bluuebunny/crossref_metadata_2025 huggingface dataset:
805 Educational programme based on bottom-up learning approach
Authors: Spaccarotella Carmen , Giordano Salvatore , Esposito Giovanni , Sinagra Gianfranco , Indolfi Ciro
Published: December 2021

A substantial part of the training programme for cardiologists in training includes several hours per week of face-to-face teaching. Since the pandemic's beginning, most of these activities in the universities have been conducted virtually using one of the available secure and reliable video platforms.

The proven standard educational method is top-down education. The teacher guides the instruction, focuses on what the students ‘need to know’, and transmits the knowledge to the fellows, then verifies the learning. Unfortunately, this method does not stimulate critical, creative ability and does not always represent what the fellows ‘want to know’.

A new additional model of education in the Board of Cardiology of the Magna Graecia University and the University of Trieste has been designed to develop education from the bottom up. The topics that have been chosen are those of the training programme in Cardiology and necessary to complete the training period.

A participants list of 60 fellows in training and a panellist list of 3 teachers were then created. The first topic was ‘Myocarditis’. Next, each fellow was asked about one topic/question (Figure 1) (see additional data). All participants then had to vote for the best five from the pool of 60 questions. Therefore, a pyramid of priorities was made between the topics/questions and assigned to the three panellists, based on specific expertise, 3 days before the event (see additional data). Then a 1, 15 H zoom session was opened at 7:00 AM, and all participants were invited.

In the digital session, the fellow authors of the first 15 questions read the question by his/herself, then the moderator entrusted the answer to one of the expert panellists.

With this approach, the student started with a question of the selected topic, performs self-directed research or experimentation, and, finally, arrives at explicit knowledge. The general rule of this approach is that participants are the producers and advantages of this method are to teach students how to seek knowledge on their own, even outside the virtual event.

In conclusion, this bottom-up educational programme presented can be a valuable teaching aid in the training trajectory of the new generation of physicians. 805 Figure 1.
Hmga2 deficiency is associated with allometric growth retardation, infertility, and behavioral abnormalities in mice
Authors: Lee Mi Ok , Li Jingyi , Davis Brian W , Upadhyay Srijana , Al Muhisen Hadil M , Suva Larry J , Clement Tracy M , Andersson Leif
Published: December 2021

The high mobility group AT-hook 2 (HMGA2) protein works as an architectural regulator by binding AT-rich DNA sequences to induce conformational changes affecting transcription. Genomic deletions disrupting HMGA2 coding sequences and flanking noncoding sequences cause dwarfism in mice and rabbits. Here, CRISPR/Cas9 was used in mice to generate an Hmga2 null allele that specifically disrupts only the coding sequence. The loss of one or both alleles of Hmga2 resulted in reduced body size of 20% and 60%, respectively, compared to wild-type littermates as well as an allometric reduction in skull length in Hmga2−/− mice. Both male and female Hmga2−/− mice are infertile, whereas Hmga2+/− mice are fertile. Examination of reproductive tissues of Hmga2−/− males revealed a significantly reduced size of testis, epididymis, and seminal vesicle compared to controls, and 70% of knock-out males showed externalized penis, but no cryptorchidism was observed. Sperm analyses revealed severe oligospermia in mutant males and slightly decreased sperm viability, increased DNA damage but normal sperm chromatin compaction. Testis histology surprisingly revealed a normal seminiferous epithelium, despite the significant reduction in testis size. In addition, Hmga2−/− mice showed a significantly reduced exploratory behavior. In summary, the phenotypic effects in mouse using targeted mutagenesis confirmed that Hmga2 is affecting prenatal and postnatal growth regulation, male reproductive tissue development, and presents the first indication that Hmga2 function is required for normal mouse behavior. No specific effect, despite an allometric reduction, on craniofacial development was noted in contrast to previous reports of an altered craniofacial development in mice and rabbits carrying deletions of both coding and noncoding sequences at the 5′ part of Hmga2.
Genome sequence of the English grain aphid,Sitobion avenaeand its endosymbiontBuchnera aphidicola
Authors: Byrne Stephen , Schughart Maximilian , Carolan James C , Gaffney Michael , Thorpe Peter , Malloch Gaynor , Wilkinson Tom , McNamara Louise
Published: December 2021

The English grain aphid, Sitobion avenae, is a major agricultural pest of wheat, barley and oats, and one of the principal vectors of barley yellow dwarf virus leading to significant reductions in grain yield, annually. Emerging resistance to and increasing regulation of insecticides has resulted in limited options for their control. Using PacBio HiFi data, we have produced a high-quality draft assembly of the S. avenae genome; generating a primary assembly with a total assembly size of 475.7 Mb, and an alternate assembly with a total assembly size of 430.8 Mb. Our primary assembly was highly contiguous with only 326 contigs and a contig N50 of 15.95 Mb. Assembly completeness was estimated at 97.7% using BUSCO analysis and 31,007 and 29,037 protein-coding genes were predicted from the primary and alternate assemblies, respectively. This assembly, which is to our knowledge the first for an insecticide resistant clonal lineage of English grain aphid, will provide novel insight into the molecular and mechanistic determinants of resistance and will facilitate future research into mechanisms of viral transmission and aphid behavior.
Both Binding Strength and Evolutionary Accessibility Affect the Population Frequency of Transcription Factor Binding Sequences in Arabidopsis thaliana
Authors: Schweizer Gabriel , Wagner Andreas
Published: December 2021

