bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of loss functions on semantic segmentation in far‐field monitoring
Authors: Chern Wei‐Chih , Nguyen Tam V. , Asari Vijayan K. , Kim Hongjo
Published: March 2022

Although previous research laid the foundation for vision‐based monitoring systems using convolutional neural networks (CNNs), too little attention has been paid to the challenges associated with data imbalance and varying object sizes in far‐field monitoring. To fill the knowledge gap, this paper investigates various loss functions to design a customized loss function to address the challenges. Scaffold installation operations recorded by camcorders were selected as the subject of analysis in a far‐field surveillance setting. It was confirmed that the data imbalance between the workers, hardhats, harnesses, straps, and hooks caused poor performances especially for small size objects. This problem was mitigated by employing a region‐based loss and Focal loss terms in the loss function of segmentation models. The findings illustrate the importance of the loss function design in improving performance of CNN models for far‐field construction site monitoring.
Paradoxes of the Always Already
Authors: Peterson Victor
Published: March 2022

This paper shows the relevance of findings from studying the logic of self‐referential statements to Cultural studies, Black Cultural Studies in particular. Results following from the incompleteness of the systems in which these statements are quantified help to clear up a paradox stemming from current Afropessimist discourse.
Picturing the Pox in Italian Popular Prints, 1550–1650☆
Authors: Strocchia Sharon , Kelly Ryan
Published: March 2022

The disease commonly known as the ‘pox’ or the ‘French Disease’ ravaged the European continent following its initial appearance circa 1495. Its devastating physical effects and sensory assaults, ranging from stinking sores to baldness and collapsed noses, invited both a social and medical evaluation of what was quickly recognized to be a sexually transmitted disease. Despite the prevalence and visibility of the pox in sixteenth‐century Europe, its visual language has not been studied in much depth. This essay examines how cheap narrative prints issued between 1550 and 1650 helped construct the iconography of pox and disseminate medical information about it in late Renaissance Italy. Focusing on a group of best‐selling Venetian and Roman prints, the essay argues that multimedial picture stories combining text and image provided one of the many sources of vernacular information by which Italians learned to read the body. In recounting stories of diseased prostitutes and their clients in vivid detail, these prints expanded vernacular health literacy and provided a ready‐made language of disease. The prints analysed here enjoyed enormous social reach as components of a new health‐promoting, communicative object – the hand‐held paper fan – whose popularity cemented visual and epistemic connections between pox and prostitution.
Financial foreign direct investment and the economic performance of developing countries
Authors: Desbordes Rodolphe
Published: March 2022

I investigate whether developed countries' financial foreign direct investment (FDI) has an indirect impact on the economic performance of developing countries' manufacturing sectors by influencing local financial financing conditions. I combine an interaction approach exploiting sector‐specific financial dependence with a “gravity‐based” instrumental variable strategy to detect a potential “access to external finance” effect. I find that higher greenfield FDI in local retail banking, but not in other financial functions, leads to better economic performance of the manufacturing sectors typically dependent on external finance during the period 2002–2014.
Waterscapes of power in Bangladesh: The politics and anthropology of contested access in large‐scale irrigation modernisation
Authors: Taylor Jim
Published: March 2022

This paper is drawn from ethnographically informed research undertaken in 2016‒2017 pertaining to the planned modernisation of two large‐scale irrigation schemes in Bangladesh, funded by the Asian Development Bank. The research confirms existing critical irrigation anthropology on the politics and power of large‐scale irrigation modernisation and related drive to privatisation. The modernisation of the scheme aimed to increase water, energy and agricultural productivity and to include a new higher‐level irrigation management service. Irrigation, it is argued, also has considerable social consequences because it defines specific patterns of cooperation and conflict in serviced agricultural areas. The modernisation of the scheme overlooked socio‐cultural, political and ethnoecological considerations largely due to complex institutional constraints and the existing social modalities of power. In the field, using the anthropological method, information was generated in order to better understand the various stakeholder perceptions of the modernisation program and advise on practical implementations. In particular, the research noted how and in what manner dominant and influential social and political alliances control these complex waterscapes.
Overcoming barriers to widespread use of CAR‐Treg therapy in organ transplant recipients
Authors: Cremoni Marion , Massa Filippo , Sicard Antoine
Published: March 2022

Preventing allograft rejection has been the main challenge of transplantation medicine since the discovery of immune responses against foreign HLA molecules in the mid‐20th century. Prevention of rejection currently relies on immunosuppressive drugs, which lack antigen specificity and therefore increase the risk for infections and cancers. Adoptive cell therapy with donor‐reactive regulatory T cells (Tregs) has progressively emerged as a promising approach to reduce the need for pan‐immunosuppressive drugs and minimize morbidity and mortality in solid‐organ transplant recipients. Chimeric antigen receptor (CAR) technology has recently been used successfully to generate Tregs specific for donor HLA molecules and overcome the limitations of Tregs enrichment protocols based on repetitive stimulations with alloantigens. While this novel approach opens new possibilities to make Tregs therapy more feasible, it also creates additional challenges. It is essential to determine which source of therapeutic Tregs, CAR constructs, target alloantigens, safety strategies, patients and immunosuppressive regimens are optimal for the success of CAR Treg therapy. Here, we discuss unmet needs and strategies to bring donor‐specific CAR Treg therapy to the clinic and make it as accessible as possible.
Therapeutic plasma exchange for the management of a type III hypersensitivity reaction and suspected immune‐mediated vasculitis assumed to be caused by human albumin administration in a dog
Authors: Klainbart Sigal , Segev Gilad , Kelmer Efrat , Chen Hilla
Published: March 2022

Objective

To describe the successful treatment of a life‐threatening type III hypersensitivity reaction suspected to have been related to human serum albumin (HSA) administration in a dog with therapeutic plasma exchange (TPE).

