematic search of records up to March 2021 was performed on PubMed, CINAHL, MEDLINE (Ovid), Cochrane and Embase to retrieve clinical trials that evaluated the efficacy of dietary nitrate supplementation on cardiovascular parameters and exercise capacity in chronic respiratory conditions. Two authors independently screened titles, abstracts and full texts of potential studies and performed the data extraction.

Results

After full-text review of 67 papers, eleven (two randomised controlled trials and nine crossover trials) involving 282 participants met the inclusion criteria. Three were single dose; seven short term; and one, the largest (n=122), done in the context of pulmonary rehabilitation. Pooled analysis showed that dietary nitrate supplementation reduced systolic blood pressure (BP), diastolic BP and mean arterial pressure (mean difference (95% CI), −3.39 mm Hg (−6.79 to 0.01); p=0.05 and –2.20 mm Hg (−4.36 to −0.03); p=0.05 and −4.40 mm Hg (−7.49 to −1.30); p=0.005, respectively). It was associated with increased walk distance in the context of pulmonary rehabilitation (standardised mean difference (95% CI), 0.47 (0.11 to 0.83), p=0.01), but no effect was identified in short-term studies (0.08 (−0.32 to 0.49).

Conclusion

Dietary nitrate supplementation may have a beneficial effect on BP and augment the effect of pulmonary rehabilitation on exercise capacity. Short-term studies do not suggest a consistent benefit on exercise capacity.

PROSPERO registration number

CRD42019130123.
Influence of individual, illness and environmental factors on place of death among people with neurodegenerative diseases: a retrospective, observational, comparative cohort study
Authors: Nicholas Richard , Nicholas Emma , Hannides Mike , Gautam Vishal , Friede Tim , Koffman Jonathan
Published: September 2021

Background

In long-term neurological conditions, location of death is poorly understood but is seen as a marker of quality of dying.

Objective

To examine individual, illness and environmental factors on place of death among people with multiple sclerosis (MS) and Parkinson’s disease (PD) in isolation or in combination and compare them with people without either condition.

Methods

Retrospective, observational, comparative cohort study of 582 people with MS, 579 people with PD and 95 controls from UK Multiple Sclerosis and Parkinson’s Disease Tissue Bank. A subset of people with MS and PD were selected for analysis of individual clinical encounters 2 years before death and further subset of all groups for analysis of impact of advance care planning (ACP) and recognition of dying.

Results

People with MS died more often (50.8%) in hospital than those with PD (35.3%). Examining individual clinical encounters over 2 years (4931 encounters) identified increased contact with services 12 months before death (F(1, 58)=69.71, p<0.0001) but was not associated with non-hospital deaths (F(1, 58)=1.001, p=0.321). The presence of ACPs and recognition of dying were high among people with MS and PD and both associated with a non-hospital death. ACPs were more likely to prevent hospital deaths when initiated by general practitioners (GPs) compared with other professional groups (χ2=68.77, p=0.0007).

Conclusions

For people with MS and PD, ACPs contribute to reducing dying in hospital. ACPs appear to be most effective when facilitated by GPs underlining the importance of primary care involvement in delivering holistic care at the end of life.
Lung cancer deaths (England 2001–2017)—comorbidities: a national population-based analysis
Authors: Henson Lesley A. , Chukwusa Emeka , Ng Yin Ling Clarissa , Khan Shaheen A. , Gao Wei
Published: September 2021

Background

The presence of comorbidities in people with lung cancer is common. Despite this, large-scale contemporary reports describing patterns and trends in comorbidities are limited.

Design and methods

Population-based patterns and trends analysis using Office for National Statistics Mortality Data. Our cohort included all adults who died from lung cancer (ICD-10 codes C33–C34) in England between 2001 and 2017. We describe decedents with 0, 1 or ≥2 comorbidities and explore changes overtime for the six most common comorbidities identified: chronic respiratory disease; diabetes; cardiovascular disease; dementia; cerebrovascular disease and chronic kidney disease. To determine future trends, the mean annual percentage change between 2001 and 2017 was calculated and projected forwards, while accounting for anticipated increases in lung cancer mortality.