Mutations in DNA sequences that bind transcription factors and thus modulate gene expression are a source of adaptive variation in gene expression. To understand how transcription factor binding sequences evolve in natural populations of the thale cress Arabidopsis thaliana, we integrated genomic polymorphism data for loci bound by transcription factors with in vitro data on binding affinity for these transcription factors. Specifically, we studied 19 different transcription factors, and the allele frequencies of 8,333 genomic loci bound in vivo by these transcription factors in 1,135 A. thaliana accessions. We find that transcription factor binding sequences show very low genetic diversity, suggesting that they are subject to purifying selection. High frequency alleles of such binding sequences tend to bind transcription factors strongly. Conversely, alleles that are absent from the population tend to bind them weakly. In addition, alleles with high frequencies also tend to be the endpoints of many accessible evolutionary paths leading to these alleles. We show that both high affinity and high evolutionary accessibility contribute to high allele frequency for at least some transcription factors. Although binding sequences with stronger affinity are more frequent, we did not find them to be associated with higher gene expression levels. Epistatic interactions among individual mutations that alter binding affinity are pervasive and can help explain variation in accessibility among binding sequences. In summary, combining in vitro binding affinity data with in vivo binding sequence data can help understand the forces that affect the evolution of transcription factor binding sequences in natural populations.
Tumors Are Evolutionary Island-Like Ecosystems
Authors: Chroni Antonia , Kumar Sudhir
Published: December 2021

Integration of ecological and evolutionary features has begun to understand the interplay of tumor heterogeneity, microenvironment, and metastatic potential. Developing a theoretical framework is intrinsic to deciphering tumors’ tremendous spatial and longitudinal genetic variation patterns in patients. Here, we propose that tumors can be considered evolutionary island-like ecosystems, that is, isolated systems that undergo evolutionary and spatiotemporal dynamic processes that shape tumor microenvironments and drive the migration of cancer cells. We examine attributes of insular systems and causes of insularity, such as physical distance and connectivity. These properties modulate migration rates of cancer cells through processes causing spatial and temporal isolation of the organs and tissues functioning as a supply of cancer cells for new colonizations. We discuss hypotheses, predictions, and limitations of tumors as islands analogy. We present emerging evidence of tumor insularity in different cancer types and discuss their relevance to the islands model. We suggest that the engagement of tumor insularity into conceptual and mathematical models holds promise to illuminate cancer evolution, tumor heterogeneity, and metastatic potential of cells.
Spatial variations of the effective elastic thickness and internal load fraction in the Cascadia subduction zone
Authors: Yu Chuanhai , Xu Min , Kirby Jon F , Shi Xiaobin , Jiménez-Díaz Alberto
Published: December 2021

The effective elastic thickness (Te) can reflect lateral change of rheological properties from subducting plate to overlying plate, and aid in understanding the relationship between geodynamic evolution and regional tectonic response to accumulated forces by plate convergence. The internal load fraction (F), calculated simultaneously with Te, is an index for subsurface mass distribution. Here we introduce high-resolution maps of Te and F in the Cascadia subduction zone by analysing the coherence between gravity anomaly and topography using a fan wavelet method. The general Te pattern correlates well with the overall tectonic characteristics. The diverse Te pattern along the forearc zone offshore North America indicates different mechanical coupling states of the slabs between the northern and southern parts. The central subducting plate is locally decoupled from the overlying plate due to a group of subducted seamounts. The F pattern shows intriguing correlations with the full locked zone (high F) and the location of episodic tremor and slip (low F) along the forearc area. F may also be a good indicator for the location of a fluid/melt upwelling in the volcanic arc area. Seismicity is more likely to occur in areas of low Te or steep Te gradient. The long-term mechanical state of lithosphere will affect or even control the temporal variations of plates during multiple seismic cycles.
Interrogating probabilistic inversion results for subsurface structural information
Authors: Zhang Xin , Curtis Andrew
Published: December 2021

The goal of a scientific investigation is to find answers to specific questions. In geosciences, this is typically achieved by solving an inference or inverse problem and interpreting the solution. However, the answer obtained is often biased because the solution to an inverse problem is non-unique and human interpretation is a biased process. Interrogation theory provides a systematic way to find optimal answers by considering their full uncertainty estimates and by designing an objective function that defines desirable qualities in the answer. In this study, we demonstrate interrogation theory by quantifying the size of a particular subsurface structure. The results show that interrogation theory provides an accurate estimate of the true answer, which cannot be obtained by direct, subjective interpretation of the solution mean and standard deviation. This demonstrates the value of interrogation theory. It also shows that fully nonlinear uncertainty assessments may be critical in order to address real-world scientific problems; this goes some way towards justifying their computational expense.
Investigation of energy and economic parameters of photovoltaic cells in terms of different tracking technologies
Authors: Alayi Reza , Sevbitov Andrey , Assad Mamdouh El Haj , Akhmadeev Ravil , Kosov Mikhail
Published: December 2021