Case summary

A 3‐year‐old neutered male mixed breed dog was suspected to have developed immune‐mediated vasculitis 2 weeks after the administration of HSA (740 mg/kg) for the management of hypoalbuminemia resulting from septic peritonitis. The dog was presented with fever, edema, hypoalbuminemia (26 g/L [2.6 g/dL]; reference interval, 30–44 g/L [3.0‐4.4 g/dL]), and coagulopathy. The dog was treated with fresh frozen plasma (FFP) and glucocorticoids but remained hypoalbuminemic (18 g/L [1.8 g/dL]) and developed acute kidney injury (AKI). Over 4 days, 3 TPE treatments were performed, with a total of 2.7 plasma volumes exchanged. Replacement fluids consisted of a combination of FFP, hydroxyethyl starch 6%, and 0.9% saline solution. Following TPE treatments, serum albumin concentration increased (from 18 g/L [1.8 g/dL] to 25 g/L [2.5 g/dL]), serum creatinine concentration decreased (from 340 μmol/L [3.9 mg/dL] to 87 μmol/L [0.98 mg/dL]), and clotting times normalized (activated partial thromboplastin time decreased from 33 seconds to 14.5 seconds). There was a gradual but consistent clinical improvement of the edema and overall demeanor of the dog. No significant adverse effects were noted during the TPE treatments, and the dog was discharged after 8 days of hospitalization. Following discharge, the dog had complete clinical resolution of edema and AKI.

New/unique information

This is the first report describing successful use of TPE for the management of an immune‐mediated reaction (type III hypersensitivity) following HSA administration.
Ustedes los pobres, nosotros los ricos: industrias culturales extranjeras y gusto social en Bogotá, 1940-1970
Authors: Flórez-Malagón Alberto G.
Published: March 2022

En Colombia, se dice que “los ricos quieren ser europeos, las clases medias norteamericanas y los pobres mexicanos”. Este libro explora el origen de este estereotipo en la presencia de las industrias culturales extranjeras, especialmente el cine en la primera mitad del siglo XX en la capital bogotana. Estas se convirtieron en instrumentos de segregación en las nuevas condiciones urbanas, para profundizar la estigmatización discursiva entre las clases sociales y mantener la estructura básica de la diferenciación social. Así, a la cabeza estaban las preferencias culturales eurocéntricas de las élites capitalinas, mientras se aceptaba lentamente la influencia cultural de los Estados Unidos, en particular en las clases medias emergentes, y se consideraba que las manifestaciones de lo mexicano se alejaban de la “alta cultura”. Ustedes los pobres, nosotros los ricos propone un acercamiento a la constitución de hegemonías y resistencias, en el contexto de las relaciones entre las clases sociales, los mecanismos de construcción de sus identidades colectivas y la negociación sobre quién producía y reproducía el capital cultural como forma de control social en la cambiante Colombia de la época.
The Effect of Rugby Union Match Play on Sleep Patterns and Subsequent Impact on Postmatch Fatigue Responses
Authors: Leduc Cedric , Weaving Dan , Owen Cameron , Lacome Mathieu , Ramirez-Lopez Carlos , Skok Maj , Tee Jason C. , Jones Ben
Published: March 2022

Purpose: Sleep is recognized as an important recovery strategy, yet little is known regarding its impact on postmatch fatigue. The aims of this study were to (1) describe sleep and postmatch fatigue, (2) understand how sleep is affected by contextual and match factors, and (3) assess how changes in sleep can affect postmatch fatigue. Methods: Twenty-three male rugby union players were monitored across 1 season (N = 71 player–match observations). Actigraphy was used during preseason to establish baseline sleep quality and quantity. Sleep was then measured 1 and 2 days after each match day (MD + 1 and MD + 2). Global positioning systems, notational analysis, and rating of perceived exertion represented external and internal load from matches. Subjective wellness and a standardized run were used to characterize postmatch fatigue 2 days prior (baseline) and at MD + 1 and MD + 2. Linear mixed models established the magnitude of change (effect size [ES]) between baseline, MD + 1, and MD + 2 for sleep and postmatch fatigue. Stepwise forward selection analysis ascertained the effect of match load on sleep and the effect of sleep on postmatch fatigue. Each analysis was combined with magnitude-based decisions. Results: Sleep characteristics and neuromuscular and perceptual postmatch fatigue were negatively affected at MD + 1 and MD + 2 (ES = small to very large). Kickoff and travel time had the greatest effect on sleep (ES = small). Wellness and soreness were influenced by sleep (fall-asleep time and fragmentation index) and collisions, respectively (ES = small). Conclusion: Sleep quality and quantity were affected independently of the match load (ie, running activity) sustained, and changes in sleep marginally affected postmatch fatigue.
Adolescence is a sensitive period for prefrontal microglia to act on cognitive development
Authors: Schalbetter Sina M. , von Arx Anina S. , Cruz-Ochoa Natalia , Dawson Kara , Ivanov Andranik , Mueller Flavia S. , Lin Han-Yu , Amport René , Mildenberger Wiebke , Mattei Daniele , Beule Dieter , Földy Csaba , Greter Melanie , Notter Tina , Meyer Urs
Published: March 2022