Results

There were 472 259 deaths from lung cancer (56.9% men; mean age 72.9 years, SD: 10.7). Overall, 19.0% of lung cancer decedents had 1 comorbidity at time of death and 8.8% had ≥2. The proportion of patients with comorbidities increased over time—between 2001 and 2017 decedents with 1 comorbidity increased 54.7%, while those with ≥2 increased 294.7%. The most common comorbidities were chronic respiratory disease and cardiovascular disease, contributing to 18.5% (95% CI: 18.0 to 18.9) and 11.4% (11.0 to 11.7) of deaths in 2017. Dementia and chronic kidney disease had the greatest increase in prevalence, increasing 311% and 289% respectively.

Conclusion

To deliver high-quality outcomes for the growing proportion of lung cancer patients with comorbidities, oncology teams need to work across traditional boundaries of care. Novel areas for development include integration with dementia and chronic kidney disease services.
Genomic temporal heterogeneity of circulating tumour DNA in unresectable metastatic colorectal cancer under first-line treatment
Authors: Wang Feng , Huang You-Sheng , Wu Hao-Xiang , Wang Zi-Xian , Jin Ying , Yao Yi-Chen , Chen Yan-Xing , Zhao Qi , Chen Shifu , He Ming-Ming , Luo Hui-Yan , Qiu Miao-Zhen , Wang De-shen , Wang Feng-Hua , Xu Mingyan , Li Yu-Hong , Xu Rui-Hua
Published: September 2021

Objective

Circulating tumour DNA (ctDNA) sequencing is increasingly used in the clinical management of patients with colorectal cancer. However, the genomic heterogeneity in ctDNA during treatments and its impact on clinical outcomes remain largely unknown.

Design

We conducted a prospective cohort study (NCT04228614) of 171 patients with unresectable metastatic colorectal cancer (mCRC) who underwent first-line treatment and prospectively collected blood samples with or without tumour samples from patients at baseline and sequentially until disease progression or last follow-up.

Results

The RAS/BRAF alterations in paired baseline tissue and plasma samples from 63 patients displayed a favourable concordance (81.0%, 51/63). After a period of first-line treatment (median time between baseline and last liquid biopsy, 4.67 months), 42.6% (26/61) of RAS-mutant patients showed RAS clearance and 50.0% (5/10) of BRAF-mutant patients showed BRAF clearance, while 3.6% (3/84) and 0.7% (1/135) of patients showed new RAS or BRAF mutations in ctDNA. Patients with plasma RAS/BRAF clearance showed similar progression-free survival (PFS) and overall survival (OS) with patients who remained RAS/BRAF wild-type, while much better outcomes than those who remained RAS/BRAF mutant. Patients who gained new RAS/BRAF mutations showed similar prognosis as those who maintained RAS/BRAF mutations, and shorter PFS and OS than those who remained RAS/BRAF wild-type.

Conclusion

This prospective, serial and large-scale ctDNA profiling study reveals the temporal heterogeneity of mCRC-related somatic variants, which should be given special attention in clinical practice, as evidenced by the finding that the shift in plasma RAS/BRAF mutational status can yield a drastic change in survival outcomes.
Diet quality and risk and severity of COVID-19: a prospective cohort study
Authors: Merino Jordi , Joshi Amit D , Nguyen Long H , Leeming Emily R , Mazidi Mohsen , Drew David A , Gibson Rachel , Graham Mark S , Lo Chun-Han , Capdevila Joan , Murray Benjamin , Hu Christina , Selvachandran Somesh , Hammers Alexander , Bhupathiraju Shilpa N , Sharma Shreela V , Sudre Carole , Astley Christina M , Chavarro Jorge E , Kwon Sohee , Ma Wenjie , Menni Cristina , Willett Walter C , Ourselin Sebastien , Steves Claire J , Wolf Jonathan , Franks Paul W , Spector Timothy D , Berry Sarah , Chan Andrew T
Published: September 2021

Objective

Poor metabolic health and unhealthy lifestyle factors have been associated with risk and severity of COVID-19, but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its interaction with socioeconomic deprivation.