The utilization of photovoltaic (PV) cells has greatly expanded due to the simplicity of technology and cheapness compared to other solar technologies. However, due to the change in the position of the sun, it has reduced the production capacity and electrical efficiency of this technology as the reduction of production capacity to supply electricity has increased investment costs. In this research, modeling of silicon crystal PV cell with the aim of influencing the types of solar trackers on the amount of power produced by PV cell and economic parameters has been done, which is intended for the following four modes: without solar tracker, horizontal tracker, vertical tracker and two-axes tracker. The highest output power is related to the two-axes tracker with a value of 9586 kWh/yr, which for this technology has a maximum output power of 4.35 kW. Also, the cost of energy produced by this technology is $ 0.875/kWh.
Measuring hidden phenotype: quantifying the shape of barley seeds using the Euler characteristic transform
Authors: Amézquita Erik J , Quigley Michelle Y , Ophelders Tim , Landis Jacob B , Koenig Daniel , Munch Elizabeth , Chitwood Daniel H
Published: December 2021

Shape plays a fundamental role in biology. Traditional phenotypic analysis methods measure some features but fail to measure the information embedded in shape comprehensively. To extract, compare and analyse this information embedded in a robust and concise way, we turn to topological data analysis (TDA), specifically the Euler characteristic transform. TDA measures shape comprehensively using mathematical representations based on algebraic topology features. To study its use, we compute both traditional and topological shape descriptors to quantify the morphology of 3121 barley seeds scanned with X-ray computed tomography (CT) technology at 127 μm resolution. The Euler characteristic transform measures shape by analysing topological features of an object at thresholds across a number of directional axes. A Kruskal–Wallis analysis of the information encoded by the topological signature reveals that the Euler characteristic transform picks up successfully the shape of the crease and bottom of the seeds. Moreover, while traditional shape descriptors can cluster the seeds based on their accession, topological shape descriptors can cluster them further based on their panicle. We then successfully train a support vector machine to classify 28 different accessions of barley based exclusively on the shape of their grains. We observe that combining both traditional and topological descriptors classifies barley seeds better than using just traditional descriptors alone. This improvement suggests that TDA is thus a powerful complement to traditional morphometrics to comprehensively describe a multitude of ‘hidden’ shape nuances which are otherwise not detected.
QbD-Based Development and Validation of Novel Stability-Indicating Method for the Assay and Dissolution of Garenoxacin in Garenoxacin Tablets
Authors: Azhakesan Ajitha , Kuppusamy Sujatha
Published: December 2021

Background

Garenoxacin mesylate is a novel des-fluoro(6) quinolone, approved and marketed for human use in Japan under the name Geninax.

Objective

In this current work, a simple and stability-indicating method for the assay and dissolution of garenoxacin in garenoxacin tablets 200 mg was performed. New method developed for the particle size measurement of Garenoxacin mesylate Active Pharmaceutical Ingredient using Malvern 2000.

Methods

A quality by design (QbD)-based stability-indicating assay method was developed using 0.1% (v/v) formic acid in water and methanol (70:30). Using a photodiode array detector the peak purity of the garenoxacin peak for all degradation samples was studied. The biopharmaceutical classification system (BCS) solubility of garenoxacin mesylate active pharmaceutical ingredient (API) was studied by a modified shake flask method. A dissolution test method was developed using 0.1 N hydrochloric acid as the medium, United State Pharmacopoeia apparatus-II (paddle), revolution per minute (rpm) 50, temperature 37 ± 0.5°C and time 30 min. Liquid paraffin was used as the dispersant in the particle size measurement of garenoxacin mesylate API using the Malvern Mastersizer—wet method.

Results

The QbD-based RP-HPLC method was stability-indicating, simple, precise, and accurate. The assay method was linear over 12.5 to 75 µg/mL at the detection wavelength of 280 nm. A UV-based method was developed and validated for the dissolution of garenoxacin 200 mg tablets and the method was found to be linear over 2.9 to 34.2 µg/mL at 280 nm. Based on data, the dissolution tolerance for garenoxacin 200 mg tablets was proposed as Q not less than 80% at time 30 min (% drug released with respect to label claim (Q). The effect of garenoxacin mesylate API particle size in the tablet dosage form was studied using particles of 92 µm and 220 µm [90% of the total particles are smaller than this size (D90)] and it was found that there was no impact on the in vitro dissolution profile.

Conclusion

The reported stability-indicating assay and dissolution test methods can be used in regular QC testing of garenoxacin 200 mg tablets. The Malvern particle size wet dispersion measurement method developed and validated for garenoxacin mesylate API is simple and robust.

Highlights

A QbD based RP-HPLC method (using Design Expert Software version 11) was developed and studied peak purity of Garenoxacin peak using Photo Diode Array detector (for all degradation samples, control sample and standard solution) and the same method is validated following USP and ICH guidelines. LC–MS compatible volatile buffer solution is used in the preparation of the mobile phase for the novel stability-indicating RP-HPLC assay method.
Efficient approximation of reliabilities for single-step genomic best linear unbiased predictor models with the Algorithm for Proven and Young
Authors: Bermann Matias , Lourenco Daniela , Misztal Ignacy
Published: December 2021