The prefrontal cortex (PFC) is a cortical brain region that regulates various cognitive functions. One distinctive feature of the PFC is its protracted adolescent maturation, which is necessary for acquiring mature cognitive abilities in adulthood. Here, we show that microglia, the brain’s resident immune cells, contribute to this maturational process. We find that transient and cell-specific deficiency of prefrontal microglia in adolescence is sufficient to induce an adult emergence of PFC-associated impairments in cognitive functions, dendritic complexity, and synaptic structures. While prefrontal microglia deficiency in adolescence also altered the excitatory-inhibitory balance in adult prefrontal circuits, there were no cognitive sequelae when prefrontal microglia were depleted in adulthood. Thus, our findings identify adolescence as a sensitive period for prefrontal microglia to act on cognitive development.
Nonredundancy of IL-1α and IL-1β is defined by distinct regulation of tissues orchestrating resistance versus tolerance to infection
Authors: Eislmayr Kevin , Bestehorn Annika , Morelli Luisa , Borroni Martina , Walle Lieselotte Vande , Lamkanfi Mohamed , Kovarik Pavel
Published: March 2022

Interleukin-1α (IL-1α) and IL-1β are inflammatory cytokines with important roles in health and disease. They trigger the same receptor and elicit comparable cellular responses but, for poorly understood reasons, are not redundant in vivo. Here, we decoupled IL-1α and IL-1β functions that drive protective responses against invasive infection with group A
Streptococcus
. IL-1β was essential for pathogen clearance, hence resistance to infection, by inducing granulocyte colony-stimulating factor at the infection site and establishing emergency granulopoiesis. In contrast, IL-1α governed reprogramming of liver metabolic pathways associated with tolerance to infection. The IL-1α−dominated hepatic regulation corresponded to high IL-1α levels in the liver during infection. Conversely, IL-1β was critical for the regulation of the spleen transcriptome, which correlated with ample IL-1β expression in this tissue. The results identify distinct and organ-specific roles of IL-1α versus IL-1β and implicate spatial restriction of their expression and bioavailability during infection as the underlying mechanism.
Single-site Pt-doped RuO
2
hollow nanospheres with interstitial C for high-performance acidic overall water splitting
Authors: Wang Juan , Yang Hao , Li Fan , Li Leigang , Wu Jianbo , Liu Shangheng , Cheng Tao , Xu Yong , Shao Qi , Huang Xiaoqing
Published: March 2022

Realizing stable and efficient overall water splitting is highly desirable for sustainable and efficient hydrogen production yet challenging because of the rapid deactivation of electrocatalysts during the acidic oxygen evolution process. Here, we report that the single-site Pt-doped RuO
2
hollow nanospheres (SS Pt-RuO
2
HNSs) with interstitial C can serve as highly active and stable electrocatalysts for overall water splitting in 0.5 M H
2
SO
4
. The performance toward overall water splitting have surpassed most of the reported catalysts. Impressively, the SS Pt-RuO
2
HNSs exhibit promising stability in polymer electrolyte membrane electrolyzer at 100 mA cm
−2
during continuous operation for 100 hours. Detailed experiments reveal that the interstitial C can elongate Ru-O and Pt-O bonds, and the presence of SS Pt can readily vary the electronic properties of RuO
2
and improve the OER activity by reducing the energy barriers and enhancing the dissociation energy of
*
O species.
Epidemiology and Antimicrobial Resistance Profiles of the
Nocardia
Species in China, 2009 to 2021
Authors: Wang Hao , Zhu Yue , Cui Qiaozhen , Wu Wenming , Li Gang , Chen Dongke , Xiang Lili , Qu Jiuxin , Shi Dongyan , Lu Binghuai
Published: March 2022

The genus
Nocardia
has the potential to cause nocardiosis, which might be underrecognized and underdiagnosed. Herein, the demographical features of 441 nonrepetitive nocardiosis cases and species distribution of their
Nocardia
strains in China, 2009 to 2021, are summarized.
Illumina MiSeq Sequencing Reveals Correlations among Fruit Ingredients, Environmental Factors, and AMF Communities in Three
Lycium Barbarum
Producing Regions of China
Authors: Chen Kaili , Huang Gang , Li Yuekun , Zhang Xinrui , Lei Yonghui , Li Yang , Xiong Jie , Sun Yanfei
Published: March 2022

The climatic and ecological environment is a complex phenomenon, involving various environmental factors that regulate the diversity and population distribution structure of AMF communities affecting plant growth, crop composition, and yield. Current studies on the effects of environmental factors on AMF communities have mainly focused on soil conditions and host plants.
Bacterial Succession and Community Dynamics of the Emerging Leaf Phyllosphere in Spring
Authors: Smets Wenke , Spada Lucia Maria , Gandolfi Isabella , Wuyts Karen , Legein Marie , Muyshondt Babette , Samson Roeland , Franzetti Andrea , Lebeer Sarah
Published: March 2022

Improving our understanding of phyllosphere ecology is key in successfully applying bacterial biological agents or modulating the leaf microbiome in order to achieve valuable ecosystem services, such as plant protection, plant growth, air purification, and developing a healthy human immune system. Modulation of the phyllosphere microbiome in the field works only with variable success.
Pseudozyma aphidis
Suppresses Microbe-Associated Molecular Pattern (MAMP)-Triggered Callose Deposition and Can Penetrate Leaf Tissue
Authors: Alster Shanee , Dafa-Berger Avis , Gafni Aviva , Levy Maggie
Published: March 2022