Design

We used data from 592 571 participants of the smartphone-based COVID-19 Symptom Study. Diet information was collected for the prepandemic period using a short food frequency questionnaire, and diet quality was assessed using a healthful Plant-Based Diet Score, which emphasises healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate HRs and 95% CIs for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalisation with oxygen support, respectively.

Results

Over 3 886 274 person-months of follow-up, 31 815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR 0.91; 95% CI 0.88 to 0.94) and severe COVID-19 (HR 0.59; 95% CI 0.47 to 0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate per 10 000 person/months for lowest vs highest quartile of diet score was 22.5 (95% CI 18.8 to 26.3) among persons living in areas with low deprivation and 40.8 (95% CI 31.7 to 49.8) among persons living in areas with high deprivation.

Conclusions

A diet characterised by healthy plant-based foods was associated with lower risk and severity of COVID-19. This association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.
Non-alcoholic fatty liver disease and incident major adverse cardiovascular events: results from a nationwide histology cohort
Authors: Simon Tracey G , Roelstraete Bjorn , Hagström Hannes , Sundström Johan , Ludvigsson Jonas F
Published: September 2021

Objective

Some data suggest a positive association between non-alcoholic fatty liver disease (NAFLD) and incident major adverse cardiovascular events (MACEs). However, data are lacking from large cohorts with liver histology, which remains the gold standard for staging NAFLD severity.

Design

This population-based cohort included all Swedish adults with histologically confirmed NAFLD and without cardiovascular disease (CVD) at baseline (1966–2016, n=10 422). NAFLD was defined from prospectively recorded histopathology and categorised as simple steatosis, non-fibrotic steatohepatitis, non-cirrhotic fibrosis and cirrhosis. Patients with NAFLD were matched to ≤5 population controls without NAFLD or CVD, by age, sex, calendar year and county (n=46 517). Using Cox proportional hazards modelling, we calculated multivariable adjusted HRs (aHRs) and 95% CIs for MACE outcomes (ie, ischaemic heart disease (IHD), stroke, congestive heart failure (CHF) or cardiovascular (CV) mortality).

Results

Over a median of 13.6 years, incident MACE was confirmed in 2850 patients with NAFLD and 10 648 controls. Patients with NAFLD had higher incidence of MACE than controls (24.3 vs 16.0/1000 person-years (PY); difference=8.3/1000 PY; aHR 1.63, 95% CI 1.56 to 1.70), including higher rates of IHD (difference=4.2/1000 PY; aHR 1.64, 95% CI 1.54 to 1.75), CHF (difference=3.3/1000 PY; aHR 1.75, 95% CI 1.63 to 1.87), stroke (difference=2.4/1000 PY; aHR 1.58, 95% CI 1.46 to 1.71) and CV mortality (difference=1.2/1000 PY; aHR 1.37, 95% CI 1.27 to 1.48). Rates of incident MACE increased progressively with worsening NAFLD severity (ptrend=0.02), with the highest incidence observed with cirrhosis (difference vs controls=27.2/1000 PY; aHR 2.15, 95% CI 1.77 to 2.61).

Conclusion

Compared with matched population controls, patients with biopsy-proven NAFLD had significantly higher incidence of MACE, including IHD, stroke, CHF and CV mortality. Excess risk was evident across all stages of NAFLD and increased with worsening disease severity.
Cardiac resynchronisation therapy in anthracycline-induced cardiomyopathy
Authors: Patel Divyang , Kumar Anirudh , Moennich Laurie Ann , Trulock Kevin , Nemer David M , Donnellan Eoin , Il'Giovine Zachary J , Martyn Trejeeve , Callahan Thomas D , Hussein Ayman A , Tarakji Khaldoun G , Kanj Mohamed , Cantillon Daniel J , Baranowski Bryan , Starling Randall C , Tang W H Wilson , Wazni Oussama M , Varma Niraj , Wilkoff Bruce L , Rickard John
Published: September 2021

Introduction

Chemotherapy-induced cardiomyopathy has been increasingly recognised as patients are living longer with more effective treatments for their malignancies. Anthracyclines are known to cause left ventricular (LV) dysfunction. While heart failure medications are frequently used, some patients may need consideration for device-based therapies such as cardiac resynchronisation therapy (CRT). However, the role of CRT in anthracycline-induced cardiomyopathy (AIC) is not well understood.