The objectives of this study were to develop an efficient algorithm for calculating prediction error variances (PEVs) for genomic best linear unbiased prediction (GBLUP) models using the Algorithm for Proven and Young (APY), extend it to single-step GBLUP (ssGBLUP), and apply this algorithm for approximating the theoretical reliabilities for single- and multiple-trait models in ssGBLUP. The PEV with APY was calculated by block sparse inversion, efficiently exploiting the sparse structure of the inverse of the genomic relationship matrix with APY. Single-step GBLUP reliabilities were approximated by combining reliabilities with and without genomic information in terms of effective record contributions. Multi-trait reliabilities relied on single-trait results adjusted using the genetic and residual covariance matrices among traits. Tests involved two datasets provided by the American Angus Association. A small dataset (Data1) was used for comparing the approximated reliabilities with the reliabilities obtained by the inversion of the left-hand side of the mixed model equations. A large dataset (Data2) was used for evaluating the computational performance of the algorithm. Analyses with both datasets used single-trait and three-trait models. The number of animals in the pedigree ranged from 167,951 in Data1 to 10,213,401 in Data2, with 50,000 and 20,000 genotyped animals for single-trait and multiple-trait analysis, respectively, in Data1 and 335,325 in Data2. Correlations between estimated and exact reliabilities obtained by inversion ranged from 0.97 to 0.99, whereas the intercept and slope of the regression of the exact on the approximated reliabilities ranged from 0.00 to 0.04 and from 0.93 to 1.05, respectively. For the three-trait model with the largest dataset (Data2), the elapsed time for the reliability estimation was 11 min. The computational complexity of the proposed algorithm increased linearly with the number of genotyped animals and with the number of traits in the model. This algorithm can efficiently approximate the theoretical reliability of genomic estimated breeding values in ssGBLUP with APY for large numbers of genotyped animals at a low cost.
Japanese Beetle (Coleoptera: Scarabaeidae) Invasion of North America: History, Ecology, and Management
Authors: Althoff Emily R , Rice Kevin B
Published: December 2021

The Japanese beetle, Popillia japonica Newman, was accidentally introduced to the United States from Asia in the early 1900s. First detected in a New Jersey nursery, it is currently established in 28 states in the United States and has been detected in 13 additional states, 3 Canadian provinces, and at least 3 European nations. Adult beetles feed on over 300 host plant species, including many agricultural commodities such as fruits, field crops, and ornamentals, often causing severe economic damage. We discuss invasion history, ecology, biology, and management options for this invasive pest species in North America.
Discovery of a luminous starburst galaxy with hundreds of thousands of Wolf–Rayet stars
Authors: Yuan Anqi , Yang Chenwei , Zhong Guohu , Xiao Lin , Pan Xiang , Zhou Hongyan
Published: December 2021

This paper reports the detection of a strong Wolf–Rayet (W-R) emission bump feature at 4400–4700 Å in the optical spectrum of a distant galaxy SDSS J150009.81+452844.4 at a redshift of 0.453. The estimated number of W-R stars is 1.5 × 105 without applying any internal extinction correction, and at least 4.5 × 105 after correcting for dust extinction. Such a number, though with uncertainties inherent from the extinction correction and others, appears to outnumber those in previous W-R galaxies after correcting for intrinsic dust extinction with the numbers available in the literature. These massive stars must have formed in an instantaneous star-forming episode lasting less than about 5 Myr. We estimate a star formation rate of at least ∼80 $\mathrm{M}_{\odot }\, \mathrm{yr^{-1}}$, indicative of a violent starburst. Its mid-infrared spectrum resembles closely those of typical local ultraluminous infrared galaxies (ULIRGs). From optical to ultraviolet, it possesses a luminous blue continuum, indicating that the starburst is not heavily obscured, in contrast to that found in most ULIRGs. There is evidence for strong outflows based on the detection of systematically blue-shifted broad wings in the nebular emission lines (a bulk velocity −190 km s−1), as well as in the blue-shifted Mg ii absorption lines. The emission-line gases show a wide velocity range, from −1200 to ∼−2000 km s−1 in blueshift to 570 km s−1 in redshift. We interpret this as a galactic fountain, of which part of the outflowing gas may be falling back to the galactic plane. Our method could be used to find a sample of similar objects, which would help understand the star formation history and stellar feedback in starburst galaxies.
The incidence of X-ray selected AGN in nearby galaxies
Authors: Birchall Keir L , Watson M G , Aird J , Starling R L C
Published: December 2021

We present the identification and analysis of an unbiased sample of active galactic nuclei (AGN) that lie within the local galaxy population. Using the MPA-JHU catalogue (based on SDSS DR8) and 3XMM DR7 we define a parent sample of 25 949 local galaxies (z ≤ 0.33). After confirming that there was strictly no AGN light contaminating stellar mass and star-formation rate calculations, we identified 917 galaxies with central, excess X-ray emission likely originating from an AGN. We analysed their optical emission lines using the BPT diagnostic and confirmed that such techniques are more effective at reliably identifying sources as AGN in higher mass galaxies: rising from 30 per cent agreement in the lowest mass bin to 93 per cent in the highest. We then calculated the growth rates of the black holes powering these AGN in terms of their specific accretion rates (∝LX/M*). Our sample exhibits a wide range of accretion rates, with the majority accreting at rates $\le 0.5\ \mathrm{ per \, cent}$ of their Eddington luminosity. Finally, we used our sample to calculate the incidence of AGN as a function of stellar mass and redshift. After correcting for the varying sensitivity of 3XMM, we split the galaxy sample by stellar mass and redshift and investigated the AGN fraction as a function of X-ray luminosity and specific black hole accretion rate. From this we found the fraction of galaxies hosting AGN above a fixed specific accretion rate limit of 10−3.5 is constant (at $\approx 1\ \mathrm{ per \, cent}$) over stellar masses of 8 < log M*/M⊙ < 12 and increases (from $\approx 1\ \mathrm{ per \, cent}$ to 10 per cent) with redshift.
Risk factors for low back pain increase in rheumatoid arthritis: Analysis of a 7-year follow-up study
Authors: Yamada Kentaro , Suzuki Akinobu , Takahashi Shinji , Inui Kentaro , Koike Tatsuya , Okano Tadashi , Yabu Akito , Hori Yusuke , Toyoda Hiromitsu , Nakamura Hiroaki
Published: December 2021