Our study demonstrates the ability of
P. aphidis
to penetrate into plant tissues, where it avoids and overcomes plant defense systems in order to establish and subsequently protect the plant.
Provenance control on the distribution of endogenic Sn-W, Au, and U mineralization within the Gondwana-Laurussia plate boundary zone
Authors: Romer Rolf L. , Kroner Uwe
Published: March 2022

The Paleozoic plate boundary zone between Laurussia and Gondwana in western Pangea hosts major magmatic and hydrothermal Sn-W-Ta, Au, and U mineralization. Individual mineral deposits represent the results of the superposition of a series of exogenic and endogenic processes. Exogenic processes controlled (1) the enrichment of the ore elements in sedimentary protoliths via residual enrichment during intense chemical weathering and via climatically or tectonically controlled redox traps, (2) the spatial distribution of fertile protoliths, and, thus, eventually (3) the spatial distribution of mineralization. Endogenic processes resulting in metamorphism and crustal melting controlled the mobilization of Sn-W, Au, and U from these enriched protoliths and, thus, account for the age distribution of Sn-W and Au mineralization and U-fertile granites. It is the sequence of exogenic and endogenic processes that eventually results in the formation of mineralization in particular tectonic zones. Whereas the endogenic processes were controlled by orogenic processes during the assembly of western Pangea itself, the exogenic processes were linked to the formation of suitable source rocks for later mineralization. The contrasting distribution of magmatic and hydrothermal Sn-W-Ta, Au, and U mineralization on the Laurussia and Gondwana sides of the plate boundary zone reflects the contrasting distribution of fertile protoliths and the contrasting tectonic situation on these margins. The Laurussian margin was an active margin during most of the Paleozoic, and the distribution of different mineralization types reflects the distribution of terranes of contrasting provenance. The Gondwanan margin was a passive margin during most of the Paleozoic, and the similar distribution of a wide range of different metals (Sn, W, Ta, Au, and U) reflects the fact that the protoliths for the various metals were diachronously accumulated on the same shelf, before the metals were mobilized during Acadian, Variscan, and Alleghanian orogenic processes.
Sedimentary provenance of Silurian basins in western Ireland during Iapetus closure
Authors: Riggs* Nancy , McConnell Brian , Graham John
Published: March 2022

Three Silurian basin fills, the Llandovery–Wenlock Croagh Patrick and Killary Harbour–Joyce Country successions and the Ludlow–Pridoli Louisburgh–Clare Island succession, overstep the tectonic contacts between elements of the Grampian (Taconic) accretionary history of the Caledonian-Appalachian orogeny in western Ireland. New U-Pb detrital zircon data from lower strata of these Silurian rocks provide insight into basin evolution and paleogeography.

The shallow-marine Croagh Patrick succession unconformably overlies the Clew Bay Complex and the northern part of the Ordovician South Mayo Trough. Two samples have zircon populations dominated by Proterozoic grains typical of the Laurentian margin, with few younger grains. Up to 13% of the grains form a cluster at ca. 950–800 Ma, which is younger than known Grenville magmatism on the local Laurentian margin and older than known magmatism from Iapetan rifting; these may be recycled grains from Dalradian strata, derived from distal Tonian intrusions. The Killary Harbour–Joyce Country succession overlies the structural contact between the Lough Nafooey arc and the Connemara Dalradian block and records a transgressive-regressive cycle. Four samples of the Lough Mask Formation show contrasting age spectra. Two samples from east of the Maam Valley fault zone, one each from above Dalradian and Nafooey arc basement, are dominated by Proterozoic grains with ages typical of a Laurentian or Dalradian source, likely in north Mayo. One sample also includes 8% Silurian grains. Two samples from west of the fault overlie Dalradian basement and are dominated by Ordovician grains. Circa 450 Ma ages are younger than any preserved Ordovician rocks in the region and are inferred to represent poorly preserved arc fragments that are exposed in northeastern North America. Cambrian to late Neoproterozoic grains in association with young Ordovician ages suggest derivation from a peri-Gondwanan source in the late stages of Iapetus closure.

The Louisburgh–Clare Island succession comprises terrestrial red beds. It unconformably overlies the Clew Bay Complex on Clare Island and is faulted against the Croagh Patrick succession on the mainland. The Strake Banded Formation yielded an age spectrum dominated by Proterozoic Laurentian as well as Ordovician–Silurian ages. Although the basin formed during strike-slip deformation along the Laurentian margin in Ireland and Scotland, sediment provenance is consistent with local Dalradian sources and contemporaneous volcanism. Our results support ideas that Ganderian continental fragments became part of Laurentia prior to the full closure of the Iapetus Ocean.
Constraints on Cosmic Rays Population in the Radio Halo of the M87 Galaxy from Gamma-Ray Observations
Authors: Nizamov B. A. , Pshirkov M. S.
Published: March 2022