Methods

We performed a retrospective review of all patients undergoing CRT implantation at our centre from 2003 to 2019 with a diagnosis of AIC. The LV remodelling and survival outcomes of this population were obtained and then compared with consecutive patients with other aetiologies of non-ischaemic cardiomyopathy (NICM).

Results

A total of 34 patients underwent CRT implantation with a diagnosis of AIC with a mean age of 60.5±12.7 years, left ventricular ejection fraction (LVEF) of 21.7%±7.4%, and 11.3±7.5 years and 10.2±7.4 years from cancer diagnosis and last anthracycline exposure, respectively. At 9.6±8.1 months after CRT implantation, there was an increase of LVEF from 21.8%±7.6% to 30.4%±13.0% (p<0.001). Patients whose LVEF increased by at least 10% post-CRT implant (42.5% of cohort) survived significantly longer than patients who failed to improve their LVEF by that amount (p=0.01). A propensity matched analysis between patients with AIC and 369 consecutive patients with other aetiologies of NICM who underwent CRT implantation during the same period revealed no significant differences in improvement in LVEF or long-term survival.

Conclusions

Patients with AIC undergo LV remodelling with CRT at rates similar to other aetiologies of NICM. Furthermore, AIC post-CRT responders have a favourable long-term mortality compared with non-responders.
Income and neighbourhood deprivation in relation to obesity in urban dwelling children 0–12 years of age: a cross-sectional study from 2013 to 2019
Authors: Anderson Laura N , Fatima Tooba , Shah Bindra , Smith Brendan T. , Fuller Anne E. , Borkhoff Cornelia M , Keown-Stoneman Charles D G , Maguire Jonathon L. , Birken Catherine S.
Published: September 2021

Background

Childhood obesity is a major public health concern. This study evaluated the independent and joint associations of family-level income, neighbourhood-level income and neighbourhood deprivation, in relation to child obesity.

Methods

A cross-sectional study was conducted in children ≤12 years of age from TARGet Kids! primary care network (Greater Toronto Area, 2013–2019). Parent-reported family income was compared with median neighbourhood income and neighbourhood deprivation measured using the Ontario Marginalization Index. Children’s height and weight were measured and body mass index (BMI) z-scores (zBMI) were calculated. ORs and 95% CIs were estimated for the three exposure variables separately using multilevel multinomial logistic regression models with zBMI categories as the outcome, adjusting in model 1 for age, sex, ethnicity and number of family members and in model 2 adding family income. A joint measure was derived combining income and deprivation measures.

Results

A total of 5962 children were included. Low family income (Q1 vs Q5: OR=4.69, 95% CI 2.65 to 8.29), low neighbourhood income (Q1 vs Q5: OR=2.18, 95% CI 1.33 to 3.58) and high neighbourhood deprivation (Q1 vs Q5: OR=2.45, 95% CI 1.52 to 3.95) were each associated with increased OR of child obesity. However, after adjustment for family income, the association for both neighbourhood income (OR=1.39, 95% CI 0.82 to 2.34) and deprivation (OR=1.56, 95% CI 0.94 to 2.58) and obesity was attenuated. Children from low-income families living in low-income or high deprivation neighbourhoods had higher OR of obesity.