Objective

Several studies have demonstrated that low back pain (LBP) is related to disease activity in patients with rheumatoid arthritis (RA). However, there is no longitudinal research. This study aimed to determine the impacts and risk factors for LBP increase in RA in a longitudinal cohort study.

Methods

The study evaluated 113 patients with RA who completed the secondary survey. LBP increase was defined as ≥1 standard deviation of mean change in visual analogue scale (VAS) between the baseline and secondary surveys. The impacts of LBP increase on quality of life (QOL) and psychological status were evaluated. Risk factors were assessed among patient demographic characteristics and radiological changes.

Results

Mean change in VAS for LBP was −0.8 ± 30.4 mm during a mean 7-year follow-up. LBP increase was defined as ≥30-mm increase in VAS for LBP. Patients with LBP increase had significantly lower QOL and worse mental status than patients without it. Poor control of RA was identified as an independent risk factor for LBP increase (odds ratio, 9.82, p = .001).

Conclusion

Patients with poor control of RA were likely to experience LBP increase in the long term. Control of RA disease activity is important for control of LBP, QOL, and mental status.
The management of lupus nephritis as proposed by EULAR/ERA 2019 versus KDIGO 2021
Authors: Anders Hans-Joachim , Loutan Jerome , Bruchfeld Annette , Fernández-Juárez Gema M , Floege Jürgen , Goumenos Dimitrios , Turkmen Kultigin , van Kooten Cees , Frangou Eleni , Stevens Kate I , Kronbichler Andreas , Segelmark Mårten , Tesar Vladimir
Published: December 2021

In 2019 and 2021, the European League for Rheumatism (EULAR) jointly with the European Renal Association (ERA) and the Kidney Disease: Improving Global Outcomes (KDIGO), respectively, released updated guidelines on the management of lupus nephritis (LN). The Immunology Working Group of the ERA reviewed and compared both updates. Recommendations were either consistent or differences were of negligible clinical relevance for: indication for kidney biopsy, kidney biopsy interpretation, treatment targets, hydroxychloroquine dosing, first-line initial immunosuppressive therapy for active class III, IV (±V) LN, pregnancy in LN, LN in paediatric patients and LN patients with kidney failure. Relevant differences in the recommended management relate to the recognition of lupus podocytopathies, uncertainties in steroid dosing, drug preferences in specific populations and maintenance therapy, treatment of pure class V LN, therapy of recurrent LN, evolving alternative drug options and diagnostic work-up of thrombotic microangiopathy. Altogether, both documents provide an excellent guidance to the growing complexity of LN management. This article endeavours to prevent confusion by identifying differences and clarifying discrepancies.
Evaporation of black holes in flat space entangled with an auxiliary universe
Authors: Miyata Akihiro , Ugajin Tomonori
Published: December 2021

We study a thermofield double type entangled state on two disjoint universes A and B, where one of the universes is asymptotically flat containing a black hole. As we increase the entanglement temperature, this black hole receives back-reaction from the stress–energy tensor of the state. This results in lengthening of the wormhole region in the black hole interior, and decreasing of its horizon area, both of which are key features of an evaporating black hole. We then compute the entanglement entropy in universe A through the island formula, and argue that it naturally follows the Page curve of an evaporating black hole in flat space. We also study the effects of local operations in the gravitating universe with the black hole. We find that they accelerate the evaporation of the black hole, thereby disrupting the entanglement between the two universes. Furthermore, we observe that, depending on whether the operation can be regarded as a local operation and classical communication or not, the behavior of the entanglement entropy changes. In particular, when the operation is made neither in the entanglement wedge of the radiation system nor that of the black hole, the transition between the island phase and the no-island phase can happen multiple times.
Fluoroquinolones
Authors: Kidd Tara , Mitchell Stephanie , Dehays Julie , Wibberley Erica
Published: December 2021

Fluoroquinolones (FQs) are highly effective, well-tolerated, broad-spectrum antibiotics, making them desirable treatment options for infections. However, their adverse reactions as well as recent trends in antibiotic susceptibility must be considered. This article discusses the spectrum of activity and adverse reactions of FQs to guide nurses in caring for patients receiving this class of antibiotics.
The Potential of Merging Intersectionality and Critical Ethnography for Advancing Refugee Women's Health Research
Authors: Al-Hamad Areej , Forchuk Cheryl , Oudshoorn Abe , McKinley Gerald Patrick
Published: December 2021