We present results of our search for extended high-energy emission around the M87 galaxy, which is the central galaxy in the Virgo cluster. The M87 galaxy harbors extremely heavy supermassive black hole, $${{M}_{{BH}}} > 4 \times {{10}^{9}}{\kern 1pt} {{M}_{ \odot }}$$ and for the last 100 Myr experiences a period of increased activity that resulted in formation of extended lobes, which are prominent radio- and X-ray sources. We perform a search in 13 yr of the Fermi-LAT data in three energy bins: 0.1–1, 1–10, and 10–100 GeV. No significant detection of extended emission was achieved in any bin, with weak indication of a signal ($$ \sim {\kern 1pt} 2.5\sigma $$) in the last bin (10–100 GeV). We used γ-ray observations to put limits on cosmic rays population in the lobes, constraining their fraction X in comparison to the thermal energy of the hot gas. Depending on the value of spectral index, for electrons $${{X}_{e}} < (0.1{-} 0.2)$$ and protons were constrained at $${{X}_{p}} < (0.2{-} 0.5)$$ level. We confirm that cosmic rays is a subdominant component of the lobes, which are dominated by thermal gas.
Dual mobility hip arthroplasty: iatrogenic intraprosthetic dislocation of a 22 mm head
Authors: Zabaglo Mate , Merchant Haider , Haggis Paul , Middleton Rory G
Published: March 2022

We describe the first intraprosthetic dislocations of a 22 mm head in a dual mobility hip replacement in the literature. This case emphasises the importance of information gathering and planning when dealing with arthroplasty complications. Furthermore, it highlights the necessity of adequate muscle relaxation and analgesia when dealing with hip dislocations. A 78-year-old patient presented to the emergency department (ED) with a spontaneous dislocation of her left dual-mobility total hip replacement 3 months after first-stage revision surgery for infection. Reduction via manipulation under analgesia was then attempted in the ED but was ultimately unsuccessful; an iatrogenic intraprosthetic dislocation of the polyethylene liner was sustained. Several factors may have contributed to liner dislocation: a failure to appreciate the implant type, multiple manipulations in ED were attempted under analgesia, but no sedation or muscle relaxation was administered to the patient. The patient subsequently underwent revision surgery.
Novel case of diabetic myonecrosis in a teenage patient with type 2 diabetes mellitus
Authors: Solankee Jasmina , Zaki Timothy , Hoff Emily , Chowdhury Shweta
Published: March 2022

Diabetic myonecrosis is a rare complication of diabetes that is typically described in patients with long-standing, uncontrolled diabetes. We report a case in which diabetic myonecrosis presents as an early complication of diabetes. To our knowledge, this is the first report of diabetic myonecrosis observed in an adolescent patient with type 2 diabetes. A 16-year-old girl presented with acute-onset, bilateral lower extremity pain and tenderness concerning for bilateral gastrocnemius myonecrosis in the setting of poorly controlled type 2 diabetes for at least 4–5 years. Investigations revealed elevated creatine kinase levels and MRI suggestive of myonecrosis. A left gastrocnemius muscle biopsy had histological findings consistent with active myofibre necrosis and multifocal perivascular lymphocytic infiltration consistent with diabetic myonecrosis. The patient’s symptoms improved after 11 days of treatment with intravenous fluids, non-steroidal anti-inflammatory drugs, glycaemic control and physical therapy.
Clear cell adenomatoid odontogenic tumour and dentigerous cyst: an uncommon hybrid combination – case and review
Authors: Venugopal Reshma , Bavle Radhika M , Muniswamappa Sudhakara , Makarla Soumya
Published: March 2022

Odontogenic tumours and cysts have a characteristic presentation, histopathologically and clinically. The diagnostic criteria and nomenclature are distinct as elaborated in 2017 WHO classification. But one can occasionally and infrequently find an association between different odontogenic tumours and cysts, like calcifying epithelial odontogenic tumour (CEOT) and adenomatoid odontogenic tumour (AOT), CEOT and ghost cell tumour. Some of the odontogenic tumours and cysts share the site of occurrence, intraosseous location, teeth involved/quadrant involved and histopathology too. Hence these lesions are considered for differential diagnoses in most cases. But some instances report hybrid or associated tumours and cyst cases. Here we present a case of dentigerous cyst in association with AOT that showed variation in cell type, pattern and induction pattern.
Massive haemoptysis following recurrent ST-elevation myocardial infarction due to undiagnosed granulomatosis with polyangiitis
Authors: Benjanuwattra Juthipong , Abdelnabi Mahmoud Hassan , Mekraksakit Poemlarp , Ansari Mohammad Mehdi
Published: March 2022

Granulomatosis with polyangiitis (GPA) is a rare small-vessel vasculitis associated with high mortality without appropriate treatment. Acute ST-elevation myocardial infarction (STEMI) has been reported as an atypical presentation of GPA. We report a case of STEMI, shortly followed by subacute in-stent thrombosis with extensive thrombus burden in a 53-year-old male patient with undiagnosed GPA. After aggressive treatment with triple therapy consisting of aspirin, clopidogrel and rivaroxaban, He started to have haemoptysis. Despite the discontinuation of aspirin, he ended up with massive haemoptysis and acute respiratory failure necessitating endotracheal intubation. CT of the chest revealed bilateral ground-glass opacities consistent with diffuse alveolar haemorrhage. Extensive workup revealed positive antiproteinase 3 antibodies; hence, a diagnosis of GPA was made. He was treated with induction therapy consisting of methylprednisolone, mycophenolate mofetil, cyclophosphamide and rituximab, leading to a gradual improvement in his clinical conditions and subsequent extubation.
Piriformis syndrome as a result of intramuscular haematoma mimicking cauda equina effectively treated with piriformis tendon release
Authors: Ward Thomas Robert William , Garala Kanai , Dos Remedios Ian , Lim Justin
Published: March 2022