Conclusion

Child obesity was independently associated with low family-level income and a joint measure suggests that neighbourhood also matters. Socioeconomic inequalities at both individual and neighbourhood levels should be addressed in childhood obesity interventions.
Properties of strange quark matter and strange quark stars
Authors: Kumari Manisha , Kumar Arvind
Published: September 2021

A Polyakov chiral$$\text {SU(3)}$$SU(3)quark mean-field (PCQMF) model is applied to study the properties of strange quark matter (SQM) and strange quark star (SQS) in$$\beta $$β-equilibrium. The effect of increasing the strength of vector interactions on the effective constituent quark mass, particle fractions, and the thermodynamical properties such as pressure, energy density, and the speed of sound is investigated. We investigate the above properties for the SQM relevant for various stages of star evolution, i.e., considering with/without trapped neutrinos and zero/finite entropy. The finite lepton fraction and the entropy of the medium is observed to cause the stiffness in the equation of state (EoS). Finally, we calculate the mass-radius relation and the dimensionless tidal deformability within the present model calculations and compare the results to the recent studies.
Inflation based on a classically scale invariant extended standard model
Authors: Tomita Katsuki
Published: September 2021

We extend a classically scale invariant model where the electroweak symmetry breaking is triggered by the dynamical chiral symmetry breaking in a hidden QCD sector, and a real singlet scalar [Formula: see text] mediates these two sectors. Our model can explain cosmic inflation without unitarity violation in addition. Slow-roll inflation occurs along a valley in scalar potential. In the original model, the coupling [Formula: see text] between the Higgs field [Formula: see text] and [Formula: see text] is always negative and therefore, the potential has its valleys in [Formula: see text]-[Formula: see text] mixed directions. For large value of the top Yukawa coupling [Formula: see text], the potential along the valley becomes negative since the Higgs quartic coupling [Formula: see text] becomes negative at inflationary scale. Then slow-roll inflation cannot occur. For inflation to definitely occur, we render the coupling [Formula: see text] positive at inflationary scale and consider the [Formula: see text]-inflation case. This is achieved by introducing a new singlet scalar [Formula: see text] with the large coupling [Formula: see text] to [Formula: see text]. By this extension, [Formula: see text] can also always be positive, and we consider this case as the simplest case. We consider inflation with the nonminimal coupling [Formula: see text] between [Formula: see text] and gravity. Although [Formula: see text] is large such as [Formula: see text], unitarity is not violated since couplings between [Formula: see text] and other fields are sufficiently small. [Formula: see text] is odd under a new symmetry [Formula: see text] not to mix with [Formula: see text] regardless of largeness of [Formula: see text]. Because of this symmetry, [Formula: see text] may have its relic abundance [Formula: see text] comparable with the observational value [Formula: see text] of the dark matter relic abundance. However, the spin-independent elastic cross-section [Formula: see text] of [Formula: see text] exceeds the observational bound [Formula: see text] cm2. Hence, we impose the resonance condition [Formula: see text] and reduce [Formula: see text] to much smaller than [Formula: see text]. Constraints from the electroweak scale physics and inflationary scale physics are much strong, and the allowed parameter space is very narrow.
Pressure dependence of the Grüneisen parameter and melting temperature of some metals
Authors: Sunil K. , Ashwini D. , Sharma Vijay S.
Published: September 2021

We have used a method for determining volume dependence of the Grüneisen parameter in the Lindemann law to study the pressure dependence of melting temperatures in case of 10 metals viz. Cu, Mg, Pb, Al, In, Cd, Zn, Au, Ag and Mn. The reciprocal gamma relationship has been used to estimate the values of Grüneisen parameters at different volumes. The results for melting temperatures of metals at high pressures obtained in this study using the Lindemann law of melting are compared with the available experimental data and also with the values calculated from the instability model based on a thermal equation of state. The analytical model used in this study is much simpler than the accurate DFT calculations and molecular dynamics.
New optical soliton solutions of Biswas–Arshed model with Kerr law nonlinearity
Authors: Tripathy A. , Sahoo S. , Ray S. Saha , Abdou M. A.
Published: September 2021

In this paper, the newly derived solutions for the optical soliton of Kerr law nonlinearity form of Biswas–Arshed model are investigated. The exact solutions are extracted by deploying two different novel methods namely, [Formula: see text]-expansion method and Riccati–Bernoulli sub-ODE method. Furthermore, in different conditions, the resultants show different wave solutions like singular, kink, anti-kink, periodic, rational, exponential and dark soliton solutions. Also, the dynamics of the attained solutions are presented graphically.
Generation of Tri-Directional Spectra-Compatible Time Histories Coupling the Influence Matrix Method and Gram–Schmidt Orthogonalization
Authors: Yang Lanlan , Xie Wei-Chau , Xu Weiya , Ly Binh-Le , Liu Wenhua , Li Wugang
Published: September 2021