Critical ethnography and intersectionality are increasingly engaged in nursing and refugee research. Both approaches study marginalized populations and explore how their daily experiences of inequality and marginalization are influenced by various forms of oppression, power structures, and cultural context. A blended approach of critical ethnography with intersectionality can inform research with marginalized groups as both have much in common, including the call for social justice and change. This article outlines the potential of using the blended theoretical approach in advancing refugee women's health research and to inform a particular methodological approach for nursing research and health care practice.
Revisioning Obesity in Health Care Practice and Research
Authors: Rogge Mary Madeline , Gautam Bibha
Published: December 2021

Obesity is a leading health problem in the United States and globally. Relatively few people with obesity achieve long-term weight control, suggesting that obesity and resistance to weight change represent functional adaption of energy homeostasis to the environment. The purpose of this article is to synthesize the literature regarding the relationship between environmental temperature and body weight and fat mass to provide a new explanation of obesity as a problem of maintaining core body temperature. Chronic exposure to cool environmental temperatures likely contributed to the obesity epidemic, and passive whole-body warming may be a promising intervention for weight control.
Proton Beam Therapy for Locally Advanced Head and Neck Tumors
Authors: Sheikh Saad , Kharouta Michael Z. , Pidikiti Rajesh , Damico Nicholas J. , Choi Serah , Dorth Jennifer A. , Mansur David B. , Machtay Mitchell X. , Yao Min , Bhatt Aashish D.
Published: December 2021

Objective:

Locally advanced tumors of the head and neck region often lie in close proximity to critical organs at risk (OARs). Providing effective treatment coverage to these malignancies while minimizing radiation dose to surrounding OARs is advantageous. Our aim is to compare dosimetric data of OARs from proton beam therapy (PBT) plans to volumetric modulated arc therapy (VMAT) treatment plans, and to evaluate clinical outcomes in patients treated with PBT.

Methods:

We identified patients with locally advanced head and neck tumors treated with PBT at our institution from 2016 to 2019. Study endpoints included mean and maximum doses for the OAR structures for each treatment plan, overall survival, time to local-regional or distant progression, and presence of acute and late toxicities. Mean and maximum doses to OAR structures were compared between treatment modalities using a paired Wilcoxon signed-rank test. P-values <0.05 were considered significant.

Results:

A total of 42 patients were identified. Clinical target volume coverage was >95% for both PBT and VMAT plans. PBT plans showed a significant reduction to the mean doses to all OARs, and max doses to most OARs (P<0.05). The largest reduction mean dose was seen in the contralateral cochlea and parotid glands at 71% and 75%, respectively. Median follow-up was 27 months. Overall survival at 4 years was 44.75%. Freedom from local-regional progression was 73.28% at 2 years. The majority of patients developed Common Terminology Criteria for Adverse Events (CTCAE) grade I dermatitis, mucositis, or both.

Conclusions:

PBT resulted in meaningful dose reductions to OARs while maintaining comparable target coverage when compared with VMAT plans. Further refinements to proton therapy may have the potential to further minimize dose to critical structures
COVID-19 induced renal injury differs from that in other viral-infections
Authors: Parise Rachel S. , Govindarajulu Manoj , Ramesh Sindhu , Thomas Tony , Moore Timothy , Dhanasekaran Muralikrishnan
Published: December 2021

Background:

Kidney injuries caused by several viral diseases have been reported worldwide among all age groups, races, and genders. Of particular importance is coronavirus disease 2019 (COVID-19), and its prevalence in communities infecting all patient populations with symptoms ranging from asymptomatic to severe, including complications and mortality.

Methods:

Data were acquired from PubMed, Scopus, Google Scholar, Centers for Disease Prevention and Control (CDC), and Lexi-Comp using the following search terms: “COVID-19 and renal pathology,” “COVID-19 induced kidney disease,” “Viral infection induced kidney disease,” and “Viral infection induced renal damage.” Titles and abstracts were manually analyzed as per the exclusion and inclusion criteria of relevant articles; relevance of articles included studies on the pathology of a specific viral infection and the impact of the virus on the adult renal system.

Results:

The mechanisms for renal disease due to COVID-19 include direct renal tubular injury, cytokine storm, inflammation, thrombosis vs. acute tubular necrosis, thrombotic events, and direct renal injury. Although some mechanisms behind renal dysfunction among the studied viral infections are similar, the prevalence rates of kidney injury or damage differ. This might be described by recommended prophylactic and therapeutic approaches that can alter the viral infection characteristics and possibly the impact a particular organ system.

Conclusion:

The patient population at risk was old in age and had a high body mass index. The mechanisms associated with renal dysfunction are similar, including direct renal injury through angiotensin converting enzyme 2 (ACE2) entry, inflammation, and thrombosis. The renal pathology of coronaviruses that differs from that of other prevalent viral infections is the activation of cytokine storm, which causes elevations of a greater number and different kinds of cytokines than other viral infections.
Single-injection regional analgesia techniques for mastectomy surgery
Authors: De Cassai Alessandro , Zarantonello Francesco , Geraldini Federico , Boscolo Annalisa , Pasin Laura , De Pinto Silvia , Leardini Giovanni , Basile Francesca , Disarò Laura , Sella Nicolò , Mariano Edward R. , Pettenuzzo Tommaso , Navalesi Paolo
Published: December 2021

BACKGROUND

Patients undergoing mastectomy surgery experience severe postoperative pain. Several regional techniques have been developed to reduce pain intensity but it is unclear, which of these techniques is most effective.