We present a case of piriformis syndrome in a woman in her 30’s following low energy trauma, presenting with unilateral lower limb weakness, altered sensation and urinary retention. CT imaging revealed a bulky piriformis muscle which was further clarified on MRI as an intramuscular haematoma within the left piriformis causing compression of the left lumbosacral plexus. Haematoma formation was exacerbated due to use of an antiplatelet medication the patient was taking for Moyamoya disease, which carries an increased risk of cerebrovascular accident. Surgical exploration of the piriformis and sciatic nerve was undertaken and confirmed a haematoma within the piriformis. A full release of the piriformis tendon was undertaken, and the sciatic nerve was inspected, no further abnormality was found. After review in clinic post-discharge, the patient reported normal sensation and normal muscle power in her feet.
Combining transplant professional’s psychosocial donor evaluation and donor self-report measures to optimise the prediction of HRQoL after kidney donation: an observational prospective multicentre study
Authors: Wirken Lieke , van Middendorp Henriët , Hooghof Christina W , Sanders Jan-Stephan , Dam Ruth , van der Pant Karlijn A M I , Wierdsma Judith , Wellink Hiske , Ulrichts Philip , Hoitsma Andries J , Hilbrands Luuk B , Evers Andrea W
Published: March 2022

Objectives

Living donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. The psychosocial evaluation of kidney donor candidates relies mostly on the clinical viewpoint of transplant professionals because evidence-based guidelines for psychosocial donor eligibility are currently lacking. However, the accuracy of these clinical risk judgements and the potential added value of a systematic self-reported screening procedure are as yet unknown. The current study examined the effectiveness of the psychosocial evaluation by transplant professionals and the potential value of donor self-report measures in optimising the donor evaluation. Based on the stress-vulnerability model, the predictive value of predonation, intradonation and postdonation factors to impaired longer term health-related quality of life (HRQoL) of kidney donors was studied.

Design

An observational prospective multicentre study.

Setting

Seven Dutch transplantation centres.

Participants

588 potential donors participated, of whom 361 donated. Complete prospective data of 230 donors were available. Also, 1048 risk estimation questionnaires were completed by healthcare professionals.

Methods

Transplant professionals (nephrologists, coordinating nurses, social workers and psychologists) filled in risk estimation questionnaires on kidney donor candidates. Furthermore, 230 kidney donors completed questionnaires (eg, on HRQoL) before and 6 and 12 months after donation.

Primary and secondary outcome measures

HRQoL, demographic and preoperative, intraoperative and postoperative health characteristics, perceived support, donor cognitions, recipient functioning and professionals risk estimation questionnaires.

Results

On top of other predictors, such as the transplant professionals’ risk assessments, donor self-report measures significantly predicted impaired longer term HRQoL after donation, particularly by poorer predonation physical (17%–28% explained variance) and psychological functioning (23%).

Conclusions

The current study endorses the effectiveness of the psychosocial donor evaluation by professionals and the additional value of donor self-report measures in optimising the psychosocial evaluation. Consequently, systematic screening of donors based on the most prominent risk factors provide ground for tailored interventions for donors at risk.
Adverse effects of remdesivir, hydroxychloroquine and lopinavir/ritonavir when used for COVID-19: systematic review and meta-analysis of randomised trials
Authors: Izcovich Ariel , Siemieniuk Reed Alexander , Bartoszko Jessica Julia , Ge Long , Zeraatkar Dena , Kum Elena , Qasim Anila , Khamis Assem M , Rochwerg Bram , Agoritsas Thomas , Chu Derek K , McLeod Shelley L , Mustafa Reem A , Vandvik Per , Brignardello-Petersen Romina
Published: March 2022

Background

To summarise specific adverse effects of remdesivir, hydroxychloroquine and lopinavir/ritonavir in patients with COVID-19.

Methods

We searched 32 databases through 27 October 2020. We included randomised trials comparing any of the drugs of interest to placebo or standard care, or against each other. We conducted fixed-effects pairwise meta-analysis and assessed the certainty of evidence using the grading of recommendations assessment, development and evaluation approach.

Results

We included 16 randomised trials which enrolled 8152 patients. For most interventions and outcomes the certainty of the evidence was very low to low except for gastrointestinal adverse effects from hydroxychloroquine, which was moderate certainty. Compared with standard care or placebo, low certainty evidence suggests that remdesivir may not have an important effect on acute kidney injury (risk difference (RD) 8 fewer per 1000, 95% CI 27 fewer to 21 more) or cognitive dysfunction/delirium (RD 3 more per 1000, 95% CI 12 fewer to 19 more). Low certainty evidence suggests that hydroxychloroquine may increase the risk of cardiac toxicity (RD 10 more per 1000, 95% CI 0 more to 30 more) and cognitive dysfunction/delirium (RD 33 more per 1000, 95% CI 18 fewer to 84 more), whereas moderate certainty evidence suggests hydroxychloroquine probably increases the risk of diarrhoea (RD 106 more per 1000, 95% CI 48 more to 175 more) and nausea and/or vomiting (RD 62 more per 1000, 95% CI 23 more to 110 more) compared with standard care or placebo. Low certainty evidence suggests lopinavir/ritonavir may increase the risk of diarrhoea (RD 168 more per 1000, 95% CI 58 more to 330 more) and nausea and/or vomiting (RD 160 more per 1000, 95% CI 100 more to 210 more) compared with standard care or placebo.