This study presents a new approach for obtaining a set of tri-directional time histories compatible with target design spectra by modifying real recorded earthquake ground motions. The influence matrix method (IMM) based on eigenfunction expansion is improved for typical design response spectra with different shapes and employed in order to achieve accurate matching with the target design spectra. By applying the Gram–Schmidt orthogonalization in each iteration of the IMM procedure, the correlation coefficient between any two components can be guaranteed to be strictly zero. Hence, the generated three components in the orthogonal directions are statistically independent. The generated time histories satisfy the requirements of current codes and standards. Two examples are presented to illustrate the procedure and the superiority of the proposed method, with the maximum relative error between the generated time histories and target design spectra being less than 0.2% in [0.6, 100] Hz, and the code requirements being satisfied strictly.
Some variations of projectivity
Authors: Ertaş Nil Orhan , Tribak Rachid
Published: September 2021

We prove that a ring [Formula: see text] has a module [Formula: see text] whose domain of projectivity consists of only some injective modules if and only if [Formula: see text] is a right noetherian right [Formula: see text]-ring. Also, we consider modules which are projective relative only to a subclass of max modules. Such modules are called max-poor modules. In a recent paper Holston et al. showed that every ring has a p-poor module (that is a module whose projectivity domain consists precisely of the semisimple modules). So every ring has a max-poor module. The structure of all max-poor abelian groups is completely determined. Examples of rings having a max-poor module which is neither projective nor p-poor are provided. We prove that the class of max-poor [Formula: see text]-modules is closed under direct summands if and only if [Formula: see text] is a right Bass ring. A ring [Formula: see text] is said to have no right max-p-middle class if every right [Formula: see text]-module is either projective or max-poor. It is shown that if a commutative noetherian ring [Formula: see text] has no right max-p-middle class, then [Formula: see text] is the ring direct sum of a semisimple ring [Formula: see text] and a ring [Formula: see text] which is either zero or an artinian ring or a one-dimensional local noetherian integral domain such that the quotient field [Formula: see text] of [Formula: see text] has a proper [Formula: see text]-submodule which is not complete in its [Formula: see text]-topology. Then we show that a commutative noetherian hereditary ring [Formula: see text] has no right max-p-middle class if and only if [Formula: see text] is a semisimple ring.
COMPARATIVE EFFECTIVENESS OF ROBOT-INTERACTIVE GAIT TRAINING WITH AND WITHOUT ANKLE ROBOTIC CONTROL IN PATIENTS WITH BRAIN DAMAGE
Authors: PARK CHANHEE , HWANG JONGSEOK , YOU JOSHUA SUNG H.
Published: September 2021

Although ankle robotic control has emerged as a critical component of robot-interactive gait training (RIGT), no study has investigated the neurophysiological and biomechanical effects on ankle muscle activity and joint angle kinematics in healthy adults and participants with brain damage, including stroke and cerebral palsy (CP). This study compared the effects of RIGT, with and without ankle control actuator, on ankle muscle activity and joint angle kinematics in healthy adults and participants with brain damage. Ten patients ([Formula: see text], left hemiparetic [Formula: see text], [Formula: see text]) underwent standardized surface electromyography (EMG) neurophysiological and kinematics biomechanical tests under the RIGT with and without ankle control actuator conditions. Outcome measures included the EMG amplitudes of the tibialis anterior and gastrocnemius muscle activity, and ankle movement angles recorded with a two-axis digital inclinometer. Descriptive statistical analysis demonstrated that RIGT with ankle control actuator showed superior effects on EMG (30%) and kinematics angles (25%) than RIGT without ankle control actuator. Our results provided novel, promising clinical evidence that RIGT with ankle control actuator can more effectively improve the neurophysiological EMG data and ankle dorsiflexion and plantarflexion movements than RIGT without ankle control actuator in participants with stroke and CP.