OBJECTIVES

To synthesise direct and indirect comparisons for the relative efficacy of different regional and local analgesia techniques in the setting of unilateral mastectomy. Postoperative opioid consumption at 24 h, postoperative pain at extubation, 1, 12 and 24 h, postoperative nausea and vomiting were collected.

DESIGN

Systematic review with network meta-analysis (PROSPERO:CRD42021250651).

DATA SOURCE

PubMed, Scopus, the Cochrane Central Register of Controlled Trials (from inception until 7 July 2021).

ELIGIBILITY CRITERIA

All randomised controlled trials investigating single-injection regional and local analgesia techniques in adult patients undergoing unilateral mastectomy were included in our study without any language or publication date restriction.

RESULTS

Sixty-two included studies randomising 4074 patients and investigating nine techniques entered the analysis. All techniques were associated with less opioid consumption compared with controls The greatest mean difference [95% confidence interval (CI)] was associated with deep serratus anterior plane block: mean difference –16.1 mg (95% CI, –20.7 to –11.6). The greatest reduction in pain score was associated with the interpectoral-pecto-serratus plane block (mean difference —1.3, 95% CI, —1.6 to — 1) at 12 h postoperatively, and with superficial serratus anterior plane block (mean difference —1.4, 95% CI, —2.4 to —0.5) at 24 h. Interpectoral-pectoserratus plane block resulted in the greatest statistically significant reduction in postoperative nausea/vomiting when compared with placebo/no intervention with an OR of 0.23 (95% CI, 0.13 to 0.40).

CONCLUSION

All techniques were associated with superior analgesia and less opioid consumption compared with controls. No single technique was identified as superior to others. In comparison, local anaesthetic infiltration does not offer advantages over multimodal analgesia alone.

TRIAL REGISTRATION

PROSPERO (CRD4202125065).
Uterine Transplantation: Recipient Patient Populations
Authors: Chung Rebecca K. , Salari Salomeh , Findley Joseph , Richards Elliott G. , Flyckt Rebecca L.R.
Published: December 2021

Uterine transplantation is an emerging treatment for patients with uterine factor infertility (UFI). In order to determine patient candidacy for transplant, it is imperative to understand how to identify, counsel and treat uterine transplant recipients. In this article, we focus on patient populations with UFI, whether congenital or acquired, including Mayer-Rokitansky-Kuster-Hauser, complete androgen insensitivity syndrome, hysterectomy, and other causes of nonabsolute UFI. Complete preoperative screening of recipients should be required to assess the candidacy of each individual prior to undergoing this extensive treatment option.
Influencing factors of supernormal vascular aging in Chinese population
Authors: Tao Boni , Li Yun , Wang Cun , Luo Xiaoyan , Chen Shuohua , Wang Guodong , Yang Peng , Hou Liying , Cui Liufu , Wu Shouling
Published: December 2021

Objectives:

Previous studies have analysed the epidemic characteristics of supernormal vascular aging (SUPERNOVA), and found that SUPERNOVA were significantly associated with lower risk of cardiovascular disease. However, the influencing factors of SUPERNOVA are still unclear. The aim of this study was to investigate the characteristics and influencing factors of SUPERNOVA.

Methods:

A total of 42 196 participants of the Kailuan Study were enrolled in the study. SUPERNOVA was defined as the lowest 2.5% of the age-quintile brachial–ankle pulse wave velocity (baPWV), early vascular aging was defined as the highest 2.5% of the age-quintile baPWV. Multivariable logistic regression analysis was applied to investigate the influencing factors of SUPERNOVA.

Results:

The population with SUPERNOVA was mostly women, nonsmokers, nondrinkers, and those with higher education. They had lower levels of cardiovascular disease risk factors and healthier lifestyles. The results of logistics regression showed that the influencing factors of SUPERNOVA include age, sex, hypertension, diabetes, resting heart rate, hypersensitive C-reactive protein, and uric acid. However, the effects of these factors were different across age groups. We also observed that in addition to the unalterable factors (age and sex), only resting heart rate above 80 bpm (OR = 0.396, 95% CI: 0.231–0.681) and SBP (OR = 0.945, 95% CI: 0.932–0.958) were significantly associated with odds of SUPERNOVA in participants without cardiovascular risk factors.

Conclusion:

This study investigated the characteristics of the population with SUPERNOVA and the factors influencing it, which provided a basis for different populations to take preventive measures to slow down the process of vascular aging.
Carotid–femoral pulse wave velocity acquisition methods and their associations with cardiovascular risk factors and subclinical biomarkers of vascular health
Authors: Aizawa Kunihiko , Gates Phillip E. , Mawson David M. , Elyas Salim , Casanova Francesco , Gooding Kim M. , Adingupu Damilola D. , Strain W David , Shore Angela C.
Published: December 2021

Background:

Different methods to measure carotid–femoral pulse wave velocity (CFPWV) may affect the measurements obtained and influence the association between CFPWV, cardiovascular risk factors and biomarkers of subclinical vascular health. The estimation of distance between the carotid and femoral artery measurement sites (the arterial path length) is particularly problematic.