Discussion

Hydroxychloroquine probably increases the risk of diarrhoea and nausea and/or vomiting and may increase the risk of cardiac toxicity and cognitive dysfunction/delirium. Lopinavir/ritonavir may increase the risk of diarrhoea and nausea and/or vomiting. Remdesivir may have no important effect on risk of acute kidney injury or cognitive dysfunction/delirium. These findings provide important information to support the development of evidence-based management strategies for patients with COVID-19.
Major cardiovascular events in patients presenting with acute stroke: a 5-year follow-up study in patients who had ischaemic stroke and stroke mimics
Authors: Al Jerdi Salman , Akhtar Naveed , Mahfoud Ziyad , Kamran Saadat , Shuaib Ashfaq
Published: March 2022

Objectives

The long-term acute stroke outcome has not been well studied in the Middle-Eastern population. The primary objective of our study is to compare the long-term outcome of acute ischaemic stroke (IS) with/without previous cerebrovascular/cardiovascular disease (CVD) to stroke mimics (SM) with CVD.

Settings and participants

The Qatar stroke database was reviewed for IS and SM admissions in Qatari Nationals between 2013 and 2019.

Outcomes

Patients were prospectively assessed for development of recurrent stroke, myocardial infarction or death. Frequency of major cardiovascular events (MACEs) were compared between patients with or without a previous CVD.

Results

There were 1114 stroke admissions (633 IS (prior CVD 211/18.9%), 481 SM (prior CVD 159/14.3%)). Patients with IS/CVD were significantly older versus others (IS/CVD: 68.3±12.2; IS/no CVD: 63.3±14.4; SM/CVD: 67.6±13.1; SM/no CVD: 52.4±17.9. p<0.0001). Vascular risk factors were significantly higher in patients with IS and SM with previous CVD. Functional recovery (90-day mRS 0–2) was significantly better in SM/no CVD (IS/CVD: 55.0%; IS/no CVD: 64.2%; SM/CVD 59.7%; SM/no CVD: 88.8%. p<0.001). MACE occurred in 36% (76/211) IS/CVD, 24.9% (105/422) IS/no CVD, 22.0% (35/179) SM/CVD and only 6.8% (22/322) SM/no CVD. MACE occurred mostly during the first year of follow-up. Mortality 90 days was significantly higher in IS/CVD (IS/CVD 36%; IS/no CVD 24.9%; SM/CVD: 22%; SM/no CVD: 6.8%. p<0.0001).

Conclusions

Prior CVD significantly increases the risk of MACE and early mortality in IS or SM patients. Age, male gender, obesity, atrial fibrillation and admission National Institute of Health Stroke Scale also increases risk of MACE during follow-up. Hence, aggressive vascular risk factor modification is needed even in patients with SM.
Implementation and evaluation of a physical activity counselling programme in primary care among cancer survivors: SoDA study protocol
Authors: Huizinga Famke , Westerink Nico-Derk Lodewijk , Berendsen Annette J , Walenkamp Annemiek M E , de Greef Mathieu H G , de Bock Geertruida H , Berger Marjolein Y , Brandenbarg Daan
Published: March 2022

Introduction

Physical activity (PA) favourably affects various health outcomes in cancer survivors, but little is known about how to implement a PA programme in primary care. We therefore aim to implement and evaluate such a programme for cancer survivors in general practice.

Methods and analyses

The Stimulation of Daily Activity study is an implementation study with a single-arm longitudinal design in 15 Dutch general practices. Patients aged ≥18 years who finished cancer treatment more than 6 months ago will be eligible for inclusion. The intervention will comprise six coaching sessions with the practice nurse in 9 months, seeking to increase PA in daily activities and using an activity tracker for goal setting and feedback. TheReach, Effectiveness, Adoption, Implementation and Maintenanceframework will be used to evaluate implementation in terms of the health outcomes, extent of implementation and barriers and facilitators to implementation, using a mixed methods approach. Descriptive analyses and linear mixed model analyses will be performed on the quantitative data, while qualitative data from focus groups and interviews will be analysed by thematic analyses.

Ethics and dissemination

The Medical Research Ethics Committee of the University Medical Centre Groningen, the Netherlands, concluded that this study was not subject to the Dutch Medical Research Involving Human Subjects Act (registration number: 201900586). The study results will be made available to patients and general practitioners via (inter)national publications and conferences, newsletters, public summaries and via (social) media.
Optimizing therapeutic outcomes of immune checkpoint blockade by a microbial tryptophan metabolite
Authors: Renga Giorgia , Nunzi Emilia , Pariano Marilena , Puccetti Matteo , Bellet Marina Maria , Pieraccini Giuseppe , D’Onofrio Fiorella , Santarelli Ilaria , Stincardini Claudia , Aversa Franco , Riuzzi Francesca , Antognelli Cinzia , Gargaro Marco , Bereshchenko Oxana , Ricci Maurizio , Giovagnoli Stefano , Romani Luigina , Costantini Claudio
Published: March 2022

Background

Despite the great success, the therapeutic benefits of immune checkpoint inhibitors (ICIs) in cancer immunotherapy are limited by either various resistance mechanisms or ICI-associated toxic effects including gastrointestinal toxicity. Thus, novel therapeutic strategies that provide manageable side effects to existing ICIs would enhance and expand their therapeutic efficacy and application. Due to its proven role in cancer development and immune regulation, gut microbiome has gained increasing expectation as a potential armamentarium to optimize immunotherapy with ICI. However, much has to be learned to fully harness gut microbiome for clinical applicability. Here we have assessed whether microbial metabolites working at the interface between microbes and the host immune system may optimize ICI therapy.

Methods

To this purpose, we have tested indole-3-carboxaldehyde (3-IAld), a microbial tryptophan catabolite known to contribute to epithelial barrier function and immune homeostasis in the gut via the aryl hydrocarbon receptor (AhR), in different murine models of ICI-induced colitis. Epithelial barrier integrity, inflammation and changes in gut microbiome composition and function were analyzed. AhR, indoleamine 2,3-dioxygenase 1, interleukin (IL)-10 and IL-22 knockout mice were used to investigate the mechanism of 3-IAld activity. The function of the microbiome changes induced by 3-IAld was evaluated on fecal microbiome transplantation (FMT). Finally, murine tumor models were used to assess the effect of 3-IAld treatment on the antitumor activity of ICI.

Results

On administration to mice with ICI-induced colitis, 3-IAld protected mice from intestinal damage via a dual action on both the host and the microbes. Indeed, paralleling the activation of the host AhR/IL-22-dependent pathway, 3-IAld also affected the composition and function of the microbiota such that FMT from 3-IAld-treated mice protected against ICI-induced colitis with the contribution of butyrate-producing bacteria. Importantly, while preventing intestinal damage, 3-IAld did not impair the antitumor activity of ICI.

Conclusions

This study provides a proof-of-concept demonstration that moving past bacterial phylogeny and focusing on bacterial metabolome may lead to a new class of discrete molecules, and that working at the interface between microbes and the host immune system may optimize ICI therapy.
Is music the food of the anesthesia in children?
Authors: Hekimoglu Sahin Sevtap , Duran Ridvan , Basaran Umit Nusret , Sut Necdet , Colak Alkin , Duran Sedef
Published: March 2022

Background

The noise in an operating room may have a detrimental effect on human cognitive functions, and it may cause perioperative anxiety with prolonged exposure. The aim of this study was to investigate the effects of music therapy and use of earplugs and normal noise level in the operating room under general anesthesia of pediatric patients on hemodynamic parameters and postoperative emergence delirium.

Methods

One hundred and five pediatric patients were involved in this study. The patients were randomly divided into three groups. Group N was exposed to the ambient operating room noise, group S received earplugs from an independent anesthesiologist, and group M used a CD player. The preoperative anxiety levels of children were evaluated with the Modified Yale Preoperative Anxiety Scale (M-YPAS). Mean arterial pressure (MAP) and heart rate were recorded at 30-minute periods until the completion of surgery, end of surgery and postoperatively. During each measurement, noise level recordings were performed using sonometer. Pediatric Anesthesia Emergency Delirium (PAED) score was evaluated after postoperative extubation.

Results

M-YPAS was similar between groups. The MAP at 30 and 60 min intraoperatively, at end of surgery, and at 5, 10, and 15 min postoperatively was significantly lower in group S than in group N. There were no differences in heart rate among the groups. Postoperative PAED score was not significantly different among the groups.

Conclusions

The music therapy was not more effective than silence and operating noise room in reducing PAED score postoperatively in pediatric patients.

Trial registration number

ClinicalTrials.gov Registry (NCT03544502).
Theoretical Insights into Impact of Electrode and Electrolyte Over Li-Air Battery
Authors: Fiates Juliane , Doubek Gustavo
Published: March 2022

The lithium-air battery is getting attention as a good technology for energy storage. Nevertheless, the design of such a device still faces some crucial limitations. The most challenging one concerns the selection of electrodes and solvents to provide good performance during the cell operation. Based on literature evidence, we have selected three system configurations of electrode/electrolyte to be evaluated via molecular dynamics simulation: gold/DMSO (dimethyl sulfoxide), graphene/DMSO, and graphene/TEGDME (tetraethylene glycol dimethyl ether) using lithium hexafluorophosphate—LiPF6. We show that the local concentration distributions for DMSO and Li+ are highly influenced by the electrode material. Furthermore, the Li+ solvation shell presents a more complex arrangement when in composition with TEGDME. Additionally, the electrical double layer capacitance in this solvent shows high impedance to the electrode surface. This investigation noticed that the electric field plays a role over the system, contributing to the solvent organization and the electrical double layer formation. Overall, this study strengthens the idea that theoretical findings may contribute to a complementary investigation, leading some light over experimental Li-air battery data reported in the literature.
Evaluating the Risk of Prescription Opioid Misuse among Adult Emergency Department Patients
Authors: Young II Henry W. , Jean Neydric , Tyndall Joseph A. , Cottler Linda B.
Published: March 2022

Background. Pain is the most commonly treated symptom in the emergency department, and opioids are often prescribed from the emergency department to treat pain. The American College of Emergency Physicians recommends that providers assess the patient's risk of abusing opioids prior to prescribing opioids. In this study, we use a validated risk assessment tool to assess the risk of opioid abuse among emergency medicine patients and the patients’ perceptions of their potential dangers. Methods. This is an observational study conducted in an academic emergency department (ED). All adults presenting to ED were eligible to participate in the study. Individuals were randomly selected to complete a survey which included the Opioid Risk Tool (ORT) and perceptions of sharing controlled substances. Results. There were 300 participants in the study. The 18–45-year age group was the most commonly represented group (58%), and nearly two-thirds (63%) of the population was female. The average opioid risk score was 8 or high risk. Individuals that were at high risk of opioid abuse were less likely to dispose of their additional medications appropriately (19% vs. 12%) and were more likely to share their additional controlled medications with family or friends (18% vs. 3%). Conclusion. The emergency department population is at high risk to abuse opioids. The introduction of safer pain management options should be considered among this high-risk group.