Method:

We determined if CFPWV and equation-based estimates of CFPWV were influenced by arterial path length and if this affected the association of CFPWV with cardiovascular risk factors and subclinical vascular biomarkers. The CFPWV derived from the measurement of surface distance (CFPWV-D), arterial path length formula (CFPWV-F), and estimated CFPWV (ePWV) were obtained from 489 older adults (67.2 ± 8.8 years). Macrovascular [carotid artery: lumen diameter (LD), inter-adventitial diameter (IAD), intima–media thickness (IMT) and total plaque area (TPA)] and microvascular [reactive hyperaemia index and urinary albumin-creatinine ratio (UACR)] biomarkers were also measured.

Results:

CFPWV-D was significantly greater than CFPWV-F [9.6 (8.0–11.2) vs. 8.9 (7.6–10.5) m/s, P < 0.001], because of estimated path length being longer in CFPWV-D than CFPWV-F (495.4 ± 44.8 vs. 465.3 ± 20.6 mm, P < 0.001). ePWV was significantly greater than both CFPWV-F and CFPWV-D [11.0 (10.0–12.2) m/s, P < 0.001]. The three CFPWV methods were similarly associated with LD, IAD, IMT, TPA and UACR but not with cardiovascular risk factors.

Conclusion:

Different methods to measure CFPWV affect the derived measurement values and the association with cardiovascular risk factors but not the association with subclinical biomarkers of vascular health. These hitherto unreported observations are important considerations in experimental design, data interpretation and of particular importance, comparison between studies where CFPWV is measured.
Clozapine Once-Daily Versus Divided Dosing Regimen
Authors: Kitagawa Kohei , So Ryuhei , Nomura Nobuyuki , Tsukahara Masaru , Misawa Fuminari , Kodama Masafumi , Uchida Hiroyuki , Bies Robert , Straubinger Thomas , Banker Christopher , Mizuno Yuya , Mimura Masaru , Takeuchi Hiroyoshi
Published: December 2021

Objective

Clozapine is generally recommended to be prescribed in a divided dosing regimen based on its relatively short plasma half-life. However, there has been little evidence to support the superiority of divided dosing of clozapine over once-daily dosing. To our knowledge, there have been no studies examining differences in actual plasma concentrations or adverse effects between the 2 dosing strategies of clozapine. We aimed to compare actual plasma concentrations of clozapine between once-daily and divided dosing regimens, and to examine the relationships of these regimens with psychiatric symptoms and adverse effects of clozapine.

Methods

We analyzed data from 108 participants of a previous study conducted in 2 hospitals in Japan. A population pharmacokinetic model was used to estimate the peak and trough plasma concentrations of clozapine based on actual plasma concentrations. We evaluated psychiatric symptoms with the Brief Evaluation of Psychosis Symptom Domains and adverse effects of clozapine with the Glasgow Antipsychotic Side-effects Scale for Clozapine.

Results

The estimated peak and trough plasma concentrations of clozapine did not differ significantly between once-daily and divided dosing regimens. There were no significant differences in psychiatric symptoms except for depression/anxiety or subjective adverse effects of clozapine between the 2 dosing strategies.

Conclusions

Our findings tentatively support the feasibility and clinical utility of once-daily dosing of clozapine in clinical practice. Further studies are needed to replicate these findings and determine causality between dosing strategies and clinical outcomes.
Benefits and risks of apps for patients
Authors: Ahn David T.
Published: December 2021

Purpose of review

As smartphones have become deeply integrated into our daily lives, diabetes apps have emerged as valuable tools for people living with diabetes (PWD's). Whether as standalone apps or companion apps to diabetes devices such as glucose meters or insulin pumps, they aim to help patients better manage their diabetes. However, with almost a half million health apps available, it is important to have a framework for understanding their benefits and disadvantages.

Recent findings

2020 was the first year that every insulin pump and continuous glucose monitor manufacturer in the United States offered a smartphone companion app for their flagship products. These companion apps enabled cloud-based data synchronization, which in turn proved to be extremely timely as the COVID-19 pandemic shifted many diabetes clinic appointments to the telemedicine format. The American Diabetes Association and European Association for the Study of Diabetes Diabetes Technology Working Group recently published a consensus report highlighting the current state of diabetes digital app technology.

While diabetes apps offer unique conveniences and advantages for PWD's, it is equally important to fully understand their potential pitfalls to better inform all diabetes stakeholders: patients, healthcare professionals, regulatory agencies, researchers, and policy makers.
Updates in childhood Sjogren's syndrome
Authors: Wright Tracey B.
Published: December 2021

Purpose of review

Childhood Sjogren's syndrome (cSS) is a rare, chronic autoimmune disease characterized by inflammation of the exocrine glands. cSS is underrecognized because of differences in clinical presentation compared with adults. Until recently, publications describing clinical manifestations in cSS were limited to case reports and case series with small numbers of patients. Diagnostic studies to assess glandular symptoms in adults, are less commonly obtained in children.

Recent findings

Recent cohort studies describe presenting diagnostic clinical features in large populations of cSS and demonstrate how current classification criteria, used in adults, are not applicable to children. Recurrent parotitis is the consistent predominant manifestation that is inversely correlated with age. Novel salivary biomarkers and salivary gland ultrasonography are important objective measure, which may improve diagnosis and disease monitoring. Standardized treatment recommendations are needed.

Findings from large cohort studies provide a framework for the future development of diagnostic criteria for cSS. Such criteria should incorporate objective measures that are easily obtained in children. Future research to improve understanding of the application of novel biomarkers and imaging and developing consensus on treatment recommendations is needed.